August 18, 2017
AAP statement on fruit juice consumption by infants, children, and adolescents
Although fruit juice consumption offers some benefits, it also has potential harmful effects. High sugar content in juice contributes to more calorie consumption and the risk of developing dental caries. The lack of protein and fiber in juice can lead to abnormal weight gain. Fruit juice offers no nutritional benefits for infants younger than 1 year and no nutritional advantages over whole fruit for infants and children.
Those conclusions are part of a June 2017 policy statement on juice consumption from the American Academy of Pediatrics.
The statement’s authors noted that children and adolescents remain the highest consumers of juice and juice drinks. They also noted that children aged 2 to 18 years consume nearly one-half of their fruit intake as juice, which lacks dietary fiber and predisposes them to excessive caloric intake. Up to one-third of adolescents consume sport drinks, and roughly 10% through 15% consume energy drinks.
The malabsorption of carbohydrates that can result from large intakes of juice is the basis for some health care providers to recommend juice to treat constipation, particularly in infants. The carbohydrate concentration for juice varies from 11 grams % (0.44 kilocalories per milliliter) to more than 16 g % (0.64 kcal/mL). Human milk and standard infant formulas, in comparison, have a carbohydrate concentration of 7 g %. Fluoride content of concentrated juice varies with the fluoride content of the water used to reconstitute the juice.
Children aged 1 through 4 years old who consume about 1,000 kcal/day should have roughly 1 cup of fruit per day. Children aged 10 through 18 years old who consume about 2,000 kcal/day should have roughly 2 cups of fruit per day. Although whole fruit is encouraged, up to one-half of the servings can be provided in the form of 100% fruit juice (not fruit drinks).
Fruit juice offers no nutritional advantage over whole fruit. There is no nutritional indication to give fruit juice to infants younger than 6 months. A drawback of fruit juice is that it lacks the fiber of whole fruit. Kilocalorie for kilocalorie, fruit juice can be consumed more quickly than whole fruit.
Pasteurized fruit juices are free of microorganisms and are safe for infants, children, and adolescents.
Juice should be offered to toddlers in a cup, not a bottle, and infants should not be put to bed with a bottle in their mouth. Allowing children to carry a bottle, easily transportable covered cup, open cup, or box of juice around throughout the day leads to excessive exposure of the teeth to carbohydrates, which promotes the development of dental caries.
Infants should be encouraged to consume whole fruit that is mashed or pureed. After 1 year of age, fruit juice may be used as part of a meal or snack. Toddlers and young children can be encouraged to consume whole fruit instead of juice.
Juice should only be introduced into the diet of infants before 1 year if clinically indicated. Juice intake should be limited to 4 ounces per day in toddlers aged 1 through 3 years, 4-6 oz per day for children aged 4 through 6 years, and 8 oz per day for children aged 7 through 18 years.
Read the full article here.
Consulting Editor: Paul S. Casamassimo, DDS, MS
Professor Emeritus, The Ohio State University College of Dentistry
and Nationwide Children's Hospital, Columbus, OH
Consulting Editor: Arthur J. Nowak, DMD
Professor Emeritus, University of Iowa College of Dentistry
Affiliate Professor, University of Washington School of Dentistry
Self-correction, intervention for ectopic eruption of maxillary permanent first molars
The magnitude of impaction and primary tooth resorption are reliable radiographic parameters to use to evaluate ectopic eruption (EE). Increased magnitude of impaction is the most reliable predictor associated with irreversible (IRR) outcome.
The findings are from a study published in the May/June issue of Journal of Pediatric Dentistry.
Researchers designed the study to determine the rate of self-correction (SC) in a sample population with ectopic eruption of the maxillary permanent first molar in which no interceptive treatment was started. They also assessed if any factors reported in literature could accurately predict an IRR outcome of an ectopic maxillary permanent first molar.
Researchers defined a self-correcting outcome as when the ectopic maxillary permanent first molar erupted into occlusion, and the primary second molar was retained with various degrees of root resorption. They also defined an IRR outcome as when the maxillary permanent first molar remained locked under the distal contour of the primary second molar until the latter exfoliated prematurely or extraction was performed owing to signs and symptoms.
Researchers identified 65 EE in 44 patients. The rate of SC of mesial EE of maxillary permanent first molars in this sample population, in which no intervention was initiated, was 71%. About one-third of the EEs that self-corrected did so after the patients was 9 years of age. Space loss, with an average of about 3 millimeters, occurred in 18 EE (28%). Increased magnitude of impaction, degree of resorption of the primary second molar, severe lock, and bilateral occurrence were positively correlated with IRR EE. Multiple regression analysis was positive for increased magnitude of impaction when adjusted for sex and bilateral occurrence.
The degree of resorption and the magnitude of impaction were the only radiographic parameters that showed a strong interrater correlation. Researchers found that the following factors were positively correlated with IRR outcome in decreasing order: magnitude of impaction, severe lock, increased resorption of the primary second molar, and bilateral occurrence.
A 1-mm increase in magnitude of impaction highly increased the odds of IRR outcome. Magnitude of impaction values were significantly higher with IRR outcome. All EE with a magnitude of impaction higher than 2.25 mm were IRR.
In the IRR outcome group, researchers observed space loss in 18 teeth (95%). The estimated average (standard deviation) space loss was about 3.7 (2.4) mm. There was a statistically significant negative correlation between age of outcome and space loss (P = .01), indicating that the earlier the IRR outcome occurred, the greater the space loss.
In the SC group, 5 primary second molars (11%) were extracted after the eruption of the maxillary permanent first molar. None of the SC EE required distalization owing to space loss.
“Only 4 teeth (6 percent) required active distalization of the permanent first molar,” the researchers noted. “Delaying intervention when unsure of the type of EE can be a viable option and may prevent unnecessary treatment and cost.”
Read the full article here.
Join your colleagues at ADA 2017
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Fissure sealant, fluoride varnish for caries prevention compared
In a community oral health program, semiannual application of a fluoride varnish (FV) resulted in caries prevention that was not significantly different from that obtained by applying and maintaining a fissure sealant (FS) after 36 months.
Those conclusions are from a study published in the July issue of Journal of Dental Research.
Researchers designed the 2-arm, parallel group study to compare the clinical effectiveness of FS and FV in preventing dental caries in permanent first molars (PFM) among 6- to 7-year-olds. They randomized participants to receive resin FS or FV. Clinical examinations and treatments were undertaken in schools via mobile dental clinics as part of Designed to Smile, a national oral health improvement program in Wales, UK. Fluoride level in the local water supply was less than 0.1 part per million.
Researchers randomized 1,016 children 1:1 to receive either FS or FV. Resin-based FS was applied to caries-free PFMs and maintained at 6-month intervals. FV was applied at baseline and at 6-month intervals for 3 years. Caries status was assessed at baseline and 12, 24, and 36 months by trained and calibrated dentists at the d1/D1 to d6/D6 level, according to criteria from the International Caries Detection and Assessment System.
Children received their usual dental care during the trial, but their dentists were asked to refrain from providing FS or FV treatments.
Primary outcome measures were the proportion of children developing caries into dentin (D4-6MFT) on any 1 of up to 4 treated PFMs after 36 months. A total of 835 children remained in the study at 36 months: 417 in the FS arm and 418 in the FV arm. A smaller proportion of children who received FV (n= 73, 17.5%) than FS (n= 82, 19.6%) developed caries into dentin on at least 1 PFM (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.59 to 1.21; P = 0.35), a nonstatistically significant difference between FS and FV treatments. The results were similar when the number of newly carious teeth (OR, 0.86; 95% CI, 0.60 to 1.22) and tooth surfaces (OR, 0.85; 95% CI, 0.59 to 1.21) were examined.
A total of 95% of children received at least 5 of the 6 scheduled treatments, and 97.6% had their treatment on time or outside the 4-week window only once. At 36 months, 74.5% of the maxillary PFMs were intact, 23.3% were partially intact, and 0.5% were lost. Corresponding figures for the mandibular PFMs were 91.4%, 5.1%, and 0.8%.
The proportion of children who developed caries into dentin (D4-6 MFT) on at least 1 PFM at 36 months was broadly similar in the FS arm (19.6%) and the FV arm (17.5%). The final model shows no significant difference in the proportion of children with caries into dentin (D4-6 MFT) on any PFM in the trial at 36 months whether the children received either FS or FV.
Read the full article here.
Detecting traumatic injuries to primary incisors in patients without accompanying clinical signs
Traumatic dental injuries (TDI) based on clinical and radiographic evidence are more prevalent than those based on clinical examination only, according to a study published in the April issue of Journal of Dental Traumatology.
Researchers designed the study to measure the proportion of patients who had radiographic evidence of trauma without any clinical signs of a history of TDI.
Researchers assessed the prevalence of TDI from the records of 674 preschool children at their first visit to a private dental practice. Evidence of the history of TDI was based on clinical and radiographic signs. Clinical signs consisted of enamel fracture, crown fracture with dentin exposure (with or without pulp exposure), internal coronal discoloration, and the presence of a draining sinus. Radiographic signs included root fracture, pulp canal obliteration (PCO), tube-like mineralization, internal resorption, arrested dentin deposition, external inflammatory root resorption, and a periapical radiolucency.
Researchers classified examined teeth as either certainly traumatized (CT) or not traumatized (NT). Children were considered to have experienced TDI if they had at least 1 of the CT signs or a combination of 3 of the following minor signs: enamel cracks, increased mobility, tenderness to percussion, dull or metallic sound when a percussion test was conducted, and swelling or redness of the soft tissue above the primary incisors. The NT group comprised all other children.
The study group consisted of 674 children, 342 boys and 332 girls. The mean age of the children was 51 months (range, 17-106; median, 49 months).
Researchers categorized the 4 most common findings of TDI as enamel fracture found in 38.0% (256/674) of the cases; PCO in 16.0% (108/674); yellow coronal discoloration in 14.4%; and gray or brown coronal discoloration in 10.5% (71/674).
Of the 674 children, 408 (60.5%) were classified as clinically CT. Of that group, 133 (19.7%) had concomitant radiographic signs of TDI, and 275 (40.8%) showed clinical evidence only. A total of 17 children (2.5%) only had radiographic evidence of TDI without any clinical signs, 15 PCO, 1 arrested dentin deposition, and 1 root fracture. The total prevalence of TDI increased to 63% when the radiographic signs were included.
Researchers found expansion of the dental sac (EDS) in 19% (128/674) of the children. The association between EDS and evidence of TDI was not statistically significant. However, this association was found to be statistically significant (P < .001) when cases of enamel fracture only without any other sign of TDI (195 cases)
Clinical signs of TDI without radiographic evidence of trauma were present in 275 (40.8%) patients.
Read the full article here.
The paradox of single-tooth treatment
Single-tooth treatment is the biggest source of many dentists’ revenue, but it can also be the biggest obstacle to achieving even greater revenue. In the latest issue of Dental Practice Success, Dr. Roger Levin discusses how to present the advantages for extensive or elective treatment to your patients.
The Summer 2017 issue of DPS also features articles on using Facebook ads to grow you practice, choosing digital radiographic equipment, how to manage growth and change in your practice, the importance of letting go of stress and more.
AAPD sedation course planned for October
Do you see children in your practice? Check out the Safe and Effective Sedation Course for the Pediatric Dental Patient by the American Academy of Pediatric Dentistry. This course features the recognized leaders in the field, both in dental anesthesia as well as pediatric dentistry. You’ll find didactic lectures, case studies, film clip sessions, panel discussions, and hands-on breakouts with personalized attention. We also have a course geared specifically toward dental assistants. Come to the Westin Gaslamp in San Diego, CA, October 27-29, 2017. Visit www.aapd.org/events for more information or to register.
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