Transcript diet counselling

L
O
V
E
L
Y
T
H
I
N
G
S
You like to
have!!!!!!
BUT, through these you send me my
enemies….
Ha!ha!ha!
Ha!ha!ha!
THE GERMS
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
 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
 Breast feeding of infants to ensure best
possible
health
,
developmental
psychosocial outcomes
and
 Educating people about association between
frequent consumption of carbohydrates and
caries
 Educating people about other health risks
associated with excess consumption
carbohydrates , fats and sodium
of
1) 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
 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 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.
Personal data
Likes and dislikes
GATHERING
INFORMATION
Cause of problem
Suggest diet diary
EVALUATE AND INTERPRET INFORMATION
Nutritional adequacy of diet
Amount of sugary foods
Frequency of sugary foods
Personal and social history
Medical history
Systemic and environmental factors
Gradual, qualitative changes in diet
Gradually eliminate sugary foods
Avoid patient dislikes
Prescribed diet should vary from normal diet pattern as little as possible
Nutritionally balanced diet
Increase intake of protective and detergent foods – fruits, vegetables, cheese, etc
Patient encouraged to involve himself in diet
monitoring and suggest changes in menu
REGULAR FOLLOW – UP
To
monitor
progress
Make
changes
To clarify
doubts
To motivate
and
encourage
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
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 Factors
Children 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
The increment of active lesions, including
new and recurrent lesions that occur over a
stated period of time
 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.
1)
2)
3)
4)
5)
6)
Lactobacillus colony count test
Calorimetric snyder test
Swab test
Streptoccocus mutans levels in saliva
Salivary buffer capacity
Enamel solubility test
7)
Saliva reductase test
8)
Albans test
9)
Fosdick calcium dissolution test
10)
Dewar test
11)
Cariostat 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.
LACTOBACILLUS COLONY COUNT TEST
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
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
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.
CALORIMETRIC SNYDER 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
Colour
Caries activity
Colour
Caries activity
Time, Hours
24
48
Yellow
Yellow
Marked
Definite
Green
Green
Continue test Continue test
72
Yellow
Limited
Green
Inactive
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.
THE SWAB TEST
Interpretation :
pH 4.1 and < 4.1
pH 4.2 to 4.4
pH 4.5 to 4.6
pH 4.6 and over
= Marked caries activity
= Active
= Slightly active
= Caries active
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.
STREPTOCOCCUS MUTANS LEVELS IN SALIVA
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
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.
SALIVARY BUFFER CAPACITY
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.
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.
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
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
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.
ALBAN TEST
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
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
= ‘3/4’
= ‘+’
= ‘++’
= ‘+++’
= ‘++++’
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”.
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
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.
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
CARIOSTAT TEST
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.
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.