CHAPTER 20CHAPTER 20
NUTRITIONAL ASPECTS OF NUTRITIONAL ASPECTS OF ALTERATIONS IN THE ORAL ALTERATIONS IN THE ORAL
CAVITYCAVITY
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
2
OrthodonticsIncreased risk for:
DecalcificationGingival inflammationSoft tissue trauma from
orthodontic appliancesRoot resorptionAccumulation of food debris in
brackets/wiresChaotic meal patterns and snack habits
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
3
OrthodonticsDental hygiene considerations
After initial placement, adjustments or repair of orthodontics may require a liquid or mechanical soft diet for 1 to 2 days
Emphasize importance of oral self-care, daily fluoride use, and possibly an alcohol-free antimicrobial rinse
Soft drinks, energy drinks, and sports drinks with fermentable carbohydrate, along with citric acid, should be avoided to minimize enamel decalcification
Adequate nutritional intake is indispensable for maintenance and repair of hard and soft tissue to withstand stresses of tooth movement
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
4
XerostomiaCommon factors contributing to xerostomia
Drug-induced More than 400 commonly used drugs can cause xerostomia
Diseases Autoimmune diseases: Sjögren’s syndrome, SLE (lupus),
rheumatoid arthritis Chronic diseases: diabetes mellitus Psychogenic causes: depression, anxiety, stress, or fear
Head and neck radiation
From Ibsen OAC, Phelan JA: Oral From Ibsen OAC, Phelan JA: Oral Pathology for the Dental Hygienist, ed 5. Pathology for the Dental Hygienist, ed 5.
St. Louis: Saunders, 2009.St. Louis: Saunders, 2009.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
5
XerostomiaDental hygiene considerations
Carefully assess adequacy of overall diet with particular attention to intake of vitamins A, B6, and C, fluid, fiber, potassium, iron, calcium, zinc, and protein
Counsel the patient about techniques/products to relieve symptoms of xerostomia
Avoid dry (saltines), crumbly (whole wheat muffins), sticky (peanut butter), and spicy (chili) food; alcohol; commercial mouthwashes containing alcohol; tobacco
Use gravies and sauces to moisten dry foodsChoose nutrient-dense, soft, moist foods (macaroni
and cheese, cottage cheese, applesauce)
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
6
Root Caries and Dentin Hypersensitivity
Root cariesParticularly susceptible to decay is area around the
CEJ, because it has anatomically thin layer of enamel, and cementum, which is thinner and contains fewer minerals than enamel
Dentin hypersensitivityErosion is major cause and often occurs as result of
exposure to acids such as those in food and beverages, as well as acid from GERD
From Bird DL, Robinson DS: Torres and From Bird DL, Robinson DS: Torres and EhrlichEhrlich Modern Dental Assisting, ed 9. St. Modern Dental Assisting, ed 9. St.
Louis: Saunders, 2009.Louis: Saunders, 2009.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
7
Root Caries and Dentin Hypersensitivity
Dental hygiene considerationsRecommend 3-month recall, meticulous oral self-care,
topical fluoride application at home, fluoridated water Brush before consuming acidic foods to neutralize the
pH of salivaUse a straw for acidic drinksAvoid foods that cause sensitivity (hot coffee or ice
water)Decrease frequency of intake of fermentable
carbohydrates or follow with a chewing gum containing xylitol or a noncariogenic food (cheese or milk)
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
8
Dentition StatusApproximately 80% of people retain
all or most of their natural teethMany mistakenly believe tooth loss is normal element
of aging; education level is the strongest determinant of tooth loss
Compromised nutritional intake may be a result of tooth loss, tooth mobility, edentulous status, and discomfort from removable appliances
With dentures may have approximately one fifth of the chewing ability
Number of teeth and presence of advanced mobility determine food choices
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
9
Dentition StatusDental hygiene considerations
During appointment preceding placement of new denture, counsel about the initial days of adaptation so appropriate foods can be available for that period
Swallowing foods may be challenge to new denture wearers
Encourage intake of dairy products fortified with vitamin D to slow rate of bone loss
Liquid nutritional supplement may be needed to meet caloric and nutrient needs to promote healing from extractions and/or sore spots
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
10
Oral and Maxillofacial SurgeryAssess nutritional needs for patients prior to
surgical procedure to better cope with postsurgical demands and minimize complications
Patients who are malnourished due to variety of chronic disease and conditions, such as anorexia nervosa, chemotherapy, or alcoholism, are at increased risk because they are likely to be immunosuppressed
May need to refer to registered dietitian for medical nutrition therapy prior to the procedure
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
11
Oral and Maxillofacial SurgeryDental hygiene considerations
If the patient loses weight unintentionally, healing appears delayed and patient should be referred to a healthcare provider or dietitian
Emphasize meeting recommendations of MyPyramid Key factor for optimal healing during the recovery process is
adequate intake of kilocalories, carbohydrates, protein, fat, vitamins, minerals, and fluids
Frequent small meals with nutrient-dense foods help meet nutrient needs
Liquid nutritional supplement or multivitamin with minerals may be necessary
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
12
Loss of Alveolar Bone
Several factors, including poor calcium intake over a lifetime, create a physiological negative calcium balance
Following tooth extractions, accelerated atrophy of alveolar bone occurs (within months)
Education in masticatory efficiency, as occurs in persons with dentures, increases resorption, loss of bone mass, or alveolar osteoporosis
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
13
GlossitisEtiology
Bacterial, fungal, and viral infection
DrugsPsychological stressAllergic reactionsNutrient deficiencies (B
vitamins, iron, etc.)
Dental hygiene considerations:Choose soft, nutrient-
dense foods (tuna salad, cream soups, cottage cheese)
Liquid nutritional supplements, such as instant breakfast, may help provide adequate nutrientsFrom Ibsen OAC, Phelan JA: Oral From Ibsen OAC, Phelan JA: Oral
Pathology for the Dental Hygienist, ed 5. Pathology for the Dental Hygienist, ed 5. St. Louis: Saunders, 2009.St. Louis: Saunders, 2009.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
14
Temporomandibular DisorderEtiology
ClenchingGrindingStressMalocclusionInjury and/or bone abnormalities
Dental hygiene considerationsLimit opening when taking a bit of foodChoose foods that are not too hard to chew
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
HEALTH APPLICATIONFunctional Foods
Discuss how functional foods are defined in the US, and recognize global differences
Discuss similarities & differences of phytochemicals and antioxidants
Discuss use of functional foods as PART of a well-balanced diet
15Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Top Related