What is Down Syndrome?

What is Down syndrome?

Down syndrome is set of mental and physical symptoms that result from having an extra copy of Chromosome 21.

Normally, a fertilized egg has 23 pairs of chromosomes. In most people with Down syndrome, there is an extra copy of Chromosome 21 (also called trisomy 21 because there are three copies of this chromosome instead of two), which changes the body’s and brain’s normal development.

What are the signs and symptoms of Down syndrome?

Even though people with Down syndrome may have some physical and mental features in common, symptoms of Down syndrome can range from mild to severe. Usually, mental development and physical development are slower in people with Down syndrome than in those without the condition.

Mental retardation is a disability that causes limits on intellectual abilities and adaptive behaviors (conceptual, social, and practical skills people use to function in everyday lives). Most people with Down syndrome have IQs that fall in the mild to moderate range of mental retardation. They may have delayed language development and slow motor development.

Some common physical signs of Down syndrome include:

• * Flat face with an upward slant to the eye, short neck, and abnormally shaped ears
• * Deep crease in the palm of the hand
• * White spots on the iris of the eye
• * Poor muscle tone, loose ligaments
• * Small hands and feet

There are a variety of other health conditions that are often seen in people who have Down syndrome, including:

• * Congenital heart disease
• * Hearing problems
• * Intestinal problems, such as blocked small bowel or esophagus
• * Celiac disease
• * Eye problems, such as cataracts
• * Thyroid dysfunctions
• * Skeletal problems
• * Dementia—similar to Alzheimer’s

What is the treatment for Down syndrome?

Down syndrome is not a condition that can be cured. However, early intervention can help many people with Down syndrome live productive lives well into adulthood.

Children with Down syndrome can often benefit from speech therapy, occupational therapy, and exercises for gross and fine motor skills. They might also be helped by special education and attention at school. Many children can integrate well into regular classes at school.

Who is at risk for Down syndrome?

The chance of having a baby with Down syndrome increases as a woman gets older—from about 1 in 1,250 for a woman who gets pregnant at age 25, to about 1 in 100 for a woman who gets pregnant at age 40. But, most babies with Down syndrome are born to women under age 35 because more younger women have babies.

Because the chances of having a baby with Down syndrome increase with the age of the mother, many health care providers recommend that women over age 35 have prenatal testing for the condition. Testing the baby before it is born to see if he or she is likely to have Down syndrome allows parents and families to prepare for the baby’s special needs.

Parents who have already have a baby with Down syndrome or who have abnormalities in their own chromosome 21 are also at higher risk for having a baby with Down syndrome.

Once the baby is born, a blood test can confirm whether the baby has Down syndrome.

Institute of Child Health and Human Development

What is Fragile X Syndrome?

What is Fragile X syndrome?

Fragile X syndrome is the most common form of inherited mental retardation.

Fragile X happens when there is a change, or mutation, in a single gene called the Fragile X Mental Retardation 1 (FMR1) gene. This gene normally makes a protein the body needs for the brain to develop. But when there is a change in this gene, the body makes only a little bit or none of the protein, which can cause the symptoms of Fragile X.

Fragile X is inherited, which means it is passed down from parents to children. Parents can have children with Fragile X even if the parents do not have Fragile X themselves. The changes in the gene can become more serious when passed from parent to child.

Some people may only have a small change in their FMR1 gene (called a premutation) and may not show any signs of Fragile X. Other people may have bigger changes in the gene, called a full mutation, that cause the symptoms of Fragile X syndrome.

What are the signs and symptoms of Fragile X syndrome?

Not everyone with Fragile X has the same signs and symptoms, but they do have some things in common. Symptoms are often milder in girls than in boys. Here are some common signs of Fragile X:

• * Intelligence and learning – Many people with Fragile X have intellectual disabilities. These problems can range from mild learning disabilities to more severe mental retardation.
• * Physical – Teens and adults with Fragile X may have long ears, faces, and jaws. Many people with Fragile X may also have loose, flexible joints. They may have flat feet and be able to extend joints like the thumb, knee, and elbow further than normal.
• * Social and Emotional – Most children with Fragile X have some behavior challenges. They may be afraid or anxious in new situations. Many children, especially boys, have trouble paying attention or may be aggressive. Girls may be shy around new people.
• * Speech and Language – Most boys with Fragile X have some problems with speech and language. They may have trouble speaking clearly, or may stutter, or leave out parts of their words. They may also have problems understanding "clues" when talking to other people, such as understanding the speaker’s tone of voice or that person’s body language. Girls usually do not have severe problems with speech or language.
• * Sensory – Many children with Fragile X are bothered by certain sensations, such as bright light, loud noises, or the way something feels. Some do not like to be touched, or have trouble making eye contact with other people.

What are the treatments for Fragile X syndrome?

There is no cure for Fragile X, but there are ways to help with the symptoms.

People with Fragile X can get help to reduce or eliminate some of the learning, physical, social and emotional, speech and language, and sensory problems common in Fragile X. The sooner those with Fragile X get help, the more they can learn and the better their outcomes.

Institute of Child Health and Human Development.

What is Klinefelter Syndrome?

What is Klinefelter syndrome?

Klinefelter syndrome, also known as the XXY condition, is a term used to describe males who have an extra X chromosome in most of their cells. Instead of having the usual XY chromosome pattern that most males have, these men have an XXY pattern.

Klinefelter syndrome is named after Dr. Henry Klinefelter, who first described a group of symptoms found in some men with the extra X chromosome. Even though all men with Klinefelter syndrome have the extra X chromosome, not every XXY male has all of those symptoms.

Because not every male with an XXY pattern has all the symptoms of Klinefelter syndrome, it is common to use the term XXY male to describe these men, or XXY condition to describe the symptoms.

Scientists believe the XXY condition is one of the most common chromosome abnormalities in humans. About one of every 500 males has an extra X chromosome, but many don’t have any symptoms.

What are the symptoms of the XXY condition?

Not all males with the condition have the same symptoms or to the same degree. Symptoms depend on how many XXY cells a man has, how much testosterone is in his body, and his age when the condition is diagnosed.

The XXY condition can affect three main areas of development:

Physical development: As babies, many XXY males have weak muscles and reduced strength. They may sit up, crawl, and walk later than other infants. After about age four, XXY males tend to be taller and may have less muscle control and coordination than other boys their age.

As XXY males enter puberty, they often don’t make as much testosterone as other boys. This can lead to a taller, less muscular body, less facial and body hair, and broader hips than other boys. As teens, XXY males may have larger breasts, weaker bones, and a lower energy level than other boys.

By adulthood, XXY males look similar to males without the condition, although they are often taller. They are also more likely than other men to have certain health problems, such as autoimmune disorders, breast cancer, vein diseases, osteoporosis, and tooth decay.

XXY males can have normal sex lives, but they usually make little or no sperm. Between 95 percent and 99 percent of XXY males are infertile because their bodies don’t make a lot of sperm.

Language development: As boys, between 25 percent and 85 percent of XXY males have some kind of language problem, such as learning to talk late, trouble using language to express thoughts and needs, problems reading, and trouble processing what they hear.

As adults, XXY males may have a harder time doing work that involves reading and writing, but most hold jobs and have successful careers.

Social development: As babies, XXY males tend to be quiet and undemanding. As they get older, they are usually quieter, less self-confident, less active, and more helpful and obedient than other boys.

As teens, XXY males tend to be quiet and shy. They may struggle in school and sports, meaning they may have more trouble "fitting in" with other kids.

However, as adults, XXY males live lives similar to men without the condition; they have friends, families, and normal social relationships.

What are the treatments for the XXY condition?

The XXY chromosome pattern can not be changed. But, there are a variety of ways to treat the symptoms of the XXY condition.

• * Educational treatments – As children, many XXY males qualify for special services to help them in school. Teachers can also help by using certain methods in the classroom, such as breaking bigger tasks into small steps.
• * Therapeutic options – A variety of therapists, such as physical, speech, occupational, behavioral, mental health, and family therapists, can often help reduce or eliminate some of the symptoms of the XXY condition, such as poor muscle tone, speech or language problems, or low self-confidence.
• * Medical treatments – Testosterone replacement therapy (TRT) can greatly help XXY males get their testosterone levels into normal range. Having a more normal testosterone level can help develop bigger muscles, deepen the voice, and grow facial and body hair. TRT often starts when a boy reaches puberty. Some XXY males can also benefit from fertility treatment to help them father children.

One of the most important factors for all types of treatment is starting it as early in life as possible.

Institute of Child Health and Human Development

What is McCune-Albright syndrome?

What is McCune-Albright syndrome?

McCune-Albright syndrome is a disease that affects the bones, skin, and endocrine (hormone) system. It results from a change (or mutation) in a gene that occurs by chance in the womb. Because it occurs by chance, it is not inherited and passed down from one generation to the next.

What are the symptoms of McCune-Albright syndrome?

People with McCune-Albright syndrome may have symptoms related to bones, the endocrine system, or skin. The symptoms can range from mild to severe.

Bone symptoms

• * Those with McCune-Albright syndrome often have polyostotic fibrous dysplasia (pronounced pa-lee-oh-STOT-ik FIE-bruss diss-PLAY-jsha), which occurs when normal bone is replaced by softer, fibrous tissue. When this happens in weight-bearing bones, such as the leg bones, it can cause limping, deformity, and fractures.
• * People with McCune-Albright syndrome often have this dysplasia condition in the bones of the skull and upper jaw, so these bones grow unevenly. There is no known hormonal or medical treatment for controlling this aspect of disease, although surgery can help correct some fractures and deformities.

Endocrine system symptoms

• * Precocious, or very early, puberty – Girls with McCune-Albright syndrome begin to show signs of puberty much younger than normal. Menstrual bleeding before two years of age is the first symptom of McCune-Albright syndrome for most female patients. Boys with the condition may show signs of puberty early, but these signs are less common than in girls.
• * Thyroid function – The thyroid is a small gland in the neck that affects the metabolism. About half of patients with McCune-Albright syndrome have problems with their thyroid glands, such as enlargement or masses (called nodules or cysts). Drug therapy can sometimes improve thyroid function.
• * Growth hormone – Some patients have too much pituitary growth hormone, which causes coarse facial features, larger hands and feet, and arthritis. Treatments include surgery and medication.
• * Cushing’s syndrome – This is a rare problem for McCune-Albright syndrome patients. Symptoms include obesity of the face and body, weight gain, skin fragility, and stopping growth in childhood. Cushing’s syndrome is treated by removing the affected glands or with medicine.

Skin symptoms

• * McCune-Albright syndrome can cause patches of increased or darker skin coloring. These areas are called café-au-lait spots because, in children with light complexions, these spots are the color of coffee with milk. In darker skinned children, the spots might be hard to see.
• * Most children have these spots from birth and the spots rarely grow. There are usually not any medical problems caused by these skin changes.

What are the treatments for McCune-Albright syndrome?

There is no cure for McCune-Albright syndrome. Drug treatments may help reduce or alleviate some of the symptoms, and surgery can help repair some of the bone problems.

Institute of Child Health and Human Development.

Menkes Syndrome

What is Menkes syndrome?

Menkes syndrome is a genetic disorder that impacts how well the body stores and distributes copper.

Menkes is caused by a mutation in the ATP7A gene that results in poor distribution of copper through the body. Copper builds up in some tissues, such as the small intestine and kidneys, while areas like the brain and liver don’t get enough copper.

Menkes syndrome is an X-linked recessive disorder, meaning that the mutated ATP7A gene is on the X chromosome and the condition is usually inherited. Males are affected by Menkes more often than females. About one-third of Menkes cases result from a spontaneous mutation in the gene, meaning that it occurs without warning and is not inherited.

Occipital horn syndrome is a less severe from of Menkes syndrome that begins in early to middle childhood.

What are the symptoms of Menkes syndrome?

Symptoms of Menkes, which appear during infancy, include normal development for 2 to 3 months, followed by a period of severe developmental delay and a loss of developmental skills.

Other symptoms may include:

• * Sparse, kinky, coarse hair
• * Failure to thrive
• * Deterioration of the nervous system
• * Weak muscle tone and sagging facial features
• * Seizures
• * Lower than normal body temperature
• * Weakened bones that can result in fractures
• * Pudgy, rosy cheeks

The prognosis for people with Menkes syndrome is poor, and most children with the disorder die within the first few years of life.

What is the treatment for Menkes syndrome?

The most common treatment for Menkes is copper injection therapy, but the studies of the treatment show mixed results. In general, the earlier the copper therapy is received, the better the results. Also, people with ATP7A mutations that don’t completely stop the copper transport in the body respond better to treatment than those with mutations causing absolutely no activity.

In addition to copper therapy, physical and occupational therapy can help maximize developmental potential, and nutritionists can recommend the best diet.

For more information about treatments for Menkes syndrome, talk to your health care provider.

Institute of Child Health and Human Development.

What is Prader-Willi Syndrome?

What is Prader-Willi Syndrome?

Prader-Willi syndrome is the most common genetic cause of life-threatening obesity in children.

People with Prader-Willi syndrome have a problem in their hypothalamus, a part of the brain that normally controls feelings of fullness or hunger. As a result, they never feel full and have a constant urge to eat that they cannot control.

Most cases of Prader-Willi syndrome result from a spontaneous genetic error in genes on chromosome 15 that occurs at conception. In very rare cases, the mutation is inherited.

What are the symptoms of Prader-Willi syndrome?

There are generally two stages of symptoms for people with Prader-Willi syndrome:

Stage 1 - As newborns, babies with Prader-Willi can have low muscle tone, which can affect their ability to suck properly. As a result, babies may need special feeding techniques to help them eat, and infants may have problems gaining weight. As these babies grow older, their strength and muscle tone usually get better. They meet motor milestones, but are usually slower in doing so.

Stage 2 - Between the ages of 1 and 6 years old, the disorder changes to one of constant hunger and food seeking. Most people with Prader-Willi syndrome have an insatiable appetite, meaning they never feel full. In fact, their brains are telling them they are starving. They may have trouble regulating their own eating and may need external restrictions on food, including locked kitchen and food storage areas.

This problem is made worse because people with Prader-Willi syndrome use fewer calories than those without the syndrome because they have less muscle mass. The combination of eating massive amounts of food and not burning enough calories can lead to life-threatening obesity if the diet is not kept under strict control.

There are other symptoms that may affect people with Prader-Willi, including:

• * Behavioral problems, usually during transitions and unanticipated changes, such as stubbornness or temper tantrums
• * Delayed motor skills and speech due to low muscle tone
• * Cognitive problems, ranging from near normal intelligence to mild mental retardation; learning disabilities are common
• * Repetitive thoughts and verbalizations
• * Collecting and hoarding of possessions
• * Picking at skin
• * Low sex hormone levels

Prader-Willi syndrome is considered a spectrum disorder, meaning not all symptoms will occur in everyone affected and the symptoms may range from mild to severe.

People with Prader-Willi often have some mental strengths as well, such as skills in jigsaw puzzles. If obesity is prevented, people with the syndrome can live a normal lifespan.

What are the treatments for Prader-Willi syndrome?

Prader-Willi syndrome cannot be cured. But, early intervention can help people build skills for adapting to the disorder. Early diagnosis can also help parents learn about the condition and prepare for future challenges. A health care provider can do a blood test to check for Prader-Willi syndrome.

Exercise and physical activity can help control weight and help with motor skills. Speech therapy may be needed to help with oral skills.

Human growth hormone has been found to be helpful in treating Prader-Willi syndrome. It can help to increase height, decrease body fat, and increase muscle mass. However, no medications have yet been found to control appetite in those with Prader-Willi.

Institute of Child Health and Human Development

What is Turner Syndrome

What is Turner Syndrome

Turner syndrome is a disorder caused by a partially or completely missing X chromosome. It is a condition that only affects females.

Most people have 46 chromosomes in each cell – 23 from their mother and 23 from their father. The 23rd pair of chromosomes is called the sex chromosomes – X and Y – because they determine whether a person is male or female. Most females have XX in most of their cells and most males have XY in most of their cells.

Females with Turner syndrome are missing all or part of one of their X chromosomes.

What are the symptoms of Turner syndrome?

People with Turner syndrome can have a wide variety of symptoms. Some people may have more severe problems, and others may have mild symptoms. Turner syndrome may affect many areas, such as:

• * Appearance – Features may include short neck, low hairline at the back of the neck, low-set ears, hands and feet that are swollen or puffy at birth, and soft nails that turn upward.
• * Stature – Children with Turner grow more slowly than other kids and without treatment tend to be very short as adults.
• * Puberty/Reproduction – Most individuals with Turner syndrome lose ovarian function in early childhood and do not start puberty at a normal age. These women usually cannot become pregnant naturally.
• * Cardiovascular – Some individuals with Turner syndrome have structural problems with their hearts or major blood vessels. For this reason, everyone with Turner syndrome needs a thorough cardiologic evaluation at the time of diagnosis. High blood pressure also affects about 20 percent of girls and 40 percent of adults with Turner syndrome.
• * Kidney – Some people with Turner have kidneys that appear to be structurally abnormal, but their kidney function is usually normal.
• * Osteoporosis – Women with Turner syndrome who do not get adequate estrogen often get osteoporosis, which can cause loss of height, and increased bone fractures.
• * Diabetes – People with Turner syndrome are at higher risk for Type II diabetes.
• * Thyroid – Many people with Turner have thyroid problems, usually hypothyroidism, or an under-active thyroid.
• * Cognitive – Even though people with Turner syndrome have normal intelligence, some have problems with specific visual-spatial coordination tasks (such as mentally rotating objects in space) and may have trouble learning math (geometry and arithmetic).

What are the treatments for Turner syndrome?

Although there is no cure for Turner syndrome, there are some treatments that can help minimize the symptoms.

• * Human growth hormone (hGH) given in early childhood can often increase adult height by a few inches.
• * Estrogen replacement therapy (ERT) can help start up secondary sexual development that normally begins at puberty for girls without Turner (such as breast development or developing wider hips). Health care providers may prescribe ERT to girls who haven’t started menstruating by age 15.
• * Assistive reproductive therapies, such as egg donation, may help some women with Turner get pregnant.

Institute of Child Health and Human Development.

Morning Breath Is A Transient Thing

Morning Breath Is A Transient Thing

It would be tough to find a person who has never suffered from morning breath. We wake up in the morning feeling as though our mouths have been immobile all night long. Indeed, they probably have been. The oral cavity is either parchment dry, from breathing through the mouth (worse if you snore), or glued together from a lack of free flowing saliva. We force our lips to move: the first word is a croak.

Morning breath is actually a consequence of naturally decreased saliva production: the body produces less saliva while we sleep. Since saliva is a potent force against the oral bacteria that produce bad breath, a decrease in saliva allows those bacteria to proliferate during the night - and proliferation of those bacteria means production of volatile sulfur compounds (VSC), which smell really bad and are the main component of bad breath.

Fortunately, morning breath is a transient thing - once we are up and around, and have brushed and rinsed, the higher daytime flow of saliva resumes and all is well in the mouth (unless there is a chronic problem with VSC-producing bacteria). For most of us, a regular program of oral hygiene is all that's needed: brush and floss regularly, and clean the tongue, especially if you notice a white or yellowish coating on it in the morning. Morning breath should be easily vanquished.

There are a few things that make morning breath worse: coffee, alcohol, smoking, snacking during the night, poor oral hygiene, and sinus congestion, to name a few. In addition, many drugs cause a dry mouth, and this effect is accentuated when saliva flow is naturally decreased. These things affect morning breath for different reasons. Some decrease saliva flow; some directly support the proliferation of VSC-producing bacteria by providing nutrients. What's important is that we know they make things worse - avoid them if possible.

If your morning breath bothers you so much that you want to do something significant about it, try stepping up your oral care first. Are you brushing your teeth and rinsing your mouth out first thing in the morning? Are you cleaning your tongue? If these measures seem inadequate, use a good oral rinse that kills or removes VSC-producing bacteria on the tongue. Perhaps you want fresh breath before you even get out of bed - a difficult order to fill, but there are products on the market that claim to stop morning breath from happening at all. Of course, you'd add these into your routine in the evening, before going to sleep.

R. Drysdale

Sinus Drainage Bad Breath

Sinus Drainage Bad Breath

Have you heard of sinus drainage bad breath? This condition implies that the bad breath is coming from the sinuses; however, that is usually not the case. When draining sinuses contribute to halitosis, the odor is coming from the back of the mouth, just as it does with regular halitosis.

When there is a problem in a sinus bad breath results for a very simple reason: drainage from the sinus runs down the back of the throat and onto the very back of the tongue. The drainage is a rich source of protein because it contains dead sinus cells that have sloughed off, blood cells, pus cells, and other molecules produced by the body. These are the exact things that oral bacteria like to use for nutrients. With a steady food supply from sinus drainage bad breath increases with the increase of bacteria.

The bacteria that are particularly known for producing sinus drainage bad breath, and other bad breath as well, are anaerobes, meaning that they live in an oxygen free environment. They cannot withstand significant amounts of oxygen - the back of the tongue is a perfect place for them to hide. They get down in the little grooves between tongue papillae and taste buds, and just wait for food to come to them. When it does, they take what they need and produce foul smelling volatile sulfur compounds as an accidental byproduct of metabolism. Unfortunately for the person with an inflamed sinus bad breath is the final result.

The good thing is that treating sinus drainage bad breath is really no different from treating any other type of bad breath. Many people suffer from post nasal drip, which essentially produces the same type of sinus bad breath. Bad breath products that work for regular bad breath will work just as well for these situations. Of course, a product that works by decreasing the population of anaerobes living at the back of the tongue will be the most effective. Look for oral care products that are antibacterial in some way - they may physically remove tongue bacteria or they may kill them. Either should help decrease the odor on your breath and allow you to focus on alleviating the discomfort of the sinus problem, instead of worrying about your sinus drainage bad breath.


R. Drysdale

Oral Health and Calcium

Oral Health and Calcium

What is calcium?

Calcium is a mineral your body needs to help build strong bones and healthy teeth. Low-fat and fat-free milk and dairy products are especially good sources of calcium.

How does calcium help keep mouths healthy?

* Even before baby teeth and adult teeth come in, they need calcium. And after teeth come in, they continue to take in calcium so they can develop fully.
* Calcium makes gums healthy. Getting enough calcium as a young adult may help prevent gum disease later in life.
* Calcium makes jawbones strong and healthy too. Jawbones need to be strong - they hold the teeth in place!

How else can I help my child have a healthy mouth?

Besides teaching your children to drink milk and eat other calcium-rich foods, there are a number of ways you can help keep your child's mouth health. For example:

* Make sure your children brush with fluoride toothpaste. Fluoride protects teeth from decay and helps heal early decay.
* Ask your child’s dental care provider or health care provider if there is fluoride in your town or city’s drinking water. If there is not, ask about fluoride tablets or drops for your child.
* Ask your child’s dental care provider about proper brushing and flossing techniques and other ways your tween and teen can make sure teeth stay healthy.


Institute of Child Health and Human Development

Dental Health: The Facts

Dental Health: The Facts

Introduction

The major source of knowledge concerning the prevalence of dental health problems comes from periodic national surveys. In 1971-1974, the National Center for Health Statistics conducted the National Health and Nutrition Examination Survey (NHANES I) on a representative sample of the U.S. population. The survey included information concerning prevalence of caries, periodontal disease, edentulousness, and other dental health problems among children and adults. A 1979-1980 National Caries Prevalence (NCP) survey conducted by the National Institute of Dental Research (NIDR) assessed the dental health of U.S. school children aged 5-17. In 1983-1984, the Indian Health Service conducted a cross-sectional study of clinical patients to assess the dental health among American Indian and Alaskan natives. The dental health data that follows comes largely from those national surveys. Fluoridation data is collected and reported by the Centers for Disease Control. In late 1986, the National Institute of Dental Research will complete an Adult Oral Health Survey, which will provide updated Information about progress made in improving dental health among adults.

The prospects of prevention in dental health are encouraging. The use of fluoride at optimal levels before and after eruption of permanent teeth reduces the amount of caries an average of 50%-60%. Newly developed and under-utilized dental sealants can result in a 90% reduction in caries in treated teeth after one year, and a 55% reduction after six years. Lack of public and professional acceptance is a major factor limiting the effectiveness of these currently available prevention strategies.

Prevalence

Caries—Children

The 1979-1980 National Caries Prevalence (NCP) survey of U.S. school children aged 5-17 revealed that, on average, a school child had at least 1 caries lesion in permanent teeth by age 8,4 caries by age 12 and 11 by age 17.

The NCP survey estimated the caries prevalence in the permanent dentition for U.S. school children age 5-17 to be 4.77 decayed, missing or filled tooth surfaces (DMFS) per child and 2.91 decayed, missing or filled teeth (DMFT) per child.

A 1971-1974 National Center for Health Statistics (NCHS) Health and Nutrition Examination Survey (NHANES I) reported that children 1-5 years old averaged 1 primary tooth that was either decayed, nonfunctional-carious or filled.

School children aged 5 years in the 1979-1980 NCP survey averaged over 4 decayed or filled surfaces. Children 5-9 years old averaged 5.3 decayed or filled surfaces and 2.6 decayed or filled teeth per child in their primary dentition.

In the 1979-1980 NCP survey, 36.6% of U.S. school children aged 5-17 had no decayed, missing or filled teeth (DMFT), 39.8% had 1-4 DMFT, 15.9% had 5-8 (DMFT); and 7.7% had 9 or more (DMFT).

White children had more caries (4.89 DMFS per child) than children of other races (4.15 DMFS per child), according to the 1979-80 NIDR survey.

A 1983-1984 study of American Indian and Alaskan Native (AI/AN) children indicated that AI/AN children aged 5-19 years had an average of 6.8 DWI, compared to an average of 4.8 DMFT among 5-17 year olds in the general U.S. population reported by the NCP survey.

Between 1971 and 1974, children 6-11 years old who ate 20% of their total calories as between-meal sweets had 20% more decayed, missing and filled teeth than those children who did not have between-meal sweets.

Among school children in the 1979-1980 survey, 16.8% of the DMF surfaces were classified as decayed and unfilled, while 76.1% had been filled or restored by dental treatment, thereby indicating a relatively high level of restorative dental care among U.S. school children.

Marked regional variation in caries prevalence among U.S. school children exists. Children from the Northeast have been reported to have the highest mean number of decayed, missing and filled surfaces (DMFS) at 6.1 compared to children from the Southwest with 3.4 DMFS.

In the Southwest, 45% of the children are caries-free, compared to 30% of the children in the Northeast.

Caries—Adults

The 1971-1974 National Health and Nutrition Evaluation Survey (NHANES I) revealed that adults aged 18-74 years with at least one natural tooth averaged 16.9 decayed, missing or filled permanent teeth per person, including 1.4 untreated decayed permanent teeth.

Blacks aged 18-74 years averaged 4.7 fewer DMFT than whites in NHANES I. Women of all races averaged 1.2 more DMFT than men, while black women averaged 2.9 more DMFT than black men.

The 1982 National Health Interview Survey reported 11.4 million days of restricted activity, 4.16 million days of bed disability, 2.01 million days of work loss and 1.37 million days of school loss as a result of 3.21 million dental conditions.

Periodontal Disease

The 1979-1980 National Caries Prevalence Survey (NCP) of U.S. school children reported that 92% of the children had moderate gingival treatment needs, 3% had severe needs and 5% had no gingival treatment needs.

NHANES I showed that 31% of U.S. adults 18-79 years old had destructive periodontal disease and 25% had gingivitis.

The prevalence and severity of periodontal disease increases with age and is more common among males than females.

Periodontal index (PI) is a composite index used in oral epidemiological surveys to indicate the presence and severity of disease in the supporting tissues of the teeth. The PI ranges from 0 (indicating no inflammation) to 8 (indicating advanced destruction). The 1971-74 NHANES I survey showed that persons not brushing their teeth daily had a mean periodontal index of 3.54, whereas persons brushing once daily had a mean PI of 1.40, and persons brushing twice daily had a mean PI of 1.05.

The same survey revealed that nonsmokers had a mean PI of 1.01 compared to current smokers whose mean PI was 1.55.

Edentulous Persons

14.7% of the U.S. population aged 18-74 years were missing all of their teeth, according to NHANES I data.

Dental Treatment Needs

A 1975-1976 study showed that more than 9.5 million persons received medical care each year for craniofacial injuries.

Oral Cancer

In 1981, 27,000 new cases of oral cancer were diagnosed, and 9,000 cancer deaths were attributed to oral cancers.

Fluoride

The natural fluoride concentration in domestic water in the U.S. supplies ranges from 0.1 to 10 mg/L. Sea water contains fluoride at 1.0 to 1.5 mg/L.

Fluoride ingested at optimal levels before eruption of permanent molars reduces caries an average of 50%-60%. Reduction of caries continues at 50%-60% only if fluoride in water at 1 mg/L washes over teeth for the lifetime of the teeth.

The use of fluoride at optimal concentrations results in a 75% decrease in premature extraction of teeth among children.

Persons with the highest concentration of fluoride in the enamel of their teeth had more than 50% fewer decayed, missing and filled teeth than persons with the lowest fluoride concentration in a 1971-1974 national survey.

Public and Professional Awareness

When asked about factors important to preventing tooth decay in a 1985 National Health Interview Survey (NHIS), 95% of those surveyed said seeing a dentist regularly, 78% said drinking water with fluoride from childhood, and 96% said regular brushing and flossing teeth.

When asked about the main cause of tooth loss in children in the above survey, 58% said tooth decay; 30% said injury to the teeth; 8% said gum disease; and 4% did not know.

When asked about the main cause of tooth loss in adults during the same survey, 55% listed gum disease; 40% tooth decay; 2% injury to teeth; and 3% did not know.

In a survey for the American Dental Association (ADA), 94% of respondents said they brush their teeth. Of those respondents that brush, 64% do so at least once a day, and an additional 23% brush after each meal.

In the ADA survey, 38% of persons responding floss their teeth. Of the respondents aged 30-40, 47% stated that they flossed their teeth.

In the ADA survey, almost one third of respondents reported visiting a dentist within 6 months of the interview, 23% had visited a dentist between 6 months to 1 year, and 22% had not visited a dentist for 3 years or longer.

Preliminary analyses of the 1983 National Health Interview Survey indicate that 94% of people using a dentifrice use a brand containing fluoride.

Service Delivery

In 1983, there was an average 1.8 dental visits per person in the U.S. 51.8% of Americans in 1983 had visited a dentist in less than one year, 23.7% had not visited a dentist in two or more years and 10.8% had never visited a dentist.

According to the Health Care Financing Administration, $25.2 billion was spent on dentist services in 1984. This represents 6.5% of the total national health expenditures for that year.

In a 1978 survey for the American Dental Association, 26% of respondents had some form of dental insurance. Of those with dental insurance, 79% received it as a job-related benefit.

Mandatory football and ice hockey mouthguard rules exist through the National High School Federation, National Collegiate Athletic Association and the Amateur Hockey Association of the United States.

Fluoridation

The Centers for Disease Control estimates that as of December 1985, 130 million Americans (or 54.8% of the U.S. population) were served by fluoridated water. This figure includes 10.7 million persons who received water with natural fluoridation and 119.3 million who received water adjusted to achieve optimal fluoridation.

In December of 1985, 87.2% of the 236.2 million persons in the U.S. received public water supplies and 62.8% of those on public water supplies were served by fluoridation.

As of December 1985, 41 of the 50 largest U.S. cities had fluoridated water supplies.

28 states, Puerto Rico, and Washington, D.C. provide fluoridated water to over half their populations.

The World Health Organization has estimated an average savings of $40 in costs of dental care per $1 of expense for community foundation worldwide. In the U.S., the benefit-cost ratio for fluoridation of water supplies has been estimated at $50: $1.

Significant Trends

Caries—Children

Surveys of school children revealed a one third reduction in caries prevalence from 1971-1973 to 1979-1980.

Periodontal Illness

National surveys of periodontal disease in adults 18-79 years of age reveal that nearly twice as many people in 1971-1974 were without periodontal disease as in 1960-1962. In 1971-1974, 45.3% of males and 57.1% of females 18-79 years old were without periodontal disease, compared to 20.9% and 31.0% (respectively) in 1960-1962.

Edentulous Persons

Young adults aged 18-24 years had, on the average, 2.3 fewer missing teeth in 1971-1974 than in 1960-1962.

Fluoridation

Since the introduction of the practice of adjusting fluoride levels in community water systems in 1945, the number of people with access to water with optimal levels of fluoride for caries reduction (0.7 parts per million or higher) has increased steadily to an estimated 130.8 million in 1985, approximately 54.8% of the total U.S. population.

Special Issues

Fluoridation Growth Slow

In 1975, 60% of the population on community water systems received fluoridated water. By December 1984, the proportion of those served by community water systems who were receiving fluoridation rose to 62.8%.

Dental Sealants

55% of caries in children 5-17 years old develops in the pits and grooves of the chewing surfaces of teeth where the benefits of fluoride are least effective. Dental sealants are plastic resins which are applied to these occlusal surfaces to prevent caries formation.

A review of studies of a popular dental sealant showed 89%-96% retention of the sealant after 1 year and 58%-68% retention after 6 years. The sealants effectiveness at preventing caries when compared to untreated teeth was 89%-91% at 1 year and 55-56% at 6 years.

A national survey revealed that in 1982, 42% of dentists in private practice were not using dental sealants.

Nursing-Bottle Tooth Decay

The practice of leaving babies with bottles containing sugared liquids results in widespread caries referred to as nursing-bottle tooth decay. A 1983-1984 Indian Health Service (IHS) study showed that up to 50% of American Indian/Alaskan Native (Al/AN) preschool-aged children who seek dental services suffer from nursing-bottle tooth decay. Over 40% of AI/AN children under age 5 years had 7 more decayed and/or filled primary teeth in the IHS study. Children with nursing-bottle caries had almost 4 times the amount of tooth decay as those children without nursing-bottle caries.

A study of children ages 3-5 in Head Start programs in Ohio revealed that 14%-15% of children in urban fluoridated areas and 18% of children in urban nonfluoridated areas had nursing-bottle tooth decay.

Smokeless Tobacco

National data suggest that 12 million people used some form of smokeless tobacco in 1985. It is estimated that 16% of 12-17 year-old males used smokeless tobacco in 1985.

A North Carolina study of women who use smokeless tobacco revealed a 4.2% increase in the relative risk of oral cancer among snuff users.

Steven Parker

Parkinson's Disease - Definition, Causes, Symptoms and Treatment

Parkinson's Disease - Definition, Causes, Symptoms and Treatment

Parkinson's disease is a degenerative disorder of the central nervous system.

Parkinson's disease occurs when nerve cells, or neurons, in an area of the brain known as the substantia nigra die or become impaired. Normally, these neurons produce an important brain chemical known as dopamine. At least 500,000 people in the United States currently have PD. Parkinson's disease belongs to a group of conditions called movement disorders. Parkinson's disease is progressive, meaning the signs and symptoms become worse over time. But although Parkinson's disease may eventually be disabling, the disease often progresses gradually. Parkinson disease affects movement (motor symptoms). Typical other symptoms include disorders of mood, behavior, thinking, and sensation (non-motor symptoms). Individual patients' symptoms may be quite dissimilar and progression of the disease is also distinctly individual. Parkinson's usually begins around age 60. It is more common in men than in women. Symptoms of Parkinson's disease often start on one side of the body first and then affect both sides.

There are many secondary symptoms associated with Parkinson's disease.

Parkinson's disease patients may notice that they are weaker or more tired. Symptoms include disorders of mood, behavior, thinking, and sensation. Poor balance is due to the impairment or loss of the reflexes that adjust posture in order to maintain balance. Falls are common in people with Parkinson's. Shaking (muscle tremor). This is one of the first symptoms in three-quarters of people, and affects most people with Parkinson's disease. Bradykinesia is the phenomenon of a person experiencing slow movements. In addition to slow movements, a person with bradykinesia will probably also have incomplete movement, difficulty initiating movements and sudden stopping of ongoing movement. The progressive loss of voluntary and involuntary muscle control produces a number of secondary symptoms associated with Parkinson's. Postural instability, or impaired balance and coordination, causes patients to develop a forward or backward lean and to fall easily.

Parkinson's disease requires broad-based management including patient and family education, support group services, general wellness maintenance, exercise, and nutrition.

Medications can help manage problems with walking, movement and tremor by increasing the brain's supply of dopamine. Amantadine may also be added to carbidopa-levodopa therapy for people in the latter stages of Parkinson's disease. Catechol-O-methyl-transferase (COMT) inhibitors drugs prolong the effect of carbidopa-levodopa therapy by blocking an enzyme that breaks down dopamine. Tolcapone (Tasmar) is a potent COMT inhibitor that easily crosses the blood-brain barrier. A medicine called levodopa is often given to people who have Parkinson's disease. Called "L-dopa," this medicine increases the amount of dopamine in the body and has been shown to improve a person's ability to walk and move around. Thalamotomy involves the destruction of small amounts of tissue in the thalamus - a major brain center for relaying messages and transmitting sensations.

Parkinson's Disease Treatment

• * Carbidopa and benserazide are dopa decarboxylase inhibitors.
• * Tolcapone inhibits the COMT enzyme, thereby prolonging the effects of L-dopa, and so has been used to complement L-dopa.
• * Selegiline and rasagiline reduce the symptoms by inhibiting monoamine oxidase-B (MAO-B).
• * An antiviral drug, amantadine, can help reduce symptoms of PD and levodopa-induced dyskinesia.
• * COMT (catechol-O-methyl-transferase) inhibitors are a new class of drugs that stop the breakdown of dopamine.
• * Other therapies that are important for managing and coping with Parkinson's disease include physiotherapy, speech therapy, and occupational therapy.
• * Amantadine acts like a dopamine replacement drug but works on different sites in the brain.

Juliet Cohen

Parkinson's Disease And Its Effects On The Mind And Emotions

Parkinson's Disease And Its Effects On The Mind And Emotions

When the phrase "Parkinson's disease" is mentioned the majority of people will automatically think about the physical symptoms associated with the condition such as the tremors, the loss of mobility and other motor impairments. However coping with Parkinson's disease also take a tremendous toll on the emotional well being of the sufferer; something that many people don't consider.

Feelings of anxiety, frustration, embarrassment at not being able to do every day things and often depression can have a huge effect on Parkinson's patients. These psychological symptoms occur as a result of the physical symptoms and can have a very negative effect on a person. Depressive episodes are seen in an average of 50% of patients and these episodes often alternate with anxiety attacks so that the patient has the symptoms of a manic-depressive. Alternating emotional outbursts of depression and anxiety are common in around 80% of cases.

Partial memory loss can also add to the psychological stresses felt by a Parkinson's sufferer. As the disease progresses, patients can begin to forget dates, names and faces which can be quite traumatic, especially when the sufferer knows that a person is a loved one but they can not recall their name or what relation they are to them.

However with a loving support system of friends and family and all the information that can possibly be known about Parkinson's disease, many of the emotional symptoms of the disease can be kept under control i.e. depressive episodes and feelings of frustration. It is very helpful to a sufferer if they can join a local support group as well so that they can talk about their emotions with people who understand exactly what they are going through. Simply having someone who is experiencing the same feelings and frustrations can prove to be a very positive influence.

It is also helpful for a Parkinson's sufferer to participate in activities that hold their interest, be they physical activities or mental activities. Having happy experiences can quickly fend off any depressive feelings and mental exercises will help to keep the brains functioning normal for longer. Any activity can be enjoyed with the support of a loved one so for example daily exercises can be made fun if they are performed to music with a partner. They can even become a bit of a competition with a reward for the winner.

For the Parkinson's sufferer, work can be both a burden and a release. Explaining the situation to management can mean that allowances are often made so that stress levels and physical labor are kept to a minimum. People in general are very understanding when it comes to long term illness in the workplace and a good boss will help in any way they can. This means that a Parkinson's disease sufferer can remain active and with the people they know for much of the day, thus leaving less time to sit and contemplate their condition. Research has shown that the most emotionally stable Parkinson's disease patients are those who can make a joke out of their symptoms and who don't let the condition get them down, under any circumstances.

Jeremy Parker