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Impact of Secondhand Smoke from Conventional Cigarettes, IQOS, and E-Cigarettes on Children's Oral Health: A Cross-Sectional Study

Ludovichetti FS, Signoriello AG, Gracco A, Lo Giudice R, Lucchi P, Stellini E, Mazzoleni S

European journal of paediatric dentistry, 2026

160 participants

Abstract

AIM: Secondhand smoke (SHS) is a major public health concern, especially for children, who are particularly vulnerable to its harmful effects. Although alternative smoking devices like IQOS and e-cigarettes are marketed as harm reduction tools, their impact on paediatric oral health remains underexplored. This study evaluates the effects of SHS from conventional cigarettes, IQOS, and e-cigarettes on cotinine levels in gingival crevicular fluid and the risk of dental caries in children.

MATERIALS: A cross-sectional study was conducted involving 160 children aged 3 to 14 years, categorised into four groups based on exposure: SHS from conventional cigarettes, SHA (secondhand aerosol) from IQOS, e-cigarettes, and a no-smoking control group. Each group included 40 participants, ensuring an equal distribution across exposure conditions. Children in the SHS/SHA groups were exclusively exposed to emissions from a single product type (cigarettes, IQOS, or e-cigarettes) to isolate product-specific effects. Cotinine levels were measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS), and dental caries were assessed via the Decayed-Missing-Filled Teeth (DMFT) index. Parental smoking habits, oral health behaviours, and environmental factors were recorded through a questionnaire. Statistical analyses included one-way ANOVA, Kruskal-Wallis tests, and Spearman's correlation.

CONCLUSION: SHS exposure from all sources negatively impacts children's oral health, with…

How strong is the evidence?

Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 160 participants or records.

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