Transcript Nutrition, Diet in prevention of oral conditions. The role

Prof. R.Kabaktchieva - 2014
 Oral
health, Diet, Nutritional status and
General health are closely linked

Nutrition is essential for the growth,
development, and maintenance of oral
structures and tissues.

During periods of rapid cellular growth,
nutrient deficiencies can have an
irreversible effect on the developing oral
tissues.
 Before
tooth eruption,
nutritional status can influence
tooth enamel maturation , chemical
composition, tooth morphology and
size.
 Early
malnutrition increases a
child's susceptibility to dental
caries in the primary teeth.
 Throughout
life, nutritional
deficiencies can affect host
resistance, healing, oral function,
and oral-tissue integrity.
 After
tooth eruption,
diet affects the dentition topically
rather than systemically.
 Dietary
factors and eating patterns can:
initiate, exacerbate, or minimize
dental decay.
Fermentable carbohydrates are essential for the
implantation, colonization, and metabolism of bacteria in
dental plaque.
Factors such as eating frequency and carbohydrate
retentiveness on the dentition influence the progression of
carious lesions,
while foods containing calcium and phosphorus, such as
cheese, enhance remineralization.
Frequent intake of acidic foods or beverages can cause
enamel erosion.
Diet Assessment and Counseling
in Dental Care
The modern dental practitioner is concerned
not only with educating patients for the
prevention of caries and periodontal disease,
but also plays an important role in screening
patients for some health risks.
a dietary assessment and screening
can help identify potential nutritional
problems that may affect, or be
affected by, dental care.
 The
role of the dental provider should be
to screen patients for nutritional risk,
provide dietary guidance related to oral
health,
and refer patients to nutrition
professionals for treatment of other
nutrition-related systemic conditions.

Example:
“Adolescents are at risk of caries because they
have high intake of soft drinks and snack foods”

Using current diet patterns patients should be
taught :
the role of diet in caries,
what are cariogenic and noncariogenic eating
patterns,
how to adapt the current diet to lower cariogenic
risk.
-
=
Primary Prevention
Secondary Prevention

This strategy targets individuals showing early
danger signs of caries, such as extensive
cervical demineralization.
Examples :
 Adolescents with cervical demineralization
after removal of orthodontic appliances.

Adolescents with demineralization due to
gastroesophageal reflux disease.
 These
individuals need from more-detailed
guidance on how to reduce cariogenicity of
their current diet.
 Thе
guidance would involve determining
the factors influencing current habits,
 Have
to work with the patient to develop
appropriate and acceptable strategies for
improvement.
Tertiary Prevention

This strategy provides supportive and
rehabilitative services to maximize the
quality of life.
Example:
 Pacients with a history of caries and many
restorations
This level of prevention should
provide dietary advices to promote
long-term change to prevent
recurrence of caries.
Example:
 Children
with new orthodontic
devices.
This level of prevention may require
dietary counseling to identify methods of
preparing foods to facilitate consumption
of a healthy diet when chewing may be
compromised by tooth loss or new
orthodontic devices.
The Basis for a Healthy Diet
“Dietary Reference Intakes”
Daily food intake
 must meet metabolic requirements
for energy (calories);
 Have
to provide the essential
nutrients that the body cannot
synthesize in sufficient quantities to
meet physiologic needs.
 The
Dietary Reference Intakes (DRIs)
are quantitative estimations of nutrient
values to be used for planning and
assessing diets for healthy people.

These reference values vary by gender
and life stage group.
The Dietary Reference Intakes /DRIs /
consist :
- Estimated Average Requirement (EAR)
- Recommended Dietary Allowance (RDA)
- Adequate Intake (AI)
- Тolerable Upper Intake Level (UL)
Types of Daily

Reference Intakes (DRI)
Estimated Average Requirement
(EAR)
The daily nutrient intake value estimated to
meet the needs of half (50%) of all healthy
people in a life stage and gender group.

Recommended Dietary Allowance
(RDA)
The average daily nutrient value considered
adequate to meet the nutrient needs of
nearly all (97%-98%) healthy people in a life
stage and gender group.

Adequate Intake (AI)
An intake value assumed to be adequate for
healthy people in each life stage and gender
group when there is not enough data to
determine an RDA.

Тolerable Upper Intake Level (UL)
The highest level of daily nutrient intake, what not
cause adverse health risks for individuals in a life
stage and gender group.
The risk of adverse effects increases with intakes
above the UL.
Dietary Guidelines
Dietary Guidelines include 9 interrelated
focus areas.
 Each of the focus areas has several
recommendations.


The Guidelines place emphasis on
consuming a nutrient-dense diet
that does not exceed energy needs,
having regular physical activity,
and maintaining a healthy weight.
Dietary Guidelines
1. Adequate Nutrients within Calorie
Needs
• Consume a variety of nutrient-dense
foods and beverages in the basic food
groups
• Choos foods that limit the intake of
saturated fats, cholesterol, added
sugars, salt, and alcohol.
• Choose a balanced eating pattern
within energy needs
Dietary Guidelines
2. Weight Management

To maintain body weight in a healthy range,
have to balance calories from foods and
beverages with calories expended.

make small decreases in food
and beverage calories
and increase physical activity.
Dietary Guidelines recommend
3. Physical Activity

Engage in regular physical activity
and reduce sedentary activities to promote
health, psychological well-being,
and a healthy body weight.

Through physical fitness achieve muscle
strength and endurance.
Dietary Guidelines recommend
4. Food Groups to Encourage

Consume a sufficient amount of fruits and
vegetables within energy needs.

Choose a variety of fruits and vegetables each
day.

Consume 3 or more ounce of whole-grain
products per day.

Consume 3 cups per day of fat-free or low-fat milk
or equivalent milk products.
Dietary Guidelines recommend
5. Fats

less than 10% of calories to be from saturated
fatty acids and less than 300 mg/day of cholesterol.

total fat intake have to be 20% - 35% of calories;
Most fats coming from sources of polyunsaturated
and monounsaturated fatty acids.

When selecting and preparing meat, poultry, dry
beans, and milk or milk products, make choices that
are with, low-fat, or fat-free.

Limit intake of fats and oils high in saturated fatty
acids, and choose products low in such fats and oils.
Dietary Guidelines recommend
6. Carbohydrates

Choose fiber-rich fruits, vegetables, and
whole grains often.

Choose and prepare foods and beverages
with little added sugars or caloric sweeteners.

Reduce the incidence of dental caries
by practicing good oral hygiene and
consuming sugar- and starch-containing
foods and beverages less frequently.
Dietary Guidelines recommend
7. Sodium and Potassium


Consume less than 2,300 mg (approximately
1 teaspoon of salt) of sodium per day.
Choose and prepare foods with little salt.
Dietary Guidelines recommend
8. Alcoholic Beverages
does not apply to children !!!
Dietary Guidelines recommend
9. Food Safety
To avoid microbial foodborne illness:

Clean hands, food contact surfaces, and fruits and
vegetables. Meat and poultry should not be washed or
rinsed.

Separate raw, cooked, and ready-to-eat foods while
shopping, preparing, or storing foods.

Cook foods to a safe temperature to kill
microorganisms.

Refrigerate perishable food promptly and defrost foods
properly.

Avoid raw (unpasteurized) milk or any products made
from unpasteurized milk, raw or partially cooked eggs or
foods containing raw eggs, raw or undercooked meat and
poultry, unpasteurized juices, and raw sprouts.
MyPyramid
MyPyramid is based on
the Dietary Guidelines
and the Daily Reference Intakes (DRIs).
It translates this information into a diet
that meets individual nutrition needs
and urges moderation of dietary components
that are commonly consumed in excess.
Food pyramid - guide for rational nutrition
Created in collaboration with the Health Ministry of USA.

“MyPyramid “ is a symbol to the 6 food
categories represented as vertical bands.

The new pyramid has a symbol “a person climbing the side of the pyramid” it indicate the need for being physically active
every day

Foods are grouped according to similar
nutrient composition.

The food categories are :
- whole grains,
- vegetables,
- fruits,
- milk,
- meats ,beans
- oils

Variety is essential to ensure adequate
nutrition, because each group provides
some, but not all, essential nutrients.

It is recommended people to eat more of
some foods (fruits, vegetables, whole grains,
and fat-free or low-fat milk products)
and less of other foods (saturated and trans
fats, added sugars, cholesterol, salt, and
alcohol)
The narrowest part of the pyramid indicates
foods that should be minimized
because they contain more added sugars and fat.
Tips to Get Started
 Make
half your grains whole.
 Vary your veggies.
 Focus on fruit.
 Get your calcium-rich foods.
 Go lean with protein.
 Find your balance between food and
physical activity.
Nutritional Factors Affecting the Oral Cavity

Nutrition plays an important role in the initial
growth and development of oral tissues and in
their continuous integrity through the lifespan.

Optimal nutrition during periods of hard and
soft tissue development allow these tissues to
reach their optimal potential for growth and
resistance to disease.
 Malnutrition,
over- or undernutrition,
during critical periods of organogenesis can
have irreversible effects on developing
tissues.
 Examples
of this effect can be seen in
- the tetracycline staining of teeth,
- dental fluorosis,
- enamel defects in children born
prematurely,
- the fever-induced enamel hypoplasia seen
in the primary teeth.

clinical cases
 Nutrients
for which deficiencies or
excesses have been directly
associated with oral conditions are :
- calories;
- protein;
- calcium;
- phosphorus;
- vitamins C, A, and D;
- iodine;
- fluoride.
A summary of the oral symptoms of
nutrient deficiencies can be found in Table
.
Oral Symptoms of Nutrient Deficiencies
 Nutrient-
 Oral Symptom of
Deficiency
 Dietary Considerations-
 Cheilosis or angular
stomatitis
 Rule out other etiology
 Glossitis
 Palliative treatment
 Riboflavin
 Hyperemia and
 Refer to MD/RD for
(vitamin B2) or edema of the
treatment with diet
iron
pharyngeal and
modifications and/or
oral mucous
supplements
membranes
Oral Symptoms of Nutrient Deficiencies
 Nutrient-
 Oral Symptom of
Deficiency
 Dietary Considerations-
•Rule out other etiology
•Palliative treatment
•Refer to MD/RD for diet
modifications: avoiding
 Niacin (vitamin
•Bright red, sore tongue spicy or acidic foods, eat
B3) or vitamin
foods at room temperatur
B12
eating nutrient and energ
dense foods that are soft
and moist
Oral Symptoms of Nutrient Deficiencies
 Nutrient-
 Vitamin C
 Vitamin A
 Oral Symptom of
Deficiency
•Inflamed, bleeding
gingiva and impaired
wound healing
(symptoms of scurvy,
which is rare)
•Changes in taste
 Dietary Considerations-
•Rule out other etiology
•Treat with diet
modifications and/or
supplements
•Rule out other etiology
•Refer to MD/RD for
treatment with diet
modifications to include
nutrient and energy-dense
foods and/or supplements
•· Avoid foods that may
Protein/Calorie Malnutrition

Protein, the most abundant organic compound
in the body, is required for the synthesis of
virtually all body tissues and structures.

Proteins account for the structure of DNA,
the tensile strength of collagen,
and the viscosity of saliva.

Thus, aberrations in protein nutrition can have
far-reaching oral and systemic effects.

The normal turnover of epithelial tissue in
the oral cavity requires a continual supply of
nutrients.

For example, every 3 to 6 days, the basal
epithelium of the gingiva undergoes renewal.
Thus, any severe deficiency of
protein/calorie intake will result in a
decrease in mitotic activity in the crevicular
epithelium, as well as elsewhere throughout
the body.
 In
chronically malnourished
children, studies have shown delays
in tooth eruption and increased tooth
enamel solubility, leading to increased
caries susceptibility.
 The
linear hypoplasia reported in
the enamel of primary teeth to be
related to the severity of the
malnutrition.

Оral defense mechanisms of saliva depend
on an adequate supply of proteins.
The glycoproteins that result in aggregation of
bacteria arise from the salivary glands
Lysozyme, salivary peroxidase, and lactoferrin are
also glycoproteins.
Secretory immunoglobulin A (sIgA) arises mainly
from the labial and buccal glands
The cell types involved in cellular immunity,
polymorphonuclear lymphocytes , macrophages and
the enzymes used in phagocytosis, also require
protein for their production.

Severe effects of protein/calorie
deficiency are decrease of the cellular
and immuno-cellular defenses of both the
oral and the connective sides of the
barrier epithelial cells lining the gingival
crevice.
 The
severity of the impaired immunologic
response parallels the severity of the
protein or calorie deficiency.
 Chronic
malnutrition may also
compromise cytokine response and
affect immune cell function.
 In
other words, undernutrition may
impact immune response , tissue
regeneration, and response to insult or
infection.
Minerals
 Calcium,
in association with
vitamin D and phosphorus, is
essential for proper development
and maintenance of mineralized
tissues, especially teeth and
alveolar bone.
 A deficiency
of these nutrients
during critical phases of tooth
development in children results in
hypomineralization of developing
teeth and possible delayed eruption
patterns.

Enamel hypoplasia in primary teeth occurs in children
born prematurely;

Enamel hypoplasia in permanent teeth in these
children is more that of controls.

Preterm infants miss the intrauterine period when
80% of the body calcium, phosphorus, and
magnesium are accumulated.

In addition, very low birthweight infants have
immature kidneys and may not metabolize adequate
levels of vitamin D, further impairing tooth
development.
Iron - iron deficiency is the most common
nutrient deficiency ;

Iron deficiency anemia manifests in the oral
cavity as pallor of oral tissues, especially the
tongue.

The tongue may appear shiny, with blunted
filiform papillae.
 The
effects of iron deficiency on
mineralized tissues are less clear.
 Supplementing
a caries-promoting diet
with iron produced a major reduction in
caries,
 Iron serves as a cofactor with ascorbic
acid in collagen synthesis, as does
copper.

Zinc regulates function in inflammation by inhibiting
the release of lysosomal enzymes and histamines.

A zinc deficiency can inhibit collagen formation and
reduce cell-mediated immunity.

Zinc deficiency can also result in delayed wound
healing, defective keratinization of epithelial cells,
epithelial thickening, atrophic oral mucosa, and
xerostomia.

In addition, zinc is essential for taste and odor
sensitivity.
Vitamins
 Vitamin A is
essential for the
development and continued integrity
of all body organs and tissues,
including the epithelial mucosa of the
oral cavity.

In vitamin A deficiency, cell differentiation is
impaired.
The result is defective tissue formation and
impaired healing.

In Vitamin A deficiency both specific and
nonspecific immuno-protective mechanisms
are impaired
Deficiency can affect tissue response to
bacterial infection, mucosal immunity, parasitic
and viral infection, activity of natural killer
cells, and phagocytosis.
 Vitamin A toxicity
can show similar
effects, with impaired healing response
being the most direct affect in the oral
cavity.
 Vitamin A toxicity
include other effects:
proliferation of oral epithelium,
reduction of the keratin layer,
thickening of the basal membrane, and
increase in the granular layer.
Vitamin
C, ascorbic acid, is essential to
oral health.
 Synthesis of hydroxyproline, an essential
component of collagen, requires ascorbic
acid.

Clinical manifestations of vitamin C
deficiency called scurvy defects in collagen synthesis
Signs of scurvy in the oral cavity include
spontaneous bleeding,
infusions of blood into interdental papillae,
loosening and exfoliation of teeth,
detachment of oral epithelial tissue,
Frank scurvy is rare,
 The development of gingivitis is one of the early
manifestations of vitamin C deficiency.

The odds of having periodontal disease are
greater in those with low dietary vitamin C
intakes.
 After grapefruit consumption by patients with
periodontitis, plasma vitamin C levels increase

and bleeding scores improved.
 People with vitamin C deficiency
supplemented with ascorbic acid have increase
in hydroxyproline in periodontal tissues.
 Because
the impact of deficient
levels of vitamin C is first observed
in gingival tissues, dentists and
dental hygienists in clinical practice
may be the first to diagnose the
phenomenon. !!!
 The
B-complex vitamins primarily function is as coenzymes in
energy metabolism.
 B-complex
vitamins are found widely
in foods, and are usually found
together.
 Deficiencies
uncommon.
of single B vitamins are
 Oral
signs and symptoms of Bcomplex vitamin deficiencies include :
- cracks in the corners of the mouth
referred to as cheilosis,
- inflammation,
- burning,
- redness,
- pain and swelling of the tongue.
Diet and Enamel Demineralization

Dental demineralization can result from
excessive tooth brushing,
regurgitation of stomach acid, as in the
eating disorder bulimia, or from excessive
consumption of acid-containing foods or
beverages.

The demineralizing effect of acid from the
diet is magnified in the presence of
xerostomia, because saliva helps to
neutralize acids and remove them from the
oral cavity.
 Dietary
sources of acid may
include ;
- citrus fruits and juices,
- acidogenic sports drinks,
- snacks containing citrus acid,
- carbonated beverages,
- chewable vitamin C tablets,
- excessive regurgitation of gastric
contents into the mouth.

Recently, attention has been focused on the
constant use of carbonated beverages, both
regular and diet.

Both contain acids and are possible contributors
to an increase in enamel demineralization, leading
to dental caries in young people.

It is important to differentiate this type of erosion
or demineralization from the caries process in
which acid produced from plaque bacteria
causes the enamel demineralization.
Diet
and Dental Caries
Role of Carbohydrates
Next lecture
Dental
caries is
a diet-related, infectious,
and transmissible
disease that is strongly
affected by diet.

Streptococcus mutans are the predominant
oral bacteria that initiate the caries process.

To development of clinical caries is
necessary the interaction of three local
factors in the mouth: a susceptible tooth,
cariogenic bacteria, and fermentable
carbohydrate.

Plaque bacteria ferment starches and
sugars, producing organic acids.
These acids demineralize dental enamel.
 Other
dietary factors counteract
the damaging effects of
carbohydrates.
 The
presence of protective
minerals and ions, such as
fluoride, calcium, and phosphorus
in plaque and saliva, promote
remineralization of incipient
lesions.

In addition to transporting minerals, saliva
contains buffering agents, bicarbonate and
phosphates, which neutralize organic acids.

Thus, the amount and composition of saliva
affect the caries process.

Other host factors that influence caries risk
include genetic predisposition, immune status,
malnutrition during tooth formation,
education level, and income status.
Caries-Protective Foods and
Nutrients

Some components of foods are protective
against dental caries - protein, fat,
phosphorus, and calcium inhibit caries .

Aged natural cheeses have been shown to be
cariostatic.
 The
protective effect of cheeses is
attributed to their texture, which stimulates
salivary flow, and their protein, calcium, and
phosphate content, which neutralizes plaque
acids.

Many dairy products are now fortified with
probiotic Lactobacillus rhamnosus GG,
which has been shown to have an inhibitory
affect on a wide range of bacteria including
Streptococcus species.

37% to 56% reduction in caries risk after
exposure, to these probiotic dairy products.

Fluoride found in drinking water, foods, and
dentifrices increase a tooth's resistance to
demineralization and enhance
remineralization of carious lesions.
 Lipids
seem to accelerate oral clearance of
food particles.
 Some
fatty acids, linoleic and oleic, in low
concentration, inhibit growth of mutans
streptococcus.
 Lectins,
proteins found in plants,
appear to interfere with microbial
colonization and may affect salivary function.
Measuring
the
Cariogenic Potential
of Foods
next lecture
Nutrition and Periodontal Diseases

Like caries, periodontal disease is an infectious
disease, is multifactorial in etiology, and occurs
when virulence of the bacterial challenge is
greater than the host defense and repair
capability.

The course of periodontal disease involves
periods of progression and remission.

Unlike the direct causative relationship between
carbohydrates and caries, nutritional factors seem
to play a much more subtle role in periodontal
status.

Nutritional factors can alter host susceptibility to
periodontal disease and/or modulate its progress.
 The
nutritional factors related to preventing
infection and enhancing wound healing in
general, applies to the prevention and
management of periodontal disease as
well.
 If
both challenges, and the defense and
repair capabilities of the periodontal tissues
are in balance, nutrition could be the
deciding factor in whether health or
disease results.

Even when the periodontium is healthy, there is
continual need for nutrients to maintain the
tissues.

Once inflammation is established, the need for
nutrients increases.

There is a close relationship between malnutrition
and infection, - infection aggravate malnutrition
and malnutrition help infection.

Host defense in the gingival crevice and
connective tissue requires an adequate intake of
all nutrients to ensure adequate production and
function of defense and supporting cells.

With the increased needs of cellular
immunity and the additional demands by
the tissue cells attempting to maintain
and repair damaged areas, a greater
supply of all nutrients is needed.

Epidemiologic research also indicates
that increasing intake of whole grains
may reduce the risk for periodontitis.

Whenever routine scaling, prophylaxis, and
oral plaque-control procedures fail to reverse
gingivitis and before any treatment for
periodontitis is attempted, a session
involving thorough diet evaluation and
patient counseling is indicated.

The patient should be informed about the
importance of systemic nutrition in the defense
and repair of oral tissues.

Recommendations should be made to help
ensure optimal nutrition to help prevent
and manage periodontal disease.
end
Importance of Diet Assessment and
Counseling in Dentistry
Question
 1 What are appropriate nutrition interventions for
dental clinicians?
 A. Assess patients' nutritional status using laboratory
and other biochemical assessment tools.
 B. Screen patients for nutritional risk.
 C. Recognize dietary problems in denture patients.
 D. Provide diet guidance related to oral health.

1. b, c, and d correct. a incorrect. It is not appropriate
or possible for the dental team to attempt to assess
actual nutritional status. This requires sophisticated
laboratory testing under the supervision of a qualified
medical professional.
The Basis for a Healthy
Diet Dietary Reference Intakes
Dietary Guidelines for Americans
Food Guide Pyramid Food Labels
Question 2
 The Daily Reference Intakes (DRI) are set at:
 A. the minimum amount of a nutrient needed to prevent
deficiency.
 B. the maximum amount that will not cause toxicity.
 C. the average estimated requirement for healthy people.
 D. the average requirement plus a margin of safety.

2. d correct. a incorrect. The minimum amount of a nutrient
needed to prevent deficiency is not considered an appropriate
standard of adequacy b incorrect. The maximum amount of a
nutrient that will not cause toxicity is the UL or upper tolerable limit
c incorrect. The average estimated requirement for healthy people
would mean that half of the population would require more. Thus it is
not used as the criteria for healthy populations
Nutrition in the Development and Integrity of Oral Tissues
and Structures
Protein/Calorie Malnutrition, Minerals , Vitamins
Question 3 Which is true about vitamins and oral health?
A. Vitamin-C-deficient wounds heal as well as nonvitamin-C-deficient wounds
B. B. Vitamin A-toxicity does not have oral effects C.
The oral manifestations of vitaminC. C deficiency are related to defects in collagen
formation
D. D. Effects of deficiency and toxicity are best studied
in humans

3. c correct. a incorrect. Vitamin C-deficient wounds
have poorer healing ability b incorrect. Vitamin-C
deficiency affects all epithelial tissues including those in
the oral cavity d incorrect. It is not ethical to conduct
such studies in humans
Diet and Nutrition in Oral Conditions: Background and
Counseling Strategies Who Needs Diet Guidance
Caries Prevention







Question 4 The diet assessment process in dentistry is designed
to: A. diagnose nutrient deficiencies
B. help screen patients for oral-health risk factors
C. serve as a teaching tool
D. determine patients' daily caloric intake
E. provide a therapeutic diet prescription for patients
F. be part of total preventive assessment
4. b, c, and f correct. a incorrect. The diet assessment process can
be used to screen patients for possible nutrition risk, but cannot be
used for true nutritional assessment d incorrect. Daily calorie intake
cannot be determined using a diet screening tool. Patient's daily
calorie intake is best assessed by a registered dietitian using an
assessment tool designed for that purpose. e incorrect. The dental
team can use screening information to refer the patient to a registered
dietitian who is qualified to provide therapeutic diets. The dental team
can provide nutrition information about healthy diet and diet/oral health
relationships.
Dental Caries: Role of Carbohydrates in Caries Development
Effects of Eating Patterns and Physical Form of Foods ( next lecture)
Question 5.
In the diet of a patient with rampant dental caries, which is
most relevant to the problem?
A. otal amount of sucrose consumed
B. total amount of sticky sweets consumed
C. nutrient quality of the meals and snacks
D. number of meals and snacks
E. what is eaten for desert in the evening
5. d correct a incorrect. Sucrose is not the only cariogenic factor,
and the amount is not as important as the distribution in the diet.
b incorrect. The amount of sticky sweets is not as relevant as
the frequency of usage of these items. c incorrect. The nutrient
quality of the diet is only related to the caries process after tooth
eruption through remineralization effects. e incorrect. Dessert
is only one of many contributing factors to dental caries.
Measuring the Cariogenic Potential of Foods
Question 6
Tooth erosion can be caused by
A. acid from vomiting
B. sugar-containing carbonated beverages
C. gastro-esophageal reflux
D. sugar-free carbonated beverages
E. all of the above
6. e correct. Tooth erosion can be caused by acid
from vomiting, sugar-containing carbonated
beverages, gastroesophageal reflux, and sugarfree carbonated beverages to name but a few
factors.
Early Childhood Caries
Nutrition and Periodontal Disease
Diet Guidelines
Question 7 Periodontal disease is caused by dietary
deficiencies. Calcium deficiency is thought to be
a contributing factor in alveolar bone loss in
humans.
A. both statements are true.
B. both statements are false.
C. the first statement is true: the second is false.
D. the first statement is false the second is true.
7. d correct. Periodontal disease is not caused by
dietary deficiencies. However, calcium deficiency is
thought to be a contributing factor to alveolar bone
loss in humans.
Eating Disorders
Question 8
Oral problems that may be seen in patients with
eating disorders include:
A. swollen salivary glands
B. orange-stained teeth
C. decreased salivary flow
D. decreased oral pH
E. severe enamel demineralization
8. a, c, d, e correct. b incorrect. Orange-stained teeth
are not necessarily caused by eating disorders. The
staining can come from food, beverages, or other
sources.