Diet Modification PDF

Diet modification  Intended Learning Skills: Be able to Explain the relationship between diet and dental caries in children and apply this knowledge to develop a personalized diet modification plan for a child, considering their unique dietary habits, preferences, and or...

Diet modification  Intended Learning Skills: Be able to Explain the relationship between diet and dental caries in children and apply this knowledge to develop a personalized diet modification plan for a child, considering their unique dietary habits, preferences, and oral health needs. Evaluate the effectiveness of diet modification strategies in reducing dental caries in children and propose evidence- based recommendations for improving these strategies based on the latest research findings and best practices.  Dietary habits and oral health role of fermentable substrates Food choices - highly processed foods Dietary habits – – manner of consumption – Structured meal and snack patterns Example T.A. Marshall / Dent Clin N Am 47 (2003) 279–303  Example A daily habit of three meals and three snacks, each 30 minutes in length with an additional 30 minutes for the plaque pH to return to normal, theoretically supports 6 hours of demineralization and 18 hours of remineralization. Rapidly growing children and adolescents require frequent opportunities to consume energy to support growth; restrictive meal patterns (eg, three meals, no snacks) are inappropriate.  Sugar and Caries Human OBSERVATIONAL studies: – Eskimos – UK children - Wartime diets – Tristan da Cunha – Hopewood House Human INTERVENTIONAL studies - Vipeholm - Turku  Stephan Curve Used to measure the time elapsed in the critical pH Time and pH values vary greatly dependent on the types of food/drink eaten  Meal environment – From a nutritional perspective, the meal should focus on eating, with few distractions (eg, television, reading) and minimal stress Skipping meals Snacking Drinking Subconscious eating T.A. Marshall / Dent Clin N Am 47 (2003) 279–303  Environment – Current agricultural production and preservation – technologies and transportation systems – Modern food processing regular soda pop and other sugar-containing beverages Vs Milk sports drinks Children live in a climate in which foods and beverages are both abundant and readily accessible – – School and youth activities, malls, play centers, and convenience stores – busy families – biggie sizes T.A. Marshall / Dent Clin N Am 47 (2003) 279–303  Dietary counseling in Children dietary counseling in pediatric oral health is caries prevention early age, prior to visible signs of the carious process carious lesion - extremely difficult to treat through diet and nutrition therapy lifetime implications  Every child’s diet should be screened and evaluated at regular intervals. Undesirable dietary habits and food choices should be identified, appropriate recommendations provided, or referrals made to limit disease risk.  The patient – infancy and the transition stage – the older child – adolescents The family context – Parental attitudes and behaviors  The problem – Inappropriate dietary habits or food offerings, – caregiver-child interaction problems, – oral-motor delays, and – underlying psychiatric or systemic diseases.  Counseling recognize that changing dietary habits is difficult but early intervention may be most successful; encourage small changes at one time because multiple changes may be overwhelming, causing the patient to revert to prior habits; reinforce the disease-risk diet-associated etiology and complement positive behavioral changes; and present ‘‘how-to’’ rather than ‘‘don’t’’ recommendations because they are more likely to be successful. T.A. Marshall / Dent Clin N Am 47 (2003) 279–303  Counseling recognize that changing dietary habits is difficult but early intervention may be most successful; encourage small changes at one time because multiple changes may be overwhelming, causing the patient to revert to prior habits; reinforce the disease-risk diet-associated etiology and complement positive behavioral changes; and present ‘‘how-to’’ rather than ‘‘don’t’’ recommendations because they are more likely to be successful. T.A. Marshall / Dent Clin N Am 47 (2003) 279–303  Steps of Diet Counseling Step 1 Diet Diaries Step 2 Detailed diet analysis Step 3 Diet Advice  Diet Diaries Provides baseline information Helps to identify the problem Highlights the problem to the patient Allows identification of ‘hidden’ sugars Identifies habits Involves patient/parent Can be used as an assessment of improvement Useful basis on which to start giving advice for patient/parent  Three Day Diet Diary – Clear instructions – Write down food, drinks, snacks – Time eaten/drank and amount – Include a weekend day – One day of little value – Verbal not as reliable  Detailed diet analysis Are main meals substantial? Check snacks and drinks – number – when – type – are snacks or drinks cariogenic? – are snacks sticky?  More Questions Any sticky slow dissolving sweets? Sugary pre-bed drinks? Night-time drinks? Medication?  Dietary Advice Modify fermentable COH intake – timing – frequency – amount – type  Dietary Advice If snacking choose fruit or vegetables Eat more at mealtimes to reduce grazing Advise eating 3 balanced meals and avoid grazing Explain the need to control ‘sugar attack’ - frequency not quantity Try and limit sugar to mealtimes Try to reduce sugar drinks – water and plain milk are safe Watch alcohol – also highly calorific and erosive Ensure no sugar after final brushing and water only as night-time drink  Safe Snacks Fruit and vegetables – Bread, crumpets and buns with butter or cheese spread (no jam or sticky topping) – Dairy foods, cheese, plain yoghurt – Plain popcorn Drinks: – Milk, plain water and sugar free squash? – Water only at bedtime  Giving advice…. Do we explain why there is a potential problem? Is our advice often negative? Do we tell patients what not to eat and drink but don’t give guidance? Do we ever consider cost or availability? Do we give the appearance of ‘knowing better’? Is it really our job to give diet advice? T.A. Marshall / Dent Clin N Am 47 (2003) 279–303  Remember Reduce FREQUENCY and AMOUNT of NON-MILK EXTRINSIC SUGARS (fermentable carbohydrate)