Diet & Dietary
Analysis
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The Link…
Oral health is closely linked to an
individual’s diet and nutritional status.
Nutrition is a vital factor---
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The Link…
• Throughout life, nutritional deficiencies or
toxicities can affect host resistance, healing,
oral function, and oral-tissue integrity
• Growth, development, and maintenance of
oral structures and tissues are dependent on
nutrition
A little history….. Before your time
http://www.choosemyplate.gov/foodgroups/downloads/MyPlate/ABriefHistoryOfUSDAFoodGuides.pdf
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More about the “Plate”
*even have it in spanish!
Lots of resources online
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http://www.choosemyplate.gov/supertracker-tools.html
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link
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Which one is “better?”
What influences the recommendations
made?
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Other resources….
• http://www.livestrong.com/article/278187free-online-nutrition-analysis/
• http://www.myfitnesspal.com/food/caloriechart-nutrition-facts
Dietary Guidelines for Americans
2010
Organized in “chapters”
-good resource
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Overview of
Nutrients
A review from Nutrition class…. the very basics….!?!?
Well…. maybe
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Oral Manifestations- Underlying
Nutritional Deficiency?
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Oral Lesions- Underlying Nutritional
Deficiency?
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Deficiency versus excess: VITAMINS
VITAMIN
DEFICIENCY OR EXCESS
Vitamin C
Asorbic acid
Collagen synthesis- helps with use/absorption of iron, B12 & folic acid; connective tissue synthesis; cell protector
Deficiency: Scurvy-red swollen gingiva; gingival friability- spontaneous bleeding; periodontal destruction- including loose teeth; soft tissue
ulceration; increased risk of candidiasis; malformed teeth (odontoblast/dentin); petechial hemorrages/gingivitis; cyanotic gingival tissues;
essential for collagen formation (fibroblasts & odontoblasts too); slow wound healing
Excess: Body increases metabolism of vitamin C when taken in excess; no oral effects noted
Vitamin D
Promotes growth & mineralization of bones/teeth; increases absorption calcium
Deficiency: Abnormal bone regeneration (failure of bone to heal), osteoporosis; incomplete mineralization of teeth - (hypoplasia); rickets in
children; osteomalacia in adults; delayed eruption; high caries rate; loss of lamina dura
Excess: Pulp calcification; enamel hypoplasia
Vitamin K
Vital for blood clotting; involved in formation of prothrombin
Deficiency: Increased risk of bleeding/gingival hemorraging; increased risk of candida
Vitamin A
Antioxidant- maintains epithelial tissues; involved in bone growth & remodeling; important for vision
Deficiency: faulty bone & teeth formation, disturbed or arrested enamel development (ameloblast)- hypoplasia, keratosis, increased risk of
candidiasis; gingival hypertrophy & inflammation; leukoplakia; decreased taste sensitivity; xerostomia; irregular tubular dentin formation and
increased caries risk, cleft lip, salivary gland hardening/drying; cell differentiation impaired;
Excess: cracking/bleeding lips, erythremic gingiva, cheilosis, hypertrophy of bone
Riboflavin B2
Coenzyme in metabolism carbs, protein, fat
Deficiency: Angular cheilosis; atrophy of filiform papillae; enlarged fungiform papillae; shiny red lips; sore tongue (glossitis);
blue-to-purple mucosa; magenta tongue
Vitamin E
Antioxidant; involved in cellular respiration
Deficiency: loss of resistance to inflammation
Niacin B3
Coenzyme in energy production
Deficiency: mucositis; stomatitis; oral pain; ulcerative gingivitis; tip of tongue is red & swollen; dorsum is dry & smooth (loss of
filiform/fungiform); beefy sore tongue
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Deficiency versus excess: VITAMINS
VITAMIN
DEFICIENCY OR EXCESS
Folic acid (Folate)
Involved in RNA & DNA synthesis- also WBC/RBC formation
Deficiency: Angular cheilosis; mucositis; stomatitis; sore or burning mouth; increased risk of candidiasis; inflamed gingiva; glossitis oral
pain; ulceration- buccal mucosa/ gingivitis; denuded tongue; glossitis; glossodynia; tip or borders of tongue red & swollen; apthous
ulcers; neural tube defects- very important for expectant mothers
B6
Pyridoxine
Coenzyme in amino acid metabolism; role in hemoglobin
Deficiency: Angular cheilosis; sore or burning mouth; glossitis; glossodynia; stomatitis
B12
Cobalamin
Coenzyme for metabolism; important in RBC formation & DNA synthesis
Deficiency: Angular cheilosis; mucositis; stomatitis; hemorrhage gingiva; halitosis; epithelial dysplasia of oral mucosa; oral parethesia;
detachment of periodontal fibers; loss or distortion of taste; parasthesia; glossitis; ulcerative gingivitis; denuded tongue; glossodynia;
tongue is "beefy", red, smooth, glossy & sore; delayed wound healing; xerostomia; bone loss; apthous ulcers; pernicious anemia; paleyellow mucosa
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MINERALS
MINERAL
Fluoride
DEFICIENCY OR EXCESS
Deficiency: Decreased resistance to caries
Excess: Disturbed amelogenesis; mottled/stained enamel; enamel hypoplasia (fluorosis)
Iron
Deficiency: Angular cheilosis; pallor of lips and oral mucosa; sore, burning tongue; atrophy/denudation of filliform papillae; increased risk of
candidiasis; glossitis around margins, anemia; fatigue; decreased immunity; thinning/ulcerated tissues
Important for synthesis of hemoglobin; essential for immune function; most common deficiency in US
Calcium
Deficiency: Incomplete mineralization of teeth (hypomineralization), rickets; osteomalacia (bone softening); osteoporosis; excessive bone
resorption & bone fragility; increased tendency to hemorrhage; increased tooth mobility & premature loss; delayed eruption; less than 1/3
intake absorbed esp with excess wheat/fiber – important for woman as they age- helps with muscle contraction & nerve impulse
Copper
Deficiency: Decreased trabeculae of alveolar bone; poor growth, low WBC, anemia; decreased tissue vascularity; increased tissue fragility
Zinc
Deficiency: Loss or distortion of taste & smell acuity; loss of tongue sensation; defective keratinization of tissues, delayed wound healing &
growth; impaired keratinization of epithelial cells, increased susceptibility to periodontal disease & infection, candidiasis
Required by cells- tissue growth & repair; regulates inflammation
Magnesium
Deficiency: Alveolar bone fragility; gingival hypertrophy & atrophy ameloblast/odontoblasts; tremors, cardiac arrhythmias, muscle spasms,
convulsions; widening of perio ligament
Phosphorus
Deficiency: Incomplete mineralization/calcification of teeth; increased susceptibility to caries if deficient during tooth formation; increased
susceptibility to periodontal disease due to effects on alveolar bone
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OTHER NUTRIENTS
NUTRIENT
Carbohydrate
DEFICIENCY OR EXCESS
Energy– brain food
Deficiency: Caries rate generally decreases when carbohydrate intakes decreases
Excess: Increased frequency of intake of all carbohydrates is a causative risk factor for caries
Fats
Source of energy; cariostatic
Deficiency: difficult to have
Excess: No direct effect orally but fats may coat teeth and protect them againts cariogenic challenge; if
excess physically = obesity
Protein
Source of energy- esp when carb intake low; cariostatic; promotes growth, maint, & synthesis of body
tissues
Deficiency: Defects in tooth composition, eruption pattern delayed & resistance to decay lowered due to
increase in tooth enamel solubility; increased susceptibility to soft tissue infection, poor healing/tissue
regeneration due to impaired immune system; kwashiorkor if severe (3rd world)
Water
Hydration & electrolyte balance
Deficiency: Dehydration and fragility of epithelial tissue; decreased muscle strength for chewing; xerostomia;
dry skin; burning/fissured tongue; common in elderly (lots meds)
from Modern Nutrition in Health and Disease (9th ed) Editors: Shils; Olsen; Shike & Ross. Published by Williams & Wilkins.
Mosby’s Review of DH 7th edition; Mosby’s Dental hygiene case 2nd edition
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Role of Nutrition in Periodontal
Disease
*Malnutrition compromises tissue regeneration and healing which
increases susceptibility to oral disease
*Certain nutritional deficiencies can modify gingival tissue resistance so that
an inflammatory condition (initiated by BIOFILM) may be accelerated or
increased in intensity
*The effects of periodontal infection
can alter the capacity of the tissues
to utilize available nutrients-therefore,
potential for healing and repair is
modified
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Role of Nutrition in Periodontal
Disease
Vitamin C-- effects collagen; immunity– increased risk of deficiency
in smokers; increase risk for perio
Zinc- response to inflammation; increase permeability tissues
if deficient
Protein- poor healing/regeneration; impairs immune system
Calcium- increased risk for disease (bone)
Others? B complex, Vitamin A, etc…
Important to counsel PERIO pts on proper nutrition
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Nutrition for a lifetime- through the
Life Cycle…..
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The Diabetic Patient
 Meals and snacks at regularly scheduled intervals, coordinated with
medication and exercise
 Use of cariogenic fermentable carbohydrates should be infrequent
 Looks at “carbs” not just sugars
 Uncontrolled should be referred to M.D.- although even controlled
should be under care of physician and nutrition professional
 Heal slower/periodontal disease can exacerbate diabetes control
 Periodontal disease much more advanced, harder to get control of &
treat
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The Aging Patient
Considered particularly susceptible to malnutritionWHY?
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Aging Issues
 Impaired taste and smell
 Impaired absorption/digestion
 Impaired hunger/thirst “mechanisms”
 Dentures/partials
 Xerostomia
 Nutrient deficiencies
 Lifestyle (living alone, access issues, fixed income, etc….)
 Thorough EOIOE needed (increased risk OC)
 Other?
Thirsty?
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Obesity
According to the National Center for Health Statistics, the
number of overweight children has more than doubled
since the 1960’s.
Children who gain too much weight are at high risk for
developing risks for heart disease- and Type II Diabetes.
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BMI
QUIZ…..
“Portion Distortion”
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*drink more calories = consume more
calories in general = overweight/obesity
Food labels
How many “servings”
for this item?
Based on 2000 calorie and
sometimes 2300 calorie diet!
Can = 1900 mg sodium!
1 serving= ½ (520 cal)
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What about SALT?
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Why is it in foods?
Is it habitual? Is it related to weight?
What should I limit my diet to (in mgs)?
Do organic foods or low fat foods usually have higher or
lower salt?
 What recommendations can I make to patients?
The Vegetarian, Vegan Diet & Others?
Can be extremely nutritious, since it is high in fiber
and low in saturated fats
However, care must be taken to get all nutrients
needed for health
Key is- balance & varied diet (not replacing meat
with processed foods)
Other things to consider . . . ?
Tips for Vegetarians
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Vitamin Supplements
Never going to supplement what you get from a balanced diet! However,
most don’t have balanced diet– so multivitamin can be helpful
(Up to 40% of adults have inadequate dietary intake of 3 or more nutrients)
People tend to overuse supplements- can be detrimental & cost $$$
Vitamins should not exceed the recommended dosage and take in forms
which can be metabolized properly
Be wary of health claims! Many, many NOT standardized or backed by
scientific research
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Herbal Alternatives
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Interactions?
OTC and herbal supplements have their
own adverse reactions just like Rx
medications
OTC and herbal supplements interact with
Rx medications and with each other
Herbal supplements are not regulated by
the FDA as OTC and Rx medications are
Lack scientific studies
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May increase the risk of bleeding
– Garlic*
– Ginger*
– Gingko biloba*
– Ginseng*
– Green tea
May induce coagulation
– Vitamin K
– Goldenseal
– Dong quai
– Garlic
These may increase blood pressure
– Green tea
– Ephedra/ma huang
– Ginseng*
– Licorice
– Guarana
*These agents have multiple adverse reactions
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St. John’s Wort also contraindicated with psychoactive drugs, warfarin,
estrogen, iron, & oral contraceptives
Several have effects on blood glucose levels
Melatonin may exaggerate an autoimmune response and suppress fertility
T or F?
Herbal supplements are very safe to the human body because they
are made from plants and other compounds naturally occurring in nature and are
highly regulated by the FDA.
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Eating Disorders
• Anorexia nervosa: self-starvation and excessive
weight loss
• Bulimia nervosa: usually secretive cycles of binge
eating extremely large quantities of food followed
by purging through vomiting
• Binge-eating disorder (BED): has periods of
uncontrolled, continuous eating much like
bulimia, but no purging is involved. Body weight
varies greatly in this group
Local support
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Eating Disorders
What is the hygienist’s role?
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Treatment
– Question patient regarding oral findings
– Be nonconfrontational
– Do not brush after vomiting (use alkaline rinse of
sodium bicarbonate or magnesium hydroxide
solution to neutralize acid)
– Reduce acidic foods/drinks
– Recommend saliva substitutes w/ fluoride
– Chew sugar free gum
– Use fluoride/sens dentifrice, mouth rinse, and
varnish for hypersensitivity