Does Your Child Wear A Bicycle Helmet?
Bicycling is the third most popular form of recreational
exercise in the nation. About 33 million children in the US ride bicycles.
Unfortunately, bicycle-related head injuries cause more than 150 deaths and
450,000 non-fatal injuries among children in the United States each year.
Although bicycle helmets are very effective in preventing head injury, only 24
percent of US children regularly wear them. The Centers for Disease Control and
Prevention (CDC) estimates that at least 75 percent of bicycle-related
fatalities in children could be prevented if all children wore helmets while
riding a bicycle. Currently, 15 states have bicycle helmet laws for children.
Bicycle helmets provide substantial protection against injuries to the head,
upper face, and mid face. Nevertheless, each year, more than 150,000 children
are treated just for craniofacial and orodental injuries related to bicycle
accidents in emergency departments across the United States. As valuable as they
are, however, bicycle helmets do not offer protection to areas of the lower face
- which includes the chin, lower jaw, lips, and teeth. It is therefore advisable
for children to also use a protective chin cup or mouthguard while bicycling,
skateboarding, or skating in-line.
Types Of Bicycle Helmets
Hard Shell: Consists of a hard outer shell with a separate crushable inner
foam shell. It is the least popular due to its increased weight.
Thin Shell: Consists of a thin, hard, outer layer of semi-rigid plastic
which is fused to a crushable foam shell.
No Shell: Consists of a soft shell which is covered with Lycra or soft
Note: Data suggest that Snell-approved helmets may be more protective
against severe brain injury than other types.
How To Properly Fit A Bicycle Helmet
The helmet label should state that it meets the ANSI Z90.1 or Snell B-90
Helmets should be tried on and fitted before purchasing.
The helmet should cover the forehead, crown, sides and back of the head.
Adjust the foam fitting pads inside of the helmet to obtain a helmet fit
with the foam pads touching all the way around.
Adjust and readjust the straps so that you have the chin strap snug
against the chin, with the V of the side straps meeting just below the ear,
with no slack to let the helmet rock back and forth.
The wearer should be able to get no more, and no less, than two fingers
between the chin straps and the chin.
Once the chin strap is closed, the helmet should be secure on the head,
with no movement from side-to-side, or front-to-back
Getting Your Child To Wear The Helmet
Provide a good example. Wear your helmet when riding a bicycle.
Make wearing a helmet part of the routine for your child.
Explain to your child why wearing a helmet is so important.
Involve your child in the purchase of the helmet.
A recent study published in Pediatrics evaluated the effect of
active police enforcement of the helmet law, combined with a helmet
give-away and education program. The study concluded that active police
enforcement, along with helmet give-aways and education was effective, and
had a lasting effect on helmet use.
Gilchrist J, Schieber RA, Leadbetter S, Davidson SC: Police
enforcement as part of a comprehensive helmet program. Pediatrics. July
The Realities Of The Dental
The internet is a global network of several hundred
million computers. It is a global information resource of unprecedented scale.
The power of the Internet comes from the fact that it connects people. There
are currently 147 million users online in the United States, and 332 million
Internet users worldwide.
The incredible growth of the Internet over the last few years has created
opportunities for rapid access to, and exchange of, an incredible amount of
health information. Oral and dental health information is now readily
available to dentists, patients, and the general public. In fact, medical
patients are now beginning to store their own health information on Web
Computers are now an important part of many dental practices. Today, 91
percent of US dentists have computers in their dental offices, and more than
half of those have Internet access. Currently, 13 percent of dentist have a
dental practice Web site, compared to 8 percent in 1999. Only 5 percent of
dentists use the internet in patient treatment rooms, however. The most common
reasons that dentists use the Internet are: obtaining information on dental
research, obtaining information about dental products, and taking online
continuing education courses.
The future of teledentistry is exciting! Teledentistry is the delivery of
dental care, and the sharing of dental information over a distance, using
telecommunications systems. The three categories of teledentistry are:
interactive video, store-and-forward transmission of images and dental
records, and remote monitoring.
Teledentistry can improve access to dental care, lower its cost, and provide
an avenue for the continuing education of dentists. It also has the potential
to replace costly, traditional, dental consultations in remote areas. Two
technological developments in the early 1990s have led to a surging interest
in teledentistry. One is the increasing use of high-speed , high-bandwidth
telecommunications systems. The second is the invention of devices capable of
capturing and transmitting images and other data in digital form. These newer
devices include digital x-ray sensors, laser scanners, and digital intraoral
Teledentistry, as used in consultation between doctors, and between doctors
and patients, can take two forms: real-time consulting, and store-and forward
consulting. In real-time consulting, a video conference is used, and all
participants are present in real time. This is a costly approach, however, as
it requires a higher investment in rather expensive telecommunications
infrastructure and equipment.
A store-and-forward (SAF) teleconsultation, on the other hand, involves
exchange of static images that are stored in the telecommunications equipment,
and are forwarded as image files. In SAF consulting, the referring dentist
collects all of the necessary clinical information, photographic images, and
radiographs - and sends them to the consultant via the Internet. The
consultant reviews the complete package and sends an opinion back to the
referring dentist. SAF teleconsulting can be quite useful, especially when the
available bandwidth is inadequate for high-resolution, real-time transmission.
SAF is also much less expensive than real-time T-1 telecommunications
technology, which transmits at 1.5 megabits per second. SAF dental
consultations can be transmitted in batches, and reviewed in batches, at the
convenience of the consulting dentist. The only items which a primary care
dentist needs in order to teleconsult are: a desktop computer, teleconsulting
software, an Internet connection, a digital camera, and a radiograph/text
Many issues still need to be resolved, however, before teledentistry will
realize its enormous potential. These issues include: interstate dental
licensure, malpractice liability, jurisdiction, data security, ethical
question, inadequate telecommunications infrastructure, and inadequate
reimbursement fees for teledentistry consultations.
A recent article in the Journal of the American Dental Association
discusses issues which need to be resolved before teledentistry can reach its
Golder DT, Brennan KA: Practicing dentistry in the age of telemedicine.
JADA. June 2000; 131:734-744.
What You Should Know About
A major factor responsible for the decline in dental
caries in the last 50 years is the fluoridation of community drinking water.
Water fluoridation is the process of adjusting the level of fluoride in water
to a concentration which will protect against tooth decay. Community water is
usually fluoridated to a level of 0.7 to 1.2 parts per million.
The use of different formulations of fluoride over the last 40 years has been
the major factor in saving nearly $40 billion in oral health care costs in the
United States. The per capita cost saving from one year of fluoridation can be
as high as $53 in large communities with a high incidence of caries disease.
This is a great return on investment, since water fluoridation costs only 31
cents per person in US communities with populations greater than 50,000.
Community water fluoridation is the most equitable and cost-effective method
of providing fluoride to all members of communities - regardless of race,
creed, income, education, or age. Water fluoridation is very beneficial for
communities with low socioeconomic status, since they experience a
disproportionate share of dental caries. Water fluoridation can reduce decay
in baby teeth by as much as 60 percent, and can reduce decay in permanent
teeth by nearly 35 percent.
Early childhood caries (ECC), previously known as baby bottle tooth decay, is
a severe form of dental decay which affects infants, toddlers, and young
children. Water fluoridation is very effective in preventing ECC, especially
in children from low socioeconomic groups. For children who are at risk for
ECC, water fluoridation is the only means of preventing tooth decay which does
not require a dental visit, or any effort on the part of parents or
Grand Rapids, Michigan was the first city in the world to fluoridate its water
supply. By the end of 1992, 10,567 public water supplies in 8,573 US
communities provided water fluoridation. Currently, only 62 percent of the
population served by water systems has access to fluoridated water.
Approximately 42,000 public water supplies in 153 US cities do not fluoridate
their water. The revised national health objectives presented in Healthy
People 2010 project that at least 75 percent of the population will be
receiving fluoridated water by 2010.
Fluoride prevents dental caries primarily by its beneficial actions at the
outer surface of tooth enamel - after the tooth has erupted into the mouth.
The biological mechanisms for fluoride's cavity-fighting properties include:
Prevention of Enamel Demineralization:
Fluoride inhibits the dissolution of dental enamel by acid from the
Enhancement of Enamel Remineralization:
Fluoride aids in the hardening and remineralization of enamel by attracting
calcium and phosphate ions at the tooth surface.
Inhibition of Bacterial Activity in Dental Plaque:
Fluoride is taken up by the bacteria which live in dental plaque. Fluoride
then interferes with the bacteria's ability to produce destructive acid.
An overwhelming amount of scientific evidence indicates that water
fluoridation is safe and in no way affects human health. Even people living
in areas with high levels of natural fluoride in their well water have shown
no adverse health effects. Currently allowed fluoride levels in drinking
water do not cause health problems such as bone disease, hip fractures,
kidney failure, or cancer. Nearly 100 national and international
organizations have affirmed the public health benefits of community water
fluoridation. These organizations include the American Dental Association,
the US Public Health Service, The American Medical Association, the World
Health Organization, and the American Cancer society.
A recent article in the Journal of the American Medical Association
discussed water fluoridation as an important and effective public health
CDC: Achievements in public health, 1990-1999: Fluoridation of
drinking water to prevent dental caries. JAMA. 8 March 2000; 283(10)