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Nutrition for Oral and Dental Health. Oral Health. Diet and nutrition play a key role in —Tooth development —Gingival and oral tissue integrity —Bone strength —Prevention and management of diseases of the oral cavity. Effects of Nutrient Deficiencies on Tooth Development.

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oral health
Oral Health
  • Diet and nutrition play a key role in

—Tooth development

—Gingival and oral tissue integrity

—Bone strength

—Prevention and management of diseases of the oral cavity

dental and oral health
Dental and Oral Health
  • Teeth are made from protein matrix that is mineralized with collagen (requiring vitamin C), calcium, and phosphorus (requiring vitamins D and A)
dental caries
Dental Caries
  • Infectious disease of teeth in which organic acid metabolites lead to gradual demineralization of enamel; proteolytic destruction of tooth structure
  • Any tooth surface can be affected.
the decay process
The Decay Process
  • Plaque formation: sticky mix of microorganisms, protein, polysaccharides
  • Bacteria metabolizing fermentable carbohydrate produce acid
  • Acid production: oral pH<5.5 allows tooth demineralization
  • Saliva function: rinses away food; neutralizes acid; promotes remineralization
  • Caries patterns:pattern depends on cause
early childhood caries
Early Childhood Caries
  • Also called “baby bottle tooth decay”
  • Nursing bottle caries—putting baby to bed with a bottle of sweetened liquid (juice, Kool-Aid, etc.)
  • Front teeth rapidly develop caries
  • Common among Native Americans
  • Wean children before age 2 from bottle
early childhood caries9

Early Childhood Caries

(From Swartz MH. Textbook of Physical Diagnosis, History, and Examination, 3rd ed. Philadelphia: W.B. Saunders, 1998.)

dental caries cont d
Dental Caries—cont’d
  • Streptococcus mutans—most common bacteria involved
  • Fermentable Carbohydrate
  • Time
  • Drop in salivary pH to below 5.5
dental caries cont d11
Dental Caries—cont’d
  • Cariogenicity of foods
  • Frequency of consumption of fermentable Carbohydrate
  • Food form—slowly dissolving
  • Food combinations
  • Nutrient composition of food/beverages
  • Timing (end of meal)
fluoride
Fluoride
  • Primary anticaries agent
  • Water fluoridation
  • Fluoridated toothpastes
  • Oral rinses
  • Dentrifices
  • Beverages made with fluoridated water
recommendations for fluoride supplementation

Recommendations for Fluoride Supplementation

(Data from American Dietetic Association: Position of ADA: The impact of fluoride on dental health. J. Am Diet Assoc. 94:1428, 1994.) * Milligrams of supplemental fluoride recommended according to fluoride concentration in drinking water.

cariogenic vs cariostatic
Cariogenic vs. Cariostatic
  • Cariogenic: containing fermentable carbohydrates that can cause a decrease in salivary pH to <5.5 and demineralization when in contact with microorganisms in the mouth; promoting caries development
  • Cariostatic: not metabolized by microorganisms in plaque to cause a drop in salivary pH to <5.5
cariogenic foods
Cariogenic Foods
  • Promote formation of caries
  • Fermentable carbohydrates, those that can be broken down by salivary amylase
  • Result in lower mouth pH
  • Include crackers, chips, pretzels, cereals, breads, fruits, sugars, sweets, desserts
cariostatic foods
Cariostatic Foods
  • Foods that do not contribute to decay
  • Do not cause a drop in salivary pH
  • Includes protein foods, eggs, fish, meat and poultry; most vegetables, fats, sugarless gums
anticariogenic foods
Anticariogenic Foods
  • Prevent plaque from recognizing an acidogenic food when it is eaten first
  • May increase salivation or have antimicrobial activity
  • Includes xylitol (sweetener in sugarless gum) and cheeses
other factors that affect diet carogenicity
Other Factors that Affect Diet Carogenicity
  • Consistency: Liquids are cleared quickly while sticky foods remain on the teeth
  • Meal frequency: frequent meals and snacks increase duration of exposure
  • Food composition
  • Food form: liquid, solid, slowly dissolving
  • Sequence of eating: cheese or milk at the end of the meal decrease the cariogenicity of the meal
periodontal disease
Periodontal Disease
  • Inflammation of the gingiva with destruction of the tooth attachment apparatus
  • Gingivitis—early form
  • Nutritional care involves increasing vitamin C, folate, and zinc
tooth loss and dentures
Tooth Loss and Dentures
  • Tooth loss—denture placement
  • Food selections change
  • Saliva production decreases
  • Reduced chewing ability
  • Lower calorie and nutrient intake occurs for many
  • Simple nutrition counseling; Food Guide Pyramid, etc.
oral manifestations of disease
Oral Manifestations of Disease
  • Stomatitis: inflammation of oral mucosa
  • Candidiasis and herpes simplex: fungal and viral infections which can affect mouth and esophagus causing pain and dysphagia
  • Xerostomia: Dry mouth
  • Periodontal disease
  • Kaposi’s sarcoma—lesions in mouth and esophagus
mnt for mouth pain oral infections
MNT for Mouth Pain/Oral Infections
  • Avoid acidic and spicy foods
  • Offer soft, cold, nutrient dense foods such as canned fruit, ice cream, yogurt, cottage cheese
  • Try oral supplements
  • Use PEG or NG feeding if oral supplementation is unsuccessful
  • For xerostomia, try artificial salivas, citrus beverages, sugar free candies or gums
dental health affects nutrition
Dental Health Affects Nutrition
  • Tooth loss may affect ability to chew (relationship between loss of teeth and reduced intake of fruits and vegetables
  • Dentures are often ill-fitting (especially common after weight loss); problem foods include fresh fruits and vegetables, chewy and crusty breads and chewy meat like steak
interventions
Interventions
  • Obtain a dental consult: if dentures are missing, find them. If they are loose, replace or reline them
  • Modify diet consistency: mechanical soft, ground, pureed
  • Use least restrictive diet possible; individualize; mix consistencies if appropriate
mnt for wired or broken jaw
MNT for Wired or Broken Jaw
  • Provide pureed, strained, or blenderized foods as appropriate
  • Encourage nutrient-dense foods such as blenderized casseroles
  • Recommend small, frequent meals with oral supplements such as milkshakes, Instant Breakfast, medical nutritionals
  • Use liquid vitamin supplement if necessary
  • Recommend patient weigh self to monitor weight status