There are likely to be plenty of ghosts and ghouls about this Halloween, but one thing that may have parents spooked this time of year is candy and dental health. Roughly 30 percent of 5-year-olds in Plymouth, England, were found to have some form of tooth decay, according to a newly released review.

The review examined the 2007-2008 dental records of U.K. children, 211 of whom were Plymouth five-year-olds. This number was just under the national average of 30.9 percent, but other regions were significantly worse.

The United States had similar rates. Almost half of children ages 12 to 15 and about one in four American children aged 2 to 5 is affected by tooth decay. Overall, it affects 4 million children in the U.S. alone. Americans consumed an average of 23.8 pounds of candy each in 2008, and with the holiday season approaching, parents should be on the watch for cavities.

As Halloween approaches, candy consumption is likely to skyrocket, but there are plenty of ways to protect trick-or-treaters from tooth decay. Try these five tips to help reduce the amount of sugar:

1. Choose reduced-sugar or sugar-free candies. Most stores carry equally tasty sugar-free or reduced-sugar versions of Halloween favorites, including chocolate, peanut butter cups and various filled or hard candies. These options won’t completely eliminate the risk of tooth decay, but they can significantly cut sugar intake.

2. Give out unconventional goodies. When it comes to candy, sugar-free gum is your safest bet. Candies that can melt and/or stick to teeth are the worst. Other ideas might include stickers, press-on tattoos, plastic rings, or other small toys.

3. Go to a Halloween program or event. Choosing alternatives to trick-or-treating significantly cuts the candy haul. These events are a great place for adults and children to socialize while enjoying snacks and fun activities.

4. Set a limit. Put a limit on the amount of candy a child is allowed daily. This helps prevent candy binges while reducing sugar consumption. Candy can also be used as a reward for good behavior.

5. Donate excess candy. Many communities have programs that will send it to troops or donate $1 for every pound of candy donated. Candy can also be donated to fire stations, schools (for rewards), or other offices in the community.

Regularly brushing teeth and reducing sugar intake can help prevent cavities. Consuming fewer sweets can also help decrease children’s risk for obesity and diabetes. Dentists and parents alike recommend that candy be consumed in moderation.

It may be in your best interest to postpone surgery until regular OR hours. According to a study appearing in The Journal of Bone and Joint Surgery, patients with after-hours operations have 24 percent more unplanned follow-up operations than those who went under the knife during regular office hours.

“Although everyone wants to be treated immediately… it is not always best to rush a patient to the OR in the middle of the night,” explains Dr. William M. Ricci MD, Associate Professor of Orthopaedic Surgery at the Washington University School of Medicine.

The study followed 203 patients who underwent orthopaedic surgery—surgery on bones and joints. While there was no significant difference between radiation exposure, healing time or actual treatment, there was a noticeable disparity between operations that occurred between the daytime and nighttime shifts.

All operations used intramedullary nail fixation to mend tibial or femoral fractures. This is a procedure in which a rod, or “nail”, is used to set the bone. The day was divided into two shifts—the morning shift between 6:00 a.m. and 4:00 p.m., and the night shift thereafter.

Second shift patients had shorter operations, but they also had more follow-up operations and more nail removal surgeries—27percent versus 3 percent for patients whose surgeries occurred during regular office hours. Dr. Ricci believes that much of this can be attributed to the long hours many surgeons put in.

“The reality is that the on-call night surgical team may not be well rested as it is likely they had just finished a normal day shift,” Ricci says. Ricci, who is also chief of the Orthopaedic Trauma Service in the Department of Orthopaedic Surgery at W.U., also explains why non-emergency operations should wait.

“We in the healthcare industry don’t have unlimited resources,” Ricci says. “Many hospitals in the U.S. do have a dedicated night team of orthopaedic surgeons who otherwise are without daytime responsibilities. There are surgical teams on-call for those instances when treatment must be immediate.”

Ricci believes giving orthopaedic surgeons more time to operate on trauma patients can help reduce the risk of minor complications from nail fixation surgeries. He encourages patients to wait for surgery if possible, but insists that actions be taken immediately in urgent situations: “Naturally, when the medical condition is emergent and time is a critical factor, immediate surgery should proceed regardless of time of day.”

Seven in ten children in the United States are not getting enough vitamin D, according to the National Health and Nutrition Examination Survey (NHANES, 2001-2004).

Vitamin D, 25-Hydroxyvitamin D, is a fat-soluble vitamin that promotes calcium absorption, fortifying bones and teeth, and maintaining the level of calcium and phosphorus in the blood.

Vitamin D deficiency can result in conditions such as rickets in children (usually <11 ng/mL), and osteomalacia and osteoporosis in adults (typically levels <25 ng/mL). Low levels of vitamin D also increase the risk of bone and heart disease, and are also associated with higher blood pressure and lower calcium and HDL cholesterol levels in later life.

Based on the information obtained from the survey, researchers found that, of more than 6,000 of children followed, nine percent (equal about 7.6 million) were vitamin D deficient, and a greater number were found to be getting an insufficient amount—61%, representing 50.8 million U.S. children. Only 4% received the recommended daily amount of vitamin D.

Children classified as “insufficient” had 15-29 ng/mL, while those who were classified as “deficient” had levels of 15 ng/mLor less. Normal range, according to the National Institute of Health, is 30-74 ng/mL.

The study is the largest of its kind to date, gaining nationwide rather than just regional data. "We expected the prevalence of vitamin D deficiency would be high,” says lead author Juhi Kumar, M.D., M.P.H., of the Children's Hospital at Montefiore Medical Center, “but the magnitude of the problem nationwide was shocking."

Vitamin D deficiency is more common for female children, those that are older, obese, drink less than one glass of milk week, and those who spend four hours or greater on the computer or watching television per day. African-American and Mexican-American children also had a greater risk.“It’s very hard to get enough vitamin D from dietary sources alone,” says Dr. Michal Melamed of the Albert Einstein College of Medicine in Bronx, New York.

Melamed, co-leader of the study, attributes part of this problem to lifestyle, recommending parents send their children outdoors. One source of vitamin D is UV-B sunlight, which converts cholesterol in the skin into vitamin D. She also recommends ditching the sunscreen for a while: “Just 15 to 20 minutes a day should be enough…don't put sunscreen on them until they've been out in the sun for 10 minutes, so they get the good stuff but not sun damage.” Individuals with darker skin and those who live in northern regions with less sun exposure should spend more time outdoors.

The American Academy of Pediatrics recommends that children and teens get at least 400 IU per day, double the previous recommendation of 200IU per day. Good sources of vitamin D include fish, milk, eggs, cod liver oil, and fortified foods. Vitamin D levels can also be increased with the use of supplements.

The study's abstract is available online, and will be published in September's issue of Pediatrics.