Parents' and Children's Categorization of Candy are Similar: A Card Sort Protocol

American children frequently consume candy and, in excess, this may contribute to poor diets with attendant effects on obesity risk. Despite the ubiquity of candy in children's diets, parental concern about children's candy intake, and the diversity of confectionery products available, very little is known about how children and their parents conceptualize candy. Card sorting tasks offer a novel and visual technique to explore and compare an individuals' perceptions of foods and are useful where literacy is limited (e.g. young children). This study aimed to understand and compare how young school-aged children and parents categorize various candy products using a photo card sorting task. In individual laboratory sessions, children (n = 42, 5 to 8 years old) and parents (n = 35) categorized 51 types of candy based on their similarity. A cluster analysis showed that parents created more categories of candies than children (11 versus 8). For example, parents distinguished between candied fruit and candied nuts, whereas children tended to collapse these categories. However, 7 clusters were virtually identical between parents and children (93% similarity). The findings from this study can inform the measurement of candy intake and the development of education materials targeted towards parent feeding around candy.

Optimizing the management of hypoglycaemia in individuals with type 2 diabetes: A randomized crossover comparison of a weight-based protocol compared with two fixed-dose glucose regimens

AIMS

To determine whether an individualized body weight-based glucose treatment in adults with type 2 diabetes (T2DM) is more likely to resolve hypoglycaemia with a single treatment without excessive rebound hyperglycaemia compared to fixed doses of 12 or 30 g of glucose.

METHODS

Adults with T2DM were enrolled in a cross-over study. Each episode of hypoglycaemia (capillary glucose <4.0 mmol/L) was randomly assigned to 1 of 3 treatment protocols: 0.3 g glucose/kg body-weight or a fixed dose of either 12 or 30 g glucose, independent of weight. All participants received each treatment in random order for up to 15 hypoglycaemic episodes. Glucose was re-tested 10 minutes after treatment, with a repeat dose if still <4 mmol/L.

RESULTS

Mean (SD) age of the 30 participants was 68 (8.1) years, mean weight was 91.5 (16.8) kg and mean HbA1c was 58.7 (9.2) mmol/mol. Among a total of 244 episodes of hypoglycaemia, 10 participants had 15 treatment episodes and 18 participants had fewer than 10 treatment episodes. The odds ratio, adjusted for multiple comparisons, for resolution of hypoglycaemia at 10 minutes, comparing weight-based treatment and 12 g treatment was 3.2 (95% CI, 1.1-9.0), P = .009, comparing 30 g treatment and 12 g treatment was 8.9 (95% CI, 2.2-36.6), P < .001, and comparing weight-based treatment and 30 g treatment was 0.36 (95% CI, 0.08-1.67) P = .10.

CONCLUSION

In T2DM, both a weight-based 0.3 g/kg treatment and a fixed 30 g glucose treatment result in higher blood glucose than a 12 g treatment, along with increased probability of resolution of hypoglycaemia after 10 minutes. Both treatments result in an excess of mild rebound hyperglycaemia (>8 mmol/L) at 30 minutes.

Total and Free Sugar Content of Pre-Packaged Foods and Non-Alcoholic Beverages in Slovenia

Scientific evidence of the association between free sugar consumption and several adverse health effects has led many public health institutions to take measures to limit the intake of added or free sugar. Monitoring the efficiency of such policies and the amount of free sugar consumed requires precise knowledge of free sugar content in different food products. To meet this need, our cross-sectional study aimed at assessing free sugar content for 10,674 pre-packaged food items available from major Slovenian food stores during data collection in 2015. Together, 52.6% of all analyzed products contained free sugar, which accounted for an average of 57.5% of the total sugar content. Food categories with the highest median free sugar content were: honey and syrups (78.0 g/100 g), jellies (62.9 g/100 g), chocolate and sweets (44.6 g/100 g), jam and spreads (35.9 g/100 g), and cereal bars (23.8 g/100 g). Using year-round sales data provided by the retailers, the data showed that chocolate, sweets, and soft drinks alone accounted for more than 50% of all free sugar sold on the Slovenian market. The results of this study can be used to prepare more targeted interventions and efficient dietary recommendations.

[Upper abdominal pain caused by oesophageal perforation]

Boerhaave's syndrome or spontaneous oesophageal perforation is associated with significant mortality de-pending on time of diagnosis and initiation of treatment. However, the diagnosis is often delayed, as the condition mimics more frequent causes of chest- and abdominal pain. This case report describes a patient with severe upper ab-dominal and back pain following ructus in an effort to loosen a piece of candy stuck in the oesophagus. The case demon-strates, that Boerhaave's syndrome should always be con-sidered in patients presenting with acute chest- or upper abdominal pain.

Habitual chocolate consumption and the risk of incident heart failure among healthy men and women

BACKGROUND

We aimed to examine the association between chocolate intake and the risk of incident heart failure in a UK general population. We conducted a systematic review and meta-analysis to quantify this association.

METHODS AND RESULTS

We used data from a prospective population-based study, the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort. Chocolate intake was quantified based on a food frequency questionnaire obtained at baseline (1993-1997) and incident heart failure was ascertained up to March 2009. We supplemented the primary data with a systematic review and meta-analysis of studies which evaluated risk of incident heart failure with chocolate consumption. A total of 20,922 participants (53% women; mean age 58 ± 9 years) were included of whom 1101 developed heart failure during the follow up (mean 12.5 ± 2.7 years, total person years 262,291 years). After adjusting for lifestyle and dietary factors, we found 19% relative reduction in heart failure incidence in the top (up to 100 g/d) compared to the bottom quintile of chocolate consumption (HR 0.81 95%CI 0.66-0.98) but the results were no longer significant after controlling for comorbidities (HR 0.87 95%CI 0.71-1.06). Additional adjustment for potential mediators did not attenuate the results further. We identified five relevant studies including the current study (N = 75,408). The pooled results showed non-significant 19% relative risk reduction of heart failure incidence with higher chocolate consumption (HR 0.81 95%CI 0.66-1.01).

CONCLUSIONS

Our results suggest that higher chocolate intake is not associated with subsequent incident heart failure.

Goodness, gracious, great balls of fire: A case of transient lingual papillitis following consumption of an Atomic Fireball

Transient lingual papillitis is a benign condition characterized by the inflammation of one or more fungiform papillae on the dorsolateral tongue. Although it is a common condition that affects more than half of the population, few cases have been reported in the dermatological literature. Therefore, it is a condition uncommonly recognized by dermatologists though it has a distinct clinical presentation that may be easily diagnosed by clinicians familiar with the entity. We report an interesting case of transient lingual papillitis in a 27 year-old healthy woman following the consumption of the hard candy, Atomic Fireball. We describe treatment and resolution of the condition, and its recurrence following re-exposure to the identified culprit. This report further reviews the literature to illustrate the clinical manifestations, etiology, differential diagnosis, course, and treatment of this condition.

Analyses of the Erosive Effect of Dietary Substances and Medications on Deciduous Teeth

This study aimed at analysing the erosive potential of 30 substances (drinks, candies, and medicaments) on deciduous enamel, and analyse the associated chemical factors with enamel dissolution. We analysed the initial pH, titratable acidity (TA) to pH 5.5, calcium (Ca), inorganic phosphate (P_i), and fluoride (F) concentration, and degree of saturation ((pK -pI)_HAP, (pK -pI)_FAP, and (pK−pI)_CaF2) of all substances. Then, we randomly distributed 300 specimens of human deciduous enamel into 30 groups (n = 10 for each of the substances tested. We also prepared 20 specimens of permanent enamel for the sake of comparison between the two types of teeth, and we tested them in mineral water and Coca-Cola^®. In all specimens, we measured surface hardness (VHN: Vickers hardness numbers) and surface reflection intensity (SRI) at baseline (SH_baseline and SRI_baseline), after a total of 2 min (SH_2min) and after 4 min (SH_4min and SRI_4min) erosive challenges (60 ml of substance for 6 enamel samples; 30°C, under constant agitation at 95 rpm). There was no significant difference in SH_baseline between deciduous and permanent enamel. Comparing both teeth, we observed that after the first erosive challenge with Coca-Cola^®, a significantly greater hardness loss was seen in deciduous (−90.2±11.3 VHN) than in permanent enamel (−44.3±12.2 VHN; p = 0.007), but no differences between the two types of teeth were observed after two challenges (SH_4min). After both erosive challenges, all substances except for mineral water caused a significant loss in relative surface reflectivity intensity, and most substances caused a significant loss in surface hardness. Multiple regression analyses showed that pH, TA and Ca concentration play a significant role in initial erosion of deciduous enamel. We conclude that drinks, foodstuffs and medications commonly consumed by children can cause erosion of deciduous teeth and erosion is mainly associated with pH, titratable acidity and calcium concentration in the solution.

When chocolate seeking becomes compulsion: gene-environment interplay

BACKGROUND

Eating disorders appear to be caused by a complex interaction between environmental and genetic factors, and compulsive eating in response to adverse circumstances characterizes many eating disorders.

MATERIALS AND METHODS

We compared compulsion-like eating in the form of conditioned suppression of palatable food-seeking in adverse situations in stressed C57BL/6J and DBA/2J mice, two well-characterized inbred strains, to determine the influence of gene-environment interplay on this behavioral phenotype. Moreover, we tested the hypothesis that low accumbal D2 receptor (R) availability is a genetic risk factor of food compulsion-like behavior and that environmental conditions that induce compulsive eating alter D2R expression in the striatum. To this end, we measured D1R and D2R expression in the striatum and D1R, D2R and α1R levels in the medial prefrontal cortex, respectively, by western blot.

RESULTS

Exposure to environmental conditions induces compulsion-like eating behavior, depending on genetic background. This behavioral pattern is linked to decreased availability of accumbal D2R. Moreover, exposure to certain environmental conditions upregulates D2R and downregulates α1R in the striatum and medial prefrontal cortex, respectively, of compulsive animals. These findings confirm the function of gene-environment interplay in the manifestation of compulsive eating and support the hypothesis that low accumbal D2R availability is a "constitutive" genetic risk factor for compulsion-like eating behavior. Finally, D2R upregulation and α1R downregulation in the striatum and medial prefrontal cortex, respectively, are potential neuroadaptive responses that parallel the shift from motivated to compulsive eating.

Chocolate-candy consumption and 3-year weight gain among postmenopausal U.S. women

OBJECTIVE

To test the hypothesis that greater chocolate-candy intake is associated with more weight gain in postmenopausal women.

METHODS

A prospective cohort study involved 107,243 postmenopausal American women aged 50-79 years (mean = 60.7) at enrollment in the Women's Health Initiative, with 3-year follow-up. Chocolate-candy consumption was assessed by food frequency questionnaire, and body weight was measured. Linear mixed models, adjusted for demographic, socio economic, anthropomorphic, and behavioral variables, were used to test our main hypotheses.

RESULTS

Compared with women who ate a 1 oz (∼28 g) serving of chocolate candy <1 per month, those who ate this amount 1 per month to <1 per week, 1 per week to < 3 per week and ≥3 per week showed greater 3-year prospective weight gains (kg) of 0.76 (95% CI: 0.66, 0.85), 0.95 (0.84, 1.06), and 1.40 (1.27, 1.53), respectively, (P for linear trend<0.0001). Each additional 1 oz/day was associated with a greater 3-year weight gain (kg) of 0.92 (0.80, 1.05). The weight gain in each chocolate-candy intake level increased as BMI increased above the normal range (18.5-25 kg/m(2)), and was inversely associated with age.

CONCLUSIONS

Greater chocolate-candy intake was associated with greater prospective weight gain in this cohort of postmenopausal women.

Clinical observations of dental erosion associated with citrus diet and intake methods

Citrus fruits and juices are an integral part of daily diets the world over; however, excessive and frequent consumption can cause damage to the human dentition. This article describes the characteristics of destruction induced by citrus products. Related factors include the fruits' acidic nature, their inherent highly fibrous content, the method of intake, and the sites of the dentition exposed for prolonged durations. The various features of the defects resulting from the combined chemical and/or mechanical destructive potential of citrus products are demonstrated in relation to intake method. Mitigating and aggravating factors that affect the erosive process are discussed also.

Primary school-based behavioural interventions for preventing caries

BACKGROUND

Dental caries is one of the most common global childhood diseases and is, for the most part, entirely preventable. Good oral health is dependent on the establishment of the key behaviours of toothbrushing with fluoride toothpaste and controlling sugar snacking. Primary schools provide a potential setting in which these behavioural interventions can support children to develop independent and habitual healthy behaviours.

OBJECTIVES

To assess the clinical effects of school-based interventions aimed at changing behaviour related to toothbrushing habits and the frequency of consumption of cariogenic food and drink in children (4 to 12 year olds) for caries prevention.

SEARCH METHODS

We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 18 October 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 4), MEDLINE via OVID (1948 to 18 October 2012), EMBASE via OVID (1980 to 18 October 2012), CINAHL via EBSCO (1981 to 18 October 2012) and PsycINFO via OVID (1950 to 18 October 2012). Ongoing trials were searched for using Current Controlled Trials (to 18 October 2012) and ClinicalTrials.gov (to 18 October 2012). Conference proceedings were searched for using ZETOC (1993 to 18 October 2012) and Web of Science (1990 to 18 October 2012). We searched for thesis abstracts using the Proquest Dissertations and Theses database (1950 to 18 October 2012). There were no restrictions regarding language or date of publication. Non-English language papers were included and translated in full by native speakers.

SELECTION CRITERIA

Randomised controlled trials of behavioural interventions in primary schools (children aged 4 to 12 years at baseline) were selected. Included studies had to include behavioural interventions addressing both toothbrushing and consumption of cariogenic foods or drinks and have a primary school as a focus for delivery of the intervention.

DATA COLLECTION AND ANALYSIS

Two pairs of review authors independently extracted data related to methods, participants, intervention design including behaviour change techniques (BCTs) utilised, outcome measures and risk of bias. Relevant statistical information was assessed by a statistician subsequently. All included studies contact authors were emailed for copies of intervention materials. Additionally, three attempts were made to contact study authors to clarify missing information.

MAIN RESULTS

We included four studies involving 2302 children. One study was at unclear risk of bias and three were at high risk of bias. Included studies reported heterogeneity in both the intervention design and outcome measures used; this made statistical comparison difficult. Additionally this review is limited by poor reporting of intervention procedure and design. Several BCTs were identified in the trials: these included information around the consequences of twice daily brushing and controlling sugar snacking; information on consequences of adverse behaviour and instruction and demonstration regarding skill development of relevant oral health behaviours.Only one included study reported the primary outcome of development of caries. This small study at unclear risk of bias showed a prevented fraction of 0.65 (95% confidence interval (CI) 0.12 to 1.18) in the intervention group. However, as this is based on a single study, this finding should be interpreted with caution.Although no meta-analysis was performed with respect to plaque outcomes (due to differences in plaque reporting between studies), the three studies which reported plaque outcomes all found a statistically significant reduction in plaque in the intervention groups with respect to plaque outcomes. Two of these trials involved an 'active' home component where parents were given tasks relating to the school oral health programme (games and homework) to complete with their children. Secondary outcome measures from one study reported that the intervention had a positive impact upon children's oral health knowledge.

AUTHORS' CONCLUSIONS

Currently, there is insufficient evidence for the efficacy of primary school-based behavioural interventions for reducing caries. There is limited evidence for the effectiveness of these interventions on plaque outcomes and on children's oral health knowledge acquisition. None of the included interventions were reported as being based on or derived from behavioural theory. There is a need for further high quality research to utilise theory in the design and evaluation of interventions for changing oral health related behaviours in children and their parents.

[Liquorice-induced hypertension and hypokalaemia]

Consumption of large amounts of liquorice can cause hypertension and hypokalaemia. Liquorice contains glycyrrhetinic acid, which inhibits the enzyme 11 beta-hydroxysteroid dehydrogenase type 2, and ultimately leads to an apparent mineralocorticoid excess syndrome. This case report describes a 50 year-old woman presenting with hypertension and hypokalaemia-induced limb paresis due to chronic liquorice ingestion. The patient was treated with potassium supplementation and spironolactone. Her blood pressure and electrolyte status normalised within a month after cessation of liquorice intake.

[Dark or white chocolate? Cocoa and cardiovascular health]

Epidemiological data show that a regular dietary intake of plant-derived foods reduces the risk of cardiovascular disease. Recent research indeed demonstrates interesting data about cocoa consumption, with high concentrations of polyphenols, and beneficial effects on blood pressure, insulin resistance and platelet function. Although still debated, a range of potential mechanisms through which cocoa might exert their benefits on cardiovascular health have been suggested: activation of nitric oxide, antioxidant, anti-inflammatory, anti-platelet effects, which might in turn improve endothelial function, lipid levels, blood pressure and insulin resistance. This article reviews available data about the effects of the consumption of cocoa and different types of chocolate on cardiovascular health, and outlines potential mechanisms involved on the basis of recent studies.

The erosive potential of lollipops

AIM

To determine the erosive potential of several commercially available lollipops and the protective effect of saliva.

METHODS

The erosive potential of lollipops was determined in vitro by measuring the pH and neutralisable acidity. Subsequently, 10 healthy volunteers tested different types of lollipops. Whole saliva was collected 5 minutes before, 15 minutes during and 10 minutes after consumption. Salivary flow rate and pH were determined.

RESULTS

Fruit flavoured and cola flavoured lollipops have a very low pH (2.3 - 2.4). Yogurt-containing and salmiak (salty liquorice) flavoured lollipops have much higher pH values (3.8-4.7). The neutralisable acidity of 1g of lollipop showed a large variation from < 200 microl to > 1700 microl 0.1 M NaOH. In vivo, lollipops induced 2.5 to 4.7-fold increase in salivary flow rate with a concomitant drop in salivary pH. For fruit flavoured and cola flavoured lollipops the salivary pH dropped below pH 5.5. For strawberry yogurt and salmiak lollipops, the salivary pH remained above this critical value. The volunteers did not report significant differences in preferences for the lollipops.

CONCLUSIONS

Lollipops differ considerable in erosive potential, with fruit flavoured and cola flavoured lollipops having the highest risk for inducing dental erosion. This information is of use for clinicians counselling juvenile patients with dental erosion.

Prevalence and severity of dental caries in schoolchildren of Porto, Portugal

OBJECTIVES

To measure the prevalence and severity of dental caries in adolescents of the city of Porto, Portugal, and to assess socioeconomic and behavioural covariates of dental caries experience.

METHODS

A sample of 700 thirteen-year-old schoolchildren was examined. Results from the dental examination were linked to anthropometric information and to data supplied by two structured questionnaires assessing nutritional factors, socio-demographic characteristics and behaviour related to health promotion. Dental caries was measured using the DMFT index, and two dichotomous outcomes, one assessing the prevalence of dental caries (DMFT > 0); the other assessing the prevalence of a high level of dental caries (DMFT > or = 4).

RESULTS

Consuming soft drinks derived from cola (irrespective of sugared or diet) two or more times per week, attending a public school, being female and having parents with low educational attainment were identified as risk factors both for having dental caries and for having a high level of dental caries.

CONCLUSION

Caries levels were positively associated with frequency of intake of sweetened foods and drinks.

Pucker up: the effects of sour candy on your patients' oral health. A review of the dental erosion literature and pH values for popular candies

Although the harmful effects of acidic beverages on teeth have been well established and communicated through a variety of clinical articles and public education pieces, the Minnesota Dental Association's Public Relations Committee has determined that the new and emerging concern of the erosive effects of sour candy on the dentition should be brought to the attention of dental professionals and the public alike. Furthermore, since the serious irreversible damage caused by erosion is difficult and costly to treat, early detection and the initiation of preventive strategies are paramount to minimizing long-term consequences. The following article should serve as a review of the general topic of erosion, and should provide additional information about the increasing prevalence of erosion and the specific risks of sour candy consumption.

[Sugar intake and public health]

BACKGROUND

Sugar is present in simple forms such as sucrose, lactose and fructose, and in the more complex forms starch and fibre. Complex carbohydrates in foods like vegetables and less refined grain products provide energy and important additions of vitamins, minerals and fibre. We have reviewed the effects of sugars on overweight, diabetes Type 2 and caries, and the intake of carbohydrates in simple and complex forms in the Norwegian population.

METHOD

Literature was found in the databases PubMed and Bibsys, and in public statistics.

RESULTS AND INTERPRETATION

Sugars in beverages and candy only contribute with energy that can lead to an increased amount of fat in the body. High sugar intakes contribute to development of overweight, diabetes type 2 and caries. Glucose from sucrose and starch increase blood glucose levels and stimulate insulin secretion. Lack of insulin response after fructose intake can result in adverse effects on lipid metabolism and satiety regulation. Norway is one of the countries in the world with the highest intake of sweetened beverages. Preventive health measures aimed at decreasing sugar intake in pre-school and school children must include increased availability of fruits and vegetables, water and better canteens. The increased sugar intake among adolescents requires measures from politicians and authorities.

Contextualising accounts of illness: notions of responsibility and blame in white and South Asian respondents' accounts of diabetes causation

We undertook a secondary analysis of in-depth interviews with white (n = 32) and Pakistani and Indian (n = 32) respondents who had type 2 diabetes, which explored their perceptions and understandings of disease causation. We observed subtle, but important, differences in the ways in which these respondent groups attributed responsibility and blame for developing the disease. Whereas Pakistani and Indian respondents tended to externalise responsibility, highlighting their life circumstances in general and/or their experiences of migrating to Britain in accounting for their diabetes (or the behaviours they saw as giving rise to it), white respondents, by contrast, tended to emphasise the role of their own lifestyle 'choices' and 'personal failings'. In seeking to understand these differences, we argue for a conceptual and analytical approach which embraces both micro- (i.e. everyday) and macro- (i.e. cultural) contextual factors and experiences. In so doing, we provide a critique of social scientific studies of lay accounts/understandings of health and illness. We suggest that greater attention needs to be paid to the research encounter (that is, to who is looking at whom and in what circumstances) to understand the different kinds of contexts researchers have highlighted in presenting and interpreting their data.

[Acidic candies affect saliva secretion rates and oral fluid acidity]

After the observation of a 9-year-old child with dental erosion in a general dental practice, the erosive potential of acidic candies was investigated in a 4-, an 8-, and a 12-year-old child. The saliva secretion rate and the acidity of the oral fluid of these children were measured before, during and after consumption of several types of candies. Consumption of most types of candies was finished after 2 minutes approximately. During the 2 minutes, the saliva secretion rate increased to minimally 2 and maximally 3.5 ml/min, with a concomitant pH decrease to less than 5 and even to 4. These effects disappeared within 2 minutes, suggesting that frequent consumption of acidic candies may contribute to the development of dental erosion.

Effects of calcium on the erosive potential of acidic candies in saliva

Theoretical calculations have shown that acidic candies may be potentially erosive upon consumption. However, little is known about the protective effect of adding calcium to potentially erosive candies and about the protective effects of saliva that cannot be fully accounted for by theoretical calculations. Therefore, the aims of this study were to (1) determine the erosive potential of acidic candies with and without calcium and (2) to determine differences between theoretically calculated erosive potential and actual erosive potential in saliva. Twenty healthy test persons sucked acidic candy with and without calcium while their whole saliva was collected into a closed system at different times: baseline, candy-stimulated, and post-stimulated. The erosive potential of the candy was evaluated from candy-induced changes in saliva degree of saturation with respect to hydroxyapatite (HAp) and directly by dissolution of HAp crystals in candy-stimulated saliva. The results showed that similar salivary stimulation was obtained with both candies. The modified candy released more than 13 mmol/l of calcium into saliva, resulting in a lower critical pH, and considerably lower erosive potential than the control (p < 0.001). Although a significant correlation was obtained between theoretical calculation of DS(HAp) and dissolution of HAp crystals (r(s) = 0.65; p < 0.001), many samples obtained by sucking modified candy showed no signs of HAp dissolution in spite of being undersaturated. We conclude that saturation levels and critical pH may not fully reflect when dental erosion is expected to occur in saliva and that calcium addition reduces the erosive potential of acidic candies.

A seven-year survival analysis of caries onset in primary second molars and permanent first molars in different caries risk groups determined at age two years

OBJECTIVE

To investigate in a group of children (n=183) the effect of possible risk factors registered at the age of 2 years on caries development in 7 years of follow-up, and to study associations between risk groups.

MATERIAL AND METHODS

Consumption of candies, use of a nursing bottle at night, use of fluorides, toothbrushing, pacifier sucking, and prolonged breastfeeding (>or=12 months) were recorded at the age of 2 years. The timing of caries onset in different groups was compared by applying a survival analysis method--the survival curves produced separately for selected teeth in different risk groups.

RESULTS

The survival curves of caries onset for both primary and permanent molars were consistently lower for children who consumed candies more than once a week, did not brush their teeth daily, were given a nursing bottle at night or a pacifier at age 2 years. The multivariate survival analysis confirmed that consumption of candies and lack of daily toothbrushing were the factors that had the major impact on caries onset in both primary and permanent molars. Prolonged pacifier sucking (>or=2 years) was related only with short duration of breastfeeding. Children with prolonged use of a nursing bottle at night also consumed candies more than once a week, did not brush their teeth regularly, and did not use fluoride tablets.

CONCLUSIONS

Consumption of candies and inadequate oral hygiene at age 2 years are important long-term risk factors for caries development in both primary and permanent molars.

Caffeine use by children: the quest for enhancement

Fair play, both in academics and sports, is a concept that is challenged by the notion of performance enhancement. Both cognitive and physical performance can be viewed as potentially enhanceable, and arguments can be made that enhancement can serve two purposes: gaining an edge or keeping up with others (who may or may not have used performance-enhancing substances). Caffeine, a central nervous system and cardiac stimulant, is frequently used by children for both academic and athletic performance enhancement. In fact, the marketplace contains a plethora of caffeinated products marketed directly to children. This article examines safety and ethical issues associated with the use of caffeine by children and explores the question: Can cognitive performance enhancement be ethically permissible if sports performance enhancement is not?

A four-year cohort study of caries and its risk factors in adolescents with high and low risk at baseline

AIM

To report and compare risk and preventive factors for caries in high- and low-risk adolescents, from a 4-year cohort study on commonly used preventive measures for caries in adolescents in the Swedish Public Dental Service.

SUBJECTS AND METHODS

In 1995 a cohort of 12-year-olds was examined for caries and completed a questionnaire. This procedure was repeated at age 14 and 16. The group identified as being at high risk was examined every year and this group was randomly assigned to one of four preventive programs. The outcomes examined were the caries increments using the DMF-indices. Poisson regression was used to assess risk and preventive factors.

RESULTS

The number of 12-year-olds participating was 3,373 in 1995 and 2,848 were still participating in 1999. A higher risk of caries increment was observed for adolescents from working-class homes, from outside Western Europe, and for those who often ate candy and did not brush their teeth twice a day. Important findings were the different results for the preventive factors when different DMF-indices were used as outcome measures and the fact that there was no difference between the high-risk group and the total group when it came to risk or preventive factors. The clinically tested prevention had a low effect i.e., the semi-annual application of fluoride varnish prevented 10% of the dentine and enamel caries development over 4 years.

Multiple chemical sensitivities following intolerance to azo dye in sweets in a 5-year-old girl

BACKGROUND

Cases of multiple chemical sensitivities (MCS) have been reported predominantly in adult patients, but pediatric cases have rarely been reported.

METHODS

We present a 5-year-old girl who suffered from recurrent reactions accompanied by urticaria, angioedema, headaches, dyspnea, loss of consciousness, and abdominal pain that were not eradicated, but were instead exacerbated, by various treatments with antihistamines and intravenous corticosteroids. Her diet diary revealed that symptoms occurred after ingestion of colorful sweets such as candies and jellybeans. Open challenge tests with food additives and nonsteroidal anti-inflammatory drugs (NSAIDs) were performed after elimination of these items. Skin prick tests using additives and NSAIDs, which were dissolved in saline, and prick- prick tests using candies and jellybeans, were carried out.

RESULTS

Open challenge tests with Tartrazine, aspirin and acetaminophen were positive, whereas skin prick tests using additives and NSAIDs and prick-prick tests using candies and jellybeans were all negative. Consequently, intolerance to azo dyes and NSAIDs such as aspirin was diagnosed. However, she appeared to react to multiple chemical odors such as those of cigarette smoke, disinfectant, detergent, cleaning compounds, perfume, and hairdressing, all while avoiding additives and NSAIDs. On the basis of her history and the neuro-ophthalmological abnormalities, a diagnosis of severe MCS was made and she was prescribed multiple vitamins and glutathione.

CONCLUSIONS

The present results suggest that in pediatric MCS, food and drug additives containing azo dyes might play important roles as elicitors.

Effects of sucking acidic candies on saliva in unilaterally irradiated pharyngeal cancer patients

Patients who have received radiation therapy on the head and neck area often use acidic candies to relieve symptoms of dry mouth. Therefore, the aim of this study was to determine the erosive potential in relation to teeth of an acidic candy in 10 such patients. The patients sucked the candy while their whole saliva was collected into a closed system at different times: baseline, candy-stimulated, and post-stimulated. The erosive potential of the candy was evaluated from candy-induced changes in saliva degree of saturation with respect to hydroxyapatite (HAp). Previously published normative values were used for comparison. The results showed that saliva became significantly more undersaturated with respect to HAp in irradiated patients, and failed to return to baseline values during the post-stimulatory period, which it normally does in healthy individuals. Thus, prevention of dental breakdown in these patients should involve counseling regarding choice of stimulant for dry mouth relief.

[Candy sprays and -gels: effect on salivary flow and pH]

After seeing a child with dental erosion in a pediatric dental clinic the fondness and use of sweets were asked. With a questionnaire it became clear that recently various candy sprays and -gels are available to keep a sweet and fresh taste in the mouth at school. The buffer capacity of a number of sprays and gels were determined and they were tested in the mouth. The taste determines the increase in salivary flow rate. The effects of a taste stimulus on increasing the flow rate and decreasing the pH disappear within 2 until 3 minutes. Concluding: the Candy sprays and particularly the Juicy Drop Pop belong, from the dental point of view, to children sweets with high risk for dental caries and erosion. The use of these fluid sweets has to be reduced as much as possible.

Effects of Sucking Acidic Candy on Whole-Mouth Saliva Composition

Limited information is available on the effects of sucking acidic candies on saliva composition and the protective role of saliva in this relation. Therefore the aim of this study was to determine salivary effects of sucking acidic candies in vivo in relation to individual variations in whole-saliva flow rate (WSFR) and buffer capacity (WSbeta). Ten healthy young males (24 +/- 2 years) sucked a rhubarb-flavoured acidic hard-boiled candy with tartaric acid available on the Danish market. The whole saliva was collected into a closed system, regarding CO2, at different times as follows: firstly, unstimulated saliva for 5 min (baseline), secondly stimulated saliva for 4 min upon sucking the candy, and finally post-stimulated saliva for 10 min. Saliva pH was determined on a blood gas analyser and WSbeta was estimated from the saliva bicarbonate concentration obtained by the analyser and by ionic balance calculation. The erosive potential of the candy in saliva was estimated from the saliva pH values and degree of saturation with respect to hydroxyapatite (DS(HAp)). The results showed that saliva pH dropped from 6.5 (baseline) down to 4.5 at the fourth minute of sucking the candy, and returned to pH 6.5 five minutes after stimulation (post-stimulated). DS(HAp) decreased upon sucking the candy and saliva from all subjects became undersaturated with respect to HAp. Significant positive correlations were obtained between pH and WSFR (r(s) = 0.47; p < 0.05) and between pH and WSbeta (r(s) = 0.65; p < 0.01). In relation to WSbeta we found that 70% of the buffer capacity originating from the bicarbonate buffer system upon sucking the candy was exerted as phase buffering. We conclude that sucking this type of acidic candies changes whole-mouth saliva composition so that it may have erosive potential and that high WSFR and WSbeta have protective effects against these salivary changes.

Maternal Diet During Pregnancy and its Association with Medulloblastoma in Children: A Children’s Oncology Group Study (United States)

Fruit, vegetables, vitamin C, and folate during pregnancy have been suggested as protective factors for medulloblastoma/primitive neuroectodermal tumor (PNET), a common brain tumor in children. The authors sought to replicate these findings and investigate other aspects of diet. Mothers of 315 cases under age six at diagnosis and 315 controls were interviewed about their pregnancy diet. The authors observed modest, inverse associations for fruits/juices (odds ratio (OR) for highest compared to lowest category = 0.6, 95% confidence interval (CI): 0.3, 1.1) and vitamin C (OR = 0.6, 95% CI: 0.4, 1.1). In contrast to the previous study, folate and vegetables showed no association. As hypothesized, cured meats were not associated with medulloblastoma/PNET, in contrast to other childhood brain tumors. An inverse association with non-fresh peaches and similar fruits (OR = 0.5, 95% CI: 0.3, 0.8) and a positive association with non-chocolate candy (OR = 1.7, 95% CI: 1.0, 3.0) replicated previous findings. French fries (OR = 2.4, 95% CI: 1.2, 4.9) and chili peppers (OR = 1.8, 95% CI: 1.0, 3.0) were associated with medulloblastoma/PNET. The results suggest that some aspects of diet are worthy of further research.

[Sugar triggers our reward-system. Sweets release opiates which stimulates the appetite for sucrose--insulin can depress it]

The consumption of sweet food has increased in Sweden, as in other Western countries. The type of food item has changed. The sweet is dominated by soft drinks. Appetite regulation for sucrose has been described in experimental animal models. It has been found that opioids stimulate appetite for sucrose. At the same time sucrose releases endogenous opioids so that a triggering of sucrose consumption occurs. Insulin has been shown to decrease sucrose intake by blocking the opioid response. Sucrose addiction has been described in rat model. With a concentrated sucrose solution to drink an opioid dependence developed with 1) increased consumption of sucrose 2) abstinence symptoms with no sucrose and 3) anxiety with an opiate blocker. Sucrose addiction in man has not been described in the scientific literature. There is an increased liking of sweets with alcoholic persons, which may be significant to support a strongly rewarding effect of sucrose, also in man. We should limit the access to sweet foods, in particular the sweet drinks. Insulin and insulin sensitivity may be an important factor to restrict the intake of sweet food.

Assessment of Caries Risk in Preschool Children

The study aimed to assess the additional caries-predictive value of visible plaque, gingival bleeding, and the reported use of fluorides and candies, when combined with the information about mutans streptococci (MS) and incipient carious lesions. The subjects were 2 years of age at the baseline examination (n = 226), and they were all given conventional prevention during the 3-year follow-up period. None of the studied single risk indicators reached an accuracy of 80% in predicting the 3-year caries increment. At best, the accuracy was 75% for the MS strip. Use of candies and incipient caries lesions had additional caries-predictive value (multiple logistic regression analysis). The combined use of these three risk indicators resulted in an accuracy of 81%. The present results indicate that in 2-year-old children, the combination of two or three risk indicators (MS strip, incipient caries lesions, and use of candies) might have caries-predictive power enough for clinical implications.