Fluoride: boobs and bottles

Type ‘fluoride’ into Google and you’ll very quickly come across a large number of anti-fluoride lobbying groups. Some of the effects they claim that fluoridation has to humans is an increased risk of down’s syndrome, brittle bone disease, alzheimers and death. The actual known effects of fluoride are quite positive in small, controlled doses which we mainly get through dental products and water fluoridation.

I could bore you with all the research on the positive effects of fluoride but I’m feeling kind, so I won’t.  Basically, fluoride ingested when teeth are developing changes the way the enamel is laid down making it harder, more impervious to acid-pooing bacteria and less full of nooks and crannies. So instead of the biting surfaces looking like the crevices of a dried up river bed, they look more like a smooth bowl with less hidey holes for little critters.

When too much fluoride is added into the mix then fluorosis can occur which can alter the appearance of the teeth. Considering fluoride is pretty abundant on earth, it is very likely you’ll come into contact with it regularly through foods, bottled waters, tap water and the obvious, dental products. #1. What does this mean for your boob or bottle-fed baby’s developing gnashers? #2. What does it mean for your toddler (like mine) who loves to suck the toothpaste from the tube when you’re not looking?

Research suggests that very little fluoride passes into boob juice and levels are lower than that found in cow’s milk (and cows don’t even brush their teeth). Therefore, the risk of your infant developing fluorosis if you’re boobing, is almost nil, even if you’re living in a fluoridated area.  The risk increases slightly with formula milk, especially if the water used to make up the feeds is fluoridated. Powdered formulas generally contain higher fluoride concentrations than ready-to-use formula and soy-based formulas contain higher concentrations than cow’s milk formulas.

That all sounds rather dramatic for formula users but fluorosis has a number of categories and the increased risk being researched is for ‘mild fluorosis’, which is sometimes barely noticeable white specks on the teeth. For more severe fluorosis to occur, children need to be excessively exposed to fluoride, critically between the ages of 1 and 4, when most infants have weaned onto low fluoride cow’s milk anyway. If you live in an area of water fluoridation and are still using formula milks, especially soy-based ones after 12 months of age, then you can reduce fluoride intake by using bottled water that is labelled “purified” “distilled” “deionized” “demineralised”.

Something that can make the teeth look like they have fluorosis is dehydration. If you notice your little one has white mottled specks on their teeth first thing in the morning, especially if they’ve been a bit bunged up with a cold, you may just be seeing natural speckling in the teeth that becomes more apparent when the teeth are dehydrated. Have another look after they’ve eaten breakfast and had something to drink.

White spot lesions more associated with demineralisation or the early stages of decay can also look very similar to fluorosis. However, fluorosis tends to appear on the incisal edges of teeth whereas decay tends to start at the gumline or at the contact points between the teeth.

Now let’s look at #2 first. Dental products are still the most common source of fluoride overexposures as they’re usually left unsecured on the bathroom sink. “…ingestion of only 1.8 ounces of a standard fluoridated dentifrice (900-1,100 mg/kg) by a 10-kg child delivers enough fluoride to reach the ‘probably toxic dose’ (5 mg/kg body weight).”  To me, that sentence may as well be in Japanese. I work in old money so I’ve translated it for those like me. A 10 kilo child is about 1.5 stone – a toddler. 1.8 ounces (approx 50g) equates to about 50ml and looks like this:

Approximately two and a half tubes of sample sized toothpaste. Now, my boy loves the taste of toothpaste but that is a serious amount of toothpaste to consume considering it is very gloopy and overpowering in taste. I used to secretly eat toothpaste (and dog biscuits) but I could only cope with a very small amount. Could this secret toothpaste eating obsession cause fluorosis?  Yes, especially if fluoride intake is high elsewhere.

Fluoride has a very valid place in improving the oral health of our little ones and dental fluorosis is really about aesthetics rather than damage. However, I think it’s important we respect the potential harm of fluoride in toothpastes and mouthwashes and keep it out of reach of curious fingers at all times as death by fluoride overdose, although now very rare, is a particularly unpleasant one.

Some parts of the world have naturally occurring fluoride in the water. If you’re unsure, a quick google search should reveal the fluoride status of your hometown.

Tits, Teeth and Tobacco

I used to smoke.  I classed myself as a ‘social smoker’. This basically meant never buying my own cigarettes but would happily smoke several packets of someone else’s fags at a weekend.  Technically not smoking. I didn’t buy them.

My last memory of smoking was taking a few drags of someone’s cigarette after several large glasses of red wine.  The red wine ended up being ejected violently down the toilet mere seconds after the head rush had caused my stomach to reject it’s ruby refreshment. That was over four years ago.

Smoking gets bad press. Cancer, emphysema, stroke, heart disease, amputation.  This ‘one size fits all’ health message doesn’t cause people to race in their droves to the nearest chemist to jack up on nicotine-laced alternatives, but instead tends to steer smokers towards testing their associated mortality. “My nan smoked until she was 103 and was running marathons up until a week before she died.” “I’ve smoked since I was 4 and have never had a chest infection in my life.” “I could get hit by a bus tomorrow.”

I grew up in a very smoking-friendly atmosphere.  Visiting grandparents consisted of sitting into a smoke-filled living room, chatting and playing games.  I remember being fascinated by the way the smoke rose up from the firey tip and how my grandmother let her ash drop onto the floor.  I would obsessively try and predict the exact moment the spent tobacco would break free from the crisp, white smoke, silently disassembling on the carpet. I remember making an ashtray in primary school for my Nan and Grandad and buying matchsticks as a present on a school trip.

Despite my own fond memories of familial smoking paraphernalia, plus my own occasional dabble, I have become vehemently opposed to the mere wisp of a cigarette-related chemical near my own children and around my general person.

Despite there being a number of unfavourable outcomes to smoking during pregnancy and breastfeeding (and bottle feeding for that matter – passive smoking occurs no matter how you feed your babies. And yes, I extend that to grandparents. Cough cough, splutter splutter), research still suggests that the benefits to boobing outweighs the risks of smoking whilst breastfeeding. However, it should still be actively discouraged due to the difficulties babies have in metabolising the nicotine in their newborn livers.

The risks to infants are listed as increased irritability, sleep disorders, increased weight gain, ear infections, chest infections, hypothyroidism and vomiting, just to name a few. These are all just risks as it is difficult to categorically state that something was definitely caused from smoking.

My job involves staring into people’s mouths, several hundred times a month.  I would say I see a larger proportion of smokers to non-smokers, probably because of stain-removal requirements and increased incidence of gum disease.  In the ten years of mouth staring, I have noticed a few definites, backed by research, of which I would like to share:

Smoking does not guarantee dentures. It doesn’t always guarantee tooth loss. However, the cigarette you put out about 3 minutes prior to entering the surgery still smells as strong as when you first lit up, thus violating my nostrils for the entire appointment. Even through my mask. It also makes the room smell like a fag bin for the following patient.

Instead of having the texture of a crisp, firm grape, your gums will resemble orange peel and will feel as rubbery to probe.  The leathery gums will be unnaturally rigid and hide a bounty of treasure underneath, normally in the form of rock-hard tartar that has absorbed all the noxious chemicals and will too emit it’s own micro-odour.  The toxic tartar will have the tenacity of builder’s cement but you’re very unlikely to be aware of it’s existence because the body’s usual warning signs, such as bleeding and inflammation, will be severely inhibited by the constriction of local blood vessels.

You do not have nicotine staining. The brown stain that coats your teeth and tongue is the tar from the tobacco. Despite my best efforts to remove it every four months, so you look acceptable to the rest of the human race, there will come a point when I can no longer polish it off and the stain becomes absorbed into the tooth’s natural structure. Sorry about that.

More worryingly, there have been three occasions where I have noticed the tongue looking unusually blue.  All three patients went on to have heart attacks in the following twelve months.

Talking of tongues, this happens. Your poor tastebuds get smothered under a heavy film of brown sludge. (Now imagine the delights of oral sex with a smoker.)

If you have ever contemplated quitting smoking, don’t do it for your improved health. Don’t do it to stop lining the greedy, taxing, politician bastard’s pockets. Don’t even do it for your baby’s newborn lungs. Do it for me. Do it for all hygienists. Because just sometimes, it is soul destroying spending the day polishing turds.

Night nursing and tooth rot.

A question I have been asked many times in the past is whether frequent night feeding increases the risk of tooth decay.

Presuming we’re talking about boobing, this is what happens in my brain when I get asked that question:

My head theory says no.  Because despite there being risk factors associated with regular intakes of boob juice, because it does contain sugars as such, boob juice sugars are not classed as cariogenic – translation: not a priority meal for the acid pooing bacteria that melts teeth.  Well certainly not in the same way that Non-Milk Extrinsic Sugars (NMEs) are cariogenic. Plus, from what we know about how babies feed from the boob, the nipple gets taken too far back in the mouth to interfere with any of the little teggers.  Shame those sharp little pearly whites don’t have the same respect for the fragile and sensitive nipplet when they decide to have a nibble.

Kellymom, as usual, has a reasonably good page on the subject. However, research is pretty low on the ground.  Systematic reviews do show no correlation between breastfeeding and tooth decay, even prolonged breastfeeding.  Probably because regular intake of NMEs has a far more devastating effect on tooth enamel than breastmilk or formula milk (unless the formula milk contains sugars/syrups which some do so check the ingredients. The market leaders won’t contain harmful sugars.)

A very recent piece of research looked into the flora and fauna of the mouth between boobing babies and formula babies by testing their saliva.  It noted that babies receiving partial or exclusive boob milk showed signs of increased incidence of Lactobacilli, indigenous to boob milk, which suppresses the main bacteria that causes tooth decay – translation: boob juice contains a bacteria that stops tooth decay. However, it wasn’t found in all boobing babies, only 30% of the 70 or so babies included in the study.  Why didn’t all the boobing baby’s saliva show up this decay-reducing bacteria? Is it more to do with the genetics of the saliva having the ability to house Lactobacilli – translation: are some people’s saliva naturally better at warding off tooth decay and therefore they pass that down to their baby? Bottle feeding has shown an increased risk of tooth decay in infants, but is there any evidence to compare babies bottle fed formula or babies fed expressed breast milk?

As well as the large number of different immune cells, boob juice contains a protein called Lactoferrin, which wards off decay-causing bacteria.  However, this is also naturally found in saliva which leads me back to the “are some people’s saliva naturally better at blah blah blah” question.

So here is my own conclusion:

Regardless of whether you boob or decant, how many fillings do you have? Have you ever been told you have ‘weak enamel’? Were your fillings really down to your weak enamel or down to a shit load of Haribo?

Advice: Genetics plays a big part so keep sugar to an absolute minimum. Try and attempt a twice daily brush with a baby toothbrush and a smear of toothpaste.  It doesn’t have to be vigorous and can even be just baby chewing on the toothbrush to begin with.  Preferably before breakfast and before bed.

Do you boob frequently at night?

Advice: Brushing teeth before bed will be more important especially with a smear of toothpaste.  Baby can be left to chew toothbrush but make sure chewing on teeth and not just on gums.  If baby doesn’t tolerate brushing, try just smearing some toothpaste around the teeth with a muslin cloth.

Does your baby regularly bottle feed at night?

Advice: Regardless of boob juice or formula, try to avoid leaving baby with the bottle.  As much as this is a pain in the arse, the baby may not finish all the milk at once and may leave milk pooling in the mouth.  This will increase the contact time of the milk sugars against the teeth and therefore increase the risk of decay. Brushing teeth before bed and first thing before breakfast with a smear of toothpaste will be very important.

Does your baby prefer bottles to sippy cups and beakers?

Advice: Occasional treats are completely fine especially at mealtimes.  I give my children apple juice as a special treat. Aren’t they lucky. However, do try to avoid anything other than milk or water in bottles/sippy cups/beakers.  Drinks are often sipped very frequently throughout the day and anything other than milk or water will dramatically increase the incidence of tooth decay. 

So in a nutshell – brush teeth regularly/allow baby to chew a toothpasty toothbrush.  Be more fastidious the morning after the marathon night feeding session.  Keep NMEs in the diet to a minimum.

This is the same advice I would give any parent – boobing or not – baby, infant, toddler or child.

I’m not entirely sure whether this answers the original question. But at least you got to see a diagram of what the inside of my head looks like.

Have your cake and eat it

After reading this article about debunking the truth about breastfeeding weight loss, I felt my hackles rise.  A defensive response I know only too well but one I haven’t felt for a while.

Obviously, looking at photos of Kate’s stupidly smooth and flat stomach is enough to make anyone feel outraged.  Stupid princess.  With her stupid princess face and stupid princess skinny body.

Boobing was cited at the reason her weight has ‘melted away’.  I’m sure there are plenty of boobing mothers out there revolting at the fact their weight hasn’t just melted away, as they melt their way through their organic Green & Blacks, fantastically silky smooth 100g milk chocolate bar (545 cals).

A 2007 Cochrane study (which is a review of lots of studies) on postpartum weight loss discussed whether it was diet and/or exercise that was most important in losing the pregnancy podge.  It looked, in great detail, at all matters breastfeeding.

“Decline in physical activity and increase in caloric intake above the ordinary demand of lactation may explain why some breastfeeding women fail to return to pre-pregnancy weight.”  No shit, Sherlock. That’s because they’re suffering with DMF and having to force another cake in their face hole just to fire the synapses up enough to aid the decision; cardigan or coat?

Some studies suggested malnutrition lowered milk production. Some studies showed that a slight decrease in calories increased milk production.  Some studies showed that exercise had no adverse effect on milk production.  Some studies showed that exercise possibly makes your milk taste a bit weird and cause the baby to say, “what the frick have you been up to? Get back on the sofa and work out that packet of chocolate hobnobs. Pronto.”  A lot of studies, all saying not a lot.

It concludes, “The results suggest diet or diet plus exercise are effective strategies in reducing body weight.” *Sighs*

Another review of literature published this year says, .“..of the five studies that were considered to be of high methodological quality, four studies demonstrated a positive association between BF and weight change. This systematic review highlights the difficulties of examining the association between BF and weight management in observational research. Although the available evidence challenges the widely held belief that BF promotes weight loss, more robust studies are needed to reliably assess the impact of BF on postpartum weight management.”

So on one hand, it says boobing does effect weight loss, but then it disparages this by saying the type of research carried out to get this information is a bit crap.

So here is my summation of the breastfeeding/eating/weight loss subject:

You burn approximately 500 calories when breastfeeding.  According to this website which suggests 50 ways to burn 500 calories, that is equivalent to 2 hours housework, 2 hours and 10 minutes of guitar playing and 2 hours of playing frisbee.

Burning 500 calories a day will help you lose one pound a week – that’s three months to lose one stone.  Considering the average weight gain during pregnancy is 25-35 pounds (22 of which is baby, blood and boobs apparently), that means, on average you have 13 extra pounds after VDD (Vaginal Destruction Day) to lose and that’s if you were sensible when pregnant and not taking full advantage of eating an extra portion of cheesecake because ‘the baby wanted it’. So whatever way you look at it, don’t expect too much for at least three months. The article points out Kate’s post baby body 89 days after VDD (although she has a princess vagina so it was probably back to pre-pubescent tightness before she’d finished delivering the placenta, which was also perfect). By my reckoning, that’s about three months.

500 calories is also equivalent to 11 Jaffa Cakes or 8 Chocolate Bourbons or 6 Chocolate digestives or a 100g bar of Cadbury’s Dairy Milk.  All of which I have probably consumed in one evening of cluster feeding.

So, you see what I’m saying….is it isn’t rocket science.  It’s not because breastfeeding has failed you. The rules are the same, breastfeeding or not – if you input more than you expend, then the baby blub won’t shift.  Eating more doesn’t increase your milk supply or quality of your milk as is still (frustratingly) advised by health professionals, and the extra 500 calorie allowance doesn’t actually go that far when you live on a breastfeeding diet of cake and biscuits.

However, should you really want to treat yourself (and your boobee) to a Starbucks grande whole milk white chocolate mocca with whipped cream….. you can. Just this once. (500 cals).

http://www.huffingtonpost.com/2012/04/18/south-korea-nsfw-oreo-ad_n_1435898.html

Down in the mouth

Mouth cancer awareness month is not until 1st November.  However, a recent article in the newspaper reporting a story of a women with oral cancer inspired me to write something a little sooner.

The story involves a 34 year old mother of three boys, who would have been put into a low risk category by her GP and dentist because of her general health, low alcohol intake and non-smoking status.  But this shows that although very rare, especially in those under 50 and even more so in women, mouth cancer is on the increase and so it is becoming vitally important to be aware of any changes that may have occurred in your mouth.

The mouth is the gateway to the inside of your body and can show a whole host of systemic problems that may be occurring elsewhere inside you.  The Chinese have mastered the art of diagnoses from looking at your tongue as changes to the colour and surface can reveal a lot about your general health.  For example, other systemic issues that can present themselves orally are Crohn disease, chronic liver disease, vitamin deficiencies, diabetes, HIV, leukaemia and sarcoidosis, just to name a few. Or it could just be plain old ulcers and a bit of stress which in the vast majority of cases, is exactly what it will be.

A great web page I have found for what oral cancer looks like, is the oral cancer foundation website with its large gallery of photos – some of oral cancer, some not. What is quintessentially important from looking at these images is the realisation that the appearance of oral cancer is hugely varied and can occur anywhere in the mouth.

The reason why it is SO important not to ignore ANY lesion that has not healed within two weeks is because that is how long it generally takes for the mouth to completely recover from a trauma – i.e. complete cell turnover takes 10-14 days.  Just like on the outside of our body when we lose skin cells and the body makes new ones, the skin on the inside of our mouths regenerates very quickly.  This works as a protective mechanism against harmful agents that might be trying to invade us.  The soft skin in our mouths can also build up hard skin like the soles of our feet through constant trauma like cheek biting or from continual exposure to heat and chemicals from smoking.  So when a cell does start to mutate and not grow as it should, things can get out of hand very quickly.  Hence, the two week window of review.

Dentists diagnose more cases of oral cancer than doctors.  If you have a good dentist/hygienist/therapist, they should be carrying out a least an 8-point examination for oral cancer screening.

If you have an excellent dentist/hygienist/therapist, they will also carry out checks around your jaw and neckline for any enlargements of your lymph nodes just as a routine check, before even looking at the teeth.

You can also check your own mouths once a month, looking and feeling for lumps with your fingers.

Although this will all sound very scary, we have to keep this in perspective.  I have practised for nearly ten years and although have referred a large number of patients to the dentist, that have ended up having lesions biopsied, none have turned out to be cancerous.  When I trained, I was told that If I was to practice for thirty years, the chances of me seeing a patient developing any malignancies in their mouth is incredibly low.

At the moment, treatment for oral cancer is pretty brutal, life changing and intensive.  But there is hope for the future and it comes in the form of HAMLET.  A protein found in, yes you’ve guessed it, human milk.

HAMLET stands for Human Alpha-lactalbumin Made Lethal to Tumor cells.  What they discovered is this human milk protein on it’s own, did not have much effect on bacterial or tumour cells, but added to fatty acids found in human milk, it became activated into a tumour killing machine by climbing inside the tumour cell and setting off a time bomb for the cell to slowly deactivate, giving the immune clean up cells a chance to mop up the dying tumour cell without its hazardous innards spilling out and causing damage to healthy cells around it.  Beyond clever.  But what is even cleverer is they have found that HAMLET has shown the ability to kill 60 different type of tumour cells, including those that cause mouth cancer.  It seems they work especially well on tumours of the mucous membranes which can be anything from mouth to bowel.  Entrance to exit.

So, what can we learn from the story about Natasha, the 34 year old Mum? Well it has taught me not to be complacent – not to just presume that a young, fit and healthy patient is low risk and therefore won’t need to be checked as thoroughly or to dismiss a lesion because it is unlikely in their case.  Despite it’s rarity, If I can do anything to wage the war on oral cancer, it will be to do my job properly, for every patient.  And that is what I will be doing from now on regardless of their ‘risk’.

What can you do? Make sure your dentist is checking your mouth properly.  Don’t be afraid to call them out if you don’t think they have. Check your own mouths once a month and don’t hesitate to get it looked at if you’re unsure.  Be aware that risk factors do include high alcohol intake and smoking.  Avoid mouthwashes with alcohol – there are plenty of alcohol-free ones on the market. But what ever you do, if you do find an ulcer, don’t be tempted to do this….unless you have permission of course.

Who are you calling Dummy?

The wonderfully, divisive dummy debate.

Pacifiers. Non-nutritive sucking.  Transition objects.  Dummies.  Whatever you call them, they have been extensively researched.

This is a perfect tits and teeth subject because it affects both so greatly.  As always, here are the facts to help you decide whether to use one at all and a few tips for weaning off:

The arguments for the use of comforters of the oral variety are:

  • There is evidence that is can reduce the incidence of SIDS
  • There is a suggestion that is encourages self-soothing
  • Easier to wean off than finger/thumb sucking
  • Shorter stays in hospital for preterm babies
  • analgesic (pain-relieving) effects when undergoing immunisations, heel pricks etc

Now the arguments against.  There are a lot of them so hold onto your pantaloons people, it’s going to be a bumpy ride.

  • Evidence suggests that babies that use pacifiers don’t breastfeed for as long (no this doesn’t belong in advantages)
  • Evidence suggests that babies that use pacifiers may have feeding cues missed which can lead to a lower milk supply (in boobs, not in the fridge) and slower weight gain
  • Evidence suggests exclusive breastfeeding reduces the chance of SIDS by 50% and possibly higher so may even negate the use of a pacifier altogether
  • Evidence suggests a baby using a pacifier has exactly the same sleep-wake patterns as a baby that doesn’t use a pacifier
  • Don’t have the worry of weaning off unless they start finger/thumb sucking in which case amputation of thumbs or fingers is advised with no ill effect to dexterity.  (Clearly a joke.  Do not attempt to remove your child’s digits or you will almost probably be imprisoned.)
  • Evidence suggests that pacifiers and bottle feeding leads to abnormal development of the muscles, palate and teeth – weaker muscles can lead to speech issues; narrowing of the palate and wrong alignment of the teeth can cause openbites or what is affectionately termed as ‘goofers’.
  • Hicklety picklety teeth (also very technical terminology) and openbites (where the teeth don’t close together properly) can lead to lip incompetence (where the lips don’t close together properly) which in turn can make the mouth dryer and more prone to decay and gum disease.
  • Use of pacifiers beyond the age of 3 has an increasingly harmful effect on the developing teeth and beyond the age of 5, it’s impossible to tell if they will even still be human.
  • There is evidence that pacifier use is strongly linked to ear infections
  • There is evidence that pacifier use increases the risk of tooth decay due to bacterial colonisation (they’re just shitting all over the place)
  • There is evidence that pacifier use is linked with more frequent cases of diarrhoea (the bacteria again).
  • There have been cases of asphyxiation when teats become detached – not going into this any more, enough said already.

Now that your fountain of generic mothering guilt has reached Bellagio heights, before you start reaching for the birch leaves to thrash yourself with, let’s look at ways to wean off.

You could say the dummy monster has eaten it and if they cry then the monster will eat them too.  A bit harsh?  Ok, a couple of good ideas I’ve seen are the ‘giving away’ ideas (creative lying I call it).  This can be that on a given day, that the child has been pre-prepared for, the dummies are taken to be donated to other babies.  I quite like the idea of taking them to a local hospital and donating them to new babies and then take them out for a reward for their good deed.  The other ‘creative lying’ method I quite like the sound of is getting a local toy shop to except dummies as currency.  Clearly, you have to pay with real money beforehand.  A poundshop would be good as everything is the same price (obviously), which makes it simpler.

Then it’s just the small matter of getting them to sleep without it – like a hit and run, this is where I abandon you and wish you luck.  *Repeats mantra* “Short term pain, long term gain…short term pain, long term gain…short term pain, long term gain.”  Let me know how it goes….