CHAPTER 19 NUTRITIONAL ASPECTS OF ALTERATIONS IN THE ORAL CAVITY Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc

CHAPTER 19CHAPTER 19

NUTRITIONAL ASPECTS OF NUTRITIONAL ASPECTS OF ALTERATIONS IN THE ORAL ALTERATIONS IN THE ORAL

CAVITYCAVITY

Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

22Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Oral Condition Affecting Nutritional StatusOral Condition Affecting Nutritional Status

Various oral conditions can interfere with food Various oral conditions can interfere with food intake and nutritional statusintake and nutritional status

Modifications of eating patterns may be Modifications of eating patterns may be requiredrequired

The dental hygienist is in the ideal The dental hygienist is in the ideal

position to recommend helpful position to recommend helpful

dietary advice for each individual dietary advice for each individual

patient’s needspatient’s needs


OrthodonticsOrthodonticsIncreased risk for:Increased risk for:

DecalcificationDecalcificationGingival inflammationGingival inflammationSoft tissue trauma fromSoft tissue trauma from

orthodontic appliancesorthodontic appliancesRoot resorptionRoot resorptionAccumulation of food debris in Accumulation of food debris in

brackets/wiresbrackets/wiresChaotic meal patterns and snack habitsChaotic meal patterns and snack habitsTendency to avoid hard foods, resulting in Tendency to avoid hard foods, resulting in

a softer more cariogenic dieta softer more cariogenic diet


OrthodonticsOrthodontics

After initial placement, adjustments or repair of OAfter initial placement, adjustments or repair of Orthodonticsrthodontics may require a liquid or mechanical soft diet for 1 to 2 days may require a liquid or mechanical soft diet for 1 to 2 days

Emphasize importance of oral self-care, daily fluoride use, Emphasize importance of oral self-care, daily fluoride use, and possibly an alcohol-free antimicrobial rinseand possibly an alcohol-free antimicrobial rinse

To minimize enamel decalcification, soft drinks, energy To minimize enamel decalcification, soft drinks, energy drinks, and sports drinks with drinks, and sports drinks with fermentable carbohydratefermentable carbohydrate along with along with citric acid citric acid should be avoidedshould be avoided

Adequate nutritional intake is indispensable for maintenance Adequate nutritional intake is indispensable for maintenance and repair of hard and soft tissue to withstand stresses of and repair of hard and soft tissue to withstand stresses of tooth movementtooth movement

Foods such as carrots and apples should not be avoided, but Foods such as carrots and apples should not be avoided, but cut into small pieces to avoid damage to ortho appliancescut into small pieces to avoid damage to ortho appliances


XerostomiaXerostomiaCommon factors contributing to xerostomiaCommon factors contributing to xerostomia

Drug-inducedDrug-induced More than 400 commonly used drugs can cause xerostomiaMore than 400 commonly used drugs can cause xerostomia

DiseasesDiseases Autoimmune diseases: Sjögren’s syndrome, SLE (lupus), Autoimmune diseases: Sjögren’s syndrome, SLE (lupus),

rheumatoid arthritisrheumatoid arthritis Chronic diseases: Diabetes mellitusChronic diseases: Diabetes mellitus Psychogenic causes: depression, anxiety, stress, or fearPsychogenic causes: depression, anxiety, stress, or fear

Head and neck radiationHead 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.


XerostomiaXerostomiaCarefully assess adequacy of overall diet with particular Carefully assess adequacy of overall diet with particular

attention to intake of vitamins A, Battention to intake of vitamins A, B66, and C, fluid, fiber, , and C, fluid, fiber,

potassium, iron, calcium, zinc, and protein potassium, iron, calcium, zinc, and protein Counsel the patient about techniques/products to relieve Counsel the patient about techniques/products to relieve

symptoms of xerostomiasymptoms of xerostomiaUse of lipbalm and a humidifierUse of lipbalm and a humidifierAvoid dry (saltines), crumbly (whole wheat muffins), sticky Avoid dry (saltines), crumbly (whole wheat muffins), sticky

(peanut butter), and spicy (chili) food; alcohol; mouthwashes (peanut butter), and spicy (chili) food; alcohol; mouthwashes containing alcohol; caffeine; tobaccocontaining alcohol; caffeine; tobacco

Suck on ice chips between meals, drink fluids between bites Suck on ice chips between meals, drink fluids between bites Choose nutrient-dense, soft, moist foods (macaroni and cheese, Choose nutrient-dense, soft, moist foods (macaroni and cheese,

cottage cheese, applesauce), use gravies and sauces to cottage cheese, applesauce), use gravies and sauces to moisten dry foodsmoisten dry foods

Tart, sour, and citrus foods/drinks stimulate saliva flow (pickles)Tart, sour, and citrus foods/drinks stimulate saliva flow (pickles)


Root Caries and Dentin Root Caries and Dentin HypersensitivityHypersensitivity

Root cariesRoot caries Susceptible to decay is the CEJ, because it has anatomically thin Susceptible to decay is the CEJ, because it has anatomically thin

layer of enamel, and cementum, which is thinner and contains fewer layer of enamel, and cementum, which is thinner and contains fewer minerals than enamelminerals than enamel

Anatomically difficult to keep clean, more food impaction in areas of Anatomically difficult to keep clean, more food impaction in areas of recession, compounded by xerostomiarecession, compounded by xerostomia

Dentin hypersensitivityDentin hypersensitivity Erosion is the major cause and often due to acid exposure such as Erosion is the major cause and often due to acid exposure such as

those in food and beverages as well as acid from GERDthose in food and beverages as well as acid from GERD Toothbrush abrasion and abfraction are also factors causing dentin Toothbrush abrasion and abfraction are also factors causing dentin

exposure, leading to dentin hypersensitivityexposure, leading to dentin hypersensitivity


Root Caries and Dentin Root Caries and Dentin HypersensitivityHypersensitivity

Recommend 3-month recall, meticulous oral self-care, Recommend 3-month recall, meticulous oral self-care, topical fluoride application at home, fluoridated water topical fluoride application at home, fluoridated water

Brush before consuming acidic foods to neutralize the pH Brush before consuming acidic foods to neutralize the pH of salivaof saliva

Use a straw for acidic drinksUse a straw for acidic drinksAvoid foods that cause sensitivity (hot coffee or ice water)Avoid foods that cause sensitivity (hot coffee or ice water)Decrease frequency of intake of fermentable Decrease frequency of intake of fermentable

carbohydrates or follow with a chewing gum with xylitol or a carbohydrates or follow with a chewing gum with xylitol or a noncariogenic food (cheese or milk)noncariogenic food (cheese or milk)

Do not brush teeth after consuming acidic foods (will Do not brush teeth after consuming acidic foods (will increase erosion), wait at least 40 minutesincrease erosion), wait at least 40 minutes


Dentition StatusDentition StatusApproximately 75% of people retainApproximately 75% of people retain

all or most of their natural teethall or most of their natural teethMany mistakenly believe tooth loss is normal part of Many mistakenly believe tooth loss is normal part of

aging; education level is the strongest determinant of aging; education level is the strongest determinant of tooth losstooth loss

Compromised nutritional intake may be a result of Compromised nutritional intake may be a result of tooth loss, tooth mobility, edentulous status, and tooth loss, tooth mobility, edentulous status, and discomfort from removable appliancesdiscomfort from removable appliances

Persons with dentures may have only 1/5 of the Persons with dentures may have only 1/5 of the chewing ability; ability declines with each tooth lostchewing ability; ability declines with each tooth lost

Number of teeth and presence of advanced tooth Number of teeth and presence of advanced tooth mobility determine food choicesmobility determine food choices


Dentition StatusDentition StatusDental hygiene considerationsDental hygiene considerationsDuring appointment preceding placement of new denture, During appointment preceding placement of new denture,

counsel about the initial days of adaptation so appropriate foods counsel about the initial days of adaptation so appropriate foods can be available for that periodcan be available for that period

Swallowing foods may be a challenge to new denture wearersSwallowing foods may be a challenge to new denture wearersGradually introduce foods: liquids, then soft foods, then firmer Gradually introduce foods: liquids, then soft foods, then firmer

foods, mastication will probably always be somewhat limitedfoods, mastication will probably always be somewhat limitedEncourage intake of dairy products fortified with vitamin D and Encourage intake of dairy products fortified with vitamin D and

calcium to slow rate of bone losscalcium to slow rate of bone loss Liquid nutritional supplement may be needed to meet caloric Liquid nutritional supplement may be needed to meet caloric

and nutrient needs to promote healing from extractions and/or and nutrient needs to promote healing from extractions and/or sore spotssore spots


Oral and Maxillofacial SurgeryOral and Maxillofacial SurgeryAssess nutritional needs for patients prior to surgery to Assess nutritional needs for patients prior to surgery to

better cope with postsurgical demands and minimize better cope with postsurgical demands and minimize complicationscomplications

Patients who are malnourished due to variety of chronic Patients who are malnourished due to variety of chronic disease and conditions, such as anorexia nervosa, disease and conditions, such as anorexia nervosa, chemotherapy, or alcoholism are at increased risk chemotherapy, or alcoholism are at increased risk because they are likely to be immunosuppressedbecause they are likely to be immunosuppressed

Review health history for bisphosphonate (Fosomax) useReview health history for bisphosphonate (Fosomax) use Slight chance for osteonecrosis with even a small extractionSlight chance for osteonecrosis with even a small extraction

May need to refer to registered dietitian for medical May need to refer to registered dietitian for medical nutrition therapy prior to the procedurenutrition therapy prior to the procedure Unintentional weight loss, delayed healing, poor healthUnintentional weight loss, delayed healing, poor health


Oral and Maxillofacial SurgeryOral and Maxillofacial SurgeryDental hygiene considerationsDental hygiene considerations

Cold foods may be soothing to postsurgical tissuesCold foods may be soothing to postsurgical tissuesIf the patient loses weight unintentionally, healing If the patient loses weight unintentionally, healing

appears delayed and patient should be referred to a appears delayed and patient should be referred to a health care provider or dietitianhealth care provider or dietitian

Emphasize meeting recommendations of MyPyramidEmphasize meeting recommendations of MyPyramid Key factor for optimal healing during the recovery process is Key factor for optimal healing during the recovery process is

adequate intake of kilocalories, carbohydrates, protein, fat, adequate intake of kilocalories, carbohydrates, protein, fat, vitamins, minerals, and fluidsvitamins, minerals, and fluids

Frequent small meals with nutrient-dense foods help meet Frequent small meals with nutrient-dense foods help meet nutrient needs, liquid or softer foods post opnutrient needs, liquid or softer foods post op

Liquid nutritional supplement or multivitamin with minerals may Liquid nutritional supplement or multivitamin with minerals may be necessarybe necessary


Loss of Alveolar BoneLoss of Alveolar BoneSeveral factors, including poor calcium intake over a lifetime, Several factors, including poor calcium intake over a lifetime,

create a physiological negative calcium balancecreate a physiological negative calcium balanceAlveolar bone is a reserve source of calcium for the body, Alveolar bone is a reserve source of calcium for the body,

leading to bone loss, which leads to tooth lossleading to bone loss, which leads to tooth lossFollowing tooth extractions, accelerated atrophy of alveolar Following tooth extractions, accelerated atrophy of alveolar

bone occurs (within months)bone occurs (within months) Resorption is greater in the mandible than in the maxillaResorption is greater in the mandible than in the maxilla

Reduction in masticatory efficiency, as occurs in persons Reduction in masticatory efficiency, as occurs in persons with dentures, increases resorption, loss of bone mass, or with dentures, increases resorption, loss of bone mass, or alveolar osteoporosisalveolar osteoporosis

Alveolar bone loss may be an early symptom of Alveolar bone loss may be an early symptom of osteoporosisosteoporosis


GlossitisGlossitisEtiologyEtiology

Bacterial, fungal, and Bacterial, fungal, and viral infectionviral infection

DrugsDrugsPsychological stressPsychological stressAllergic reactionsAllergic reactionsNutrient deficiencies Nutrient deficiencies

(B-vitamins, iron, etc)(B-vitamins, iron, etc)

Dental hygiene Dental hygiene considerations:considerations:Choose soft, nutrient-Choose soft, nutrient-

dense foods (tuna dense foods (tuna salad, cream soups, salad, cream soups, cottage cheese)cottage cheese)

Liquid nutritional Liquid nutritional supplements, such as supplements, such as instant breakfast, may instant breakfast, may help provide adequate help provide adequate nutrientsnutrientsFrom 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.


Temporomandibular DisorderTemporomandibular DisorderEtiologyEtiology

ClenchingClenchingGrindingGrindingStressStressMalocclusionMalocclusionInjury and/or bone abnormalitiesInjury and/or bone abnormalities


Temporomandibular DisorderTemporomandibular DisorderSymptomsSymptoms

Orofacial painOrofacial pain Frequent headachesFrequent headaches Tinnitus (ringing in the ears)Tinnitus (ringing in the ears) ClickingClicking Crepitus (crackling or crunching sound)Crepitus (crackling or crunching sound) Popping Popping

Dental hygiene considerationsDental hygiene considerations Limited opening when taking a bit of foodLimited opening when taking a bit of food Choose foods that are not too hard to chewChoose foods that are not too hard to chew

Caramels, taffy, bagels, tough meatCaramels, taffy, bagels, tough meat Avoid chewing gumAvoid chewing gum Soft diet may be warrantedSoft diet may be warranted

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CHAPTER 19 NUTRITIONAL ASPECTS OF ALTERATIONS IN THE ORAL CAVITY Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc