Transcript nutritional aspects of gingivitis and periodontal disease

NUTRITIONAL ASPECTS OF
GINGIVITIS AND PERIODONTAL
DISEASE
CHAPTER 18
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Introduction
 Nutrient deficiencies, excesses,
or imbalances do not initiate
periodontal disease nor do
megadoses of supplements cure
or prevent periodontal disease
 However, nutrition may alter
development, resistance, and/or
repair of the periodontium
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
From Bird DL, Robinson DS: Torres and
Ehlrlich Modern Dental Assisting, ed 9. St.
Louis: Saunders, 2009.
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DEFINITIONS
Gingivitis
Periodontal Disease
 Present:
 Chronic inflammation
Inflammation
 Swelling
 plaque accumulation
 possible calculus
accumulation
 bleeding on probing
 Not present:
 attachment loss,
 connective tissue loss
 bone loss
 Communicable infection

 Loss of connective tissue
 Bone loss
 Gingival bleeding
 Pain
 Supppuration
Leading cause of tooth loss in
adults over 35 years
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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PERIODONTAL DISEASE AS A
HEALTH RISK
 Causes increased risk for:
1. Cardiovascular disease
2. Stroke
3. Premature births
4. Respiratory infections
5. Diabetic problems

High glucose levels with uncontrolled diabetes
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Physical Effects of Food on Periodontal Health
 An imbalance of one or more
nutrients can be a factor in
disruption of tissue integrity
and immune response
 Normal growth and
development of periodontal
and oral tissues need:



Vitamin A
 (salivary glands, epithelial
tissue)
Vitamin C
 (collagen, connective tissue)
Vitamin B-complex
 (epithelial, connective tissue)
 Calcification of bone and
cementum requires:

Amino acids, calcium,
phosphorus, vitamin D, and
magnesium
 Maintenance of oral tissues,
immunity and repair
responses requires:







Vitamins A, C, and D
Proteins
Carbohydrates
Calcium
Iron
Zinc
Folic acid
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Physical Effects of Food on
Periodontal Health
 Food consistency
 Chewing firm, coarse, and fibrous
foods, such as raw fruits and
vegetables, stimulates saliva flow

The increase in saliva will enhance oral
clearance of food and reduce food
retention
 Plaque biofilm is not physically
removed by eating firm foods,
but soft, sticky foods may increase
accumulation of food.
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Nutritional Considerations for
Periodontal Patients
 Increased nutrients and energy are required by periodontal
patients experiencing:
 Stress
 Tissue catabolism
 Infection
 Medical and social history can indicate
whether patient at risk for nutrient deficiencies
 i.e.; alcoholism, anorexia
 Dietary counseling of all periodontal patients enhances:
 Tissue repair and wound healing
 Resistance to infection
 Reduction in number/severity of complications
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Gingivitis
 Gingivitis may develop with the combination of local factors
and systemic factors.
 Systemic factors:
 Immunocompromised system (AIDS)
 Medications
 Hormonal changes (pregnancy, puberty)
 Vitamin C deficiency
 A lack of nutrients does not cause gingival inflammation but
may be a predisposing factor in that it disrupts the process
of tissue repair
 Encourage vitamin C–rich foods and well-balanced, nutrientdense diet using MyPyramid as a guide
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Chronic Periodontitis
 Initiation and progression of periodontitis do not occur unless
plaque biofilm is present
 Excess glucose and sucrose also results in an increased rate of
bacterial growth in early stages of biofilm development
 Certain types of food (soft, retentive, and/or a fermentable
carbohydrate) can enhance food retention and severity of
gingival inflammation
 Nutritional status determines the immunocompetence of the
periodontium
 Intake of nutrients beyond the recommended amount does
not improve or speed up healing and may be detrimental
 Maintain nutritional diet; avoid retentive foods
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Chronic Periodontitis: Periodontal
Surgery Preoperative
 Immunological competency is important for optimal healing
 Conduct preliminary assessment of patient for adequate
nutrient reserves
 An elective surgery may need to be postponed for 1 or 2
weeks to allow nutritional status to be improved in a patient
with poor nutrition
 Medically compromised patient should be referred to a
registered dietitian
 Patient should be given tailored meal plan listing nutrientdense foods and beverages (e.g.;Ensure) to
choose/consume during recovery
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Chronic Periodontitis: Periodontal Surgery Postop
 Adequate nutrient intake by the patient is required, following
periodontal surgery, due to:
 Blood loss
 Increased catabolism, tissue regeneration
 Host defense activities
 Dietary intake can be influenced by complications of anorexia,
nausea, dysphagia, and oral discomfort
 Full-liquid diet

If patient is unable to chew (by cup-no straw)
 Mechanical soft diet (p. 358, Box 18-3)
 If chewing is compromised
 For Perio dressing, no hard, sticky, or brittle foods, soft diet
for 1-2 days, cool liquids for 1st 24 hrs to harden dressing
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Necrotizing Periodontal Diseases
 Nutrient deficiencies, such as protein or Vitamin C and/or B-
complex deficiency, are contributing factors to NUG
because of lowered host resistance
 Those with NUG may lose the desire to eat because of pain or may
choose soft foods that are easier to eat
 Tissue infection and destruction increase requirements for
all nutrients
 When fever is present, a 12% increase in energy and nutrients is
recommended for each degree above normal body temperature
 Severity of NUG determines initial dietary recommendations
 Liquid nutrition supplements may be
needed until a regular diet can be
resumed
From Perry DA, Beemsterboer P: Periodontology
for the Dental Hygienist, ed 2. St. Louis:
Saunders, 2007.
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Necrotizing Periodontal Diseases
 Dental hygiene considerations
 While ulcerations are present, encourage bland,
soothing foods (such as gelatin, pudding) and
avoidance of spicy and acidic foods (such as citrus
fruits and tomatoes)
 A liquid diet may be needed initially with advancement
to a mechanical soft diet followed by a regular diet,
depending on the patient’s tolerance and comfort
 Cooler-temperature foods are more soothing when
ulcerations are present
 Referral to an RD may be indicated
Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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