title: Effect of environmental tobacco smoke from smoker parents on gingival pigmentation in children and young adults: a cross-sectional study.
abstract: BACKGROUND
  Non-smokers exposed to environmental tobacco smoke (ETS) absorb nicotine and other compounds just as smokers do, and as the exposure to ETS increases, the level of these harmful compounds in the body also increases. The ill effects of ETS range from gingival pigmentation to lung cancer and death. The exposure to ETS is difficult to quantitatively measure and has been approximated by self-reported estimates, primarily of the smoking history of spouses. However, the documentation of gingival pigmentation in non-smokers is meager and has remained contentious. We aimed to assess the effects of ETS from smoker parents on gingival pigmentation in children and young adults and assess the urine cotinine levels in these individuals.
  
  
  METHODS
  A total of 153 non-smoking participants with ≥1 smoker parent were randomly selected from the outpatient Department of Periodontics, Bangalore Institute of Dental Sciences and Postgraduate Research Center, Bangalore, India. These participants were divided into three groups based on age, and the smoking history of parents was established by an interview with participants and parents. The degree of gingival pigmentation of participants was assessed by using the gingival pigmentation index and a standardized digital oral photograph. A urine analysis was conducted to assess levels of cotinine. The κ statistic was performed for interexaminer agreement, and χ(2) and Fisher exact tests were used for statistical analyses.
  
  
  RESULTS
  The prevalence of gingival pigmentation in passive smokers was statistically significant (P <0.05). Increased levels of urinary cotinine were observed in all three groups with the highest levels in group 3 (19 to 24 years old).
  
  
  CONCLUSIONS
  This study depicts the effects of ETS on gingival melanin pigmentation.
authors.affiliation: Department of Periodontics, Bangalore Institute of Dental Sciences and Postgraduate Research Center, Bangalore, India. docranga@yahoo.com
authors.forename: Srirangarajan
authors.initials: S
authors.lastname: Sridharan
authors.forename: Kavita
authors.initials: K
authors.lastname: Ganiger
authors.forename: Aparna
authors.initials: A
authors.lastname: Satyanarayana
authors.forename: Aparna
authors.initials: A
authors.lastname: Rahul
authors.forename: Shreya
authors.initials: S
authors.lastname: Shetty
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D003367:Cotinine / Q000652:urine; D003430:Cross-Sectional Studies; D005260:Female; D005881:Gingiva / Q000473:pathology*; D005882:Gingival Diseases / Q000145:classification; D006801:Humans; D008297:Male; D008543:Melanins / Q000032:analysis; D010290:Parents; D023861:Photography, Dental; D010858:Pigmentation / Q000502:physiology*; D010859:Pigmentation Disorders / Q000145:classification; D012907:Smoking; D013997:Time Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects; D055815:Young Adult
chemical_list: D008543:Melanins; D014028:Tobacco Smoke Pollution; D003367:Cotinine