Mother's Perception of General Family Functioning and Sugar Consumption of 3- and 4-Year-Old Children: The East London Family Study.

Frequent consumption of sugary foods is a common risk factor for chronic diseases such as dental caries and obesity. Dietary patterns are acquired at home during early life and form a blueprint for dietary behaviours in later life. A favourable family environment can provide a supportive context that enhances the adoption of healthy dietary habits. The aim of this study was to identify the contribution of general family functioning towards the frequent consumption of sugary foods by 3- and 4-year-old children in Outer North East London. The research question was explored with data from the East London Family study, which collected data through home visits from a representative sample of adults and children living in Outer North East London in 2008-2010. This study analysed data from 3- and 4-year-old children (n = 698) and their mothers and included logistic regression, conceptual hierarchical modelling and mediation analysis. The results showed that 17% of the sample consumed sugary foods more than 4 times per day, and that effective general family functioning may help reducing frequent consumption of sugary foods. There was a 67% reduction in children's frequent consumption of sugary foods with every unit increase in the general family functioning score. Mother's higher education may also help reduce the frequent consumption of sugary foods by children. The negative impact of mother's lower education was buffered by the effect of effective general family functioning. The study findings underscore the prospect of identifying factors that contribute to the acquisition of good dietary behaviours.

[Fiber, food intolerances, FODMAPs, gluten and functional gastrointestinal disorders--update 2014]. / Fiber, food intolerances, FODMAPs, gluten und funktionelle darmerkrankungen--update 2014.

The controversial effects of dietary fiber on symptoms in functional gastrointestinal disorders are summarized. Studies concerning adverse reaction to foods are mentioned and the possible role of food allergy and food intolerances, especially pseudoallergic reactions to biogenes amines, in symptom provocation is discussed. The known effects of lactose deficiency and fructose malabsorption are reviewed. The FODMAP concept (fermentable oligo-, di-, monosaccharides and polyols) is presented in more detail and recent studies on pathophysiological effects of FODMAP constituents and of therapeutic effects of a low FODMAP diet on symptoms in patients with irritable bowel syndrome are discussed. Finally, studies on the new disorder non-celiac gluten sensitivity (NCGS) are summarized and the state of the discussion whether wheat intolerance is due to gluten or the grains is given.

Microbial colonization and their relation with potential cofactors in patients with denture stomatitis.

AIM: To determine microbial prevalence in the mucous membrane and prosthesis of denture wearers with and without denture stomatitis and to study its relationship with potential clinical cofactors. MATERIALS AND METHODS: Saliva was collected from 200 patients (100 female and 100 male) wearing dental prosthesis for measurement of pH. Oral samples of the mucous membrane and of dentures were taken with sterile swab for microbiological analysis. Medical and dietary history of the subjects was recorded. Chi-square test and analysis of varience were used for statistical analysis. RESULTS: Diabetes, hypertension and high carbohydrate ingestion was observed in majority of patients. The pH average in saliva was of 5.1. The presence of C. albicans, S. aureus and S. mutans in the mucous membrane was of 55.4, 56.4 and 63.6% respectively. C. albicans was isolated in 69.7% from the prosthesis, whereas S. aureus and S. mutans were isolated in 45.3%. The isolation of C.albicans was more frequent in patients with denture stomatitis. CONCLUSION: C. albicans, S. aureus and S. mutans frequently colonize the oral mucous of denture wearers. This is more frequently observed in patients with denture stomatitis. CLINICAL SIGNIFICANCE: Denture stomatitis is associated to Candida albicans, different bacteria and other cofactors, such as salivary pH, carbohydrate ingestion, systemic illnesses and medication.

[Sugar substitute products impact on oral fluid biochemical properties].

Sugar substitute products impact on oral fluid protein and carbohydrate content, as well as oxidative balance were studied in 60 medical school students in compare with conventional sugar. Sugar intake proved to cause cariesogenic carbohydrate metabolism disorders in oral fluid, intensification of lipoperoxidation and decrease in antioxidation activity. Sugar substitute products help to prevent dental decay.

Carbohydrate fatty acid monosulphate esters are safe and effective adjuvants for humoral responses.

Carbohydrate fatty acid sulphate esters (CFASEs) formulated in a squalane-in-water emulsion are effective adjuvants for humoral responses to a wide range of antigens in various animal species but rise in body temperature and local reactions albeit mild or minimal hampers application in humans. In rabbits, body temperature increased 1°C one day after intramuscular (IM) injection, which returned to normal during the next day. The effect increased with increasing dose of CFASE but not with the number of injections (up to 5). Antigen enhanced the rise in body temperature after booster immunization (P<0.01) but not after priming. Synthetic CFASEs are mixtures of derivatives containing no sulphate, one or multiple sulphate groups and the monosulphate derivatives (CMS) were isolated, incorporated in a squalane in-water emulsion and investigated. In contrast to CFASE, CMS adjuvant did not generate rise in body temperature or local reactions in rabbits immunized with a purified, recombinant malaria chimeric antigen R0.10C. In comparison to alum, CMS adjuvant revealed approximately 30-fold higher antibody titres after the first and >100-fold after the second immunization. In ferrets immunized with 7.5µg of inactivated influenza virus A/H7N9, CMS adjuvant gave 100-fold increase in HAI antibody titres after the first and 25-fold after the second immunisation, which were 10-20-fold higher than with the MF59-like AddaVax adjuvant. In both models, a single immunisation with CMS adjuvant revealed similar or higher titres than two immunisations with either benchmark, without detectable systemic and local adverse effects. Despite striking chemical similarities with monophospholipid A (MPL), CMS adjuvant did not activate human TLR4 expressed on HEK cells. We concluded that the synthetic CMS adjuvant is a promising candidate for poor immunogens and single-shot vaccines and that rise in body temperature, local reactions or activation of TLR4 is not a pre-requisite for high adjuvanticity.

Drug-induced disorders of teeth.

It is essential that every health care professional who is involved with the prescription or recommendation of drugs be fully aware of any resultant disorders that may arise as a side-effect. A range of drugs can affect the teeth. In this review article, drugs that have the potential to induce changes in teeth have been classified as those leading to tooth discoloration (intrinsic and extrinsic), physical damage to tooth structure (enamel, dentin, and cementum), and alteration in tooth sensitivity.

Sugar content, cariogenicity, and dental concerns with commonly used medications.

BACKGROUND AND OVERVIEW: Oral adverse events such as cariogenicity are often overlooked as drug-associated effects because the sugar content of many medications may be negligible compared with the patients' overall dietary intake of sugar. There are, however, several liquid formulations of medications with significantly high sugar content that are commonly used in patients with swallowing difficulties. These medications may be associated with negative oral health sequelae and should be considered part of the oral health care providers' differential diagnosis of oral pathologies. METHODS: We reviewed the literature regarding the sugar content of oral liquid medications commonly prescribed by oral health care providers, with consideration to their caries potential. Where not available via public sources, pharmaceutical companies were contacted directly for additional information on the sugar (carbohydrate) content of these oral liquid medication formulations. RESULTS: Over 50 commonly used oral liquid medications prescribed for patients with swallowing difficulties were reviewed and found to contain sugar in varying amounts up to 4 grams per dose (usually 1 teaspoon or 5 milliliters). Patients who are required to take multiple doses per day of these sugar-containing oral liquid medications may be at increased risk for caries and associated oral health consequences. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Recognition and avoidance of sugar-containing oral liquid medications can help clinicians optimize patient treatment, decreasing the risk for potential drug-induced caries while emphasizing patient safety and improved oral health.

Changing trends in dental caries.

In underdeveloped countries the number of dental caries is increasing at a frightening rate whereas in industrialized countries the caries rate has declined by about 40% in the past 10 years. In 1982, for the first time ever, the average 12-year-old in underdeveloped countries, where 80% of the world's children live, had a higher dental caries score (decayed, missing, filled-DMF) than those in industrialized countries. The increase in caries is associated with increases in sugar consumption. By 1984, sugar consumption in underdeveloped countries is predicted to exceed that of industrialized countries. The decline in caries is associated with the widespread availability of fluoride toothpaste, changes in the pattern and quantity of sugar consumption and possibly with the frequent use of antibiotics. The declines have been greater in areas with fluoridated water supplies. The trends in rates of dental caries have important public health implications. They include the urgent need for a food policy to limit the consumption of refined sugars, policies to ensure the availability of fluoride, a reduction in the number of dentists in industrialized countries, the greater use of dental therapists and increasing the interval between dental check-ups to two years or more.

Promoting sugar-free medicines: parents' views.

BACKGROUND: A long-standing concern among dental health professionals has been about the harmful effects of sugered medicines on teeth, especially in children who regularly take such medications. AIM: To investigate parental attitudes, perceptions, and motivations to sugar-free medicines so that an effective promotional campaign could be mounted. METHOD: A qualitative, focus group approach was used to gather data. RESULTS: These show the dominant influence of the doctor over the patient/parent, and the bearing this has on the prescribing of sugar-free medicines. CONCLUSION: This study highlights the scope for sugar-free medicine promotion for prescribed and over-the-counter products, and the polarizing of attitudes to the use of sugar-free medicines based on social class.

Dental caries and fluorosis in Arussi province, Ethiopia.

A dental health survey was carried out in the Arussi province in Ethiopia. The survey comprised 1,700 persons between 6 and 54 years of age in five age groups from four areas of the province. The present paper deals with findings on dental fluorosis and dental caries. Dental fluorosis was found in 18% of the subjects, mainly in a very mild form. The fluoride content of the water (0.2-0.3 part/10(6) F-) in combination with a high tea consumption was assumed to give a fluoride intake optimal for caries prevention. The prevalence of dental caries was low. Thirty-eight percent of the 6-7-year-old group had decayed primary teeth and 51% of the total sample had decayed permanent teeth. Comparisons with a study from 1958 revealed that the prevalence of dental caries had increased in the last few decades, probably due to the recently adopted habit of using sugar in the diet.

Update on the nomenclature of carbohydrates and their dental effects.

OBJECTIVES: This review aims to clarify the nomenclature of carbohydrates, including novel manufactured carbohydrates which are becoming increasingly popular within the food industry, and to summarise what is known about the effects of different carbohydrates on dental health. DATA SOURCES: This review compiles information from articles published in mainstream microbiological, nutritional and dental journals that are of relevance to carbohydrates and dental health. STUDY SELECTION: The review considers literature on classification of carbohydrates by chain length, for example mono-di-oligo- and poly-saccharides and classification for dental health purposes, namely intrinsic, non-milk extrinsic sugars. This paper includes a comprehensive review of information on novel carbohydrates including isomaltosaccharides, fructo-oligosaccharides and gluco-oligosaccharides, maltodextrins and glucose syrups. Information on polyols and non-starch polysaccharides is also presented and current knowledge on the dental effects of all carbohydrates are discussed. CONCLUSION: There is a wealth of information on dietary sugars and the effects of sugars on dental health is established knowledge. However, the range of 'novel' manufactured carbohydrates which are becoming available for food use is increasing and information regarding the cariogenicity of these substances is sparse. Research indicates that maltodextrins and glucose syrups are cariogenic, however, initial studies on some synthetic oligosaccharides have suggested reduced cariogenicity compared to sucrose. Further human plaque pH and in vitro and in vivo tests of cariogenicity are required to clarify these initial observations.

Evaluation of a sugar-free medicines campaign in north east England: quantitative analysis of medicines use.

OBJECTIVE: The aim of the study was to evaluate the effectiveness of a sugar-free medicines campaign using suitable prescribing and purchasing indicators. BASIC RESEARCH DESIGN: Quantitative analysis of sugar-free medicine use, before (1995) and after (1996) the campaign. CLINICAL SETTING: Two test and two control districts in north east England. PARTICIPANTS: General medical practitioners (GPs) and community pharmacists. INTERVENTION: A 12-month campaign involving development and distribution of information packs designed to increase the proportion of prescriptions dispensed sugar-free for paediatric use. MAIN OUTCOME MEASURES: Changes in the proportion of the following which were sugar-free: (a) for target prescribed medicines (i) number of prescriptions dispensed. (ii) number of prescribed daily amounts (PDA); (b) for target over the counter (OTC) medicines, (i) number of bottles sold, (ii) number of standard daily amounts (SDA) sold. RESULTS: Quantitative analysis of prescriptions and OTC sales showed statistically highly significant changes towards sugar-free prescribing and dispensing of prescribed medicines but only small increases in the proportion of some sugar-free OTC sales. CONCLUSIONS: The impact of the campaign was shown to be greatest in changing prescribing habits of GPs with less effect on OTC medicine use. The outcome measures used were suitable for quantitative evaluation of the campaign. POST-CAMPAIGN DEVELOPMENT: Sustainable changes in GPs' prescribing behaviour can be facilitated by software suppliers' modifications to computing software used for prescription writing.

Sugar, drinks, deprivation and dental caries in 14-year-old children in the north west of England in 1995.

OBJECTIVES: To examine associations between dental caries and reported drink consumption. DESIGN: A cross-sectional caries prevalence study including reported drink consumption. SETTING: Secondary schools across the former North Western Region of England. SUBJECTS: A random sample of 6,014, 14-year-old children. RESULTS: The mean DMFT of the sample was 2.74. The reported mean weekly consumption of cans of carbonated drinks was 5.66, with a range of zero to 42. There was a significant gender difference in drink consumption and a significant correlation between the reported weekly consumption of cans of carbonated drinks and DMFT. Logistic regression analysis showed tea drinkers had a significantly lower DMFT than coffee drinkers and that this effect was independent of the addition of sugar and the number of cans of drink consumed. Reported use of sugar-free carbonated drinks was not associated with better dental health. CONCLUSIONS: Reported consumption of sugared drinks and carbonated drinks was associated with significantly higher levels of dental caries. Drinking tea was associated with lower levels of caries. Sugar-free drinks were not associated with better dental health.

Development and evaluation of a sugar-free medicines campaign in north east England: analysis of findings from questionnaires.

OBJECTIVE: To develop a strategy for a campaign aimed at general medical practitioners (GPs) and pharmacists and to evaluate the effectiveness of the campaign on (a) awareness of the role of liquid oral medicines containing sugar in dental disease and (b) changing prescribing and dispensing of sugar-containing medicines. DESIGN: Pre- and post-campaign questionnaires were sent to community pharmacists and GPs and following a series of qualitative interviews with them, a campaign was developed. Following post campaign questionnaires, changes due to the effects of the campaign were evaluated. SETTING: The test area was Newcastle and North Tyneside Health Authority area with Sunderland and South Tyneside Health Authority areas as control. INTERVENTIONS: An information pack followed up by a personal contact was the main form of intervention. The pack comprised a Smile for Sugar-Free Medicines leaflet used in the north west campaign, abstracts from professional journals illustrating the benefits of sugar-free medicines, local dental health information and computing information which could be used to adapt computer terminals in surgeries to display sugar-free options more prominently. MAIN OUTCOME MEASURES: Changes in the knowledge and awareness of both pharmacists and GPs to liquid oral medicines containing sugar as assessed by questionnaires. RESULTS: Increased knowledge and awareness of both pharmacists and GPs to the role of liquid oral medicines containing sugar and the use of sugar-free medicines had taken place but these were not statistically significant. CONCLUSION: The campaign created awareness amongst GPs and pharmacists about dental issues and it is hoped that this awareness can be built upon in future oral health promotion campaigns. However, it is likely that facilitation of sugar-free medicines use will occur only if sustained and constant reinforcement is available. The methodology used presented several difficulties in evaluating change.

The role of medication and sugars in pediatric dental patients.

It is now widely accepted that sugar-containing medicines are a cause of dental caries in chronically sick children. The increase of prescribed medicine intake and of self-medication in developed countries exposes a growing number of children to medication caries, which can be considered a public health problem. Health workers should first of all be informed. The second step consists of involving each country's institutional structures in charge of public health to ensure that they modify the legislation on medicine manufacture and sale, following the exemplary action of Great Britain. The third step is to pressurize manufacturers so that they decide to produce all liquid pediatric medicine in sugared and nonsugared forms. This step can be accomplished only if prescribers preferentially prescribe sugar free medicines and promote sugar free medicines to their patients.

Simple tests for caries susceptibility.

Two major problems dominate today's clinical cariology: although it has been known for centuries that sugar harms teeth this still does not often impinge on personal behaviour; the development of clinical caries is so slow that any snapshot of the present situation does not necessarily predict future caries incidence. Some simple tests have been developed for overcoming these problems in a causally directed diagnostic and therapeutic system of providing dental care. Routine measurement of stimulated salivary flow collected over 5 min objectively reveals the hyposalivation or xerostomic patients and directs them toward careful dental and medical examinations as well as to intensified preventive measures. Measurement of the pH and buffering capacity of the saliva related to a knowledge of the present caries prevalence gives an indication of the caries susceptibility of the patient. A high salivary lactobacillus count reveals in most cases a high frequency of sugar intake (or removable dentures and/or open carious lesions), and a salivary yeast infection is an indicator of reduced salivary flow and removable dentures. Both these microbiological shifts are shown by caries active patients. Using modern dip-slide techniques salivary aciduric lactobacilli and yeasts are easily cultured, and thus the development of new caries lesions may be predicted. Such cultures can also be used in the motivation phases of patient management. These simple tests help the modern dentist to evaluate the risk of future caries development, and to strengthen the motivation in patients to adopt healthy dietary habits.

[Excess caloric intake induced severe hypercapnia in a patient with Duchenne muscular dystrophy on noninvansive positive pressure ventilation].

In many patients with neuromuscular diseases, respiratory failure is mainly caused by alveolar hypoventilation in their terminal stages. Malnutrition is one of the common and serious problems in patients with chronic respiratory failure. Energy consumption for breathing is remarkably high in respiratory compromised patients, causing subsequent increase of total energy expenditure. However, most patients have limited capacity of oral intake. Nutritional depletion is associated with wasting of respiratory muscles, impairment of respiratory drive, alteration of respiratory pattern, and pathological change of pulmonary parenchyma. These indicate that nutritional and ventilatory support is very important in these patients. However, overfeeding also may have detrimental influence on respiratory failure. We experienced a Duchenne muscular dystrophy (DMD) patient on noninvasive positive pressure ventilation (NIPPV) who developed hypercapnia after total parenteral nutrition (TPN). Analysis of clinical course of this patient revealed that there is a significant correlation between PaCO2 and caloric intake. Excess carbohydrate intake can precipitate fat synthesis which induces over-production of carbon dioxide (CO2). Since NIPPV doesn't have a closed circuit, there are some difficulties in respiratory management, such as air leakage to stomach and mouth, and airway obstruction. Failure to optimize NIPPV setting against increased CO2 load might cause hypercapnia in this patient. These suggest that evaluation of energy expenditure and design of nutritional program are essential to avoid hypercapnia due to nutritional support.

A comparison of oral hygiene status and dental caries in children on long term liquid oral medications to those not administered with such medications.

Young chronically ill children receive a greater sugar load from liquid medications than do healthy children. They receive variety of oral liquid medications that healthy children do not This study was planned to know the levels of oral hygiene and Dental caries in children on long term liquid oral medicines (LOM) and to know out if any difference existed between these and children not on LOM. 51 children on LOM were compared to 54 not on LOM after equalising for age, oral hygiene and diet intake. Highly significant difference was found for dmft and dmfs in 2-6 year age group and dmft+ DMFT for 6-13 years age group, mostly posterior teeth were affected and for this the difference was statistically significant in 2-6 year old children. Percentage of children with dmft>5 significantly increased in 2-6 years old children on LOM, when compared to that of control. Percentage of various grades of lesions (relating to the severity) also increased with an increase in the duration of LOM.

[Sugar and the birth of dentistry]. / Suiker aan de wieg van de tandheelkunde.

It took mankind some ten thousand years to get sugarcane from the Pacific to the Mediterranean. Once it reached Europe and the Europeans knew how to handle it, it took them only a hundred years to turn the production of sugar into the biggest industry of the world. Exactly in those hundred years the birth of modern medicine--and dentistry--is placed. This coincidence is too particular to be left unnoticed.

Alkali production in the mouth and its relationship with certain patient's characteristics.

OBJECTIVES: To assess the relationships among alkali production, diet, oral health behaviors, and oral hygiene. METHODS: Data from 52 subjects including demographics, diet, and oral hygiene scores were analyzed against the level of arginine and urea enzymes in plaque and saliva samples. An oral habit survey was completed that included: use of tobacco (TB), alcohol (AH), sugary drinks (SD), and diet. Alkali production through arginine deiminase (ADS) and urease activities were measured in smooth-surface supragingival dental plaque and un stimulated saliva samples from all subjects. ADS and urease activities were measured by quantification of the ammonia generated from the incubation of plaque or saliva samples. Spearman correlations were used to compute all associations. RESULTS: Participants in the lowest SES (Socio-economic status) group had the habit of consuming sugary drinks the most and had the highest rate of tobacco use. Males consumed significantly more alcohol than females. No significant relationship was found between age or gender and alkali production. Higher rates of sugary drink consumption and tobacco use were significantly related to lower alkali production. CONCLUSION: The study showed a relationship between alkali production and oral hygiene, diet, and certain oral health behaviors. Poor oral hygiene was significantly associated with age, lower SES, tobacco use, and alcohol, and sugary drinks consumption. Clinical relevance Certain oral health behaviors have an impact on oral hygiene and on alkali production; it is important to address these factors with patients as a strategy for caries control.