Pursuing Christ-glorifying priorities

At the beginning of the year about the time I (re)started blogging, I was thinking about priorities and how they contribute to excellence.  Funny how certain things continually resurface.  After a few hiccups, I think things are finally starting to fall in order again here at our little home, but it's crazy how easy it is for things to get out of hand (sin and the second law of thermodynamics in action, I guess).

When it comes to priorities and managing my home wisely, I think the difficulty lies in the fact that too often, what ought to be done at a given moment is really not what I want to do at that moment. But yet, if I want to keep things moving in the right direction I need to keep my priorities in line with what God would have for me, and consistently choose the right "next thing" to do.  Persevering in choosing the right "next thing" can be hard for me, especially if that "next thing" is to clean the tub, or to start dinner when I'd really rather have some computer time.

I originally had high hopes for multiple posts a week here at Excellence, Etc., but I'm afraid if dinner won't be ready on time, or my home is not orderly, or my son needs attention I can't really glorify God by sitting down to write.  It's just a hobby for me, so it falls pretty low on the priorities list.

In their proper place, I believe that some hobbies can be Christ-glorifying, refreshing, and edifying, but how do you  fit hobbies and things you enjoy into your already full day?

I've been trying to be more efficient at keeping my house clean (which is the biggest time sink/area of avoidance for me) as well as planning further ahead by starting dinner early in the afternoon.  This way, when Baby sleeps longer, or I somehow have some "extra" time, I'm caught up on the essentials and can sit down at the computer and have some time to write without having neglected my higher priorities.
 
Have you found any ways to be more efficient so you can have time to do some "optional" but enjoyable activities?  I'd love to hear any other ideas about how you keep your priorities in order!

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).

ADA recommendations (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

motherhood, a lesson in thanksgiving

More than anything else I've experienced in my life, motherhood has shown me the need to start the day (and night!) with an attitude of humility, knowing that I don't deserve anything good, and that all good things I do receive (and there are many!) are a gracious gift from my Heavenly Father.

I think the reason motherhood highlights this for me is the frequency and intensity with which my desires are thwarted.  Babies are just so needy and, at times, unpredictable.

Baby has finally started sleeping through the night again, but there was a period over the last few months where we were travelling on and off, he was teething, and then we were sick, so he was definitely not consistently sleeping through the night.  When I was needed, I'd get out of bed, assess his needs, attempt to meet his needs, comfort him back to sleep, and then crawl back to bed myself.  This got old rather quickly, and my heart would start to grumble, telling me that I deserved sleep, or wondering why it was always my "turn" to take care of Baby.

One morning after my heart had been particularly grumbly, I took the time to sit down and study and remind myself of what God had to say in the Bible about grumbly hearts.  It struck me that this attitude really all comes back to the idea of what I deserve.

The reality is, as much as I'd like to think otherwise, I don't deserve anything good, since I am by nature a child of wrath (Ephesians 2).  (This attitude sure fosters humility, doesn't it?!) Yet, God gives me many good things (life! a son! rest!) (James 1:17).  God is always good, even when life interferes with my personal desires, and my attitude ought to reflect this magnificent goodness.

When we cultivate this attitude of humility--because the good things we receive are gifts, and not something we deserve,  it becomes oh so much easier to be thankful in all things and to replace our grumbly hearts with happy hearts!

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:

"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)

They even included a picture of what a "smear" versus "pea-size" amount of toothpaste is.

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!

(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.

living life at home

This week has been full of many little things, getting back from our visit to New Mexico, fighting colds, switching to two-naps-a-day for the little one, and starting a spring cleaning challenge, to name a few.  Oh right, and then there was Easter too.  It's been a good week, I just haven't had time to prepare the post I was hoping to.

time at the zoo with Nana and Papa!

My friend Tifo and I have been planing on doing a cleaning challenge for some time, and we finally started this week.   So instead of gaining more head knowledge and blogging about it, I am (hopefully) gaining a cleaner home.  It's been a real challenge for me to try and fit in the extra cleaning projects-- our home needs them done so bad, but it seems like I'm doing well most weeks if all the laundry is put away and the floors vacuumed.  After yesterday, the fridge looks much better though!

look! I have teeth!

As you can see, Baby now has teeth!  When we were in New Mexico, he got to meet our favorite dentist, and dare I say it, he even liked the office. Maybe he'll be a dentist when he grows up ;).  

Next week I hope to write a post about caring for baby teeth... there are so many varying and different opinions on the web, but like usual, we will look at what the available evidence has to say. 

Have a happy weekend!

is the HPV vaccine fundamentally different?

A few weeks ago BabyCenter News posted an article from HealthDay News, Parents' worries about the safety of HPV vaccine on the rise, study says (March 15, 2013).  Years ago I spent a semester studying HPV and its relationship to oral cancer, so I'm naturally a bit interested in the HPV vaccine discussions.

Before I say too much, I want you to know that I am not an expert on vaccines, and am not either recommending, or not recommending that you or your children get the HPV vaccine.  I do think it's interesting to critically think through this article and the recommendations that accompany it. 

According to this article, the safety concerns of parents in regards to the HPV vaccine nearly quadrupled between 2008 and 2010.  HealthDay News doesn't tell us which study actually found this out, merely using using the catch words of "experts" and "study."  I'd be curious to know how the study actually measured these concerns, since there could certainly be room for error here.  Did the concerns really quadruple?

The article also states that, "There are more than 100 strains of HPV....".  It's true that there are many different strains of HPV, but to emphasize this when focusing on the  HPV vaccine seems a little over dramatic since the HPV vaccine is only effective against 4 strains of HPV(1).

But what really jumps out the most to me is that the article states that,

"...the worries [about safety] seem specific to the HPV vaccine. Parents in the study were also asked about two other vaccines recommended for teenagers: the "Tdap" vaccine against tetanus, diphtheria and whooping cough; and the "MCV4" vaccine against bacterial meningitis -- a potentially fatal inflammation around the brain and spinal cord.  Across the study period, less than 1 percent of parents cited safety concerns over those two vaccines."

This makes sense to me-- think about the different modes of transmission.  Tetanus, diphtheria, whooping cough, and meningitis are all highly contagious and can be transmitted in an everyday
setting.  HPV is different.  HPV is a sexually transmitted disease.  I believe that's at least part of the reason why it was reported that just over 17% of parents said that the HPV vaccine was "not necessary." 

The ways of acquiring HPV are directly related to a specific lifestyle, whereas the other diseases can be acquired simply by going to the grocery store or stepping on a rusty nail.  And that is a difference that ought to be considered when thinking about  this vaccine.

No matter how safe a medical intervention is, there will always be associated risks and costs (at least to someone).  In critically thinking about this, we must weigh these risks and benefits.  The article may be right that there are very few risks associated with the vaccine, but we should also be careful to think about the potential benefits since this disease is a result of a lifestyle that is chosen. 

But anyways, just some musing on how the HPV vaccine is a little different ideologically than other vaccines.

What do you think though? Is a different mode of transmission for the disease a big enough difference to put this vaccine in a different sort of category?  Or, does it all just seem the same to you?


(1) CDC. (2012). Human Papillomavirus (HPV) Vaccine. http://www.cdc.gov/vaccinesafety/Vaccines/HPV/index.html. Accessed 3/27/2013

baby wearing

Yesterday I bought a new baby carrier!  I've been researching and trying different models out for a few months now.  I can't wait until my new carrier gets here, hopefully later this week!   

Since Baby was born, I've been borrowing a friend's Ergo Baby Carrier and have also tried and used a smattering of other carrying options.  I've found that unless I'm planning on running, I really would rather wear Baby in the carrier than put him in a stroller or a grocery cart.  Carrying him is just so much easier for me.  I always know where he is, I don't have to push a stroller around (or carry the stroller downstairs, put it in the car, get it out of the car...), I don't have to find stroller friendly routes, and I always have my hands free.  With the proper carrier, it's also really comfortable for me.

This discovery is slightly surprising to me since "baby wearing", as it is often called, is closely associated with the Attachment Parenting movement.  As a general philosophy I don't really agree with much of the Attachment Parenting movement, but I'm starting to see that even if I don't agree with the entire philosophy, that doesn't mean that everything they endorse is necessarily void of value.

I feel like that has been the story of my adult life, learning that not everything is black and white like I wanted it to be when I was in high school.  This is a perfect example to me of the importance of not being dogmatic in overgeneralizing my feelings towards a specific set of beliefs.  Yes, certainly if I disagree with a philosophy I should take time and think it through before I adopt one of their practices, but it's also foolish to simply write off everything that falls under the broader umbrella of a philosophy I disagree with. 

Have you every written something off because of it's associations? Or I suppose the opposite could be true too-- being too accepting of other ideas before examining them to see how they'd fit into your philosophy of life.  Do you lean towards one or the other?

I'm glad I didn't ignore the idea of baby wearing since it turns out it fits our needs and lifestyle quite nicely.