Teens Health Crisis Has Dental Implications

The future isn’t looking so bright for the many California teens who are giving into bad eating habits and sedentary lifestyles and setting themselves up for serious health problems down the road.

Poor nutrition, inactivity and obesity are threatening the health of the next generation of adults and could lead to record rates of heart disease, diabetes, stroke, and cancer, according to the recent CalTEENS study conducted by the Berkeley-based Public Health Institute.

While the study casts a potential shadow on the future, it also sheds light on the increasingly integral role of dentists in alerting patients to the influence of these factors on oral and overall health. California dentists are among the health care professionals expressing concern about the study findings, which include:

* The percentage of young people who are overweight has nearly doubled in the past 20 years, and one-third of the state’s youth are obese or on the verge of becoming overweight. At particular risk are Latino and African-American teens.

* Of the 1,200 teens surveyed, more than 60 percent reported eating candy or drinking soda daily.

* Just 2 percent of adolescents met all five dietary recommendations in the California Daily Food Guide (see box).

* Almost half of all teens surveyed reported eating no vegetables on the survey day; 30 percent ate the minimum recommended serving of fruits and vegetables.

* Teens spend twice as much time watching television or playing video games as being physically active.

"I don’t think any observant person was surprised by the results from the study," said Carmen Nevarez, MD, MPH, vice president of external relations for the institute. "However, what was shocking and unexpected is the degree of the decline in diet and exercise. The study revealed how little exercise teens actually get and how many meals they eat out of the home."

"As dentists, we should be concerned about these findings," said Kerry K. Carney, DDS, chair of CDA’s Council on Community Health. "With the release of the surgeon general’s report and the focus on the integral approach to oral health and overall health, we need to be more aware of factors such as poor nutrition and obesity."

The institute also reports that poor eating and physical inactivity have created a new phenomenon in which type 2 diabetes is appearing in adolescents for the first time. Type 2 diabetes is directly linked to the rising rates of obesity and has been referred to as a new epidemic among minority youth.

"Type 2 diabetes used to be called adult-onset diabetes, but that term doesn’t apply any more," Nevarez said. "In findings over the last 10 years, we have gotten enough information to know that this is not a fluke, it’s a trend."

"Diabetes is of special concern because of the relationship to how well the body, including the oral cavity, heals," Carney said. "People with diabetes are also at a higher-than-average risk for developing periodontal disease."

Nevarez notes that many of the interrelated factors that contribute to diabetes are preventable. "With active intervention and support to encourage physical activity, smart food choices, and weight management, diabetes is preventable in many people."

The institute is using the study to renew support in creating a society where young people are encouraged and empowered to make healthy choices. "Dentists are in a prime position to encourage sound nutritional practices," Nevarez said. "They are often in the unique position of being the first to notice signs of a poor diet, especially one high in sugary sweets. Oral health professionals are high on the list of people who can play a tremendous role in talking to parents and young people about eating well."

Carney notes that in her practice, nutrition information is incorporated with information about plaque control. "We emphasize foods to avoid, especially sticky sweets and soda."

"It’s our responsibility to help structure an environment to live a healthy life," Nevarez said. She noted that another institute project has been involved in working with Oakland and Sacramento school districts in defeating contracts with a major soda company that was seeking to install vending machines in schools.

The American Dental Association reports that in exchange for money to the school, "pouring rights" contracts give soft drink companies the right to place their vending machines on school property and that some contracts allow vendors to take other measures to increase the

exposure of soft drinks to children. The ADA House of Delegates this year approved a resolution that, in part, opposes contracts that promote increased access to soft drinks in schools.

The study also reports that teens who have taken nutrition and health classes were more likely to report healthy eating practices. "This is a very important point," Nevarez noted. "It shows that if you give young people the knowledge they need to make smart choices, they will do so."

The entire CalTEENS study is available online at www.phi.org.

The California Daily Food Guide: Dietary Guidelines for Californians

These guidelines include special recommendations for adolescents, namely:

* Five servings or more of fruits and vegetables every day for adolescent girls and seven serving or more a day for boys;

* Four servings or more of whole grain breads, cereals, and grains per day (plus additional servings of other grains to total at least seven servings a day);

* Three servings of fat-free or 1 percent milk products every day;

* Two small servings of lean animal protein (totaling five ounces for adolescent girls and seven ounces for adolescent boys) or a vegetarian alternative;

* One serving of beans every other day; and

* One hour or more of active play or vigorous physical activity every day.

Courtesy of the Public Health Institute, 2001 Addison St., Berkeley, CA 94704, (510) 644-8200, www.phi.org.

Where Kids Get Their Fill

Outside the home, schools and fast-food restaurants are the most common places that adolescents obtains meals and snacks. Typically these food have more calories per nutrient that foods consumed at home.

* The number of teaspoons of sugar contained on one 32 oz. soda: 17

* Percent of all vegetables consumed by U.S. teens that were french fries: 25

* The amount of fat (grams) in an order of "supersized" fries: 28

* Percent of total calories eaten by adolescents that come from meals eaten outside the home: 33

* The average number of calories that soda adds to a teen’s diet: 300 to 500

* The number of calories an average cinnamon roll at the mall adds to a teen’s diet: 670

Examples of high calorie, mass-merchandised fast food popular with teens:

* BK Double Whopper (w/cheese): 1010 calories

* 7-11 Double Gulp: 800-900 calories

* Taco Bell taco salad (w/salsa): 850 calories

* Pizza Hut Supreme Personal Pan Pizza: 808 calories

* Jack in the Box fish and chips: 780 calories

* Jack in the Box Oreo cookie shake: 740 calories

* Jack in the Box chicken teriyaki bowl: 670 calories

* McDonald’s super size french fries: 610 calories

* Burger King chocolate shake: 570 calories

* McDonalds’ apple danish: 340 calories

Courtesy of the Public Health Institute

Smoke Gets in Your Eyes, Heart and Ovaries

Smoking can cause serious health problems for anyone, regardless of age or gender, but some of tobacco’s harmful effects are reserved for women only.

"Women who smoke are four times more likely to develop cervical cancer than women who don’t use tobacco," said Sandra Brooks, MD, director of gynecologic oncology at the University of Maryland Medical Center. But Dr. Brooks said a surprising number of women are unaware of the increased risk.

"Health care professionals need to make their female patients aware of the short- and long-term effects of smoking," Brooks said. "Smoking affects many cells in the human body. The longer a woman smokes, the more damage is done."

Smoking also increases the risk of infertility. "Studies have shown that tobacco use can decrease the supply of eggs within the ovaries, even in young women," said Howard D. McClamrock, MD, director of the medical center’s in-vitro fertilization program. "Doctors should urge women to stop smoking if they plan to become pregnant in the future."

Women smokers who do conceive should quit. Research links maternal smoking to underweight babies, sudden infant death syndrome, and learning and behavior problems. Despite extensive publicity about such dangers, about one-quarter of pregnant women continue to smoke cigarettes.

"Our prevention efforts need to be focused on young teenage girls because they make up the fastest growing group of new smokers," says Mary Corretti, MD, a cardiologist at the University of Maryland Medical Center. "In addition to the threat of cancer and reproductive problems, women smokers increase their risk of developing cardiovascular disease, which is the No. 1 cause of death among women."

Apnea Treatment May Alter Occlusion

Removable appliances, usually made by orthodontists, for treatment of sleep apnea may cause unexpected complications, according to a recent orthodontics journal article. Sleep apnea is a relatively recently discovered disorder that has attracted growing interest among researchers in the field of oral and maxillofacial surgery and orthodontics

The purpose of removable appliances is mostly to advance the mandible and keep it in a protruded occlusal relationship during sleep, wrote authors Kari Panula, DDS, and Katri Keski-Nisula, DDS, of Vaasa Central Hospital in Finland. More airway space is thought to be created retrolingually in the hypopharynx to reduce the obstruction that causes snoring and apnea, they explained.

These appliances are generally used in adults and therefore are not supposed to have the capacity to irreversibly change occlusion, as is the case when children are treated with activator-type appliances, the authors said. Patients can use these devices on a temporary basis to determine whether orthognathic surgery could be effective in correcting apnea problems.

A mandibular advancement appliance can be a good solution for these patients, Panula and Keski-Nisula said. However, complications can also occur. Their article reported on an adult woman who was treated with a mandibular advancement appliance and later found to develop a permanent alteration in her occlusion.

This case confirms the growing impression among researchers that mandibular advancement appliance treatment may carry the risk of remodeling changes in the glenoid fossa, even in adults. The authors ruled out alternative explanations for the occlusal change in their patient, based on clinical, radiographic and magnetic resonance imaging examinations.

For the authors’ patient, the appliance was made very thick to conveniently position the TMJs and improve retention of the appliance. Consequently, they propose that appliances be fabricated as thin as possible to promote more horizontal protrusion and prevent counterclockwise rotation.

The article appeared in the International Journal of Adult Orthodontics & Orthognathic Surgery, Volume 15, No. 3, 2000.

Educating Parents Key to Reducing Fluorosis

Young children brushing their teeth with parental assistance were found to ingest a significantly higher amount of dentifrice than those brushing by themselves, according to a study in the September/October 2000 issue of Pediatric Dentistry.

The study was performed to assess the actual amount of dentifrice used and ingested among 28 U.S. preschoolers.

The prevalence of permanent tooth dental fluorosis has increased in fluoridated and nonfluoridated communities in North America, according to the article. Even though most of the increase has been in milder forms and may not be considered a public health problem, the authors commented, it can be considered an esthetic problem, especially in anterior teeth.

Early use of fluoride dentifrice has been documented in a number of studies as a risk factor for dental fluorosis, the authors state. Almost all dentifrices sold in North America are fluoridated.

Most children start brushing by the age of 18 to 24 months. Although earlier reports have agreed with this study’s finding that the amount of dentifrice used is the strongest determinant of the amount ingested, few recent studies have been conducted on the amount of dentifrice actually used by preschoolers. And no U.S. study has been published that assessed other factors associated with dentifrice use and ingestion among preschoolers, they add.

These authors found that their study participants ingested a mean of 62 percent of the dentifrice used per brushing, and the amount of fluoride ingested was significantly associated with the amount of dentifrice used. The amount of fluoride ingested did not differ according to the age or gender of the child, mother’s age or education, family income, dentifrice flavoring, total brushing time, number of times the child expectorated, or number of rinsings.

According to the article, the fact that children who had parental assistance while brushing ingested more fluoride than those who brushed by themselves may have been due to longer brushing, along with parents’ desires to achieve excellent oral hygiene and caries prevention for their child, coupled with a lack of knowledge regarding fluorosis and fluoride ingestion.

The authors recommend that dental professionals educate parents about using small amounts of fluoride dentifrice and ways to avoid having children ingest it.

Reduced Bite Force a Problem for Elderly

As patients age, their bite force and salivary flow rates decrease, according to an article in the August 2000 Journal of Dental Research. The article also highlights the importance of maintaining healthy dentition, capable of masticating a variety of food textures, as a solid defense against oral disease.

The authors of the study state that this is the first direct investigation of the association between bite force and salivary flow rates and note that bite force is directly correlated with salivary flow, regardless of a patient’s age or gender. The 399 study subjects were residents of San Antonio, Texas, who were participating in the Oral Health: San Antonio Longitudinal Study of Aging.

Bite force is involved in the mastication of food, and the forces required to chew food are related to the firmness of the diet, according to the article. Age-related decreases in bite force and salivary flow rates may relate to an overall decrease in masticatory function associated with a reduced caloric intake, loss of teeth and the wearing of dentures, oral pain, or periodontal disease, the authors noted.

The size of the masseter muscle is a factor in muscle strength and therefore the magnitude of force that can be applied during a clenching cycle, the authors said. Previous studies have shown that masseter muscle size decreases with increasing age, and this decrease in muscle size may be related to a reduction in masticatory force as individuals age.

A growing number of faculty researchers report financial relationships with industry sponsors beyond grants for an individual research project, according to an article in the Nov. 1 issue of the Journal of the American Medical Association.

Elizabeth A. Boyd, PhD, and Lisa A. Bero, PhD, of the University of California at San Francisco School of Medicine, conducted a case study using data from disclosure forms and official documents maintained by the administrator of conflict of interest policies in the UCSF Office of Research Administration. The university is a major research institution with more than 12,000 faculty and staff, and it ranks among the top five in National Institutes of Health funding. The authors assessed the extent to which faculty researchers have personal financial relationships with the sponsors of their research, the nature of those financial relationships, and efforts made at the institutional level to address disclosed financial relationships and perceived conflicts of interest.

According to background information cited in the study, academic institutions receive about $1.5 billion from industry each year. While a growing number of academic researchers receive industry funding for clinical and basic research, little is known about the personal financial relationships of researchers with their industry sponsors.

The authors examined UCSF disclosure forms and other documents dating from December 1980 through October 1999. "By 1999, almost 7.6 percent of faculty investigators reported personal financial ties with sponsors of their research," they wrote. "Throughout the study period, 34 percent of disclosed relationships involved paid speaking engagements (from $250 to $20,000 per year), 33 percent involved consulting agreements between researcher and sponsor (from less than $1,000 to $120,000 per year), and 32 percent involved the investigator holding a position on a scientific advisory board or board of directors." Fourteen percent of cases involved investigators reporting equity in the sponsoring company, and 12 percent involved multiple relationships.

The UCSF Chancellor’s Advisory Panel on Relations With Industry made decisions regarding the presence or absence of conflicts of interest and recommended management strategies to mitigate or eliminate conflicts. "The advisory panel recommended managing perceived conflicts of interest in 26 percent of the cases, including recommending the sale of stock, refusing additional payment for talks, resigning from a management position, or naming a new principal investigator for a project," the authors reported.

The authors asserted that specific guidelines regulating faculty relationships are lacking, even as these types of financial relationships and their accompanying risks to research integrity are likely to increase. "Thus, our findings raise questions for university, state, and federal policymakers who are concerned about enforcing consistent standards of behavior among faculty researchers," they wrote.

"Guidelines for what constitutes a conflict and how the conflict should be managed are needed if researchers are to have consistent standards of behavior among institutions," they conclude.
The study was funded by grants from the Industry-University Corporate Research Program; the University of California Office of the President; and the Office of the Vice Chancellor for Academic Affairs, University of California, San Francisco.

Web Watch

California Dental Association

CDA maintains a comprehensive database for its members as a member benefit. A log-in name and password are required for access. Instruction on obtaining those can be accessed by going to the CDA homepage, www.cda.org and clicking on the "Members Only" button.

The following are the main buttons at the CDA member homepage, www.cda.org, and highlights of the information available from those pages.

Publications

Online versions of the Journal of the California Dental Association and CDA Update.

Professional Development

Information on Sessions; risk management classes; continuing education, including online courses; licensure; and staff training.

Legislation & Regulations

Information on CDA Legislative Day, CalDPAC, legislators, and election results.

CDA Marketplace

Journal classified ads, the ADA and CDA product catalogs, and CDA subsidiary services.

Membership Benefits

Information on peer review, including the manual; direct reimbursement, the relief fund, chemical dependency, dues, ethics, and the Regulatory Compliance Manual.

Honors

Robert L. Merin, DDS, MS, (photo) has been named Dental Alumnus of the Year 2000 by the University of California at Los Angeles School of Dentistry.

Myron J. Bromberg, DDS, (photo TK) has been recognized with the Academy of General Dentistry’s Distinguished Service Award.

Richard D. Udin, DDS, (photo) received an honorable mention from the American Society of Association Executives Gold Circle Awards for his article "Newer Approaches to Preventing Dental Caries in Children," which appeared in the November 1999 issue of the Journal of the California Dental Association.

Paul Glassman, DDS, (photo) has been appointed assistant dean for information and educational technology at the University of the Pacific School of Dentistry. Richard Fredekind, DDS, (photo) has been named acting assistant dean for clinical services at UOP. Jeffrey S. Kirk, DDS, has been named group practice administrator of UOP’s third-year clinic. Larry Loos, DDS, and Marc Geissberger, DDS, have been named co-chairs of the newly formed Department of Restorative Dentistry at UOP.

Upcoming Meetings

2001

Feb. 9-10 Interdisciplinary Care Conference, Dallas, (314) 993-1700, Ext. 260

Feb. 21-22 American Equilibration Society 46th Annual Meeting, Chicago, (847) 965-2888, www.occlusion-tmj.org.

Feb. 28-March 4 American Academy of Dental Practice Administration Annual Meeting (open to nonmembers), San Antonio, Texas, (800) 689-7515

March 4-10 U.S. Dental Tennis Association Spring Meeting, Longboat Key, Fla., (800) 445-2524

March 21-24 Academy of Laser Dentistry 8th Annual Conference & Exhibition, (954) 346-3776, www.laserdentistry.org

April 19-22 CDA Scientific Session, Anaheim, (916) 443-3382, Ext. 4470

May 4-8 Australian Dental Congress, Brisbane, +61 (0) 7 3369 0477

May 18-20 California Society of Periodontists, San Francisco, (805) 962-7144

Sept. 14-16 CDA Scientific Session, San Francisco, (916) 443-3382, Ext. 4470

To have a meeting included on this list, please send the information to Upcoming Meetings, CDA Journal, P.O. Box 13749, Sacramento, CA 95853 or fax the information to (916) 443-2943.