Perio Reports Vol. 25 No. 6. Child s First Dental Visit. page 2. page 1. June Being a Pedo Dental Hygienist. Message Board, page 11

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1 Child s First Dental Visit page 1 Perio Reports Vol. 25 No. 6 page 2 June 2013 Being a Pedo Dental Hygienist Message Board, page 11

2 in this section Child s First Dental Visit by Trisha E. O Hehir, RDH, MS Hygienetown Editorial Director When is the ideal time for a child s first visit to the dental office? It used to be three years of age when all deciduous teeth were erupted. More recently the American Academy of Pediatric Dentistry (AAPD) recommends the first visit occur by one year or within six months of the first tooth erupting. This first visit is to establish a dental home for the child. The ADA concurs, suggesting the first birthday is the time for the first dental visit. In all cases, experts suggest the visit be after the teeth erupt. According to the research presented in this month s feature article Window of Opportunity by Dr. John Peldyak, it might be time to rethink the age for a child s first visit. To prevent colonization of Streptococcus mutans, (S mutans) the mother should be seen during pregnancy to be sure her mouth is healthy and not harboring high levels of acid producing S mutans. Bringing the mother s mouth to health will ensure she passes a good oral flora on to her baby after birth. The bacteria are passed from mother to baby through shared saliva from kissing, tasting food before giving it to the baby and sharing utensils. Although mothers tend to be the primary caregivers, we shouldn t forget the fathers or the grandparents. The child s first dental visit should be for both mom and dad. In some families other caregivers are involved in the day-to-day routines of the baby. Anyone sharing saliva with the new baby should be sure to have good oral health and low levels of S mutans. Making sure these people have good oral health is the first step in the preventive process for the child. The child s first dental visit is really for the family. n Inside This Section 2 Perio Reports 5 Continuing Education: Window of Opportunity for» Prevention: Health Benefits of Early Xylitol Use 11 Message Board: Being a Pedo Dental Hygienist 1 JUNE 2013» hygienetown.com

3 perio reports Mother-child Study Phase One Mothers are the primary source of oral bacterial transmission to infants. As teeth erupt, they are colonized with Strep mutans, primarily transmitted through the mother s shared saliva. Preventing Strep mutan colonization in an infant s mouth until age two provides a significant primary preventive strategy. Mother-child research studies allow for an intervention with the mother to determine Strep mutan transmission to the child. Researchers in Finland compared daily xylitol chewing gum consumption by mothers to professionally applied fluoride and chlorhexidine varnish. There were 106 mothers who chewed xylitol-sweetened gum three to five times daily from the time their newborn was three months old until they were two years old. The varnishes were applied to those mothers every six months from the time those children were Perio Reports Vol. 25, No. 6 Perio Reports provides easy-to-read research summaries on topics of specific interest to clinicians. Perio Reports research summaries will be included in each issue to keep you on the cutting edge of dental hygiene science. six months old until two years. The fluoride varnish group was 33 mother-child pairs and the chlorhexidine varnish group was 30. Mothers were selected based on high Strep mutan levels. Thus these mothers were at high risk for transmitting Strep mutans to their babies. At age two, 10 percent of the children of mothers who chewed xylitol gum were colonized with Strep mutans, based on plaque and saliva samples. In the chlorhexidine group it was 29 percent, and 49 percent in the fluoride group. The mother s use of xylitol-sweetened chewing gum significantly reduced the risk of bacterial colonization in their babies. Clinical Implications: Advise new moms to chew 100 percent xylitol-sweetened gum three to five times daily from the time their babies are three months old until their second birthday to prevent transmission of Strep mutans from mother to child. n Söderling, E., Isokangas, P., Pienihäkkinen, K., Tenovuo, J.: Influence of Maternal Xylitol Consumption on Acquisition of Mutans Streptococci by Infants. J Dent Res 79: , t Mother-child Study Phase Two In the first part of this research, mothers with high Strep mutan levels who chewed xylitol-sweetened gum were less likely to have children with Strep mutan colonization by age two. Despite the mothers high Strep mutan levels throughout the study, the xylitol seems to alter the colonization ability of the Strep mutans. The mothers receiving fluoride varnish or chlorhexidine varnish were more likely to have Strep mutan colonization in their children at age two. All these children were followed for an additional three years after termination of the two-year intervention. Children in Finland are seen regularly for dental care. For this part of the study, there were 103 from the xylitol group, 28 from the chlorhexidine varnish group and 33 from the fluoride varnish group. Children who were Strep mutan negative at age two were 3.6 times less likely to experience tooth decay than those who were Strep mutan positive when evaluated to age five. Analysis of the decayed, missing and filled teeth revealed that children whose mothers consumed xylitol chewing gum had 71 percent fewer lesions than the fluoride varnish group and 74 percent fewer lesions than the chlorhexidine varnish group. These findings agree with other studies showing prevention of Strep mutan colonization up to age two provides significant protection against tooth decay in the following years. Xylitol alters the adhesion of Strep mutans to tooth surfaces. Clinical Implications: Advising moms to use xylitol several times each day themselves during tooth eruption for their infants will provide long-term caries reduction benefits. n Isokangas, P., Söderling, E., Pienihäkkinen, K., Alanen, P.: Occurrence of Dental Decay in Children after Maternal Consumption of Xylitol Chewing Gum, a Follow-up From 0 to 5 Years of Age. J Dent Res 79(11): , continued on page 3 hygienetown.com «JUNE

4 perio reports continued from page 2 Recent Mother-child Study from Japan Many of the xylitol studies include European or North American subjects. Researchers in Japan wanted to see if xylitol consumption by Japanese mothers would have the same result in lowering Strep mutan levels in their babies. Researchers at Okayama University recruited pregnant mothers from the Miyake Obstetrics and Gynecology Clinic in central Okayama, Japan. Mothers with high Strep mutan levels were invited to participate in the study. In this study design, mothers randomly assigned to the xylitol-sweetened chewing gum began using the gum when they were six months pregnant and continued until their babies were seven months old, generally prior to tooth eruption. The xylitol group consisted of 46 mothers and the control group 31 mothers who completed the study. The dental exams and plaque and saliva samples were done at the Hello Dental Clinic that is part of the OBGYN clinic. Both groups of mothers received the same oral health information from the dental clinic. Xylitol chewing gum consumption averaged three pieces per day with the range being 1.2 pieces to 5.3 pieces daily. The gram dosage varied accordingly and averaged four grams per day. Plaque and salivary Strep mutan levels were measured until children reached the age of two. Children whose mothers chewed xylitol gum were less likely to have Strep mutan colonization by age two compared to controls; 72 percent of the xylitol group had zero Strep mutan scores compared to 39 percent with a score of zero in the control group. Clinical Implications: Even short term, xylitol consumption by mothers can prevent Strep mutan colonization in babies. n Swedish Mother-child Study Evidence confirms the benefits of mothers consuming xylitol-sweetened chewing gum to prevent the transmission and colonization of Strep mutans in their infants. Researchers in Sweden compared three chewing gums used by new mothers. The gums were 1) xylitol, 2) chlorhexidine plus xylitol and 3) sodium fluoride. A group of 173 mothers with high Strep mutan levels were randomly assigned to one of the three chewing gum groups. Mothers with low to moderate Strep mutan levels comprised the control group that did not chew gum. Gum chewing began when the babies were six months old and continued for one year until the children were 18 months of age. Mothers were instructed to chew their assigned gums for five minutes, three times daily. Salivary and plaque levels of Strep mutan were measured for all the children. At the end of the study, 10 percent of the children of mothers chewing xylitol gum were positive for Strep mutans. In the chlorhexidine plus xylitol chewing gum group, 16 percent were positive for Strep mutans. In the fluoride chewing gum group, 28 percent of children were positive for Strep mutans. The control group, children of mothers with low levels of Strep mutans had 10 percent positive, similar to the xylitol group. The xylitol reduced the risk of Strep mutan transmission and colonization in high-risk mothers to that of low-risk mothers. The chlorhexidine seemed to mildly reduce the effect of xylitol, but not of statistical significance. Nakai, Y., Shinga-Ishihara, C., Kaji, M., Moriya, K., Murakami-Yamanaka, K., Takimura, M.: Xylitol Gum and Maternal Transmission of Mutans Streptococci. J Dent Res 89(1):56-60, Clinical Implications: Xylitol-sweetened chewing gum is the best choice for reducing Strep mutan transmission and colonization. n Thorild, I., Lindau, B., Twetman, S.: Effect of Maternal Use of Chewing Gums Containing Xylitol, Chlorhexidine or Fluoride on Mutans Streptococci Colonizations in the Mothers Infant Children. Oral Health Prev Dent 1:53-57, JUNE 2013» hygienetown.com

5 perio reports Xylitol Syrup Reduces Incidence of Early Childhood Caries There are many bacteria that colonize the mouth, and two are associated with caries and are highly damaging: S. mutans and S. sobrinus. These bacteria will colonize the teeth and produce lactic acid that demineralizes enamel, leading to cavitation. Xylitol effectively prevents the transmission of S. mutans from mother to child. Researchers at the University of Washington wanted to know if applying a xylitol syrup to infants teeth would prevent early childhood caries (ECC). The study was carried out on 94 nine- to 15-month-old children in the Marshall Islands where the caries rate is two to three times that of mainland USA. The average five year old has seven untreated carious lesions. Three treatment programs were compared: eight grams of xylitol syrup twice daily, eight grams of xylitol syrup three times daily and the control group receiving 2.67 grams of xylitol in a single dose. This was not a true control group, but mandated by the internal review committee. To be sure each child received three syrup doses each day, one or more sorbitol syrup doses were added to make three for each group. After 12 months, the control group had more children (52 percent), and more teeth (two per child) with tooth decay. The two xylitol syrup groups had much lower caries rates affecting 0.6 to one tooth per child. The researchers estimated that the xylitol syrup used during primary tooth eruption could prevent up to 70 percent of decayed teeth. Clinical Implications: Xylitol syrup given during primary tooth eruption prevent caries. n Influence of Maternal Xylitol Consumption Milgrom, P., Ly, K., Tut, O., Manci, L., Roberts, M., Briand, K., Gancio, M.: Xylitol Pediatric Topical Oral Syrup to Prevent Dental Caries: A Double-Blind Randomized Clnical Trial of Efficacy. Arch Pediatrics 163: (7) , Caries is an infectious, transmissible, diet-dependent, salivary mediated disease. When the balance between demineralization and remineralization tips toward demineralization, cavitation might result. It begins with transmission of the Strep mutans from a primary caregiver, usually the mother, to the child. Efforts to prevent transmission and colonization of Strep mutans in infants begin with the pregnant mother with diet changes, improved oral hygiene and daily xylitol consumption. Efforts to prevent the initial colonization of Strep mutans in an infant is considered primary-primary prevention. The caries process has two disease stages prior to cavitation: infectious disease and life-style disease. The infectious disease stage occurs before the child s teeth erupt, after eruption and continues through infection. The life-style disease stage refers to the dietary influences of frequent sugar consumption, oral hygiene and the quality of saliva that enhance acid production leading to decalcification. Mothers asked to rinse daily with chlorhexidine, which attacks the bacteria, experienced a lower Strep mutan level and this delayed colonization in their infants for four months. The use of xylitol doesn t attack the bacteria; it simply changes the environment to be less hospitable to acidproducing Strep mutans. Xylitol elevates the ph of the plaque and saliva and, as a five-carbon sugar rather than a six-carbon sugar, provides no usable nutrition for the bacteria. Xylitol provides not only immediate reductions in Strep mutans, it provides long-term caries reduction. Clinical Implications: Xylitol comes in many forms, tastes sweet and is easy to incorporate into the daily routine of new mothers to reduce the risk of sharing Strep mutans with their newborn babies. n Nakai, Y.: Influence of Maternal Xylitol Consumption on Mother-Child Transmission of Cariogenic Bacteria During and After Pregnancy. Finn Dent J, Suppl 1: 12-17, hygienetown.com «JUNE

6 continuing education feature by John Peldyak, DMD This print or PDF course is a written self-instructional article with adjunct images and is designated for 1.5 hours of CE credit by Farran Media. Participants will receive verification shortly after Farran Media receives the completed post-test. See instructions on page 10. AGD Code: 432 Farran Media is an ADA CERP Recognized provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Approved PACE Program Provider FAGD/MAGD Credit Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. 1/1/2013 to 12/31/2015 Provider ID# JUNE 2013» hygienetown.com

7 continuing education feature Abstract Dental caries is a transmissible infectious disease triggered by mutans streptococci bacteria. Mothers, as the primary caregivers, are the principal source of these bacteria as early colonizers of infants mouths. The window of infectivity associated with mutans streptococci colonization also offers a window of opportunity to break the dental caries transmission cycle. A twopronged approach utilizing xylitol for mothers and their babies can yield impressive dental health benefits. Educational Objectives At the end of the course, participants will be able to: 1. Describe the window of infectivity relating to oral mutans streptococci. 2. Explain the results of mother-child xylitol research trials. 3. List the benefits of daily xylitol use for mothers, infants and children. 4. Understand the long-term impact of xylitol use on oral health. 5. Recognize the many benefits of xylitol nasal spray. Long-Term Protection with Xylitol One of the main features to arise from earlier xylitol prevention trials was the recognition of a long-lasting caries-protective effect of habitual xylitol use. A follow-up five years after discontinuation of a xylitol chewing gum trial in Ylivieska, Finland, showed that the preventive effect persisted. The subjects of the Belize trials in Central America showed a similar persistence of the xylitol-preventive effect at a five-year recheck. The very best results, more than 90 percent caries reduction, were observed in teeth that erupted during the second year of habitual xylitol use. Theoretical explanations suggest that new teeth erupting into a cleaner environment experience initial colonization by cariogenic bacteria being blocked and the new enamel becoming optimally mineralized. This established the concept that the time prior to and during tooth eruption is the ideal time to use xylitol to achieve the best preventive effect. Mothers Use Xylitol, Babies Benefit A field trial was conducted in Finland in the early 1990s to see if xylitol use by mothers could affect the transmission of mutans streptococci from the mothers to their babies. Mothers chewed 100 percent xylitol-sweetened gum four times a day (about seven grams of xylitol per day), from the time their babies were three months old, and discontinued at 24 months of age. Control groups received either chlorhexidine or fluoride varnish. Colonization by mutans streptococci at age two years was three- to five-times higher in the children whose mothers did not use xylitol. At the age of five years, the children of the xylitol-using mothers had a 70 percent lower caries experience. Follow-ups on this trial were continued for 10 years. A detailed economic analysis found the mothers xylitol use was effective in reducing the costs of dental treatment for their children. Other benefits were noted such as missing fewer school days and avoiding the inconvenience, discomfort and pain associated with tooth decay. A similar mother-child trial was conducted in Sweden where the control groups also chewed gum. The results mirrored the Finland experience: the children of mothers who used xylitol had significantly reduced colonization by mutans streptococci and a lower occurrence of dental caries. Mothers who express a high level of dental anxiety tend to avoid routine professional dental visits and have less effective oral hygiene habits. A group of anxious mothers were given xylitol lozenges to use when their children were between the ages of three and 36 months. The xylitol use was well accepted and found to prevent or at least delay mutans streptococci colonization in their children. Xylitol in Pregnancy A trial in Japan began the xylitol use during pregnancy in a group of women identified as being at high risk for tooth decay. Xylitol chewing gum was used four times each day for 13 months, although they reported lower actual use than the recommended levels. Improved oral health with decreased caries activity was noted in the women of the xylitol group. These xylitol mothers had lower counts of mutans streptococci resulting in reduced colonization of their babies teeth and about 70 percent reduced risk of early childhood caries. Xylitol for the Infant One recent double-blind randomized trial by researchers at the University of Washcontinued on page 7 hygienetown.com «JUNE

8 continuing education feature continued from page 6 ington in Seattle shows just how effective xylitol is for preventing caries when used directly on the teeth of infants between nine and 15 months for a treatment period of one year. There were two xylitol groups and a control group. The test groups got xylitol syrup at least twice per day and the control group received sorbitol syrup twice a day and xylitol syrup only once a day. While more than half of the children in the control group had tooth decay after 10 months, there were significantly fewer caries in both of the xylitol groups. The authors concluded providing xylitol syrup to infants at least twice a day (total 8gm per day) could reduce early childhood decay by more than 70 percent. Now there are commercial gels available that contain a high concentration of xylitol and are safe to swallow. Combining Mother and Child Use Often research must focus on one piece of the comprehensive puzzle. We have seen that xylitol can be an effective adjunct in breaking the mother-to-child transmission cycle when the mother chews xylitol gum or when xylitol is applied directly to the child s teeth. Why not use both approaches together? We should have more information soon. There was a recently completed trial using xylitol for both mothers and their babies at a Public Health Center in Finland. Infants received xylitol topically on their available tooth surfaces from the age of approximately six months. The mothers were also using xylitol regularly. The preliminary bacteriological reports suggest a favorable trend. Most mothers continued breast-feeding until the child was approximately 12 months old. Milk was not analyzed, but no harmful effects were observed in the infants as result of the intervention. The infants mutans streptococci levels and caries rates decreased significantly. This experiment is currently in press and will be published in the International Dental Journal. Xylitol and Ear Infections Xylitol in chewing gum or syrup has been shown to reduce the incidence of ear infections by up to 40 percent. It was found that xylitol reduces the adherence of important upper respiratory pathogens, particularly Streptococcus pneunomiae and hemophilus influenza, to epithelial cells. A physician in private practice, Dr. Lon Jones, used this information to develop a saline xylitol nasal wash for babies. He noted a dramatic reduction of ear infections with a related decrease in antibiotic use. Dr. Jones recommends preventive use of saline/xylitol nasal spray routinely, such as after diaper changes. He suggests that nasal xylitol helps to keep the nasal airway open, encourages proper nasal breathing and leads to more ideal development of the palate and dental arches. Safety of Perinatal Xylitol In amounts required for dental benefits, xylitol has a long history of safety. During the Turku Sugar Studies in the early 1970s, six of the volunteers in the xylitol-feeding group were pregnant. They were consuming about ten times more xylitol than dental recommendations, with no untoward health effects. There were no negative effects reported on mothers, births or the infants. In Ylivieska, Finland, 91 mothers were breastfeeding regularly through several months of the trial, with no reports of any adverse effects. The Swedish study was very similar in this respect. In Japan 51 pregnant women regularly used xylitol without any negative side effects on them or their children. Professors Kauko Mäkinen and Pentti Alanen at the Institute of Dentistry, in Turku, Finland, tell us that in Finland, where the awareness of xylitol is universal, thousands of breastfeeding mothers use xylitol habitually. Consumers simply consider xylitol as part of their normal life. Other Co-factors Xylitol forms weak complexes with calcium in solution and can function as a carrier for minerals. Saliva production is stimulated by xylitol. This stimulated saliva has a higher ph and greater mineralization potential than resting saliva. A series of studies carried out at Tokyo Dental College demonstrated greater saliva-mediated remineralization with regular xylitol use. They also showed deeper, more complete mineralization occurred with a calcium buffer added to xylitol. Fluoride and xylitol have a combined effect. Toothpaste containing both fluoride and xylitol should be encouraged for 7 JUNE 2013» hygienetown.com

9 continuing education feature maternal use. Erythritol is a four-carbon polyol. Preliminary evidence suggests some dental benefits similar to xylitol, with different mechanisms involved. Although this is speculative, there is a good possibility that xylitol and erythritol are complementary. Used together or sequentially they could have an additive or even synergistic effect. Introducing oral probiotic bacteria to erupting teeth is a relatively new concept. Harmless or even helpful oral bacteria could possibly get established early to block or crowd out the harmful varieties. Xylitol could be an indifferent bystander or possibly a prebiotic agent that would favor the probiotics while suppressing the virulent strains. There are several groups of oral bacteria that are said to be xylitol-resistant. In effect, habitual use of xylitol leads to less adhesive, less acidogenic, less inflammatory oral flora that can maintain a long-term peaceful co-existence with the host. Delivery Systems Mothers, family members and caregivers are encouraged to use xylitol in three to five divided servings throughout the day. Chewing gum is considered an ideal delivery system for xylitol, especially immediately after meals or snacks. Xylitol mints or candy can be effective where chewing gum is not practical. Additionally, xylitol toothpaste or mouthrinse can be part of routine daily home care. Xylitol nasal drops or sprays can be used with babies. By the age of six months or even before the first teeth begin to erupt, babies can be given xylitol syrup or gel. The xylitol can be squirted, brushed or wiped on the teeth by mother after feeding. Pacifiers have been developed with a reservoir to slowly release xylitol over a period of time. Well-designed pacifiers can have a beneficial orthopedic effect for the proper development of the palate and dental arches. Conclusion A simple strategy of mothers chewing xylitol gum during pregnancy and after delivery, along with their babies receiving xylitol in nasal sprays and tooth gels could effectively block or delay early transmission of pathogenic bacteria. Additionally, xylitol assists optimal mineralization of newly erupted tooth surfaces. In conjunction with standard prevention strategies and optimized nutrition, using xylitol could have a profound benefit in reducing childhood dental caries, ear infections and antibiotic overuse. n References: 1. Scheinin, A. Mäkinen, K. (eds) The Turku Sugar Studies, I-XXI Acta Odontologica Scandinavia, vol. 33, supplement 70, Uhari, T. Kontiokari, M. Koskela, M. Niemelä, Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial. British Medical Journal vol. 313, no. 7066, pp , Kontiokari, M. Uhari, M. Koskela, Antiadhesive effects of xylitol on otopathogenic bacteria, Journal of Antimicrobial Chemotherapy vol. 41, no. 5, pp , May, Söderling, P. Isokangas, Pienihäkkinen, J. Tenovuo, Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants, Journal Dental Research vol. 79, pp , Isokangas, E. Söderling, K. Pienihäkkinen, P. Alanen, Occurrence of dental decay in children after maternal consumption of xylitol chewing gum, a follow-up from 0 to 5 years of age, Journal of Dental Research, vol. 79, no. 11, pp , Aaltonen, J. T. Suhonen, J. Tenovuo, I. Inkilä-Saari, Efficacy of a slow-release device containing fluoride, xylitol and sorbitol in preventing infant caries Acta Odontologica Scandinavica, vol. 58, no. 6, pp , Takahashi, M. Saeki, Y. Miake,Y. Yanagisawa, T., Effects of sugar alcohols and calcium compounds on remineralization, Shikwa Gakuho, vol. 100, pp , Thorild, B. Lindau, S. Twetman, Effect of maternal use of chewing gums containing xylitol, chlorhexidine or fluoride on mutans streptococci colonization in the mothers infant children, Oral Health Preventive Dentistry, vol. 1, no. 1, pp , Thorild, B. Lindau, S. Twetman, Caries in 4-year-old children after maternal chewing of gums containing combinations of xylitol, sorbitol, chlorhexidine and fluoride, European Archives of Paediatric Dentistry, vol. 7, no. 4, pp , Söderling, Xylitol reduces mother-child transmission of mutans streptococci, Finnish Dental Journal, supplement 1, pp. 8-11, Nakai, Influence of maternal xylitol consumption on mother-child transmission of cariogenic bacteria during and after pregnancy a promising strategy against initiation of caries, Finnish Dental Journal, supplement 1, pp , Vernacchio, R. M. Vezina, A. A. Mitchell, Tolerability of oral xylitol solution in young children: implications for otitis media prophylaxis, International Journal of Pediatric Otorhinolargology vol. 71, no. 1, pp , Coldwell, T. K. Oswald, D. R. Reed, A marker of growth differs between adolescents with high vs. low sugar preference, Behavior Physiologyvol. 96, no. 23, pp , March, Fontana, D. Catt, G. J. Eckert, S. Ofner, M. Toro, R. L. Gregory, A. F. Zandona, H. Eggertsson, R. Jackson, J. Chin, D. Zero, C. H. Sissons, Xylitol: effects on the acquisition of cariogenic species in infants, Pediatric Dentistry, vol. 31, no. 3, pp , Milgrom, K. A. Ly, O. K. Tut, L. Mancl, M. C. Roberts, K. Briand, M. J. Gancio, Xylitol pediatric topical oral syrup to prevent dental caries a double-blind randomized clinical trial of efficacy, Archives of Pediatrics and Adolescent Medicine, vol. 163, no. 7, pp , Nakai, C. Shinga-Ishihara, M. Kaji, K. Murakami-Yamanaka, M. Takimura, Xylitol gum and maternal transmission of mutans streptococci, Journal of Dental Research vol. 89, no. 1, pp , Laitala, Dental Health in Primary Teeth After Prevention of Mother-Child Transmission of Mutans Streptococci A Historical Cohort Study on Restorative Visits and Maternal Prevention Costs, Academic Dissertation presented at the University of Turku Institute of Dentistry, September 24, Olak, M. Saag, T. Vahlberg, E. Söderling, S. Karjalainen, Caries prevention with xylitol lozenges in children related to maternal anxiety, Eur Arch Paediatr Dent 13:64-69, Makinen, M. Jarvinen, K., Antilla, C., Luntamo, L. Vahlberg, T. "Topical xylitol administration by parents for the promotion of oral health in infants: a caries prevention experiment at a Finnish Public Health Centre,"* International Dental Journal, doi: /idj.12038* Author s Bio Dr. John Peldyak is a general dentist in Michigan. He received his DMD degree from Southern Illinois University in 1980 and was a member of professor Kauko Mäkinen s University of Michigan xylitol research group on sugar substitutes from Dr. Peldyak is also a founding member of the American Academy of Oral Systemic Health. Disclosure: The author declares that neither he nor any member of his family have a financial arrangement or affiliation with any corporate organization offering financial support or grant monies for this continuing education program. Although commercially available products are discussed, no financial arrangements exist between the manufacturers and the author. continued on page 9 hygienetown.com «JUNE

10 continuing education feature continued from page 8 Post-test Claim Your CE Credits» Answer the test in the Continuing Education Answer Sheet and submit it by mail or fax with a processing fee of $36. We invite you to view all of our CE courses online by going to and clicking the View All Courses button. Please note: If you are not already registered on you will be prompted to do so. Registration is fast, easy and of course, free. 1. The window of infectivity for mutans streptococci colonization most likely occurs: a. prior to birth. b. before first six months of life. c. first 36 months of life. d. time between years four and six. 2. When mothers regularly use xylitol themselves: a. their children also experience dental benefits. b. their children have much earlier MS colonization. c. mothers tooth decay rates dramatically increases d. no benefits are realized. 3. Oral health benefits of xylitol have been documented even years after discontinuation of regular use. a. True b. False 4. Xylitol use during pregnancy is safe for both mother and infant. a. True b. False 5. Providing xylitol gel to infants can reduce early childhood caries by: a. 0 percent. b. less than 10 percent. c. less than 30 percent. d. up to 70 percent. 6. Xylitol/saline nasal spray reduces the adherence of pathogens to epithelial cells and: a. keeps the nasal airway open. b. encourages proper nasal breathing. c. can lead to more ideal development of the palate and dental arches. d. All of the above 7. Benefits of xylitol are maximized when: a. used only by the mother. b. used regularly by both mother and infant. c. used only by the infant. d. used without fluoride. 8. Xylitol use by breastfeeding mothers is safe with no negative side effects reported on mother or child. a. True b. False 9. Daily xylitol use should be: a. divided into three to five servings for mother and at least two for baby. b. taken all at once. c. whatever the person wants. d. taken every other day. 10. Daily xylitol use can have profound benefits in reducing: a. childhood dental caries. b. ear infections. c. antibiotic overuse. d. All of the above. Legal Disclaimer: The CE provider uses reasonable care in selecting and providing content that is accurate. The CE provider, however, does not independently verify the content or materials. The CE provider does not represent that the instructional materials are error-free or that the content or materials are comprehensive. Any opinions expressed in the materials are those of the author of the materials and not the CE provider. Completing one or more continuing education courses does not provide sufficient information to qualify participant as an expert in the field related to the course topic or in any specific technique or procedure. The instructional materials are intended to supplement, but are not a substitute for, the knowledge, expertise, skill and judgment of a trained healthcare professional. You may be contacted by the sponsor of this course. Licensure: Continuing education credits issued for completion of online CE courses may not apply toward license renewal in all licensing jurisdictions. It is the responsibility of each registrant to verify the CE requirements of his/her licensing or regulatory agency. 9 JUNE 2013» hygienetown.com

11 continuing education feature Continuing Education Answer Sheet Instructions: To receive credit, complete the answer sheet and mail it, along with a check or credit card payment of $36 to: Dentaltown.com, Inc., 9633 S. 48th Street, Suite 200, Phoenix, AZ You may also fax this form to or answer the post-test questions online at This written self-instructional program is designated for 1.5 hours of CE credit by Farran Media. You will need a minimum score of 70 percent to receive your credits. Participants only pay if they wish to receive CE credits, thus no refunds are available. Please print clearly. This course is available to be taken for credit June 1, 2013 through its expiration on June 1, Your certificate will be ed to you within 3-4 weeks. Window of Opportunity for Prevention: Health Benefits of Early Xylitol Use by John Peldyak, DMD License Number AGD# Name Address City State ZIP Daytime phone (required for certificate) o Check (payable to Dentaltown.com, Inc.) o Credit Card (please complete the information below and sign; we accept Visa, MasterCard and American Express.) CE Post-test Please circle your answers. 1. a b c d 2. a b c d 3. a b 4. a b 5. a b c d 6. a b c d 7. a b c d 8. a b 9. a b c d 10. a b c d Card Number Expiration Date Month / Year / Signature Date Program Evaluation (required) Please evaluate this program by circling the corresponding numbers: (5 = Strongly Agree to 1 = Strongly Disagree) 1. Course administration was efficient and friendly Course objectives were consistent with the course as advertised COURSE OBJECTIVE #1 was adequately addressed and achieved COURSE OBJECTIVE #2 was adequately addressed and achieved COURSE OBJECTIVE #3 was adequately addressed and achieved COURSE OBJECTIVE #4 was adequately addressed and achieved COURSE OBJECTIVE #5 was adequately addressed and achieved Course material was up-to-date, well-organized, and presented in sufficient depth Instructor demonstrated a comprehensive knowledge of the subject Instructor appeared to be interested and enthusiastic about the subject Audio-visual materials used were relevant and of high quality Handout materials enhanced course content Overall, I would rate this course: Overall, I would rate this instructor: Overall, this course met my expectations Comments (positive or negative): For questions, contact Director of Continuing Education Howard Goldstein at hogo@dentaltown.com hygienetown.com «JUNE

12 message board» Being a Pedo Dental Hygienist Townie loves working with children. What is your niche? Hygienetown Message Board > Dentistry > Pediatric Dentistry > Being a Pedo Dental Hygienist t lacaza3 Member Since: 02/18/06 Post: 1 of 16 pedobrusher Member Since: 09/20/10 Post: 2 of 16 skr RDH Member Since: 07/21/07 Post: 3 of 16 After a year of temping, I ve found my niche in hygiene. When I temp in an office with adults, I just don t enjoy hygiene as much as when I temp in a pedo office. I m in a good mood at the end of the day in a pedo office and I enjoy the children and the parents. For me, it s more psychological than physical with kids. Working with adults leaves me tired at the end of a day. What is your hygiene niche and what made you pick it? n Working with children is definitely a plus. I like the way you said it: it is more psychological than physical. I have worked both general and pedo, and pedo is my niche. I have been with the same office now for 13 years and, yes, we have our issues, (what office doesn t?) but overall, there is so much more satisfaction with young patients than there is with adults. I can give hygiene instructions to a young person and they are more likely to go home and at least try it. Ever try to tell a 40-year-old man how to brush better? The just do your job and get me out of here look occurs more often than not. n I have to say you two are a gift to humanity! I commend you on your willingness to embrace pedo hygiene. The kids really need a motivated hygienist to understand them and teach them well at a time when their oral health is most vulnerable. But please, don t book them in my column! Sad to say, I don t have the gift to be a great pedo hygienist. My specialty seems to be defusing the anxiety of a certain segment of middle-aged ladies and building their involvement in their oral health. It s heavy on the psychotherapeutic approach. I really take it as a challenge when I see a new patient with a benzodiazepine listed in their meds and it is rewarding work. n DEC SEP SEP joymoeller Member Since: 09/16/08 Post: 5 of 16 How about oral myology? I worked 25 years in a pedo-ortho practice not doing hygiene, but thumb sucking therapy and myofunctional therapy. It was so rewarding and many times the kiddos had gingivitis from mouth breathing that I was able to help with. n OCT sfbailey Member Since: 09/22/10 Post: 6 of 16 In school we didn t learn knee-to-knee exams and were taught that a child needed to come in at three years old. I don t mind working with kids at all, but I do feel more worn out mentally than when I work on adults. Most of the time, it s the whole family. Mom comes in with her two or three kids and I do hygiene on all of them. Half the time the mom is worn out by the end and the kids are running around the operatory, pulling things down or clicking the assistant chair. So yes, I am mentally and physically drained by the end of my afternoon. I just feel blessed to be able to educate patients and help them become healthier. We have one of the best jobs, whether that be with kids or adults. n OCT JUNE 2013» hygienetown.com

13 message board In the early 80s, I was a school dental hygienist for two years, but due to declining enrollment and school closings I was laid off. I loved it. If I wasn t laid off, I could have seen myself doing it until retirement! The RDH I replaced did! To me, everything comes down to behavior modification, whether patients are two or 92, I teach brushing the same way. Both ends of the spectrum have their challenges. Yes the children can be more mentally challenging, but the adults are not without their mentally challenging days! Teens are very tough and I think getting worse every day. When I started all those years ago, I don t remember the arrogance as prevalent as it is today. Patients, whether young or old, weren t as disrespectful as they are today. They didn t have as much attitude. n I worked in Rick Kushner s Comfort Dental Practice doing accelerated hygiene using two assistants out of three operatories. The best part of that job was not seeing anyone under age 15. I probably make doing pedos harder than it is. I hear my voice going up a notch to that girly sound I use for kids. I am good at customer service, but very exhausted with the wheelbarrow full of TLC that small kids need and deserve. I feel like I am chirping all day. Adults can be reasoned with. Adults have never bitten me so hard that my fingernail turned purple; adults have never vomited on me; adults rarely cry; adults don t need to sit on mom s lap; adults don t require that I turn myself into a pretzel to view their innards. Everyday-all day praise-giving wears me out. n I work in a predominantly child-geared office (though we see adults too, just more kids usually) and laughed out loud reading Shaz s post. Most of the time I love seeing little kids. But just last week I got bitten extremely hard one day, and then had two days back-to-back where a child vomited on me. Boy, does that get old quick. n I do love seeing children, however my niche is geriatric patients! I love caring for our older patients more than any other patient population. My dream would be to own my own little practice where I could go and care for the patients in nursing home facilities. Talk about no access to preventive dental care the geriatric population has been forgotten. Shame! n OCT MAR APR APR JERSEY DEVIL Member Since: 11/04/05 Post: 7 of 16 shazammer1 Member Since: 12/20/00 Post: 11 of 16 Cavitron Member Since: 04/24/11 Post: 13 of 16 VirginiaRDH Member Since: 04/09/08 Post: 16 of 16 Find it online at: search Pedo Hygiene t» hygienetown.com «JUNE

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