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DENTAL HEALTH
ORAL HEALTH
Diet
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.
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.
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
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
PERIODONTAL DISEASE
Inflammation
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.
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
Kaposis Sarcoma
in AIDS
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
DYSPHAGIA = DIFFICULTY
SWALLOWING
Mechanical causes
Trauma
DYSPHAGIA = DIFFICULTY
SWALLOWING
Neuromuscular causes
brain tumors
Head injury
Parkinsons disease
Achalasia (cardiospasm)
Spinal cord injury
1: pureed
Level 2: mechanically altered
Level 3: advanced