Friday, May 9th, 2014
The government-backed U.S. Preventive Services Task Force (USPSTF) is now recommending that pediatricians apply a painted-on fluoride treatment to baby teeth as soon as they emerge, as a cavity-prevention measure. More from Reuters:
“Only one in four preschool children is seeing a dentist, but most see a primary care clinician,” Dr. Michael LeFevre told Reuters Health. “Primary care clinicians can play an important complementary role in helping dentists keep children’s teeth healthy.”
A family physician from the University of Missouri School of Medicine in Columbia, LeFevre chairs the USPSTF.
The panel declined to state how often doctors should apply fluoride varnish to infants’ teeth, saying research is inconclusive.
Pediatric dentist Dr. Mary Hayes welcomed the help from pediatricians, family doctors and nurse practitioners.
“It’s a good thing that dentistry and medicine are working hand in hand trying to attack decay in kids’ mouths,” she told Reuters Health. Hayes is an American Dental Association spokeswoman and was not involved with the new recommendations.
In addition to applying fluoride varnish to all baby teeth, the task force continues to urge doctors to prescribe oral fluoride supplements to infants who have not had fluoride added to their drinking water. Supplements come in daily doses of drops, tablets or lozenges.
In an effort to prevent tooth decay, fluoride was first added to the water supply in Grand Rapids, Michigan, in 1945. Since then, communities throughout the U.S. have debated whether to add the naturally occurring mineral to public water systems.
About two-thirds of Americans currently drink water from fluoridated community systems, according to the Centers for Disease Control and Prevention.
The task force last updated its recommendations on prevention of tooth decay in preschool-aged children 10 years ago.
Earlier this year, the American Dental Association recommended parents use a tiny amount of fluoride toothpaste on children before they turn 2, though fluoride remains controversial in some circles amid allegations–based, medical officials say, on questionable science–that fluoride is a carcinogen and can lower children’s IQs. In 2012, New Jersey was embroiled in the controversy when it considered legislation that would require each town in the state to fluoridate its water.
Image: Baby teeth, via Shutterstock
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Tuesday, February 18th, 2014
The American Dental Association is now recommending that children begin using a tiny amount of fluoride toothpaste twice daily as soon as their first teeth appear. This is a change from the previous guidelines, which had suggested brushing with water until age 2, when a pea-sized amount of fluoride toothpaste could be used. More on the new recommendation from The New York Times:
To fight the rising number of cavities in the very young, the dental group now advises getting a jump-start on prevention. However, they emphasize only the tiniest amount of fluoride toothpaste should be used to minimize the risk of mild discoloration, white spots or streaking of the teeth, a condition called fluorosis that is caused by ingesting fluoride toothpaste at a young age.
“We want to minimize the amount of fluoride consumption to reduce the risk of fluorosis while simultaneously adding a preventive tool for kids 2 and under that we haven’t recommended previously,” said Dr. Jonathan Shenkin, a spokesman for the A.D.A. and a pediatric dentist in Augusta, Me. Only a tiny amount of toothpaste should be smeared on the brush since some youngsters are likely to ingest some of the fluoride, he said.
The change comes after a systematic review of 17 studies published in The Journal of the American Dental Association this month. It concluded that scientific evidence, though limited in children under age 6 and more robust in older children, demonstrated that fluoride toothpaste is effective in controlling tooth decay, and that “the appropriate amount” should be used “by all children regardless of age.”
An early start is crucial, Dr. Shenkin said, because children with dental decay are at greater risk of developing cavities as adults. “By starting earlier, we can effectively reduce a lifetime of disease for a lot of kids.”
Dr. Man Wai Ng, the dentist in chief at Boston Children’s Hospital, applauded the new recommendation and said, “It’s a great thing for parents to know: ‘Use a tiny amount of fluoride, and brush two times a day to counter the effects of frequent snacking.’”
Most of the children she sees with tooth decay are using “a training toothpaste without fluoride,” she said.
The new A.D.A. guidelines stress that children should spit out toothpaste as soon as they are able, but not being able to spit does not preclude the use of a rice-grain-size bit of fluoride toothpaste.
Fluoride is controversial in some circles, amid allegations–based, medical officials say, on questionable science–that fluoride is a carcinogen and can lower children’s IQs. In 2012, New Jersey was embroiled in the controversy when it considered legislation that would require each town in the state to fluoridate its water.
What kind of behaviors can you expect from your growing toddler? Take our quiz to find out!
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Friday, May 10th, 2013
Pregnant women who are in need of dental care too often find themselves facing obstacles including refusal to treat or a delay in treatment. The issue is due to a number of reasons, ranging from lack of oral health attention from OB-GYNs to outdated ideas among dentists that it’s not safe to treat pregnant women. The New York Times reports:
The problem among dentists is decades old. Many “were taught in dental school that you can’t treat a pregnant woman,” said Dr. Renee Samelson, a professor of obstetrics and gynecology at Albany Medical Center, who was an editor of the first guidelines on oral health in pregnancy, which were published by the New York State Department of Health and advised on two more sets of guidelines. Dentists simply erred on the side of caution, she added: “There was no evidence of harm.”
Today, although dental treatment during pregnancy is considered beneficial, some dentists still hesitate to see pregnant women, because they fear litigation or harm to the fetus, or their knowledge of appropriate care lags behind the current evidence. One 2009 survey of 351 obstetrician gynecologists nationwide found 77 percent reported their patients had been “declined dental services because of pregnancy.”
“A lot of dentists still fear treating pregnant women, and think, ‘What happens if I have to do an X-ray?’ or ‘What happens if I give antibiotics or local anesthesia?’” said Dr. Howard Minkoff, the chairman of obstetrics and gynecology at Maimonides Medical Center in Brooklyn. “None of these are legitimate reasons not to provide appropriate care for women.”
Since 2006, a few state organizations and dental associations have issued practice guidelines declaring that dental care is safe and effective at any stage of pregnancy, including diagnostic X-rays, cavity restorations and root canals.
OB-GYNs should check for bleeding gums or oral infection and refer a patient to a dentist if her last visit was longer than six months ago, according to the first national consensus statement on dental care during pregnancy, published in September by the National Maternal and Child Oral Health Resource Center at Georgetown University.
The statement advised dentists to provide emergency care in any trimester. OB-GYNs can be consulted, as necessary, if a pregnant patient is diabetic or hypertensive, or if general anesthesia is required.
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Friday, April 5th, 2013
Having wisdom teeth removed can be a rite of passage in the teen or young adult years. But a new study has found that children who get shots of anesthetic for dental work may not grow lower wisdom teeth. More from NBC News:
The findings, published in The Journal of the American Dental Association, suggest it might be possible to deliberately prevent the development of the often-troublesome teeth, the team at Tufts University School of Dental Medicine said.
“It is intriguing to think that something as routine as local anesthesia could stop wisdom teeth from developing,” says Dr. Anthony Silvestri, who oversaw the study.
The team just looked at children being treated at Tufts, and they only have a few hundred records, so the findings would have to be repeated in a larger group of children to be sure. But they suggest it might be possible to apply an already widely used medication to prevent the development of a common tooth problem.
As many as 5 million Americans get their wisdom teeth pulled every year. Medically known as third molars, these very back teeth usually emerge in the late teens or early 20s and they can sometimes cause trouble, pushing against other teeth. They are also difficult to clean and can become decayed.
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Monday, February 4th, 2013
The popular squeezable baby food snacks that allow babies and toddlers to suck pureed food directly form foil pouches may actually be harmful to growing teeth, according to a statement from the American Academy of Pediatric Dentistry (AAPD). The new statements about the pouches, which were launched in 2008 by Plum Organics and now are made by a number of baby food brands, makes similar recommendations to what the AAPD already says about babies who walk around with milk- or juice-filled sippy cups. More from NPR.org:
“The constant exposure of sugar on their teeth is detrimental,” says Paul Casamassimo, the oral health research and policy center director at the American Academy of Pediatric Dentistry. “My concern would be if the child walks around with this little pouch, then they might be doing the same thing,” he says.
In fact, the academy recommends ditching the sippy cup and going straight from bottle to cup between 12 and 15 months because of the potential risk of tooth decay. Casamassimo calls them “baby bottle methadone.”
Carbohydrates in all foods are used by bacteria to produce acid, and the acid eats away at the enamel of the teeth, creating the potential for cavities — a growing problem among all children, he says.
And the pouch food, because of its consistency, may be particularly tough on teeth if it’s allowed to sit there for long periods. “We know that tends to stick on teeth and prolong the opportunity for the bacteria to build,” he says.
Brushing kids’ teeth twice a day and making them rinse with water after eating the pouch foods or drinking juice can help, Cassamassimo says.
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