A comprehensive resource for parents and caregivers, MyChildrensTeeth.org gathers together all of the AAPD’s articles and information that are useful to the general public in one convenient place.

Some of parents’ most frequently asked questions of pediatric dentists are answered on the site, such as:

• When should I take my child to the dentist for the first check-up?
• What should I use to clean my baby’s teeth?
• Are baby teeth really that important to my child?
• How do dental sealants work?
• How safe are dental X-rays?

The AAPD launched the new site in order to meet the growing need for high quality, evidence-based dental information that gives the most up-to-date information on children’s oral health directly to consumers. AAPD CEO Dr. John S. Rutkauskas said, “One of the primary challenges in dentistry is keeping parents fully informed on good oral health practices, so they can lay down a foundation of oral health that their children can follow all their lives.

“This new site will inform parents and caregivers and empower them to start making informed choices for their children as soon as possible, all driven by the best dental science and practices available.”

The site provides access to the AAPD’s full line of brochures, covering issues like fluoride, diet and snacking, dental care for infants, toddlers and teens, as well as the importance of regular dental visits. A section on recent pediatric dentistry items in the news, where AAPD members provide important tips and information and address current news stories dealing with children’s dental health, is also available.

The same Find a Pediatric Dentist tool that has connected patients and pediatric dentists since the launch of the original AAPD website in 2002 is also available on MyChildrensTeeth.org.

“The Find a Pediatric Dentist tool is consistently one of the most used and most useful features the AAPD provides,” Rutkauskas said. “Adding it to this site just makes sense: we can connect parents with the best information and then immediately to our member providers. If you know your ZIP code, you’re just a click away from knowing a pediatric dentist in your area that can treat your child. It really is that easy.”

“It’s frightening how severe this metabolic disease is in children,” said Dr. David M. Nathan, an author of the study and director of the diabetes center at Massachusetts General Hospital. “It’s really got a hold on them, and it’s hard to turn around.”

Before the 1990s, this form of diabetes was hardly ever seen in children. It is still uncommon, but experts say any increase in such a serious disease is troubling. There were about 3,600 new cases a year from 2002 to 2005, the latest years for which data is available.

The research is the first large study of Type 2 diabetes in children, “because this didn’t used to exist,” said Dr. Robin Goland, a member of the research team and co-director of the Naomi Berrie Diabetes Center at Columbia University Medical Center in New York. She added, “These are people who are struggling with something that shouldn’t happen in kids who are this young.”

Why the disease is so hard to control in children and teenagers is not known. The researchers said that rapid growth and the intense hormonal changes at puberty might play a part.

The study followed 699 children ages 10 to 17 at medical centers around the country for about four years. It found that the usual oral medicine for Type 2 diabetes stopped working in about half of the patients within a few years, and they had to add daily shots of insulin to control their blood sugar. Researchers said they were shocked by how poorly the oral drugs performed because they work much better in adults.

The results of the study and an editorial were published online on Sunday by The New England Journal of Medicine.

The findings could signal trouble ahead because poorly controlled diabetes significantly increases the risk of heart disease, eye problems, nerve damage, amputations and kidney failure. The longer a person has the disease, the greater the risk. So in theory, people who develop diabetes as children may suffer its complications much earlier in life than previous generations who became diabetic as adults.

“I fear that these children are going to become sick earlier in their lives than we’ve ever seen before,” Dr. Nathan said.

But aggressive treatment can lower the risks.

“You really have to be on top of these kids and individualize therapy for each person,” said Dr. Barbara Linder, a senior adviser for childhood diabetes research at the National Institute of Diabetes and Digestive and Kidney Diseases, which sponsored the new study.

Sara Chernov, 21, a college senior from Great Neck, N.Y., learned that she had Type 2 diabetes when she was 16. Her grandfather had had both legs amputated as a result of the disease, and one of the first questions she asked was when she would lose her legs and her eyesight.

A doctor scolded her for being fat and told her she had to lose weight and could never eat sugar again. She left the office in tears and did not go back; soon after, she joined the study at Columbia. Like many of the children in the program, she did not even know how to swallow a pill.

Ms. Chernov believes that the disease “is not a death sentence,” she said, if she is careful about controlling her blood sugar. But it has been a struggle. Her family tends to be overweight, she sometimes craves sweets and she has orthopedic problems that have required surgery and have made it hard for her to exercise. She is also being treated for high blood pressure.

A few weeks ago, because her blood sugar shot up despite the diabetes pills she was taking, Ms. Chernov began using insulin.

Most of the participants in the study came from low-income families: 42 percent had yearly incomes under $25,000, and 34 percent below $50,000. About 40 percent were Hispanic, 33 percent black, 20 percent white, 6 percent American Indian and less than 2 percent Asian. Poor people and minority groups have some of the highest rates of obesity and diabetes in both adults and children.

Dr. Phil Zeitler, an author of the study and a professor of pediatrics at the University of Colorado, Denver, said many participants lived with a single parent or guardian and, like Ms. Chernov, came from families with a history of diabetes and had relatives with kidney failure or amputations.

“They’re wrapped up in a lot of family chaos,” Dr. Zeitler said, calling them a “challenging population” with a lot of stress in their lives, on top of the normal chaos of the teenage years.

Type 2 diabetes used to be so rare in children that it was called adult-onset diabetes. Type 1, a much less common form, was most likely to strike children and teenagers, and was called juvenile diabetes. Both forms of the disease cause high blood sugar, but their underlying causes are different.

Type 1 occurs because the patient’s own immune system mistakenly destroys the cells in the pancreas that make insulin, a hormone needed to control blood sugar levels. Patients have to take insulin.

Type 2 is thought to be brought on by obesity and inactivity in people who have a genetic predisposition to develop the disease when they gain weight. And they may also have an inborn tendency to put on weight. The pancreas still makes insulin, though not enough, and the body does not use insulin properly — a condition called insulin resistance. High blood pressure and cholesterol often come with the disease. Initial treatments include dietary changes, exercise and oral medicines, but many people eventually need insulin.

Doctors began noticing an alarming increase in Type 2 cases in children in the 1990s, especially among blacks and Hispanics from poorer families. The problem had started even earlier in American Indians, who have had sharp increases in obesity in recent years.

The current study was meant to find the best treatment. The participants were all overweight, some very obese. All, with a parent or guardian, got diabetes education. They were then assigned at random to one of three groups. One group took only metformin, a standard diabetes pill (also called Glucophage). Another took metformin and a second drug, rosiglitazone (also called Avandia). A third group took metformin and went through an intensive diet, exercise and weight-loss program (which has worked in adults). They were followed for an average of about four years.

The results were disappointing: all three regimens had high failure rates, meaning that they could not control blood sugar. Metformin alone failed in 52 percent of patients, metformin plus rosiglitazone failed in 39 percent, and metformin plus the diet program failed in 47 percent. Metformin alone was least effective in blacks, and metformin combined with rosiglitazone worked better in girls than in boys. The failure rates were high even in the patients who adhered most strictly to their treatment programs.

The obvious conclusion is that better treatments are needed. Adding rosiglitazone is not a good option, researchers say, even though the combination worked better than metformin alone; rosiglitazone has been linked to an increased risk of heart attack and stroke in adults, and its use has been restricted by the Food and Drug Administration. There are other oral diabetes drugs, but none have been approved or tested in children. In the meantime, the doctors said, the best solution is to move quickly to insulin shots if metformin does not work.

Ideally, Type 2 diabetes should be preventable with improvements in diet and exercise. But so far, that has been easier said than done.

CHAPEL HILL About 1 in 88 American children have autism or similar disorders, and the prevalence in North Carolina is even higher, according to new estimates from the Centers For Disease Control.

That’s a jump of 23 percent since the last national estimate of autism spectrum disorders two years ago.

The numbers are just estimates, and researchers acknowledge that the increase is attributable at least partly – and perhaps greatly – to increased awareness about the disorders and greater ability to diagnose them, rather than more kids developing ASDs.

ASDs are developmental disorders that include autism and Asperger’s syndrome, and are characterized by trouble with social interaction and communication. Symptoms usually start before the age of 3, and include repetitive behavior such as repeating actions or words, and obsessive adherence to routines.

The CDC estimates the prevalence of autism spectrum disorders in the nation every two years using a monitoring network with teams at 14 sites across the country that tally cases among 8-year-olds. The new numbers were based on data from 2008.

The North Carolina estimate came from an 11-county chunk of the central part of state including Wake, Durham, Orange and Chatham counties, and the major Triad counties. In that area, nearly 1 in 70 children were estimated to have been diagnosed – up from 1 in 96 in the 2010 report.

One valuable aspect of the estimate is that it helps the public and policy makers understand how big a problem ASDs are, said Julie Daniels, an associate professor of epidemiology in maternal and child health at the UNC Gillings School of Global Public Health, and leader of the team responsible for the North Carolina part of the estimate.

Among other things, more attention for ASDs could lead to diagnosis at earlier ages, which is important because early treatment has been shown to improve patient outcomes.

“For most, while it doesn’t cure, it helps parents and kids handle things better, gives them a better quality of life, and allows them to do better in managing the symptoms,” Daniels said.

ASDs are significantly more common in males, and in this state the new estimates suggest 1 in 43 boys have one of the disorders, compared with 1 in 196 girls.

Support in Wake County

The numbers are up because of more awareness and better diagnosis. But they also seem to reflect more actual cases here, in part because families with ASDs move to Wake County from places where less support is available, such as educators trained to work with kids who have the disorders, said David Laxton, a spokesman for the Autism Society of North Carolina.

Whatever the mix of reasons, it’s clear from phone calls and other interactions with parents, educators and health care providers that the sheer number of cases in North Carolina is up, Laxton said.

Indeed, the society’s annual conference today and Saturday in Charlotte reached capacity this year for the first time.

“We had to turn people away,” Laxton said.

No matter the reasons for the jump in the new CDC estimates, they can only help by drawing yet more attention to the estimated 60,000 people in the state affected by ASDs, Laxton said. Thousands are on waiting lists for state-funded services such as vocational training and employment programs that could help them be better-functioning members of society.

“There are a lot of misconceptions, but they can succeed, they can live in the community, and get a job and drive,” he said. “But if we’re going to make sure they’re a help to society, we need to invest in that because it costs far less to help them succeed than it costs in the long run if you don’t.”

The doctors then took X-rays, which showed that 11 of his 20 baby teeth had cavities. His pediatric dentist extracted two incisors, performed a root canal on a molar, and gave the rest of the teeth fillings and crowns.

Devon’s mother, Melody Koester, a homemaker, and her husband Matthew, an information technology manager, said they began worrying about brushing Devon’s teeth only after Melody Koester noticed they were discolored when he was 18 months old.

“I had a lot on my mind, and brushing his teeth was an extra thing I didn’t think about at night,” she said.

The number of preschoolers requiring extensive dental work suggests that many other parents make the same mistake. The Centers for Disease Control and Prevention noted an increase, the first in 40 years, in the number of preschoolers with cavities in a study five years ago.

Dentists nationwide say they are seeing more preschoolers at all income levels with six to 10 cavities or more. The level of decay is so severe that they often recommend using general anesthesia because young children are unlikely to sit through such extensive procedures while they are awake.

There is no central clearinghouse for data on the number of young children undergoing general anesthesia to treat multiple cavities, but interviews with 20 dentists and others in the field of dental surgery suggest that the problem is widespread.

“Pediatric dentists and public health dentists have seen a rising trend in childhood tooth decay for some time now,” says Dr. Ron Venezie of Apex. Before entering private practice in 2004, Venezie spent seven years working for the N.C. Department of Health and Human Services in dental programs.

Adds Dr. Martha Ann Keels, associate professor in surgery and pediatrics at Duke Children’s Hospital and Health Center in Durham, “We are seeing more and more cases of young children (ages 3-5) with what we call the ‘eight chewing cavities,’ which means cavities between all eight back molars and on top of all back molars.”

“We are treating at least five children per week in the operating room at Duke with significant tooth decay,” says Keels.

“While we always see quite a bit of early childhood (cavities) in our practice, we have … also seen an increase in the severity of the disease,” says Dr. Margaret Lochary, a Charlotte dentist and spokeswoman for the American Academy of Pediatric Dentists.

Such operations are largely preventable, said Dr. Jonathan Shenkin, a pediatric dentist in Augusta, Maine, and a spokesman for the American Dental Association. “I have parents tell me all the time, ‘No one told us when to go to the dentist, when we should start using fluoride toothpaste’ – all this basic information to combat the No. 1 chronic disease in children.”

Dentists offer a number of reasons so many preschoolers suffer from such extensive dental decay: endless snacking and juice or other sweet drinks at bedtime, parents who choose bottled water rather than fluoridated tap water for their children, and a lack of awareness that infants should, according to pediatric experts, visit a dentist by age 1 to be assessed for future cavity risk, even though they may have only a few teeth.

“Consumption of carbohydrate-rich foods (sugars and starches) on a frequent basis seems to be one of the biggest factors related to early childhood tooth decay in my practice,” says Venezie. “Our hectic lifestyles can certainly lead to parents relying heavily on ready-to-go processed snacks and juices, sports drinks, etc.”

Keels says soft, sticky foods – “gummies, gummy vitamins, cereal bars, granola bars, Skittles, Starbursts, fruit chews, Fruit Roll-ups, raisins and craisins” – are especially problematic.

Because some toddlers dislike tooth-brushing, some parents do not enforce it.

“Let’s say a child is 1 1/2, and the child screams when they get their teeth cleaned,” said Dr. Jed Best, a pediatric dentist in New York. “Some parents say, ‘I don’t want my little darling to be traumatized.’ The metaphor I give them is, ‘I’d much rather have a kid cry with a soft toothbrush than when I have to drill a cavity.’ ”

Exercising good oral health care early on is important, says Keels of Duke.

“There are 20 baby teeth. Twelve of the 20 should last until age 10 to 12, and they are very important space holders for the adult teeth. If you lose a baby tooth prematurely, then you are potentially creating a crowding problem for the adult set. Not to mention, how sad it is to have your child missing teeth in their smile.”

Tooth decay in children ages two through five is on the rise.

Devon’s mother, Melody Koester, a homemaker from Stanwood, Wash., and her husband, Matthew, an information technology manager, said they began worrying about brushing Devon’s teeth only after Mrs. Koester noticed they were discolored when he was 18 months old. “I had a lot on my mind, and brushing his teeth was an extra thing I didn’t think about at night,” she said.

The number of preschoolers requiring extensive dental work suggests that many other parents make the same mistake. The Centers for Disease Control and Prevention noted an increase, the first in 40 years, in the number of preschoolers with cavities in a study five years ago. But dentists nationwide say they are seeing more preschoolers at all income levels with 6 to 10 cavities or more. The level of decay, they added, is so severe that they often recommend using general anesthesia because young children are unlikely to sit through such extensive procedures while they are awake.

There is no central clearinghouse for data on the number of young children undergoing general anesthesia to treat multiple cavities, but interviews with 20 dentists and others in the field of dental surgery suggest that the problem is widespread.

“We have had a huge increase in kids going to the operating room,” said Dr. Jonathan Shenkin, a pediatric dentist in Augusta, Me., and a spokesman for the American Dental Association. “We’re treating more kids more aggressively earlier.”

But such operations are largely preventable, he said. “I have parents tell me all the time, ‘No one told us when to go to the dentist, when we should start using fluoride toothpaste’ — all this basic information to combat the No. 1 chronic disease in children.”

Dentists offer a number of reasons so many preschoolers suffer from such extensive dental decay. Though they are not necessarily new, they have combined to create a growing problem: endless snacking and juice or other sweet drinks at bedtime, parents who choose bottled water rather than fluoridated tap water for their children, and a lack of awareness that infants should, according to pediatric experts, visit a dentist by age 1 to be assessed for future cavity risk, even though they may have only a few teeth.

And because some toddlers dislike tooth-brushing, some parents do not enforce it. “Let’s say a child is 1 ½, and the child screams when they get their teeth cleaned,” said Dr. Jed Best, a pediatric dentist in Manhattan. “Some parents say, ‘I don’t want my little darling to be traumatized.’ The metaphor I give them is, ‘I’d much rather have a kid cry with a soft toothbrush than when I have to drill a cavity.’ ”

Dental decay often starts with a dull ache that may be mistaken for teething. That is why parents do not realize their child’s teeth are infected until they break or the pain becomes so acute that the child cannot sleep, said Dr. Joel Berg, director of the Center for Pediatric Dentistry, a joint venture since 2010 between the University of Washington and Seattle Children’s Hospital, which built a surgical wing because of the demand for oral surgery for preschoolers.

With a cooperative child, a cavity — or even many — can be treated in a dentist’s office with an injection of local anesthesia and an episode of “The Backyardigans” to distract patients.

But dentists routinely recommend general anesthesia for preschoolers with extensive problems, particularly if they will not even let X-rays be taken. The cost to parents for dental restoration under general anesthesia for a child ranges from $2,000 to $5,000 or more, depending on insurance coverage and the amount of work, several dentists said.

Dr. Megann Smiley, a dentist-anesthesiologist at Nationwide Children’s Hospital in Columbus, Ohio, is used to hearing parents question the need for general anesthesia to fix their children’s infected teeth. “It seems like putting a match out with a fire hydrant,” Dr. Smiley said. “But if any of us tried to get 12 teeth treated, we wouldn’t think that’s small.”

The dental surgery center at Nationwide has three operating rooms, which staff members and local dentists used to treat roughly 2,525 children in 2011, 6 percent more than in 2010. The average age of patients is 4, and most have decay in six to eight teeth, she said.

“The most severe cases have 12 or 16, which is seen several times a week,” Dr. Smiley added.

Using general anesthesia on healthy children has risks, including vomiting and nausea, and, in very rare cases, brain damage or death. Using anti-anxiety drugs to relax a child coupled with local anesthesia for pain has risks, too, including an overdose that could suppress breathing.

Hannah Schwartz of Brooklyn refused general anesthesia for her 3 ½-year-old daughter, Alice. By then, one of Alice’s eight cavities had already been treated in a dentist’s office using a papoose board to immobilize her from head to ankle with straps. Her daughter screamed, “Take it off me!” for the 20-minute procedure, said Ms. Schwartz, a nursing student.

Afterward, “I left the room and burst into tears without Alice seeing,” she said, adding that she would try a third option, laughing gas.

Of course, the lack of money or insurance can be an issue, but several dentists in interviews nationwide attributed extensive cavities in part to lax parenting, at all income levels.

“It’s not just about kids in poverty, though kids of lower socioeconomic status tend to get more cavities,” said Dr. Rochelle Lindemeyer, director of the pediatric dentistry residency program at Children’s Hospital of Philadelphia and the University of Pennsylvania dental school. Affluent families may have nannies who “pacify kids by giving them a sippy cup all day,” Dr. Lindemeyer said.

Brushing teeth twice a day used to be nonnegotiable, she said, but not anymore. “Some parents say: ‘He doesn’t want his teeth brushed. We’ll wait until he’s more emotionally mature.’ It’s baffling,” she added.

Dr. Man Wai Ng , the dentist in chief at Children’s Hospital Boston, said she heard parents, rich and poor, make similar rationalizations about their preschoolers’ snacking, like, “I can’t ever imagine Johnny being hungry, so I’m laying out a whole-wheat spread that’s always available.”

With a grant from the DentaQuest Institute, Dr. Ng started a disease-management program to alter the habits of parents of children with cavities so some could avoid the operating room. Her advice includes less frequent snacks, and only four ounces of juice a day. She does not forbid sweets, but suggests brushing afterward, and bacteria-killing Xylitol lollipops.

Multiple studies have shown that even children who undergo general anesthesia to treat dental decay end up with cavities again. Janine Costantini, the ambulatory practice director at Children’s Hospital Colorado, said the staff treated a 3-year-old who was making his second visit to the operating room for dental work. The boy arrived with a bottle of Coca-Cola.

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