Fluoride levels in UK infant milks.

AIM: To provide a comprehensive report of fluoride concentration in UK infant milks and estimate their contribution to daily fluoride intake. METHODS: A total of 60 formula milk products available commercially or within a hospital environment were analysed, along with eight pasteurised cow's milk samples. Formula milk products requiring preparation were reconstituted with fresh Leeds tap water (0.02 ppmF). Fluoride concentration was measured for all products directly using an ion selective electrode after addition of low-level total ionic strength adjustment buffer. RESULTS: The overall median fluoride concentration for the 68 infant milks was 0.025 ppmF, with a wide range of 0.002-0.282 ppmF. Analysis revealed variation between composition and manufacturer, in addition to differences between measured and labeled fluoride concentration. Although all products contained low fluoride concentration, the fluoride concentrations for formula milks used within the hospital setting (0.029 ppmF) were statistically higher in comparison to the commercial formula milk (0.016 ppmF) and cow's milk (0.017 ppmF) products. The daily fluoride contribution from infant milks was low; 0.0034 mgF/kg body weight per day was estimated between birth and 6 months of age, further decreasing as intake of infant milk decreased with age. CONCLUSIONS: Fluoride concentration of the analysed infant milks is low, providing minimal contribution towards total daily F intake and alone are unlikely to pose a threat for the development of dental fluorosis.

Service evaluation of patients with orofacial granulomatosis and patients with oral Crohn's disease attending a paediatric oral medicine clinic.

AIM: Presenting features associated with orofacial granulomatosis (OFG) and oral Crohn's disease (OCD) are varied, making successful diagnosis and management difficult. The aim of this service evaluation was to establish a profile of patients with these conditions attending a paediatric oral medicine clinic and to determine their overall satisfaction with the care received. STUDY DESIGN: A retrospective case note analysis to establish the patient profile and a postal patient satisfaction questionnaire for service evaluation. METHODS: All patients with OFG and OCD who had attended the joint paediatric dentistry/oral medicine clinic at Charles Clifford Dental Hospital, Sheffield in the previous 14 years were included in the study. Hospital case notes were retrospectively reviewed and patient demographics, clinical features, investigations, diagnosis, treatment and outcomes of treatment were recorded. An anonymous patient satisfaction questionnaire using the Healthcare Satisfaction Generic Module of the Paediatric Quality of Life Inventory (PedsQLTM) was distributed to all patients by mail. RESULTS: A total of 24 patients (13 females and 11 males) were identified. Median age at presentation was 11 years (SD± 3.79, range 2-15). Fifteen patients (63%) were diagnosed with OCD, and 9 (37%) with OFG. Overall, the most common orofacial feature was oral ulceration (75%) followed by lip/facial swelling (71%), angular cheilitis (67%) and mucosal cobblestoning (67%). Differences in presentation were seen between the two conditions with oral ulceration (87%) and mucosal cobblestoning (80%) being the most frequently observed features of OCD and lip swelling (78%) and angular cheilitis (67%) being the most common features of OFG. 58% of patients reported relief of symptoms through treatment. Thirteen patient satisfaction questionnaires were completed (54%). 85% (n=11) felt the overall care received in the clinic was 'excellent'. CONCLUSIONS: This service evaluation highlights the variety of presenting features of OFG and OCD. Despite only a moderate response to treatment, patient satisfaction with the service was high, emphasising the importance of good communication when managing children with chronic, debilitating conditions.

Case report: Blue chromogenic dental staining in child with West syndrome.

BACKGROUND: Tooth discolouration can be caused by a variety of local and systemic factors. Extrinsic dental stains may be caused by predisposing factors, and other factors such as dental plaque, foods and beverages, chromogenic bacteria, metallic compounds and medications. Studies have reported a correlation between the colour of extrinsic staining and caries risk. CASE REPORT: A 4-year-old boy with West syndrome, characterised by epileptic seizures and severe muscle spasm, was referred to the paediatric dentistry clinic at School of Clinical Dentistry, Sheffield. He had a percutaneous endoscopic gastrostomy (PEG) tube and had no oral food or fluid intake. The presenting complaint was his parent's concern of trauma to the oral tissues from epileptic fits. An examination revealed an unusual navy-blue staining to his teeth that appeared extrinsic in nature. There was evidence of tooth-wear of his primary dentition, and marked calculus deposits. No caries was detected. TREATMENT: A further dental examination and treatment was carried out under general anaesthesia. The mandibular central incisors were extracted, due to imminent pulp exposure from bruxism, and were sent for histopathology to determine the nature of the staining. A moderate growth of Pseudomonas aeruginosa, a blue pigment-producing bacteria usually implicated in chronic pulmonary infections, was recovered from a swab sample. FOLLOW-UP: The patient was reviewed at 4 months at which time the staining had returned. CONCLUSION: The patient had no oral intake of food or drink, which placed him in a low caries risk category despite limited oral hygiene practice. His extensive lists of medications were not found to have extrinsic dental staining as a possible side effect. However, these may have altered the oral flora such that growth of pigmented bacteria, normally absent from the oral cavity, was favoured, causing generalised extrinsic staining.