Objective: This study aimed to assess the effect of passive tobacco smoking (PTS) through the comparison of the periodontal status and the C-reactive protein (CRP) and cotinine levels in the biologic fluids in children who are exposed and unexposed to PTS. Methods: A total of 148 participants, whom had smokers (PTS-exposed, n=82) and non-smokers (PTS-unexposed, n=66) in their families, respectively, were included in the study. Gingival index, plaque index, probing depth, and bleeding on probing were recorded. Moreover, saliva, urine, and gingival crevicular fluid samples were collected. CRP and cotinine levels in the biological fluids were determined by the enzyme-linked immunosorbent assay method. Results: Both groups exhibited similar values for periodontal parameters and salivary CRP levels were higher in PTS-exposed group but not significant. The mean urinary cotinine level was significantly higher in children exposed to PTS than in unexposed children. Conclusions: There was no evidence for causative role of PTS in periodontal disease in this study. Longitudinal studies including large populations should be conducted to provide stronger evidence for the causative role of PTS in periodontal disease. Also, further epidemiological studies on the social context of smoking should be performed to improve the quality of life and lifespan of the society.


  1. Könönen E, Gursoy M, Gursoy UK. Periodontitis: A Multifaceted Disease of Tooth-Supporting Tissues. J Clin Med. 2019:8(8):1135.
  2. Genco RJ, Borgnakke WS. Risk factors for periodontal disease. Periodontol 2000. 2013;62:59‑94.
  3. Nociti FH Jr., Casati MZ, Duarte PM. Current perspective of the impact of smoking on the progression and treatment of periodontitis. Periodontol 2000. 2015;67:187‑210.
  4. Arbes SJ, Agustsdottir H, Slade GD. Environmental tobacco smoke and periodontal disease in the United States. Am J Public Health. 2001;91:253-7.
  5. Cook DG, Strachan DP. Health effects of passive smoking-10: summary of effects of parental smoking on the respiratory health of children and implications for research. Thorax. 1999;54:357-66.
  6. Weitzman M, Gortmaker S, Sobol A. Maternal smoking and behavior problems of children. Pediatrics. 1992;90:342-9.
  7. Sasco AJ, Vainio H. From in utero and childhood exposure to parental smoking to childhood cancer: a possible link and the need for action. Hum Exp Toxicol. 1999;18:192-201.
  8. Oberg M, Jaakkola MS, Woodward A, Peruga A, Pruss-Ustun A. Worldwide burden of disease from exposure to second hand smoke: a retrospective analysis of data from 192 countries. Lancet. 2011;377:139-46.
  9. Matsumoto A, Matsumoto A, Ichiba M, Payton NM, Oishi H, Hara M. Simultaneous measurement of urinary total nicotine and cotinine as biomarkers of active and passive smoking among Japanese individuals. Environ Health Prev Med. 2013;18:244-50.
  10. Al-Sayed EM, Ibrahim KS. Second-hand tobacco smoke and children. Toxicol Ind Health. 2014;30:635-44.
  11. Nuca CI, Amariei CI, Badea VV, Zaharia AN, Arendt CT. Salivary cotinine, selfreported smoking status and heaviness of smoking index in adults from Constanta, Romania. Oral Health Dent Manag. 2011;10:22-31.
  12. Azar R, Nolan R, Stewart D. Listening to the heart-brain talk: persistent depressive symptoms are associated with hsCRP in apparently healthy individuals at high risk for coronary artery disease. Eur J Prev Cardiol. 2012;19:857-63.
  13. Ouellet-Morin I, Danese A, Williams B, Arseneault L. Validation of a high sensitivity assay for C-reactive protein in human saliva. Brain Beh Imm. 2011;25:640-6.
  14. Azar R, Richard A. Elevated salivary C-reactive protein levels are associated with active and passive smoking in healthy youth: A pilot study. J Inflamm. 2011;8:37.
  15. Ueno M, Ohara S, Sawada N, Inoue M, Tsugane S, Kawaguchi Y. The association of active and second hand smoking with oral health in adults: Japan public health center-based study. Tob Induc Dis. 2015;13:19.
  16. Javed F, Bashir Ahmed H, Romanos GE. Association between environmental tobacco smoke and periodontal disease: a systematic review. Environ Res. 2014;133:117-22.
  17. Silness J, Loe H. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand. 1964;22:121-35.
  18. Loe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand. 1963;21:533-51.
  19. Benowitz NL, Bernert JT, Caraballo RS, Holiday DB, Wang J. Optimal serum cotinine levels for distinguishing cigarette smokers and nonsmokers within different racial/ethnic groups in the United States between 1999 and 2004. Am J Epidemiol. 2009;169:236-48.
  20. Erdemir EO, Sonmez IS, Oba AA, Bergstrom J, Caglayan O. Periodontal health in children exposed to passive smoking. J Clin Periodontol. 2010;37:160-4.
  21. Avila-Tang E, Al-Delaimy WK, Ashley DL, Benowitz N, Bernert JT, Kim S, et al. Assessing second hand smoke using biological markers. Tob Control 2013;22:164-71.
  22. Balhara YPS, Jain R. A receiver operated curve-based evaluation of change in sensitivity and specificity of cotinine urinalysis for detecting active tobacco use. J Cancer Res Ther. 2013;9:84-9.
  23. Hukkanen J, Jacob P 3rd, Benowitz NL. Metabolism and disposition kinetics of nicotine. Pharmacol Rev. 2005;57:79-115.
  24. Benowitz NL, Dains KM, Dempsey D, Herrera B, Yu L, Jacob P 3rd. Urine nicotine metabolite concentrations in relation to plasma cotinine during low-level nicotine exposure. Nicotine Tob Res. 2009;11:954-60.
  25. Walter C, Kaye EK, Dietrich T. Active and passive smoking: assessment issues in periodontal research. Periodontol 2000. 2011:58(1), 84-92.
  26. Willemsen MC, Brug J, Uges DR, Vos de Wael ML. Validity and reliability of self-reported exposure to environmental tobacco smoke in work offices. J Occup Environ Med. 1997: 39: 1111-4.
  27. Chen X, Wolff L, Aeppli D, et al. Cigarette smoking, salivary/gingival crevicular fluid cotinine and periodontal status. A 10-year longitudinal study. J Clin Periodontol. 2001;28:331-9.
  28. Tanaka K, Miyake Y, Hanioka T, Arakawa M. Active and passive smoking and prevalence of periodontal disease in young Japanese women. J Periodont Res. 2013;48:600-5.
  29. Nishida N, Yamamoto Y, Tanaka M, et al. Association between passive smoking and salivary markers related to periodontitis. J Clin Periodontol. 2006;33:717-23.
  30. de Carvalho Ribeiro FA, de Moraes MK, de Morais Caixeta JC, et al. [Perception of parents about second hand smoke on the health of their children: an ethnographic study]. Rev Paul Pediatr. 2015;33:394-9.
  31. Morzel M, Truntzer C, Neyraud E, et al. Associations between food consumption patterns and saliva composition: Specificities of eating difficulties children. Physiol Behav. 2017;173:116-23.



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