Keeping caries at bay in breastfeeding babies.

As an infant grows, human milk may become the substrate for cariogenic bacteria. Here's what to watch for and how to counsel parents.

Identification of early childhood caries in primary care settings.

Early childhood caries (ECC) is the most common chronic disease affecting young children in Canada. ECC may lead to pain and infection, compromised general health, decreased quality of life and increased risk for dental caries in primary and permanent teeth. A multidisciplinary approach to prevent and identify dental disease is recommended by dental and medical national organizations. Young children visit primary care providers at regular intervals from an early age. These encounters provide an ideal opportunity for primary care providers to educate clients about their children's oral health and its importance for general health. We designed an office-based oral health screening guide to help primary care providers identify ECC, a dental referral form to facilitate dental care access and an oral health education resource to raise parental awareness. These resources were reviewed and trialled with a small number of primary care providers.

Dental amalgam and urinary mercury concentrations: a descriptive study.

BACKGROUND: Dental amalgam is a source of elemental and inorganic mercury. The safety of dental amalgam in individuals remains a controversial issue. Urinary mercury concentrations are used to assess chronic exposure to elemental mercury. At present, there are no indications of mercury-associated adverse effects at levels below 5 µg Hg/g creatinine (Cr) or 7 µg Hg/L (urine). The purpose of the present study is to determine the overall urinary mercury level in the Canadian general population in relation to the number of dental amalgam surfaces. METHODS: Data come from the 2007/09 Canadian Health Measures Survey, which measured urinary mercury concentrations in a nationally representative sample of 5,418 Canadians aged 6-79 years. Urinary mercury concentrations were stratified by sex, age, and number of dental amalgam surfaces. RESULTS: The overall mean urinary mercury concentration varied between 0.12 µg Hg/L and 0.31 µg Hg/L or 0.13 µg Hg/g Cr and 0.40 µg Hg/g Cr. In general, females showed slightly higher mean urinary mercury levels than men. The overall 95th percentile was 2.95 µg Hg/L, the 99th percentile was 7.34E µg Hg/L, and the 99.9th percentile was 17.45 µg Hg/L. Expressed as µg Hg/g Cr, the overall 95th percentile was 2.57 µg Hg/g Cr, the 99th percentile was 5.65 µg Hg/g Cr, and the 99.9th percentiles was 12.14 µg Hg/g Cr. Overall, 98.2% of participants had urinary mercury levels below 7 µg Hg/L and 97.7% had urinary mercury levels below 5 µg Hg/g Cr. All data are estimates for the Canadian population. The estimates followed by the letter "E" should be interpreted with caution due to high sampling variability (coefficient of variation 16.6%-33.3%). CONCLUSIONS: The mean urinary mercury concentrations in the general Canadian population are significantly lower than the values considered to pose any risks for health.

Transient elastography in patients with cystic fibrosis.

BACKGROUND: Hepatic involvement is frequent in patients with cystic fibrosis (CF), with focal biliary cirrhosis being the pathognomonic hepatic manifestation. In around one-quarter of CF patients, it results in CF-associated liver disease (CFLD). This occurs as a relatively early complication with the majority of patients presenting in childhood or their early teens. However, a normal US does not preclude significant liver fibrosis and liver biopsy is an invasive procedure that is hampered by potential sampling errors. Transient elastography (TE) (Fibroscan) is a non-invasive, user-friendly and quick technique that provides an objective and reproducible measure of liver stiffness. This is accomplished with a device using an US probe mounted in the axis of a vibrator. Vibrations are transmitted by the transducer, inducing an electronic shear wave that propagates through the underlying tissue. OBJECTIVES: We aimed to prospectively compare TE and transabdominal US scanning in children and adults attending a CF clinic. MATERIALS AND METHODS: A total of 134 consecutive patients with documented CF were prospectively studied. In each case, transient elastography measurement was performed immediately after the routine annual US evaluation of the liver. Sonographic appearance of the liver was classified from 1 to 5. Ten validated TE measurements were performed in each patient with the result expressed in kilopascals (kPa). The median value was considered representative of the elastic modulus of the liver. RESULTS: Measurements were performed in 59 CF adults, 75 CF children and 31 control children. There was no relationship between age and liver stiffness in either the control group or CF patients. Elasticity values of controls, CF pancreatic sufficient (PS) patients and pancreatic insufficient (PI) CF patients with a US score <3 were comparable and significantly lower than in CF patients with a US score > or = 3 (all PI) (P < 0.002). Median elasticity in CF patients was significantly higher in males (4.7 kPa) than in females (3.9 kPa) (P = 0.0013). CONCLUSION: Considering the limitations of US and the low risk-benefit rate of liver biopsy in most CF patients, this preliminary study suggests that TE is an attractive non-invasive way to assess and follow-up liver disease in these patients.