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
ANATOMY OF
OF A
A TOOTH
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 cariesputting 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
EARLY CHILDHOOD
CHILDHOOD CARIES
CARIES

(From Swartz MH. Textbook of Physical Diagnosis, History, and Examination, 3rd ed. Philadelphia: W.B. Saunders, 1998.)

DENTAL CARIESCONTD
Streptococcus mutansmost common bacteria
involved
Fermentable Carbohydrate
Time
Drop in salivary pH to below 5.5

DENTAL CARIESCONTD
Cariogenicity

of foods
Frequency of consumption of
fermentable Carbohydrate
Food formslowly 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
RECOMMENDATIONS FOR
FOR FLUORIDE
FLUORIDE SUPPLEMENTATION
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
Gingivitisearly form
Nutritional care involves increasing
vitamin C, folate, and zinc

TOOTH LOSS AND DENTURES

Tooth

lossdenture 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
Kaposis sarcomalesions in mouth and
esophagus; associated with AIDS

Kaposis Sarcoma
in AIDS

INSTRUCTION ON 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
For xerostomia, try artificial salivas, 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 ;
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

INSTRUCTION FOR WIRED OR

BROKEN JAW
Provide

pureed, strained, or blenderized

foods as appropriate
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

DYSPHAGIA = DIFFICULTY
SWALLOWING

Neuromuscular causes

brain tumors
Head injury
Parkinsons disease
Achalasia (cardiospasm)
Spinal cord injury

INSTRUCTION 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