Health Briefs TV Presents Segment on Personalized Medicine

Coral Springs, FL (PRWEB) August 08, 2013

Health Briefs TV will present a segment geared toward the rise of personal medicine in healthcare today. Although the term is rather new, medicine tailored to a patient’s needs has always been in use. Genetic information plays a major role in personalized medicine though, and it gives physicians deeper knowledge into their patient’s medical history. The program will air the segment throughout the summer.

The Health Briefs TV show host is Terry Bradshaw, a Hall of Fame quarterback from the Pittsburgh Steelers. His popularity began on the football field while leading the legendary team to four Super Bowl titles and picking up two Super Bowl MVP awards. Terry is just as popular now as he was then. From the locker room to the Board room, he has become a valuable commodity in Corporate America. He is a favorite motivational speaker and an often-requested celebrity for endorsing companies and their products. His well-known outgoing personality and credibility are key factors in his continuing celebrity. Throw in some cameo appearances in a few major motion pictures and close to a hundred appearances on the Jay Leno show, and the reason is clear why Terry Bradshaw is a great host and segment narrator for the Health Briefs TV show.

The program covers topics relating to the health and medical fields and offers valuable information about the diagnosis, treatment and prevention of many common ailments. It also features interviews with innovative business leaders in the industry. The show is headquartered in South Florida, home of the NBA team the Miami Heat. For more information about the show or its host, please visit Health Briefs on Facebook, Twitter or Google+, or watch the Behind the Scenes video with this release.

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Dental Health and Nutrition During Pregnancy

Pregnancy is one of those times where there must be extra attention placed on good dental hygiene for the sake of the expecting mother, but also for the dental development of the foetus. Many pregnant women will ask about future dental needs for their child but are not fully educated on proper care for themselves, despite a high level of concern. Many expectant parents are unsure about the exact timing they should begin dental hygiene practices for their children, along with the proper cleaning and toothbrushing techniques.

Historically, it has been said that for every pregnancy there is a loss of one tooth. Of course this is not the case but there are some factors that make pregnancy a time where the dental health can become worse over the period of the pregnancy.

There is a hormonal alteration in the pregnant individual, and most of the changes are caused by a hormone called oestrogen. There is also a bacteria found in the mouth called Prevotella intermedia. In pregnancy, there is an increase in the number of hormones and bacteria, which causes the amount of inflammation to increase. Inflammation will occur to a greater extent when there is more plaque and calculus on the teeth, so even slightly poor dental hygiene could result in lots of bleeding gums, or gum disease due to inflammation.

Gum disease in pregnant individuals is also linked with preterm, low birth-weight neonates (newborns).

Another concern is that pregnant women will feel quite nauseous and may frequently vomit. This will make looking after teeth much harder, and will contribute to dental erosion due to the presence of stomach acids coming into the mouth. The effects of vomiting on the teeth can be minimised by consuming dairy products, rinsing with a bicarbonate rinse (warm water, half tablespoon of salt, and a tablespoon of bicarbonate soda), or purchasing CPP-ACP from a dentist.

For more information on milk products and teeth, see the Dairy Australia fact sheet on dental health.

Pregnant individuals may also have cravings for sugar-rich foods, which will cause an increased chance of dental decay, as sugar is one of the main reasons for getting decay and needing fillings. This will consequently lead to an increase in dental visits, expenditure, and possible loss of teeth due to tooth decay.

The development of teeth starts around 6 weeks after the embryo starts to form. There is a lot of research going on at the moment to determine if anything affects the foetus' development of the teeth and jaws prenatally.

During the early phase of tooth growth, damage can occur to the teeth and jaws due to things like malnutrition. These can have irreversible changes on the teeth and jaws.

Poor maternal nutrition can have the following effects on the foetus:

Evidence from underdeveloped countries with poor nutrition shows that a defect in enamel called enamel hypoplasia is common. People with enamel hypoplasia have a much greater chance of developing tooth decay on those areas; andPoor prenatal nutrition is associated with a higher risk of mothers having tooth decay, and consequently are also more likely to transmit decay-causing bacteria to their children through oral contact e.g. kissing and sharing cutlery.A woman planning on a pregnancy should see a dentist prior to becoming pregnant if at all possible, to complete all dental treatment required and to assess what level of risk she is at. Pregnancy is a critical time to focus on preventing dental problems. Emphasis on the food pyramid, eating a well balanced diet, along with lots of calcium is of great importance. Sweets and low-nutrient foods should be minimised. It is important to concentrate on low fat, and low sugar snacks if at all possible i.e. celery sticks, carrot sticks, milk, cheese, other milk products as these will minimize the risk of dental decay.Reducing those bacteria that cause tooth decay via mouthwashes containing chlorhexidine gluconate has been shown to reduce both the transfer of decay-causing bacteria to their children and also tooth decay in the children.

Kindly written by Dr Akhil Chandra BDSc. (Hons UWA)

Dentist, Whitfords Dental Centre and Editorial Advisory Board Member of the Virtual Dental Centre

?For more information about pregnancy, including preconception advice, stages of pregnancy, investigations, complications, living with pregnancy and birth, see?Pregnancy.
For more information on nutrition, including information on?types and composition of food, nutrition and people, conditions related to nutrition, and diets and recipes, as well as some useful videos and tools, see Nutrition.?Fitzsimons D, Dwyer JT, Palmer C, Boyd LD. Nutrition and oral health guidelines for pregnant women, infants, and children. J Am Diet Assoc. 1998 Feb;98(2):182-6.Tsamtsouris A, Stack A, Padamsee M. Dental education of expectant parents. J Pedod. 1986 Summer;10(4):309-22.Newman M, Takei H, Klokkevold P. Carranza's Clinical Periodontology. 10th ed. Carranza F, editor. St Louis: Saunders, Elsevier; 2006.Chiodo GT, Rosenstein DI. Dental treatment during pregnancy: a preventive approach. J Am Dent Assoc. 1985 Mar;110(3):365-8.Ferris GM. Alteration in female sex hormones: their effect on oral tissues and dental treatment. Compendium. 1993 Dec;14(12):1558-64, 66; quiz 71.Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, Maynor G, et al. Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol. 1996 Oct;67(10 Suppl):1103-13.Tinanoff N. Association of diet with dental caries in preschool children. Dent Clin North Am. 2005 Oct;49(4):725-37.Tinanoff N, Palmer CA. Dietary determinants of dental caries and dietary recommendations for preschool children. J Public Health Dent. 2000 Summer;60(3):197-206; discussion 7-9.Proffit W. Contemporary Orthodontics. 3rd ed. St Louis: Mosby, Inc; 2000.Davies GN. A comparative epidemiological study of the diet and dental caries in three isolated communities. Ala Dent Rev 1958;4:19-28.Johnsen D, Krejci C, Hack M, et al. Distribution of enamel defects and the association with respiratory distress in very low birth weight infants. J Dent Res 1984;63:59-64.Kohler B, Bratthall D. Intrafamilial levels of Streptococcus mutans and some aspects of the bacterial transmission. Scand J Dent Res 1978;86:35-42.Kohler B, Andreen I, Jonsson B. The effect of caries-preventive measures in mothers on dental caries and the oral presence of the bacteria Streptococcus mutans and lactobacilli in their children. Arch Oral Biol. 1984;29(11):879-83.Leverett DH, Adair SM, Vaughan BW, Proskin HM, Moss ME. Randomized clinical trial of the effect of prenatal fluoride supplements in preventing dental caries. Caries Res. 1997;31(3):174-9.

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Chocolate and Health

Chocolate is a food typically associated with pleasure and indulgence. It is a sugary food, high in fat and energy, which should be consumed in moderation. Many individuals consume chocolate as a treat or share chocolate at special occasions like birthdays and Christmas. Boxes of chocolates may be given as gifts on special occasions and in Australia it is common to exchange chocolate eggs to celebrate Easter.

There is considerable temptation to also buy chocolate at other times. The confectionary industry in Australia, which monitors chocolate sales, reports that some 70% of confectionary is purchased on impulse and encourage sellers to display confectionary prominently to tempt customers. Australians spend more money on chocolate confectionary products (including chocolate blocks, bars, boxes of chocolates and novelty chocolates like Easter eggs) than on other type of confectionary combined. In 2002, Australians spent $1,550 million on chocolate products (compared to $950 million and $220 million on sugar confectionary and gum).

The consumption of cocoa, which gives chocolate its flavour, has a long history. Since as early as 1500BC, ancient Olmec and Mayan civilisations of South America have consumed cocoa (usually as bitter, aromatic drinks) and associated cocoa with the gods.

Cocoa has been consumed in many cultures for medicinal purposes. The word ‘chocolate' (derived from the Mayan cacauatol) was coined by Spanish colonisers of South American in the 16th century and since that time chocolate preparation has changed considerably. Cocoa is now usually consumed as sweet beverages or snacks. Mass production of chocolate sweets dates back to the 1800s.

Chocolate is made from cocoa beans which are derived from the cacao tree, a tropical rainforest plant. The cacoa tree is native to Latin America, but is now grown in other tropical areas of the world, mostly to meet the demand for chocolate production. It grows brightly colours pods of seeds, roughly the size of a football. The 30-50 seeds (sometimes called beans) contained within each pod are the key ingredients from which chocolate is made. The seeds are harvested, fermented and dried or roasted to enhance their aroma, before being heated and mixed with other ingredients (e.g. sugar, milk, cocoa butter) to make chocolate. These typically include cocoa or cocoa liquor (non-alcoholic), milk and/or milk solids, sugar and cocoa butter (or vegetable fats).

There are many different types of chocolate, which can be broadly classified as white chocolate, milk chocolate and dark chocolate, depending on the relative proportions of cocoa and milk they contain.

White chocolate contains milk but no cocoa, while dark chocolate contains cocoa (in higher concentrations than milk chocolate) but no milk. Milk chocolate contains both milk and cocoa.

White, milk and dark chocolate can be manufactured in different ways and may therefore take different forms. For example, they may be sold as blocks of plain chocolate, as chocolate bars with additional ingredients such as nuts and wafers or as sauces or drinks.

Another means of classifying chocolate is as either block or compound chocolate. Compound chocolate, most often used for cooking, is made from cocoa and vegetables fats. Block chocolate (white, milk and dark) mixes cocoa with cocoa butter. The distinct compositions of compound compared to block chocolate have an effect on the relative proportions of saturated, mono-unsaturated and poly-unsaturated fat levels in each (see Table 1).

Chocolate contains a variety of ingredients which contain different nutrients and affect the body's functioning in different ways. Depending on the relative proportions of cocoa, milk and other ingredients, the overall nutritional content of a bar or piece of chocolate varies considerably. For example, chocolate containing greater quantities of milk or milk solids (white or milk chocolate) has a higher calcium content, while chocolate containing greater concentrations of cocoa (dark chocolate) is higher in caffeine. Adding nuts, fruit or other ingredients to chocolate changes its nutritional composition (see Table 1). Chocolate also contains over 400 chemicals including micronutrients which protect the body and its function in various ways. These include Vitamin E, phosphorous, magnesium, iron, copper and plant chemicals.

Cocoa and cocoa butter also contains three types of fat, a monounsaturated fat known as oleic acid, and two saturated fats, stearic acid and palmitic acid. Oliec acid, like other monounsaturated forms of fat including olive oil, does not affect cholesterol levels. There is also evidence that stearic acid, despite being a saturated form of fat has a neutral effect on cholesterol. While palmitic acid (which comprises about one third of chocolate's fat content) is a saturated fat which is known to affect cholesterol levels, there is no evidence that eating chocolate raises cholesterol levels.

Please note that the values in the table are a general guide and that the nutritional value of a particular brand of chocolate may vary, depending on the relative proportions of cocoa and other ingredients and the manufacturing process used to make the chocolate.

Table 1 - Nutritional composition of chocolate (all per 100g)

Nutrients derived from cocoa

In terms of the health benefits which may be derived from chocolate consumption (discussed below) the cocoa content is of key importance. Cocoa contains high concentrations of a powerful type of antioxidant known as polyphenols. Flavanoids, the most common subclass of polyphenols, are found in higher concentrations in chocolate than in other flavanoid rich substances (e.g. red wine). A further subclass of flavanoids, flavanols (or flavan-3-ols), are also found in particularly high quantities in cocoa.

Flavanol in chocolate is derived from its cocoa content, and thus the quantity of flavanol varies depending on the amount of cocoa in the chocolate. White chocolate does not contain cocoa and presumably contains no flavanol, while dark chocolate contains more flavanol than milk chocolate. The flavanol content of various types of milk and dark chocolate also varies depending on the quantity of cocoa contained (some types of dark chocolate contains more cocoa than other types), the agricultural environment in which the cocoa was grown and the method used to process the chocolate. Heating of ingredients and other steps in the chocolate production process can reduce the flavanol content by as much as 90%.

The extent to which flavanol from chocolate is absorbed by the body after consumption also varies depending on the type of chocolate. Dark chocolate flavanol is absorbed more readily by the body than milk chocolate flavanol. However, this does not appear to result from the differing milk content of milk and dark chocolate.

For more information on nutrition, including information on?types and composition of food, nutrition and people, conditions related to nutrition, and diets and recipes, as well as some useful videos and tools, see Nutrition.?

There is no conclusive evidence linking chocolate consumption to a higher risk of any health conditions, although chocolate is widely perceived to cause migraines, acne and obesity. Evidence suggests that chocolate consumption alone cannot cause any of these health conditions. However, acne is associated with high glycaemic index diets and high intakes of refined carbohydrates, and consuming large quantities of chocolates could considerably increase the glycaemic index and refined carbohydrate content of a diet. Similarly, chocolate consumption alone does not cause obesity, which is a disease that arises from excessive calorie intake. However, consuming large quantities of chocolate can considerably increase an individual's calorie intake and may lead to weight gain and obesity, which in turn increase the risk of cardiovascular disorders including high blood pressure (hypertension), diabetes and dyslipidaemia.

Consumption of chocolate may also increase the risk of dental health problems. Dental caries (cavities) are associated with high sugar intakes, so chocolate products with high concentrations of sugar increase the risk of dental caries. There is also evidence that regular intake of chocolate can cause tooth discolouration.

Improved endothelial function and cardiovascular parameters and chocolate

Proposed mechanism

Evidence suggests that consuming chocolate can improve cardiovascular health by improving endothelial function, that is, by increasing the amount of nitric oxide produced by the endothelium. The endothelium is the layer of tissue which lines the inside of the arteries. It regulates the flow of blood through the arteries, by producing (or not producing) a substance called nitric oxide. Nitric oxide causes the arteries to expand to facilitate blood flow. The more nitric oxide produced by the endothelium, the more easily blood can flow through the arteries and the less likely an individual is to experience cardiovascular problems such as stroke and heart attack. This may also influence a man's erectile function and the orgasmic function of men and women, as erection and orgasm are nitric oxide dependent processes (see sexual health and chocolate).

The cardiovascular health benefits of chocolate consumption are related to the activity of the polyphenols (and particularly flavanol) found in the cocoa content of chocolate. Flavanols stimulate nitric oxide secretion and thus consumption of cocoa and flavanol-containing chocolate enhances nitric oxide secretion and widens the arteries. This in turn enhances blood flow and improves a range of cardiovascular parameters. Nitric oxide also has anti-platelet effects (meaning it protects against the formation of blood clots), anti-inflammatory and anti-atheroschlerotic effects (protects against hardening of the walls of the blood vessels).

The anti-oxidant effect of flavanols is also thought to provide cardiovascular protection. Antioxidants are compounds which scavenge and neutralise free radical molecules, or molecules which contain unpaired oxygen atoms. The unpaired oxygen atoms react with and can damage other chemical compounds and cells in the body and also reduce the production of nitric oxide (and thus impair endothelial function). Antioxidants also react with the unpaired oxygen atoms on free radical molecules, and in doing so they neutralise the oxygen atoms and prevent them from damaging the body's cells. The antioxidant effects of flavanols are thought to underlie the association between chocolate consumption and improved cholesterol. Flavanols assist in the oxidation of low density lipoproteins (LDLs) which are "bad" forms of cholesterol. In doing so, they reduce blood concentrations of LDLs.

Anti-oxidants also counter the nitric oxide suppressing effects of free radical molecules and stimulate nitric oxide secretion. There is also evidence that the flavanols contained in chocolate improve glucose metabolism (and thus reduce insulin sensitivity and other markers of diabetes), by stimulating nitric acid production. Insulin sensitivity is regulated by the availability of nitric oxide concentrations.

Evidence

Endothelial function

There is considerable evidence that cocoa consumption improves endothelial function. One study in which participants consumed either dark chocolate (containing 22g of cocoa) or cocoa-free chocolate daily, reported significantly improved endothelial function (increased arterial blood flow) in the dark chocolate group. Participants who consumed the dark chocolate then tested a cocoa beverage (containing 22g of cocoa). They also experienced improved endothelial function compared to participants who drank a cocoa free beverage. Evidence shows that endothelial function improves after both short-term and long-term consumption of chocolate.

Cardiovascular disease

There is also evidence that chocolate consumption protects against ill-health and death associated with cardiovascular disease. One large study reported that men with high cocoa intake were 50% less likely to die of cardiovascular causes than men with the low cocoa intake. Another study reported a dose-response relationship between cocoa consumption and cardiovascular mortality, meaning that the more chocolate an individual consumed, the less chance they had of dying from cardiovascular complications. Individuals who consumed chocolate more than once a week were 66% less likely to die of cardiovascular causes compared to those who never ate chocolate, while those who consumed chocolate less than once a month were 27% less likely to experience cardiovascular mortality.

Studies have also reported a protective effect regarding cardiovascular ill health. One reported that elderly individuals (aged 70-74) who consumed chocolate in the previous year were significantly less likely to have a history of cardiovascular disease compared to those who did not.

Blood pressure

There is also considerable evidence that chocolate consumption can reduce blood pressure. For example, a study of Dutch men reported that those who consumed high quantities of cocoa had lower blood pressure than those with low chocolate consumption. Another compared blood pressure in healthy individuals consuming 100 grams of dark chocolate everyday for 15 days, with blood pressure of subjects consuming 90 grams of white chocolate everyday. It reported significantly lower blood pressure amongst the dark chocolate consumers. Evidence suggests that consuming chocolate can reduce blood pressure as much as some medications used to reduce blood pressure, and chocolate consumption could reduce the risk of stroke and cardiovascular disease by 20% and 10% respectively.

Inflammatory markers

There is also some evidence that cocoa consumption reduces inflammation which contributes to vascular ill-health. For example, one study showed consumption of dark chocolate was inversely associated with c-reactive protein levels. High levels of c-reactive protein are a marker of inflammation and an indicator of coronary heart disease. However, the study found that the relationship was only present when chocolate was consumed in moderation (~20 grams of dark chocolate every three days). The association disappeared when greater quantities of dark chocolate were consumed. The authors of this study concluded that moderate consumption of dark chocolate could reduce the risk of coronary events in men by 26% and in women by 33%.

Platelet activity

Evidence that cocoa consumption positively effects platelet activity, that is reduces the risk of platelets forming clots in the blood and causing blockages in arteries, is also growing. Studies have shown that cocoa consumption can reduce platelet clotting and thin an individual's blood, in a similar way to which aspirin does.

Diabetes

Evidence also suggests that chocolate consumption can improve insulin sensitivity and reduce the risk of diabetes. A Norwegian study reported a significantly lower prevalence of diabetes amongst elderly subjects (70-74) who consumed chocolate in the previous year compared to those who did not. A study of healthy individuals (average age 34 years) reported improved insulin sensitivity in subjects who consumed polyphenol-rich dark chocolate compared to those who consumed polyphenol-free white chocolate. Insulin sensitivity improved after just 15 days of consuming 100 grams of dark chocolate per day.

Improved cholesterol

Studies have also shown that consumption of dark chocolate improves cholesterol. One study, in which healthy individuals consumed either a flavanol-enriched dark chocolate bar or a dark chocolate bar with no added flavanols, reported significant reductions in total cholesterol and LDLs (bad cholesterol) amongst flavanol-enriched chocolate consumers. As high cholesterol is a significant risk factor for heart disease, dark chocolate consumption therefore also indirectly reduces the risk of cardiovascular disease, by improving cholesterol.

For more information on cholesterol, including the health effects of high cholesterol and ways to lower cholesterol levels, as well as some useful tools, see Cholesterol.

Cancer and chocolate

Proposed mechanism

The anti-oxidant properties of cocoa are thought to protect against cancer by protecting cells from oxidative damage which contributes to the growth of cancerous cells. Flavanoids in cocoa appear to interrupt the cell cycle of cancerous cells (the process through which cancerous cells replicate themselves and grow excessively to form tumours). Effectively, they impair the growth of cancerous tumours, however the way in which flavanoids exert this effect is not yet well understood.

Evidence

Evidence regarding the effect of chocolate or flavanoid consumption on cancer risk is somewhat contradictory. While test tube/laboratory studies have shown that cocoa-derived flavanoids interrupt the replication of cancer cells, there is no evidence from studies of cocoa consumption and incidence of cancer amongst humans to indicate whether or not flavanoids exert the same effect in the human body.

For more information on cancer, including breast, prostate, kidney and stomach cancer, see Cancer: Overview.

Cognitive performance and chocolate

Proposed mechanism

The proposed mechanism through which increased chocolate intake improves cognitive performance is via increasing blood flow to the cerebral grey matter (grey matter in the brain which regulates sensory responses).

Evidence

Evidence suggests that elderly individuals who consume chocolate have better cognitive function than those who do not. A study of Norwegian 70-74 year olds reported that chocolate intake in the past year was associated with better performance on numerous cognitive tests. The best cognitive performance was achieved with consumption of 10 grams of chocolate per day.

Photoprotection (protection from light) and chocolate

Proposed mechanism

Photoprotection refers to protection from light. In the human body, the skin provides photoprotection by absorbing the sun's rays. This results in the production of free radical molecules (molecules with unpaired oxygen atoms which can break away and damage or alter other molecules and cells in the body). Free radical molecules can cause damage to skin cells and result in the growth of cancerous cells.

The properties of skin vary between individuals according to their genes (e.g. pigmentation of their skin) and the extent to which the skin is exposed to sunlight (e.g. use of sunscreen or a hat), and these factors influence the extent to which the skin is photoprotective. Nutritional intake is one factor affecting skin photoprotection and dietary antioxidants (including flavanols in cocoa) are thought to exert a photoprotective effect. The proposed mechanism by which they exert this effect is by reducing the sensitivity of skin cells to UV exposure.

Evidence

One study which compared the effect of UV-exposure on the skin of women who had consumed high and low flavanol cocoa drinks daily prior to UV exposure, reported increased photoprotection (reduced sunburn) and improved skin condition (greater blood flow to skin, increased skin density and hydration) amongst women who consumed the high flavanol cocoa drink.

General health and wellbeing and chocolate

One study of elderly European men found that those who preferred chocolate had better general health than those who preferred other types of confectionary. For example, men who preferred chocolate were significantly less likely to be lonely or depressed and more likely to feel happy and have plans for the future. However, the mechanisms by which chocolate preference improves wellbeing are not well understood.

Sexual health and chocolate

Chocolate has also been proposed to have an aphrodisiac effect (increase sexual desire) because it stimulates the release of serotonin (a mood regulating hormone which also regulates blood flow) and phenylethylamine (a stimulant which regulates mood). However, there is currently limited scientific evidence to support this theory.

Chocolate may also enhance sexual response in men and women (e.g. improve erectile function and vaginal lubrication) because chocolate consumption stimulates the release of nitric oxide which plays an important role in regulating sexual function. As mentioned above, nitric oxide regulates blow flow through the arteries, and the more nitric oxide released, the more blood that flows through the arteries. As erectile function depends on increased blood flow to the penis, the availability of nitric oxide can affect a man's ability to get an erection. Nitric oxide also plays a role in regulating the movement of smooth muscles, that is, muscles which expand and contract involuntarily. Smooth muscles in the genitals of men and women are involved in genital arousal and orgasm, and thus chocolate may also affect an individual's genital arousal and orgasmic ability. However, research studies are yet to be undertaken investigating the effect of eating chocolate on sexual response.

While there is a growing body of evidence that some nutritional components of chocolate have beneficial health effects, it is important to remember that consumption of other anti-oxidant containing foods (particularly fresh fruit and vegetables) also produces these beneficial effects and individuals consuming a healthy balanced diet can obtain sufficient antioxidants without adding chocolate.

There is a risk of weight gain (and associated cardiovascular ill-health which accompanies weight gain) from increasing chocolate consumption and so chocolate should be consumed with caution.

Chocolate is an energy rich food which is high in fat and sugar and the National Health and Medical Research Council recommend that such foods are consumed in moderation.

People who enjoy consuming chocolate will benefit most from dark varieties of chocolate which have cocoa or cocoa liquor listed first (and before sugar) in the ingredients. Chocolate should be consumed in small quantities (e.g. 10-15 grams per day). It is also important to bear in mind that over consumption of chocolate is likely to lead to weight gain and obesity, due to its high energy content. Individuals who wish to consume chocolate may need to reduce their calorie intake from other components of their diet, or increase their physical activity to offset the energy gained from consuming chocolate.

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A quick and easy low-fat slice packed with dates, walnuts and chocolate.

For more information, see Chocolate Date?Slice.
Indulge in a deliciously low-fat dark chocolate brownie. Serve warm from the oven with fresh berries for a great dessert.

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[Abstract | Full text]Grassi D, Lippi C, Necozione S,?et al.?Short-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons. Am J Clin Nutr. 2005;81(3):611-4. [Abstract | Full text]Hooper L, Kroon PA, Rimm EB,?et al.?Flavonoids, flavonoid-rich foods, and cardiovascular risk:?A meta-analysis of randomized controlled trials. Am J Clin Nutr. 2008;88(1):38-50. [Abstract | Full text]Buijsse B, Feskens EJ, Kok FJ, Kromhout D.?Cocoa intake, blood pressure, and cardiovascular mortality: The Zutphen Elderly Study. Arch Intern Med. 2006;166(4):411-7. [Abstract | Full text]Janszky I, Mukamal KJ, Ljung R,?et al.?Chocolate consumption and mortality following a first acute myocardial infarction: The Stockholm Heart Epidemiology Program. J Intern Med. 2009;266(3):248-57. [Abstract]Taubert D, Roesen R, Schomig E.?Effect of cocoa and tea intake on blood pressure:?A meta-analysis. 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[Abstract | Full text]Hertog MG, Kromhout D, Aravanis C,?et al. Flavonoid intake and long-term risk of coronary heart disease and cancer in the seven countries study. Arch Intern Med. 1995;155(4):381-6. [Abstract]Heinrich U, Neukam K, Tronnier H,?et al. Long-term ingestion of high flavanol cocoa provides photoprotection against UV-induced erythema and improves skin condition in women. J Nutr. 2006;136(6):1565-9. [Abstract | Full text]Strandberg TE, Strandberg AY, Pitkala K,?et al.?Chocolate, well-being and health among elderly men. Eur J Clin Nutr. 2008;62(2):247-53. [Abstract]Afoakwa E. Cocoa and chocolate consumption: Are there aphrodisiac and other beneficial implications on human health? South Afr J Clin Nutr. 2008;21(3):107-13. [Abstract | Full text]Dietary guidelines for Australian adults [online]. Canberra, ACT: National Health and Medical Research Council; 10 April2003 [cited 3 March 2010]. Available from: URL link

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Dental Health for Babies and Young Children

It is very important that primary teeth are kept in place until they are lost naturally. Most children will have some of their primary teeth up until the age of 12.?

Primary teeth:

allow the child to maintain good nutrition and digestion by being able to chew properly;are important in speech development - if a child has missing teeth, especially the ones at the front of the mouth, the child may encounter difficulties talking when they get older, and this will resultantly require management;are needed for the permanent tooth to form;aid the permanent teeth by saving space for them and "guiding" them into their correct position; andcreate a healthy smile that can help children feel good about the way they look to others.

What?is early childhood caries?

The most common chronic disease of childhood is early childhood caries (aka nursing bottle decay, or baby bottle decay). Early childhood caries is the presence of one or more primary teeth with tooth decay, or missing or filled tooth surfaces due to tooth decay in a child aged less than 3 years of age. Early childhood decay is completely preventable if proper dental hygiene is maintained well.

The cause of early childhood caries and how they develop

Early childhood caries can develop as soon as the primary teeth erupt. Decay may be visible to the dentist as early as 10 months of age. Usually, the first stage of tooth decay looks like white spots or lines on the front teeth and if your child is not taken to the dentist immediately, these white areas will rapidly break down into yellow-brown spots and the disease will spread to the back teeth, which may eventually look like black holes. All white lines are not tooth decay, but it is a good idea to get the dentist to look at your child if you notice marks on their teeth.

The main bacteria that are involved in all tooth decay (including early childhood caries) is Streptococcus mutans. This bacteria uses sugars and carbohydrates that we eat as a part of a diet as nutrition for its survival. The waste products the bacteria produce is very acidic, and this dissolves a very small amount of the tooth, as well as allows bacteria to enter your tooth, and starts the process of tooth decay. Teeth, bacteria, and sugar, as well as time, control the severity of the disease; if left for a long time in a person who eats a lot of sugar and does not brush properly, decay will progress.

Figure 3: Note decay on molars on both left and right hand sides.?

What increases the chance of a baby getting early childhood caries?

If any of the following apply, they increase the chance of your child getting early childhood caries:

Teeth that erupt with white, brown, or rough enamel are at greater risk of decay. Defects are more likely in children who are born prematurely or have a low birth weight, and in children of low socioeconomic status. If the mum has high levels of the bacteria Streptococcus mutans, the risk of the child getting early childhood caries is more likely, as the mum is able to transfer this bacteria to the child e.g. kissing the child on the mouth, or sharing food and cutlery. Tooth decay at the end of the day is an infection and can be passed from mother to child. Parents who smoke may also increase the chance of having a high quantity of the bacteria Streptococcus mutans, and thus will be more likely to transfer the bacteria to their children.When we have sugar, it takes about 20 - 40 minutes to stop the negative effects of sugar on the tooth. If someone has a sugary snack every hour, the time for the tooth to recover from the negative effects will be almost non-existent, and the person will have a high chance of getting tooth decay in their mouth i.e. children should not be given sugary snacks throughout the day.

Severe early childhood caries

The consequences of not treating early childhood caries in an early stage are:

severe pain due to infection, pus formation, and eventual death;loss of sleep and inability to focus and learn for the child due to discomfort;inability to eat healthy foods, or foods that the child desires;difficulty talking as the child gets older;loss of space in the arch, and possible crowding that may require orthodontics;higher chance of getting decay in permanent teeth; and/orself-consciousness about smile and appearance, and long-term effects regarding social interactions and self-esteem.

Determining if your child is at risk

In pregnant women, periodontal disease has been linked to premature births, and that if a dental hygiene is maintained well, there is a lower chance of having a premature birth. ?Ideally, the oral health of the mother should be monitored after delivery because decreasing the level of Streptococcus mutans can reduce the chance of the baby coming into contact with tooth decay-causing bacteria.

In the first few months of life (0-4 months), the primary teeth are still are not through; however, it is good for the child to be introduced to a dental setting and the dentist can obtain valuable information that can may indicate what sort of risk your child is at of getting tooth decay.

These factors can increase the chance of your baby getting tooth decay:

young infants with special health care needs will be at high risk of developing early childhood caries; mothers with high caries rates have a higher chance of passing on decay to their children; families of low socioeconomic status have high caries risk;the child's diet; breastfeeding is the preferred source of infant nutrition. Fruit juice is discouraged because it can cause early childhood caries and has been linked with failure to thrive. Some formulas, especially soy-based formulas that contain sucrose, are also linked with tooth decay in children's teeth; andthe sources of systemic fluoride, which in Australia consists mostly of fluoridated tap water; one of the most effective tools in the prevention of dental decay and shown to reduce tooth decay in half for children. Fluoride is essentially good at strengthening teeth against the attack of tooth decay.

How to look after teeth in your baby

Neonate/infant (0-6 months)

It is important to clean your baby's gums every day before the teeth have even come through into the mouth according the following procedure:

Cradle your child with one arm: and Wrap a moistened gauze square or washcloth around the index finger of the hand of the other arm and gently massage the teeth and gingival tissues; orIntroduce a soft-bristled toothbrush during this age only if you feel comfortable using the toothbrush, and do not use toothpaste.

Infant/toddler (6-18 months)

Once the baby teeth start to appear, it is recommended that parents brush the baby's mouth using a baby's toothbrush with a small head and soft, rounded bristles. Up to the age of 18 months the teeth should be brushed with plain water and preferably, teeth should be brushed or cleaned twice a day - morning and evening.

Too much fluoride intake can result in fluorosis; an unattractive mottling of the teeth. Therefore, fluoride intake should be optimal but not excessive. In Australia, if your child is under 18 months of age, toothpastes containing fluoride should not be used.

Toddler/early childhood (18 months- 6 years)

There are special low-fluoride toothpastes with about half the amount of fluoride that have been developed for children and these can be introduced from around the age of 18 months - 6 years. Only a smear of toothpaste (pea-size) should be used and ensure your child spits and does not swallow the toothpaste.

From around the age of 4-5 years children should begin to learn how to brush their own teeth, and these are some of the considerations whilst teaching children how to take care of their teeth:

Children do not have the manual skills to effectively clean their own teeth properly until around 8 years of age thus, parents should be involved with the brushing till the age of 8-10 years of age;Move the toothbrush gently in small circles to clean all surfaces of the teeth. Avoid side-to-side scrubbing, which can damage teeth and gums; Electric toothbrushes, which rotate and oscillate can be used, but one with a small brush head should be employed to ensure access to all areas of the mouth;In total, you should aim to brush for about two minutes - with patience your child will soon learn to tolerate it; andToothbrushes should also be replaced every 3 months (if used properly).

The Australian Dental Association also advocates that when a child is about two and a half years old, flossing can be done daily and at a minimum, at least twice a week.

Fluoride in the quantity we use it in is very safe; however the risk of giving a toddler fluoride toothpaste is fluorosis. In other countries, and in the past in Australia, parents have given their children supplements or fluoride tablets. These have been found to increase the risk of fluorosis and are no longer recommended in Australia.

If your toddler resists brushing or cannot sit still for two minutes, then try these suggestions:

Consider a battery-powered brush, which adds novelty to cleaning their teethSing nursery rhymes or play a favourite song while you help your child brush their teethOffer a reward (ensure that this reward is either non-food or low fat/sugar snacks such e.g. celery or carrot sticks) every time your toddler allows you to brush for two minutesMake flossing and brushing as much fun as you can to avoid any negative association or resistance. Talk to your dentist if you need advice.

It is also important to set a good example for your children. Children tend to imitate their parents' behaviours, and if oral hygiene and dental care are important to you, a child is more likely to take care of their teeth. Visit your dentist regularly to maintain your own oral health which will in turn benefit your child.

The Australian Dental Association and the American Academy of Pediatric Dentistry recommend that the first check-up occur within 6 months of the first primary tooth coming through but by no later than 12 months of age.

Early dental checkups can provide an opportunity to give oral health education for parents in areas such as:

proper dental hygiene; prevention of dental injuries; and prevention of early childhood caries.

Such visits at an early age may also allow children to become comfortable in the dentist's office.

Once the baby or primary teeth start to appear, it is recommended that parents use a baby's toothbrush with a small head and soft, rounded bristles. Up to the age of 18 months the teeth should be brushed with plain water and preferably, teeth should be brushed twice a day - morning and evening.There are special low-fluoride toothpastes that have been developed for children and these can be introduced from around the age of 18 months.Store all toothpastes out of your child's reach. Some small children love the taste of toothpaste and will eat it if given the chance.Most children should be brushing their own teeth with parental supervision, from eight years of age. By age 10, children should be able to brush their own teeth without the need for ongoing supervision.When your child is about two and a half years old, flossing can be done daily and at a minimum, at least twice a week.Set a good example as a parent or guardian and look after your own teeth.

Kindly written by Dr Akhil Chandra BDSc. (Hons UWA)
Dentist, Whitfords Dental Centre and Editorial Advisory Board Member of the Virtual Dental Centre

For more information on dental health and hygiene in children aged 0 to 5 years, see Dental Health in Kids.Cameron A, Widmar R. Handbook of Paediatric Dentistry. London: Mosby; 1997. [Book]For the dental patient. Tooth eruption: The primary teeth. J Am Dent Assoc. 2005;136(11):1619. [Full text]Crippen DJ. Frequently asked questions: Why are primary teeth (baby teeth) important??[online]. Sacramento, CA:?Capital?Pediatric Dentistry;?3 September 2009 [cited 20 October 2009]. Available from: URL linkProffit W. Contemporary Orthodontics (3rd editon). St Louis: Mosby; 2000. [Book]Edelstein BL, Douglass CW. Dispelling the myth that 50 percent of U.S. schoolchildren have never had a cavity. Public Health Rep. 1995;110(5):522-33. [Abstract | Full text]Definition of early childhood caries (ECC) [online]. Chicago, IL: American Academy of Pediatric Dentistry; 2005 [cited 13 August?2007]. Available from: URL linkDouglass JM, Douglass AB, Silk HJ. A practical guide to infant oral health. Am Fam Physician. 2004;70(11):2113-20. [Abstract | Full text]Oral health risk assessment training for pediatricians and other child health professionals. Elk Grove Village, IL: American Academy of Pediatrics;?2005 [cited 13 August?2007]. Available from: URL linkDouglass JM, Tinanoff N, Tang JM, Altman DS. Dental caries patterns and oral health behaviors in Arizona infants and toddlers. Community Dent Oral Epidemiol. 2001;29(1):14-22. [Abstract]Therapeutic Guidelines: Oral and Dental (1st edition). North Melbourne: Therapeutic Guidelines Limited; 2007. [Book]Seow WK. Biological mechanisms of early childhood caries. Community Dent Oral Epidemiol. 1998;26(1 Suppl):8-27. [Abstract]Seow WK. Enamel hypoplasia in the primary dentition: a review. ASDC J Dent Child. 1991;58(6):441-52. [Abstract]Kohler B, Bratthall D. Intrafamilial levels of Streptococcus mutans and some aspects of the bacterial transmission. Scand J Dent Res. 1978;86(1):35-42. [Abstract]Aligne CA, Moss ME, Auinger P, Weitzman M. Association of pediatric dental caries with passive smoking. JAMA. 2003;289(10):1258-64. [Abstract | Full text]Rugg-Gunn A. Diet and dental caries. In: Murray JJ (ed). The Prevention of Oral Disease (3rd edition). New York: Oxford University Press; 1996. [Book]Lopez NJ, Smith PC, Gutierrez J.?Periodontal therapy may reduce the risk of preterm low birth weight in women with periodontal disease: a randomized controlled trial. J Periodontol. 2002;73(8):911-24. [Abstract]Kohler B, Andreen I.?Influence of caries-preventive measures in mothers on cariogenic bacteria and caries experience in their children. Arch Oral Biol. 1994;39(10):907-11. [Abstract]Hale KJ. Oral health risk assessment timing and establishment of the dental home. Pediatrics. 2003;111(5 Pt 1):1113-6. [Abstract | Full text]Dennison BA. Fruit juice consumption by infants and children: a review. J Am Coll Nutr. 1996;15(5 Suppl):4-11S. [Abstract]Erickson PR, McClintock KL, Green N, LaFleur J. Estimation of the caries-related risk associated with infant formulas. Pediatr Dent. 1998;20(7):395-403. [Abstract]Tinanoff N, Douglass JM. Clinical decision-making for caries management in primary teeth. J Dent Educ. 2001;65(10):1133-42. [Abstract | Full text]Sanchez OM, Childers NK. Anticipatory guidance in infant oral health: rationale and recommendations. Am Fam Physician. 2000;61(1):115-20. [Abstract | Full text]Oral hygiene for babies and toddlers [Brochure]. Australian Dental Association;?2009.Pendrys DG. Risk of enamel fluorosis in nonfluoridated and optimally fluoridated populations: considerations for the dental professional. J Am Dent Assoc. 2000;131(6):746-55. [Abstract | Full text]Daly CG, Chapple CC, Cameron AC. Effect of toothbrush wear on plaque control. J Clin Periodontol. 1996;23(1):45-9. [Abstract]Nowak AJ, Casamassimo PS, McTigue DJ. Prevention of dental disease from nine months in utero to eruption of the first tooth. J Am Soc Prev Dent. 1976;6(5):6-12. [Abstract]Your child's first dental visit [Brochure]. Australian Dental Association;?2008. Oral health policies. American Academy of Pediatric Dentistry. Pediatr Dent 1999;21:18-37. [Abstract]Crall JJ. Prevention of oral disease in children: concepts and practices. Pediatr Ann. 1985;14(2):140-1. [Abstract]

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Effect of Nutrition on Dental Health from One to Two Years of Age

Between the age of 12 and 24 months, most of the baby teeth come through into the mouth. As the toddler is introduced to a variety of new foods, healthy meal and snack patterns should be exercised routinely by the parent or guardian. Variety, moderation, and attention to what is eaten by the child for snacks are of crucial importance.

During the toddler years, there is a great development in the ability to eat, have control over their hands and fingers and since there are teeth present in the toddler's mouth, the toddler can control more of what he/she eats.

Nutritious finger foods such as cheese and fruit should be offered as snacks. Frequent snacks that increase the risk of tooth decay considerably or continual sipping of liquids that increase the risk of decay place the toddler with a very high chance of developing tooth decay, and needing fillings or possible removal of teeth in extreme cases.

The following table has three groups; the no risk categories are those foods that have essentially no contribution to decay; the low risk category has a mild effect on dental decay; and the high risk category plays a big role in dental decay if the teeth are not cleaned properly. Parents should of course concentrate on giving their children snacks from the first two columns.

CheesesDried meat sticksPlain milk and low sugar yoghurtVegetablesFlavoured club sodaDiet sodasFruits (except dried)Chocolate milkWholegrain productsCandy; especially those that are stickyCookiesCakeSweetened beverages (including fruit juices)Fruit roll-ups, dried fruitBreakfast bars

In terms of children's food intake, only 2% of children consume the recommended number of servings of foods in the food pyramid, and 11% do not meet any of the recommendations. This is a great concern as it means many children are not eating a nutritious diet, filled with a variety of food groups.

The rationale behind the food pyramid emphasises the need to include generous amounts of plant-based foods (cereals, legumes, fruits and vegetables) and moderate amounts of animal products (meat, fish, milk, eggs) in our diets. Furthermore, a healthy diet should contain only small amounts of energy-dense foods (e.g. sugar, fats and oils). The base of the pyramid is broad, and the top narrow; if food is selected according to the structure of the food pyramid, then the diet will most likely be healthy, thereby maintaining a stable healthy lifestyle.

High sugar intake is also of concern to general as well as dental health because high sugar-containing foods are generally low in essential nutrients and may substitute for foods that are more nutritious. An example of this problem is the large consumption of juices by toddlers. Juice consumption has increased from an average of 95ml to 163 ml, and 11% of preschoolers consumed more than 355ml of juice daily. This high juice consumption, especially those high in sorbitol and fructose, can cause "toddlers' diarrhoea''.

Additionally, sugar rich foods should be limited to mealtimes and should be followed by either toothbrushing or by consumption of protective foods such as cheese and milk.

Dental hygiene is of great importance at this age as many of the baby teeth come through into the mouth. It is important to take excellent care of these teeth, as decay at this stage will most likely result in the loss of teeth, and future problems with the adult teeth.

To promote good nutrition and decrease caries risk in toddlers:

Don't put a child to bed with a bottle;Complete weaning of infants from the bottle;Discourage a child from carrying and continuously drinking from a bottle or sippy cup;Limit juice or sugar-containing drink intake to about 120ml a day and only in a cup;Restrict sugar-rich foods to mealtimes;Establish routine meals with family members eating together; andStimulate a child's appetite at mealtimes by reducing between-meal snacking.

Kindly written by Dr Akhil Chandra BDSc. (Hons UWA)
Dentist, Whitfords Dental Centre and Editorial Advisory Board Member of the Virtual Dental Centre

For more information on dental health and hygiene in children aged 0 to 5 years, see Dental Health in Kids.Proffit W. Contemporary Orthodontics. 3rd ed. St Louis: Mosby, Inc; 2000.Fitzsimons D, Dwyer JT, Palmer C, Boyd LD. Nutrition and oral health guidelines for pregnant women, infants, and children. J Am Diet Assoc. 1998 Feb;98(2):182-6, 9.Tinanoff N, Palmer CA. Dietary determinants of dental caries and dietary recommendations for preschool children. J Public Health Dent. 2000 Summer;60(3):197-206; discussion 7-9.Tinanoff N. Association of diet with dental caries in preschool children. Dent Clin North Am. 2005 Oct;49(4):725-37.United States Department of Agriculture, Centre for Suhition, Policy and Promotion, 1999. Available from: URL link Dennison BA. Fruit juice consumption by infants and children: a review. J Am Coll Nutr. 1996 Oct;15(5 Suppl):4S-11S.

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How Smoking Affects Skin Health

Smoking is associated with a range of?detrimental health effects, the most well known?of which are?lung cancer and cardiovascular disease. There are many lesser known health effects as well, including effects?on the skin.

In many cases, these changes to skin are not life threatening, though they can change the physical appearance of the smoker. For example, smoking?is associated with premature ageing and wrinkles. Smoking is also associated with very serious skin conditions, including squamous cell carcinoma of the skin (a type of skin cancer) and psoriasis. Awareness of?the?changes to physical appearance and the serious skin conditions associated with smoking may help motivate individuals to quit smoking.

The precise ways in which tobacco smoke damages or changes skin are not fully understood, though scientific studies have produced evidence about a number of possible ways. Studies suggest that tobacco smoke exposure decreases capillary and arteriolar blood flow, possibly damaging?connective tissues?that help maintain healthy?skin. Skin fibroblasts (the cells in connective tissue that form collagen and elastin) are damaged by tobacco smoke.

There is also evidence that tobacco smoke is phototoxic. Smoke becomes more toxic in the presence of ultraviolet light (UV),?such as is found in?sunlight, and causes more damage to skin cells than either smoke or UV would cause on their own.

Have you quit smoking? Or are thinking about trying to quit? Use this tool to see what health benefits you have already achieved and what benefits you can expect in the future if you stick with it. For more information, see Health Benefits of Quitting Smoking Tool.

Ageing

As people?age, their skin also ages. The ageing process is influenced by a number of environmental factors. Sun exposure is the most prominent risk factor for premature ageing. Although it is much less well?known, cigarette smoking is also a risk factor for?premature skin ageing.

Several studies have reported that cigarette smoking causes an individual's skin?to age?even more than exposure to sunlight does. Studies have also reported that the effect of exposure to tobacco smoke and sunlight at the same time is more dangerous than the combined effect of either exposure alone, and that women are at greater risk than men.

The ageing of skin can be measured by a number of features. Most obviously, skin becomes wrinkled. Wrinkling is caused by changes to skin elasticity and concentrations of skin components such as collagen and elastin. Differences in skin features between individuals who do and do not smoke can therefore be measured by physical appearance, or by analysing skin tissues for concentrations of components.

Wrinkles

Numerous studies have found that premature wrinkling is associated with smoking. There is evidence that the more an individual smokes, the more the premature ageing effect occurs, so heavy smokers will experience more premature wrinkles than those who only smoke occasionally. One study, in which eight judges individually rated the age of smokers and non-smokers from their photographs, reported that smokers were, on average, rated as being 2.7 years older than their actual age, while non-smokers were rated at?0.7 years younger than their actual age.

Another study reported that moderate smokers were almost twice as likely to wrinkle prematurely than non-smokers,?and?heavy smokers were almost three times more likely to wrinkle prematurely.

Other studies have examined exposure to both cigarettes and sunlight, to assess the relative importance of each of these exposures in the development of wrinkles. Evidence from these studies suggests that smoking may be a more important factor in the development of wrinkles than sun exposure.

There is evidence?that individuals?exposed to both tobacco smoke and sunlight prematurely winkle more than individulas exposed to tobacco smoke or sunlight alone. One study found that smokers were 5.8 times more likely to develop wrinkles than non-smokers, while those with excessive sun exposure (i.e.?more than two?hours per day) were only 2.65 times more likely to wrinkle than those who were not excessively exposed to sunlight. Individuals who smoked heavily (35 pack years or more) and had excessive sun exposure were 11.4 times more likely than non-smokers with?less than?two hours per day of sun exposure to develop wrinkles. This is a considerably greater risk than the combined individual risks of?exposure (i.e. 5.8 for tobacco + 2.65 for sunlight = 8.45 times more likely). As tobacco smoke is phototoxic, this synergistic effect of combined tobacco smoke and sun exposure is unsurprising.

Another study reported that smoking?more than?20 cigarettes per day was associated with an almost 10-year increase in skin ageing. The study found no significant association between sun exposure and wrinkles.

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There is some evidence that women's skin is more affected by tobacco smoke exposure than men's skin. One study reporting a premature ageing effect in both sexes found that smoking men were 2.3 times more likely than non-smoking men, and smoking women more than 3 times as likely?as non-smoking women, to age prematurely. The study did not explore the possible reasons why women's skin was more sensitive to the detrimental effects of tobacco smoke than men's skin.

Skin tissue?composition

As skin ages, the composition of skin tissues changes. A number of studies have examined the skin tissues of smokers and non-smokers as a measure of premature ageing. A Dutch case control study?measuring the extent of elastosis (a condition in which skin loses elasticity as a result of connective tissue degeneration) and telangiectasia (a condition characterised by fine red lines in the skin caused by?the dilation of small blood vessels) in smokers and non-smokers reported that the likelihood of developing either condition increased with the number of cigarettes smoked. This was true for both men and women, although the effect was most apparent in men. Another study, which used computer assisted analysis to assess elastosis in four layers of facial skin, reported significantly greater elastosis in smokers compared to non-smokers.

Skin tone and colour

In addition to wrinkles, smoking increases an individual's risk of gauntness and facial discolouration.

There is evidence that smoking tobacco decreases the ability of skin to regenerate and repair wounds.This is particularly evident in patients undergoing surgery. For example, smokers who undergo face lift surgery are more likely than non-smokers to experience unsatisfactory wound healing.

There are a number of possible ways by which exposure to tobacco smoke may inhibit the skin's ability to regenerate and repair. Nicotine, one of the toxic components of tobacco smoke, is a vasoconstrictor (an agent which causes the blood vessels to contract). When blood vessels are constricted they transport less blood through the body, and therefore reduce the supply of nutrients upon which the skin depends to regenerate. Similarly, carbon monoxide, another toxic component in tobacco smoke, reduces oxygen flow through the body, thus reducing the supply of oxygen needed by damaged cells?to regenerate.

Moisture

Dry skin can feel uncomfortable because it is less flexible than moisturised skin. Unmoisturised skin becomes unattractive and may take on a red, flaky or scaly appearance. Dry skin is also more likely to crack or itch than well-moisturised skin.?

Evidence about the effects of smoking on the moisture content of skin is limited, but the available evidence suggests that smoking reduces moisture in the skin. An Israeli study examining skin moisture found that women who smoked more than?ten cigarettes per day had significantly lower mean moisture values than non-smokers.

Skin blood flow

Cigarette smoking reduces skin blood flow by increasing the release of a hormone called vasopressin.Vasopressin is produced naturally by humans. One of its functions is to reduce blood flow. Studies have shown that concentrations of vasopressin in the blood rise immediately after smoking tobacco.

A review of all published studies examining the associations between skin health and smoking reported that smoking increases the risk of skin lesions in people with diabetes, lupus and AIDS.

Exposure to sunlight is the predominant risk factor for squamous cell carcinoma of the skin (a type of skin cancer). There is considerable evidence that smoking also increases the risk of skin cancer. A Dutch study found that cigarette and pipe smokers were twice as likely as non-smokers to develop squamous cell carcinoma of the skin, when other risk factors (e.g. age and sun exposure) were taken into account. Interestingly, there was no significant association between cigar smoking and squamous cell carcinoma. The same study reported that current smokers were more likely to develop the condition than former smokers.

The Nurses' Health Study, a large study conducted amongst nurses from the US, found that nurses who smoked were 50% more likely to develop squamous cell carcinoma of the skin, compared to non-smoking nurses. A number of other studies have also identified smoking as a risk factor for squamous cell carcinoma of the skin.

Tobacco smoke exposure increases the risk of developing psoriasis, a rare skin condition characterised by the formation of silvery, plaque-like scales on the arms and legs (particularly at?the elbows and knees). Smokers with psoriasis?are less likely than non-smokers?to improve following treatment.

A recent review of literature on the topic reported that women who smoked were 3.3 times more likely to develop psoriasis than non-smoking women. While no significant association between smoking and development of psoriasis in men was found, there was evidence that men who smoked?at least ten cigarettes per day were more likely to have severe psoriasis. Decreased improvement rates following treatment were noted in both men and women.

For more information on smoking and its health effects, and some useful tools, videos and animations, see Smoking. Scollo MM, Winstanley MH [eds]. Tobacco in Australia [3rd edition].?Chapter 3: The health effects of active smoking [online]. Melbourne: Cancer Council Victoria. 21 November?2008 [cited 18 May 2009]. Available from URL: http://www.tobaccoinaustralia.org.au/Grady D, Ernster V. Does cigarette smoking make you ugly and old? Am J Epidemiol. 1992; 135(8): 839-42.Behnam SM, Behnam SE, Koo JY. Smoking and psoriasis. Skinmed. 2005; 4(3): 174-6.Placzek M, Kerkmann U, Bell S, Koepke P, Przybilla B. Tobacco smoke is phototoxic. Br J Dermatol. 2004; 150(5): 991-3.Kennedy C, Bastiaens MT, Bajdik CD, Willemze R, Westendorp RG, Bouwes Bavinck JN. Effect of smoking and sun on the aging?skin. J Invest Dermatol. 2003; 120(4): 548-54.Yin L, Morita A, Tsuji T. Skin aging induced by ultraviolet exposure and tobacco smoking: Evidence from epidemiological and molecular studies. Photodermatol Photoimmunol?Photomed. 2001; 17(4): 178-83.Ernster VL, Grady D, Miike R, Black D, Selby J, Kerlikowske K. Facial wrinkling in men and women, by smoking status. Am J Pub Health. 1995; 85(1): 78-82.Boyd AS, Stasko T, King LE Jr, Cameron GS, Pearse AD, Gaskell SA. Cigarette smoking-associated elastotic changes in the skin. J Am Acad Dermatol. 1999; 41(1): 23-6.Raitio A, Kontinen J, Rasi M, Bloigu R, Roning J, Oikarinen A. Comparison of clinical and computerized image analyses in the assessment of skin ageing in smokers and non-smokers. Acta Derm Venereol. 2004; 84(6): 422-7.Koh JS, Kang H, Choi SW, Kim HO. Cigarette smoking associated with premature facial wrinkling: Image analysis of facial skin replicas. Int J Dermatol. 2002; 41(1): 21-7.Leung WC, Harvey I. Is skin ageing in the elderly caused by sun exposure or smoking? Br J Dermatol. 2002; 147(6): 1187-91.Freiman A, Bird G, Metelitsa AI, Barankin B, Lauzon GJ. Cutaneous effects of smoking. J Cutan Med Surg. 2004; 8(6): 415-23.Wolf R, Tur E, Wolf D, Landau M. The effect of smoking on skin moisture and on surface lipids. Int J Cosmet Sci. 1992; 14(2): 83-8.Waeber B, Schaller MD, Nussberger J, Bussien JP, Hofbauer KG, Brunner HR. Skin blood flow reduction induced by cigarette smoking: Role of vasopressin. Am J Physiol. 1984; 247(6 Pt 2): H895-901.Rowe JW, Kilgore A, Robertson GL. Evidence in man?that cigarette smoking induces vasopressin release via an airway-specific mechanism. J Clin Endocrinol Metab. 1980; 51(1): 170-2.Silverstein P. Smoking and wound healing. Am J Med. 1992; 93(1A): 22-4S.de Hertog SA, Wensveen CA, Bastiaens MT, Kielich CJ, Berkhout MJ, Westendorp RG, et al. Relationship between smoking and skin cancer. J Clin Oncol. 2001; 19(1): 231-8.Grodstein F,?Speizer FE, Hunter DJ. A prospective study of incident squamous cell carcinoma of the skin in the Nurses' Health Study. J Natl Cancer Inst. 1995; 87(14): 1061-6.Aubry F, MacGibbon B. Risk factors of squamous cell carcinoma of the skin. A case-control study in the Montreal region. Cancer. 1985; 55(4): 907-11.Flynn TC, Petros J, Clark RE, Vieham GE. Dry skin and moisturizers. Clin Dermatol. 2001; 19(4): 387-92.

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How Sexually Transmitted Infections Affect Sperm Health

A healthy male produces millions of sperm?each day, although?only a few of these sperm will ever go on to fertilise an egg and create an embryo. Despite the vast quantity of sperm produced by a healthy man, the number of sperm which actually fulfil their fertilising potential is therefore extremely small. Even when a man is producing sperm at a healthy capacity and his partner is fertile, it is not uncommon for couples to take up to a year to conceive.

Some men produce sperm which is suboptimal, either in quantity or quality. These men will typically take longer to conceive and are more likely to require the assistance of artificial reproduction techniques to do so. Some men may experience suboptimal sperm production because of a genetic or birth trait (e.g. deletions on the Y chromosome or history of cryptorchidism). In many cases, sperm production declines over time as a result of exposure to a range of risk factors.

Sexually Transmitted Infection (STIs) have a range of negative health affects. In males, one effect of STIs is reduced fertility. Avoiding STIs is therefore an important measure men can take to maintain optimal sperm production and maximise their chances of conception.

The extent to which sexually transmitted infections impact on male fertility depends on the prevalence of these infections in the population. In developed countries, STIs play only a minor role in impairing male fertility.

For the most part, STIs affect sperm transport (e.g. by causing infection and subsequent damage to the testicular tubes through which sperm travel) rather than spermatogenesis (the production of sperm in the testes). There is however evidence that the STIs Ureaplasma urealyticum, Trichomonas vaginalis and Chlamydia Trachomanis all impair sperm production. As these STis are often asymptomatic and can be difficult to diagnose, it is likely that their contribution to male infertility is underestimated.

The ways in which impaired sperm production related to STIs is an area that requires further research. However, a number of hypotheses have been put forward. Laboratory studies have shown that some bacteria impair sperm motility and viability, and it is possible that the bacteria which cause STIs also impair sperm in these ways. Chronic inflammatory conditions (untreated STIs are considered chronic inflammatory conditions) are associated with sub optimal sperm function. Infections of the genital tract may cause damage to the testes. There is also some evidence that the production of anti-sperm antibodies in the genital tract increase in response to infection, and increased anti-sperm antibodies are associated with decreased semen parameters.

Human Immunodeficiency Virus (HIV) also impacts on sperm production and semen parameters deteriorate as immunodeficiency progresses. For example, one recent study reported decreased concentrations of motile sperm in HIV+ compared to HIV- men. The ways in which HIV is related to male sub-fertility is also unclear. It may be associated with decreased immune function, the effects of anti retroviral therapy medication, or co-existing genito-urinary tract infection.

STIs, as the name suggests are spread through sexual contact. The two main ways individuals can avoid STIs are by avoiding sexual activity, or using a male or female condom to prevent the mixing of sexual fluids which transmit STIs, during intercourse. Individuals who do not use condoms consistently should be tested for STIs such as Chlamydia, which are typically asymptomatic and may therefore only be diagnosed if laboratory tests are conducted.

Individuals who do not manage to avoid STIs should seek prompt treatment. Many STIs can be treated quickly and easily using antibiotics. Prompt treatment can limit damage to the male reproductive system and its negative effects on sperm production and transport.

For?more information on sperm health and male fertility, see Sperm Health

Royal College of Obstetricians and Gynaecologists. Fertility: Assessment and treatment for people with fertility problems - Clinical Guideline [online]. Royal College of Obstetricians and Gynaecologists. 2004 [cited 30 October 2008]. Available from URL: http://www.rcog.org.uk/index.asp?PageID=696Ochsendorf, F.R. Sexually Transmitted Infections: impact on male fertility. Andrologia. 2008;40(2):72-5.Cunningham, K.A. Beagley, K.W. Male genital tract chlamydial infection: implications for pathology and infertility. Biol Reprod. 2008;79(2):180-9.Coates, T.J. Richter, L. Caceros, C. Behavioural Strategies to reduce HIV transmission: how to make them work better. The Lancet. 2008;372:669-84.McLachlan, R.I. de Krester, D.M. Male Infertility: The Case for Continued Research. MJA, 2001;174:116-7.Cengiz, T. AydoganliL. Baykam, M. et al. Chlamydial infections and male infertility. Int Urol Nephrol. 1997.;29(6):687-93.Bunjan, L. Serserie, M. Moinard, N. et al. Decreased semen volume and spermatozoa motility in HIV-1 infected patients under antiretroviral treatment. J Androl. 2007;28(3):444-52.

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Health Benefits of Quitting Smoking

100 million people were estimated to have died from causes related to smoking in the 20th century. This is around three times more people than those who died in World War I. The 100 million people who died from smoking in the 20th century died from a preventable cause of death.

This trend is continuing into the 21st century, with the World Health Organisation estimating that about 5 million people around the world die from smoking every year. With the extensive knowledge we possess regarding the detrimental health effects associated with this habit, it is time to quit.

Health impact

In 2003, tobacco smoking was the second leading cause of disease burden in Australia, (obesity being the leading cause), with 15,511 smoking-related deaths. The Australian Bureau of Statistics estimates that 8% of the total disease and injury burden in Australia is attributed to tobacco smoking. 20% of all cancer deaths are due to smoking – more specifically, 80% of lung cancer deaths in 2003 were attributed to tobacco smoking.

The most recent smoking statistics have confirmed that daily smoking rates are declining. In 2007, 16.6% of Australians over 14 years smoked daily, which is almost 3% less than the 19.5% of smokers in 2001. The rate was slightly higher for men?at 18%, and was 15.2% for women. The highest rates of smokers were found in the 18–24 age bracket for males, and the 25–34 age?bracket in females. In the 12–17 age bracket, 9% of boys and 10% of girls admitted to smoking in a survey conducted in 2005; these figures peaked at age 17.

Indigenous Australians have the highest smoking rates, with 50% of adults smoking daily in 2005. Manual labourers and factory workers have a higher incidence of smokers (almost 40%) than office workers and professionals (approximately 13%).

Economic impact

In 2004–2005, the cost of smoking to Australia?was $31.5 billion dollars. This figure is thought to be quite conservative, as it does not include hidden social costs such as reduced workplace productivity, litter, extended hospital stays (due to decreased post-operative outcomes), medical costs associated with birth complications, and mental and emotional suffering experienced by smokers and their family and friends.

Treatment of disease is one of the major costs attributed to tobacco use. Lifetime costs for smokers are greater than for non-smokers, even when taking into consideration that non-smokers live substantially longer than smokers. Treatment of disease includes medical costs, hospital, nursing home, pharmaceutical and ambulance. It is not just the individual and the government that bear these costs, but businesses, employers and society as a whole.

The costs borne by businesses include increased rates of absenteeism and loss of labour, which are substantially more in smokers than in non-smokers.

Governments provide mass education and health campaigns in order to deliver information about the dangers of smoking, which add substantially to the overall cost that Australia bears.

No matter what your age or how long you have been smoking, there are many immediate and long-term benefits of quitting. There is comprehensive and conclusive scientific evidence confirming that the risk of disease in former smokers is less than that in smokers of the same age and gender. Quitting smoking slows disease progression and can even reverse some of the acute body changes induced by smoking.

The earlier you quit, the greater?the benefit of quitting. Smokers who quit when they are 30 years old can avoid most of the?excess risk and add about 10 years to their life expectancy. Quitting at 50 can halve the risk of dying from smoking and add 6 years to life expectancy. Even stopping at 60 can have benefits, raising life expectancy by 3 years.

Some health benefits of quitting can be noticed as soon as smoking stops. Within only a few hours without a?cigarette, the carbon monoxide levels in the body are decreased,?followed?a week later by a decline in nicotine?levels. After 5 days without a cigarette, you may notice an improvement in taste and smell.

For some people, the health benefits of quitting continue for years after they quit. In some cases, former smokers may even return to being as healthy as a non-smoker and carry the same risk of disease, although this does not apply to cancer. People who have smoked will always have a greater risk of some cancers than people who have never smoked.

Have you quit smoking? Or are thinking about trying to quit? Use this tool to see what health benefits you have already achieved and what benefits you can expect in the future if you stick with it. For more information, see Health Benefits of Quitting Smoking Tool.

After quitting smoking there are a multitude of benefits for your body, some noticeable and some not. Some effects will occur straight away and others may take a number of years. As the amount of time since your last cigarette increases, you will be fitter,?have less risk of developing disease, and feel healthier.

Lungs

Everyone's lungs?stop working as well?the older they get, but for smokers this process happens sooner, faster and more severely. Smoking also causes permanent damage to lung tissue. By quitting smoking, you will give your body the best chance of improving airway functioning and stopping any further damage.

The benefits to the lungs are widespread:

1 month after quitting smoking, improvements in airway function are noticeable;After 2 months tobacco-free, your cilia resume their proper functioning. Cilia are little cells that line the lungs, and their job is to clear the lungs of mucus and debris. Once the cilia start performing their normal duties, the rates of chronic coughing, bronchitis, respiratory infections and pneumonia will also decrease;Quitting slows the increased pulmonary function decline experienced by smokers;Hospitalisation and symptoms of chronic obstructive pulmonary disease?(COPD) are reduced;Post-operative pulmonary complications associated with smoking are reduced;Lung cancer is substantially reduced in those who quit smoking by 30. At 50, the risk for lung cancer is reduced by half, compared with someone who continues smoking for another 25 years; andThe positive effects on the lungs will allow an increase in exercise capacity and therefore fitness will improve.

The positive effect on the lungs will really start kicking in around 2 months after quitting, as long as there is no permanent emphysematous lung damage.

Blood

After not smoking for 24 hours, the levels of carbon monoxide in the body system reduce dramatically, which frees up haemoglobin. Haemoglobin is responsible for transporting oxygen; therefore, if more of it is available, then more oxygen will be transported around the body.

Greater oxygen levels and better oxygen transportation throughout the body have many health benefits:

After 6 weeks, wound infection is less likely; andAfter 6 weeks, blood viscosity is improved, which?has a positive effect on blood flow to the hands and feet. This reduces the risk of peripheral vascular disease. For those who already have the disease, amputations are less likely to be necessary.

Heart

Smoking promotes thickening of the arteries, or atherosclerosis. Atherosclerosis is associated with many negative health outcomes in various body systems, including the heart.

By quitting smoking, atherosclerosis is less likely to occur and therefore the risk of developing heart disease is reduced. After 1 year without smoking, the risk of developing heart disease is half as much as it would otherwise be. Amazingly, after 15 years without smoking, your risk of developing heart disease is equal to that of someone who never smoked, which means you have a chance to reverse the negative effects of smoking on the heart.

Blood pressure returns to normal levels 2 months after smoking cessation.

Brain

Atherosclerosis increases the risk of stroke, which is why smokers have a much higher risk of experiencing a stroke than non-smokers. Therefore, by not smoking for 2–5 years, you will reduce your stroke risk. Amazingly, after 25 years without smoking, your stroke risk is equal to that of?a non-smoker.

Cancer

After 5 years without smoking, your risk of developing throat, mouth and oesophageal cancers is half as much as it would have been had you continued to smoke.

The risk of cancer in general for smokers will always be greater than that?for non-smokers, even 15 years after quitting. This is not to say that there is no point in?quitting. Every cigarette you smoke is exposing you to more carcinogens, and therefore the longer you smoke, the higher your risk of developing cancer. The sooner you stop, the lower your overall risk will be.

Eyes

Rates of blindness are reduced after quitting. After 20 years without smoking, you will have the same risk of age-related macular degeneration (the deterioration of vision with age) as a non-smoker.

Mouth

Smoking has a detrimental impact on oral health, including a reduced ability to smell and taste.?Five days without a cigarette, smokers will notice an improvement in taste and smell.

Smoking tobacco is one of the principle causes of teeth discolouration. Quitting will prevent further staining.

Cosmetic

In addition to?all the negative health impacts of smoking on the body, it also has a negative effect on your appearance. Smoking has been shown to have visible effects on the skin, including:

Increased facial wrinkling;Premature ageing; andDecreased capillary and arteriolar blood flow.

These are effects you can actually see develop. Quitting smoking is the first step you should take in order to keep your appearance radiant and fresh-looking.

Immune system

Within days of stopping smoking, previous smokers will experience improvements in immunity. This means fewer colds and flu, fewer sore throats and fewer infections!

Reproductive system

Tobacco can have detrimental effects on sperm production,?including reduced concentrations of sperm in the semen and reduced concentrations of normal and motile sperm. In order to give yourself the best chance of conceiving, you should stop smoking.

Quitting smoking can also reduce erectile dysfunction caused by smoking.

Females who smoke are twice as likely to be infertile as non-smokers. This effect is reduced after stopping smoking, so quitting should be the first step taken by couples planning to get pregnant.

In order to provide yourself with the best opportunity you can for a good pregnancy outcome you must quit smoking. It is best to quit smoking well before you become pregnant –?this will:

Reduce your chance of miscarriage, premature labour?and placental abruption, all of which are associated with smoking during pregnancy;Mean you have no extra risk of having a low birthweight baby compared to a non-smoker. Lower birthweight babies have more chance of catching illness, developing disease and dying throughout childhood?and adulthood.

While it is best to quit smoking before you conceive, it is still possible to reduce the risk of negative pregnancy outcomes by quitting up to two months after you become pregnant. This is not to say you should wait?two months into the pregnancy before you try to quit. Cutting down on the amount you smoke?without completely quitting will not be of any benefit to you or your baby.

In order to have the best possible pregnancy outcome, you must quit completely.

If you smoke, you are not only exposing yourself to adverse health outcomes, but also exposing your family, your friends and your workmates. In the same regard, quitting smoking will benefit the people closest to you as well as yourself.

Second-hand smoke is the smoke from your cigarette that has the potential to be inhaled by the people around you. Inhaling second-hand smoke, known as passive smoking, is associated with serious health consequences. The risks associated with second-hand smoking increase depending on the length of exposure to the smoke and how often the second-hand smoke is inhaled. For example, if you smoke a lot of cigarettes inside the house, the risk of negative effects on the?health of people who live with you will be high.

People exposed to second-hand smoke have a greater risk of developing:

Research has determined that inhaling second-hand smoke is almost as dangerous as smoking. Within minutes of exposure to second-hand smoke, blood platelets are activated. After time, this can promote thrombosis, cellular artery damage and atherosclerosis.

Children are especially susceptible to the negative health effects associated with second-hand smoke, both physically and environmentally. Children have immature lungs, a greater lung surface and a higher breathing rate than adults, which makes them more vulnerable to the effects of smoking than adults. Children cannot control their environment, so are often put in situations that render them unable to avoid second-hand smoke.

Children and infants exposed to environmental tobacco smoke have an increased risk of developing:

Chronic respiratory symptoms, including asthma, decreased lung function and lower respiratory tract infections;Long term developmental effects;Childhood cancers;Reduced sense of smell;Middle ear infections; andComplications during surgery.

Reducing the amount of cigarettes smoked per day may be helpful as a quit strategy, but there is no evidence that it has a significant improvement on health outcomes or life expectancy.

While you may think you are smoking less, it is believed that once you have developed a nicotine addiction, your brain requires a certain level to feel satisfied. This means that you are more likely to take more puffs and inhale harder if you reduce the number of cigarettes per day. You may not even notice you are doing this. In any case, you will not be reducing your exposure in the long run. In order to experience any benefit from quitting smoking, you must quit completely.

Cigarette smoking affects more than just your health and the health of those around you. The financial impact can be huge; in 2008, pack-a-day smokers spent ~$3,000 per year on cigarettes! That can be a holiday or a new plasma TV! More recently, the Australian government has increased the excise tax on cigarettes by 25%. It is predicted that this tax increase will generate an extra $5 billion over the next 4 years, which will increase the annual cost for an individual smoker even more.

Life insurance and health insurance for smokers also tends to be more expensive. Furthermore, people who do not smoke tend to take fewer sick days, which will financially benefit casual workers.

You spend $ on cigarettes each month.

Which means that you spend $ each year.

With this amount of money you could have:

Since you first started you have spent $.

If you continue smoking, here is how much you will have spent:

Age : $

Age : $

Age : $

Age : $

Age : $

This information will be collected for educational purposes, however it will remain anonymous.

Reference: Smoking cessation guidelines for Australian general practice [online]. Canberra, ACT:?Australian Government Department of Health and Ageing;?2004 [cited 11 January 2011]. Available from: URL link

Quitting smoking will substantially improve your quality of life. Just think about how the following will improve your day-to-day life:

Not having to constantly and intermittently leave social occasions to have a cigarette;Not having bad breath, smelly hair and smelly clothes;Being able to play chasey with your kids for longer; andNot having the extra financial burden of the expensive habit!

Quitting is a truly positive step to take. If you accept the challenge to quit and succeed, you will experience a boost in confidence which will carry over to all areas of your life.

Talk to your doctor about quitting today, and start your new, healthier life as a non-smoker!

?For more information on smoking and its health effects, and some useful tools, videos and animations, see Smoking. Worldwide smoking statistics [online]. Sans Souci, NSW: Think Quit; 2008 [cited 28 July 2010]. Available from: URL linkTobacco smoking in Australia: A snapshot, 2004-05 [online]. Belconnen, ACT: Australian Bureau of Statistics; 9 November 2009 [cited 10 August 2010]. Available from: URL linkSmoking in Australia: Statistics [online]. Woolloomooloo, NSW: Cancer Council NSW; [cited?15 June 2010]. Available from: URL link?Tobacco [online]. Canberra, ACT: Australian Government Department of Health and Ageing; 11 March?2010 [cited 28 July 2010]. Available from: URL linkLal A, Scollo M.?The economics of tobacco control: 17.3 The costs of smoking to Australian society. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkLal A, Scollo M. The economics of tobacco control: 17.1 The economic rationale for intervention in the tobacco market. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkWinstanley M.?The health effects of active smoking: 3.6: Reproductive health and smoking. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL link?Ellerman A, Ford C, Stillman S.?Smoking cessation: 7.2: Health and other benefits of quitting. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkBenefits of quitting [online]. Fairbairn, ACT: quitnow, Australian Government Department of Health and Ageing; 2007 [cited 28 July 2010]. Available from: URL linkYee BE, Ahmed MI, Brugge D, et al. Second-hand smoking and carboxyhemoglobin levels in children:?A prospective observational study. Paediatr Anaesth. 2010;20(1):82-9. [Abstract | Full Text]Benefits of quitting [online].?Carlton South, VIC: Quit Victoria;?2010 [cited August 2010]. Available from: URL linkFertility: Assessment and treatment for people with fertility problems [online]. London: Royal College of Obstetricians and Gynaecologists; 2 January?2004 [cited 30 August 2010]. Available from: URL linkSham AS, Cheung LK, Jin LJ, Corbet EF. The effects of tobacco use on oral health. Hong Kong Med J. 2003;9(4):271-7. [Abstract | Full Text]Winstanley M.?The health effects of secondhand smoke: 4.2: What is in secondhand smoke? In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkWinstanley M.?The health effects of secondhand smoke: 4.3: What is in secondhand smoke? In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkWinstanley M.?The health effects of secondhand smoke: 4.5: Lung cancer and secondhand smoke. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkWinstanley M.?The health effects of secondhand smoke: 4.4: Cardiovascular disease and secondhand smoke. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL link?Winstanley M.?The health effects of secondhand smoke: 4.6: Cancers of other sites. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkWinstanley M.?The health effects of secondhand smoke: 4.7: Health effects of secondhand smoke for infants and children. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL link?Zwar N, Richmond R, Borland R, et al (eds). Smoking cessation guidelines for Australian general practice [online]. Fairbairn, ACT: quitnow, Australian Government Department of Health and Ageing; 2004 [cited August 2010]. Available from: URL link?Plotino G, Buono L, Grande NM, et al. Nonvital tooth bleaching: A review of the literature and clinical procedures. J Endod. 2008;34(4):394-407. [Abstract | Full Text]Prime Minister of Australia. Media release: Anti-smoking action [online]. Canberra, ACT: Australian Government; 29 April?2010 [cited 8 August 2010]. Available from: URL linkGrady D, Ernster V. Does cigarette smoking make you ugly and old? Am J Epidemiol. 1992;135(8):839-42. [Abstract]Ellerman A, Ford C, Stillman S.?Smoking cessation: 7.7 Personal factors associated with quitting. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkEllerman A, Ford C, Stillman S.?Smoking cessation: 7.3 The process of quitting. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL link?

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