Nutrition for Oral and Dental Health

Dr. joko wahyu wibowo MKes

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

Diet and Dental Health

The foods you choose and how often you eat them

can affect your general health and the health of your teeth and gums, too. consume too many sugar-filled sodas, sweetened fruit drinks or non-nutritious snacks, could be at risk for tooth decay. Tooth decay is the single most common chronic childhood disease, but the good news is that it is entirely preventable. Tooth decay happens when plaque come into contact with sugar in the mouth, causing acid to attack the teeth

Contd

diet lacks certain nutrients, it may be more

difficult for tissues in mouth to resist infection. This may contribute to gum disease. Severe gum disease is a major cause of tooth loss in adults. Many researchers believe that the disease progresses faster and is potentially more severe in people with poor nutrition.

For good dental health

Drink plenty of water. Eat a variety of foods from each of the five major

food groups, including:

whole grains fruits vegetables lean souces of protein such as lean beef, skinless poultry and fish; dry beans, peas and other legumes low-fat and fat-free dairy foods

Impact of Sugary Foods and Snacks on Childrens Oral Hygiene

Everyone has bacteria in their mouths, and bacteria

love sugar! It only takes about 20 seconds for your mouths bacteria to convert sugar into the acid that destroys tooth enamel. acid is active for about 20 to 30 minutes. So the amount of sugar, and how often its eaten, are very important to monitor. The less sugar in diet, the better for their teeth and overall health. For snacking, fresh fruits and vegetables are the best. Popcorn and nuts are good runner-ups.

Impact of Soda, Juice and Bottled Water on Childrens Oral Hygiene

sugary drinks like juice and soda arent the best.

When children, or anyone, drink sugary drinks throughout the day, the acid thats created from the mouths bacteria/sugar combination just keeps being produced. acid is working on destroying teeth. When it comes to juice, give only 4 to 6 ounces per day as a part of a meal or snack. Avoid using juice boxes as a convenient on-the-go drink of choice. A better choice would be water.

Effects of Nutrient Deficiencies on Tooth Development

Dental and Oral Health

Teeth are made from protein matrix that is

mineralized with collagen (requiring vitamin C), calcium, and phosphorus (requiring vitamins D and A)

Anatomy of a Tooth

Dental Caries
Infectious disease of teeth in which organic

acid metabolites lead to gradual demineralization of enamel; proteolytic destruction of tooth structure Any tooth surface can be affected.

The Decay Process

Plaque formation: sticky mix of microorganisms,

protein, polysaccharides Bacteria metabolizing fermentable carbohydrate produce acid Acid production: oral pH<5.5 allows tooth demineralization Saliva function: rinses away food; neutralizes acid; promotes remineralization Caries patterns:pattern depends on cause

Early Childhood Caries

Also called baby bottle tooth decay Nursing bottle cariesputting baby to bed

with a bottle of sweetened liquid (juice, Kool-Aid, etc.) Front teeth rapidly develop caries Common among Native Americans Wean children before age 2 from bottle

Early Childhood Caries

(From Swartz MH. Textbook of Physical Diagnosis, History, and Examination, 3rd ed. Philadelphia: W.B. Saunders, 1998.)

Dental Cariescontd
Streptococcus mutansmost common

bacteria involved Fermentable Carbohydrate Time Drop in salivary pH to below 5.5

Dental Cariescontd
Cariogenicity of foods Frequency of consumption of fermentable

Carbohydrate Food formslowly dissolving Food combinations Nutrient composition of food/beverages Timing (end of meal)

Medical Sequelae of Dental Caries

Bacteria from tooth decay can enter

bloodstream and inoculate heart valves, cause bacterial endocarditis Oral-pharyngeal secretions inoculated with bacteria can cause aspiration pneumonia

Fluoride
Primary anticaries agent Water fluoridation

Fluoridated toothpastes
Oral rinses Dentrifices Beverages made with fluoridated water

Recommendations for Fluoride Supplementation

(Data from American Dietetic Association: Position of ADA: The impact of fluoride on dental health. J. Am Diet Assoc. 94:1428, 1994.) * Milligrams of supplemental fluoride recommended according to fluoride concentration in drinking water.

Cariogenic vs. Cariostatic

Cariogenic: containing fermentable

carbohydrates that can cause a decrease in salivary pH to <5.5 and demineralization when in contact with microorganisms in the mouth; promoting caries development Cariostatic: not metabolized by microorganisms in plaque to cause a drop in salivary pH to <5.5

Cariogenic Foods
Promote formation of caries Fermentable carbohydrates, those that

can be broken down by salivary amylase Result in lower mouth pH Include crackers, chips, pretzels, cereals, breads, fruits, sugars, sweets, desserts

Cariostatic Foods
Foods that do not contribute to decay
Do not cause a drop in salivary pH Includes protein foods, eggs, fish, meat and

poultry; most vegetables, fats, sugarless gums

Anticariogenic Foods
Prevent plaque from recognizing an

acidogenic food when it is eaten first May increase salivation or have antimicrobial activity Includes xylitol (sweetener in sugarless gum) and cheeses

Other Factors that Affect Diet Carogenicity

Consistency: Liquids are cleared quickly while

sticky foods remain on the teeth Meal frequency: frequent meals and snacks increase duration of exposure Food composition Food form: liquid, solid, slowly dissolving Sequence of eating: cheese or milk at the end of the meal decrease the cariogenicity of the meal

Caries Prevention Guidelines

Periodontal Disease
Inflammation of the gingiva with destruction

of the tooth attachment apparatus Gingivitisearly form Nutritional care involves increasing vitamin C, folate, and zinc

Tooth Loss and Dentures

Tooth lossdenture placement Food selections change Saliva production decreases Reduced chewing ability Lower calorie and nutrient intake occurs for

many Simple nutrition counseling; Food Guide Pyramid, etc.

Oral Manifestations of Disease

Stomatitis:

inflammation of oral mucosa Candidiasis and herpes simplex: fungal and viral infections which can affect mouth and esophagus causing pain and dysphagia

Photo: http://webpages.marshall.edu/~gain/bactnote/Image9.gif

Oral Manifestations of Disease

Xerostomia: Dry mouth

Periodontal disease
Kaposis sarcomalesions in mouth and

esophagus; associated with AIDS

Kaposis Sarcoma in AIDS

MNT for Mouth Pain/ Oral Infections

Avoid acidic and spicy foods

Offer soft, cold, nutrient dense foods such

as canned fruit, ice cream, yogurt, cottage cheese Try oral supplements Use PEG or NG feeding if oral supplementation is unsuccessful For xerostomia, try artificial salivas, citrus beverages, sugar free candies or gums

Medications That May Cause Xerostomia

Dental Health Affects Nutrition

Tooth loss may affect ability to chew

(relationship between loss of teeth and reduced intake of fruits and vegetables Dentures are often ill-fitting (especially common after weight loss); problem foods include fresh fruits and vegetables, chewy and crusty breads and chewy meat like steak

Interventions
Obtain a dental consult: if dentures are

missing, find them. If they are loose, replace or reline them Modify diet consistency: mechanical soft, ground, pureed Use least restrictive diet possible; individualize; mix consistencies if appropriate

MNT for Wired or Broken Jaw

Provide pureed, strained, or blenderized foods

as appropriate Encourage nutrient-dense foods such as blenderized casseroles Recommend small, frequent meals with oral supplements such as milkshakes, Instant Breakfast, medical nutritionals Use liquid vitamin supplement if necessary Recommend patient weigh self to monitor weight status

Dysphagia = difficulty swallowing

Mechanical causes Trauma to esophagus with scar tissue Inelasticity due to repeated inflammation Tumor of esophagus Aneurism of aorta

Dysphagia = difficulty swallowing

Neuromuscular causes
CVA, brain tumors

Head injury
Parkinsons disease, MS, ALS Achalasia (cardiospasm) Spinal cord injury

Dysphagia
Oral phase problems

Pocketing food Drinking from cup or straw Drooling Pharyngeal phase Gagging Choking Nasal regurgitation Esophageal phase Obstruction

Symptoms of Dysphagia
Drooling, choking, coughing during or

after meals Inability to suck from a straw Holding pockets of food in cheeks (pt may be unaware) Absent gag reflex Chronic upper respiratory infections Gargly voice quality or moist cough after eating

Diagnosis of Dysphagia
Nerve assessment X-rays

Fluoroscopic swallow study: barium

swallow/cookie swallow Measurement of esophageal sphincter pressure and peristalsis

Aspiration
Inhalation of food, liquid into lungs Can cause aspiration pneumonia

Appears to be dose-dependent
A major cause of aspiration pneumonia

is thought to be aspiration of oropharyngeal secretions, particularly if contaminated by bacteria

MNT for Dysphagia (National Dysphagia Diet)

Intervention depends on severity of deficit Mealtime supervision, cueing Thickened liquids: thin nectarlike honeylike spoon thick Altered consistency:
Level 1: pureed Level 2: mechanically altered Level 3: advanced

Thickened Liquids

MNT for Dysphagia

In severe cases, patient may

be made NPO and enteral feedings initiated

National Dysphagia Diet

NDD diets are more restrictive than

dental consistency diets; may wish to use more liberal diet for edentulous patients Developed by consensus committee; no evidence as yet that it is effective in preventing aspiration Provides much-needed standardization

NDD: Level 1 -- Pureed

Foods are totally pureed; no coarse textures or

lumps of any kind Breads must be pureed or pregelled, slurried through entire product thickness Cereals should be homogeneous or puddinglike; such as cream of wheat, cream of rice, farina; avoid oatmeal Fruits pureed without pulp, seeds, skins; juice should be thickened to desired consistency Soups should be pureed, strained, and thickened to desired consistency Mashed potatoes and pureed pasta are main starches

NDD Level 2 Mechanically Altered

Foods are soft-textured and moist so they easily form a

bolus Breads must be slurried, pre-gelled through entire thickness, but well-moistened pancakes are allowed Cooked cereals may have some textures and some try, well-moistened cereals allowed Soft canned or cooked fruits, no seeds or skins Ground or minced tender meats with no larger than inch pieces, well-cooked casseroles, cottage cheese; avoid peanut butter, sandwiches, pizza Most soups Soft, well-cooked vegetables with less than inch pieces; no corn, peas, fibrous varieties

NDD Level 3 -- Advanced

Nearly normal textures, but exclude crunchy,

sticky, hard foods Foods should be bite-sized and moist Moist, tender meats and casseroles with small pieces Most vegetables except corn Potatoes, rice, stuffing allowed All beverages if they meet ordered consistency Moist breads allowed; no tough, crusty bread Most desserts allowed, no nuts, seeds, pineapple, coconut, dried fruit

Strategies for Improving Acceptance

Thickened liquids: commercial products

can improve quality and consistency of thickened liquids Seasoning: persons with dysphagia often have dulled sense of taste. Serve seasoned foods such as spaghetti, chili, apple pie Piping and molding: pureed foods can be thickened and molded for more attractive appearance

Piped and Molded Pureed Foods

Dysphagia Diet Issues

Patients on altered

consistencies tend to eat less and often lose weight Patients on thickened liquids are at risk for dehydration Re-evaluate patients and advance diet as quickly as possible