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JADA Specialty Scan - Pediatric Dentistry
Pediatric DentistryJADA Specialty Scan

Breast- and bottle-feeding effects on occlusal characteristics

Breast-feeding has been shown to influence the maturation process of dentofacial structures. The constant repetitive effort promotes development of muscles that establish correct oral function. A child who doesn’t breast-feed performs fewer oral exercises.
Some research has shown that lack of breast-feeding leads to underdevelopment of the muscles, incorrect positioning of the lip and tongue and harmful oral habits, all of which may be associated with dental malocclusions.

However, there is conflicting research about the link between feeding practice and occlusal problems. While some studies have reported that breast-feeding is a protective factor against malocclusion, no relationship between the duration of breast-feeding in the first year of life and any dental arch or occlusal parameters was found in others. Furthermore, some reports have suggested that bottle-feeding may be a factor in the development of nonnutritive sucking habits, such as pacifier and digit sucking, and that these habits may account for some forms of malocclusion.

Scientists in China publishing in the April 2015 issue of BMC Pediatrics found studies about feeding methods during childhood and their effects on occlusal characteristics particularly lacking in Beijing, China. They aimed to assess the effects of breast-feeding duration, bottle-feeding duration and nonnutritive sucking habits on the occlusal characteristics of primary dentition in 3- to 6-year-old children there.

To investigate, scientists combined the results of an examination of the occlusal characteristics of 734 children from two day care centers with questionnaires filled out by their parents or guardians. The feeding method (breast and/or bottle), and duration used during each six-month period of the first three years of the child’s life and past and present nonnutritive sucking habits were among the factors examined. A child who was both breast- and bottle-fed was considered one or the other according to which method was more frequently used. A child who had been sucking an object not related to feeding for more than the first year of life was considered to exhibit nonnutritive sucking habits.

Among results, scientists found that failure to breast-feed or breast-feeding for only a short period was associated with a higher prevalence of posterior crossbite and no maxillary space in the primary dentition.

“We suggest that early weaning may interfere with the normal development of alveolar ridges and the hard palate, and hence result in posterior crossbite, a lack of space or crowding in the upper arch,” authors said in discussion.

In children breast-fed for ≤ 6 months, scientists found the probability of developing pacifier-sucking habits was four times that for those breast-fed for > 6 months. Children who were bottle-fed for more than 18 months had a significantly higher risk of nonmesial step occlusion and class II canine relationships.

Also among results, nonnutritive sucking habits affected occlusion. A prolonged digit sucking habit increased the probability of an anterior open bite, while a pacifier-sucking habit associated with excessive overjet and absence of lower arch development space. In discussion, authors noted that a digit-sucking habit is difficult to give up and 62 percent of the children in their study who had the habit maintained it up to three years of age.

Authors said the results of their study suggests that children should be predominantly breast-fed or exclusively breast-fed for no less than six months where possible and that parents should be more aware of the potentially deleterious effects of nonnutritive sucking habits on oral development.

Read the original article.


Consulting Editor: Paul S. Casamassimo, DDS, MS
Professor of Pediatric Dentistry, 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

The privately insured and early oral evaluation

Can the value of the age one dental visit be calculated?

Although only about two percent of children receive a first preventive dental visit at or around the age of one, national specialty organizations including the American Academy of Pediatric Dentistry and the American Academy of Pediatrics advocate for such primary disease prevention education and early identification of at risk infants and toddlers.

Previous research in a Medicaid population showed that the age of the first preventive dental visit has a significant positive effect on subsequent utilization and dental related expenditures. Considering these findings, researchers publishing in the July/August 2015 issue of Pediatric Dentistry conducted a study to examine the cost-effectiveness of the early dental visit and its effect on successive treatment needs in the privately insured.

To explore, scientists examined dental claims submitted by both general and pediatric dentists to a major dental insurer for patients who had been continuously covered from birth through five years of age during the years of 2006 to 2012. The records were from California, New York, Pennsylvania and Texas. The numbers of specific Current Dental Terminology (CDT) codes and the amount paid for the claim were included. The data was organized into five groups based on the age of the first preventive dental visit with Group 1 consisting of children at younger than one year old and Group 5 consisting of children at age four or older, but younger than five years old.     

Scientists collected and analyzed data with three objectives: to determine the prevalence of the age one dental visit in a privately insured population; to learn if there is a relationship between the age of the patient’s first dental visit and their average annual cost of dental care; and to assess the prevention potential of the age one dental visit.

From the claims of 94,574 children, scientists found approximately one percent had their first preventive dental visit by age one; 12 percent had it by age two; 37 percent by age three and 74 percent were four years old.

Also among primary findings, the average annual cost per child per year of coverage for groups one through five was $154.54, $240.32, $291.01, $356.55 and $602.74 respectively.

The prevention potential was calculated by extrapolating the number of complex procedures in each of the groups by using the ratio of complex procedures experienced by Group 1, which was .19.  Scientists found an overall prevention potential of more than 2,500 complex procedures, meaning that if every child had a first preventive dental visit by age one, the cohort would have hypothetically received 2,500 fewer complex procedures over five years.

Authors said the following conclusions can be made based on the study results: (1) the result of lowered annual cost per child supports the age one dental visit in the privately insured population; and (2) a majority of children in the privately insured population do not have their first dental visit until after they are three years old.

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Preventive dental care and nondentist providers

Strategies that promote physician-dentist collaborations to improve continuity of dental care for children receiving dental services in medical settings are needed, new research showed.

The finding was among conclusions drawn by authors investigating the impact of comprehensive preventive oral health services (POHS) on dental caries among kindergarten students. Although POHS provided by nondental providers in medical settings were associated with a reduction in caries, POHS were not associated with improvement in subsequent use of treatment services in dental settings.

The idea behind POHS provided by nondental providers in medical settings is that, because most children have more physician visits than dentist visits by age three, access to POHS would be increased if provided by physicians and nurses for the highest risk children until they establish a dental home. The literature suggests such access would reduce treatment needs, avert hospitalizations and lower Medicaid costs.

However, studies reporting improved oral health have either provided circumstantial evidence on the basis of administrative claims or have not examined comprehensive services, which include fluoride varnish applications. Scientists publishing in the July 2015 issue of Pediatrics aimed to add to the previous body of literature by evaluating the impact of comprehensive POHS (which includes screening and risk assessment, fluoride varnish applications and parental oral health counseling provided in medical offices by nondental providers) on the dental caries experience of children enrolled in kindergarten during 2005 and 2006 who were also enrolled in North Carolina’s Medicaid program.

Linking Medicaid claims with public health surveillance data, the team of scientists at the University of North Carolina at Chapel Hill investigated the association between number of POHS visits and two variables:  (1) decayed, missing, and filled primary teeth; and (2) untreated decayed teeth.

Their analysis showed that 69.7 percent of children had 0 visits with POHS. Among children who received POHS, 51.3 percent had one visit; 29.3 percent had two visits, 13.1 percent had three visits and 6.3 percent had four or more visits. Students enrolled in kindergarten who had four or more medical comprehensive POHS visits their third birthday experienced fewer caries than those who did not receive these services.

Authors said previous studies of North Carolina’s POHS program provided circumstantial evidence of improved oral health status on the basis of administrative claims, including a reduction in dental caries-related treatments and Medicaid payments up to six years of age.

However, the study provided the first empirical evidence that comprehensive POHS provided by physicians in nondental primary care settings as part of a statewide Medicaid benefit reimbursement policy are associated with a reduction in dental caries in children, authors said. They noted previous research showing that among the different types of POHS provided, fluoride varnish has the strongest available evidence of a preventive effect for the primary dentition.

Scientists said the Medicaid-enrolled kindergarten students included in their sample had a high prevalence of untreated caries — approximately one in four students had caries that showed no evidence of treatment.

Furthermore, although children with four or more POHS visits had experienced less disease overall than those with no visits, they had the same amount of untreated decayed teeth in kindergarten.

“The high levels of dt [decayed teeth] among students receiving POHS supports implementation of strategies to improve the quality of screening and referral services within medical practices,” authors said in discussion.

The authors cited dental literature noting that pediatricians can identify children with cavitated lesions with an acceptable level of accuracy, but are less accurate in identifying and assessing individual risk factors and tend to under-refer.

“Our assessment of the literature and results of this study lead us to conclude that multifaceted interventions targeted to the referral process along with rigorous evaluation of these efforts are needed to help ensure an effective outcome,” authors said.

Read the original article.


Community water fluoridation in England

Extensive studies during the past 50 years have shown that reduced dental decay and dental fluorosis are long recognized effects of water fluoridation, which was introduced in the U.S. in 1945 and in England in 1964.

However, a substantial range of nondental health conditions have been alleged as a consequence of water fluoridation. Finding no consistent or high quality scientific evidence to support these associations, a team of public health scientists in the United Kingdom compared rates of selected dental and nondental health outcomes between areas according to whether drinking water is fluoridated or nonfluoridated. They published their findings in the July 8, 2015, online edition of Community Dentistry and Oral Epidemiology.

The scientists estimated ecological level exposure to fluoridated water for small areas and districts and drew associations between fluoridation and dental and nondental health indicators, adjusting for confounding ecological barriers. They chose outcomes data following a review of existing evidence and based on theoretical plausibility, potential population health impact, quality and availability of data and outcome validity.

Results showed no evidence of an association between fluoridation and hip fractures, all-cause mortality, Down syndrome and all cancers. Scientists found a significantly lower prevalence of dental caries among children living in fluoridated areas; “the effects seen are of considerable public health significance and are consistent with previous international studies,” authors said. “Additionally there is a suggestion that the effect is greater within the most deprived communities.”

Among conclusions authors said, “The study uses the comprehensive routine data sources and national dental surveys available in England to provide further reassurance that water fluoridation is a safe and effective public health measure to reduce the significant burden of dental caries.”

Read the original article.

AAPD’s Symposium on Important Oral and Cutaneous Lesions in Infants and Children

The Symposium is designed to update the practitioner on the diagnosis and management of common and important orofacial and cutaneous disorders and lesions. Dental anomalies, soft tissue and jaw lesions and specific skin disorders will be presented. This multidisciplinary discussion will also include newly defined lesions and the latest diagnostic and therapeutic approaches. Because these small patients are not immune to oral pathology, you’ll learn how to spot common intraoral lesions and less common malignant disease. Register now for this important course, Dec. 4-5 in Las Vegas.


New ‘Your Child’s Teeth’ brochure

Put kids on the path to good oral health by giving their parents complete information. The ADA’s newly revised booklet, Your Child’s Teeth, is a detailed guide to caring for children’s teeth up to age 12.

Starting with advice for expectant mothers, Your Child’s Teeth covers brushing and flossing techniques for children, nutrition, fluoride and the importance of regular dental visits. Tips on teething, early childhood caries and thumb sucking are included.

The illustrated booklet encourages parents to establish good dental habits — including regular dental visits — for their baby. Parents of older children are coached on sealants, bite development and injury prevention. New brushing and flossing photos and a tear-and-save dental emergencies section are featured.

The 20-page booklet is sold in packs of 50. Brochure contents can be viewed on this page. To order, call 1-800-947-4746 or go to A Spanish version is also available. Readers who use the code 15418E before October 9 can save 15 percent on all ADA Catalog products.


What is Specialty Scan?

This is one in a series of quarterly newsletters updating dentists on selected specialties in dentistry. Information presented is aggregated and summarized from previously published materials, each item attributed to its publication of origin. This issue of JADA Specialty Scan focuses on pediatric dentistry, the third in the series on this topic for 2015. Other Specialty Scan issues are devoted to endodontics, oral pathology, oral and maxillofacial radiology, orthodontics, periodontics and prosthodontics. The ADA has engaged the specialty organizations in these areas as well as its own Science Institute and Division of Legal Affairs to assist with these newsletters. We welcome feedback on this and all Specialty Scan issues.

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Any statements of opinion or fact are those of the authors and do not necessarily reflect the views of the American Dental Association. Neither the ADA nor any of its subsidiaries have any financial interest in any products mentioned in this publication. Any reference to a product or service, whether in advertisements or otherwise, is not intended as an endorsement or as approval by the ADA or any of its affiliated organizations unless accompanied by an authorized statement that such approval or endorsement has been granted.

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