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Children under 5 and perio prevention
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Sent: Tuesday, March 06, 2001 02 57
Subject: [Periodontal] Children under 5 and perio prevention

I have a 2 1/2 year old son who's family (me and my parents) have a
history of periodontal disease.  I have not had him checked by a
dentist but his teeth and gums look normal to my untrained eyes.  My
questions are:

1)  Is periodontal disease something you see in children under age
Five?  Would it be of concern if they are not the permanent teeth?

2)  Should I be doing anything with his first teeth to minimize the
risk of perio from developing in them as well as in his permanent
teeth?

3)  At what age should he first be checked to catch signs of perio
and by whom should he be checked (pediatric dentist, hygienist,
regular dentist)?

4)  Along the lines of cooperating with the person doing the
evaluation, what would he be expected to do?  Regards, Vince.

1. You are rightfully concerned about your child's oral health 2. Do not agree on Fluoride tablet supplements 3. caries control is all you have to worry about for now. 4. If your hygienist and dentist are comfortable... 5. The case for eliminating the use of dietary fluoride supplements for young children - recent paper 6. The bacteria that cause periodontal disease are passed through direct contact - mostly through kissing. 7. The aerobic bacteria in the plaque bacteria metabolize oxygen rapidly . 8. children were getting the correct amount in their vitamins... 9. the amount of fluoride in the toothpaste that kids were swallowing

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Sent: Tuesday, March 06, 2001 05 20
Subject: Re: [Periodontal] Children under 5 and perio prevention

Hi Vince, This is Olena and I have worked in a pediatric dental practice for
14 years as a Certified Dental Assistant and also a RDH. You are rightfully
concerned about your child's oral health. Children normally do not develop
periodontal disease to the extent that an adult does, not to say if you
neglected him/her that you could not start to get bone loss over a period of
time. You should brush your childs teeth daily using a very small amount of
toothpaste, kind of take the tube and hold it against the toothbrush and dab
that is about all you would need. The concern here is for the child not to
ingest alot of fluoride which is found in great amounts in toothpaste, he/she
should be getting their fluoride intake by fluoride vitamins. This fluoride
is for their permanant teeth which are forming  underneath their baby teeth,
the fluoride in the toothpaste is for the baby teeth which are already in
his/her mouth. Normally we like to see the children at age 2 1/2 and I would
take him/her to a pediatric dentist. This is a dentist who only sees children
and who has specialized training in treating kids. Practices will have a
hygienist depending on office protocal you may see the hygienist first then
the dentist or vice versa. In my practice we have a tv in the room, and
usually kids that young sit on the parents lap while we do the exam, cleaning
and fluoride treatment. We explain in what we call tell show do method. First
we tell them what we do ( in childrens terminology) then we show them, then
we do it. We look with a mirror, count their teeth, brush with a special
electric toothbrush, put on vitamins for their teeth etc. Let me know if you
have more questions, I would be happy to answer them. Warm regards Olena RDH


Larry interjects:

Vince, I doubt if everyone would be in agreement on this particular item of
Fluoride tablet supplements.

I would be partial to first taking the child to a hygienist to see if there
would be any reason for recomending a pedodontist.  Just a matter of opinion.
but since you allready know hygienists that you have confidence in . . .

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Larry writes So caries control is all you have to worry about for now. The best you can do is brush his molars with a soft toothbrush and a very minimal amt. of fluoridated toothpaste, less than a pea size drop. More times per day is most effective. Don't put him to bed with a bottle where the juice or milk will stay in contact with teeth while he's asleep.
Janet writes I would tend to agree with this statement as well. Our practice is about 25% very young children. I see them at about age 3 for the first time, and go through the same routine that Olena suggested, most of them do quite well. In fact, often when one of the parents has an appointment, the other parent will bring the child in to watch for a few moments, so it is not unfamiliar to them for their 1st appointment. If your hygienist and dentist are comfortable treating young children, you don't necessarily need to see a pedodontist. In the 3.5 years I have been with this practice, only 1 has been referred to a pedodontist, because of special needs that my boss did not feel comfortable with. Sent: Tuesday, March 06, 2001 4:38 AM Subject: Re: [Periodontal] Children under 5 and perio prevention Hi Larry, I am curious to why you wouldnt give a child fluoride supplements, such as polyvifluor etc? It is a recommendation from the Academy of Pediatric Dentistry. Olena
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Larry Responds: Hi Olena, Here is a recent paper on the subject. TITLE: The case for eliminating the use of dietary fluoride supplements for young children. AUTHORS: Burt BA AUTHOR AFFILIATION: Program in Dental Public Health, School of Public Health, University of Michigan, Ann Arbor 48109-2029, USA. bburt@umich.edu SOURCE: J Public Health Dent 1999 Fall;59(4):269-74 CITATION IDS: PMID: 10682335 UI: 20146916 ABSTRACT: Fluoride supplements have been used for years to prevent dental caries; nevertheless, there are three reasons why their use is inappropriate today among infants and young children in the United States. Evidence for the efficacy of fluoride supplements when used from birth or soon after is weak, supplements are a risk factor for dental fluorosis, and fluoride has little preeruptive effect in caries prevention. While there are many reports on the caries-preventive efficacy of supplements, few meet standards for acceptability as clinical trials, and those that do have tested chewable tablets or lozenges under supervision in school-aged children. North American children today are exposed to fluoride from many sources--drinking water, toothpaste, gels, rinses, and in processed foods and beverages. The additional cariostatic benefits that accrue from using supplements are marginal at best, while there is strong risk of fluorosis when young children use supplements. Available evidence suggests that the public is more aware of the milder forms of fluorosis than was previously thought; thus, it is prudent for caries-preventive policies to aim to maximizing caries reductions while minimizing the risk of fluorosis. It is therefore concluded that the risks of using supplements in infants and young children outweigh the benefits. Because alternative forms of fluoride for high-risk individuals exist, fluoride supplements should no longer be used for young children in North America. MAIN MESH HEADINGS: Cariostatic Agents/*administration & dosage *Dietary Supplements Fluorides/*administration & dosage
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Sent: Tuesday, March 06, 2001 7:49 AM Subject: Re: [Periodontal] Children under 5 and perio prevention Dear Vince, The bacteria that cause periodontal disease are passed through direct contact -- mostly through kissing. There is a strong bond between children and mothers so that is the most logical source. The innoculation requires that the bacteria find a suitable site. They require a reduced oxygen tension in order to grow. This means that the pocket around the tooth must be more than 2 mm. deep. Most babies have less than that and therefore periodontal disease is not initiated. As the permanent teeth erupt, there are deeper pockets for a time and this is a window for the establishment of disease. Other conditions, such as swollen gums from gingivitis, can be a window. Orthodontic appliances are probably one of he leading causes of susceptibility. In my practice, we wanted to see the children before their third birthday. We looked for gingivitis. If it was present, we wanted the child on a high baking soda content dentifrice, such as Arm & Hammer Dentalcare. Many times, this is all that is needed. We would start microscopic exams after the permanent teeth begin to erupt. Hope this helps. - Dan Larry Adds: Another area for reduced oxygen tension is provided when plaque layer is allowed to thicken and grow "more mature" even in a shallow sulcus. The aerobic bacteria in the plaque bacteria metabolize oxygen rapidly thus depleting the oxygen supply in a area where the plaque has some thickness to it, even if it's barely under the gum margin. This is a good reason for brushing the child's teeth to keep the plaque from staying and having more plaque formed adding thickness.
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Sent: Tuesday, March 06, 2001 2:12 PM Subject: Re: [Periodontal] Children under 5 and perio prevention Hi Larry, If there is no clinical benefit of caries reduction then why does the Academy still endorse giving fluoride supplements to children? Larry replies: Specialist societies and schools are notoriously slow in picking up on what's new and pertinent. Do you know how many years the Gastroenterologists argued about whether ulcers was a bacterial infection or not? Many! All the while continuing to treat people with useless diets and antacids. There are many examples of this in all specialized areas including our own.
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Sent: Wednesday, March 07, 2001 03 42 Subject: Re: [Periodontal] Children under 5 and perio prevention Hi Larry, If there is no clinical benefit of caries reduction then why does the Academy still endorse giving fluoride supplements to children? I do know that a couple of years ago they lowered the dosage and started the regiment at a later age because of the fluorosis that was seen but this was mostly because children were getting the correct amount in their vitamins but ingesting too much toothpaste. For instance here in NJ our water is not fluoridated so kids are not getting it in their drinking water. Thanks for the info I will pass it on to the doctors in the office. Warm regards Olena
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Sent: Friday, March 09, 2001 17 23 Subject: Re: [Periodontal] Children under 5 and perio prevention Hi Larry It is interesting isnt it? I guess we are so conditioned into thinking one way it is hard to always be open minded. I do know that for awhile we did see alot of fluorosis and that is why the Academy of Pediatric Dentistry lowered the dosage and increased the age of when to begin the supplements. The problem was more in the amount of fluoride in the toothpaste that kids were swallowing. It tastes good and of course the companies advertising applying toothpaste the whole length of the toothbrush so people do this and kids eat it! Anyway if you come accross more articles i would be interested in seeing them. I am only in pedo very part time now, mostly GP offices at this point. I did my time fo 14 years in pedo. It was time for a change. Hope all is well. Olena PS I got that booklet from Parkell on ultrasonics it is wonderful.
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