Early in June I remembered that I had a dental radiology license that needed renewing by the end of the month, and in order to renew it, I needed 30 hours of continuing education (yikes!). Thankfully, acquiring the hours wasn't as bad as I anticipated since I was able to finish them online during nap times and in the evening.
One of the courses I took, Interviews with the Experts, Key Topics in Dentistry Today, spent a few minutes talking about parenting and children's dental health. Although nothing that Dr. Lott shared was ground breaking, I think some of it is worth sharing.
As a side note, unlike most of my other posts where I spend time examining published research, this post is different since I will only be summarizing "expert opinion". Expert opinion is an important way that we know things, but it is not as reliable as certain other ways of knowing. (Sometime I'll have to write a post about the hierarchy of evidence.) For this reason, you won't find a list of references at the bottom--I'm simply reporting on one pediatric dentist's opinion.
With that disclaimer, one habit that greatly contributes to the demise of oral health is sipping and snacking. I'm not particularly great at controlling this in my life (to be honest, I have quite a sweet tooth), but it truly is important. As a mom, I certainly see the appeal of feeding kids food throughout the day to keep them happy and quiet (especially when under social pressure!) but as a former dental professional I cringe inside when I consistently observe it.
The concept that Dr. Lott talked about to combat sipping and snacking was the idea of "bundling". If your child drinks juice or eats dessert, bundle it with the meal. Don't eat lunch, let your child play for an hour, and then offer dessert, but let them eat it all at the same time. Don't let your child sip on juice throughout the day, but instead, treat it as a part of their meal. One reason this is so important is that your teeth don't care that much about how many fermentable carbohydrates (e.g. sugars, starches, fruits) they are exposed to at one sitting, but rather how often they are exposed. Perhaps think of it like a cut that you get on your hand, if you wash it and then leave it alone it will get better much quicker than if you don't wash it but instead irritate it every half hour and rub dirt on it multiple times during the afternoon. Obviously the illustration only goes so far, but the point is that certain foods weaken your teeth, and prolonged exposure only exacerbates the problem. (Mayo Clinic has a reasonable explanation of how tooth decay forms.)
Like most habits that we want to discourage in our children, it's important to take a look at what our habits are. Take the sippy cup, for example. Do you have an adult version of the sippy cup? We know that it's best for the toddler to not carry a cup with juice in it around all day, but do I do this in my adult way? I prefer to sip on coffee throughout the morning, but really, I ought to bundle it with my breakfast, or at least drink it in one prolonged sitting when I'm doing my morning devotions.
When thinking about sipping and snacking, for me, it's not just the immediate disadvantages that bother me, but it's the habit that you're fostering, a habit that your child may struggle with for his entire life.
Showing posts with label oral health. Show all posts
Showing posts with label oral health. Show all posts
Monday, July 8, 2013
Wednesday, May 1, 2013
The weekly dose: xylitol-- a good augment to fluoride?
{About once a week we will examine the evidence pertaining to a health-related matter-- usually something that would be of interest to families with young children. You should expect a thought out and concise summary of the issue along with several solid references-- there may or may not be a true conclusion. Sometimes, “more research is needed” really is the best answer that can be given. Please leave me a comment if you have thoughts, questions, or another topic idea that you’d like addressed.}
When I was reading and writing about oral hygiene for children under two, I came across an interesting recommendation from the American Academy of Pediatric Dentists regarding maternal oral hygiene. In their recommendations on Infant Oral Health Care, they say that, "Evidence suggests that the use of xylitol chewing gum (at least 2-3 times a day by the mother) has a significant impact on mother-child transmission of MS [mutans Streptococci] and decreasing the child’s caries rate.” It seems likely to me (or at least biologically plausible) that if chewing xylitol gum can reduce the transmission of bacteria it could also reduce the mother's susceptibility to get cavities herself. I wanted to see what the evidence had to say about xylitol and gum chewing.
The question I'm interested in today is, is xylitol chewing gum effective at preventing dental cavities?
It turns out that xylitol has been talked about and studied for some time in relation to dental cavities. The oldest applicable reference on Pubmed is from 1970-- "The effect on rat fissure caries of xylitol and sorbitol." Despite the fact that study was published 43 years ago, and that there have been multiple published trials in the last decade there is still no firm consensus about xylitol, especially when it comes to the adult population (1). The American Dental Association published a report on Non-fluoride Caries Preventative agents in 2011 and addressed many different preventative treatments to supplement fluoride use (2).
In the report published by the ADA, the panel concluded that the evidence supporting adults chewing xylitol gum was relatively non-existent, and so this recommendation only earned a strength of "expert opinion". In the figure I attached you can see that the strength of the recommendation for chewing xylitol (or another polyol gum) is actually "stronger" for children. This is because most of the research that has been done surrounding xylitol and chewing gum as an anti-caries agents have focused on children.
When studying xylitol chewing gum it can be difficult to distinguish between the gum and the xylitol, since it is biologically plausible that gum chewing in itself could reduce the incidence of cavities. This is because the act of chewing might both increase the rate at which any left over food is removed from the mouth, and increasing salivation(2). Because of this, it is unfortunate that there has not been a study that compared xylitol gum to other sugar free gums. This fact significantly contributes to the "weak," or "expert opinion" ratings that you see in the figure for the recommendations to use xylitol gum(2).
Earlier this year, a fascinating 3-year trial was published that looked at the effects of xylitol on the incidence of cavities in adults (1) (Medscape has a pretty good summary here, if you're interested but don't want to read the original). This study did not look at chewing gum, but instead used xylitol lozenges. Even though this study doesn't directly relate to my question, I think it is a well designed study (well, at least the study lasted longer than a year and was a randomized controlled trial) and can contribute to our understanding of xylitol. The authors concluded that in adults, xylitol lozenges have little or no effect on caries. Although they did see a small reduction in the incidence of cavities in the experimental group, it was not large enough to be significant. One interesting observation the authors make is that because of the small magnitude of reduction in cavities (~10%), previously published trials could have either missed or magnified this relationship due to unintentional incorporation of bias.
So, where does all this leave us? After nearly two weeks of thinking off and on about xylitol gum, do I have an answer for my question? Is chewing xylitol gum an effective measure against dental cavities? I think I can conclude that there is no strong, evidence-based support for this, but that there is a possibility that chewing (sugar free) gum may mildly help to reduce the incidence of dental cavities. And, since the gum I buy contains xylitol, I will be chewing xylitol gum. But, since the recommendations are so weak, I won't be seriously working on changing my gum chewing habits. (Although, to be honest I'm chewing gum right now, and I think I've chewed a little more than previously since starting the post. ;) )
How about you? What are your gum-chewing habits?
(1) Bader, JD, et al. Results from the Xylitol for Adult Caries Trial (X-ACT). J Am Dent Assoc. 2013 Jan;144(1):21-30. Accessed from http://www.ncbi.nlm.nih.gov/pubmed/23283923 on 4/30/2013.
(2) Rethman, MP, et al. Non-fluoride Caries Preventative Agents: Full report of a systematic review and evidence-based recommendations. ADA Center for Evidence Based Dentistry, 3/24/2011. Accessed from http://ebd.ada.org/contentdocs/clinical_recommendations_non_fluoride_caries_preventive_agents_full_report.pdf on 4/30/2013
When I was reading and writing about oral hygiene for children under two, I came across an interesting recommendation from the American Academy of Pediatric Dentists regarding maternal oral hygiene. In their recommendations on Infant Oral Health Care, they say that, "Evidence suggests that the use of xylitol chewing gum (at least 2-3 times a day by the mother) has a significant impact on mother-child transmission of MS [mutans Streptococci] and decreasing the child’s caries rate.” It seems likely to me (or at least biologically plausible) that if chewing xylitol gum can reduce the transmission of bacteria it could also reduce the mother's susceptibility to get cavities herself. I wanted to see what the evidence had to say about xylitol and gum chewing.
The question I'm interested in today is, is xylitol chewing gum effective at preventing dental cavities?
It turns out that xylitol has been talked about and studied for some time in relation to dental cavities. The oldest applicable reference on Pubmed is from 1970-- "The effect on rat fissure caries of xylitol and sorbitol." Despite the fact that study was published 43 years ago, and that there have been multiple published trials in the last decade there is still no firm consensus about xylitol, especially when it comes to the adult population (1). The American Dental Association published a report on Non-fluoride Caries Preventative agents in 2011 and addressed many different preventative treatments to supplement fluoride use (2).
ADA recommendations (2) |
When studying xylitol chewing gum it can be difficult to distinguish between the gum and the xylitol, since it is biologically plausible that gum chewing in itself could reduce the incidence of cavities. This is because the act of chewing might both increase the rate at which any left over food is removed from the mouth, and increasing salivation(2). Because of this, it is unfortunate that there has not been a study that compared xylitol gum to other sugar free gums. This fact significantly contributes to the "weak," or "expert opinion" ratings that you see in the figure for the recommendations to use xylitol gum(2).
Earlier this year, a fascinating 3-year trial was published that looked at the effects of xylitol on the incidence of cavities in adults (1) (Medscape has a pretty good summary here, if you're interested but don't want to read the original). This study did not look at chewing gum, but instead used xylitol lozenges. Even though this study doesn't directly relate to my question, I think it is a well designed study (well, at least the study lasted longer than a year and was a randomized controlled trial) and can contribute to our understanding of xylitol. The authors concluded that in adults, xylitol lozenges have little or no effect on caries. Although they did see a small reduction in the incidence of cavities in the experimental group, it was not large enough to be significant. One interesting observation the authors make is that because of the small magnitude of reduction in cavities (~10%), previously published trials could have either missed or magnified this relationship due to unintentional incorporation of bias.
So, where does all this leave us? After nearly two weeks of thinking off and on about xylitol gum, do I have an answer for my question? Is chewing xylitol gum an effective measure against dental cavities? I think I can conclude that there is no strong, evidence-based support for this, but that there is a possibility that chewing (sugar free) gum may mildly help to reduce the incidence of dental cavities. And, since the gum I buy contains xylitol, I will be chewing xylitol gum. But, since the recommendations are so weak, I won't be seriously working on changing my gum chewing habits. (Although, to be honest I'm chewing gum right now, and I think I've chewed a little more than previously since starting the post. ;) )
How about you? What are your gum-chewing habits?
(1) Bader, JD, et al. Results from the Xylitol for Adult Caries Trial (X-ACT). J Am Dent Assoc. 2013 Jan;144(1):21-30. Accessed from http://www.ncbi.nlm.nih.gov/pubmed/23283923 on 4/30/2013.
(2) Rethman, MP, et al. Non-fluoride Caries Preventative Agents: Full report of a systematic review and evidence-based recommendations. ADA Center for Evidence Based Dentistry, 3/24/2011. Accessed from http://ebd.ada.org/contentdocs/clinical_recommendations_non_fluoride_caries_preventive_agents_full_report.pdf on 4/30/2013
Thursday, April 11, 2013
The weekly dose: Baby has teeth! (and how shall I care for them?)
{About once a week we will examine the evidence pertaining to a health-related matter-- usually something that would be of interest to families with young children. You should expect a thought out and concise summary of the issue along with several solid references-- there may or may not be a true conclusion. Sometimes, “more research is needed” really is the best answer that can be given. Please leave me a comment if you have thoughts, questions, or another topic idea that you’d like addressed.}
Last week I spilled the beans that Baby has two little teeth. They're so cute! (Or at least I think they are.) Even though it's recommended that you wipe your baby's gums with a wet washcloth from the time he's born, I really haven't been that consistent at caring for his gums, but the advent of actual teeth is certainly motivation enough for me to become consistent and establish a good oral care routine for Baby.
I have a fairly high risk for cavities, or caries, so unfortunately that puts Baby at a high risk too. Because of this, it's especially important to me to establish good habits for Baby to minimize (hopefully prevent!) cavities both with his baby teeth now, and then later with adult teeth.
It is known that diet plays a huge role in oral health, and that certain feeding habits are strongly associated with early childhood caries(1), but today, I will be focusing only on the actual oral care routine and not the other factors that may contribute to early childhood caries (ECC). I just want you to remember and know that simply using the right toothbrush and toothpaste, even if used consistently, is probably not enough to ward off all early childhood caries. In technical terms, caries are an infectious disease with a multifaceted etiology (2).
Before we go any further, the question I seek to answer today is, what is the best way to care for a baby's (< 2 years old) teeth?
After a quick Google search, it became evident that there are many different opinions about what is the best way to care for a baby's teeth, the main differences being whether to use a fluoride-containing toothpaste, or "training" toothpaste, and whether to use a baby washcloth, or a baby toothbrush. To highlight this disparity, the American Dental Association (ADA) recommends against fluoride toothpaste for children under two unless told otherwise by a dentist, while the American Academy of Pediatric Dentistry (AAPD) says a qualified yes for fluoride for children under two(2).
The best resources I found this time where the policy reviews by the AAPD. Fortunately, the policy reviews are well notated and not based solely on expert opinion. I tried a few PubMed searches, but was sadly fairly unsuccessful on that front.
In regards to infant oral hygiene, the AAPD's policy is that:
(1) American Academy of Pediatric Dentistry. (2012). Policy on the Dietary Recommendations for Infants, Children and Adolescents. Reference Manual V 34/No 6. pages 56-58.
(2) American Academy of Pediatric Dentistry. (2011). Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies. Reference Manual V 34/No 6. pages 50-52.
http://www.aapd.org/media/Policies_Guidelines/P_ECCClassifications.pdf. Accessed 4/11/13.
Last week I spilled the beans that Baby has two little teeth. They're so cute! (Or at least I think they are.) Even though it's recommended that you wipe your baby's gums with a wet washcloth from the time he's born, I really haven't been that consistent at caring for his gums, but the advent of actual teeth is certainly motivation enough for me to become consistent and establish a good oral care routine for Baby.
I have a fairly high risk for cavities, or caries, so unfortunately that puts Baby at a high risk too. Because of this, it's especially important to me to establish good habits for Baby to minimize (hopefully prevent!) cavities both with his baby teeth now, and then later with adult teeth.
It is known that diet plays a huge role in oral health, and that certain feeding habits are strongly associated with early childhood caries(1), but today, I will be focusing only on the actual oral care routine and not the other factors that may contribute to early childhood caries (ECC). I just want you to remember and know that simply using the right toothbrush and toothpaste, even if used consistently, is probably not enough to ward off all early childhood caries. In technical terms, caries are an infectious disease with a multifaceted etiology (2).
Before we go any further, the question I seek to answer today is, what is the best way to care for a baby's (< 2 years old) teeth?
After a quick Google search, it became evident that there are many different opinions about what is the best way to care for a baby's teeth, the main differences being whether to use a fluoride-containing toothpaste, or "training" toothpaste, and whether to use a baby washcloth, or a baby toothbrush. To highlight this disparity, the American Dental Association (ADA) recommends against fluoride toothpaste for children under two unless told otherwise by a dentist, while the American Academy of Pediatric Dentistry (AAPD) says a qualified yes for fluoride for children under two(2).
The best resources I found this time where the policy reviews by the AAPD. Fortunately, the policy reviews are well notated and not based solely on expert opinion. I tried a few PubMed searches, but was sadly fairly unsuccessful on that front.
In regards to infant oral hygiene, the AAPD's policy is that:
They even included a picture of what a "smear" versus "pea-size" amount of toothpaste is."Toothbrushing should be performed for children by a parent twice daily, using a soft toothbrush of age-appropriate size. In children considered at moderate or high caries risk under the age of 2, a ‘smear’ of fluoridated toothpaste should be used. In all children ages 2 to 5, a ‘pea-size’ amount should be used." (2)
It makes me happy to see recommendations that allow for flexibility to be tailored to an individual's needs, since truly, one size rarely fits all. I suppose also that this flexibility could explain the difference between the AAPD's policy and the ADA's policy-- maybe the ADA is assuming a low risk for people reading their webpage(?).
Well, the suggestion to use a smear of fluoride toothpaste is in line with what my dentist recommended when I asked him about it a few weeks ago. As far as toothbrushes versus baby washcloths go, my dentist suggested the washcloth until baby has more teeth since it's probably a little easier to get into Baby's mouth and actually clean the teeth than it would be with a toothbrush. Once Baby has molars, if not before, I'll certainly plan on switching over to a baby toothbrush though.
We can't forget about flossing though! Well, maybe we can since without teeth that touch, there's no need to floss.
Happy toothbrushing!
(2) American Academy of Pediatric Dentistry. (2011). Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies. Reference Manual V 34/No 6. pages 50-52.
http://www.aapd.org/media/Policies_Guidelines/P_ECCClassifications.pdf. Accessed 4/11/13.
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