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. 2002 Oct;110(10):A625–A630. doi: 10.1289/ehp.021100625

Blood lead level and dental caries in school-age children.

Allison Gemmel 1, Mary Tavares 1, Susan Alperin 1, Jennifer Soncini 1, David Daniel 1, Julie Dunn 1, Sybil Crawford 1, Norman Braveman 1, Thomas W Clarkson 1, Sonja McKinlay 1, David C Bellinger 1
PMCID: PMC1241049  PMID: 12361944

Abstract

The association between blood lead level and dental caries was evaluated in cross-sectional analyses of baseline data for 543 children 6-10 years old screened for enrollment in the Children's Amalgam Trial, a study designed to assess potential health effects of mercury in silver fillings. Approximately half of the children were recruited from an urban setting (Boston/Cambridge, MA, USA) and approximately half from a rural setting (Farmington, ME, USA). Mean blood lead level was significantly greater among the urban subgroup, as was the mean number of carious tooth surfaces. Blood lead level was positively associated with number of caries among urban children, even with adjustment for demographic and maternal factors and child dental practices. This association was stronger in primary than in permanent dentition and stronger for occlusal, lingual, and buccal tooth surfaces than for mesial or distal surfaces. In general, blood lead was not associated with caries in the rural subgroup. The difference between the strength of the associations in the urban and rural settings might reflect the presence of residual confounding in the former setting, the presence of greater variability in the latter setting in terms of important caries risk factors (e.g., fluoride exposure), or greater exposure misclassification in the rural setting. These findings add to the evidence supporting a weak association between children's lead exposure and caries prevalence. A biologic mechanism for lead cariogenicity has not been identified, however. Our data are also consistent with residual confounding by factors associated with both elevated lead exposure and dental caries.

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Selected References

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  1. Appleton J. The effect of lead acetate on dentine formation in the rat. Arch Oral Biol. 1991;36(5):377–382. doi: 10.1016/0003-9969(91)90008-I. [DOI] [PubMed] [Google Scholar]
  2. Brodeur J., Lacasse Y., Talbot D. Influence of removal from occupational lead exposure on blood and saliva lead concentrations. Toxicol Lett. 1983 Oct-Nov;19(1-2):195–199. doi: 10.1016/0378-4274(83)90282-5. [DOI] [PubMed] [Google Scholar]
  3. Brody D. J., Pirkle J. L., Kramer R. A., Flegal K. M., Matte T. D., Gunter E. W., Paschal D. C. Blood lead levels in the US population. Phase 1 of the Third National Health and Nutrition Examination Survey (NHANES III, 1988 to 1991) JAMA. 1994 Jul 27;272(4):277–283. doi: 10.1001/jama.272.4.277. [DOI] [PubMed] [Google Scholar]
  4. Brudevold F., Aasenden R., Srinivasian B. N., Bakhos Y. Lead in enamel and saliva, dental caries and the use of enamel biopsies for measuring past exposure to lead. J Dent Res. 1977 Oct;56(10):1165–1171. doi: 10.1177/00220345770560100701. [DOI] [PubMed] [Google Scholar]
  5. Campbell J. R., Moss M. E., Raubertas R. F. The association between caries and childhood lead exposure. Environ Health Perspect. 2000 Nov;108(11):1099–1102. doi: 10.1289/ehp.001081099. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Caufield P. W., Griffen A. L. Dental caries. An infectious and transmissible disease. Pediatr Clin North Am. 2000 Oct;47(5):1001-19, v. doi: 10.1016/s0031-3955(05)70255-8. [DOI] [PubMed] [Google Scholar]
  7. Cleymaet R., Collys K., Retief D. H., Michotte Y., Slop D., Taghon E., Maex W., Coomans D. Relation between lead in surface tooth enamel, blood, and saliva from children residing in the vicinity of a non-ferrous metal plant in Belgium. Br J Ind Med. 1991 Oct;48(10):702–709. doi: 10.1136/oem.48.10.702. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. DiGregorio G. J., Ferko A. P., Sample R. G., Bobyock E., McMichael R., Chernick W. S. Lead and delta-aminolevulinic acid concentrations in human parotid saliva. Toxicol Appl Pharmacol. 1974 Mar;27(3):491–493. doi: 10.1016/0041-008x(74)90028-3. [DOI] [PubMed] [Google Scholar]
  9. Dietrich K. N., Berger O. G., Succop P. A. Lead exposure and the motor developmental status of urban six-year-old children in the Cincinnati Prospective Study. Pediatrics. 1993 Feb;91(2):301–307. [PubMed] [Google Scholar]
  10. Drasch G. A., Böhm J., Baur C. Lead in human bones. Investigations on an occupationally non-exposed population in southern Bavaria (F.R.G.). I. Adults. Sci Total Environ. 1987 Jul;64(3):303–315. doi: 10.1016/0048-9697(87)90252-x. [DOI] [PubMed] [Google Scholar]
  11. Drasch G. A., Ott J. Lead in human bones. Investigations on an occupationally non-exposed population in southern Bavaria (F.R.G.). II. Children. Sci Total Environ. 1988 Jan;68:61–69. doi: 10.1016/0048-9697(88)90361-0. [DOI] [PubMed] [Google Scholar]
  12. Gil F., Facio A., Villanueva E., Pérez M. L., Tojo R., Gil A. The association of tooth lead content with dental health factors. Sci Total Environ. 1996 Dec 2;192(2):183–191. doi: 10.1016/s0048-9697(96)05313-2. [DOI] [PubMed] [Google Scholar]
  13. Gil F., Pérez M. L., Facio A., Villanueva E., Tojo R., Gil A. Dental lead levels in the Galician population, Spain. Sci Total Environ. 1994 Nov 25;156(2):145–150. doi: 10.1016/0048-9697(94)90351-4. [DOI] [PubMed] [Google Scholar]
  14. Grobler S. R., Theunissen F. S., Kotze T. J. The relation between lead concentrations in human dental tissues and in blood. Arch Oral Biol. 2000 Jul;45(7):607–609. doi: 10.1016/s0003-9969(00)00024-8. [DOI] [PubMed] [Google Scholar]
  15. Gulson B. L., Gillings B. R. Lead exchange in teeth and bone--a pilot study using stable lead isotopes. Environ Health Perspect. 1997 Aug;105(8):820–824. doi: 10.1289/ehp.97105820. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Gulson B. L. Tooth analyses of sources and intensity of lead exposure in children. Environ Health Perspect. 1996 Mar;104(3):306–312. doi: 10.1289/ehp.96104306. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Kaste L. M., Selwitz R. H., Oldakowski R. J., Brunelle J. A., Winn D. M., Brown L. J. Coronal caries in the primary and permanent dentition of children and adolescents 1-17 years of age: United States, 1988-1991. J Dent Res. 1996 Feb;75(Spec No):631–641. doi: 10.1177/002203459607502S03. [DOI] [PubMed] [Google Scholar]
  18. Lawson B. F., Stout F. W., Ahern D. E., Sneed W. D. The incidence of enamel hypoplasia associated with chronic pediatric lead poisoning. S C Dent J. 1971 Nov;29(11):5–10. [PubMed] [Google Scholar]
  19. Manton W. I., Angle C. R., Stanek K. L., Reese Y. R., Kuehnemann T. J. Acquisition and retention of lead by young children. Environ Res. 2000 Jan;82(1):60–80. doi: 10.1006/enrs.1999.4003. [DOI] [PubMed] [Google Scholar]
  20. Masters R. D., Coplan M. J., Hone B. T., Dykes J. E. Association of silicofluoride treated water with elevated blood lead. Neurotoxicology. 2000 Dec;21(6):1091–1100. [PubMed] [Google Scholar]
  21. McMichael A. J., Baghurst P. A., Robertson E. F., Vimpani G. V., Wigg N. R. The Port Pirie cohort study. Blood lead concentrations in early childhood. Med J Aust. 1985 Nov 25;143(11):499–503. [PubMed] [Google Scholar]
  22. Mobarak N., P'an A. Y. Lead distribution in the saliva and blood fractions of rats after intraperitoneal injections. Toxicology. 1984 Jul;32(1):67–74. doi: 10.1016/0300-483x(84)90035-0. [DOI] [PubMed] [Google Scholar]
  23. Moss M. E., Lanphear B. P., Auinger P. Association of dental caries and blood lead levels. JAMA. 1999 Jun 23;281(24):2294–2298. doi: 10.1001/jama.281.24.2294. [DOI] [PubMed] [Google Scholar]
  24. Needleman H. L., Allred E., Bellinger D., Leviton A., Rabinowitz M., Iverson K. Antecedents and correlates of hypoplastic enamel defects of primary incisors. Pediatr Dent. 1992 May-Jun;14(3):158–166. [PubMed] [Google Scholar]
  25. Needleman H. L., Gunnoe C., Leviton A., Reed R., Peresie H., Maher C., Barrett P. Deficits in psychologic and classroom performance of children with elevated dentine lead levels. N Engl J Med. 1979 Mar 29;300(13):689–695. doi: 10.1056/NEJM197903293001301. [DOI] [PubMed] [Google Scholar]
  26. P'an A. Y. Lead levels in saliva and in blood. J Toxicol Environ Health. 1981 Feb;7(2):273–280. doi: 10.1080/15287398109529978. [DOI] [PubMed] [Google Scholar]
  27. Pounds J. G., Long G. J., Rosen J. F. Cellular and molecular toxicity of lead in bone. Environ Health Perspect. 1991 Feb;91:17–32. doi: 10.1289/ehp.919117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Purchase N. G., Fergusson J. E. Lead in teeth: the influence of the tooth type and the sample within a tooth on lead levels. Sci Total Environ. 1986 Jul;52(3):239–250. doi: 10.1016/0048-9697(86)90124-5. [DOI] [PubMed] [Google Scholar]
  29. Rabinowitz M. B., Leviton A., Bellinger D. Relationships between serial blood lead levels and exfoliated tooth dentin lead levels: models of tooth lead kinetics. Calcif Tissue Int. 1993 Nov;53(5):338–341. doi: 10.1007/BF01351840. [DOI] [PubMed] [Google Scholar]
  30. Rabinowitz M. B., Wang J. D., Soong W. T. Dentine lead and child intelligence in Taiwan. Arch Environ Health. 1991 Nov-Dec;46(6):351–360. doi: 10.1080/00039896.1991.9934402. [DOI] [PubMed] [Google Scholar]
  31. Rabinowitz M. B., Wetherill G. W., Kopple J. D. Kinetic analysis of lead metabolism in healthy humans. J Clin Invest. 1976 Aug;58(2):260–270. doi: 10.1172/JCI108467. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Rabinowitz M., Leviton A., Needleman H. Variability of blood lead concentrations during infancy. Arch Environ Health. 1984 Mar-Apr;39(2):74–77. doi: 10.1080/00039896.1984.10545838. [DOI] [PubMed] [Google Scholar]
  33. Schafer T. E., Adair S. M. Prevention of dental disease. The role of the pediatrician. Pediatr Clin North Am. 2000 Oct;47(5):1021-42, v-vi. doi: 10.1016/s0031-3955(05)70256-x. [DOI] [PubMed] [Google Scholar]
  34. Smith M., Delves T., Lansdown R., Clayton B., Graham P. The effects of lead exposure on urban children: the Institute of Child Health/Southampton Study. Dev Med Child Neurol Suppl. 1983;47:1–54. [PubMed] [Google Scholar]
  35. Vargas C. M., Crall J. J., Schneider D. A. Sociodemographic distribution of pediatric dental caries: NHANES III, 1988-1994. J Am Dent Assoc. 1998 Sep;129(9):1229–1238. doi: 10.14219/jada.archive.1998.0420. [DOI] [PubMed] [Google Scholar]
  36. Watson G. E., Davis B. A., Raubertas R. F., Pearson S. K., Bowen W. H. Influence of maternal lead ingestion on caries in rat pups. Nat Med. 1997 Sep;3(9):1024–1025. doi: 10.1038/nm0997-1024. [DOI] [PubMed] [Google Scholar]
  37. Winneke G., Krämer U., Brockhaus A., Ewers U., Kujanek G., Lechner H., Janke W. Neuropsychological studies in children with elevated tooth-lead concentrations. II. Extended study. Int Arch Occup Environ Health. 1983;51(3):231–252. doi: 10.1007/BF00377755. [DOI] [PubMed] [Google Scholar]

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