Transcript Nutrition for Oral and Dental Health

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 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 caries
• Common among Native Americans
• Wean children before age 2 from bottle
Early 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
Carbohydrate
• Food form—slowly dissolving
• Food combinations
• Nutrient composition of food/beverages
• Timing (end of meal)
Fluoride
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Primary anticaries agent
Water fluoridation
Fluoridated toothpastes
Oral rinses
Dentrifices
Beverages made with fluoridated water
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: 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 form
• Nutritional care involves increasing vitamin C,
folate, and zinc
Tooth Loss and Dentures
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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
• Xerostomia: Dry mouth
• Periodontal disease
• Kaposi’s sarcoma—lesions in mouth and
esophagus
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
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 (especially
common after weight loss); 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
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