DENTAL CARIES To THE EDITOR In my pediatric practice, several patients have asked about the following advice given by dentists children with severe caries, namely, that they must eliminate all sweets from the diet including fruits and other naturally occurring sugars. One mother actually was in tears after trying to prepare a diet eliminating all carbohydrates. 1. Are sugar and other carbohydrates of primary importance in dental caries. 2. What sort of a diet would be advisable yet practical? 3. Does not heredity play a major role in dental caries? M.D., California. ANSWER. The problem of dental caries has been vigorously attacked by research and clinical investigators with no final answer of single etiology nor prophylaxis yet available. Answers given here conform to findings of more than one investigator in each case. 1. Sugar as a substrate for acidogenic fermentation in the mouth is of importance in the cariessusceptible individual. As sugar particular reference is made to glucose and sucrose separately or in prepared foods. Polysaccharides allow fermentation degradation productive of acid at a much slower rate. Ninety per cent of the caries reduction accomplished by sharp limitation of all carbohydrates has been accomplished by removal of monosaccharides and disaccharides. 2. Complete elimination of carbohydrates from the diet is untenable, and as in the correspondents case, virtually impossible. An advisable diet for such a cariessusceptible child should be free of jams, jellies, candy, heavily sugared beverages, canned (sweetened) fruits, sweetened pastries, and canned peas or corn. Recent confirmed evidence of caries activity during and for about 15 minutes after each feeding correlate well with higher caries activity in those who spend greater time in feeding either by slow eating, or frequent, between meals supplements. Glutinous foods result in greater caries activity than those of thinner consistency by their prolonged apposition to the tooth. These two factors have made it worth while to advise cariessusceptible individuals to brush teeth, or at least rinse the mouth thoroughly after each meal. An excellent, simple, and explicit dietary is available (Dietary Program for the Control of Dental Caries, Ann Arbor, The answers here published have been prepared by competent authorities. They do not, however, represent the opinions of any medical or other organization unless specifically so stated in the reply. Anonymous communications and queries on postal cards cannot be answered. Every letter must contain the writers name and address, but these will be omitted on request. CONVULSIONS OF CHILDHOOD To THE EDITOR I would like information about fatal asphyxia resulting from the convulsions of childhood that are caused by rapidly rising temperature. Physicians generally seem to regard these convulsions as more alarming to parents than dangerous to the child. Having seen a few cases where the child became blue and limp and showed no sign of resuming respiration without aid, I wonder if these convulsions are entirely without mortality. I am not referring to convulsions from disease or injury primarily involving the central nervous system. Hugh A. Thompson, M.D., Raleigh, N. C.ANSWER. Death resulting from asphyxia during a febrile convulsion must be rare, if it occurs. However, it has been shown that febrile convulsions may involve more or less severe brain damage. About 5 to 10 percent of the children show residual paralysis, electroencephalogram changes, or other signs of brain injury, usually clearing up promptly but sometimes lasting several days or months. Various reports have indicated that from 5% to as high as 60% of children who suffered febrile convulsions developed epilepsy in later life. Certainly there is a direct relation between the duration and severity of the initial febrile convulsion and development of epilepsy later. Therefore, it is important that the convulsion be stopped as soon as possible with sedatives and measures to reduce the fever.