Infant and Toddler Warning Regarding Benzocaine.

A recent warning from the FDA indicates infants and toddlers under 2 years old are particularly vulnerable to developing Methemoglobinemia if exposed to Benzocaine.

Methemoglobinemia is a rare disorder of the blood that limits the blood’s ability to carry oxygen.  It can occur as an acquired disease and as an inherited disease.  The inherited version of the disease can have mild consequence for some up to severe and life threatening consequences for others, depending on the type.  Families with the inherited version are generally well versed in the prognosis of their type of Methemoglobinemia.

The acquired version of the disease is generally less dramatic and easily managed once the triggering agent is identified and avoided.  It is, however, very frightening and stressful when it develops and warrants an immediate trip to the doctor.  On rare occasion this type has also been life threatening.

Benzocaine is a known trigger for this disease and the FDA has issued a warning regarding use for children under age 2.  They are significantly more susceptible and vulnerable to a more severe reaction.  The soothing agents for teething and other mouth sores like canker sores and viral ulcers typically contain Benzocaine.  This warning is particularly important for parents of toddlers and their dentists.  Some typical agents containing Benzocaine are: Anbesol, Hurricaine, Orajel, Baby Orajel, Orabase, and store brands.  Many of the dentist’s topical anesthetics contain Benzocaine.

Also common sense reminds us, topical anesthetics have not been available until very recent human history.  Infants get through their teething issues with good nurturing, good food, and friendly things to chew on.

Next Blog:  Babies don't come with cavities.

Setting Your Child’s Cavity Risk Early

Few people realize that cavities are the result of a contagious disease. As infants, when we are teething those precious little baby teeth, we are also being exposed to the kinds of bacteria that cause cavities. These bacteria typically come from our closest caretakers, like moms, dads, nannies and siblings. Typically via slobbery kisses, shared spoons, and other close encounters. It is inevitable so don’t panic about it. However, there are numerous ways to insure this contagion will not destroy your child’s teeth.

First, reduce the amount of bad bacteria being transferred to the child. Parents with clean healthy mouths and no recent cavities will have fewer of the cavity causing bacteria in their saliva. Learn how to truly clean your teeth when brushing and flossing. Also, if you are a gum chewer or mint popper, find Xylitol gum and mints on the internet and health food stores. There are numerous studies showing dramatic reduction of the cavity causing bacteria in the mouths of those who put Xylitol (a natural sweetener) in their mouths several times daily.

Secondly, don’t feed those bacteria and promote their growth. These bacteria thrive on sugars and simple carbohydrates (cooked starch). It has been shown that frequent (frequency is the issue here!) exposure to simple carbohydrates promotes the preferred growth of the cavity causing bacteria (mutans streptococcus, sobrinus streptococcus, etc.). If we promote these bacteria early, they establish in high numbers and will continue to be in high numbers in the saliva and on teeth for a lifetime. Juice is an especially common mistake in sippy cups and bottles. Let’s not do that to our children. When your children are ready to give up milk and formula in the bottle, move to water. Do not, I repeat, do not start them on juice or any other sweetened beverage when they move away from milk, unless your pediatrician has specifically written a prescription for your child to have juice because of some metabolic reason. Ask your pediatrician and they will confirm this. The American Academy of Pediatrics does not support the use of juice as a snack or hydration beverage until age 4. Even at age 4 there is a word of caution and recommendation for continued use of water.

Thirdly, clean your child’s teeth effectively each day. It has been shown that the more the plaque (a biofilm of over 600 different bacteria) builds on the teeth, the more it promotes the acid loving bacteria that cause cavities. By simply disrupting this biofilm each day and forcing it to rebuild will prevent it from maturing to the level that it harbors and promotes the growth of the acid loving bacteria that make cavities. As the plaque matures and stagnates, it supports acid loving bacteria which begin to flourish and dominate the plaque. As acid loving bacteria numbers grow, they begin to control the plaque growth and with a higher balance in the saliva, they cause a more rapid maturing of the plaque into a destructive acid loving plaque which dissolves holes in the calcium rich enamel of your teeth. Once established, this balance can be extremely hard to change and may remain for a lifetime. Don’t let it start.

Give your kids a healthy start. Help them become water drinkers as a habit and you will create a lifetime of better health for them. Clean the gum line and between teeth daily to promote a healthier bacterial balance in your mouth’s dental biofilm. If you like gum or mints, discover Xylitol.

Give Your Teeth a Rest

I get a chuckle when children come into the office the week after Halloween or Easter.  They have eaten a bunch of candy in the last week and are worried that it made some cavities.  The reality is cavities take months or more commonly years to form.  When the complex biofilm of bacteria develops in the nooks around your teeth it creates acids as a byproduct of sugar metabolism.  These acids dissolve calcium out of tooth enamel.  As the disease progresses the enamel first develops a white mark as the calcium is dissolved out.  The enamel is softening and beginning to look like white chalk.

Next the microscopic voids where calcium has dissolved begin to collect stain and the mark on the tooth darkens brown or black.  Eventually the softening of enamel reaches the point that pieces of enamel begin to chip out and leave a hole, the cavity.  Depending on your habits, this process can take months or years or never become a cavity at all.

Each time we put simple carbohydrate (sugar or cooked starch) in our mouth the dental biofilm will function at a high metabolic rate for about 40 minutes.  During this time the high acid production is attacking all teeth.  Calcium is being dissolved out of our teeth in large quantities.  Don't despair!  Saliva has the ability to capture and hold that calcium in super saturation.

After the 40 minutes of high acid output, the biofilm bacteria hibernate and wait for their next sugar meal.  Now the saliva can neutralize the remaining acid.  When the mouth is neutral, the calcium balance favors calcium uptake and so the enamel recaptures the calcium that was lost during the acid attack.

If we eat 3 meals and a snack each day our teeth are under attack for about 5 hours each day and they here 19 hours to REST and RECOVER the calcium they lost.  A good balance with good rest time.

Grazers, however, especially children, have acids attacking their teeth all day with little or no recovery time.  If a child eats 3 meals and also has a sippy cup of juice to sip (hourly) between meals, her teeth will be under attack all day.  No recovery period for the teeth to regain lost calcium.  If the child goes to sleep sipping something, it will pool in the mouth and feed the bacteria all night.  The acids are attacking all day and all night!  This is why I have seen teeth with no detectable cavity on exam or x-ray develop a cavity so large and deep it requires a root canal treatment and crown within 6 months.

Give your teeth a rest!  Eat 3 meals and a snack and give your teeth a chance to rest and recuperate between meals.  If you like sweet beverages have them with meals where the sugar and acids get buffered by the other food.  For snacks use protein (nuts, seeds, cheese) and complex raw carbohydrate (carrots, celery, cauliflower, broccoli, jicama), perhaps with a nut or cheese spread.  Calories with robust nutritional support and no simple carbohydrates to threaten teeth.  Between meal beverage?  Water.  Only water.  That is what the human body needs.

Next:  1) Setting your cavity rate early.  2) Changing your cavity rate.

Sports/Energy Drinks - Are We Addicting Our Kids to Them?

We all want more energy and more alertness on the playing field, whether it is sports, debate, cards, or just joking around.  It is not surprising the distinction between sports drinks and energy drinks is blurring.  The concerns for our youth with growing bodies and developing physiologic systems are multiple.  The sugars in these drinks are addicting enough and challenging to the insulin endocrine system.  The energy drinks, however, are fundamentally different due to many additives in them.

The most obvious concern is caffeine.  Energy drinks typically contain 10 mg (to 16 mg) per ounce.  This totals 240mg (to 390 mg) for a 24 oz. drink.  Note: The amount of caffeine necessary to create measurable physiologic changes in a full size adult is about 50mg.  Also note: Cardiac arrest (heart failure) has been anecdotally associated with drinking large energy drinks.  Although the direct causal relationships has not been proven (obviously difficult research to do if someone’s life is at risk), the implications are obvious.  For some young children with sensitive myocardium (heart muscle) the potential threat is clear and catastrophic.

Are we addicting our children's physiologic developing systems to caffeine?  The amount of caffeine for full size adults to develop an addiction is about 100 mg per day.  In a recent study of 228 families with young children, 75% of the children consumed caffeine.  For those children who consumed caffeine, the average daily consumption for 5 to 7 year olds was 52 mg and for 8 to 12 year olds it was 109 mg.  Yikes.  An additional note about caffeine for youth.  Caffeine consumption in youth age 5 to 12 has been correlated with decreased average sleep.  Sleep studies have linked inadequate sleep with ADHD type behavior.

Guarana, an additional ingredient in energy drinks contains both caffeine and guaranine, a stimulant that acts very much like caffeine in our bodies.  The amount of guaranine (nor Guarana) is not listed in these drinks.  Guaranine has documented cardiac side affects like caffeine and the medical literature recommends patients under cardiac care consult their physician before taking any Guarana supplements.  I have not seen a potency comparison between caffeine and guaranine, but the cardiac affect of the 2 is additive.  Should we be allowing our growing athletes to consume these addictive substances?

Taurine, another ingredient, an amino-acid, is more difficult to pinpoint.  The literature contains a broad list (with some warnings) of the possible effects and mechanisms of this stimulant.  Though we know it stimulates changes in physiologic function within cells, the specific results are ambiguous in the research literature.  It is added to these beverages because of its stimulant value.  It is concerning to me when I realize children with developing physiologic systems are consuming supplemental amounts of taurine.  All of these ingredients (Caffeine, Guarana, Taurine) came to us from ancient cultures in which the shaman discovered the mood altering capabilities of these herbal plants. 

Once again I come to some basic tenets of sports (and energy) drinks.

Water - the basic ingredient of these drinks - is usable and vital to our bodies.  Next time try plain water, it is nature’s best.

Sugar (fructose, sucrose) - We don't need more if we eat regular meals.  Most of us are damaged by the excess empty calories.  Children getting extra calories from beverages become picky eaters because they are not really hungry at meal time.  And they become overweight despite their activity level.

Electrolytes - If we eat real food at our meals, we don't need more electrolytes.

Energy stimulants (Caffeine, guaranine, taurine) we don't need.  A college student might appreciate it if studying late and some of us need a “wake up” in the morning.  However, our youth, including the college student and young athlete, don't need artificial stimulants (energy?) for physical activity.

Next blog: Give Your Teeth a Rest.       

Dr. Scott Thompson  - Pediatric Dentistry 

 www.winningwithsmiles.com

Sports Drinks - How to Dissolve Your Teeth

 This is about those wonderful fruity flavors.  In order to create the flavors in today’s beverages, those tangy and/or fruity flavors, the makers use fruit juice as their base or they add organic acids that come from organic juices.  Reading the label you will usually find citric, ascorbic, or malic acid; often several.  Also, there is commonly a fruit juice concentrate which will have high amounts of organic acids.

"Organic "systems are designed to maintain stability.  In other words, if nature establishes a fruit with a certain acid level, there is also a "buffering" system that holds that acid level constant.  This reserve system is huge so that living systems can resist significant insults from the outside world and still survive.  For example:  Comparing a glass of Coca Cola (inorganic) with apple juice (organic), the apple juice will require 8 times as much base (antacid) to upset the balance and neutralize the apple juice compared to the Coke.  It is this lasting power that makes it possible for sports drink acids to do so much damage to teeth.

The other crucial ingredient is how we use these drinks ... sipping.  Sports literature expounds the value of maintaining hydration during physical activity.  This has translated into sipping patterns to maintain hydration during sports.  Large bottles (lots of calories) are at game side for frequent gulps during game breaks.  The athlete is bathing her teeth in acid attack.  This frequently translates into a sipping style of hydration every day for many of us, especially our youth.  Athletes in sports that allow a hydration pack on their back are bathing their teeth continuously with enamel dissolving acids.

The most alarming example I witnessed was a patient of mine.  For 13 years this bright and personable boy had been a cavity free patient in my practice.  He is quiet, studious and has a real creative talent with computers.  He developed a habit of coming home from school, doing his homework and then his computer graphics and programming.  He was bathing (sipping) his teeth in organic acids (sports drinks and other beverages) all afternoon and evening several days a week.  In the short period between 2 regular cheek-ups his teeth deteriorated so severely he needed several crowns. And it was not cavities nearly so much as he just dissolved the enamel off of his teeth.

My simple rules of thumb.

Hydration - nature designed us to use water.

Electrolytes-we get plenty of them if we eat “real food.”

Calories.  We get enough in our meals so be careful about snacking.  Our bodies store plenty of glycogen to get us through long periods of exercise and exertion.

Next week:  Sports Drinks becoming energy drinks with dangerous implications.