DIET COUNSELINGLOVELY

THINGS

You like to have!!!!!!

BUT, through these you send me my enemies….

THE GERMS

Ha!ha!ha!Ha!ha!ha!

These germs destroy me!!!

Ah!! Help me &Please help me!!

IT IS THE ACT OF PROVIDING ADVISE AND

GUIDANCE TO A PATIENT OR THE PATIENTS

FAMILY REGARDING THE TYPE OF FOOD

THAT SHOULD BE TAKEN AND ITS

RELATION TO BOTH HEALTH AND DISEASE

Diet counseling

NEED FOR COUNSELING To modify dietary habits, particularly ingestion

of sucrose containing foods, in forms and amounts that promote caries

To correct dietary imbalances that could interfere with the patient’s general health and well being

AAPD (2005) Recommends Breast feeding of infants to ensure best

possible health , developmental and psychosocial outcomes

Educating people about association between frequent consumption of carbohydrates and caries

Educating people about other health risks associated with excess consumption of carbohydrates , fats and sodium

STEPS OF A DIET COUNSELING PROGRAMME1) First appointment - Identification of high-risk patients. - Maintaining the diet diary

2) Second appointment - Evaluation of the diet diary - Develop an action plan - Well balanced diet - Use of Nutritive sugar

substitutes

3) Third appointment - Evaluation of the progress

DIET DIARY Record every food item consumed solid or

liquid during 6 consecutive days

Record food consumed during mealtimes, between meals.

Use appropriate household measures to measure the amount of food.

The kind of food and how it was prepared. Addition to the food in cooking or at table

PATIENT SELECTIONPatient should have a positive attitude and

be willing and to make long- term efforts towards improvement of oral status through dietary means.

Should have a demonstrable need for dietary improvement.

GUIDELINES FOR COUNSELING

Personal data

Likes and dislikes

Cause of problem

Suggest diet diary

GATHERING

INFORMATION

EVALUATE AND INTERPRET INFORMATION

DEVELOP AND IMPLEMENT A TREATMENT PLAN

ACTIVE PARTICIPATION OF PATIENT

Patient encouraged to involve himself in diet monitoring and suggest changes in menu

REGULAR FOLLOW – UP To

monitor progres

s

Make change

s

To clarify doubts

To motivate

and encourag

e

Caries susceptibility Caries susceptibility refers to the number of new lesions that may develop in an individual over a period of time

Caries susceptibility Varies: -in different individuals, -in an individual in different teeth -also on the different surfaces of each tooth

Effect of demographic factors on the prevalence of caries

Sex Higher caries experience in permanent Teeth of females as compared to males of the same chorological age Age New carious lesion per years has 3 peaks – at ages 4-8 ,11-19 & between 55 and 65 yrs

Race Race also effects as it implies cultural social economic and possibly genetic differences and therefore differences in the diet ,oral hygiene and education African & Asian people have low caries scores as compared to the industrialized countries of Europe and North America

Familial FactorsChildren of parents with low caries have a low caries experience.Siblings of individuals that are caries free exhibit a low caries rate [Gaemetal, 1976]

Time factors for caries development after eruption After a tooth erupts there is a rapid rise and then an equally sharp decrease in caries susceptibility

CARIES ACTIVITY TESTS

CARIES ACTIVITY

The increment of active lesions, including new and recurrent lesions that occur over a stated period of time

Caries activity test facilitates the clinical management of patients for the following reasons:

To determine the need and extent of personalized preventive measures.

To serve as an index of the success of the therapeutic measures.

To motivate and to monitor the effectiveness of education programs relating to dietary and oral hygiene procedures.

To manage the progress of restorative procedures.

To identify high risk groups and individuals.

Various caries activity tests

1) Lactobacillus colony count test2) Calorimetric snyder test3) Swab test4) Streptoccocus mutans levels in saliva5) Salivary buffer capacity6) Enamel solubility test

7) Saliva reductase test

8) Albans test

9) Fosdick calcium dissolution test

10) Dewar test

11) Cariostat test

1. LACTOBACILLUS COLONY COUNT TEST

Introduced by HADLEY in 1933 and popularized by JAY.

METHOD: Immediately after arising the patient chews a small piece of paraffin. The saliva that accumulates in the following 3 minute period is collected in a sterile container.

Saliva collected is shaken by a machine for 2 minutes.

The saliva sample is diluted with distilled water and duplicate 1 ml and 0.1ml aliquots

Diluted sample are spread evenly on petridishes containing 20ml of cooled liquefied agar (Rogasa’s SL agar plate). The plates are incubated for 3 to 4 days at 37°C The number of Lactobacillus colonies that develop are counted.

LACTOBACILLUS COLONY COUNT TEST

The lactobacillus colony counts in saliva as related to caries susceptibility.

No. Of organisms per ml saliva

Symbolic designation

Degree of caries activity suggested

0 - 1000 ± Little or none

1000 - 5000 + slight

5000 – 10,000 + + moderate

More than 10,000

+ + + OR + + + +

marked

LACTOBACILLUS COLONY COUNT TEST

2. CALORIMETRIC SNYDER TEST

It measures the ability of salivary micro-organisms to form organic acids from a carbohydrate medium.

The medium contains an indicator dye, Bromocresol green. This dye changes colour from green to yellow in the range of pH 5.4 to 3.8.

Salivary sample is collected in the same manner used in the Lactobacillus test.

Immediately after arising the patient chews a small piece of paraffin. The saliva that accumulates in the following 3 minute period is collected in a sterile container.

Saliva collected is shaken by a machine for 2 minutes

CALORIMETRIC SNYDER TEST

After the salivary sample is thoroughly mixed, 0.2 cc of saliva is pipetted into the melted medium at 50°C.

The inoculation period is upto 72 hours.

The rate of colour change from green to yellow is indicative of the degree of caries activity.

CALORIMETRIC SNYDER TEST

The colour observations in Synder’s tests is as shown in Table

Time, Hours 24 48 72Colour Yellow Yellow YellowCaries activity Marked Definite Limited Colour Green Green Green Caries activity Continue test Continue test Inactive

CALORIMETRIC SNYDER TEST

3. THE SWAB TEST Developed by GRAINGER et al in 1965. Advantage- no collection of saliva is necessary. So it is valuable in evaluation caries activity in very young children.

Principle: ( same as Snyder's test )The oral flora is sampled by swabbing the buccal surfaces of the teeth with a cotton applicator, which is subsequently incubated in the medium.

The change in the pH following a 48 hour incubation is read on a pH meter or the colour change is read by the use of a colour comparator.

Interpretation :

pH 4.1 and < 4.1 = Marked caries activitypH 4.2 to 4.4 = ActivepH 4.5 to 4.6 = Slightly active pH 4.6 and over = Caries active

THE SWAB TEST

4. STREPTOCOCCUS MUTANS LEVELS IN SALIVA

Measures the number of Streptococcus mutans colony forming units per unit volume of saliva.

Procedure: The samples of organisms is obtained by the use of tongue blades (wooden spatulas)

Sample then pressed against Streptococcus Mutans selective MSB (Mitus Salivarius Bacitracin) Agar in special Petri dishes.

Interpretation : Levels of Streptococcus Mutans > 10 5/ ml of saliva = unacceptable,

Colonization of a new surface does not occur readily unless the level of S. mutans in saliva reaches a critical value of about 4.5 x 104 Per ml for smooth surface and about 103

for occlusal fissures

STREPTOCOCCUS MUTANS LEVELS IN SALIVA

5. SALIVARY BUFFER CAPACITY

Collection and titration of saliva in this test must be carried out under a layer of paraffin oil to prevent loss of bicarbonate anion.

2 ml of saliva collected under paraffin oil are

+ 4 ml of distilled water (under a paraffin seal. )

The delivery end of a microburet and a microglass electrode are introduced under the seal and the amount of 0.5 N HCL, required to bring the saliva to pH 5.0 is measured.

Saliva samples requiring less than 0.45 ml of standard HCI in this test have low buffer capacity

Those requiring 0.45 ml or more have high buffer capacity.

SALIVARY BUFFER CAPACITY

6. ENAMEL SOLUBILITY TEST

Based on the fact that when glucose is added to the saliva containing powdered enamel, organic acids are formed.

These inturn decalcify the enamel, resulting in an increase in the amount of soluble calcium in the Saliva – Glucose – Enamel mixture.

The extent of increased calcium is a direct measure of the degree of caries susceptibility.

7. SALIVARY RECUCTASE TEST (SUSCEPTIBILITY TEST)

This test measures the activity of the reductase enzyme present in salivary bacteria.

Kit used is -Treatex.

Saliva collected in a plastic container.

The sample is then mixed with the dye Diazoresorcinal,

The colour changes and the “Caries Conduciveness” reading is taken after 15 minutes

COLOUR CHANGS IN SALIVARY REDUCTASE TEST AS RELATED TO CARIES CONDUCIVENESS

COLOUR CARIES CONDUCIVENESS

Blue in 15 minutes Non – Conducive

Orchid in 15 minutes Slightly Conducive

Red in 15 minutes Moderately Conducive

Red Immediately on Mixing

Highly Conducive

Colourless in 15 minutes

Extremely Conducive

8. ALBAN TEST (modified Synder test)

Main Features:Use of a somewhat softer medium that permits the diffusion of saliva and acids without the necessity of melting the medium.

Use of simpler sampling procedure in which the patient expectorates directly into tubes that contain the medium.

The tubes are observed daily for:

Change of colour from bluish green (pH 5) to definite yellow (pH 4 or below).

The depth in the medium to which the change has occurred. The daily results collected for a 4 day period should be recorded on the patients chart.

ALBAN TEST

Scale for Scoring:

1. No colour change = ‘3/4’2. Beginning colour change = ‘+’ (from to of medium down)3. One hald colour change = ‘++’ (from top down)4. Three fourths colour change = ‘+++’ (from top down)5. Total colour changes to yellow = ‘++++’

ALBAN TEST

The following method is used for final recordings, after 72 or 96 hours of incubation

Readings negative for the entire incubation period are labeled “negative”

All other readings are labeled “positive” whether +, ++, +++, or ++++.

ALBAN TEST

Slower change or less colour change (compared to previous test) is labeled “improved”

Faster change or more pronounced colour change (compared to previous test) is labeled “worse”.

When consecutive readings are nearly identical, they are labeled “no change”.

ALBAN TEST

9. FOSDICK CALCIUM DISSOLUTION TEST

Measures the amount of powdered enamel dissolved in 4 hours, when mixed with glucose and the patients saliva.

Disadvantage: Correlation between the amount of enamel dissolved and the caries susceptibility of the patient has not been found to be accurate

10. DEWAR TEST

Test similar to fosdick calcium dissolution test

Except that in this test the pH of the mixture is measured instead of the amount of calcium dissolved by the acid.

11. CARIOSTAT TEST

C.R.T. (caries risk test) -new, quick and effective caries activity test Enables some acid producing bacteria and acid tolerating bacteria to survive in its medium so that the ability of acid production by these bacteria can be measured

Cariostat is superior to radiographic examination for detection of initial proximal caries

C.R.T. has 2 components:

1. C.R.T. bacteria- which allows a number of cariogenic bacteria in the patients saliva

2. C.R.T. buffer- which determines the buffering capacity of the patients saliva

C.R.T. bacteria is a two-in –one dip – in –slide test which identifies counts of a) mutans streptococci b) lactobacilli

CARIOSTAT TEST

METHOD:

Stimulated saliva is collected Applied to both the slides of the dip-in-slide

This is then incubated for 48hours at 37°C The C.R.T. buffer is available in strip form, which changes colour to indicate whether the patient has high, medium or low buffering capacity. This occurs in 5 minutes.

CARIOSTAT TEST

Limitations of caries activity tests

None of the tests are highly reliable as indicators of expected caries increment

Caries activity tests measure a single parameter such as acid produced or colony count of a bacterial species

However caries is a multifactorial disease and caries predictive tests do not encompass those factors involved in determining caries resistance such as fluoride exposure, maturation of enamel, or immune protection.