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Nutrition for Oral and Dental Health
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
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 ToothAnatomy 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 caries—putting 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 CariesEarly Childhood Caries
(From Swartz MH. Textbook of Physical Diagnosis, History, and Examination, 3rd ed. Philadelphia: W.B. Saunders, 1998.)
Dental Caries—cont’d
Streptococcus mutans—most common bacteria involved
Fermentable Carbohydrate Time Drop in salivary pH to below 5.5
Dental Caries—cont’d
Cariogenicity of foods Frequency of consumption of fermentable
Carbohydrate Food form—slowly 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 SupplementationRecommendations 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 Gingivitis—early form Nutritional care involves increasing vitamin C,
folate, and zinc
Tooth Loss and Dentures
Tooth loss—denture 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 Kaposi’s sarcoma—lesions in mouth and
esophagus; associated with AIDS
Kaposi’s 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 Parkinson’s disease, MS, ALS Achalasia (cardiospasm) Spinal cord injury
Dysphagia Oral phase problems
Pocketing foodDrinking from cup or strawDrooling
Pharyngeal phaseGaggingChokingNasal regurgitation
Esophageal phaseObstruction
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
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
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
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