Secondhand Smoke in Pregnancy Linked to Higher Cavity Risk in Preschoolers

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Posted: May 19, 2026

Secondhand Smoke in Pregnancy Linked to Higher Cavity Risk in Preschoolers

Edited by Dentaltown staff

Secondhand smoke exposure during pregnancy and early childhood was significantly associated with a higher prevalence of early childhood caries, according to a prospective cohort study published May 9 in the Journal of Dentistry. The second trimester emerged as the most vulnerable exposure window, and paternal smoking habits independently elevated risk.

Researchers evaluated 712 children ages 3–5 in southern India, drawing the cohort from the HAPIN birth-cohort trial conducted from 2018 to 2020. Dental examinations were performed by a trained, calibrated dentist between April and September 2023. Among the children assessed, 478, or 67.2%, were diagnosed with early childhood caries.

Children exposed to secondhand smoke during gestation showed a 29% higher caries prevalence than unexposed children, with an incidence rate ratio of 1.29 (95% CI, 1.18–1.42). Postnatal exposure independently raised risk, with an IRR of 1.19 (95% CI, 1.08–1.31). Children whose fathers smoked 11 or more cigarettes per day had nearly twice the odds of caries (OR, 1.90; 95% CI, 1.10–3.41).

Exposure was assessed using both questionnaires and urinary nicotine metabolites — cotinine and 3-hydroxycotinine — which strengthened the findings beyond self-reporting. The biomarkers showed a dose-response relationship with caries risk, with the strongest association during pregnancy. Children classified as slow nicotine metabolizers were more vulnerable to third-trimester exposure (OR, 1.74; 95% CI, 1.15–2.64).

The authors proposed several plausible biological pathways, suggesting secondhand smoke may affect enamel development, mineralization, salivary function, immune response, and cariogenic bacterial activity during critical developmental windows.

The study was led by Sneha S. Patil of Sri Ramachandra Institute for Higher Education and Research in Chennai, India, with co-authors from Stanford University, the University of California Berkeley, Emory University, Colorado State University, and additional institutions in India. The research was funded by the Foundation for the National Institutes of Health, the Gates Foundation, and the NIH Fogarty International Center.

The authors concluded that the findings underscore the need for integrated oral and environmental health prevention strategies, particularly during pregnancy and early childhood.

Sources:
Journal of Dentistry, “Dental caries linked to gestational and early-life secondhand smoke exposure,” Sneha S. Patil et al., published May 9, 2026: doi.org/10.1016/j.jdent.2026.106743
National Library of Medicine, PubMed listing (PMID: 42114646): pubmed.ncbi.nlm.nih.gov/42114646
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