How to protect children from dental cavities
Dr H.S. Chawla

The problem of early childhood dental caries, even as the
teeth make their appearance in the mouth of your child, is
becoming common.

Apart from these cavities affecting the looks and general health of the child, it affects his/her performance in the school.

The number of children seeking treatment of such dental cavities is increasing. It is possible for your child to remain free from dental caries if the following simple regimens are adhered to right from the beginning.

Clean your child's teeth

When the child is born, the oral cavity has only gum pads, and no teeth. The first tooth makes its appearance at about 6 months of age.

It is important to start caring for the child's oral hygiene right after birth, even before the teeth cut into the mouth, by thoroughly cleaning the gum pads.

Take a piece of clean soft cloth; slightly wet it so that it is damp. Wrap it around your finger and wipe the gum pads of the child with it at least two times a day.

As soon as a single tooth cuts in the mouth, this should be meticulously wiped with a clean piece of cloth.

Subsequently, as more teeth erupt, these should be brushed every day. Parents should assist their children in cleaning the teeth.

After the above attempt has been made, the parents should perform the cleaning to complete the brushing attempted by the child.

This help can gradually be tapered off as the child learns to use the brush effectively on his own.

One way of inculcating the brushing habit in your child is by letting the child play with the brush while you brush your own teeth.

Do not feed the child ad libitum

It has been observed in epidemiologic studies that the intake of food/meals more than five times a day leads to an increase in the number of cavities.

The same is true with breast-feeding. Providing food each time the child demands can also lead to the development of childhood dental caries.

Do not share spoon with your child

When the child is born, there are no bacteria in the mouth. The bacteria gain entrance in the child's mouth through the sharing of utensils with the mother, father or care-giver. Spoon-sharing is the most obvious culprit.

Cleaning the pacifier by licking and passing it on to the child is another source of transmitting infection to the child. Kissing the child on the lips is also to blame.

One of the preventive measures is not to share the same utensils you are eating with your child. This will prevent your caries-producing bacteria from being transferred to the child.

Second, maintain your own oral hygiene to reduce your microbiological load. This will lessen the risk of transmitting disease-producing bacteria from you to the child.

Use fluoride toothpaste

Use fluoridated toothpaste. You should start using these toothpastes only after your child learns to spit toothpaste out — as opposed to swallowing it — during brushing.

It has been observed that on an average a child of three-four years ingests 30 per cent of the toothpaste he uses during brushing.

The quantity of toothpaste recommended for a child of two-and-a-half-years to three years is half a pea-size; pea-size for three-five years, and one-fourth the length of the bristle-head for older children.

It is important that the child does not swallow toothpaste after brushing. Parents should dispense the toothpaste themselves and also supervise brushing until the child is seven years old.

Restrict frequency of sugary items to three times a day

It has been proved that sugar taken in any form more than three times a day would increase the chances of getting cavities in children.

The frequency of intake of sugar and sugary items is more important than the amount consumed.

Get topical fluoride applications at two-and-a-half years of age and after six months subsequently

Professional topical fluoride applications by the dentists are known to reduce the chances of occurrence of new cavities by 30 per cent.

The preventive topical fluoride applications can be got started at two and a half to three years and be repeated every six months. It saves the teeth from decay.

The writer is a former Professor and Head, Oral Health Sciences Centre, PGI, Chandigarh. Email: chawlahs@gmail.com

Inhalation route to drug delivery
Dr S.K. Jindal

Inhalation through the respiratory tract has emerged as an important addition to the list of methods of drug administration.

Factually speaking, this is one of the most ancient methods used for centuries in the past. But the technique has gained tremendous importance during the last two to three decades.

It is the introduction of different inhalational devices which has dramatically changed the scene.

The respiratory system is the obvious first site for the effects and actions of smoke or of any other inhaled drug.

The interest in the inhalation devices and the inhaled drugs, therefore, grew as the first choice of treatment for lung diseases.

This is especially so for disorders such as asthma and chronic obstructive pulmonary disease. The two together constitute a global burden of about 400 million patients.

Another 400 million suffer from allergic nasal problems. Naturally, this is a huge market for the inhalation therapy.

But what is more important for us is the potential use of the inhalation therapy. It is precisely for the enormous therapeutic advantages that the inhalation route has become popular amongst the medical community.

Incidentally, the patients are not too happy with the method — certainly not as the first choice. There are a number of apprehensions with their use. Habituation and the stigma of use are the common misgivings.

Inhaled drugs act locally — similar to what the creams and lotions do for the skin diseases and the drops or ointments for diseases of the eyes, nose, ears or throat.

The dose of the drug is, therefore, small and the side-effects are minimal. More importantly, the speed of action is rapid — almost like that of an injection.

Nebulization of drugs is particularly helpful in emergency situations when a patient is very breathless and/or with altered consciousness.

This is also so in case of small children and the elderly. A doctor will, therefore, be happy to prescribe an inhaler more than a tablet or an injection.

But a patient, besides the misgivings, is also bothered about the costs and the usefulness (or efficacy) of inhalers for relief of symptoms and disease-treatment.

Several of the above cited problems are best solved by an appropriate explanation of the technique and the device.

Unfortunately, the technique of inhalation is cumbersome and somewhat difficult. More than three-fourths of a dose is usually not inhaled and gets actually lost.

It is, therefore, crucial to properly follow the inhalation instructions. The use of the newer and the technologically superior devices also helps in increasing the amount of the drug delivered to the lungs.

There are several options which include the use of ‘dry-powder’ inhalers, add-on systems (like a spacer) with an inhaler and breath-actuated devices.

Each method has its own advantages and costs. The individual choice is best discussed with the physician concerned.

Inhalation therapy has now expanded to include a variety of other drugs such as antibiotics, hormones (for example, the insulin) and miscellaneous drugs such as heparin — the anti-coagulant.

Some of these drugs for the inhalation route are already available while others remain in the pipeline. A number of other agents might follow the same trend.

Nonetheless, the inhalation route for asthma and some other respiratory diseases is well established. This is a preferred method of treatment for its safety and efficacy.

The writer is Professor & Head, Department of Pulmonary Medicine, PGI, Chandigarh.