Transcript
8/17/2019 Oral& Dental Health Lecture Slides
1/40
Nutrition for Oral and Dental
Health
8/17/2019 Oral& Dental Health Lecture Slides
2/40
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
8/17/2019 Oral& Dental Health Lecture Slides
3/40
Effects of Nutrient Deficiencies on
Tooth Development
8/17/2019 Oral& Dental Health Lecture Slides
4/40
Dental and Oral Health
♦ Teeth are made from protein matri that is
minerali!ed "ith collagen #re$uiring vitamin
%&' calcium' and phosphorus #re$uiring
vitamins D and (&
8/17/2019 Oral& Dental Health Lecture Slides
5/40
(natomy of a Tooth
8/17/2019 Oral& Dental Health Lecture Slides
6/40
Dental %aries
♦ )nfectious disease of teeth in "hich organic
acid meta*olites lead to gradual
deminerali!ation of enamel+ proteolytic
destruction of tooth structure
♦(ny tooth surface can *e affected,
8/17/2019 Oral& Dental Health Lecture Slides
7/40
The Decay Process
♦ Pla$ue formation- sticky mi of microorganisms' protein' polysaccharides
♦ Bacteria meta*oli!ing fermenta*le car*ohydrate
produce acid♦ (cid production- oral pH./,/ allo"s tooth
deminerali!ation
♦ 0aliva function- rinses a"ay food+ neutrali!es
acid+ promotes reminerali!ation♦ %aries patterns-pattern depends on cause
8/17/2019 Oral& Dental Health Lecture Slides
8/40
Early %hildhood %aries
♦(lso called 1*a*y *ottle tooth decay2
♦ Nursing *ottle caries—putting *a*y to *ed
"ith a *ottle of s"eetened li$uid #3uice'
4ool5(id' etc,&
♦ 6ront teeth rapidly develop caries
♦ %ommon among Native (mericans
♦7ean children *efore age 8 from *ottle
8/17/2019 Oral& Dental Health Lecture Slides
9/40
Early %hildhood %aries
(From Swartz MH. Textbook of Physical Diagnosis, History, an !xamination, "r e. Philael#hia$ %.&. Sa'ners, ))*.+
8/17/2019 Oral& Dental Health Lecture Slides
10/40
Dental %aries—cont9d
♦ Streptococcus mutans —most common
*acteria involved♦6ermenta*le %ar*ohydrate
♦Time
♦Drop in salivary pH to *elo" /,/
8/17/2019 Oral& Dental Health Lecture Slides
11/40
Dental %aries—cont9d♦ %ariogenicity of foods
♦ 6re$uency of consumption of fermenta*le
%ar*ohydrate
♦ 6ood form—slo"ly dissolving
♦ 6ood com*inations
♦ Nutrient composition of food:*everages
♦ Timing #end of meal&
8/17/2019 Oral& Dental Health Lecture Slides
12/40
;edical 0e$uelae of Dental %aries
♦Bacteria from tooth decay can enter
*loodstream and inoculate heart valves'
cause *acterial endocarditis
♦Oral5pharyngeal secretions inoculated "ith
*acteria can cause aspiration pneumonia
8/17/2019 Oral& Dental Health Lecture Slides
13/40
6luoride
♦Primary anticaries agent
♦7ater fluoridation
♦6luoridated toothpastes♦Oral rinses
♦Dentrifices
♦Beverages made "ith fluoridated "ater
8/17/2019 Oral& Dental Health Lecture Slides
14/40
8/17/2019 Oral& Dental Health Lecture Slides
15/40
%ariogenic vs, %ariostatic
♦ %ariogenic- containing fermenta*lecar*ohydrates that can cause a decrease insalivary pH to ./,/ and deminerali!ation "hen
in contact "ith microorganisms in the mouth+ promoting caries development
♦ %ariostatic- not meta*oli!ed *ymicroorganisms in pla$ue to cause a drop insalivary pH to ./,/
8/17/2019 Oral& Dental Health Lecture Slides
16/40
%ariogenic 6oods
♦Promote formation of caries
♦6ermenta*le car*ohydrates' those thatcan *e *roken do"n *y salivary amylase
♦
8/17/2019 Oral& Dental Health Lecture Slides
17/40
%ariostatic 6oods
♦6oods that do not contri*ute to decay
♦Do not cause a drop in salivary pH
♦ )ncludes protein foods' eggs' fish' meat and poultry+ most vegeta*les' fats' sugarless
gums
8/17/2019 Oral& Dental Health Lecture Slides
18/40
(nticariogenic 6oods
♦Prevent pla$ue from recogni!ing an
acidogenic food "hen it is eaten first
♦
;ay increase salivation or haveantimicro*ial activity
♦ )ncludes ylitol #s"eetener in sugarless
gum& and cheeses
8/17/2019 Oral& Dental Health Lecture Slides
19/40
Other 6actors that (ffect Diet
%arogenicity♦ %onsistency- =i$uids are cleared $uickly "hilesticky foods remain on the teeth
♦ ;eal fre$uency- fre$uent meals and snacks
increase duration of eposure♦ 6ood composition
♦ 6ood form- li$uid' solid' slo"ly dissolving
♦ 0e$uence of eating- cheese or milk at the end ofthe meal decrease the cariogenicity of the meal
8/17/2019 Oral& Dental Health Lecture Slides
20/40
%aries Prevention Guidelines
8/17/2019 Oral& Dental Health Lecture Slides
21/40
Periodontal Disease♦ )nflammation of the gingiva "ith destruction
of the tooth attachment apparatus
♦Gingivitis—early form
♦ Nutritional care involves increasing vitamin %'
folate' and !inc
8/17/2019 Oral& Dental Health Lecture Slides
22/40
Tooth =oss and Dentures
♦ Tooth loss—denture placement
♦ 6ood selections change
♦ 0aliva production decreases
♦
8/17/2019 Oral& Dental Health Lecture Slides
23/40
Oral ;anifestations of Disease
♦ 0tomatitis-
inflammation of oral
mucosa
♦ %andidiasis and herpessimple- fungal and
viral infections "hich
can affect mouth and
esophagus causing
pain and dysphagia
Photo- http-::"e*pages,marshall,edu:>gain:*actnote:)mage?,gif
8/17/2019 Oral& Dental Health Lecture Slides
24/40
Oral ;anifestations of Disease
♦@erostomia- Dry mouth♦Periodontal disease
♦4aposi9s sarcoma—lesions in mouth and
esophagus+ associated "ith ()D0
4aposi9s 0arcoma
in ()D0
8/17/2019 Oral& Dental Health Lecture Slides
25/40
;NT for ;outh Pain:
Oral )nfections♦(void acidic and spicy foods♦Offer soft' cold' nutrient dense foods such
as canned fruit' ice cream' yogurt' cottage
cheese
♦Try oral supplements
♦
Ase PEG or NG feeding if oralsupplementation is unsuccessful
♦6or erostomia' try artificial salivas' citrus
*everages' sugar free candies or gums
8/17/2019 Oral& Dental Health Lecture Slides
26/40
;edications That ;ay %ause
@erostomia
8/17/2019 Oral& Dental Health Lecture Slides
27/40
Dental Health (ffects Nutrition
♦ Tooth loss may affect a*ility to che"
#relationship *et"een loss of teeth and
reduced intake of fruits and vegeta*les
♦ Dentures are often ill5fitting #especiallycommon after "eight loss&+ pro*lem foods
include fresh fruits and vegeta*les' che"y
and crusty *reads and che"y meat like
steak
8/17/2019 Oral& Dental Health Lecture Slides
28/40
)nterventions
♦O*tain a dental consult- if dentures are
missing' find them, )f they are loose'
replace or reline them
♦;odify diet consistency- mechanical soft'
ground' pureed
♦Ase least restrictive diet possi*le+
individuali!e+ mi consistencies if
appropriate
8/17/2019 Oral& Dental Health Lecture Slides
29/40
;NT for 7ired or Broken a"
♦ Provide pureed' strained' or *lenderi!ed foods asappropriate
♦ Encourage nutrient5dense foods such as
*lenderi!ed casseroles♦
8/17/2019 Oral& Dental Health Lecture Slides
30/40
Dysphagia C difficulty
s"allo"ing♦ ;echanical causes
Trauma to esophagus "ith scar tissue
)nelasticity due to repeated inflammation
Tumor of esophagus
(neurism of aorta
8/17/2019 Oral& Dental Health Lecture Slides
31/40
Dysphagia C difficulty
s"allo"ing Neuromuscular causes
♦ %(' *rain tumors♦ Head in3ury
♦ Parkinson9s disease' ;0' (=0
♦ (chalasia #cardiospasm&
♦ 0pinal cord in3ury
8/17/2019 Oral& Dental Health Lecture Slides
32/40
Dysphagia♦ Oral phase pro*lems
Pocketing food
Drinking from cup or stra"
Drooling♦ Pharyngeal phase
Gagging
%hoking
Nasal regurgitation♦ Esophageal phase
O*struction
8/17/2019 Oral& Dental Health Lecture Slides
33/40
0ymptoms of Dysphagia
♦ Drooling' choking' coughing during orafter meals
♦
)na*ility to suck from a stra"♦ Holding pockets of food in cheeks #pt
may *e una"are&♦ (*sent gag refle
♦ %hronic upper respiratory infections♦ Gargly voice $uality or moist cough
after eating
8/17/2019 Oral& Dental Health Lecture Slides
34/40
Diagnosis of Dysphagia♦ Nerve assessment
♦ @5rays
♦
6luoroscopic s"allo" study- *ariums"allo":cookie s"allo"
♦ ;easurement of esophageal sphincter
pressure and peristalsis
8/17/2019 Oral& Dental Health Lecture Slides
35/40
(spiration♦ )nhalation of food' li$uid into lungs
♦ %an cause aspiration pneumonia
♦
(ppears to *e dose5dependent♦ ( ma3or cause of aspiration pneumonia
is thought to *e aspiration of
oropharyngeal secretions' particularly ifcontaminated *y *acteria
8/17/2019 Oral& Dental Health Lecture Slides
36/40
;NT for Dysphagia
#National Dysphagia Diet&)ntervention depends on severity of deficit
♦ ;ealtime supervision' cueing
♦ Thickened li$uids- thin F nectarlike F
honeylike F spoon thick
♦ (ltered consistency-
=evel - pureed
=evel 8- mechanically altered
=evel - advanced
8/17/2019 Oral& Dental Health Lecture Slides
37/40
;NT for Dysphagia♦ )n severe cases' patient may
*e made NPO and enteral
feedings initiated
8/17/2019 Oral& Dental Health Lecture Slides
38/40
National Dysphagia Diet♦ NDD diets are more restrictive than dental
consistency diets+ may "ish to use more
li*eral diet for edentulous patients
♦ Developed *y consensus committee+ no
evidence as yet that it is effective in
preventing aspiration
♦ Provides much5needed standardi!ation
8/17/2019 Oral& Dental Health Lecture Slides
39/40
0trategies for )mproving
(cceptance♦ Thickened li$uids- commercial productscan improve $uality and consistency of
thickened li$uids
♦ 0easoning- persons "ith dysphagia oftenhave dulled sense of taste, 0erve seasoned
foods such as spaghetti' chili' apple pie
♦ Piping and molding- pureed foods can *ethickened and molded for more attractive
appearance
8/17/2019 Oral& Dental Health Lecture Slides
40/40
Dysphagia Diet )ssues♦ Patients on altered
consistencies tend to eat
less and often lose
"eight♦ Patients on thickened
li$uids are at risk for
dehydration♦
top related