CHAPTER 20 NUTRITIONAL ASPECTS OF ALTERATIONS IN THE ORAL CAVITY Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc

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.

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OrthodonticsIncreased risk for:

DecalcificationGingival inflammationSoft tissue trauma from

orthodontic appliancesRoot resorptionAccumulation of food debris in

brackets/wiresChaotic meal patterns and snack habits


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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


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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.


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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)


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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.


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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)


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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


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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


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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


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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


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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


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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.


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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


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.

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CHAPTER 20 NUTRITIONAL ASPECTS OF ALTERATIONS IN THE ORAL CAVITY Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc