Common dental problems in children

By Carol Aloysius

Dental problems in children have increased in recent years largely due to changes in eating habits.

Unlike in the past, most children today yearn for sugar based foods including sweets, cakes, chocolates, ice creams and fruit juices filled with sugar. What is worse is that many of don't have proper dental hygiene which has resulted in dental caries, and other dental problems.

The Sunday Observer spoke to Deputy Director Health Eduction Bureau, Dr R.D.F.C. KANTHI for her views on this subject.

Q. What are the most common dental problems in schoolchildren?

A. Dental caries or dental decay, dental trauma and malocchusen (irregular teeth.)

Q. Of all of these what is the most common dental problem in one sees among school children in Sri Lanka at present?

A. Dental caries.

Q. What is dental caries?

A. It means dental decay or cavities in the teeth.

Q. How do these cavities occur?

A. For two main reasons: Firstly due to high ingestion of fermentable sugar in one's daily diet, and secondly due to poor oral hygiene.

Q. How can eating sweet based foods harm the teeth?

A. Today, the trend is for children to eat adhesive sweets that stick to the gums and teeth and are difficult to clean. Fermentable carbohydrates contain acids that attack the tooth surface.

This is the initial stage of dental caries. Germs- a group of bacteria called acid forming bacteria which are present in the plaque thrive and multiply in the presence of sugar. The moment sugar containing foods and drinks are consumed, these bacteria ferment the sugar producing acid inside the plaque. The acid thus formed is strong enough to attack the tooth under the plaque deposit and early decay begins.

Q. What if the sugar concentration is low?

A. Even if the concentration of sugar consumed is low, if the frequency of ingesting sugary foods is high it can still lead to dental caries.

Q. Can the danger be reduced if one were to brush one's teeth immediately after consuming a sweet food?

A. Yes. If sugar is taken in low concentration and infrequently you can reverse the decaying process. Brushing the teeth within an hour of eating something sugary will also reduce this process. But remember to use toothpaste that has fluoride in it.

Q. Why?

A. Because fluoride provides resistance to acid that attacks the tooth.

Q. Can brushing the teeth with fluoride stop a cavity that has already formed in the tooth?

A. No. You can stop its formation by brushing regularly with fluoride, but once the cavity has formed the child will need to have his/her tooth seen by a dental surgeon and the cavity filled.

Q. What happens if the cavity is not filled and is neglected?

A. Then it will progress and can open the pulp cavity where the blood vessels and nerves are exposed.

Q. How long does it take for a cavity to progress? Is it true that it takes longer in adults than in children?

A. No. It depends on person to person and so many other factors such as genetic factors, brushing of teeth with fluoride, etc.

Q. Once dental decay has passed through the enamel of the tooth into the next layer, what happens?

A. Once dental decay passes through the enamel into the next layer of dentine and then into the pulp of the tooth there can be severe pain.

Q. Can this be reversed?

A. If it goes beyond to the pulp then it can only be repaired with a root canal procedure.

Q. And if this too is jot done?

A. Further neglect can lead to the spread of infection resulting in a dental abscess (alveolar abscess) which if untreated can cause man complications. If caries has destroyed the tooth beyond repair and a root filling is not done, the tooth will have to be extracted.

Q. Will this pose a problem?

A. It can change the appearance of the face and cause problems with chewing.

Q. How will a child know whether he has a cavity in his tooth?

A. If he has a cavity he would feel it with his tongue. Or he will feel extra sensitivity when he ingests hot or cold foods.

Q. What does a tooth- ache or pain in the tooth signal?

A. A tooth ache occurs only when the nerve is exposed.

Q. What is the treatment?

A. The dental surgeon will decide on the treatment. Usually it could be a root canal treatment.

Q. How long does it take for a cavity to progress? Is it true that it takes longer in adults than in children?

A. No. It depends on person to person and so many other factors such as genetic factors, brushing of teeth with fluoride, etc.

Q. Dental fluoride is a common phenomenon in certain parts of this island. How is it caused?

A. This occurs when a person ingests too much fluoride often through the water sources which contain high levels of fluoride as in the Dry Zone areas like Anuradhapura, Polonnaruwa, Jaffna, Moneragala.

Q. What are the symptoms?

A. The teeth become discoloured and stained.

Q. How much toothpaste with fluoride should a person use?

A. For children - size of a green gram seed. For adults - pea size.

Q. Today it is common to see young children below 10 with gaps in their teeth caused by early tooth extractions. Your comments?

A. This is because their teeth have decayed due to high consumption of sugary foods and the cavities have not been attended to in time.

Q. What happens if you extract milk teeth early?

A. If milk teeth are extracted early, then the dental arch will collapse and the child will have irregular teeth which will affect his appearance.

Q. Is this a disease? Are there other reasons for developing malacuseum?

A. it is not a disease. It can be the result of pre-extraction, or finger sucking or too many teeth. But it can cause health problems because one could be unable to chew properly, cause facial disfigurement, make it difficult to clean teeth properly which can cause gingivitis or periodontal disease and also affect the phonation ( sound production).

Q. What is periodontal disease? Is it common in school children?

A. Gingivitis or periodontal disease is not a common childhood disease. But those who don't brush their teeth well can develop it.

Q. How does it occur?

A. When the plaque containing bacteria which produces toxins accumulates and causes inflammation of the gums (oedema) showing reddish inflamed bleeding gums.

Q. Symptoms?

A. When brushing you can spot blood and sometimes there will be a bad smell (halitosis) and a visible inflamed gum.

Q. You spoke about trauma at the beginning of our interview. What is trauma with regard to teeth?

A. This can be an injury involving sports or a fight among children when the anterior teeth can get injured especially the upper teeth.

Q. What happens if this is neglected?

A. Then the tooth can die and will turn black there is no blood flow. The child will be unable to bite his food and this will affect his digestion. His facial appearance too will be altered.

Q. How can this be prevented?

A. To avoid this parents must immediately take their child to a dentist. If it is a mild injury it can be corrected with a filling depending on the situation.

The dentist will usually take an X-ray and thereafter decide on what steps to take depending on the extent of the trauma and injury.

Q. What kind of services has the Health Ministry provided for treating dental problems in children?

A. Most schools now have dental clinics for school children as well as adolescent dental clinics which are all manned by qualified dental surgeons. We also have special dental services for school children on Saturday mornings on their school premises, children who have been unable to attend the dental clinics during school hours can attend.

Working parents who are unable to bring their children to the clinics on week days can also come on a Saturday when they are free.

Or they can go to their nearest dental clinic which most state hospitals now have and get treatment free of charge.

Q. Your message to students?

A. At least once a month, self examine your mouth in front of a mirror and look out for any changes such as discolouration of the teeth or cavities or swelling inside the cheeks, or gums. Brush your teeth gently every morning and evening especially after meals using tooth paste with fluoride.

Q. Finally your message to parents?

A. Caries is predominantly a childhood disease. It is thus a responsibility of parents to inculcate healthy dietary habits in their children from the earliest age. Avoid buying them sweet snacks and drinks during the day.

If you need to give them a treat, limit a sweet snack to a main meal preferably once a day.

Make sure your child brushes his/her teeth after every meal and after consuming a sweet snack.

A tooth can last a life time if cared for well. Good oral hygiene throughout life is the key.

'Three-parent babies': Britain votes strongly in favour of law change

In a milestone for medical science, Britain is to become the first country to allow the creation of so-called "three-parent" babies as MPs voted overwhelmingly in favour of the controversial technique of mitochondrial donation.

After a heated House of Commons debate, with MPs across the chamber speaking passionately on both sides of the argument, the government motion was passed in a free vote by a bigger-than-expected majority of 254 votes.

The result marks a victory for the British researchers who have pioneered the technique and the medical establishment that has backed them. The motion was opposed by the Catholic Church, which objects to the regulations on principle, and the Church of England, which was concerned about the safety of the technique.

Government ministers accepted that mitochondrial donation, which combines the DNA of three people into one IVF embryo, will for the first time alter the human genetic make-up or "germ-line", not just of the IVF babies created by the process, but of future generations of children within affected families.

The proposed amendment to the 2008 Human Fertilisation and Embryology Act will now be passed to the House of Lords, which will be expected to give its approval within the next two weeks.

A senior science adviser warned at the end of last year that plans to allow the creation of so-called 'three-parent' in vitro fertilisation (IVF) babies were premature because of unresolved safety concerns about the future health of the children.

The law allowing the licensing of mitochondrial donation will then come into effect in October, opening the way for the first IVF licence to be issued later this year, with the birth of the first three-parent baby in 2016.

A health minister, Jane Ellison, told MPs that mitochondrial donation is like replacing the battery packs of the cells with a new set of batteries.

She emphasised it will not lead to a slippery slope of genetically modified "designer babies" with enhanced inherited traits.

"For many families affected, this is the light at the end of the tunnel," Ms Ellison told MPs at the end of the debate.

About 2,500 women of child-bearing age in Britain are thought to be at risk of passing on mitochondrial disorders to their children. About one in 6,500 babies is born with a severe form of the disease, which affects vital organs such as the brain, heart and muscles.

Scientists at Newcastle University, which already has a licence for research on IVF embryos using mitochondrial donation, said they expect to apply for a full clinical licence later this year, once it becomes legal for the Human Fertilisation and Embryology Authority to consider applications.

Facing repeated interruptions from MPs from all parties, Ms Ellison repeated the Government's position that mitochondrial donation is not genetic modification because it only involves the movement of the 37 genes of the mitochondria - tiny energy-producing structures in the cell - rather than the 22,000 genes of the chromosomes in the cell nucleus. "No one would

say that this is not gr und-breaking science - it is. [But] we've taken all rigorous steps for Parliament to make an informed decision," she said.

Labour's shadow health minister, Luciana Berger, supported the amendment and said it will help affected families have healthy children, but accepted that the technique is not guaranteed to be safe.

Fiona Bruce, a Tory MP who is opposed to mitochondrial donation because it results in embryos being deliberately created and destroyed, said that allowing the technique in law will set a dangerous precedent. "We will be approving uncontrolled experimentation on children... Once we approve this procedure, where will it end?"

Bishop John Keenan, the Bishop of Paisley, was among the Catholic leaders who condemned the vote, claiming the technique "seeks to remove anyone affected by certain conditions from the human gene pool".

- The Independent

Eternal life could be achieved by procedure to lengthen chromosomes

The key to eternal life could be a procedure to lengthen chromosomes.

The procedure would allow scientists to lengthen telomeres, the protective caps that are on the end of chromosomes and shorten with age.

The telomeres protect chromosomes from getting damage as cells divide and grow. But as they do, they slowly become shorter and eventually are unable to protect the chromosomes. When that happens, they are liable to deteriorate - thought to be a key part of the ageing process.

The new process allows scientists to lengthen the telomeres, effectively turning back the biological clock and making the chromosomes - and the people that are made out of them - younger.

When the cells have been treated, they behave as if they are younger and multiply quickly rather than stagnating or dying.

The procedure could eventually be used to treat patients with genetic diseases that lead to the telomere being shortened before it should be, such as Duchenne muscular dystrophy. It could also be used to treat more general symptoms of ageing, like diabetes and heart disease.

"This new approach paves the way towards preventing or treating diseases of ageing," said one of the researchers on the study. "There are also highly debilitating genetic diseases associated with telomere shortening that could benefit from such a potential treatment."

The researchers behind the study hope that the procedure will be able to allow scientists to generate large numbers of cells to study or use to develop drugs.

The process has been discovered by Helen Blau of Stanford University, who was senior author on a paper describing the procedure with John Ramunas of Stanford and Eduard Yakubov from the Houston Methodist Research Institute.

"Now we have found a way to lengthen human telomeres by as much as 1,000 nucleotides, turning back the internal clock in these cells by the equivalent of many years of human life," said Helen Blau, who is also professor of microbiology and immunology at Stanford and director of the university's Baxter Laboratory for Stem Cell Biology. "This greatly increases the number of cells available for studies such as drug testing or disease modelling.

- The Independent

Illusion aids understanding of autism

New research could lead to a better understanding of how the brain works in people with autism.

There is an enormous disease burden from autism, and little is known about the cognitive processes involved.

Researchers looked at new theories of autism that focused on the way in which the brain combines new information from its senses with prior knowledge about the environment.

PhD student Colin Palmer said autism was a life-long condition that affects many people in the community.

"It is still unclear what is happening differently in the brain to produce the social, sensory and other difficulties that individuals with autism can face," Palmer said. "We are testing a new type of theory, which implicates the brain's capacity for making predictions about its own sensory input. Autism may be related to problems with making those predictions sensitive to the wider context. This means that new sensory input is interpreted out of context, making it difficult to understand the world and to generalise to new situations."

Using the 'rubber-hand' illusion, the researchers examined how adults with autism experienced 'ownership' of a fake prosthetic hand. In the 'rubber-hand' illusion, one of the subject's hands is placed out of sight, while a rubber hand sits in front of them.

- MNT