Nutrition Counseling for Oral Health

Objectives of Nutrition Counseling for Oral Health

• Understand the relationship between diet and the development of dental caries.
• Discuss the caries process and factors decreasing caries risk to prevent demineralization.
• Understand the differences between sugar alcohols and synthetic sweeteners.
• Understand how host factors affect caries risk, either increasing or decreasing it.
• Explain how to counsel patients on ways to prevent dental caries with better food choices.
• Be able to recognize oral symptoms of early childhood caries.
• Discuss the benefits of ample saliva production and how this is affected by xerostomia
• Identify the bacteria most responsible for metabolizing carbohydrates and the various acids that result.
• Be able to identify groups most at risk for dental caries

Diet and Dental Caries

• Frequent carbohydrate consumption can have a detrimental effect on teeth.
• Bacteria + Carbohydrates = Acid Demineralization
• Other host factors can influence the strength of the above formula; these can include:
  • Exposing developing and erupted teeth to fluoride
  • Placing sealants
  • Better oral hygiene
  • Having ample saliva

Factors of Caries Development

• Six factors determine someone's susceptibility to dental caries:
  • Presence of specific bacteria
    • Strep mutans
    • Lactobacillus
  • Susceptible tooth structure
  • Carbohydrates in the diet
  • Absence of fluoride
  • Salivary gland hypofunction (SGH)
  • Poor oral hygiene

Bacteria Responsible for Dental Caries

• Streptococcus mutans and Lactobacillus are two of more than 500 bacteria involved in caries formation found in dental plaque.
• The presence of S. mutans is needed to initiate pit and fissure, smooth surface, and root surface decay.
• S. mutans starts this process, proceeding to the enamodentin junction where Lactobacillus takes over, extending the lesion into the dentin.

Tooth Structure

• Posterior molars with shallow gooves are less susceptible to dental caries because they don't retain as much plaque and food as molars with very deep grooves.
• Teeth with deeper grooves retain plaque because toothbrush bristles cannot reach the deepest parts on a daily basis.
• Teeth that are rotated or crowded provide protected areas for plaque to grow which cannot be cleansed by chewing or brushing.
• Chewing has a cleansing effect on aligned teeth with shallow grooves.

Host Resistance to Caries

• Good maternal nutrition and a good gene pool may contribute to the difference between caries-free teeth.
• Factors that can reduce risk:
  • Teeth with shallow anatomy (pits and fissures)
  • Straight teeth in alignment
  • Good pre-eruptive nutrition
    • Certain nutrient deficiencies during fetal development can cause crowded or rotated teeth
  • Well mineralized newly erupted teeth

Cariogenic Properties of Carbohydrates

• Physical form of the food:
  • Liquids clear the oral cavity twice as fast as solid foods.
  • Sticky foods stay around the longest.
• Frequency matters as any carbohydrate food or beverage consumed within 20 minutes on either side of a meal is another separate opportunity for bacteria to feed and produce acid.
• Sequence of what order foods are eaten in is important, ensuring the impact of acid is minimized.
  • Fats and proteins eaten with the meal can lay a protective coating on teeth.
  • Dairy products keep the saliva rich in calcium and phosphorus, allowing for remineralization.
  • Cheese eaten after sugar prevents the pH from dropping below 5.5.

Acidic Enamel Demineralization

• All foods and beverages with carbohydrates can cause dental caries as plaque bacteria feeds on these carbohydrates and produce acid that can demineralize enamel.
• The normal 7 pH in the mouth can drop, so once the critical pH level drops to 5.5 enamel demineralization starts.
• Demineralized enamel looks like a rough parchment-white spot on the tooth, usually at the gingival 1/3 where plaque accumulates.
• pH can start dropping within seconds, becoming critical in about 5 minutes.
• Demineralization continues until the mouth's pH has returned to 7.0 (basic)

Fluoride

• Fluoride reduces the amount of detrimental effect of sugar consumption on teeth.
• Ingesting fluoride either through food or water will increase fluoride in saliva to strengthen and remineralize enamel.
• Using fluoridated toothpaste, bathing teeth, and remineralizing enamel can elevate fluoride levels for up to 3 hours.
• Fluoride accumulates in plaque to offer protection for the enamel.

Saliva

• Besides adequate fluoride, adequate saliva is the #1 way to protect teeth.
• Saliva contents include calcium, phosphate, sodium bicarbonate, and proteins:
  • Calcium and phosphate = components of enamel
  • Sodium bicarbonate = high pH that neutralizes acids that demineralize enamel
• Saliva clears liquid and solid foods from the oral cavity, reducing the amount of time bacteria can feed on carbohydrates and make acid.
• Saliva dilutes acids and carries them out, thus eating chewy or crunchy foods can increase salivation.

Physical Factors of Increased Saliva

• Saliva rinses particles in and between teeth.
• Fluid saliva is more effective than ropey saliva.
• Abundance of saliva clears food faster, allowing pH to return to 7.0 more quickly.

Chemical Factors of Increased Saliva

• Saliva with sodium bicarbonate buffers acid at the plaque/enamel interface.
• Calcium and phosphorus in saliva can remineralize enamel.
• Sialin reduces the amount of pH drops and helps return the oral pH to 7.0 quicker.
• Increased saliva flow has more remineralizing, buffering, and antibacterial components from chewing firm foods.

Antibacterial Factors of Increased Saliva

• Mucins trap bacteria and remove it when swallowing.
• Proteins in saliva are antibacterial.

Signs of Dry Mouth (Xerostomia)

• Frequent water bottle use
• Needs to spit out hard candy/breath mint
• Visible foam line of sticky saliva on tongue
• Anterior gingiva inflammed, especially maxillary incisors
• Saliva resembles a thick but small rope when polishing
• Infrequent swallowing
• Cracked lips / fissured tongue
• Frequent throat clearing
• Candidiasis on tongue/palate

Questions to Ask

• Mouth ever feel dry when eating?
• Is it hard to eat dry foods?
• Tongue ever feel burning or sticky?
• Frequent sipping of liquids/sucking on candies?
• Waking up at night to drink liquids?
• Is it hard to speak or swallow
• Mouth breathing?
• Saliva ever feel too thick?

Oral Hygiene

• The ability and motivation to remove plaque is important to keep teeth caries-free.
• Plaque has to be left on teeth and carbohydrates have to be consumed for the bacteria count to increase, which will produce a stickier plaque.
• Home care eliminating bacterial plaque controls this.

Plaque, Saliva and Acid Facts

• Plaque holds bacteria close to the teeth.
• Once carbohydrates have diffused through it, plaque bacteria will have a chance to metabolize.
• The product of this is acid.
• Lactic acid production causes the pH to drop from 7.0 to 5.5, meaning the plaque/enamel interface is in danger.
• Thin, immature plaque can still be penetrated by saliva.
• Thicker plaque can't be buffered as easily by saliva.
• Acid production will continue until all carbohydrates have been cleared.
• Demineralization stops as soon as carbohydrates have been cleared.
• Once acid production stops after eating, remineralization can start.
• Remineralization can be stronger if the patient does this with fluoridated toothpaste, or by drinking fluoridated water.

Early Childhood Caries (ECC)

• In 1994, mouth caries was changed to its more modern name of Early Childhood Caries, ECC
• ECC can be diagnosed when there's decay present on even just one smooth surface; though is usually more severe.
• ECC is considered extensive decay of deciduous teeth in children 5 years or younger.
• When children stop sucking when sleeping, formula, breast milk, or juice will pool here; this initiates demineralization especially with the body's lowered saliva production through sleeping

Effects of ECC

• Leads to issues with self-esteem
• Causes children to miss school
• Associated with behavioral issues.
• Causes oral pain.
• Can impair eating and growth.
• Leads to oral abscesses.
• Permanent teeth will erupt out of alignment.

Etiology of ECC

• Strep Mutans is the bacteria associated with ECC stemming from mother-to-child transference.
• Transference rates increase when parents share toothbrushes & utensils.
• Parents tasting food before feeding.
• Cleaning pacifiers with saliva.
• Allowing a child to place fingers into an adult's mouth.
• Kisses on the cheek are preferred instead of the mouth to avoid this.
• Increased risk is caused by:
  • Delayed or abnormal nutritional progression during infancy
  • Carb exposure rate.
  • Excessive reliance on beverages for nutrition.
  • Delayed solid food introduction.
  • Feeding with bottles & closed cups.
  • Nocturnal bottle use combined with low saliva.

Prevention of ECC

• Early evaluation of diet habits.
• Appropriate guidance.
• Appropriate transition to table food.
• Limiting sugary drinks.
• Prevent ECC by weaning the child off the bottle around 9 months.
• Always feed before bedtime.
• Remove bacterial plaque daily.
• If the child must use bottles, only use plain water.

Treatments for ECC

• Fluoride treatments and varnishes can remineralize teeth.
• Further stage can implement more restorative processes and dentist visits for teeth extraction
• Fluoride supplements are often recommended.
• Stainless steel crowns will be placed to maintain space between teeth.
• Space maintainers can be used depending on severity.

Cariogenic Foods

• Contain fermentable substrates that can cause a decrease in plaque pH < 5.5, resulting in enamel demineralization/caries.
• Caries potency will be impacted on the ability these substrates have based on conducive conditions for the caries to form

Examples of Foods High in Sugar

• Fruits
• Fruit Juices & Soft Drinks
• Sweets
• Desserts
• Sweet Potato
• Ready-To-Eat Cereals
• Avoid the above

Cariostatic Foods

• Foods that don't contribute to initiation of demineralization or continuation of the caries process.
• Won't bring on a pH drop.
• These properties may be helpful in preventing the spread of dental caries.
• Include protein foods such as; eggs, fish, meat and poultry, most vegetables, and fats, may even increase the pH after consuming the carbohydrates.
• The sequencing in which food is taken will have an effect i.e. taking a small bite of cheese or sugar.
• Phosphates also buffer acid.
• Fluoride has protective factors that can continue operating well after any meal
• Fluoride can occur in small doses in foods such as seafood and tea.
• Fluoride has both anti-bacterial and anti-plaque qualities

Sugar Substitutions

• Synthetic sweeteners reduce the level of caries caused by sugar.
• Synthetic sweeteners such as saccharine, aspartame, sugar alcohol
• Many sweeteners are non-cariogenic/caloric

Groups At Risk For Dental Caries

• Certain groups may have high dependency on diet counseling
  • New and returning patients should be examined for a best plan and treatment
  • Using a Caries tool to determine the current patient assessment risk factors
    • Previous experiences with caries
    • Fluoride resources and quantities
    • Meal / Snack Habits
    • Socioeconomic status
    • Level of Bacteria Plaque
    • Saliva Nature
    • Dental Checkup Frequency

Groups Prone To Cavity Risks

• High Carbohydrate Diets
• Children Adolescents
• Elderly
• Have a past experience with dental caries
• Xerostomia
• Have an inadequate level of fluoride in their bodies
• Patients who don't partake in oral hygiene

High Carbohydrate Diet

• Kids can average about seven snacking's a day with foods containing high levels of sugar.
• Individuals with more than 3 to 5 oral exposures have a higher risk of dental caries.

Elderly

• Elderly is prone to the risk of Carie due to Xerostomia for two main reasons
  • Sense of thirst
  • Certain medications

Xerostomia

Xerostomia Is described as an absence/lack of saliva flow that is very high for Dentinal/Root Caries

Inadequate Fluoride

• No Flouride / Water supply
• Fluoride treatment Regiments
  • Easily absorbed and ingested through the Enamel Beneficial fluoride can be achieved by Achieving fluoride with toothpaste

Negative Effects Of SODA

• In a 12-oz Soda it can have 10 teaspoons of sugar According to most dentists Soda / non cola contains harmful ingredients for dental cavities
• Consuming this product for long duration can increase the amount of damage to the teeth
• Individuals who brush directly after any soda / acidic drink brushing too soon can be harmful.

Techniques To Minimize Damage

• Consume during meals as opposed to drinking alone, make short time between bottle and meals
• The best method is to simply drink by straw
• It can be that people will reduce their soda / sugary drinks and opt. for diet alternatives which are harmful at levels Ph 2.3 to 2.6

Steps To Reducing The Caries Potential Of Soda

• Clean your mouth after consuming soda
• Drink soda from a can as opposed to a drinking container

Steps and Techniques To Advise Patient

• Connect and describe the effect of certain foods when it comes to oral cavity problems that directly impacts overall diet
• Try Rearranging the types of foods and drinks taken during mealtime

More Techniques To Advise Patient

• Reduce intake of sugary foods that contain citric acids
• Do not snack on carbs before bed
• Try mixing a group of foods such as sweets, fats follow it up with cheese
• Try making sure high levels of saliva are taken when possible
• Consuming Citrus Fruits for the effects of acid

Techniques And Assistance Counseling The Patients

• To gain high levels of calcium it's best to enjoy a cookie with milk
• Ensure not to rush cleaning too soon while drinking acidic drinks (wait roughly 30 minutes prior)
• Gum that's sugar free can still stimulate the saliva production.
• Even normal gum if lost its flavor can help

Practice

-23 year old is going for dental needs in 5 year a absence who is in good health

• Use of antihistamines from possible allergies
• Radiographic and clinical Examination reveled 5 lesions
• Previous anterior restoration
• High Levels of Carbs and prefers the option. for soda mints/soft foods
• 45 Seconds to clean along with flossing for 2 to 3 weeks

Things To Address in the Practice

• 1. Factors relating to contribution of Dental Caries formation, explain in as much detail their relations

2. What recommendation Is to be implied

Oral Disease Chart For Causes and Outcomes

• Excessive Sweet foods Outcome is -Less Consumption Of Sugary Drinks
  • Can Be done mixing certain drinks into a 5050
  • Substitution of other less dangerous drinks
  • Change / Shift for energy replacement
• Eat the carbonated snack on top of meals
  • Take short amount of time

Oral Maxlifocial

Includes Surgeries

• Teeth extraction

• Site/Bone Biopsy - Surgery (Orthognathic)

  • Repair from trauma and bone graft.
  • Crown Lengthening / Dental Implants
  • Gingivoplasty / Gingival Graft

• Below Is a listing of Food that needs to be Avoided with the first 3 to 5 Day

• Spicy Foods

• Cruncny / Spicy Foods

• Saly Foods

• Hot Foods / Alchol

• Eat Soft food during the first 12-24Hours

• Keep the food far away from the surgery zone

NUP

• Necrotizing ulcerative
• Fiery with constant bleeding, extreme level of pain
  • The patient will find both elevated temp and low energy
• The treatment consist of - Debridement, counsel, education for the patient

Recomended Assistance For Diet

• Liquid Diet

• More intake of caloric, soothes well

• Avoide Spice / Bad Foods

• Take minerals/vitamins

• Dentuture needs patience to learn the mechanism

• Follow new rules / advice

The new rules include that -The patient requires the knowledge that test is different / less

• The patient needs to know that food is to be cut. Into small pieces and needs to be chewing with the back teeth to prevent tipping.

• Consume Small Pieces over 3 days

• Go with soft foods such as ( Eggs / FIsh / veggies / pudding )

• Consume HotFood / Sticky

TMJ Disorders

Consunig the correct nutrients is important learning management to assist the professional with relief

-Consuming liquid and nutreints as high levels will help sooth pain A soft diet with events divied into smaller meals that limit chewing

OrthAdos /Orthodontic

Plaque Accumulation is to be removed.

• Food Should be Cut and Consumed as small as can be
• Avoid gum , Soda Pop, hard pretzels

Diabetes

• Nutrition needs to be balanced in the diet not to high in sugar
• The patient need to be helped should be the goal
• With a balanced diet prescribed

Patients with Aides

• Check from side effects in medications that can dry mouth out and affect salivary output

  • Recommend the patient to suck and chewy on gum with a type of sugar

• Ensure the correct intake of moisture via gravy

• Chemotherapy also causes issues such as mouth and check for bleeding ulcers ( these issues can happen for long durations)

  • Help with certain nutrients
    • Soft Foods