VENDING MACHINE THREAT Schools

LETTERS

1. Curado M, Hashibe M. Recent changes in the Story M. The association of the school food i s in��, restoring functions, such as epidemiology of head and neck cancer. Curr Opin environment with dietary behaviors of young ado- speech and ability to eat, can provide Oncol 2009; 21: 194–200. lescents. Am J Public Health 2003; 93: 1168–1173. 2. Lajer C B, von Buchwald C. The role of human 4. Maliderou M, Reeves S, Noble C. The effect of social mn a y challenges for the patient as well papillomavirus in head and neck cancer. APMIS demographic factors, snack consumption and vend- ase th clinician. 2010; 118: 510–519. ing machine use on oral health of children living in London. Br Dent J 2006; 201: 441–444, 437. Witec h th in rease in incidence of oro� DOI: 10.1038/sj.bdj.2013.691 5. American Academy on Pediatric Dentistry Council phay r nge�� cancers, particularly in those on Clinical Affairs. Policy on vending machines in VENDING MACHINE THREAT schools. Pediatr Dent 2008; 30(7 Suppl): 49-50. d iagn�� as HPV positive, we are now 6. Center for Science in the Public Interest. School seen ing you ger, more dentate patients.1,2 Sir,e th use of vending machines is Vending Machines “Dispensing Junk”. Washing- ton: Center for Science in the Public Interest, Pinat e ts undergoing treatment for head b i e��m ng popular in developing coun� 2004. Available at: http://www.cspinet.org/ and neck cancer, particularly involv� tris e such as India and China.1 eTh ir use new/200405111.html (accessed 13 April 2013). ideng ra ioth rapy and chemotherapy, ic s in re��ingly found in school premises, DOI: 10.1038/sj.bdj.692 face very difficult challenges including we h re th income from them can be m u��itis, dry mouth, radiation caries used to supplement limited budgets.2 The CEMENT-INDUCED TRISMUS andc an in reased risk of osteonecrosis of perobl m is accessibility; students can Sir, a paediatric patient was referred to teh jaws as a result of extractions. Many wl a k from their classroom and use one ou r A&E department from their GDP of th�� challenges are life long, and can cot in to ob ain a whole range of sugary fo s r trismu . The 8-year-old patient had r e��t in complex dental treatment being snacks and carbonated drinks. Y oung at et e�� th dentist two days earlier rdequi e in the long term with associated chdn il re enjoy this freedom, yet the for occlusal fillings on both his 26 and conse id rabl cost. Specialist restorative m a��in�� offer them some of the most 36.d Imme iately on leaving the dental tramn e t e t is not universally available unhealthy food options and increase sug e r ery th patient and parent noticed wite hin th NHS in England. snaci k ng frequency during school hours. taeh t th young child could not open W e wou�� like to share with you the I sn��, mo t studies show that the use his mouth and was locked in position. specl ia ist restorative oncology service of school vending machines is positively C oncern��, they re-attended the dental deled iv re to all head and neck can� cor d r e��te with confectionery consump� sug r ery, and on examination the dentist cein r pat e ts at Torbay Hospital, South tino and negatively correlated with fruit could not decipher the cause of the D l e��. Al patients receive a pre- consuin mpt o .3 Evid�� from developed tris smu and urgently referred the child opeie rat v oral screen by the restorative coun s trie shows significant differences in teio th max llofacial A&E department. oncolo gy team, and a full and ongo� teish car e level of children from schools Tei h dent st had used two ID blocks to iramnng t e t e t plan is made. Necessary with and without vending machines.4 anesie thet s the patient. tramn e t e t, prior to cancer treatment, We hil some schools in some countries Oia n exam n tion in A&E there was no i ds carrie out within the department, are trying to implement rules and pro� facl ia asymmetry, swelling or bruis� ande advic on oral care is given to help grms am e that eliminate these unhealthy ihng whic would indicate any potential pain t e ts through their cancer treatment. opi t o��, it is often difficult and expen� trauma caused by an ID block resulting I nn additio , after cancer treatment, seiv to offer fresh fruits and vegetables iben possi l trismus. Furthermore, the pain t e ts re��ive continuing restorative asa an altern tive.5 Howe��r, according to mouth opening was less than 1 mm, and care and regular hygienist care at no te�h Cr�en��t� e� �fo��r�� Sc�i�e�nce�� in� ��th�e� ��Pu�b�l�i�c� ��In�t�e�r�� tshis wa an unusual acute finding with chag r e. We feel this puts head and neck est (CSPI), schools that have switched no ol extra ra or intraoral signs of swell� cancei r pat ents in line with the sup� to selling healthier foods in vending i eng. Th pat ent was in no pain, and was po rt re��iv�� by patients suffering from m a��in�� have not experienced a reduc� qtnui e asto ished that the filling had been oey th r t p�� of cancer. This service is of tino in vending machine revenue.6 tarn h t ‘st o g’. This idea of the filling being sg i nific��t benefit to all head and neck D e�� countries have learnt this ‘rn st o g’ led to further questioning. The cancei r pat ents. With the evolvement of lesson and adopted a public health chd t il re��r ed that on placement of both ne w commissioning, this issue needs to app ro�� by developing guidelines and/ teh upper and lower filling he had been b e dis�� and understood. oi nr leg s��t o about the appointment asd ke to bite down hard. Nothing was Our newly launched website, www. ofds bo ie re��ible for the manage� placed in between the teeth when biting m outh��reincancer.co.uk has been mn e t of vending machines in school down, and the patient left the surgery desg i n�� to provide information for ( eg US De��rtment of Agriculture) and sil t l biting down. Following this the head and neck cancer patients, health� wa h t should be loaded in the machines.6 pain t e t could not open his jaw. ca re pro��ionals and patients under� D e��ing countries should not delay in Using a Mitchell’s trimmer the con� going chemotherapy for other cancers. adopi t ng th�� positive lessons. tca t points between the 26 and 36 were W e wou�� welcome feedback from M. Masood, Y. Masood, Malaysia brn oke . Immediate resolution of the oeth r head and neck cancer specialist J. T. Newton, London tris smu wa achieved. cenrs t e regarding their services and 1. Euromonitor International. Vending in emerging Il be ie�� this may be the first case of countries. Market Research World, 17 May 2013. ei xp r e�� in the hope that we can Available at: www.marketresearchworld.net/ g l��io��mer cement induced trismus im e pro�� th care for these patients content/view/157/77/ r tde��r e in the scientific literature! 2. Damle S G. Fill it, shut it, and forget it...!!! J Indian ac e ro�� th country. Soc Pedod Prev Dent 2008; 26: 4. M. Basati, by email C. Drysdale, A. Green, Torquay 3. Kubik M Y, Lytle L A, Hannan P J, Perry C L, DOI: 10.1038/sj.bdj.2013.693

60 BRITISH DENTAL JOURNAL VOLUME 215 NO. 2 JUL 27 2013