Bambini June 2018 Newsletter 
Fluoride & Dental Health
It's been a decade since Poughkeepsie removed fluoride from it's drinking water. This was a contentious decision. This is not surprising, as the city lies about halfway between Newburgh and Kingston.
Why is that significant? On May 2, 1945, fluoride was added to the municipal water supply in Newburgh. Kingston served as a control. Over the next year, no difference was observed in the rate of caries in children between these two cities. Over the ensuing two years, however, the rate of caries in Newburgh dropped by 30%. Public health officials considered this a success, and to this day, Newburgh water remains fluoridated.
In December 1998, Jayanth Kumar DDS and others took a second look at these two cities. Interestingly, they noted that both the poverty and unemployment rates in Newburgh was double that of Kingston's. 43% of Kingston is college educated, versus 29% in Newburgh.  Could fluoride be responsible?

Moreover, while the rate of caries in 7 to 14 year-olds between the two cities had evened out (Newburgh now actually a little higher), the rate of fluorosis in kids from Newburgh was almost double that of Kingston (11.7 versus 19.6%). Fluorosis is a sign of excessive fluoride.
So, what's happened in Poughkeepsie since fluoride was removed? Have caries shot up? According to NYU researchers, t hird-graders cavity rates declined steadily - 61% in 2013; 51% in June 2014; 45% in October 2014; and 31% in 2015. Similar findings have been reported in other locales.
Inclined Bed Therapy
Why do you sleep flat? Is that the best way to sleep?
Andrew Fletcher, an engineer from the England, has challenged prevailing wisdom and promoted inclined bed therapy (IBT) for more than 20 years. Building upon observations on the flow of plant sap, he noted that ancient Egyptians slept with their head raised about 6 inches. It's also been noted that elk and deer have a preference for sleeping with their head higher than their hoofs.
It's been suggested (but not rigorously studied) that IBT may benefit acid reflux, migraine, sleep apnea / snoring, SIDS, backache, and even varicose veins. Some of these make intuitive sense, others less so.
Conversely, others suggest sleeping with legs elevated. They note that animals like bats, sloths, and opossums sleep inverted. None of these critters develop arthritis. Moreover, sleeping inverted allows the adrenal glands to relax - the demand to produce adrenaline to pump blood to the brain is greatly reduced. This can induce a deeper, more effective sleep state.
Which is the best position for your child? Clearly, the jury is out on this one. It may be worth trying out both options.
Nursemaid Elbow:  What to Know
About once a month, a toddler from our practice develops nursemaid's elbow. Typically, this happens when a parent pulls a straying child to safety or lifts / swings a tot by the arms.
It doesn't take a whole lot of force to sublux (partially dislocate) an elbow in the 1 to 4 year-old age group. Girls, perhaps due to estrogen effect, are a bit more susceptible; and the left arm is a little more common than the right.
Typically, the child will cry for a few minutes immediately and calm down, but then they will not move the forearm -- holding it in pronation (palm facing down).
When we see kids in the office with a suspected nursemaid elbow, we generally do not order an x-ray before attempting reduction unless the history includes a fall rather than traction or there is notable tenderness, bruising, or swelling on exam. If reduction fails and there is no improvement within a day, we also check x-rays.
There are two approaches to reduction. The traditional one, you may see in videos online, is the "supination" (palm up) technique. In our experience, it is only about 60% effective and hurts quite a bit. The newer "pronation" (palm down) method, again in our experience, is about 85% effective and much less painful. Plus it's a lot easier to feel the reassuring "pop" of the radial head returning back into place.
Once a toddler has had a nursemaid's elbow, the recurrence risk is about 20-25%. We have had a couple patients sublux their elbow four or five times. These parents learn how to put the elbow back in place themselves. Fortunately, there are no long term effects like arthritis associated with nursemaid's elbow.
Teething Necklaces
Most of us are well aware that the FDA recently clamped down on belladonna-containing teething remedies like Hyland's & Humphrey's (while giving thumbs up to Oxycontin - go figure!).
With options getting limited, more parents have been asking us about Baltic amber necklaces. Composed of fossilized tree resin mined from Lithuania and surrounding regions, Baltic amber is high in succinic acid. Released into the skin, succinic acid may have a natural anti-inflammatory effect.
Unfortunately, we're not aware of any clinical research to support efficacy. What we hear from parents, fairly consistently, is a 10-20% "home run" rate - pretty comparable to teething tablet success rates. Last week, a parent told us that her first baby had horrible teething. She didn't know about amber. With her second child, she used a necklace and - no teething trouble.
Many pediatricians, however, are skeptical. A group of French physicians called this a "quack remedy." Others are concerned about the potential strangulation risk citing concern that 50% of safety-clasps failed to break away in their study. Some safety conscience parent thus put the Baltic amber beads over the ankle rather than the neck.
What was your experience with Baltic amber?  Other teething remedies?  Let us know by posting your comment on our Facebook page where this newsletter will be shared. 
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