Dental Implications of Asthma

The work of several Swedish dental researchers offers striking contrast between the dental health of 20 12- to 16-year-old adolescents with severe, long-term (at least four years) asthma and of 20 otherwise similar peers without asthma. The teens with asthma were three times more likely to develop tooth decay (caries).

The question is: Why?

The researchers offered possible answers in 2010 in the journal Caries Research. Previous studies demonstrated a correlation between asthma, on one hand, and, on the other, caries and gingivitis (inflammation and irritation of the gums). So it would seem possible, they reasoned, that the longer asthma lasts or the greater its degree of severity, the higher the risk for caries.

But they delved deeper. Perhaps lower rates of salivary secretion (a.k.a. a tendency toward “dry mouth”) in people with asthma could be to blame. Most of the 20 teens with asthma had allergic asthma, with associated rhinitis (chronic inflammation of nasal mucous membranes). Stuffy noses lead to “mouth breathing,” which leads to a greater chance of dry mouth. And lower-than-average quantities of saliva are detrimental to tooth health.

So could the culprit be bacteria that develop more easily in asthmatics (and others with dry mouth), rather than asthma itself? It could: The teens with asthma also had more gingivitis than the controls; bacteria is a factor in the development of gingivitis.

But another possibility is that the asthma itself IS causing the dental problems—in the form of an unspecified related inflammatory process or altered immune response. The researchers raised those issues for possible further study, too.

Or perhaps the culprit is the most common treatment for asthma: inhaled steroids. While they undeniably reduce airway inflammation, earlier studies have shown that inhaled steroids detrimentally decrease the pH level of saliva and dental plaque; a pH level in plaque lower than the 5.5-to-6.0 range is more conducive to demineralization (loss of tooth matter).

While only further research will answer these questions definitively, kids with asthma (and their parents) should be particularly vigilant about dental care to counter whatever factors are at work that predispose their teeth to cavity formation.

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Snacking on Chips May Cause Cavities in Young Children

While it’s well understood that sugary foods like candy and cookies can increase the number of cavities a child may develop, a new study says those sweet treats are not the only snacks that can cause cavities. Results of a study by researchers in the United States and Europe have identified chips as another contributor to the development of cavities in young children at highest risk for cavity development. The study is the first to link consumption of chips with the formation of cavities in children.

The researchers evaluated the snacking habits of 1,206 preschool-aged children who had been seen for well-patient checkups at two pediatric clinics in Boston and compared those habits with the number of cavities found in the children. Parents were asked to complete questionnaires regarding snacking habits for the children, who were between six months and four years of age. The study population was 61% black, 10% Asian, 27% white and 15% Hispanic. In addition to chips, the researchers also looked at the effects of other sugary and non-sugary snacks, including popcorn, cereal, cookies, yogurt, crackers, ice cream, candy, and fresh and dried fruit on the development of cavities.

According to the results of the study, 97% of children ate snacks on most days, and 60% ate one or two sweet snack items on most days. Cavities were more prevalent among children who ate chips on most days, and the number of cavities was higher compared with children who did not eat chips on most days. Snacking on candies, cookies, ice cream, dry cereal and dried fruit also was associated with a higher number of cavities. Fresh fruit, crackers and yogurt were not associated with the development of cavities.

Although the nature of the association between chips and cavities was unclear, the researchers noted that previous studies have shown that the starch in chips acts like sugar to create an environment conducive to the development of cavity-causing bacteria and also enhances the potential of sugar to cause cavities. They also noted that in this study, children who ate chips were also more likely to eat sugary snacks, which could also explain the association.

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Tongue Piercings and Dental Health

Since the 1980s, tongue piercings have become a popular form of self-expression, especially among teens and young adults. While that glint of metal may seem appealing to young people looking for ways to proclaim their individuality, tongue piercings can cause an array of long-term dental health problems. One recent study has linked the piercings to the development of receding gums—also called gingival recession.

In addition to looking unattractive, receding gums have long been associated with tooth hypersensitivity, tooth decay and tooth loss. As gums recede, the roots of teeth can become exposed to bacteria, and tiny pockets can form that allow bacteria to lodge and grow. In time, that bacteria can cause tooth decay and rot which may, in turn, result in tooth loss.

The study looked at 180 dental patients between 13 and 28 years of age, including 60 with tongue piercings and 120 “control” patients who had no tongue piercings. Researchers performed dental examinations on each patient, and all patients were asked to complete questionnaires about their lifestyle and the piercings, including when the piercings were made, if there had been any complications with the piercing and if they had any habits of moving the piercing—for instance, rattling the stud against the teeth.

When they looked at data from the two groups, the researchers found that gingival recession occurred more often and at more severe levels in patients with tongue piercings compared to patients who did not have the piercings. In fact, patients with tongue piercings had an 11 times greater chance for the occurrence of gingival recession along the lower front jaw compared to patients without piercings. Gingival recession was also more commonly associated with older patients and with male patients.

Many young adults and teens considering tongue piercings may not be aware of the potential pitfalls they can face or may not heed parents’ warnings. To help ensure that young patients understand the risks of tongue piercings, the study authors recommend that, to help these patients reduce their risk of tooth sensitivity, decay and eventual loss, dentists and other oral health professionals warn their young patients about the oral risks associated with piercings.

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Reflux: Many Unhappy Returns

If your child suffers frequently from heartburn, it can wear on his or her patience, making your child reluctant to eat for fear of the subsequent discomfort that might follow. It can, unfortunately, wear on his or her teeth as well, resulting in a condition called tooth erosion.

In tooth erosion, a tooth’s hard enamel gradually wears away, potentially exposing the sensitive dentin. Exposed dentin means heightened, likely painful, tooth sensitivity.

Tooth erosion is caused by acid. It can be acid that is ingested; people who drink considerable quantities of acidic beverages, for instance, such as more than a half-liter total of soda and fruit juice per day, are at greater risk.

Or, the culprit can be acid that one’s own body produces—stomach acid. Heartburn is a primary symptom of the condition called gastric reflux, which occurs when some of the acidic contents of the stomach flow the wrong way—backwards—into the esophagus, and sometimes the mouth. (When gastric reflux occurs very often, it’s labeled gastroesophageal reflux disease, or GERD.) Reflux happens because the esophageal sphincter, the muscle connecting the stomach to the esophagus, either doesn’t close properly or has faulty timing. The acid coming back up through the esophagus causes the “burning” in heartburn.

Reflux-afflicted children are more likely than others to have, or be at risk for, tooth erosion, a conclusion drawn by Icelandic scientists who recently evaluated a study group of 249 people, more than a third of whom reported reflux symptoms. They reported their findings in 2009 in the Journal of Dental Research.

Tooth erosion is defined as the loss of tooth enamel by a chemical process that does not involve bacteria. Excess acid triggers this process, and it can be worsened by a lower-than-average saliva flow. It is different from tooth decay (also called caries, or, commonly, cavities) which does involve bacteria, and from attrition, which results in the loss of tooth substance due to tooth-to-tooth contact (such as grinding).

Treating reflux is important for numerous medical reasons, and successful treatment will also lower mouth acid levels and reduce the chance of dental erosion.

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You Are What You Eat

The increasing rate of overweight and obesity among American children has raised alarms throughout the nation. Eating patterns are established very early in a child’s life; what a child eats as an infant and toddler influences his or her eating patterns for many years to come. Meal and snack patterns establish themselves as early as age 7 to 8 months and are well established by age 11 months. And these patterns deteriorate during adolescence.

Many factors contribute to poor eating habits. Studies have associated a relationship between a child’s nutrient intake and

  • declining frequency of family meals
  • increasing number of skipped meals
  • snacks eaten instead of meals
  • meals eaten at fast-food restaurants

According to a recent study, children aged 6 to 24 months typically eat 7 times a day: breakfast, morning snack, lunch, afternoon snack, dinner, evening snack and one other snack at some time during the day. Breakfast provides less than 20% of all energy intake, while snacks provide more than 25% of all energy intake.

Pediatric guidelines suggest toddlers should consume 17 to 19 grams of fiber daily; however, this study showed that toddlers typically consumed only 7 grams of fiber. This age group also shows an increase in the consumption of sweetened fruit drinks and carbonated beverages, an area of concern because these contributed approximately one-third of all sugar consumed by children aged 2 years and older.

Encouraging toddlers to try new foods is an important step in creating a more varied and healthful diet. Often, children do not take to a food immediately. Studies show that a particular food may need to be served 10 to 15 times before a child accepts it. Complicating this situation is the fact that mothers frequently do not offer their children food that they themselves do not like.

Because they are such an important part of a toddler’s diet, snacks need to be planned to complement meals. Replacing fruit drinks, cookies and crackers with fruits, vegetables and whole grains will increase fiber intake while limiting fat and sugar. If the toddler is resistant at first to these new foods, be persistent. These steps can help establish healthy eating patterns for life.

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How Sucking Affects Your Child’s Teeth

An English study about sucking habits looked at how the alignment of children’s teeth related to their sucking habits. The study tracked the presence of

  • posterior crossbite (rear teeth out of alignment with their matching teeth in the other jaw)
  • overjet (the projection of upper teeth, either front or back, beyond the bottom teeth)
  • anterior open bite or overbite (front upper teeth overlapping the front bottom teeth)

The study also classified the relationship of the canine teeth.

Children who sucked pacifiers or their fingers for less than a year had the same dental characteristics at 5 years old as did children who were breast-fed for six to 12 months; both groups showed a low percentage of crossbite, overjet and overbite. Children who sucked their fingers for more than 36 months had higher rates of overjet and overbite, while children who sucked a pacifier showed higher rates of posterior crossbite and overbite. Interestingly, finger suckers had a higher rate of overjet than did pacifier suckers, but pacifier suckers had a higher rate of posterior crossbite than did finger suckers.

This and several other studies have shown that finger and pacifier sucking after 12 months of age has a negative effect on tooth alignment, although finger and pacifier sucking create different problems. The longer the habit endures, the greater the injury done to the alignment of the teeth. Parents should attempt to help their children break their sucking habits as early as possible after their first birthdays. If your child has a sucking habit, inform your child’s dentist so he or she can evaluate your child for any developing alignment abnormalities.

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