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
More about the “Plate” *even have it in spanish! Lots of resources online
Which one is “better?” What influences the recommendations made?
Other resources…. • http://www.livestrong.com/article/278187-free-online-nutrition-analysis/ • http://www.myfitnesspal.com/food/calorie-chart-nutrition-facts
Dietary Guidelines for Americans 2010 Organized in “chapters”-good resource
Overview of Nutrients A review from Nutrition class…. the very basics….!?!? Well…. maybe
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
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 *Malnutrition compromises tissue regeneration and healing which increases susceptibility to oral disease *The effects of periodontal infection can alter the capacity of the tissues to utilize available nutrients-therefore, potential for healing and repair is modified
Role of Nutrition in Periodontal Disease Vitamin C-- effects collagen; immunity– increased risk of deficiency in smokers; increase risk for perio Zinc- response to inflammation; increase permeability tissues if deficient Protein- poor healing/regeneration; impairs immune system Calcium- increased risk for disease (bone) Others? B complex, Vitamin A, etc… Important to counsel PERIO pts on proper nutrition
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
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?
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.
*drink more calories = consume more calories in general = overweight/obesity
Food labels How many “servings” for this item? Based on 2000 calorie and sometimes 2300 calorie diet! Can = 1900 mg sodium! 1 serving= ½ (520 cal)
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?
The Vegetarian, Vegan Diet & Others? Can be extremely nutritious, since it is high in fiber and low in saturated fatsHowever, 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
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
Interactions? OTC and herbal supplements have their own adverse reactions just like Rx medications OTC and herbal supplements interact with Rx medications and with each other Herbal supplements are not regulated by the 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 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 levelsMelatonin may exaggerate an autoimmune response and suppress fertility 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
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