- Email: [email protected]
Fruit juice consumption
when more information is available and appears to have no adverse effect on the tooth’s status during the observation period or after. Makhija S, Gilbert GH, Funkhouser E, et al: Twenty-month follow-up of occlusal caries lesions deemed questionable at baseline:
Findings from The National Dental Practice-Based Research Network. J Am Dent Assoc 145:1112-1118, 2014 Reprints available from S Makhija, Dept of Clinical and Community Sciences, School of Dentistry, Univ of Alabama at Birmingham, Diagnostic Sciences, 1919 7th Ave South, SDB 115, Birmingham, AL 35294-0007; e-mail: [email protected]
Fruit juice consumption Background.—Early childhood caries (ECC) is defined as having one or more decayed, missing, or filled tooth surfaces in a primary tooth before age 6 years. It is more common among children living in poverty and in minority ethnic groups, but traditionally low-risk children are now being affected in larger numbers. The beverage consumption patterns of preschool-aged children have also changed, with higher consumption of sugared beverages, juices, and other sweet drinks rather than milk. Some factors linked to the increase in drinking 100% fruit juice are convenience, perception that it is a healthy choice, lower cost than milk, and marketing that challenges consumers to include more fruit and vegetables in their daily diets. The American Academy of Pediatrics (AAP) recommends that young children limit their intake of 100% fruit juice to 4 to 6 ounces a day, but the average preschooler consumes about twice that amount. Data linking 100% fruit juice consumption to dental caries in young children is insufficient. The relationship between drinking 100% fruit juice and ECC was investigated with respect to poverty and race/ethnic factors in US preschoolers. Methods.—The data were taken from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) and included 2290 children age 2 through 5 years. Associations between caries and intake of 100% fruit juice were analyzed statistically, noting whether 100% fruit juices were consumed, how much was consumed in the previous 24 hours, and the usual intake levels. Results.—About two thirds of the children in the population studied were non-Hispanic white, 14% were nonHispanic black, 14% were Mexican-American, and less than 11% represented other racial/ethnic groups. About a quarter lived in poverty (defined as less than 100% of the federal poverty guideline [FPG]) and a third lived at or above 300% of the FPG. About 46% reported having visited the dentist over the past year. About 54% of the children consumed 100% fruit juice over the previous 24 hours, with lower levels of
consumption with increasing age. No differences were found between the children living in poverty and those from affluent families. Fruit juice consumption was significantly less among children living at the 100% to 299% FPG level than among those in families at the higher FPG level. About 39% of the children consumed more than 6 ounces of 100% fruit juice in the preceding 24 hours. Poverty level did not correlate with 100% fruit juice consumption. No significant differences in the consumption of 100% fruit juice were related to gender or race/ethnicity. The presence or absence of dental caries and consumption of 100% fruit juice also showed no statistically significant relationship. The prevalence of ECC among 2- to 5-year-olds was 28.5%, with an increase in dental caries prevalence with increasing age. At age 2 years the prevalence was 12%; by age 5 years it was nearly 40%. Gender had no effect on ECC prevalence. Mexican-American children had the highest rate of dental caries at 42.6% compared to all other ethnic/racial groups. All of the others had prevalences less than 30%. As poverty increased, dental caries prevalence increased from about 13% among those in the R 300% FPG category to about 43% among those in the < 100% FPG category. Standard regression modeling showed no significant relationship between dental caries and the consumption of 100% fruit juice. Controlling for age, sex, race/ethnicity, poverty, and dental visits, no correlation was noted between the consumption of 100% fruit juice and ECC. Discussion.—No relationship was found between the consumption of 100% fruit juice in the previous 24 hours and the occurrence of ECC in young children. It is possible that biological, behavioral, and social factors can explain this finding. Fluoride exposure through toothpaste and water consumption, among other sources, may provide biologic protection against caries even with the consumption of sugary drinks. The frequency and timing of the sugar consumption can also explain the lack of connection
Volume 60
Issue 3
2015
157
between drinking fruit juice and ECC. Behaviorally, parents who give their children 100% fruit juice in the belief that this is a healthier choice are more likely to ensure that their children also consume other healthy foods and engage in healthy behaviors. Considering the multifactorial etiology of caries, these behaviors may be protective against caries.
intake to 4 to 6 ounces per day, do so in light of the overall nutritional value of the drink rather than as a way to prevent caries.
Vargas CM, Dye BA, Kolasny CR, et al: Early childhood caries and intake of 100 percent fruit juice: Data from NHANES, 1999-2004. J Am Dent Assoc 145:1254-1261, 2014
Clinical Significance.—ECC is not related to the consumption of 100% fruit juice. If you want to caution parents to limit their children’s
Reprints available from CM Vargas, School of Dentistry, Univ of Maryland, 650 W Baltimore St, Rm 2217, Baltimore, MD 21201; email: [email protected]
Dental Imaging Cone-beam computed tomography in endodontics Background.—Cone-beam computed tomography (CBCT) imaging produces three-dimensional (3D) images of the teeth and surrounding tissues. This may be especially helpful in identifying and managing endodontic problems. Other forms of imaging can produce distortions and anatomic ‘‘noise’’ because the 3D anatomy is compressed in a two-dimensional (2D) image. The usefulness of CBCT imaging in diagnosing, treatment planning, and assessing the outcome of endodontic complications was evaluated. Methods.—The information on CBCT in endodontic treatment was collected from a search of PubMed electronic databases. A total of 112 articles were selected. Basic Information.—In CBCT the 3D data are captured in a single scan, then the raw data from each rotation is reconstructed into an image. Field of view (FOV) size can vary. The four categories of CBCT devices are dentoalveolar (FOV < 8 cm), maxillomandibular (FOV 8 to 15 cm), skeletal (FOV 15 to 21 cm), and head and neck (FOV > 21 cm). Radiation dose varies but can be comparable to that of a panoramic dental x-ray and much less than that of a medical CT scan. Smaller FOV, fewer projections, and a bigger voxel size can limit the dose. Number of projections may not affect image quality, but FOV and number of projections may significantly affect root canal visibility. In addition, using a big voxel size to acquire an image, then reconstructing it at smaller voxel sizes can reduce radiation dose but obtain an image of similar quality. If diagnostic accuracy is not compromised, the clinician should choose resolution settings that limit radiation
158
Dental Abstracts
exposure. This may include the use of smaller scanners for a single or a few teeth. Radiation dose is machine specific. The risk for patients varies with patient age, with older adults (over age 80 years) at negligible risk because the latent period between exposure and clinical tumor development is probably longer than the patient’s life span. Young people have more radiosensitive tissues and longer life spans, so limits on exposure are advisable. At all ages, female patients run a higher risk for adverse events associated with radiation exposure than do male patients. Imaging quality and diagnostic accuracy can be adversely affected by scatter and beam hardening caused by high-density adjacent structures and materials. Existing complications can be hidden by crowns, bridges, implants, fillings, and intracanal posts; these structures can also mimic problem areas. Technical factors that can compromise image quality include device, FOV, voxel size, number of projections, tube voltage, and current. Artifacts may develop because of fractured files and root canal filling material. Image quality also varies with patient age, which is positively correlated with the amount of artifacts present. Age also adversely affects the ability to identify anatomic structures, which may be related to the increasing number of dental restorations with age. Applications.—CBCT imaging is better than periapical radiographs in depicting the number of roots present (Fig 1). In addition, CBCT reconstructions can assess teeth with unusual numbers of roots, dilacerated teeth, and dens in dente more effectively than conventional imaging. Root morphology evaluation is improved when viewed in 3D. However, CBCT scans are not indicated as a standard
Findings from The National Dental Practice-Based Research Network. J Am Dent Assoc 145:1112-1118, 2014 Reprints available from S Makhija, Dept of Clinical and Community Sciences, School of Dentistry, Univ of Alabama at Birmingham, Diagnostic Sciences, 1919 7th Ave South, SDB 115, Birmingham, AL 35294-0007; e-mail: [email protected]
Fruit juice consumption Background.—Early childhood caries (ECC) is defined as having one or more decayed, missing, or filled tooth surfaces in a primary tooth before age 6 years. It is more common among children living in poverty and in minority ethnic groups, but traditionally low-risk children are now being affected in larger numbers. The beverage consumption patterns of preschool-aged children have also changed, with higher consumption of sugared beverages, juices, and other sweet drinks rather than milk. Some factors linked to the increase in drinking 100% fruit juice are convenience, perception that it is a healthy choice, lower cost than milk, and marketing that challenges consumers to include more fruit and vegetables in their daily diets. The American Academy of Pediatrics (AAP) recommends that young children limit their intake of 100% fruit juice to 4 to 6 ounces a day, but the average preschooler consumes about twice that amount. Data linking 100% fruit juice consumption to dental caries in young children is insufficient. The relationship between drinking 100% fruit juice and ECC was investigated with respect to poverty and race/ethnic factors in US preschoolers. Methods.—The data were taken from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) and included 2290 children age 2 through 5 years. Associations between caries and intake of 100% fruit juice were analyzed statistically, noting whether 100% fruit juices were consumed, how much was consumed in the previous 24 hours, and the usual intake levels. Results.—About two thirds of the children in the population studied were non-Hispanic white, 14% were nonHispanic black, 14% were Mexican-American, and less than 11% represented other racial/ethnic groups. About a quarter lived in poverty (defined as less than 100% of the federal poverty guideline [FPG]) and a third lived at or above 300% of the FPG. About 46% reported having visited the dentist over the past year. About 54% of the children consumed 100% fruit juice over the previous 24 hours, with lower levels of
consumption with increasing age. No differences were found between the children living in poverty and those from affluent families. Fruit juice consumption was significantly less among children living at the 100% to 299% FPG level than among those in families at the higher FPG level. About 39% of the children consumed more than 6 ounces of 100% fruit juice in the preceding 24 hours. Poverty level did not correlate with 100% fruit juice consumption. No significant differences in the consumption of 100% fruit juice were related to gender or race/ethnicity. The presence or absence of dental caries and consumption of 100% fruit juice also showed no statistically significant relationship. The prevalence of ECC among 2- to 5-year-olds was 28.5%, with an increase in dental caries prevalence with increasing age. At age 2 years the prevalence was 12%; by age 5 years it was nearly 40%. Gender had no effect on ECC prevalence. Mexican-American children had the highest rate of dental caries at 42.6% compared to all other ethnic/racial groups. All of the others had prevalences less than 30%. As poverty increased, dental caries prevalence increased from about 13% among those in the R 300% FPG category to about 43% among those in the < 100% FPG category. Standard regression modeling showed no significant relationship between dental caries and the consumption of 100% fruit juice. Controlling for age, sex, race/ethnicity, poverty, and dental visits, no correlation was noted between the consumption of 100% fruit juice and ECC. Discussion.—No relationship was found between the consumption of 100% fruit juice in the previous 24 hours and the occurrence of ECC in young children. It is possible that biological, behavioral, and social factors can explain this finding. Fluoride exposure through toothpaste and water consumption, among other sources, may provide biologic protection against caries even with the consumption of sugary drinks. The frequency and timing of the sugar consumption can also explain the lack of connection
Volume 60
Issue 3
2015
157
between drinking fruit juice and ECC. Behaviorally, parents who give their children 100% fruit juice in the belief that this is a healthier choice are more likely to ensure that their children also consume other healthy foods and engage in healthy behaviors. Considering the multifactorial etiology of caries, these behaviors may be protective against caries.
intake to 4 to 6 ounces per day, do so in light of the overall nutritional value of the drink rather than as a way to prevent caries.
Vargas CM, Dye BA, Kolasny CR, et al: Early childhood caries and intake of 100 percent fruit juice: Data from NHANES, 1999-2004. J Am Dent Assoc 145:1254-1261, 2014
Clinical Significance.—ECC is not related to the consumption of 100% fruit juice. If you want to caution parents to limit their children’s
Reprints available from CM Vargas, School of Dentistry, Univ of Maryland, 650 W Baltimore St, Rm 2217, Baltimore, MD 21201; email: [email protected]
Dental Imaging Cone-beam computed tomography in endodontics Background.—Cone-beam computed tomography (CBCT) imaging produces three-dimensional (3D) images of the teeth and surrounding tissues. This may be especially helpful in identifying and managing endodontic problems. Other forms of imaging can produce distortions and anatomic ‘‘noise’’ because the 3D anatomy is compressed in a two-dimensional (2D) image. The usefulness of CBCT imaging in diagnosing, treatment planning, and assessing the outcome of endodontic complications was evaluated. Methods.—The information on CBCT in endodontic treatment was collected from a search of PubMed electronic databases. A total of 112 articles were selected. Basic Information.—In CBCT the 3D data are captured in a single scan, then the raw data from each rotation is reconstructed into an image. Field of view (FOV) size can vary. The four categories of CBCT devices are dentoalveolar (FOV < 8 cm), maxillomandibular (FOV 8 to 15 cm), skeletal (FOV 15 to 21 cm), and head and neck (FOV > 21 cm). Radiation dose varies but can be comparable to that of a panoramic dental x-ray and much less than that of a medical CT scan. Smaller FOV, fewer projections, and a bigger voxel size can limit the dose. Number of projections may not affect image quality, but FOV and number of projections may significantly affect root canal visibility. In addition, using a big voxel size to acquire an image, then reconstructing it at smaller voxel sizes can reduce radiation dose but obtain an image of similar quality. If diagnostic accuracy is not compromised, the clinician should choose resolution settings that limit radiation
158
Dental Abstracts
exposure. This may include the use of smaller scanners for a single or a few teeth. Radiation dose is machine specific. The risk for patients varies with patient age, with older adults (over age 80 years) at negligible risk because the latent period between exposure and clinical tumor development is probably longer than the patient’s life span. Young people have more radiosensitive tissues and longer life spans, so limits on exposure are advisable. At all ages, female patients run a higher risk for adverse events associated with radiation exposure than do male patients. Imaging quality and diagnostic accuracy can be adversely affected by scatter and beam hardening caused by high-density adjacent structures and materials. Existing complications can be hidden by crowns, bridges, implants, fillings, and intracanal posts; these structures can also mimic problem areas. Technical factors that can compromise image quality include device, FOV, voxel size, number of projections, tube voltage, and current. Artifacts may develop because of fractured files and root canal filling material. Image quality also varies with patient age, which is positively correlated with the amount of artifacts present. Age also adversely affects the ability to identify anatomic structures, which may be related to the increasing number of dental restorations with age. Applications.—CBCT imaging is better than periapical radiographs in depicting the number of roots present (Fig 1). In addition, CBCT reconstructions can assess teeth with unusual numbers of roots, dilacerated teeth, and dens in dente more effectively than conventional imaging. Root morphology evaluation is improved when viewed in 3D. However, CBCT scans are not indicated as a standard