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

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)

ANATOMY OF A TOOTHANATOMY OF A TOOTH

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

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

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 cariesCommon among Native AmericansWean children before age 2 from

bottle

EARLY CHILDHOOD CARIESEARLY CHILDHOOD CARIES

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

DENTAL CARIES—CONT’D

Streptococcus mutans—most common bacteria involved

Fermentable Carbohydrate Time Drop in salivary pH to below 5.5

DENTAL CARIES—CONT’D

Cariogenicity of foods Frequency of consumption of

fermentable CarbohydrateFood form—slowly dissolvingFood combinations Nutrient composition of

food/beveragesTiming (end of meal)

MEDICAL SEQUELAE OF DENTAL CARIES Bacteria from tooth decay can enter

bloodstream and inoculate heart valves, cause bacterial endocarditis

Oral-pharyngeal secretions inoculated with bacteria can cause aspiration pneumonia

FLUORIDE

Primary anticaries agent Water fluoridation Fluoridated toothpastes Oral rinses Dentrifices Beverages made with fluoridated water

RECOMMENDATIONS FOR FLUORIDE SUPPLEMENTATIONRECOMMENDATIONS 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: 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 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

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 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

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

CARIES PREVENTION GUIDELINES

PERIODONTAL DISEASE Inflammation of the gingiva with

destruction of the tooth attachment apparatus

Gingivitis—early formNutritional care involves increasing

vitamin C, folate, and zinc

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 Stomatitis:

inflammation of oral mucosa

Candidiasis and herpes simplex: fungal and viral infections which can affect mouth and esophagus causing pain and dysphagia

Photo: http://webpages.marshall.edu/~gain/bactnote/Image9.gif

ORAL MANIFESTATIONS OF DISEASE Xerostomia: Dry mouth Periodontal disease Kaposi’s sarcoma—lesions in mouth and

esophagus; associated with AIDS

Kaposi’s Sarcoma in AIDS

INSTRUCTION ON 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 For xerostomia, try artificial salivas, sugar free

candies or gums

MEDICATIONS THAT MAY CAUSE XEROSTOMIA

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 ; problem foods include fresh fruits and vegetables, chewy and crusty breads and chewy meat like steak

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

INSTRUCTION FOR WIRED OR BROKEN JAW

Provide pureed, strained, or blenderized foods as appropriate

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

DYSPHAGIA = DIFFICULTY SWALLOWING

Mechanical causes Trauma to esophagus with scar tissue Inelasticity due to repeated inflammation Tumor of esophagus

DYSPHAGIA = DIFFICULTY SWALLOWING

Neuromuscular causes brain tumors Head injury Parkinson’s disease Achalasia (cardiospasm) Spinal cord injury

INSTRUCTION FOR DYSPHAGIA (NATIONAL DYSPHAGIA DIET)

Intervention depends on severity of deficit Mealtime supervision, cueing Thickened liquids: thin » nectarlike »

honeylike » spoon thick Altered consistency:

Level 1: pureed Level 2: mechanically altered Level 3: advanced