being a pedo dental hygienist - where the hygiene ...11 message board: being a pedo dental hygienist...

Child’s First Dental Visitpage 1

June 2013

Perio Reports Vol. 25 No. 6page 2

Being a Pedo Dental HygienistMessage Board, page 11

HT June Cover_Layout 1 5/23/13 12:59 PM

JUNE 2013 » hygienetown.com1

hygienetownin this section

»Inside This Section2 Perio Reports5 Continuing Education: Window of Opportunity for

Prevention: Health Benefits of Early Xylitol Use11 Message Board: Being a Pedo Dental Hygienist

Child’s First Dental Visitby Trisha E. O’Hehir, RDH, MSHygienetown Editorial Director

When is the ideal time for a child’s first visit tothe dental office? It used to be three years of age whenall deciduous teeth were erupted. More recently theAmerican Academy of Pediatric Dentistry (AAPD)recommends the first visit occur by one year orwithin six months of the first tooth erupting. Thisfirst visit is to establish a dental home for the child.The ADA concurs, suggesting the first birthday is thetime for the first dental visit. In all cases, experts sug-gest the visit be after the teeth erupt.

According to the research presented in thismonth’s feature article “Window of Opportunity”by Dr. John Peldyak, it might be time to rethinkthe age for a child’s first visit. To prevent coloniza-tion of Streptococcus mutans, (S mutans) the mothershould be seen during pregnancy to be sure hermouth is healthy and not harboring high levels ofacid producing S mutans. Bringing the mother’smouth to health will ensure she passes a good oralflora on to her baby after birth. The bacteria arepassed from mother to baby through shared salivafrom kissing, tasting food before giving it to thebaby and sharing utensils.

Although mothers tend to be the primary care-givers, we shouldn’t forget the fathers or the grand-parents. The child’s first dental visit should be forboth mom and dad. In some families other care-givers are involved in the day-to-day routines of thebaby. Anyone sharing saliva with the new babyshould be sure to have good oral health and low lev-els of S mutans. Making sure these people have goodoral health is the first step in the preventive processfor the child. The child’s first dental visit is really forthe family. n

HT_InThisIssue_Layout 1 5/23/13 1:04 PM Page 1

hygienetown.com « JUNE 20132

hygienetownperio reports

Mothers are the primary source of oral bacterial trans-mission to infants. As teeth erupt, they are colonized withStrep mutans, primarily transmitted through the mother’sshared saliva. Preventing Strep mutan colonization in aninfant’s mouth until age two provides a significant primarypreventive strategy. Mother-child research studies allow foran intervention with the mother to determine Strep mutantransmission to the child.

Researchers in Finland compared daily xylitol chewinggum consumption by mothers to professionally applied flu-oride and chlorhexidine varnish. There were 106 motherswho chewed xylitol-sweetened gum three to five times dailyfrom the time their newborn was three months old untilthey were two years old. The varnishes were applied to thosemothers every six months from the time those children were

six months old until two years. The fluoride varnish groupwas 33 mother-child pairs and the chlorhexidine varnishgroup was 30.

Mothers were selected based on high Strep mutan levels.Thus these mothers were at high risk for transmitting Strepmutans to their babies.

At age two, 10 percent of the children of mothers whochewed xylitol gum were colonized with Strep mutans, basedon plaque and saliva samples. In the chlorhexidine group itwas 29 percent, and 49 percent in the fluoride group. Themother’s use of xylitol-sweetened chewing gum significantlyreduced the risk of bacterial colonization in their babies.

Clinical Implications: Advise new moms to chew 100percent xylitol-sweetened gum three tofive times daily from the time theirbabies are three months old until theirsecond birthday to prevent transmissionof Strep mutans from mother to child. n

Söderling, E., Isokangas, P., Pienihäkkinen, K., Tenovuo, J.: Influence of

Maternal Xylitol Consumption on Acquisition of Mutans Streptococci by

Infants. J Dent Res 79: 882-887, 2000.

Mother-child Study Phase Two

In the first part of this research, mothers with highStrep mutan levels who chewed xylitol-sweetened gumwere less likely to have children with Strep mutan coloniza-tion by age two. Despite the mothers’ high Strep mutanlevels throughout the study, the xylitol seems to alter thecolonization ability of the Strep mutans. The mothersreceiving fluoride varnish or chlorhexidine varnish weremore likely to have Strep mutan colonization in their chil-dren at age two.

All these children were followed for an additional threeyears after termination of the two-year intervention.Children in Finland are seen regularly for dental care. Forthis part of the study, there were 103 from the xylitol group,

28 from the chlorhexidine varnish group and 33 from thefluoride varnish group.

Children who were Strep mutan negative at age two were3.6 times less likely to experience tooth decay than those whowere Strep mutan positive when evaluated to age five. Analysisof the decayed, missing and filled teeth revealed that childrenwhose mothers consumed xylitol chewing gum had 71 percentfewer lesions than the fluoride varnish group and 74 percentfewer lesions than the chlorhexidine varnish group.

These findings agree with other studies showing preven-tion of Strep mutan colonization up to age two provides sig-nificant protection against tooth decay in the following years.Xylitol alters the adhesion of Strep mutans to tooth surfaces.

Clinical Implications: Advising moms to use xylitol several times each day themselves during tooth eruption for theirinfants will provide long-term caries reduction benefits. n

Isokangas, P., Söderling, E., Pienihäkkinen, K., Alanen, P.: Occurrence of Dental Decay in Children after Maternal Consumption of Xylitol Chewing Gum, a Follow-up From 0 to 5 Years of Age. J Dent Res 79(11):1885-1889, 2000.

Perio Reports Vol. 25, No. 6Perio Reports provides easy-to-read research summaries on topics of specificinterest to clinicians. Perio Reports research summaries will be included in eachissue to keep you on the cutting edge of dental hygiene science.

Mother-child Study Phase One

www.hygienetown.com t

continued on page 3

Perio Reports_Layout 1 5/23/13 1:08 PM Page 2



Recent Mother-child Study from Japan

Many of the xylitol studies include European or NorthAmerican subjects. Researchers in Japan wanted to see if xyl-itol consumption by Japanese mothers would have the sameresult in lowering Strep mutan levels in their babies.

Researchers at Okayama University recruited pregnantmothers from the Miyake Obstetrics and Gynecology Clinicin central Okayama, Japan. Mothers with high Strep mutanlevels were invited to participate in the study. In this studydesign, mothers randomly assigned to the xylitol-sweetenedchewing gum began using the gum when they were sixmonths pregnant and continued until their babies were sevenmonths old, generally prior totooth eruption. The xylitol groupconsisted of 46 mothers and thecontrol group 31 mothers whocompleted the study.

The dental exams and plaqueand saliva samples were done atthe Hello Dental Clinic that ispart of the OBGYN clinic. Bothgroups of mothers received thesame oral health information fromthe dental clinic. Xylitol chewinggum consumption averaged three pieces per day with therange being 1.2 pieces to 5.3 pieces daily. The gram dosagevaried accordingly and averaged four grams per day. Plaqueand salivary Strep mutan levels were measured until childrenreached the age of two.

Children whose mothers chewed xylitol gum were lesslikely to have Strep mutan colonization by age two comparedto controls; 72 percent of the xylitol group had zero Strepmutan scores compared to 39 percent with a score of zero inthe control group.

Clinical Implications: Even short term, xylitol consump-tion by mothers can prevent Strep mutan colonization in babies. n

Nakai, Y., Shinga-Ishihara, C., Kaji, M., Moriya, K., Murakami-Yamanaka, K., Takimura, M.: Xylitol

Gum and Maternal Transmission of Mutans Streptococci. J Dent Res 89(1):56-60, 2010.

Swedish Mother-child Study

Evidence confirms the benefits of mothers con-suming xylitol-sweetened chewing gum to preventthe transmission and colonization of Strep mutans intheir infants. Researchers in Sweden compared threechewing gums used by new mothers. The gums were

1) xylitol, 2) chlorhexidine plus xylitol and 3)sodium fluoride.

A group of 173 mothers with high Strepmutan levels were randomly assigned to one ofthe three chewing gum groups. Mothers withlow to moderate Strep mutan levels comprisedthe control group that did not chew gum. Gumchewing began when the babies were six monthsold and continued for one year until the childrenwere 18 months of age. Mothers were instructedto chew their assigned gums for five minutes,three times daily.Salivary and plaque levels of Strep mutan were

measured for all the children. At the end of thestudy, 10 percent of the children of mothers chewingxylitol gum were positive for Strep mutans. In thechlorhexidine plus xylitol chewing gum group, 16percent were positive for Strep mutans. In the fluo-ride chewing gum group, 28 percent of childrenwere positive for Strep mutans. The control group,children of mothers with low levels of Strep mutanshad 10 percent positive, similar to the xylitol group.

The xylitol reduced the risk of Strep mutan trans-mission and colonization in high-risk mothers tothat of low-risk mothers. The chlorhexidine seemedto mildly reduce the effect of xylitol, but not of sta-tistical significance.

Clinical Implications: Xylitol-sweetened chewinggum is the best choice for reducing Strep mutantransmission and colonization. n

Thorild, I., Lindau, B., Twetman, S.: Effect of Maternal Use of Chewing Gums Containing

Xylitol, Chlorhexidine or Fluoride on Mutans Streptococci Colonizations in the Mothers’

Infant Children. Oral Health Prev Dent 1:53-57, 2003.

continued from page 2




There are many bacteria that colonize themouth, and two are associated with caries and are

highly damaging: S. mutans and S.sobrinus. These bacteria will colonizethe teeth and produce lactic acid thatdemineralizes enamel, leading to cav-itation. Xylitol effectively preventsthe transmission of S. mutans frommother to child.

Researchers at the University ofWashington wanted to know ifapplying a xylitol syrup to infants’teeth would prevent early childhoodcaries (ECC). The study was carriedout on 94 nine- to 15-month-old

children in the Marshall Islands where the cariesrate is two to three times that of mainland USA.

The average five year old has seven untreated cari-ous lesions.

Three treatment programs were compared: eightgrams of xylitol syrup twice daily, eight grams of xylitolsyrup three times daily and the control group receiving2.67 grams of xylitol in a single dose. This was not atrue control group, but mandated by the internalreview committee. To be sure each child received threesyrup doses each day, one or more sorbitol syrup doseswere added to make three for each group.

After 12 months, the control group had morechildren (52 percent), and more teeth (two perchild) with tooth decay. The two xylitol syrupgroups had much lower caries rates affecting 0.6 toone tooth per child. The researchers estimated thatthe xylitol syrup used during primary tooth eruptioncould prevent up to 70 percent of decayed teeth.

Xylitol Syrup Reduces Incidence of Early Childhood Caries

Influence of Maternal Xylitol Consumption

Caries is an infectious, transmissible, diet-dependent, sali-vary mediated disease. When the balance between demineral-ization and remineralization tips toward demineralization,cavitation might result. It begins with transmission of the Strepmutans from a primary caregiver, usually the mother, to thechild. Efforts to prevent transmission and colonization of Strepmutans in infants begin with the pregnant mother with dietchanges, improved oral hygiene and daily xylitol consumption.Efforts to prevent the initial colonization of Strep mutans in aninfant is considered primary-primary prevention.

The caries process has two disease stages prior to cavita-tion: infectious disease and life-style disease. The infectiousdisease stage occurs before the child’s teeth erupt, after erup-tion and continues through infection. The life-style diseasestage refers to the dietary influences of frequent sugar con-

sumption, oral hygiene and the quality of saliva that enhanceacid production leading to decalcification.

Mothers asked to rinse daily with chlorhexidine, whichattacks the bacteria, experienced a lower Strep mutan leveland this delayed colonization in their infants for fourmonths. The use of xylitol doesn’t attack the bacteria; it sim-ply changes the environment to be less hospitable to acid-producing Strep mutans. Xylitol elevates the pH of the plaqueand saliva and, as a five-carbon sugar rather than a six-carbonsugar, provides no usable nutrition for the bacteria. Xylitolprovides not only immediate reductions in Strep mutans, itprovides long-term caries reduction.

Clinical Implications: Xylitol comes in many forms, tastes sweet and is easy to incorporate into the daily routine ofnew mothers to reduce the risk of sharing Strep mutans with their newborn babies. n

Nakai, Y.: Influence of Maternal Xylitol Consumption on Mother-Child Transmission of Cariogenic Bacteria During and After Pregnancy. Finn Dent J, Suppl 1: 12-17, 2006.

Clinical Implications: Xylitol syrup given duringprimary tooth eruption prevent caries. n

Milgrom, P., Ly, K., Tut, O., Manci, L., Roberts, M., Briand, K., Gancio, M.: Xylitol

Pediatric Topical Oral Syrup to Prevent Dental Caries: A Double-Blind Randomized

Clnical Trial of Efficacy. Arch Pediatrics 163: (7)601-607, 2009.



hygienetowncontinuing education feature

This print or PDF course is a written self-instructional article with adjunct images and is designated for1.5 hours of CE credit by Farran Media. Participants will receive verification shortly after Farran Mediareceives the completed post-test. See instructions on page 10.

AGD Code: 432

Approved PACE Program Provider

FAGD/MAGD Credit

Approval does not imply acceptance

by a state or provincial board of

dentistry or AGD endorsement.

1/1/2013 to 12/31/2015

Provider ID#304396

Farran Media is an ADA CERP Recognized provider. ADA CERP is a service of the American

Dental Association to assist dental professionals in identifying quality providers of con-

tinuing dental education. ADA CERP does not approve or endorse individual courses or

instructors, nor does it imply acceptance of credit hours by boards of dentistry.

by John Peldyak, DMD

Pioh-CE-Prevention_Layout 1 5/23/13 1:12 PM Page 5



AbstractDental caries is a transmissible infectious disease triggered by

mutans streptococci bacteria. Mothers, as the primary caregivers,are the principal source of these bacteria as early colonizers ofinfants’ mouths. The “window of infectivity” associated withmutans streptococci colonization also offers a “window of oppor-tunity” to break the dental caries transmission cycle. A two-pronged approach utilizing xylitol for mothers and their babiescan yield impressive dental health benefits.

Educational ObjectivesAt the end of the course, participants will be able to:1. Describe the window of infectivity relating to oral

mutans streptococci.2. Explain the results of mother-child xylitol research trials. 3. List the benefits of daily xylitol use for mothers, infants

and children.4. Understand the long-term impact of xylitol use on oral

health. 5. Recognize the many benefits of xylitol nasal spray.

Long-Term Protection with XylitolOne of the main features to arise from earlier xylitol preven-

tion trials was the recognition of a long-lasting caries-protectiveeffect of habitual xylitol use. A follow-up five years after discon-tinuation of a xylitol chewing gum trial in Ylivieska, Finland,showed that the preventive effect persisted. The subjects of theBelize trials in Central America showed a similar persistence ofthe xylitol-preventive effect at a five-year recheck.

The very best results, more than 90 percent caries reduction,were observed in teeth that erupted during the second year ofhabitual xylitol use. Theoretical explanations suggest that newteeth erupting into a cleaner environment experience initial col-onization by cariogenic bacteria being blocked and the newenamel becoming optimally mineralized. This established theconcept that the time prior to and during tooth eruption is theideal time to use xylitol to achieve the best preventive effect.

Mothers Use Xylitol, Babies BenefitA field trial was conducted in Finland in the early 1990s to

see if xylitol use by mothers could affect the transmission ofmutans streptococci from the mothers to their babies. Motherschewed 100 percent xylitol-sweetened gum four times a day

(about seven grams of xylitol per day), from the time theirbabies were three months old, and discontinued at 24 months ofage. Control groups received either chlorhexidine or fluoridevarnish. Colonization by mutans streptococci at age two years wasthree- to five-times higher in the children whose mothers didnot use xylitol. At the age of five years, the children of the xyli-tol-using mothers had a 70 percent lower caries experience.

Follow-ups on this trial were continued for 10 years. Adetailed economic analysis found the mothers’ xylitol use waseffective in reducing the costs of dental treatment for their chil-dren. Other benefits were noted such as missing fewer schooldays and avoiding the inconvenience, discomfort and pain asso-ciated with tooth decay.

A similar mother-child trial was conducted in Sweden wherethe control groups also chewed gum. The results mirrored theFinland experience: the children of mothers who used xylitolhad significantly reduced colonization by mutans streptococci anda lower occurrence of dental caries.

Mothers who express a high level of dental anxiety tend toavoid routine professional dental visits and have less effectiveoral hygiene habits. A group of anxious mothers were given xyl-itol lozenges to use when their children were between the ages ofthree and 36 months. The xylitol use was well accepted andfound to prevent or at least delay mutans streptococci coloniza-tion in their children.

Xylitol in PregnancyA trial in Japan began the xylitol use during pregnancy in a

group of women identified as being at high risk for tooth decay.Xylitol chewing gum was used four times each day for 13months, although they reported lower actual use than the rec-ommended levels. Improved oral health with decreased cariesactivity was noted in the women of the xylitol group. These “xyl-itol” mothers had lower counts of mutans streptococci resulting inreduced colonization of their babies’ teeth and about 70 percentreduced risk of early childhood caries.

Xylitol for the Infant

One recent dou-ble-blind randomizedtrial by researchers atthe University of Wash-

continued on page 7



hygienetowncontinuing education feature continued from page 6

ington in Seattle shows just how effective xylitol is for prevent-ing caries when used directly on the teeth of infants betweennine and 15 months for a treatment period of one year. Therewere two xylitol groups and a control group. The test groups gotxylitol syrup at least twice per day and the control groupreceived sorbitol syrup twice a day and xylitol syrup only once aday. While more than half of the children in the control grouphad tooth decay after 10 months, there were significantly fewercaries in both of the xylitol groups. The authors concluded pro-viding xylitol syrup to infants at least twice a day (total 8gm perday) could reduce early childhood decay by more than 70 per-cent. Now there are commercial gels available that contain ahigh concentration of xylitol and are safe to swallow.

Combining Mother and Child UseOften research must focus on one piece of the comprehen-

sive puzzle. We have seen that xylitol can be an effective adjunctin breaking the mother-to-child transmission cycle when themother chews xylitol gum or when xylitol is applied directly tothe child’s teeth. Why not use both approaches together?

We should have more information soon. There was a recentlycompleted trial using xylitol for both mothers and their babies ata Public Health Center in Finland. Infants received xylitol topi-cally on their available tooth surfaces from the age of approxi-mately six months. The mothers were also using xylitol regularly.The preliminary bacteriological reports suggest a favorable trend.Most mothers continued breast-feeding until the child wasapproximately 12 months old. Milk was not analyzed, but noharmful effects were observed in the infants as result of the inter-vention. The infants’ mutans streptococci levels and caries ratesdecreased significantly. This experiment is currently in press andwill be published in the International Dental Journal.

Xylitol and Ear InfectionsXylitol in chewing gum or syrup has been shown to reduce

the incidence of ear infections by up to 40 percent. It was foundthat xylitol reduces the adherence of important upper respira-tory pathogens, particularly Streptococcus pneunomiae and hemo-philus influenza, to epithelial cells.

A physician in private practice, Dr. Lon Jones, used thisinformation to develop a saline xylitol nasal wash for babies. Henoted a dramatic reduction of ear infections with a relateddecrease in antibiotic use. Dr. Jones recommends preventive use

of saline/xylitol nasal sprayroutinely, such as after diaperchanges. He suggests thatnasal xylitol helps to keep thenasal airway open, encour-ages proper nasal breathingand leads to more idealdevelopment of the palateand dental arches.

Safety of Perinatal Xylitol

In amounts required fordental benefits, xylitol has along history of safety. Duringthe Turku Sugar Studies inthe early 1970s, six of thevolunteers in the xylitol-feeding group were pregnant. Theywere consuming about ten times more xylitol than dental rec-ommendations, with no untoward health effects. There were nonegative effects reported on mothers, births or the infants.

In Ylivieska, Finland, 91 mothers were breastfeeding regu-larly through several months of the trial, with no reports of anyadverse effects. The Swedish study was very similar in thisrespect. In Japan 51 pregnant women regularly used xylitolwithout any negative side effects on them or their children.

Professors Kauko Mäkinen and Pentti Alanen at theInstitute of Dentistry, in Turku, Finland, tell us that in Finland,where the awareness of xylitol is universal, thousands of breast-feeding mothers use xylitol habitually. Consumers simply con-sider xylitol as part of their normal life.

Other Co-factorsXylitol forms weak complexes with calcium in solution and

can function as a carrier for minerals. Saliva production is stim-ulated by xylitol. This stimulated saliva has a higher pH andgreater mineralization potential than resting saliva. A series ofstudies carried out at Tokyo Dental College demonstratedgreater saliva-mediated remineralization with regular xylitol use.They also showed deeper, more complete mineralizationoccurred with a calcium buffer added to xylitol.

Fluoride and xylitol have a combined effect. Toothpaste con-taining both fluoride and xylitol should be encouraged for




maternal use. Erythritol is a four-carbon polyol. Preliminaryevidence suggests some dental benefits similar to xylitol, withdifferent mechanisms involved. Although this is speculative,there is a good possibility that xylitol and erythritol are com-plementary. Used together or sequentially they could have anadditive or even synergistic effect.

Introducing oral probiotic bacteria to erupting teeth is arelatively new concept. Harmless or even helpful oral bacteriacould possibly get established early to block or crowd out theharmful varieties. Xylitol could be an indifferent bystander orpossibly a “prebiotic” agent that would favor the probioticswhile suppressing the virulent strains. There are several groupsof oral bacteria that are said to be “xylitol-resistant.” In effect,habitual use of xylitol leads to less adhesive, less acidogenic,less inflammatory oral flora that can maintain a long-term“peaceful co-existence” with the host.

Delivery SystemsMothers, family members and caregivers are encouraged to

use xylitol in three to five divided servings throughout the day.Chewing gum is considered an ideal delivery system for xyli-tol, especially immediately after meals or snacks. Xylitol mintsor candy can be effective where chewing gum is not practical.Additionally, xylitol toothpaste or mouthrinse can be part ofroutine daily home care.

Xylitol nasal drops or sprays can be used with babies. Bythe age of six months or even before the first teeth begin toerupt, babies can be given xylitol syrup or gel. The xylitol canbe squirted, brushed or wiped on the teeth by mother afterfeeding. Pacifiers have been developed with a reservoir toslowly release xylitol over a period of time. Well-designed paci-fiers can have a beneficial orthopedic effect for the properdevelopment of the palate and dental arches.

ConclusionA simple strategy of mothers chewing xylitol gum during

pregnancy and after delivery, along with their babies receivingxylitol in nasal sprays and tooth gels could effectively block or

delay early transmission of pathogenic bacteria. Additionally,xylitol assists optimal mineralization of newly erupted toothsurfaces. In conjunction with standard prevention strategiesand optimized nutrition, using xylitol could have a profoundbenefit in reducing childhood dental caries, ear infections andantibiotic overuse. n

References:1. Scheinin, A. Mäkinen, K. (eds) The Turku Sugar Studies, I-XXI Acta Odontologica Scandinavia, vol. 33,

supplement 70, 19752. Uhari, T. Kontiokari, M. Koskela, M. Niemelä,“Xylitol chewing gum in prevention of acute otitis media:

double blind randomised trial. British Medical Journal vol. 313, no. 7066, pp. 1180-1184, 1996.3. Kontiokari, M. Uhari, M. Koskela, “Antiadhesive effects of xylitol on otopathogenic bacteria,” Journal of

Antimicrobial Chemotherapy vol. 41, no. 5, pp. 563-565, May, 19984. Söderling, P. Isokangas, Pienihäkkinen, J. Tenovuo,“Influence of maternal xylitol consumption on acquisi-

tion of mutans streptococci by infants,”Journal Dental Research vol. 79, pp. 882-887, 2000.5. Isokangas, E. Söderling, K. Pienihäkkinen, P. Alanen, “Occurrence of dental decay in children after mater-

nal consumption of xylitol chewing gum, a follow-up from 0 to 5 years of age,” Journal of Dental Research,vol. 79, no. 11, pp. 1885–1889, 2000.

6. Aaltonen, J. T. Suhonen, J. Tenovuo, I. Inkilä-Saari,“Efficacy of a slow-release device containing fluoride,xylitol and sorbitol in preventing infant caries” Acta Odontologica Scandinavica, vol. 58, no. 6, pp.285–292, 2000.

7. Takahashi, M. Saeki, Y. Miake ,Y. Yanagisawa, T., “Effects of sugar alcohols and calcium compounds onremineralization,” Shikwa Gakuho, vol. 100, pp. 755-762, 2000.

8. Thorild, B. Lindau, S. Twetman,“Effect of maternal use of chewing gums containing xylitol, chlorhexidineor fluoride on mutans streptococci colonization in the mothers’ infant children,” Oral Health PreventiveDentistry, vol. 1, no. 1, pp. 53–57, 2003.

9. Thorild, B. Lindau, S. Twetman, “Caries in 4-year-old children after maternal chewing of gums contain-ing combinations of xylitol, sorbitol, chlorhexidine and fluoride,” European Archives of PaediatricDentistry, vol. 7, no. 4, pp. 241–245, 2006.

10. Söderling,“Xylitol reduces mother-child transmission of mutans streptococci,” Finnish Dental Journal, sup-plement 1, pp. 8-11, 2006.

11. Nakai,“Influence of maternal xylitol consumption on mother-child transmission of cariogenic bacteria dur-ing and after pregnancy – a promising strategy against initiation of caries,” Finnish Dental Journal, sup-plement 1, pp. 12-17, 2006.

12. Vernacchio, R. M. Vezina, A. A. Mitchell,“Tolerability of oral xylitol solution in young children: implica-tions for otitis media prophylaxis,”International Journal of Pediatric Otorhinolargology vol. 71, no. 1, pp.89-94, 2007.

13. Coldwell, T. K. Oswald, D. R. Reed, “A marker of growth differs between adolescents with high vs. lowsugar preference,”Behavior Physiologyvol. 96, no. 23, pp. 574-580, March, 2009.

14. Fontana, D. Catt, G. J. Eckert, S. Ofner, M. Toro, R. L. Gregory, A. F. Zandona, H. Eggertsson, R. Jackson,J. Chin, D. Zero, C. H. Sissons,“Xylitol: effects on the acquisition of cariogenic species in infants,”PediatricDentistry, vol. 31, no. 3, pp. 257–266, 2009.

15. Milgrom, K. A. Ly, O. K. Tut, L. Mancl, M. C. Roberts, K. Briand, M. J. Gancio, “Xylitol pediatric top-ical oral syrup to prevent dental caries – a double-blind randomized clinical trial of efficacy,” Archives ofPediatrics and Adolescent Medicine, vol. 163, no. 7, pp. 601–607, 2009.

16. Nakai, C. Shinga-Ishihara, M. Kaji, K. Murakami-Yamanaka, M. Takimura,“Xylitol gum and maternaltransmission of mutans streptococci,” Journal of Dental Research vol. 89, no. 1, pp. 56-60, 2010.

17. Laitala, “Dental Health in Primary Teeth After Prevention of Mother-Child Transmission of MutansStreptococci – A Historical Cohort Study on Restorative Visits and Maternal Prevention Costs,”AcademicDissertation presented at the University of Turku Institute of Dentistry, September 24, 2010.

18. Olak, M. Saag, T. Vahlberg, E. Söderling, S. Karjalainen,“Caries prevention with xylitol lozenges in chil-dren related to maternal anxiety,”Eur Arch Paediatr Dent 13:64-69, 2012.

19. Makinen, M. Jarvinen, K., Antilla, C., Luntamo, L. Vahlberg, T. "Topical xylitol administration by par-ents for the promotion of oral health in infants: a caries prevention experiment at a Finnish Public HealthCentre,"* International Dental Journal, doi: 10.1111/idj.12038*

continued on page 9

Author’s Bio

Dr. John Peldyak is a general dentist in Michigan. He received his DMD degree from Southern Illinois University in 1980 and was a member of professorKauko Mäkinen’s University of Michigan xylitol research group on sugar substitutes from 1986-1992. Dr. Peldyak is also a founding member of theAmerican Academy of Oral Systemic Health.

Disclosure: The author declares that neither he nor any member of his family have a financial arrangement or affiliation with any corporate organization offering financial support or grant moniesfor this continuing education program. Although commercially available products are discussed, no financial arrangements exist between the manufacturers and the author.


1. The window of infectivity for mutans streptococci coloniza-tion most likely occurs:a. prior to birth.b. before first six months of life.c. first 36 months of life.d. time between years four and six.

2. When mothers regularly use xylitol themselves:a. their children also experience dental benefits. b. their children have much earlier MS colonization.c. mothers’ tooth decay rates dramatically increasesd. no benefits are realized.

3. Oral health benefits of xylitol have been documented evenyears after discontinuation of regular use.a. Trueb. False

4. Xylitol use during pregnancy is safe for both mother andinfant.a. Trueb. False

5. Providing xylitol gel to infants can reduce early childhoodcaries by:a. 0 percent.b. less than 10 percent.c. less than 30 percent.d. up to 70 percent.

6. Xylitol/saline nasal spray reduces the adherence of pathogensto epithelial cells and:a. keeps the nasal airway open.b. encourages proper nasal breathing.c. can lead to more ideal development of the palate and den-

tal arches.d. All of the above

7. Benefits of xylitol are maximized when:a. used only by the mother.b. used regularly by both mother and infant.c. used only by the infant.d. used without fluoride.

8. Xylitol use by breastfeeding mothers is safe with no negativeside effects reported on mother or child.a. Trueb. False

9. Daily xylitol use should be:a. divided into three to five servings for mother and at least

two for baby.b. taken all at once.c. whatever the person wants.d. taken every other day.

10. Daily xylitol use can have profound benefits in reducing:a. childhood dental caries.b. ear infections.c. antibiotic overuse.d. All of the above.

Legal Disclaimer: The CE provider uses reasonable care in selecting and providingcontent that is accurate. The CE provider, however, does not independently verifythe content or materials. The CE provider does not represent that the instructionalmaterials are error-free or that the content or materials are comprehensive. Anyopinions expressed in the materials are those of the author of the materials and notthe CE provider. Completing one or more continuing education courses does notprovide sufficient information to qualify participant as an expert in the field relatedto the course topic or in any specific technique or procedure. The instructionalmaterials are intended to supplement, but are not a substitute for, the knowledge,expertise, skill and judgment of a trained healthcare professional. You may be con-tacted by the sponsor of this course.

Licensure: Continuing education credits issued for completion of online CEcourses may not apply toward license renewal in all licensing jurisdictions. It is theresponsibility of each registrant to verify the CE requirements of his/her licensingor regulatory agency.


hygienetowncontinuing education feature continued from page 8

Post-test»

Claim YourCE Credits

Answer the test in the Continuing Education Answer Sheet and submit it by mail or fax with a processing fee of $36. We inviteyou to view all of our CE courses online by going to http://www.dentaltown.com/onlinece and clicking the View All Coursesbutton. Please note: If you are not already registered on www.dentaltown.com, you will be prompted to do so.Registration is fast, easy and of course, free.




Continuing Education Answer Sheet

CE Post-testPlease circle your answers.

1. a b c d

2. a b c d

3. a b

4. a b

5. a b c d

6. a b c d

7. a b c d

8. a b

9. a b c d

10. a b c d

Instructions: To receive credit, complete the answer sheet and mail it, along with a check or credit card payment of $36 to: Dentaltown.com,Inc., 9633 S. 48th Street, Suite 200, Phoenix, AZ 85044. You may also fax this form to 480-598-3450 or answer the post-test questions onlineat www.dentaltown.com/onlinece. This written self-instructional program is designated for 1.5 hours of CE credit by Farran Media. You will needa minimum score of 70 percent to receive your credits. Participants only pay if they wish to receive CE credits, thus no refunds are available. Pleaseprint clearly. This course is available to be taken for credit June 1, 2013 through its expiration on June 1, 2016. Your certificate will be e-mailed to you within 3-4 weeks.

Window of Opportunity for Prevention:Health Benefits of Early Xylitol Use by John Peldyak, DMD

License Number ______ ______ ______ ______ ______ ______ ______ ______ ______ _______

AGD# _____________________________________________________________________________________

Name _____________________________________________________________________________________

Address ___________________________________________________________________________________

City___________________________________________ State __________ ZIP _________________________

Daytime phone_____________________________________________________________________________

E-mail (required for certificate) _________________________________________________________________

o Check (payable to Dentaltown.com, Inc.)

o Credit Card (please complete the information below and sign; we accept Visa, MasterCard and American Express.)

Card Number _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____

Expiration Date – Month / Year ______ ______ / ______ ______ ______ ______

Signature ________________________________________________________________________________________ Date____________________

Program Evaluation (required)

Please evaluate this program by circling the corresponding numbers: (5 = Strongly Agree to 1 = Strongly Disagree)1. Course administration was efficient and friendly 5 4 3 2 12. Course objectives were consistent with the course as advertised 5 4 3 2 13. COURSE OBJECTIVE #1 was adequately addressed and achieved 5 4 3 2 14. COURSE OBJECTIVE #2 was adequately addressed and achieved 5 4 3 2 15. COURSE OBJECTIVE #3 was adequately addressed and achieved 5 4 3 2 16. COURSE OBJECTIVE #4 was adequately addressed and achieved 5 4 3 2 17. COURSE OBJECTIVE #5 was adequately addressed and achieved 5 4 3 2 18. Course material was up-to-date, well-organized, and presented in sufficient depth 5 4 3 2 19. Instructor demonstrated a comprehensive knowledge of the subject 5 4 3 2 110. Instructor appeared to be interested and enthusiastic about the subject 5 4 3 2 111. Audio-visual materials used were relevant and of high quality 5 4 3 2 112. Handout materials enhanced course content 5 4 3 2 113. Overall, I would rate this course: 5 4 3 2 114. Overall, I would rate this instructor: 5 4 3 2 115. Overall, this course met my expectations 5 4 3 2 1Comments (positive or negative): _____________________________________________________________________________________

For questions, contact Director of Continuing Education Howard Goldstein at [email protected]



hygienetownmessage board

lacaza3Member Since: 02/18/06

Post: 1 of 16

pedobrusherMember Since: 09/20/10

Post: 2 of 16

skr RDH Member Since: 07/21/07

Post: 3 of 16

joymoellerMember Since: 09/16/08

Post: 5 of 16

sfbaileyMember Since: 09/22/10

Post: 6 of 16

Being a Pedo Dental HygienistTownie loves working with children. What is your niche?

»After a year of temping, I’ve found my niche in hygiene. When I temp in an office with

adults, I just don’t enjoy hygiene as much as when I temp in a pedo office. I’m in a goodmood at the end of the day in a pedo office and I enjoy the children and the parents. Forme, it’s more psychological than physical with kids. Working with adults leaves me tired atthe end of a day. What is your hygiene niche and what made you pick it? n

Working with children is definitely a plus. I like the way you said it: it is more psycho-logical than physical. I have worked both general and pedo, and pedo is my niche. I havebeen with the same office now for 13 years and, yes, we have our issues, (what office does-n’t?) but overall, there is so much more satisfaction with young patients than there is withadults. I can give hygiene instructions to a young person and they are more likely to go homeand at least try it. Ever try to tell a 40-year-old man how to brush better? The “just do yourjob and get me out of here” look occurs more often than not. n

I have to say you two are a gift to humanity! I commend you on your willingnessto embrace pedo hygiene. The kids really need a motivated hygienist to understandthem and teach them well at a time when their oral health is most vulnerable. Butplease, don’t book them in my column! Sad to say, I don’t have the gift to be a great pedohygienist. My specialty seems to be defusing the anxiety of a certain segment of middle-agedladies and building their involvement in their oral health. It’s heavy on the psychotherapeu-tic approach. I really take it as a challenge when I see a new patient with a benzodiazepinelisted in their meds and it is rewarding work. n

How about oral myology? I worked 25 years in a pedo-ortho practice not doinghygiene, but thumb sucking therapy and myofunctional therapy. It was so rewardingand many times the kiddos had gingivitis from mouth breathing that I was able tohelp with. n

In school we didn’t learn knee-to-knee exams and were taught that a child needed tocome in at three years old. I don’t mind working with kids at all, but I do feel more wornout mentally than when I work on adults. Most of the time, it’s the whole family. Momcomes in with her two or three kids and I do hygiene on all of them. Half the time the momis worn out by the end and the kids are running around the operatory, pulling things downor clicking the assistant chair. So yes, I am mentally and physically drained by the end of myafternoon. I just feel blessed to be able to educate patients and help them become healthier.We have one of the best jobs, whether that be with kids or adults. n

DEC 10 2008

SEP 25 2010

SEP 25 2010

OCT 1 2010

OCT 5 2010

Hygienetown Message Board > Dentistry > Pediatric Dentistry > Being a Pedo Dental Hygienist t

HT_MB_Pedio_Layout 1 5/23/13 11:40 AM Page 11


hygienetownmessage board

shazammer1Member Since: 12/20/00 Post: 11 of 16

CavitronMember Since: 04/24/11 Post: 13 of 16

VirginiaRDHMember Since: 04/09/08 Post: 16 of 16

Find it online at: www.hygienetown.com

tsearch Pedo Hygiene

»

In the early ‘80s, I was a school dental hygienist for two years, but due to declin-ing enrollment and school closings I was laid off. I loved it. If I wasn’t laid off, I couldhave seen myself doing it until retirement! The RDH I replaced did! To me, everything

comes down to behavior modification, whether patients are two or 92, I teach brushing thesame way. Both ends of the spectrum have their challenges. Yes the children can be more“mentally” challenging, but the adults are not without their “mentally” challenging days!Teens are very tough and I think getting worse every day. When I started all those years ago,I don’t remember the arrogance as prevalent as it is today. Patients, whether young or old,weren’t as disrespectful as they are today. They didn’t have as much “attitude.” n

I worked in Rick Kushner’s Comfort Dental Practice doing accelerated hygieneusing two assistants out of three operatories. The best part of that job was not seeinganyone under age 15.

I probably make doing pedos harder than it is. I hear my voice going up a notch to thatgirly sound I use for kids. I am good at customer service, but very exhausted with the wheel-barrow full of TLC that small kids need and deserve. I feel like I am chirping all day. Adultscan be reasoned with. Adults have never bitten me so hard that my fingernail turned purple;adults have never vomited on me; adults rarely cry; adults don’t need to sit on mom’s lap;adults don’t require that I turn myself into a pretzel to view their innards. Everyday-all daypraise-giving wears me out. n

I work in a predominantly child-geared office (though we see adults too, just more kidsusually) and laughed out loud reading Shaz’s post. Most of the time I love seeing little kids.But just last week I got bitten extremely hard one day, and then had two days back-to-backwhere a child vomited on me. Boy, does that get old quick. n

I do love seeing children, however my niche is geriatric patients! I love caring for ourolder patients more than any other patient population. My dream would be to own my ownlittle practice where I could go and care for the patients in nursing home facilities. Talk aboutno access to preventive dental care — the geriatric population has been forgotten. Shame! n

JERSEY DEVIL Member Since: 11/04/05 Post: 7 of 16

OCT 5 2010

MAR 24 2012

APR 9 2013

APR 9 2013

HT_MB_Pedio_Layout 1 5/23/13 11:40 AM Page 12

designer

Typewritten Text

designer

Typewritten Text

http://www.towniecentral.com/MessageBoard/thread.aspx?a=11&s=3&f=462&t=122117&g=1

FREE FACTS, circle 33 on card

Xlear_0613_Layout 1 5/23/13 11:42 AM Page BC1

being a pedo dental hygienist - where the hygiene ...11 message board: being a pedo dental hygienist...

Documents