DENT2064 Module 1: Primary Preventive Dentistry PDF

Primary Preventive Dentistry DENT 2064 _________________________ Image courtesy of: https://jigsa...

Primary Preventive Dentistry DENT 2064 _________________________ Image courtesy of: https://jigsaw.vitalsource.com/books/9780133560954/epub/OPS/ Professor: Sara Gordon, RDH, BEd, MEd images/cover.jpg Introduction to Nutrition Module 1 Image courtesy of: https://food-guide.canada.ca/en/food-guide-snapshot/ Module One: Learning Objectives 1) Explain the role of the dental hygienist in dietary assessment and nutritional counselling for optimized oral health. 2) Define diet, nutrition, essential nutrient, primary deficiency and secondary deficiency. 3) Describe prevention as it relates to nutrition. 4) Identify the macronutrients and micronutrients obtained from food, including recommended proportions and caloric values. 5) Define the four types of dietary reference intake values. 6) Describe the role of digestion in nutrition, including the role of the teeth and saliva. 7) Analyze Canada’s Food Guide and dietary guidelines as a food guidance system, with a focus on the the role of the health professional. 8) Describe the parts of the Canadian food label.  Role of the Dental Hygienist Identify harmful dietary habits that may initiate oral disease (*nutritional risk) ØNote: Compromised oral health may affect food choices. For example, clients who lose their teeth may avoid foods that are hard to chew; this reduces the quality and variety of their diet Promote health and wellness as a health professional Ø Opportunity to see clients on a more regular basis than many other health professionals (screen clients) Ø Support interventions initiated by other health care professionals Identify clients needing referral to a registered dietitian for complex nutrition needs that may ultimately affect general health Image courtesy of: https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcQ1YExOQKfmvQyrfKbsUHppHPKE1OF_y3IkAA&usqp=CAU Basic Nutrition Diet Image courtesy of: https://images.emedicinehealth.com/images/article/main_image/diet-and-nutrition.jpg Ø Refers to the foods and drinks one regularly consumes Nutrition Ø Process by which living things use food to obtain nutrients for energy, growth, and maintenance Essential nutrients Ø Substance obtained from food that the body cannot produce in sufficient quantities to meet physiological requirements *Nutrition is what we need. Our diet is how we choose to get it! Inadequate Nutrition Nutritional deficiencies occur when adequate amounts of nutrients are not available to sustain biochemical functions. Primary Deficiency—a nutritional deficiency as a result of decreased intake e.g., inadequate maternal intake of calcium may lead to enamel hypoplasia during development of teeth Secondary Deficiency—a nutritional deficiency caused by inadequate absorption or utilization, increased requirements, excretion, or destruction e.g., inadequate absorption of calcium (will impact the strength of your teeth and bones) Primary Prevention Ø Uses strategies and agents to prevent the onset of diseases, before secondary preventive treatment becomes necessary ØIncludes discussing guidelines for a healthy diet and information on dietary implications in dental caries and periodontal disease (nutritional counselling) ØProvide education routinely … do not wait until a problem exists Clients who may be at increased risk include: ü(Adolescents) at risk of caries because of high intake of soft drinks, sports drinks, energy drinks, and snack foods üCaries-prevention counselling for clients with xerostomia or cariogenic diet patterns üProactive diet suggestions for new denture wearers Image courtesy of: https://assets.shop.loblaws.ca/products/20702466/b2/en/front/[email protected] Secondary Prevention Ø Uses routine treatment methods to terminate a disease process and/or restore tissues to as near normal as possible ØIncludes providing guidance that involves determining the factors influencing current dietary habits and working with the client to develop appropriate strategies for improvement (nutritional counselling!) Conditions: üEarly childhood caries üNew or recurrent carious lesions in any age group üExtensive cervical demineralization üCervical decalcification after removal of orthodontic appliances üDecalcification due to gastroesophageal reflux disease üSevere periodontal disease üXerostomia-related caries Image courtesy of: https://www.mybracesdoctor.com/storage/app/media/decalcification-information-1.png Tertiary Prevention Ø Uses measures necessary to replace lost tissues and rehabilitate clients to as near normal as possible, to maximize quality of life ØEspecially for adults with a history of many restorations and clients with new prosthetic devices (nutritional counselling) ØRequires ongoing nutritional counselling to promote long-term change to prevent recurrence of caries ØCould require nutritional counselling to discuss methods of preparing foods to facilitate consumption of a healthy diet when chewing is compromised by tooth loss or new dentures Image courtesy of: http://res.cloudinary.com/stchi/image/upload/v1620113878/Main/Fixodent/en_US/Foods_to_eat_for_new_denture_wearers_icons_750x550.jpg Basic Concepts of Nutrition Good nutrition is evaluated in context of client’s: — Physiological needs for essential nutrients — Nutrient content of the food — Cultural or environmental circumstances — Personal preferences Image courtesy of: http://clipart-library.com/img1/1465916.png Encourage variety of foods to minimize nutrient deficiencies or excesses. Basic Concepts of Nutrition Foods differ in the amount of nutrients they provide Increasing the variety of foods consumed reduces the probability of developing nutrient deficiencies or nutrient excesses Essential nutrients are needed throughout life; only the amounts of nutrients needed change across the lifespan Water is the most important nutrient. After water, the nutrients that provide energy are the next priority for the body. Image courtesy of: https://www.priorlakemn.gov/home/showpublishedimage/1078/63738452807 Food guidance in Canada comes from Canada’s 7200000 Food Guide (2019) Classes of Nutrients Macronutrients ØRequired in larger amounts as they provide the body with energy — Water* (Note: Needed in large amounts, BUT does not provide energy) 0 cal/g — Proteins (ideally 10-35% of our daily calorie consumption) @ 4 cal/g — Carbohydrates (ideally 45-65% of our daily calorie consumption) @ 4 cal/g — Fats (ideally 25-35% of our daily calorie consumption) @ 9 cal/g — *Alcohol (not required, but it provides energy) @ 7cal/g Micronutrients Calories are the potential energy value of ØRequired in smaller amounts foods. Consuming too many calories can — Minerals cause weight gain. Consuming too little — Vitamins calories can cause weight loss. Dietary Reference Intakes (DRIs) Estimated average requirement (EAR) Ø Amount of nutrients estimated to meet needs of 50% of healthy individuals in a specific age and gender group * Recommended dietary allowances (RDAs) Ø The average daily amount of nutrients considered adequate to meet the requirements of nearly all (97%–98%) healthy individuals Adequate intake (AI) Ø An amount of nutrient that appears to maintain a defined nutritional state; **used when there is not enough data to determine RDA Tolerable upper intake level (UL) Ø Maximum daily level of nutrient intake that probably will not cause adverse health or toxic effects for most individuals; especially important to know this level because many people use supplements e.g., multivitamins  Dietary Reference Intakes: Dental Hygiene Considerations Guidelines apply to average daily intakes- Recommended dietary allowances (RDA ) Ø Individual’s specific requirement unknown Encourage a variety of healthy food choices DRIs are guidelines for healthy people Upper intake level may be used to warn clients against megadoses of nutrients Government of Canada. (2023, July 28). Dietary reference intake report list. https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/dietary-reference-intakes/dietary-reference-intake-report-list.html General Dietary Guidelines: Dental Hygiene Considerations Encourage nutrient-dense food: whole grains, fruits, and vegetables Encourage moderation in salt, sugars, and alcohol intake Encourage intake of water (fluoridated) What is an empty calorie? Image courtesy of: https://www.canada.ca/content/dam/dnd-mdn/images/maple-leaf/articles/2022/06/06-15-food-guide-en.jpg The Role of Digestion in Nutrition Foods are composed of large chemical molecules that cannot be used unless they are broken down to an absorbable form Only carbohydrates, proteins, fats (energy- providing nutrients) must be digested before they can be absorbed Most vitamins, minerals, and water can be absorbed as eaten The digestive system is designed to: üingest foods üdigest or break down complex molecules into simple, soluble materials that can be absorbed Image courtesy of: https://childrenswi.org/- /media/chwlibrary/images/medical-care/gi-liver-and- nutrition-program/digestive-system- üeliminate unused residues diagram.jpg?h=479&w=400&hash=C3069074D927D4A3 3307EB53F9CAB5EB Hydrolysis of Energy Nutrients Macronutrients (proteins, fats, carbohydrates) are the nutrients our bodies use for energy that must be broken down to be useful These large molecules are split during digestion, often by enzymes, into smaller water-soluble molecules These small molecules are then used by the cells of the body Protein + H2O à amino acids Fat + H2O à fatty acids + glycerol Carbohydrate + H2O à monosaccharides Saliva’s Role in Digestion Some chemical action or hydrolysis of nutrients begins in the mouth Since food is normally in the mouth briefly, an enzyme known as salivary amylase will initiate carbohydrate digestion If a carbohydrate food, such as a cracker, is chewed and held in the mouth for a few seconds, it will begin to taste sweet, denoting the fact that some starch is being hydrolyzed into complex sugars, dextrin and maltose Teeth and Digestion Chewing reduces food particle size ØDigestion of food is facilitated by increasing its surface area Chewing firm foods also helps maintain proper balance between alveolar bone resorption and new bone formation Teeth and supporting bone structures are affected by intake of adequate nutrients, adequate digestive function, and hormonal balance Image courtesy of: https://www.researchgate.net/publication/338649892/figure/fig1/AS:84831719810662 4@1579265989431/Periodontium-with-its-components-gingiva-periodontal-fibers-PDL- and-cementum-around.ppm Canada’s Food Guide (2019) ______________________________ Canada’s Food Guide (2019) Sets out Health Canada’s guidelines and considerations on healthy eating Based on the best available scientific evidence Promotes healthy eating and overall nutritional well-being, and supports improvements to the Canadian food environment Standardized and well-respected guidance *tool for nutritional counselling Important for health professionals to understand its principles Canada’s Food Guide (2019) The ‘new’ Canada’s Food Guide: 1) Removed traditional ‘food groups’ and serving sizes Ø Removed “milk and alternatives” to make a protein group that includes dairy products 2) Contains a balanced plate model along with a list of healthy eating behaviours 3) Emphasizes plant-based foods, reducing sugar sweetened beverages, and reducing saturated fat What we eat influences our health… In Canada, dietary risks are one of the three leading risk factors for disease burden, as measured by death and disability combined (tobacco use and high body mass index (BMI) are the other two) Chronic diseases impacted by diet: ischemic heart disease, stroke, colorectal cancer, diabetes, and breast cancer (among the leading causes of premature death in Canada) Oral diseases, such as dental decay, share common nutrition-related risk factors with some of the leading chronic diseases in Canada such as diabetes and cardiovascular disease ØDental decay affects 57% of Canadian children aged 6 to 11 years and 96% of Canadian adults over their lifetime Chronic Disease Burden and Diet The burden of chronic disease in Canada varies across populations Indigenous Peoples in Canada face a greater burden of chronic disease than the general population e.g., diabetes ØRates vary across communities and between First Nations, Inuit, and Métis populations ØIn addition, Indigenous Peoples face barriers to adequately managing chronic disease In Canada, chronic diseases account for approximately one-third of direct health care costs ØThe Canadian population is aging, faces high rates of obesity, and engages in sedentary lifestyle behaviours ØThe impact of chronic diseases is likely to continue to increase, unless we take action to address the many factors that influence what we eat The food environment influences what we eat... The foods and beverages available in homes, retail food outlets, and restaurants can have a big impact on what and how we eat and drink For Indigenous Peoples, food intakes can be negatively influenced by the limited availability of food acquired in traditional ways (such as hunting, fishing, trapping, and gathering), and the numerous barriers to traditional food access We receive a constant stream of changing and conflicting messages on healthy eating, making it difficult to make healthy eating choices ØFood marketing now includes social media as a channel Supporting healthy eating is a shared responsibility… Canada’s Dietary Guidelines can make an important contribution to nutritional health Health professionals and policy makers in all sectors and at all government levels can use these guidelines as a resource to support program and policy decisions vhttps://food-guide.canada.ca/sites/default/files/artifact-pdf/CDG-EN-2018.pdf ØPolicies that reflect these guidelines can improve the food environment in settings such as schools, workplaces, recreation centres, and health care facilities ØCreating supportive environments across settings can help increase the positive influence that dietary guidelines can have on individuals, families, and communities e.g., discuss in various healthcare settings Eat a variety of healthy foods… 1) Vegetables and fruits 2) Whole grain foods 3) Protein foods 4*) Foods with healthy fats 1) Vegetables and Fruits üTo obtain vitamins, minerals, fibre üChoose different textures/colours/shapes to fit your taste üEat dark green vegetables daily (*calcium); orange vegetables a few times/week (vitamin A) üFrozen fruits/vegetables are a good option üIf canned, try to avoid added salt and sugar üDried fruit sticks to your teeth (eat it with meals) ü*Eat fruits instead of opting for fruit juice üChoose healthy cooking options: roast/steam/stir-fry üCup up raw vegetables and fruit for snacks 2) Whole Grain Foods üTo obtain vitamins, minerals, fibre üWhole grain foods have more fibre than refined grains üLowers risk for: stroke, colon cancer, heart disease, Type 2 diabetes üEat a variety daily: quinoa, pasta, bread, oatmeal, brown/wild rice üAvoid grains with extra sodium/sugar/fats e.g., baked goods, sugary cereals, pre-packaged frozen pasta dishes üEat whole grain (better than whole wheat) üAvoid adding salt/sauces; use spices, vegetables, vegetable oil üTry a new grain each week: farro, buckwheat üEat as snacks üAdd to soups and salads 3) Protein Foods üTo obtain protein, vitamins, minerals üPlant-based protein foods can provide more fibre and less saturated fat than other types of protein foods ØBeneficial for your heart health ØInclude foods and beverages fortified with vitamin B12 in your diet (as vitamin B12 is only found in animal-based foods) üeggs ülean meats and poultry (lean cuts of beef, pork, wild game, turkey, chicken) ünuts and seeds (peanuts, almonds, cashews, nut butters, sunflower seeds) üfish and shellfish (trout, perch, shrimp, salmon, pickerel, sardines, mackerel) ülower fat dairy products (milk, yogurt, lower sodium cheeses) übeans, peas and lentils (lentils, chickpeas, dried black and kidney beans) üfortified soy beverages, tofu, soybeans and other soy products ü*Avoid eating the skin, avoid ‘breading’, avoid adding salt ü Prepare by baking, grilling, roasting, poaching ü Enhance the flavour by: seasoning with herbs, lemon or salsas; using small amounts of olive or canola oil ü Snack on: nuts and seeds, hard-boiled eggs, oven roasted chickpeas, hummus with fresh veggies, peanut butter on celery sticks, lower fat yogurt with fresh fruit 4*) Choose Foods With Healthy Fats Choose unsaturated oils: olive, canola, peanut, sesame, soybean, flaxseed, safflower, sunflower ØHelps lower your risk of heart disease ØThe type of fat you eat over time is more important for health than the total amount of fat you eat Foods containing healthy fats: nuts, seeds, avocado, fatty fish, vegetable oils, soft margarine, soybeans/soy products (tofu) Foods containing saturated fat: fatty meats, high fat dairy products, some highly processed foods, some tropical oils such as palm oil and coconut oil Limit: processed meats, canned coconut milk or cream, ice cream, baked goods, deep fried foods, candy bars, chocolate Choose: lean cuts of meat and skinless poultry. Trim off as much of the visible fat as possible. Drain fat from cooked ground meat Choose: lower fat dairy products like lower fat milk Limit Highly Processed Foods Processed or prepared foods and drinks often add excess sodium, sugars or saturated fat to our diets Sodium can lead to hypertension and heart disease Sugar can lead to obesity, Type 2 diabetes, caries Saturated fat can lead to heart disease Avoid: sugary drinks, syrups and jams, chocolate and candies, potato chips and pretzels, sauces, dressings and gravies, ice cream and frozen desserts, baked goods, fast foods, frozen entrées, processed meats sausages and deli meats Do: Replace sugary drinks with water, try not to keep highly processed foods at home, choose healthier menu options when eating out, use leftover baked chicken instead of deli meats, steel-cut oats instead of sweetened instant oats, make homemade versions of your favourite highly processed foods, stock your kitchen with healthy snacks (nuts, fruit, carrots, hard-boiled eggs) Plan your meals and snacks in advance J Limit the use of highly processed spreads and dressings in your meals and snacks Food Label Nutrition facts table: provides information on serving size, calories, certain nutrients and % daily values (% DV). The % DV can be used as a guide to show you if the serving of stated size has a little or a lot of a nutrient. (The DV relates to the RDA discussed earlier in this PPT.) Ø5% DV or less is a little Ø15% DV or more is a lot Ingredient list: lists all of the ingredients in a food product by weight. The list starts with the ingredient that weighs the most and ends with the ingredient that weighs the least. Nutrition claims: includes nutrient content claims and health claims. All foods with a claim must meet certain criteria but some foods may not have a claim even though they meet the criteria. Food allergen labelling: provides information to help you avoid specific food allergens or sensitivities. Date labelling: provides information on how long your unopened food product will last and the safety of certain products. The most common types of dates are “best-before,” “packaged on” and “expiration” dates.  Nutrition Facts Table Image courtesy of: https://www.canada.ca/content/dam/hc-sc/healthy-canadians/migration/alt/images/eating-nutrition/label-etiquetage/changes-modifications/changes-modifications-1-eng.jpg Food Labelling Changes Changes to the nutrition facts table Learn about the changes made to the nutrition facts table and how it can help you make healthier food choices. Changes to the serving size Learn about the changes to serving sizes which will make it easier to compare similar prepackaged foods when using the nutrition facts table. Changes to the information on sugars Learn how to use information on the food label to better understand the amount of sugars in your food. Changes to information on sweeteners Learn how to use information on the food label to better understand the amount of sweeteners in your food. Changes to the list of ingredients Read about the changes to the list of ingredients which will make it easier to read and understand. Front-of-package nutrition labelling Find out about the front-of-package nutrition symbol and how it can help you make healthier food choices Review Questions 1. What is the difference between nutrition and diet? 2. Define and provide examples of a macronutrient and a micronutrient. 3. Describe how a dental hygienist would use the different levels of prevention as it relates to nutritional counselling. 4. Compare the different dietary reference intake terms. 5. Describe the role of digestion in nutrition. 6. Describe how the foods we eat have led to a chronic disease burden in Canada. How can a dental hygienist support healthy eating? 7. How did Canada’s Food Guide change in 2019? 8. Describe the four main considerations for variety in a healthy diet. 9. How has food labelling changed in Canada over the past five years? 10. Take some time to explore the Canada’s Food Guide website, ensuring an understanding of different options for a healthy diet. References Government of Canda. (2019). Canada’s food guide for health professionals and policy makers. https://food-guide.canada.ca/sites/default/files/artifact-pdf/CDG-EN-2018.pdf Government of Canada. (2023, August 29). Canada’s food guide. https://foodguide.canada.ca/en/ Harris, N., Garcia-Godoy, F., & Nielsen Nathe, C. (2014.) Primary preventive dentistry (8th ed.). Pearson Education Inc. Sroda, R., & Reinhard, T. (2018). Nutrition for dental health: A guide for the dental professional (3rd ed.). Jones and Barlett Learning