The American Academy of Pediatrics (AAP) issued a policy statement recommending no fruit juice consumption for children <1 year old.

In the past, the AAP had recommended fruit juice not be given to children <6 months. This update is in response to the increasing rates of obesity and oral health issues. A high intake of fruit juice can cause excessive weight gain and tooth decay. Melvin B. Heyman, MD, FAAP, co-author of the statement, noted, “Small amounts in moderation are fine for older kids, but are absolutely unnecessary for children under 1.” 

The updated recommendations include:

• No juice before age 1
• For toddlers ages 1–3, up to half a cup per day (4oz); do not give juice at bedtime
• For children ages 4–6, up to three-quarters cup per day (6oz)
• For children and teens ages 7–18, up to 1 cup per day (8oz)
• Do not put juice in a “sippy cup” or bottle that the child carries around
• Offer your child whole fruit, which has both the vitamins and fiber that children need
• Unpasteurized juice products should be strongly discouraged for children of all ages
• Children who take specific forms of medication should not be given grapefruit juice, which can impact the medication’s efficacy
• Fruit juice is not appropriate to treat dehydration or manage diarrhea

The AAP also states that human milk or infant formula is sufficient for infants whereas low-fat/nonfat milk and water are sufficient for older children. 

For more information visit AAP.org.

Funded by a Food and Drug Administration-provided grant, the new clinical practice guideline for adults and adolescents was developed by the American Dental Association Science & Research Institute, the University of Pittsburgh School of Dental Medicine and the Center for Integrative Global Oral Health at the University of Pennsylvania School of Dental Medicine. This is the second guideline the ADA created for managing acute dental pain; recommendations for pediatric patients were published in 2023.

According to the guideline, following surgical tooth extraction, a nonopioid analgesic such as naproxen 440mg or ibuprofen 400mg either alone or in combination with acetaminophen 500mg should be used as first-line treatment for short-term dental pain. In rare cases when pain control is not attained with the use of an NSAID and acetaminophen, an opioid analgesic (1 tablet combination of acetaminophen 325mg plus hydrocodone 5-7.5mg or oxycodone 5mg) may be added at the lowest effective dose and for the shortest duration possible (eg, max of 3 days). In cases where an NSAID is contraindicated, the panel recommends acetaminophen at its full therapeutic dose (1000mg) or 1 tablet of acetaminophen 325 plus an acetaminophen 325mg/opioid (hydrocodone 5-7.5mg or oxycodone 5mg) combination. 

For simple tooth extraction, the panel recommends against the use of opioid analgesics, favoring only the use of NSAIDs (naproxen 440mg, ibuprofen 400mg) alone or in combination with acetaminophen 500mg. If NSAIDs are contraindicated, the full therapeutic dose of acetaminophen (1000mg) should be used. 

Additional good practice statements outlined in the guideline include:

• Reviewing patient records thoroughly prior to prescribing to avoid potential drug interactions or the possibility of overdose in patients who have reported prior illicit or recreational drug use.
• Writing prescriptions for the minimum effective dose and for the shortest duration possible; routine use of “just-in-case” prescribing of opioids should be avoided.
• Counseling patients on appropriate storage and  disposal of opioids.
• Reviewing the state’s prescription drug monitoring program to determine if the patient is already being prescribed a controlled substance.
• Prioritizing the use of nonopioid analgesics for patients receiving opioids to manage chronic pain.

“It’s important to take special consideration when prescribing any type of pain reliever, and now, dentists have a set of evidence-based recommendations to determine the best care for their patients,” said Dr Paul Moore, DMD, PhD, MPH, the guideline’s senior author and panel chair and professor emeritus at the University of Pittsburgh’s School of Dental Medicine. “Patients are encouraged to discuss pain management expectations and strategies with their dentist so they can feel confident that they are receiving the safest, most effective treatment for their symptoms.”

The full guideline is available here.

According to the results of the Reducing Anesthetic Complications in Children Undergoing Tonsillectomies (REACT) trial, young children who received inhaled albuterol sulfate prior to receiving anesthesia for tonsillectomy had decreased rates of perioperative respiratory adverse events compared with those who received placebo.

The randomized, triple-blind, placebo-controlled study was conducted between July 15, 2014 and May 18, 2017 and included a total of 484 children 0 to 8 years old who received 2 actuations of albuterol (200μg total) or placebo prior to undergoing anesthesia for tonsillectomy. The main outcome of the study was the rate of respiratory adverse events (bronchospasm, laryngospasm, obstruction of the airway, desaturation, coughing, and stridor) that occurred perioperatively until discharge from the postanesthesia care unit.

The intention-to-treat analysis included a total of 479 data sets. The median (range) age of the children included in the study was 5.6 (1.6, 8.9) and 58.9% (N=285) were boys. The study authors reported that 27.8% (67/241) of children who received albuterol experienced a perioperative respiratory adverse event compared with 47.9% (114/238) of children who received placebo. Additionally, the likelihood of perioperative respiratory adverse events was found to be significantly higher in children who received placebo compared with those who received albuterol after adjustments for age, airway device type, and severity of obstructive sleep apnea (OSA) were made in a binary logistic regression model (odds ratio [OR] 2.8; 95% CI, 1.9-4.2; P <.001).

“Significant differences were seen in children receiving placebo vs albuterol in laryngospasm (28 [11.8%] vs 12 [5.0%]; P =.009), coughing (79 [33.2%] vs 27 [11.2%]; P <.001), and oxygen desaturation (54 [22.7%] vs 36 [14.9%]; P =.03),” the study authors also reported. They added, “For every 5 children undergoing adenotonsillectomy treated with albuterol, 1 additional case of respiratory adverse events was prevented (NTT [number needed to treat], 4.8; 95% CI, 8.6-3.5).”

According to the findings of this trial, premedication with albuterol prior to undergoing anesthesia for tonsillectomy significantly reduced perioperative respiratory adverse events. Based on this data, the authors suggest that, “anesthetists should consider the use of albuterol in routine practice, particularly in children with moderate to severe OSA.”

For more information visit jamanetwork.com.

Biodegradable collagen sponges that deliver tideglusib, an Alzheimer’s disease treatment, were shown to stimulate renewal of stem cells in the tooth pulp, encouraging natural tooth repair. Those are the findings from a study published in Scientific Reports.

After an infection or trauma, the inner soft pulp of a tooth can become exposed and infected. To prevent infection, a thin band of dentine is naturally produced and seals the tooth pulp but it is not enough to effectively correct large cavities. Cements or fillings are used to treat the larger cavities and fill in the holes; the cement does not disintegrate and remains in the tooth. If or when fillings fail or infections develop, dentists have to remove and fill an area that is larger than what is affected; tooth extraction may be required after multiple treatments. 

Researchers from King’s College London have discovered a method to stimulate stem cells found in the tooth pulp and generate new dentine in large cavities, which could potentially minimize the need for cements or fillings. 

One of the small molecules that was investigated in stimulating the cells was tideglusib, an agent previously studied to treat neurological disorders such as Alzheimer’s disease. Researchers applied low doses of small molecule glycogen synthase kinase (GSK-3) antagonist to the tooth using biodegradable collagen sponges. The sponges degraded with time and new dentine was shown to replace it, resulting in complete repair. 

Collagen sponges are clinically approved and available, further adding to the treatment’s potential testing and availability. Professor Paul Sharpe, lead author, stated, “The simplicity of our approach makes it ideal as a clinical dental product for the natural treatment of large cavities, by providing both pulp protection and restoring dentine.”

For more information visit nature.com.

HealthDay News — Administering oral acetaminophen to all pediatric patients undergoing tonsillectomy during the preoperative admission process reduces intravenous acetaminophen use, according to a study presented at the annual meeting of the American Society of Anesthesiologists, held from October 8 to 12 in San Diego.

Melissa Brooks Peterson, MD, from the University of Colorado School of Medicine in Aurora, and colleagues assessed the impact of giving oral acetaminophen (12.5mg/kg oral acetaminophen; maximum dose, 650mg) to all pediatric otorhinolaryngologic patients undergoing tonsillectomy with or without adenoidectomy during the preoperative admission process as part of the standing anesthesia preoperative order set.

The researchers found that changing from an “opt-in” model to an “opt-out” model dramatically reduced the amount of intravenous acetaminophen dispensed (−23.8 doses per month). The resultant cost savings was more than $27.00 per patient, yielding an annual savings of more than $50,000.

“Nurses find managing kids in the recovery room after tonsillectomies can be challenging because the children go into the procedure fine and can come out of surgery in extreme pain,” Brooks Peterson said in a statement. “Under the new protocol, perioperative nurses control the acetaminophen dosing. Getting medication into the patient in a more reliable way reduces variability, improves care for our patients, and helps the nurses serve an important role in pain control.”

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Study authors concluded there was insufficient evidence to either support or refute the use of any interventions in managing burning mouth syndrome (BMS). 

BMS refers to oral mucosal pain such as burning pain or discomfort in the tongue, lips, or entire oral cavity without a known cause. A Cochrane database systematic review of randomized controlled trials was conducted to determine the safety and efficacy of any intervention against placebo for symptomatic relief and changes in quality of life (QoL), taste, and feeling of dryness in patients with BMS. 

The primary outcomes were symptom relief (pain/burning) and change in QoL. Secondary outcomes included changes in taste, feeling of dryness, and adverse effects. Data were analyzed as either short-term (up to 3 months) or long-term (3–6 months).  

Twenty-three randomized controlled trials (n=1,121) were included for the review. BMS interventions included antidepressants, antipsychotics, anticonvulsants, benzodiazepines, cholinergics, dietary supplements, electromagnetic radiation, physical barriers, psychological therapies, and topical treatments. The quality of evidence for efficacy was very low for all interventions and outcomes. 

For short-term relief of BMS, authors cited very low quality evidence of benefit from electromagnetic radiation (1 study), topical benzodiazpeines (2 studies), physical barrriers (1 study), and anticonvulsants (1 study). 

Insufficient/contradictory data was found regarding the efficacy of antidepressants, cholinergics, systemic benzodiazpeines, dietary supplements or topical treatments. No randomized controlled trials involved psychological therapies for short-term symptom relief. 

For long-term relief of BMS, authors cited very low quality evidence of benefit from psychological therapies (1 study), capsaicin oral rinse (topical treatment) (1 study), and topical benzodiazepines (1 study). There was no evidence of a difference for dietary supplements vs. lactoperoxidase oral rinse. No randomized controlled trials involving  antidepressants, anticonvulsants, cholinergics, electromagnetic radiation or physical barriers evaluated long-term symptom relief.

Authors further concluded very low quality evidence for short-term change in QoL; none evaluated for long-term effect. Electromagnetic radiation proved beneficial in 1 study but findings were inconclusive for antidepressants, benzodiazepines, dietary supplements, and physical barriers. 

Regarding side effects, there was very low quality evidence that antidepressants increase dizziness and drowsiness, and that alpha lipoic acid increases headache and gastrointestinal (GI) complaints. Insufficient/contradictory evidence were found regarding adverse events for anticonvulsants or benzodiazepines. 

Overall, the findings call for a need to discover effective treatment approaches for patients with BMS. More studies are needed with better methodology and standardized outcomes to determine which treatments are effective. Future studies should investigate treatments used for other neuropathic pain conditions and psychological therapies in the treatment of BMS.

For more information visit onlinelibrary.wiley.com.

Repeated use of over-the-counter (OTC) mouthwash was linked to a higher risk of developing prediabetes and diabetes in a study of more than 1,000 overweight/obese adults. The full findings were published in the journal Nitric Oxide.

For many individuals, use of OTC mouthwash is part of their regular oral hygiene care. The potential adverse effects of long-term daily use, however, have not been investigated. Study authors explained that using antibacterial mouthwash can eradicate oral microbes needed for nitric oxide formation and place the user at risk for metabolic disorders. 

To evaluate this association, they conducted the San Juan Overweight Adults Longitudinal Study (SOALS) among 1,206 overweight or obese adults aged 40–65 years; patients were followed for 3 years. Patients had no diabetes or major cardiovascular disease; 945 patients had complete follow-up data for analyses. Hazard ratios (HR) were adjusted for baseline age, sex, smoking, physical activity, waist circumference, alcohol consumption, and hypertension. 

The data showed that 43% of patients used mouthwash at least once a day and 22% used mouthwash at least twice a day. Adults who used mouthwash at least twice a day at baseline showed a significantly increased risk of prediabetes/diabetes vs. those who used it less frequently (HR 1.67, 95% CI: 1.24–2.26) or never used mouthwash (HR 1.65, 95% CI: 1.19–2.28). The size of the effects were consistent after factoring in income, education, oral hygiene, oral conditions, sleep breathing disorders, diet, medications, HOMA-IR, fasting glucose, 2-hour post-load glucose, or C-reactive protein to the multivariate models. 

“Both associations were significant among never-smokers and obese,” added lead author Kaumudi J. Joshipura. 

Study participants who used mouthwash less than twice a day did not demonstrate a risk, suggesting that the effect starts at a threshold of use of twice a day or more. 

For more information visit sciencedirect.com.

Sealants can cut cavities by 80% for up to two years, and by 50% for up to four years, a new CDC report shows. “Unfortunately, most kids don’t have them — 40% of kids have dental sealants, but 60% don’t,” Tom Frieden, MD, MPH, director of the CDC, said during a news conference. “Kids without dental sealants have almost three times more cavities that those who do have sealants.” 

Low-income children are more than twice as likely as children in more affluent families to have untreated tooth decay, the report found. “School-based sealant programs can be a win-win,” Frieden said. “Governments, schools, parents, and kids all come out ahead. Dental sealants are simple, quick, easy, and completely painless; there are no unwanted side effects; and the benefits start immediately.”

Frieden added that progress has been made with dental sealants in the past decade. In that period, the number of children from low-income families who had dental sealants increased nearly 70%. “This prevented about one million cavities, but still, poorer children are 20% less likely to have sealants than children from higher-income families,” he said. “Every tooth that gets sealant saves $11.70 in dental costs.” Sealants for 6.5 million low-income children in schools could save up to $300 million in dental care costs.

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