Oral& Dental Health Lecture Slides

8/17/2019 Oral& Dental Health Lecture Slides

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Nutrition for Oral and Dental

Health


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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


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Effects of Nutrient Deficiencies on

Tooth Development


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Dental and Oral Health

♦ Teeth are made from protein matri that is

minerali!ed "ith collagen #re$uiring vitamin

%&' calcium' and phosphorus #re$uiring

vitamins D and (&


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(natomy of a Tooth


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Dental %aries

♦ )nfectious disease of teeth in "hich organic

acid meta*olites lead to gradual

deminerali!ation of enamel+ proteolytic

destruction of tooth structure

♦(ny tooth surface can *e affected,


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The Decay Process

♦ Pla$ue formation- sticky mi of microorganisms' protein' polysaccharides

♦ Bacteria meta*oli!ing fermenta*le car*ohydrate

produce acid♦ (cid production- oral pH./,/ allo"s tooth

deminerali!ation

♦ 0aliva function- rinses a"ay food+ neutrali!es

acid+ promotes reminerali!ation♦ %aries patterns-pattern depends on cause


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Early %hildhood %aries

♦(lso called 1*a*y *ottle tooth decay2

♦ Nursing *ottle caries—putting *a*y to *ed

"ith a *ottle of s"eetened li$uid #3uice'

4ool5(id' etc,&

♦ 6ront teeth rapidly develop caries

♦ %ommon among Native (mericans

♦7ean children *efore age 8 from *ottle


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Early %hildhood %aries

(From Swartz MH. Textbook of Physical Diagnosis, History, an !xamination, "r e. Philael#hia$ %.&. Sa'ners, ))*.+


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Dental %aries—cont9d

♦ Streptococcus mutans —most common

*acteria involved♦6ermenta*le %ar*ohydrate

♦Time

♦Drop in salivary pH to *elo" /,/


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Dental %aries—cont9d♦ %ariogenicity of foods

♦ 6re$uency of consumption of fermenta*le

%ar*ohydrate

♦ 6ood form—slo"ly dissolving

♦ 6ood com*inations

♦ Nutrient composition of food:*everages

♦ Timing #end of meal&


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;edical 0e$uelae of Dental %aries

♦Bacteria from tooth decay can enter

*loodstream and inoculate heart valves'

cause *acterial endocarditis

♦Oral5pharyngeal secretions inoculated "ith

*acteria can cause aspiration pneumonia


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6luoride

♦Primary anticaries agent

♦7ater fluoridation

♦6luoridated toothpastes♦Oral rinses

♦Dentrifices

♦Beverages made "ith fluoridated "ater


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%ariogenic vs, %ariostatic

♦ %ariogenic- containing fermenta*lecar*ohydrates that can cause a decrease insalivary pH to ./,/ and deminerali!ation "hen

in contact "ith microorganisms in the mouth+ promoting caries development

♦ %ariostatic- not meta*oli!ed *ymicroorganisms in pla$ue to cause a drop insalivary pH to ./,/


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%ariogenic 6oods

♦Promote formation of caries

♦6ermenta*le car*ohydrates' those thatcan *e *roken do"n *y salivary amylase

♦


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%ariostatic 6oods

♦6oods that do not contri*ute to decay

♦Do not cause a drop in salivary pH

♦ )ncludes protein foods' eggs' fish' meat and poultry+ most vegeta*les' fats' sugarless

gums


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(nticariogenic 6oods

♦Prevent pla$ue from recogni!ing an

acidogenic food "hen it is eaten first

♦

;ay increase salivation or haveantimicro*ial activity

♦ )ncludes ylitol #s"eetener in sugarless

gum& and cheeses


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Other 6actors that (ffect Diet

%arogenicity♦ %onsistency- =i$uids are cleared $uickly "hilesticky foods remain on the teeth

♦ ;eal fre$uency- fre$uent meals and snacks

increase duration of eposure♦ 6ood composition

♦ 6ood form- li$uid' solid' slo"ly dissolving

♦ 0e$uence of eating- cheese or milk at the end ofthe meal decrease the cariogenicity of the meal


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%aries Prevention Guidelines


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Periodontal Disease♦ )nflammation of the gingiva "ith destruction

of the tooth attachment apparatus

♦Gingivitis—early form

♦ Nutritional care involves increasing vitamin %'

folate' and !inc


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Tooth =oss and Dentures

♦ Tooth loss—denture placement

♦ 6ood selections change

♦ 0aliva production decreases

♦


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Oral ;anifestations of Disease

♦ 0tomatitis-

inflammation of oral

mucosa

♦ %andidiasis and herpessimple- fungal and

viral infections "hich

can affect mouth and

esophagus causing

pain and dysphagia

Photo- http-::"e*pages,marshall,edu:>gain:*actnote:)mage?,gif


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Oral ;anifestations of Disease

♦@erostomia- Dry mouth♦Periodontal disease

♦4aposi9s sarcoma—lesions in mouth and

esophagus+ associated "ith ()D0

4aposi9s 0arcoma

in ()D0


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;NT for ;outh Pain:

Oral )nfections♦(void acidic and spicy foods♦Offer soft' cold' nutrient dense foods such

as canned fruit' ice cream' yogurt' cottage

cheese

♦Try oral supplements

♦

Ase PEG or NG feeding if oralsupplementation is unsuccessful

♦6or erostomia' try artificial salivas' citrus

*everages' sugar free candies or gums


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;edications That ;ay %ause

@erostomia


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Dental Health (ffects Nutrition

♦ Tooth loss may affect a*ility to che"

#relationship *et"een loss of teeth and

reduced intake of fruits and vegeta*les

♦ Dentures are often ill5fitting #especiallycommon after "eight loss&+ pro*lem foods

include fresh fruits and vegeta*les' che"y

and crusty *reads and che"y meat like

steak


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)nterventions

♦O*tain a dental consult- if dentures are

missing' find them, )f they are loose'

replace or reline them

♦;odify diet consistency- mechanical soft'

ground' pureed

♦Ase least restrictive diet possi*le+

individuali!e+ mi consistencies if

appropriate


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;NT for 7ired or Broken a"

♦ Provide pureed' strained' or *lenderi!ed foods asappropriate

♦ Encourage nutrient5dense foods such as

*lenderi!ed casseroles♦


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Dysphagia C difficulty

s"allo"ing♦ ;echanical causes

Trauma to esophagus "ith scar tissue

)nelasticity due to repeated inflammation

Tumor of esophagus

(neurism of aorta


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Dysphagia C difficulty

s"allo"ing Neuromuscular causes

♦ %(' *rain tumors♦ Head in3ury

♦ Parkinson9s disease' ;0' (=0

♦ (chalasia #cardiospasm&

♦ 0pinal cord in3ury


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Dysphagia♦ Oral phase pro*lems

Pocketing food

Drinking from cup or stra"

Drooling♦ Pharyngeal phase

Gagging

%hoking

Nasal regurgitation♦ Esophageal phase

O*struction


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0ymptoms of Dysphagia

♦ Drooling' choking' coughing during orafter meals

♦

)na*ility to suck from a stra"♦ Holding pockets of food in cheeks #pt

may *e una"are&♦ (*sent gag refle

♦ %hronic upper respiratory infections♦ Gargly voice $uality or moist cough

after eating


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Diagnosis of Dysphagia♦ Nerve assessment

♦ @5rays

♦

6luoroscopic s"allo" study- *ariums"allo":cookie s"allo"

♦ ;easurement of esophageal sphincter

pressure and peristalsis


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(spiration♦ )nhalation of food' li$uid into lungs

♦ %an cause aspiration pneumonia

♦

(ppears to *e dose5dependent♦ ( ma3or cause of aspiration pneumonia

is thought to *e aspiration of

oropharyngeal secretions' particularly ifcontaminated *y *acteria


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;NT for Dysphagia

#National Dysphagia Diet&)ntervention depends on severity of deficit

♦ ;ealtime supervision' cueing

♦ Thickened li$uids- thin F nectarlike F

honeylike F spoon thick

♦ (ltered consistency-

=evel - pureed

=evel 8- mechanically altered

=evel - advanced


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;NT for Dysphagia♦ )n severe cases' patient may

*e made NPO and enteral

feedings initiated


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National Dysphagia Diet♦ NDD diets are more restrictive than dental

consistency diets+ may "ish to use more

li*eral diet for edentulous patients

♦ Developed *y consensus committee+ no

evidence as yet that it is effective in

preventing aspiration

♦ Provides much5needed standardi!ation


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0trategies for )mproving

(cceptance♦ Thickened li$uids- commercial productscan improve $uality and consistency of

thickened li$uids

♦ 0easoning- persons "ith dysphagia oftenhave dulled sense of taste, 0erve seasoned

foods such as spaghetti' chili' apple pie

♦ Piping and molding- pureed foods can *ethickened and molded for more attractive

appearance


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Dysphagia Diet )ssues♦ Patients on altered

consistencies tend to eat

less and often lose

"eight♦ Patients on thickened

li$uids are at risk for

dehydration♦

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