Effect of Secondhand Smoking on Dental Caries among Schoolchildren Aged 6–12 Years in Odisha

Dental caries remains one of the most prevalent chronic diseases of childhood and continues to affect nutrition, school attendance, sleep, growth, and oral-health-related quality of life. 1 Although the immediate biological pathway of caries involves acidogenic and aciduric microbial biofilm, fermentable carbohydrate exposure, susceptible tooth surfaces, and time, contemporary caries epidemiology increasingly recognizes the role of environmental and householdlevel determinants.2,3 Among these determinants, secondhand smoke exposure is gaining attention because children are often involuntarily exposed within the household, where repeated low-dose exposure may coincide with poor ventilation, lower oral-health literacy, dietary risk patterns, and delayed preventive dental visits.[4][5][6] Secondhand smoke, also referred to as passive smoking or environmental tobacco smoke, contains a mixture of sidestream smoke from burning tobacco and mainstream smoke exhaled by the smoker.Children are physiologically vulnerable because of smaller body size, higher respiratory rate relative to body weight, immature detoxification pathways, and greater dependence on household environments controlled by adults.7,8 In India, household exposure to secondhand smoke remains a public health concern, with national tobacco surveillance showing substantial exposure at home and workplace settings.9 This context is particularly relevant for children in mixed dentition, where both primary and erupting permanent teeth may be simultaneously vulnerable to cariogenic insult.