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Diet & Dietary Analysis
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The Link…
Oral health is closely linked to an individual’s diet and nutritional status.
Nutrition is a vital factor---
The Link…
• Throughout life, nutritional deficiencies or toxicities can affect host resistance, healing, oral function, and oral-tissue integrity
• Growth, development, and maintenance of oral structures and tissues are dependent on nutrition
A little history….. Before your time
http://www.choosemyplate.gov/food-groups/downloads/MyPlate/ABriefHistoryOfUSDAFoodGuides.pdf
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More about the “Plate”
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*even have it in spanish!
Lots of resources online
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http://www.choosemyplate.gov/supertracker-tools.html
Which one is “better?”
What influences the recommendations made?
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Other resources….
• http://www.livestrong.com/article/278187-free-online-nutrition-analysis/
• http://www.myfitnesspal.com/food/calorie-chart-nutrition-facts
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Dietary Guidelines for Americans
2010
Organized in “chapters”-good resource
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Overview of Nutrients
A review from Nutrition class…. the very basics….!?!? Well…. maybe
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Oral Manifestations- Underlying Nutritional Deficiency?
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Oral Lesions- Underlying Nutritional Deficiency?
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VITAMIN DEFICIENCY OR EXCESS
Vitamin C Asorbic acid
Collagen synthesis- helps with use/absorption of iron, B12 & folic acid; connective tissue synthesis; cell protectorDeficiency: Scurvy-red swollen gingiva; gingival friability- spontaneous bleeding; periodontal destruction- including loose teeth; soft tissue ulceration; increased risk of candidiasis; malformed teeth (odontoblast/dentin); petechial hemorrages/gingivitis; cyanotic gingival tissues; essential for collagen formation (fibroblasts & odontoblasts too); slow wound healingExcess: Body increases metabolism of vitamin C when taken in excess; no oral effects noted
Vitamin DPromotes growth & mineralization of bones/teeth; increases absorption calciumDeficiency: Abnormal bone regeneration (failure of bone to heal), osteoporosis; incomplete mineralization of teeth - (hypoplasia); rickets in children; osteomalacia in adults; delayed eruption; high caries rate; loss of lamina duraExcess: Pulp calcification; enamel hypoplasia
Vitamin K Vital for blood clotting; involved in formation of prothrombinDeficiency: Increased risk of bleeding/gingival hemorraging; increased risk of candida
Vitamin A
Antioxidant- maintains epithelial tissues; involved in bone growth & remodeling; important for visionDeficiency: faulty bone & teeth formation, disturbed or arrested enamel development (ameloblast)- hypoplasia, keratosis, increased risk of candidiasis; gingival hypertrophy & inflammation; leukoplakia; decreased taste sensitivity; xerostomia; irregular tubular dentin formation and increased caries risk, cleft lip, salivary gland hardening/drying; cell differentiation impaired;Excess: cracking/bleeding lips, erythremic gingiva, cheilosis, hypertrophy of bone
Riboflavin B2Coenzyme in metabolism carbs, protein, fatDeficiency: Angular cheilosis; atrophy of filiform papillae; enlarged fungiform papillae; shiny red lips; sore tongue (glossitis);blue-to-purple mucosa; magenta tongue
Vitamin E Antioxidant; involved in cellular respirationDeficiency: loss of resistance to inflammation
Niacin B3Coenzyme in energy productionDeficiency: mucositis; stomatitis; oral pain; ulcerative gingivitis; tip of tongue is red & swollen; dorsum is dry & smooth (loss of filiform/fungiform); beefy sore tongue
Deficiency versus excess: VITAMINS
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Deficiency versus excess: VITAMINS
VITAMIN DEFICIENCY OR EXCESS
Folic acid (Folate)Involved in RNA & DNA synthesis- also WBC/RBC formationDeficiency: Angular cheilosis; mucositis; stomatitis; sore or burning mouth; increased risk of candidiasis; inflamed gingiva; glossitis oral pain; ulceration- buccal mucosa/ gingivitis; denuded tongue; glossitis; glossodynia; tip or borders of tongue red & swollen; apthous ulcers; neural tube defects- very important for expectant mothers
B6Pyridoxine
Coenzyme in amino acid metabolism; role in hemoglobinDeficiency: Angular cheilosis; sore or burning mouth; glossitis; glossodynia; stomatitis
B12Cobalamin
Coenzyme for metabolism; important in RBC formation & DNA synthesisDeficiency: Angular cheilosis; mucositis; stomatitis; hemorrhage gingiva; halitosis; epithelial dysplasia of oral mucosa; oral parethesia; detachment of periodontal fibers; loss or distortion of taste; parasthesia; glossitis; ulcerative gingivitis; denuded tongue; glossodynia; tongue is "beefy", red, smooth, glossy & sore; delayed wound healing; xerostomia; bone loss; apthous ulcers; pernicious anemia; pale-yellow mucosa
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MINERAL DEFICIENCY OR EXCESS
Fluoride Deficiency: Decreased resistance to cariesExcess: Disturbed amelogenesis; mottled/stained enamel; enamel hypoplasia (fluorosis)
IronDeficiency: Angular cheilosis; pallor of lips and oral mucosa; sore, burning tongue; atrophy/denudation of filliform papillae; increased risk of candidiasis; glossitis around margins, anemia; fatigue; decreased immunity; thinning/ulcerated tissuesImportant for synthesis of hemoglobin; essential for immune function; most common deficiency in US
CalciumDeficiency: Incomplete mineralization of teeth (hypomineralization), rickets; osteomalacia (bone softening); osteoporosis; excessive bone resorption & bone fragility; increased tendency to hemorrhage; increased tooth mobility & premature loss; delayed eruption; less than 1/3 intake absorbed esp with excess wheat/fiber – important for woman as they age- helps with muscle contraction & nerve impulse
Copper Deficiency: Decreased trabeculae of alveolar bone; poor growth, low WBC, anemia; decreased tissue vascularity; increased tissue fragility
ZincDeficiency: Loss or distortion of taste & smell acuity; loss of tongue sensation; defective keratinization of tissues, delayed wound healing & growth; impaired keratinization of epithelial cells, increased susceptibility to periodontal disease & infection, candidiasisRequired by cells- tissue growth & repair; regulates inflammation
Magnesium Deficiency: Alveolar bone fragility; gingival hypertrophy & atrophy ameloblast/odontoblasts; tremors, cardiac arrhythmias, muscle spasms, convulsions; widening of perio ligament
Phosphorus Deficiency: Incomplete mineralization/calcification of teeth; increased susceptibility to caries if deficient during tooth formation; increased susceptibility to periodontal disease due to effects on alveolar bone
MINERALS
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NUTRIENT DEFICIENCY OR EXCESS
CarbohydrateEnergy– brain foodDeficiency: Caries rate generally decreases when carbohydrate intakes decreasesExcess: Increased frequency of intake of all carbohydrates is a causative risk factor for caries
FatsSource of energy; cariostaticDeficiency: difficult to have Excess: No direct effect orally but fats may coat teeth and protect them againts cariogenic challenge; if excess physically = obesity
Protein
Source of energy- esp when carb intake low; cariostatic; promotes growth, maint, & synthesis of body tissuesDeficiency: Defects in tooth composition, eruption pattern delayed & resistance to decay lowered due to increase in tooth enamel solubility; increased susceptibility to soft tissue infection, poor healing/tissue regeneration due to impaired immune system; kwashiorkor if severe (3rd world)
WaterHydration & electrolyte balanceDeficiency: Dehydration and fragility of epithelial tissue; decreased muscle strength for chewing; xerostomia; dry skin; burning/fissured tongue; common in elderly (lots meds)
OTHER NUTRIENTS
from Modern Nutrition in Health and Disease (9th ed) Editors: Shils; Olsen; Shike & Ross. Published by Williams & Wilkins.Mosby’s Review of DH 7th edition; Mosby’s Dental hygiene case 2nd edition
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Role of Nutrition in Periodontal Disease
*Certain nutritional deficiencies can modify gingival tissue resistance so that an inflammatory condition (initiated by BIOFILM) may be accelerated or
increased in intensity
*The effects of periodontal infection can alter the capacity of the tissues
to utilize available nutrients-therefore,
potential for healing and repair is modified
*Malnutrition compromises tissue regeneration and healing which increases susceptibility to oral disease
Role of Nutrition in Periodontal Disease
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Vitamin C-- effects collagen; immunity– increased risk of deficiency in smokers; increase risk for perio
Zinc- response to inflammation; increase permeability tissues if deficient
Others? B complex, Vitamin A, etc…
Important to counsel PERIO pts on proper nutrition
Calcium- increased risk for disease (bone)
Protein- poor healing/regeneration; impairs immune system
Nutrition for a lifetime- through the Life Cycle…..
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The Diabetic Patient
Meals and snacks at regularly scheduled intervals, coordinated with medication and exercise
Use of cariogenic fermentable carbohydrates should be infrequent Looks at “carbs” not just sugars
Uncontrolled should be referred to M.D.- although even controlled should be under care of physician and nutrition professional
Heal slower/periodontal disease can exacerbate diabetes control Periodontal disease much more advanced, harder to get control of &
treat
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The Aging Patient
Considered particularly susceptible to malnutrition- WHY?
Aging Issues
Impaired taste and smell Impaired absorption/digestion Impaired hunger/thirst “mechanisms” Dentures/partials Xerostomia Nutrient deficiencies Lifestyle (living alone, access issues, fixed income, etc….) Thorough EOIOE needed (increased risk OC) Other?
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Thirsty?
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Obesity
According to the National Center for Health Statistics, the number of overweight children has more than doubled
since the 1960’s.Children who gain too much weight are at high risk for developing risks for heart disease- and Type II Diabetes.
BMI
QUIZ…..
*drink more calories = consume more calories in general = overweight/obesity
Food labels
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How many “servings” for this item? Based on 2000 calorie and sometimes 2300 calorie diet!
Can = 1900 mg sodium!
1 serving= ½ (520 cal)
What about SALT?
Why is it in foods? Is it habitual? Is it related to weight? What should I limit my diet to (in mgs)? Do organic foods or low fat foods usually have higher or
lower salt? What recommendations can I make to patients?
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The Vegetarian, Vegan Diet & Others?
Can be extremely nutritious, since it is high in fiber and low in saturated fats
However, care must be taken to get all nutrients needed for health
Key is- balance & varied diet (not replacing meat with processed foods)
Other things to consider . . . ?
Tips for Vegetarians
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Vitamin Supplements
Never going to supplement what you get from a balanced diet! However, most don’t have balanced diet– so multivitamin can be helpful
(Up to 40% of adults have inadequate dietary intake of 3 or more nutrients) People tend to overuse supplements- can be detrimental & cost $$$
Vitamins should not exceed the recommended dosage and take in forms which can be metabolized properly
Be wary of health claims! Many, many NOT standardized or backed by scientific research
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Herbal Alternatives
Interactions?
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OTC and herbal supplements have theirown adverse reactions just like Rxmedications
OTC and herbal supplements interact withRx medications and with each other
Herbal supplements are not regulated bythe FDA as OTC and Rx medications are
Lack scientific studies
May increase the risk of bleeding
– Garlic*
– Ginger*
– Gingko biloba*
– Ginseng*
– Green tea
May induce coagulation
– Vitamin K
– Goldenseal
– Dong quai
– Garlic
*These agents have multiple adverse reactions
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These may increase blood pressure– Green tea– Ephedra/ma huang– Ginseng*– Licorice– Guarana
St. John’s Wort also contraindicated with psychoactive drugs, warfarin, estrogen, iron, & oral contraceptives
Several have effects on blood glucose levels
Melatonin may exaggerate an autoimmune response and suppress fertility
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T or F?Herbal supplements are very safe to the human body because theyare made from plants and other compounds naturally occurring in nature and arehighly regulated by the FDA.
Eating Disorders
• Anorexia nervosa: self-starvation and excessive weight loss
• Bulimia nervosa: usually secretive cycles of binge eating extremely large quantities of food followed by purging through vomiting
• Binge-eating disorder (BED): has periods of uncontrolled, continuous eating much like bulimia, but no purging is involved. Body weight varies greatly in this group
Local support
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Eating Disorders
What is the hygienist’s role?
Treatment– Question patient regarding oral findings– Be nonconfrontational– Do not brush after vomiting (use alkaline rinse of
sodium bicarbonate or magnesium hydroxide solution to neutralize acid)
– Reduce acidic foods/drinks– Recommend saliva substitutes w/ fluoride– Chew sugar free gum– Use fluoride/sens dentifrice, mouth rinse, and
varnish for hypersensitivity
