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 of a 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 Childhood 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 for
Fluoride 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

MNT for 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
Use PEG or NG feeding if oral
supplementation is unsuccessful
For xerostomia, try artificial salivas, citrus
beverages, 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 (especially
common after weight loss); 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

MNT for Wired or Broken Jaw

Provide pureed, strained, or blenderized foods as

appropriate
Encourage nutrient-dense foods such as
blenderized casseroles
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
Aneurism of aorta

Dysphagia = difficulty
swallowing
Neuromuscular causes
CVA, brain tumors
Head injury
Parkinsons disease, MS, ALS
Achalasia (cardiospasm)
Spinal cord injury

Dysphagia
Oral phase problems

Pocketing food
Drinking from cup or straw
Drooling
Pharyngeal phase
Gagging
Choking
Nasal regurgitation
Esophageal phase
Obstruction

Symptoms of Dysphagia
Drooling, choking, coughing during or

after meals
Inability to suck from a straw
Holding pockets of food in cheeks (pt
may be unaware)
Absent gag reflex
Chronic upper respiratory infections
Gargly voice quality or moist cough
after eating

Diagnosis of Dysphagia
Nerve assessment
X-rays
Fluoroscopic swallow study: barium

swallow/cookie swallow
Measurement of esophageal sphincter
pressure and peristalsis

Aspiration
Inhalation of food, liquid into lungs
Can cause aspiration pneumonia
Appears to be dose-dependent
A major cause of aspiration pneumonia

is thought to be aspiration of
oropharyngeal secretions, particularly if
contaminated by bacteria

MNT 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

MNT for Dysphagia

In severe cases, patient may

be made NPO and enteral

feedings initiated

National Dysphagia Diet

NDD diets are more restrictive than dental

consistency diets; may wish to use more

liberal diet for edentulous patients
Developed by consensus committee; no
evidence as yet that it is effective in
preventing aspiration
Provides much-needed standardization

Strategies for Improving

Acceptance
Thickened liquids: commercial products
can improve quality and consistency of
thickened liquids
Seasoning: persons with dysphagia often
have dulled sense of taste. Serve seasoned
foods such as spaghetti, chili, apple pie
Piping and molding: pureed foods can be
thickened and molded for more attractive
appearance

Dysphagia Diet Issues

Patients on altered

consistencies tend to eat

less and often lose
weight
Patients on thickened
liquids are at risk for
dehydration
Re-evaluate patients and
advance diet as quickly
as possible