NUTRITIONAL COUNSELING FOR VARIOUS PATIENT TYPES

VARIOUS PATIENT TYPES

CHILDREN ADOLESCENTS ELDERLY PREGNANT DIABETIC HEART DISEASE HIGH CARIES RATE EATING DISORDER

CHILDREN/INFANTS

Prevent baby bottle decay

Never give bottle at bedtime Do not give sweet juices or milk Recommend cup at 12 months of age Dont use bottle as pacifier Avoid on demand breast feeding Non-cariogenic snacks Rinse mouth after sweetened medications

PRE-SCHOOL

Eating at regular times Limit snacking Provide nutrient-dense snacks Stress consumption during formation and calcification of teeth

Protein Vitamins C, A, and D Calcium Phosphorous Fluoride

ADOLESCENT

Nutrition requirements

Undernutrition common in boys

Highest of any time in life for boys Exceeded only in pregnancy for girls

Girls practice voluntary diet restrictions

Overactivity Poor food selection

Poor food selection Reduced calorie intake Iron deficiency anemia develops, especially after menstruation

IRON DEFICIENCY ANEMIA

Oral signs and symptoms

Pallor of mucosa Tongue changes

Atrophic glossitis Loss of filiform papilla

Moderate and severe anemia

Hemoglobin below 10 Tongue appears smooth and shiny Glossodynia occurs with burning, painful sensations Oral ferrous iron Liquid preparations for children

Therapy

ANOREXIA NERVOSA

Self imposed starvationrefusal to eat, get preoccupied with food Medical complicationsmalnutrition and dehydration Treatment- medical and psychiatric therapies Objective- promote weight gain, restore nutritional status

ORAL CARE FOR ANOREXIA

Xerostomia from medications leading to enamel and cervical root caries Perimylolysis (binge-eating/purging) causes erosion of enamel and dentin as a result of chemical and mechanical effects Appointment interventions

Respect shy, anxious manner Develop rapport Patient denial is common Assess nutritional status Record vital signs Introduce preventive program

BULEMIA

Normal body weight Food consumed can be highly cariogenic Often favorite foods selected Medical complications- dehydration, electrolyte imbalance, protein malnutrition, cardiac arrhythmia Self-medication- abuse of laxatives and diuretics (gastrointestinal disturbances)

ORAL FINDINGS: BULEMIA

Perimylolysis

Acid retained by tongue papillae contacts palatal surfaces of maxillary teeth Erosion of enamel makes them appear raised Increases, particularly cervical PH changes result in demineralization

Restorations

Dental caries

Xerostomia occurs with loss of body fluids Hypersensitive teeth due to loss of enamel/exposed dentin Oral trauma to soft palate occurs Parotid gland enlargement Bruxism tooth wear related to stress

APPOINTMENT INTERVENTION

Reduce cariogenic foods Provide suggestions for substituting sugar-free products Improve oral care/brush tongue Advise sugar-free mints or chewing gum to stimulate salivary flow

ELDERLY

Diet and nutrition deficiencies common in older people Vitamin B deficiencies- burning tongue, angular cheilitis, atrophic glossitis Factors contributing to dietary and nutritional deficiencies: Limited budget

Living alone No regular meals Nonnutritious snacks and foods Alcoholism Lacking interest in shopping or preparing food

FACTORS CONTD

Taste, smell altered, may seek highly seasoned or sweetened foods Childish likes and dislikes Tends to follow lifetime food habits-no change in food preparation Unable to chew well May only select foods can chew Follow fad diets Loss of appetite Difficulty in swallowing Lack of self-discipline

DIETARY NEEDS OF ELDERLY

Decrease caloric intake Geriatric nutrition

Retard progression of diet-induced chronic diseases

4 or 5 day record of diet

Instruction in diet

Inaccuracy of recent memory problem Suggest well-balanced diet limit sugars and carbohydrates Motivation

Appeal to appearance Lower resistance to disease Premature aging

PREGNANT PATIENT

Prevent caries Maintain healthy tissues Varied diet containing essential food groups Maintain daily strength Provide nutrients for developing tissues Minimize post-partum problems

DIETARY NEEDS

Protein for tissue construction Minerals, calcium & phosphorus (bones and teeth) iron- red blood cells Vitamins
D for calcium Folate for neural tube defects Low birth weight A to prevent preterm birth

DENTAL CARIES CONTROL

Incidence

Previous neglect

Same as during any other time

Diet

Could be a result of years

Unusual cravings for sweet foods Patient may be eating every few hours to prevent nausea, could be cariogenic May lack interest in plaque removal, may not rinse after carious foods Calcium &phosphorus of bones and teeth added to fetus during 3rd trimester Encourage intake 10-12cups fluid day & well-balanced diet

Frequency of eating

Neglect of oral care

Calcium from mothers teeth Breastfeeding

DIABETIC PATIENT

Planned by physician and dietitian Ongoing and based on individual needs No specific diabetic diet Goals of nutritional therapy

Maintain normal blood glucose levels by balance of food intake with medications Maintain optimal lipid levels Provide adequate calories for individual needs and reasonable weight

DIABETIC PATIENT FUNDEMENTALS OF DIET

COH

Total food Obese

Monitor and control amount consumed with less regard to source Daily intake may be identical with normal for patients age and stature Needs weight reduction Adequate calories needed to maintain ideal body weight & prevent hyperglycemia Low fat-maintain normal serum cholesterol and triglycerides Consistent with specific times for medication and food intake to control blood glucose levels

Diet selectionHigh fiber

Timing of meals and snacks

CVD and HBP

Predisposing or risk factor

Overweight Salt in excess (reduce to 2.4 g of sodium) Potassium Calcium Magnesium

Maintain adequate diet containing

Reduce dietary intake

Saturated fat Cholesterol intake

Elevated levels of blood lipids Result in increased

Atherosclerosis

Dietary intake of cholesterol Saturated fat Carbohydrate, especially sucrose Alcohol and calories

ALCOHOLIC PATEINT

Alcoholic beverages many calories Days allotment of calories ingested when alcohol is used in excess empty calories no nutritional elements Alcohol affects absorption of any digestion of many nutrients by changes in mucosa of GI tract Liver damage affects metabolism of nutrients

HIGH CARIES RATE

Consume fermentable COH at mealtimes Foods that require chewing help stimulate salivary flow Noncariogenic snacks Read food labels to assess sugar content COH- sticky-retained in mouth longer Cough drops contain sugar Use sugar substitutes