Effects of breastfeeding and sucking habits on malocclusion in a birth cohort study

OBJECTIVE

To estimate the prevalence of malocclusion and to examine the effects of breastfeeding and non-nutritive sucking habits on dentition in six-year-old children.

METHODS

A cross-sectional study was carried out nested into a birth cohort conducted in Pelotas, Southern Brazil, in 1999. A sample of 359 children was dentally examined and their mothers interviewed. Anterior open bite and posterior cross bite were recorded using the Foster & Hamilton criteria. Information regarding breastfeeding and non-nutritive sucking habits was collected at birth, in the first, third, sixth and 12th months of life, and at six years of age. Control variables included maternal schooling and child's birthweight, cephalic perimeter, and sex. Data were analyzed by Poisson regression.

RESULTS

Prevalence of anterior open bite was 46.2%, and that of posterior cross bite was 18.2%. Non-nutritive sucking habits between 12 months and four years of age and digital sucking at age six years were the main risk factors for anterior open bite. Breastfeeding for less than nine months and regular use of pacifier between age 12 months and four years were risk factors for posterior cross bite. Interaction between duration of breastfeeding and the use of pacifier was identified for posterior cross bite.

CONCLUSIONS

Given that breastfeeding is a protective factor for other diseases of infancy, our findings indicate that the common risks approach is the most appropriate for the prevention of posterior cross bite in primary or initial mixed dentition.

Transverse features of subjects with sucking habits and facial hyperdivergency in the mixed dentition

INTRODUCTION

The aim of this study was to analyze the transverse characteristics of subjects with sucking habits and hyperdivergency in the mixed dentition.

METHODS

The test group consisted of 80 subjects with sucking habits and hyperdivergency in the intermediate mixed dentition, and it was compared with a control group of 185 subjects. The prevalence rate of posterior crossbite was recorded. Maxillary and mandibular intercanine and intermolar widths, and anterior and posterior transverse interarch discrepancies were measured on the dental casts. The statistical comparisons between the test and control groups were performed with independent sample t tests and chi-square tests (P <.05).

RESULTS

The prevalence rate of posterior crossbite in the test group was significantly greater (52%) than in the control group (14%) (P <.001). The test group had significantly smaller maxillary intermolar and intercanine widths and significantly greater posterior transverse discrepancy (P <.01). No significant differences were found for mandibular intermolar and intercanine widths or anterior transverse discrepancy.

CONCLUSIONS

Prolonged sucking habits and hyperdivergency in the mixed dentition were associated with narrow maxillary intermolar and intercanine widths, increased posterior transverse discrepancies, and increased prevalence of posterior crossbites.

Feeding patterns of Brazilian preterm infants during the first 6 months of life, Londrina, Parana, Brazil

The present study evaluated the breastfeeding practice of 278 preterm infants born at the University Hospital of Londrina, Paraná, Brazil, during hospitalization and in the first 6 months of life. Data were obtained from the hospital records, and the mothers were interviewed by home visit (75.5%) or by telephone (24.5%) when the children were 6 months old. Data were analyzed statistically using the Kaplan-Meier survival method and Cox's multivariate regression model. During hospitalization, 100% of the preterm infants received human milk and 31% received exclusive breastfeeding. The median duration of exclusive breastfeeding and breastfeeding was 63.5 and > 180 days, respectively. The prevalence of breastfeeding in the sixth month was 54.7%, and 6.8% of the infants were still exclusively breastfed. Pacifiers were used (currently using or ever used) by 127 (45.7%) preterm infants and were associated with a 1.67 times higher risk of interruption of exclusive breastfeeding.

Crossbite associated with open bite in primary dentition: case report

Posterior crossbites and anterior open bites can alter a patient's esthetics and function, and affect the balance of the stomatognathic system. Pediatric dentists and orthodontists play an important role in preventing, intercepting, and correcting these problems. This article describes a clinical case that corrected malocclusion that had resulted in simultaneous posterior crossbite and anterior open bite. The article also defends the importance of early treatment for children with this condition and discusses the diverse clinical aspects involved.

Fatores de risco para internação por doença respiratória aguda em crianças até um ano de idade

OBJETIVO: Avaliar fatores de risco para hospitalização por doença respiratória aguda em crianças até um ano de idade. MÉTODOS: Estudo de casos e controles na cidade de Pelotas, RS. Os casos foram crianças de até um ano de idade, que se hospitalizaram por doença respiratória aguda, de agosto de 1997 a julho de 1998. Os controles foram crianças da comunidade, da mesma idade, sem hospitalização prévia por essa doença. Um questionário investigando exposição a fatores de risco foi aplicado às mães de casos e controles. Os dados foram submetidos à análise univariada, bivariada e multivariada por meio de regressão logística para avaliação dos fatores de risco sobre o desfecho de interesse. RESULTADOS: Foram analisadas 777 crianças, sendo 625 casos e 152 controles. Na análise bruta, os fatores de risco associados ao desfecho foram: sexo masculino, faixa etária menor de seis meses, aglomeração familiar, escolaridade materna, renda familiar, condições habitacionais inadequadas, desmame precoce, tabagismo materno, uso de bico, história de hospitalização e antecedentes de sintomas respiratórios. O trabalho materno foi fator de proteção para internação por doença respiratória aguda. Na análise multivariada, permaneceram associadas: ausência de ou baixa escolaridade materna (OR=12,5), história pregressa de sibilância (OR=7,7), desmame precoce (OR=2,3), uso de bico (OR=1,9), mãe fumante (OR=1,7), idade abaixo de seis meses (OR=1,7) e sexo masculino (OR=1,5). CONCLUSÕES: Os resultados mostraram a importância dos aspectos sociais e comportamentais da família, assim como morbidade respiratória anterior da criança como fatores de risco para hospitalização por doença respiratória aguda.

Prevalence of posterior crossbite among pacifier users: a study in the deciduous dentition

The aim of this study was to evaluate the prevalence of posterior crossbite among children whose pacifier-sucking habit persisted until different ages. Children aged 3 to 6 years were randomly selected from public preschools in São Paulo, SP, Brazil. Their mothers were asked to complete a questionnaire on non-nutritive sucking behaviors. The sample consisted of 366 children assigned to 2 groups: control (n = 96) and pacifier users (n = 270). Pacifier users were further assigned to 3 subgroups, according to the age of habit persistence: P1 - until 2 years of age; P2 - between 2 and 4 years of age; and P3 - between 4 and 6 years of age. One dentist assessed the children for occlusal relationships through clinical examination. Associations between the age interval of habit discontinuation and the prevalence of posterior crossbite were analyzed using the chi-square test (p < 0.05). The prevalence of posterior crossbite was significantly higher among pacifier users (20.4%), compared to control children (5.2%), p < 0.01. Unilateral posterior crossbite was more prevalent than bilateral crossbite among pacifier users (9.8% versus 3.6%). Functional posterior crossbites were diagnosed in 3.1% of the control children and 7% of the pacifier users. The frequencies of posterior crossbite were notably high for children in the 3 pacifier subgroups, P1, P2, and P3, corresponding to 17.2%, 16.9%, and 27.3%, respectively. The high prevalence of posterior crossbite may be associated with pacifier-sucking habits that persisted after 2 years of age.

Breast-feeding and deleterious oral habits in mouth and nose breathers

Aim

Breast-feeding promotes several benefits in childhood, among them favoring the nasal breathing. In the present study, the relationship between breathing pattern and the history of breast-feeding and of deleterious oral habits was determined.

Study design

clinical with transversal cohort.

Material and Method

The study population consisted of 62 children ranging in age from 3 years and 3 months to 6 years and 11 months who were submitted to otorhinolaryngologic evaluation to determine nasal and mouth breathers and to a speech language pathologic interview. The otorhinolaryngologic evaluation involved the following exams: anterior rhinoscopy, oroscopy and radiologic examination. The parents of the children were questioned about the form of feeding (natural and/or artificial), the duration of breast-feeding and the presence of deleterious oral habits (suction and biting). The Fisher exact test was used to compare groups regarding the presence and absence of habits and the different periods of breast-feeding.

Results

The breast-feeding period was longer among nasal breathers and was concentrated in the period between 3 and 6 months of age. Regarding the use of bottle, the results showed that most of the children in both groups used this type of feeding during the first years of life, with no significant difference between groups (p = 0.58). There was a marked presence of deleterious oral habits among mouth breathers, with a statistically significant difference between groups regarding suction (p = 0.004) and biting habits (p = 0.0002).

Conclusion

Mouth breathing children were breast-fed for a shorter period of time and had a history of deleterious oral habits compared to nose breathers.

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.

Occlusal and orofacial myofunctional evaluation in children with anterior open bite before and after removal of pacifier sucking habit

The aim of this study was to evaluate occlusal and orofacial myofunctional characteristics in children with primary dentition and anterior open bite, before and after removal of pacifier sucking habit. A dentist checked anterior open bite, overjet and upper intercanine distance and a speech therapist evaluated posture and tonus of lips and tongue, cheek tonus, swallowing, breathing and speech of twenty-seven 3-5 year-old children at baseline and 3 months later. Habit removal propitiated a mean reduction of 1.97 mm on anterior open bite (P < .001), promoted improvement of lip posture (P = .03), favored nasal breathing (P =. 008) and reduced the occurrence of tongue interposition during swallowing (P = .008). Lack of proper tongue rest posture was capable of preventing spontaneous correction of anterior open bite (odds ratio 17.50).

Non-nutritive sucking with a pacifier: pros and cons

The detrimental effects of prolonged pacifier use on the developing oral structures are often the primary focus of dental professionals; however, non-nutritive sucking with a pacifier has other consequences that include not only harmful effect but positive influences as well. This article will address some of the issues for consideration regarding the use of pacifiers and provide information for appropriate recommendations to parents of infants and toddlers regarding the use and cessation of non-nutritive sucking with a pacifier.

Occlusal and orofacial myofunctional evaluation in children with primary dentition, anterior open bite and pacifier sucking habit

The aim of this study was to evaluate occlusal and orofacial myofunctional characteristics in children three to five years of age with anterior open bite related to a pacifier sucking habit. Sixty-nine children participated in this study: 35 with anterior open bite (Anterior Open Bite Group - AOBG) and 34 with normal occlusion (Control Group - CG). In AOBG, the mean anterior open bite was 2.96 mm, the mean overjet was 4.1 mm and the mean upper intercanine distance was 28.7 mm. In the CG, the mean overjet was 2.6 mm and the upper intercanine distance was 30.3 mm. The mean overjet was greater (p=0.001) in AOBG than in CG, and the mean upper intercanine distance was smaller (p<0.001) in AOBG. The number of children with a canine Class II relationship was greater in AOBG than in CG (p<0.001). Simple logistic regression analysis showed that greater overjet, smaller upper intercanine distance and Class II canine relationship coexisted with anterior open bite. In AOBG, the number of children with incompetent lips, inadequate lip tonus, lack of proper tongue rest position, inadequate cheek tonus, anterior tongue interposition during swallowing and speech was greater (p<0.05) than in CG. Multiple logistic regression analysis identified anterior tongue interposition during swallow and speech, as well as incompetent lips, as the main orofacial myofunctional characteristics in children with anterior open bite.

Sudden infant death syndrome: risk factors for infants found face down differ from other SIDS cases

OBJECTIVE

To test the hypothesis that infants with sudden infant death syndrome (SIDS) found face down (FD) would have SIDS risk factors different from those found in other positions (non-face-down position, NFD).

STUDY DESIGN

We used the New Zealand Cot Death Study data, a 3-year, nationwide (1987 to 1990), case-control study. Odds ratios (univariate and multivariate) for FD (n = 154) and NFD SIDS (n = 239) were estimated separately, and statistical differences between the two groups were assessed.

RESULTS

Of 12 risk factors for SIDS, there were 8 with a statistically significant difference between FD and NFD infants. After adjustment for the potential confounders, younger infant age, Maori ethnicity, low birth weight, prone sleep position, use of a sheepskin, and pillow use were all associated with a greater risk of SIDS in the FD than the NFD group. Sleeping during the nighttime, maternal smoking, and bed-sharing were associated with a risk of SIDS only in the NFD group. Pacifier use was associated with a decreased risk for SIDS only in the NFD group, whereas being found with the head covered was associated with a decreased risk for SIDS for the FD group.

CONCLUSIONS

Infants with SIDS in the FD position appear to be a distinct subgroup of SIDS. These differences in risk factors provide clues to mechanisms of death in both SIDS subtypes.

Association between allergic rhinitis, bottle feeding, non-nutritive sucking habits, and malocclusion in the primary dentition

AIM

To determine the association between allergic rhinitis, bottle feeding, non-nutritive sucking habits, and malocclusion in the primary dentition.

METHODS

Data were collected on 1160 children aged 4-5 years, who had been longitudinally followed since the age of 4 months, when they were admitted to nurseries in a suburban area of Tampico-Madero, Mexico. Periodically, physical examinations were conducted and a questionnaire was given to their parents or tutors.

RESULTS

Malocclusion was detected in 640 of the children (51.03% had anterior open bite and 7.5% had posterior cross-bite). Allergic rhinitis alone (adjusted odds ratio = 2.87; 95% CI 1.57 to 5.25) or together with non-nutritive sucking habits (adjusted odds ratio = 3.31; 95% CI 1.55 to 7.09) had an effect on anterior open bite. Bottle feeding alone (adjusted odds ratio = 1.95; 95% CI 1.07 to 3.54) or together with allergic rhinitis (adjusted odds ratio = 3.96; 95% CI 1.80 to 8.74) had an effect on posterior cross-bite. Posterior cross-bite was more frequent in children with allergic rhinitis and non-nutritive sucking habits (10.4%).

CONCLUSIONS

Allergic rhinitis alone or together with non-nutritive sucking habits is related to anterior open bite. Non-nutritive sucking habits together with allergic rhinitis seem to be the most important factor for development of posterior open bite in children under the age of 5 years.

Changes in the prevalence of nonnutritive sucking patterns in the first 8 years of life

INTRODUCTION

The purposes of the study were to determine prospectively the duration of nonnutritive sucking behaviors of children between 1 and 8 years of age and the effect of persistent habits on selected occlusal characteristics in the late deciduous dentition.

METHODS

Sucking behavior data were initially collected from 797 children who were followed longitudinally from birth; the data came from periodic questionnaires completed by the parents. In addition, study models were obtained for 372 children at 4 to 5 years of age and assessed for posterior crossbite, anterior open bite, and overjet. The subjects were grouped according to the duration and type of habit (pacifier or digit, for less than 12 months or more than 48 months). Children with nonnutritive sucking of less than 12 months were further grouped according to the duration of breast-feeding. The McNemar nonparametric test was used to compare the changes in the incidence and effect of the habits with time.

RESULTS

There was a significant (P = .001) decrease in the incidence of pacifier habits between 1 and 5 years of age, from 40% to 1%. There was a significant (P = .01) decrease in the incidence of digit habits between 1 and 4 years of age, from 31% to 12%. Between 4 and 7 years of age, the decrease in the incidence reached a plateau--ie, the decrease continued but at a slower rate. Between 7 and 8 years of age, there was an additional significant (P = .008) decrease in the incidence of digit habits, but 4% of the children were, to various extents, still sucking fingers. Children who had pacifier or digit habits lasting less than 12 months did not have significantly different occlusal characteristics than children who were breast-fed for 6 to 12 months. Prolonged pacifier and digit habits caused significant changes in the occlusal characteristics in the late deciduous dentition, and the effects of pacifier habits were different from those of digit sucking.

CONCLUSIONS

To intercept the development of crossbites and functional shifts, the developing occlusion should be observed in the deciduous dentition in children with prolonged digit or pacifier habits. The transverse occlusal relationship, particularly in pacifier-sucking children, should be evaluated between 2 and 3 years of age. If there are interfering contacts of the deciduous canines, the parents should be instructed to reduce pacifier-sucking time, and appropriate treatment should be rendered, if required.

Early childhood pacifier use in relation to breastfeeding, SIDS, infection and dental malocclusion

This information on best practice is based on a systematic review (Callaghan et al 2005) conducted by the Institute Nurses' Network (Telethon Institute of Child Health Research), Western Australian community and child health nurses and the Western Australian Centre for Evidence Based Nursing and Midwifery, a collaborating centre of the Joanna Briggs Institute. The primary references on which this information is based are available online via Blackwell Synergy: www.blackwell-synergy.com and to members of the institute via the web site: www.joannabriggs.edu.au

Remoção de hábitos e terapia miofuncional: restabelecimento da deglutição e repouso lingual

TEMA: hábitos prolongados de sucção de chupeta e mamadeira podem provocar distúrbios miofuncionais como o padrão incorreto de deglutição e repouso lingual. OBJETIVO: estudar os efeitos da associação da Terapia Miofuncional (TMF) e da remoção de hábitos (REM) de sucção na reabilitação da deglutição e repouso lingual. MÉTODO: dois grupos composto por dez crianças de quatro anos a quatro anos e oito meses de idade que inicialmente apresentavam hábitos de sucção de chupeta e mamadeira foram estudados. O grupo denominado REM foi submetido à REM pelo Método de Esclarecimento modificado, enquanto que o grupo denominado TMF também teve os hábitos de sucção removidos pelo mesmo método e foi associada a TMF. Foram realizados exames pré-tratamento, 60 e 180 dias pós-procedimentos. Os dados foram submetidos aos testes estatísticos de Mann-Whitney e Wilcoxon p < 0,05. RESULTADOS: os resultados evidenciaram que o grupo submetido à REM e TMF apresentou adequação dos padrões de deglutição aos 60 dias e 180 dias e correto posicionamento de língua em repouso aos 180 dias, enquanto que o grupo submetido apenas à REM demonstrou adequação do padrão de deglutição apenas aos 180 dias e não apresentou melhora significativa do correto padrão de posicionamento de língua em repouso durante os períodos de avaliação. CONCLUSÃO: a TMF associada à REM de sucção de chupeta e mamadeira produziu melhor e mais rápida adequação do padrão de deglutição e de posicionamento lingual em repouso do que apenas a REM de sucção.

Effects of nonnutritive sucking habits on occlusal characteristics in the mixed dentition

PURPOSE

Little is known about the extent to which nonnutritive sucking habits contribute to malocclusion in the mixed dentition. The purpose of this study was to report on the relationship between certain occlusal traits in the mixed dentition and longitudinal sucking behaviors.

METHODS

Dental examinations were conducted on 630 children in the mixed dentition who participated in a large, ongoing longitudinal study. Five hundred eighty consented to impressions, and 524 adequate study models were obtained. Of these, 444 also had adequate longitudinal nonnutritive sucking data obtained via mailed questionnaires to parents at 3- to 6-month intervals from birth to 8 years. Sucking behaviors were grouped by predominant type and duration. Study models were hand articulated using wax bites to evaluate the occlusion for the presence of open bite, crossbite, molar relationship, and excessive overjet. Bivariate statistical analyses related presence of these malocclusions to sucking duration and type.

RESULTS

Fifty-five percent of the children had malocclusions (anterior open bite, posterior crossbite, bilateral Class II molar relationship, or overjet >4 mm). Class II molar relationship was most common (30%). Overall, anterior open bite and posterior crossbite was associated with habits of 36 months or more. Sustained pacifier habits, including those of 24 to 47 months, were associated with anterior open bite and Class II molar relationships, while digit habits were associated with anterior open bite when sustained for 60 months or longer.

CONCLUSIONS

Malocclusions are quite prevalent in the mixed dentition, and anterior open bite and posterior crossbite may be preventable by modifying nonnutritive sucking behaviors.

Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis

OBJECTIVE

Pacifier use has been reported to be associated with a reduced risk of sudden infant death syndrome (SIDS), but most countries around the world, including the United States, have been reluctant to recommend the use of pacifiers because of concerns about possible adverse effects. This meta-analysis was undertaken to quantify and evaluate the protective effect of pacifiers against SIDS and to make a recommendation on the use of pacifiers to prevent SIDS.

METHODS

We searched the Medline database (January 1966 to May 2004) to collect data on pacifier use and its association with SIDS, morbidity, or other adverse effects. The search strategy included published articles in English with the Medical Subject Headings terms "sudden infant death syndrome" and "pacifier" and the keywords "dummy" and "soother." Combining searches resulted in 384 abstracts, which were all read and evaluated for inclusion. For the meta-analysis, articles with data on the relationship between pacifier use and SIDS risk were limited to published original case-control studies, because no prospective observational reports were found; 9 articles met these criteria. Two independent reviewers evaluated each study on the basis of the 6 criteria developed by the American Academy of Pediatrics Task Force on Infant Positioning and SIDS; in cases of disagreement, a third reviewer evaluated the study, and a consensus opinion was reached. We developed a script to calculate the summary odds ratio (SOR) by using the reported ORs and respective confidence intervals (CI) to weight the ORs. We then pooled them together to compute the SOR. We performed the Breslow-Day test for homogeneity of ORs, Cochran-Mantel-Haenszel test for the null hypothesis of no effect (OR = 1), and the Mantel-Haenszel common OR estimate. The consistency of findings was evaluated and the overall potential benefits of pacifier use were weighed against the potential risks. Our recommendation is based on the taxonomy of the 5-point (A-E) scale adopted by the US Preventive Services Task Force.

RESULTS

Seven studies were included in the meta-analysis. The SOR calculated for usual pacifier use (with univariate ORs) is 0.90 (95% confidence interval [CI]: 0.79-1.03) and 0.71 (95% CI: 0.59-0.85) with multivariate ORs. For pacifier use during last sleep, the SORs calculated using univariate and multivariate ORs are 0.47 (95% CI: 0.40-0.55) and 0.39 (95% CI: 0.31-0.50), respectively.

CONCLUSIONS

Published case-control studies demonstrate a significant reduced risk of SIDS with pacifier use, particularly when placed for sleep. Encouraging pacifier use is likely to be beneficial on a population-wide basis: 1 SIDS death could be prevented for every 2733 (95% CI: 2416-3334) infants who use a pacifier when placed for sleep (number needed to treat), based on the US SIDS rate and the last-sleep multivariate SOR resulting from this analysis. Therefore, we recommend that pacifiers be offered to infants as a potential method to reduce the risk of SIDS. The pacifier should be offered to the infant when being placed for all sleep episodes, including daytime naps and nighttime sleeps. This is a US Preventive Services Task Force level B strength of recommendation based on the consistency of findings and the likelihood that the beneficial effects will outweigh any potential negative effects. In consideration of potential adverse effects, we recommend pacifier use for infants up to 1 year of age, which includes the peak ages for SIDS risk and the period in which the infant's need for sucking is highest. For breastfed infants, pacifiers should be introduced after breastfeeding has been well established.

Unilateral posterior crossbite with mandibular shift: a review

Based on this literature review, early orthodontic treatment of unilateral posterior crossbites with mandibular shifts is recommended. Treatment success is high if it is started early. Evidence that crossbites are not self-correcting, have some association with temporomandibular disorders and cause skeletal, dental and muscle adaptation provides further rationale for early treatment. It can be difficult to treat unilateral crossbites in adults without a combination of orthodontics and surgery. The most appropriate timing of treatment occurs when the patient is in the late deciduous or early mixed dentition stage as expansion modalities are very successful in this age group and permanent incisors are given more space as a result of the expansion. Treatment of unilateral posterior crossbites generally involves symmetric expansion of the maxillary arch, removal of selective occlusal interferences and elimination of the mandibular functional shift. The general practitioner and pediatric dentist must be able to diagnose unilateral posterior crossbites successfully and provide treatment or referral to take advantage of the benefits of early treatment.

Growth and development in the pediatric patient

What is the most important aspect of children's dentistry? Some may argue that it is the restoration orprevention of decay and disease. Others may describe nutrition. The diagnosis and treatment of proper growth and development, I feel is the most important responsibility of our practices. What we do or don't do can affect the child for life. Unfortunately, many of us lack the abilities we need to affectively monitor or augment, if necessary, proper growth and development. The purpose of this paper is to provide us with some basic knowledge, tools and treatments.

International Child Care Practices study: breastfeeding and pacifier use

Although the Baby-Friendly Hospital Initiative advises that no pacifiers be given to breastfeeding infants, both breastfeeding and pacifier use may protect against sudden infant death syndrome. The International Child Care Practice Study data set on child care practices associated with sudden infant death syndrome risk from 21 centers in 17 countries was used to describe infant-feeding practices and pacifier use and assess factors associated with breastfeeding. At approximately 3 months of age, rates of breastfeeding only (4%-80%) and pacifier use(12.5%-71%) varied between centers. Pacifier use was negatively associated with breastfeeding, and a dose-response effect was noted. Other negative (multiple birth, smoking by mother) and positive (intention to breastfeed, bed sharing, mothers' education) associations with breastfeeding only were identified. Although causality should not be inferred, these associations are consistent with previous studies. Advice on pacifiers should include potential benefits as well as risks.

Oral health, sociodemographic factors, dietary and oral hygiene practices in Jordanian children

OBJECTIVES

To investigate the association between oral health, in terms of dental caries and gingivitis, and sociodemographic factors, dental plaque, oral hygiene behaviours, infant feeding and dietary practices in 4-5-year-old Jordanian children.

METHODS

Two-stage random sampling procedure was used to select children enrolled in kindergartens in Amman, Jordan. Clinical examinations were carried out by one examiner. Mothers completed questionnaires relating to sociodemographic factors, oral hygiene behaviours, infant feeding and dietary practices of the children.

RESULTS

About 67% of the children had caries, 31% had dmft greater than 4 and 66% had gingivitis. Of the children who had been wholly breast-fed, 86% had been fed on demand. Mothers of children attending kindergartens with the lowest tuition fees were more likely to have breast-fed their children on demand and for more than 18 months (prolonged breast feeding) compared to those attending kindergartens with higher fees. Savory snacks were consumed by 82%, confectionery by 76% and teas with sugar by 42% of the children. Multivariate analysis showed age, dental plaque, sleeping beside the mother, use of comforters and selected dietary habits to have an independent effect on caries prevalence. Dental plaque and prolonged breast feeding exerted an independent effect on caries severity and gingivitis. The strongest association with gingivitis was dental plaque.

CONCLUSIONS

In Jordan as elsewhere health promotion strategies need to be targeted to mothers from less advantaged backgrounds. Messages about infant breast feeding should emphasise that the method is beneficial to the oral health of the children if appropriately used.