Pacifier Use in Children: A Review of Recent Literature

Meghan Sullivan Walsh June 8, 2011

Literature Review - St. Joseph/LMC Pediatric Dentistry

Pacifier Use in Children: A Review of Recent Literature

Resident: Meghan Sullivan Walsh

Program: Lutheran Medical Center- Providence

Article Title: Pacifier Use in Children: A Review of Recent Literature

Authors: Steven M. Adair, DDS, MS

Journal: Pediatric Dentistry

Volume (number), Year, Page #’s; 25:5, 2003, 449-458.

Major Topic: Review of literature concerning the role of pacifier in nonnutritive sucking in four areas 1) SIDS, 2) breast-feeding 3) otitis media and other infections and 4) safety.

Overview of Method of Research: Review of studies published since 1950. Searches limited to clinical trials, meta-analysis and multicenter studies. Diagnosis limited to sensitivity and specificity. Etiology/harm limited to cohort studies, case control studies and risk. Natural history/prognosis included prognosis, cohort studies, disease progression and time factors.

Findings:

1) Relationship between pacifier use and SIDS

Studies have shown that pacifier use at sleep time was associated with a greater than 50% reduction in the risk of SIDS. There were several explanations offered: 1) Airway may be less compromised or restricted with pacifier use. 2) Pacifier use may prevent the infant from turning to a prone position. 3) Infants are aroused while sleeping when they lose their pacifier 4) other misc such as reduced risk of GERD, simulation of saliva, simulation of somatostatin and gastrin and altered mother’s behavior causing the mom to check on the infant more frequently.

2) Effect of pacifier use on breast-feeding

Recent decades have shown a trend towards reduced breast-feeding and many studies blame pacifier use. Studies have refuted the “nipple confusion” theory, however, mother’s have admitted to using pacifiers to control the interval between breast-feeding, or to wean their infants from the breast. It is reasonable to consider that mothers who do not plan on breast-feeding may use a pacifier to comfort the infant and assist in weaning.

3) Pacifier use and it’s relationship with acute otitis media and other aspects of health.

Data shows a strong relationship between pacifier use and acute otitis media (AOM). Higher percentages of children with a history of AOM has used a pacifier for less than 4 years. In addition pacifiers have been proved to become a vector for bacterial and fungal transport.

4) Physical safety.

Pacifier material and design, combined with improper usage has been reported towards morbidity and mortality. Ventilation holes are essential as well as flanges with a minimum horizontal and vertical dimension of 43mm. Parents and caregivers are warned not to use cords on pacifiers for fear of strangulation.

Chemical safety includes a volatile n-nitrosamines found in baby bottle nipples that have shown to produce carcinogens in animal testing. In addition, there are questionable reports on latex allergies associated with pacifier use.

Key Points: Summary: Recommendations for our patient’s parents should include:

1) Education on the safety of pacifier use

2) Withhold pacifiers until breast-feeding is established. Limit pacifier use for soothing only.

3)Advise parents to exercise judgment and restraint with pacifier use.

4) Instruct parents to clean pacifiers routinely and avoid sharing.

5)Curtailing pacifier use before the age of 2 to prevent habits and malocclusion.

Assessment of the Article: Great article. Very thorough and usefu

06/08/2011 Predictors of Bruxism, Other Oral Parafunctions, and Tooth Wear over a 20-Year Follow-up Period

Resident: J. Hencler
Date: 06/08/2011

Article title: Predictors of Bruxism, Other Oral Parafunctions, and Tooth Wear over a 20-Year Follow-up Period

Author: Carlsson et al
Journal: Journal of Orofacial Pain Volume 17, Number 1, 2003

Major topic: Oral parafunctions

Type of Article: Longitudinal study

Main Purpose:
Analyze predictors of bruxism, other oral parafunctions, and anterior tooth wear by the use of logistical regression models w/ variables recorded at the first exam as independent variable.

Overview of method of research:
Originally 402 randomly selected 7-, 11-, and 15-year old patients were examined clinically and by questionnaire. Twenty years later 320 completed and returned the questionnaire. 100 returned patients underwent a clinical exam focusing on occlusal factors and function/dysfunction of the masticatory system. For analyses of predictors of oral parafunctions and tooth wear registered at the 20 yr f/u, logistic regression was used w/ recordings at the first exam as independent variables.

Findings:
The bivariate analyses between the dependent variable (reported bruxism at 20 year f/u) and selected variables from the first exam 20 years earlier resulted in five significant associations. These 5 variables (reported bruxism and other oral parafunctions, headache, pain after heavy chewing, TMD symptoms including pain after chewing) plus 1 dental variable (anterior open bite) were included in the logistical regression model with reported bruxism at the 20 year f/u as the dependent variable. See tables for details.

Key points in the article discussion:
The hypothesis was that bruxism and other oral parafunctions in childhood would be identified as predictors of bruxiam and other oral parafunctions and tooth waer 20 years later. Many clinicians have suggested a positive between relationship bruxism and TMD but the knowledge of what causes TMD is limited. The etiology of bruxism has also been controversial and theories have considered occlusal, psychological, genetic, and stress factors. Currently, there is a concensus about the multifactorial nature of its etiology, and bruxism is thought to be a CNS phenomenon related to stress and pain behavior more than to structural components.

Summary of conclusions:
This study found:
1) Reports in childhood bruxism, tooth clenching, tooth grinding at night and nail biting and/or other parafunctions were predictors of the same oral parafunctions 20 yrs later. This suggests that oral parafunctions may be a persistent trait in many subjects
2) Predictors of the 2 components of bruxism, tooth clenching during daytime and tooth grinding at night, were not the same, which supports the opinion that these 2 occlusal parafunctions may be different
3) Postnormal occlusion (Class II) and tooth wear in childhood predicted increased tooth wear in adulthood
4) Nonworking-side interference reduced the risk for extensive tooth wear of the anterior teeth in 100 35-year old subjects.

Assessment of article:
Interesting conclusion. I find that many parents report that their children grind their teeth and want to know if there are any specific causes and possible treatment to make them stop. I find the answer to this question one of the more difficult to explain to parents because we don’t really know the answer for sure. Usually occlusal guard or TMJ therapy is not indicated in very young patients so the best we can do is encourage the parents and continue to monitor the bruxism.

6/8/11 Sucking, Chewing, and Feeding Habits and the Development of Crossbite: A Longitudinal Study of Girls from birth to 3 years of Age

Department of Pediatric Dentistry
Resident’s Name:Murphy Program: Lutheran Medical Center - Providence
Article title: Sucking, Chewing, and Feeding Habits and the Development of Crossbite: A Longitudinal Study of Girls from birth to 3 years of Age
Author(s): Erik Larsson, Odont Dr
Journal: Angle Orthodontist
Year. Volume (number). Page #’s: 2001. vol 71, No 2
Major topic: Development of post. X bite
Minor topic(s): various things that may cause xbite
Main Purpose: Follow the development of xbites in pacifier suckers and to determine the possibility of reducing the prevalence of xbite by informing/instructing the parents about sucking habits and reducing the amount of time the child has the pacifier in the mouth

Overview of method of research:
60 Swedish girls, all born from 1995-1997 were followed from birth until age three. Over this time period, 5 interviews/exams were conducted. The child’s eating habits, their habit, if they had one, was discussed, and an assessment of their dentition was completed. Variables assessed at the interviews include the following
1. Breast feeding, duration, and frequency
2. Chewing resistance of food
3. Sucking habits, duration, intensity, changes in intensity
4. Biting/chewing habits
5. xbites, functional interferences
6. Problems with teething
7. Design and material of teat

Findings:
Numerous studies have shown that there is an increased prevalence of post. Xbite in children with artificial sucking habits. These studies indicate that a xbite is more likely to develop in pacifier users as opposed to digit suckers. It has been suggested that when the ‘teat’ of a pacifier is kept in the mouth, the tongue is forced to a lower position, thereby reducing palatal support for the max. canines and molars against the cheeks. Conversely, the tongue will increase lateral pressure on the mand. canines and molars, These changes act synergistically to create a transverse instability, possibly leading to post. Xbite. Profit concluded that pressure must be applied to the teeth for 6h/d to produce tooth movement. Therefore, we must encourage the parents to decrease the amount of time the child uses their paci, or sucks their digits.

90% of the children were breastfed. 72% of the girls developed a paci habit, 10% a digit habit, and 18% had no habit. Interferring contacts were noted in 12 of the girls with the paci habit. In all 12 of the girls, the interfering teeth were the primary canines.

In conjunction with previous studies, it was found that the longer a child is breastfed, the less likely they are to develop a sucking habit.

5% of the girls who were still paci users at age three had developed a xbite. In one girl who had a habit until age 2.5 and had developed a xbite, her xbite self corrected by the 3 year check up. As we have heard many times before, we must try to stop the habit before age 3.

Key points/Summary:
Long term artificial sucking habits can cause posterior xbite. Habits should be stopped at all costs by age 3. We should encourage parents to decrease the amount of time the child has their paci, for example only when they are falling asleep.

Assessment of Article: Good, informative article. Things to remember for boards are 1, Stop habits ASAP, definitely by age 3. 2. Try to educate the caregivers on why it is important to stop the habit, and give them tools and ideas to help them stop it.

The relationship of bottle feeding and other sucking behaviors with speech disorder in Patagonian preschoolers

Resident: Cho
Author(s): Barbosa C et al.
Journal: BMC Pediatrics
Year. Volume (number). Page #’s: 2009. 9:1-8.
Major topic: Speech disorders, nonnutritive sucking habits
Type of Article: Research Article

Main Purpose: Evaluate risk factors among pre-school Chilean Patagonia children focusing on past and present sucking behaviors for developing speech disorders.

Methods: Observational study on 128 children aged 37 to 70 months old attending three local public kindergartens in Punta Arenas (Patagonia), Chile, during a one year period. Information was gathered using parent questionnaires (feeding hx., demographics, social economic status), child speech evaluations (TEPROSIF test used by Chilean speech therapist – child shown drawing and examiner tells him/her standardized phrase that includes name of the drawing and child is asked to imitate the phrase) and physical examinations of the children’s mouths conducted by the pediatrician.

Results: 58 three year olds, 49 four year olds, and 21 five year olds were evaluated in this study. Children with below normal occurrence of speech phonological processes were breastfed for a shorter period of time. More than twice as many children with below normal speech used a pacifier for more than three years compared to those without speech problems.

Key points:
Sucking habits such as pacifier use, finger sucking and bottle feeding are associated with speech disorders in preschool children. Starting bottle feeding after 9 months was found to be protective of developing speech disorders. Children who suck their fingers were 3X more likely to obtain an abnormal classification on the TEPROSIF evaluation. Pacifier use was shown to negatively impact the development of speech alterations if used for more than 3 years old while less use was found not be harmful.

Dental Caries of Refugee Children Compared with US Children

Meghan Sullivan Walsh June 1, 2011

Literature Review - St. Joseph/LMC Pediatric Dentistry

Dental Caries of Refugee Children Compared with US Children

Resident: Meghan Sullivan Walsh

Program: Luterhan Medical Center - Providence

Article Title: Dental Caries of Refugee Children Compared with US Children

Authors: Susan Cote, RDH, MS; Paul Geltman, MD, MPH; Martha Nunn, DDS, PhD; Kathy Lituri, RdH, MPH; Michelle Henshaw, DDS, MPH; and Raul I. Garcia, DMD

Journal: Pediatrics

Volume, Number, Year, Pages; Vol. 114, No.6, December 2004, pgs 733-740

Major Topic: To describe the prevalence of caries experience and untreated decay among newly arrived refugee children classified by their region of origin and compared with US children.

Overview of Method of Research: Within 90 days of arrival to Massachusetts, US, screenings were completed of some 224 refugees starting January 2001 and ending in September 2002. A dental hygienist performed the screening and the parent and/or child was interviewed about their dental history and history of pain. Demographic information was recorded (age, gender, race/ethnicity, and country of origin.) Caries experience was recorded as well as ‘ECC’. Treatment urgency was estimated with their own scale. In comparison to these numbers, the NHANES III database was used including a total of 11,296 US children between the ages of 2 to 16.9. Information gathered was used to construct comparisons to the refugee database. Logistical regression models were constructed to test the differences in prevalence of untreated cares and the prevalence of caries experience between US and refugee children.

Findings:

REFUGEE ANALYSIS

*Refugee children from Africa were the least likely ever to have been to a dentist

*For treatment urgency:

1) 5% of children from Africa were classified as needing urgent care as compared to 32.2% of Eastern Europeans and 13.6% from other areas.

2)Highest proportion of children with NO obvious dental problems were from Africa 40.5%

*Caries experience in total refugee population was 51.3% ; 38% - African, 79.9% -Eastern European and 50% - Other

*Refugee children from Africa had the fewest dental needs while Eastern Europeans had the greatest.

US NHANES analysis

*77.7% of US children exhibited “no obvious problem”

*77.2% of US children has no untreated caries

Comparison

*White/other refugee children were 9.4 times as likely to have untreated caries compared to white US children, 5.4 times as likely compared to African American children and 4.4 times as likely compared with other US children.

*African refugee children were only twice as likely to have untreated caries compared with white US children and not significantly different from African American children or other US children.

*White/other refugee children were 4.6 times as likely to exhibit caries compared with African refugee children.

*African refugee children were only half as likely to have caries experience compared with white US children and African American children.

Key Points/Summary:

African refugee children had significantly lower dental caries experience as well as fewer untreated caries as compared to Eastern European refugee children. African refugees were also less likely to have seen a dentist. In addition, African refugee children were also half as likely to have had a caries experience were compared with African American children. Eastern European refugees in contrast were three times as likely to have caries experience than US children and 9.4 times as likely to have untreated caries as white US children. Many factors can be attributed to these numbers. It’s been found that many Eastern African countries have naturally occurring optimal levels of fluoride in drinking water with others having very high levels of fluoride. In addition the African countries which were studied also consume far less annual per capita sugar as compared to Eastern Europeans and the US. One interesting fact in the article was that many African’s use ‘chewing sticks’ to clean their teeth which have been found to be an effective means of plaque removal.

Assessment of the Article:

I’m unsure as to why I was ‘randomly’ selected to report on this article?... In any case, this article and research was fascinating! When comparing the few families we’ve treated at St. Joseph, the numbers don’t match up, however, our families in Providence have been from Western African communities which may account for the differences. Many questions came into my head... Are Western Countries in Africa fluoridated? What kind of diets are these families consuming while in these refugee camps? Are these children now at higher risk for dental disease now that they’ve moved to the US? It would be interesting to use the data were are collecting at St. Joseph to form our own research project! The article does mention several times how important it is for us to become aquatinted with Refugee families and the children as the US does receive a huge number of these families each month. Fortunately for us we are already getting a good sense of their dental history, caries experience and the many barriers they and we face when attempting to treat their dental needs.

Oral Lesions in HIV Infection in Developing Countries: An Overview

Resident: Adam J. Bottrill
Date: 01JUN11
Region: Providence
Article title: Oral Lesions in HIV Infection in Developing Countries: An Overview
Journal: Adv Dent Res
Page #s: 63-68
Vol:No Date: 19, Apr, 2006
Major topic: HIV Infection. Oral Lesions
Minor topic(s): None
Type of Article: Descriptive article

Main Purpose: The objective of this work was to ascertain the nature and prevalence of oral lesions in different regions, and to identify any gaps in our understanding of these lesions in HIV disease.

Key points in the article discussion:

I. General:
A. Studies are needed WRT these oral lesions in developing countries and developed countries if a proper course of treatment is to be effectively formulated.
B. End of 2003: 46mill ppl infected... with more than 95% from developing countries.
C. Oral lesions are often an early finding in HIV infection.
D. 2.9 million children with HIV.

II. Methods:
A. Oral lesion reports from developing countries over a 14 year period.
B. Reports sub-grouped into 4 groups, based on region: India, Thailand, Africa, Latin America.

III. Results:
A. Detailed report and data tabulation presented in article...
B. Route of transmition primarily sexual for adults... with the exception of the Thai cohort which showed predominately IV drug use.
C. Men primarily infected with women as the majority in Zaire, Kenya, Zambia and Thailand.
D. Pediatric patients with oral lesions ranged from 25% to 63%.
E. Oral Candidiasis most common with the most common type of pseudomembranous.
F. Angular Cheilitis and Oral Hairy Leukoplakia reported from ALL regions.
G. Other common lesions: Gingivitis, Periodontitis, Linear gingival erythema, necrotizing ulcerative periodontitis, ulcers, oral hyperpigmentation.
H. Oral Kaposi's Sarcoma most prevalent in Mexico and Zimbabwe.
I. Oral submucous fibrosis in India due to areca nut chewing.
J. Often, the predominance of certain oral lesions was a direct effect of the populations access to care or stage of disease.

Assessment of Article: This article serves as a baseline for further studies regarding geographic prevalence and the nature of the disease process.

Oral Health and Preterm Delivery Education

Resident: Swan
Article Title: Oral Health and Preterm Delivery Education: A New Role for the Pediatric Dentist
Author: Katz et al.
Journal: Pediatric Dentistry
Volume (Number): 28:6 2006
Major Topic: Preterm Delivery and Poor oral health status
Type of Article: Literature Review
Main Purpose: Review the current literature that correlates poor oral health status and risk of preterm delivery; identify pediatric dentist’s role in educating expecting mothers
Findings: Periodontal disease and its associated bacteria are thought to be involved with various systemic conditions. Recent literature has suggested that these bacteria or their byproducts may cross the placenta and affect the developing fetus by stimulating an inflammatory response in the mother, which may ultimately result in PTD (before 37 weeks). Several human studies have highlighted this potential correlation:
1. significant inverse relationship between mother’s P.Gingivalis-specific IgG levels and birth weight
2. women with severe periodontal disease 7-8 times more likely to have PLBW infants
3. PTD significantly associated with attachment loss; periodontal disease independently associated with PTD and LBW
4. one systematic review: of 25 relevant studies, 18 suggested association between perio disease and adverse pregnancy outcome.
5. trends in literature support association between perio disease and adverse outcomes, primarily in economically disadvantaged populations.

One possible mechanism: PGE2, TNF alpha levels rise within amniotic fluid until threshold is reached, which induces labor/delivery. These molecules are produced in perio disease, possibly inducing labor if they cross the placenta. (PGE2 in crevicular fluid can be measured to give current perio disease activity).
Interventional Studies:
1. SRP may reduce Spontaneous Preterm Birth (study with 300 pregnant women)
2. Perio therapy significantly decreased levels of PGE2.
Animal Models:
1.rabbit model showed that P gingivalis cells implanted into subcutaneous chambers resulted in systemic dissemination, transplacental passage and fetal exposure. All rabbits exposed showed placental exposure to the bacteria.
2. Injected LPS from 3 perio bacteria compared to E. Coli LPS in sheep. Perio LPS had high rates of fetal lethality compared to E Coli LPS.
Key Points/Summary: PTD is a major public health concern. >20 % among poor/minorities and hasn’t changed for 30 years. Studies in humans argue for a correlation between perio disease and preterm delivery/LBW infants. Could be argued that those at increased risk for perio disease are more prone to experience pregnancy complications—intervention and animal model studies support the link though—especially with P. Gingivalis. It’s our job to emphasize the importance of oral health care during pregnancy to the mothers we see in the clinic.
Assessment of Article: Good review that helped clarify and somewhat murky subject.

Survey of Oral Helath Knowledge and Behavior of Pregnant Minority Adolescents

Resident’s Name: Jessica Wilson

Article title: Survey of Oral Helath Knowledge and Behavior of Pregnant Minority Adolescents

Author(s): Fadavi et al.

Journal: Pediatric Dentistry

Year. Volume (number). Page #’s: 2009. 31:5. 405-408.

Major topic: Pregnant Adolescents

Overview of method of research: Survey

Background:
Studies have shown that periodontal disease is a clinically significant risk factor for preterm low birth weight babies. Many women may be unaware of this correlation. In one study the most common periodontal finding in pregnant women was gingivitis due to plaque accumulation and periodontal status was significantly associated with smoking, insurance status and race with African-Americans and Hispanic-Americans experiencing higher rates than Caucasians.

Purpose:
To compare dental visits and oral health knowledge of African-American (AA) and Hispanic-American (HA) adolescents in a community health clinic.

Methods:
Subjects were between the ages of 12 and 20 who were pregnant within one year of the study and were patients of a community health center were given a questionnaire. The questionnaire contained 21 questions about demographics, dental behaviors and dental knowledge. 50 AAs and 61 HAs were used for analysis.

Results:
There were no significant differences in age, number of pregnancies, education level or employment status. There was a significant difference of 85% AAs and 60% HAs who used public assistance to pay for dental care. 31% of HAs and only 8% of AAs were self-pay. AAs were more likely to live with their parents or family while the HAs were more likely to live with their boyfriends/husbands. HAs were found to floss more than AAs, while AAs reported flossing more than HAs. Both groups were not likely to receive regular dental care while pregnant. Both groups had similar oral health knowledge, however HAs were more likely to know about the association between pregnancy and gingivitis.

Key points/Summary:
The younger the pregnant adolescent, the more likely they were to utilize dental care during pregnancy.
The subjects who had had previous dental visits were 13.6 times more likely to visit the dentist while pregnant.
The odds of a pregnant adolescent living with a husband/boyfriend visiting the dentist while pregnant were 4.4 times higher than those who did not.

Assessment of Article:
This was a simple questionnaire study with a low sample size, but some interesting enough findings.

The Childhood Obesity Epidemic: A Role for Pediatric Dentists?

Resident: Cho
Author(s): Vann et al.
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2005. 27:271-276.
Major topic: Childhood Obesity
Type of Article: Literature Review

Main Purpose: Review the causes of childhood obesity, discuss relevance of obesity to dental health and disease, and highlight some of the actions pediatric dentists should take.

Key points:
Obesity is defined as an excess amount of body fat in proportion to lean body mass. BMI is calculated by the person’s weight in kg divided by the square of his or height in meters. BMI higher than 30 is considered obese.
8 common sense reasons for childhood obesity was discussed in Sports Illustrated: neighborhoods without sidewalks and parks, fear of childhood abduction, hard-working parents, less children in organized sports, emphasis on test scores, fast food, technology, and family traits.
Finnish study followed 516 children from birth to age 12 and used weight to predict caries experience. They found that obesity alone was not a good predictor of dental decay. Swedish study examined relationship between dental caries and risk factors for atherosclerosis in nearly 200 15-year olds in one small urban community. This study reported that children with DMFT score greater than 9 had a significantly higher BMI than caries-free children.

Recommendations:
AAP has 8 recommendations for Pediatric Dentists:
1. Encourage parents, teachers, coaches, and others who influence the child to discuss health habits.
2. Enlist policymakers to support a healthy lifestyle for children.
3. Encourage organizations responsible for health care to provide coverage for effective obesity prevention and treatment strategies.
4. Encourage public and private sources to fund research on obesity in children.
5. Support and advocate social marketing intended to promote healthy food choices.

5/24/11 Tobacco Use by Adolescents: The Role of the Oral Health Professional in Evidence-based Cessation Programs

Department of Pediatric Dentistry
Resident’s Name:Murphy Program: Lutheran Medical Center - Providence
Article title: Tobacco Use by Adolescents: The Role of the Oral Health Professional in Evidence-based Cessation Programs
Author(s): David Alert, DDS Herbert Severson, PhD, Judy Andrews, PhD
Journal: Ped Dent.
Year. Volume (number). Page #’s: 2006. vol 28 #2. 177-186
Major topic: How we can help stop tobacco use by adol.
Minor topic(s): Health effects of tobacco
Main Purpose: To provide clinicians with info on tobacco and health, the epidemiology of adol tobacco use, and cessation programs for parents and patients.
Overview of method of research: Review

Findings:
The use of tobacco products, particularly smoking represents the leading cause of preventable illness and death in the developed world (this was a question on the boards this year). Major gains have been made to reduce smoking in adults, however similar gains have not been realized in adolescents. Most tobacco users admit to starting when they were an adol. Every year more than 1 million teenagers become habitual smokers. We, as clinicians, should start screening for smoking and tobacco product risk factors at age 10(this was a question on the boards this year). Also, we should encourage parents who smoke to quit smoking. If they cannot or will not quit, we should advice them to not smoke around the kids, to have a smoke free home, and to watch their kids for smoking signs.
Tobacco is bad for you. It can cause a number of cancers, cardiovascular disease, respiratory disease, reproductive complications, etc. Adol who smoke have a reduced rate of lung growth and level of maximum lung function. Exposure to second hand smoke can also hinder lung growth, and increase the incidence of developing lung cancer. Chronic smoking can lead to increased prevalence and severity of perio disease. Studies have shown that approx. 50% of all perio cases can be attributed to smoking. Smoking and smokeless tobacco use can cause the following oral health issues.
1.Loss of taste
2. perio disease
3. stained teeth
4. altered taste perception
5. intraoral lesions
5. gum recession
7. drifting of teeth
8. abrasion to tooth enamel
9. oral malodor
Tobacco use by youths is assoc. with many risk factors, including having parents/friends who smoke, comorbid psych disorders, weight concerns, and ADD.

Tobacco Cessation
The best public health strategy is to prevent tobacco use completely, or to intervene as early as possible. Most cessation programs are implemented by schools and in the community. However, the effectiveness of these programs decrease over time. Dentists are in a unique position of being able to associate cessation advice with readily visible changes in oral health and status. Brief tobacco cessation in the dental office has been found to be effective when directed at adults. Since nearly 75% of all adol see the dentist at least yearly for care, the dental office is the ideal place to implement cessation programs. However, more research is necessary in terms of directing the advice towards adol.
The “5 A’s” is a recommended process that clinicians can follow. They can be applied and completed in up to 3 minutes. However, the adol. Needs to be a willing participant. The five A’s include
1. Ask about tobacco use
2. Advise to quit
3.Asses willingness to quit
4. Assist in quitting
5. Arranging follow up
6. Anticipatory guidance
(Don’t ask me why they call it the “5” A’s, when there are actually 6…)

Various pharmacological therapies have been shown to be effective in tobacco cessation. Bupropion SR, nicotine gums and inhalers and sprays and patches are all available on the market today. The FDA does not condone the use of these drugs in adol, however they are still prescribed to children to aid in cessation. The AAPD does NOT approve of children using these medications (this was a question on the boards this year).

Key points/Summary:
1. Tobacco is bad for you.
2. As physicians, particularly ones who see children multiple times a year, it is our duty to screen for and to assess tobacco use and risk. We should be asking EVERY adol about tobacco use and exposure at every visit.
3. Adol who use tobacco are likely to use it in adulthood

Assessment of Article:
Great conference review. I’m sure all of you ask every adol. You treat about tobacco use every time you see them, I however do not. I need to do a better job, and be more aware of it. In the past tobacco use and cessation programs have been a focus on the boards. It was on the boards this year, but only for a few questions.