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DIET COUNSELLING
DR JJ
 Introduction
 Diet
 Types of diet
 Importance of balanced diet
 Diet counselling
 Diet chart
 Dental health diet s...
Diet & dental caries
Dietary studies
Non- cariogenic diet
Diet & periodontal disease
Conclusion
References
Previous...
Introduction
• When man broke from the natural food chain, he
developed new energy resources and applied
technologies to f...
• The science which deals with the study of nutrient and foods
and their effects on the nature & function of organism unde...
• Nizel (1989): Total oral intake of a substance that provides
nourishment & supply.
BALANCED DIET :
• One providing each ...
TYPES OF DIETS
Vegetarian diets
• A vegetarian diet is one which excludes meat.
• Fruitarian diet: A diet which predominantly consists of...
• Lacto-ovo vegetarianism: A vegetarian diet that includes eggs
and dairy.
• Vegan diet: In addition to the requirements o...
Semi-vegetarian diets
• Flexitarian diet: A predominantly vegetarian diet, in which meat
is occasionally consumed.
• Kanga...
Belief-based diets
• Buddhist diet: While Buddhism does not have specific dietary
rules, some buddhists practice vegetaria...
• Islamic dietary laws: Muslims follow a diet consisting solely
of food that is halal – permissible under Islamic law. The...
Diets followed for medical reasons
• Best Bet Diet: A diet designed to help prevent multiple
sclerosis, by avoiding foods ...
• Diabetic diet: An umbrella term for diets recommended to
people with diabetes. There is considerable disagreement in
the...
Importance of balanced diet
• A balanced diet is important because your organs
and tissues need proper nutrition to work e...
COUNSELLING
• Optimal growth and development are the primary objectives of
pediatric nutrition.
• Food is merely a vehicle for nutrien...
• One of the key focuses with Dietary Counselling is making a
step by step approach, so that changes are achievable in the...
Diet chart
• A diet history concerning food intake patterns, diet
adequacy, consumption of fermentable carbohydrates
(incl...
DENTAL HEALTH DIET SCORE
• The dental health diet score gives points earned as a result of an
adequate intake of food from...
Instructions for Calculating a Dental
Health Diet Score:
• Step 1 >
• To ascertain the average daily intake, list everythi...
Step 2
• Circle the foods in the diary that have been sweetened with added
sugar or are concentrated natural sweets (honey...
Step 3
• How many of the foods listed contain one or more of the ten
nutrients essential for dental-oral health? In the Nu...
• In each of the eight columns of foods, check the one or more
eaten on this usual weekday. If a food is checked, circle t...
Step 4
• List the sweets and sugar-sweetened foods and the frequency
with which they are consumed in a typical day.
• Clas...
Step 5
• Now put it all together. Transfer the 4 Food Group Score and
the Sweet Score to the Totaling the Scores page.
• I...
Communication Techniques :
Three rules
1. for motivating behavioural change.
2. verbal and nonverbal.
3. Personalization of the message is more likel...
• Interviewing
• Teaching
• Counselling
• Motivating
Interview
• (1) the problem,
• (2) the factors that contribute to it, and
• (3) the personality of the patient.
Why should a dental health professional elicit
information concerning the food and dietary
intake and habits of patients?
• First, the dietary interview can serve as a valuable diagnostic
aid. Food selection and eating habits may affect a perso...
• Second, knowledge of a person's daily routine is important for
adapting the caries-preventive diet to an individual's li...
• Third, many practical research contributions could be made if
data from nutritional assessments could systematically be
...
Physical Setting :
THE DIET INTERVIEWER:
• Certainly nutritionists can readily qualify with some
extra course work in the nature of dental caries and
periodontal d...
• Ideally, as the professional authority, the dentist should be the
diet interviewer, but it is probable that he or she wi...
Teaching and Learning:
• Even with these various aids available, teaching will not be
effective if the information is not presented in small incr...
• The more the patient is involved in the educational process the
greater is the extent of learning. People learn least we...
Counseling :
GUIDELINES FOR COUNSELING:
1. Gather information- Personal identifying data, likes and
dislikes, and the patient's percept...
• 3. Develop and implement a plan of action - a patient is
prescribed diet consisting primarily of gradual, qualitative
mo...
MOTIVATION
• Motivation stimulates or is an incentive for action. To modify
a patient's diet, the clinician can only seen ...
• According to Garn, the basic factors that motivate people are
self preservation, recognition, love, and money. The order...
MOTIVATING PATIENTS TO MODIFY FOOD
HABITS:
1. Awareness
2. Interest
3. Involvement
4. Action
5. Habit
1. Awareness
2. Interest
3. Involvement
4. Action
5. Habit
DIET AND DENTAL CARIES
Process of caries formation
1. Frequency of eating:
• Vipeholm study showed that frequency of consumption of sugars
and the oral clearance time for su...
• A significant correlation was found between a high sugar
concentration in saliva with a prolonged clearance time and car...
• The availability of sucrose for support of bacterial metabolism
in plaque which is influenced by the texture, consistenc...
Dietary studies in human population
HOW TO ASSIST THE PATIENT TO
SELECT AN ADEQUATE
NONCARIOGENIC DIET:
Step 1
• Commend the patient. It is important to commence a
counseling procedure on a positive note. Patients do
not like ...
Step 2
• Allow the patient to suggest improvements and write his or her
own diet prescription. Again refer to the evaluati...
Step 3
• Allow the patient to delete from the diet plaque-forming, sugar-
sweetened foods.
• By reexamining the sweets int...
Step 4
• Allow the patient to select non-plaque promoting snack
substitutes. If snacking is a habit of long standing, real...
Step 5
• Allow the patient to select menus.
• Starting with the existing menu as a nucleus, encourage the
patient to exami...
Reinforcement by Follow-up Reevaluation:
• Schedule a follow up visit for 2 weeks later. The patient is
asked to complete ...
Effect of diet on oral health
Systemic mechanism
Absorption and
circulation of nutritents to
cells and tissues
These effec...
Artificial sugar substitutes
Sorbital
Xylitol
Aspartame
Saccharine
Cyclamate
REDUCING THE CARIOGENICITY OF THE DIET
 Caries in rodents have been reduced significantly by adding
casein to an otherwise cariogenic diet. Since casein is a
ph...
 There is indirect evidence that
dietary fats may help prevent caries
in humans.
 For example those Eskimos whose
diets ...
 In Vitamin A deficient animals, atrophic changes in the
ameloblasts, subsequent abnormalities in tooth
morphology has be...
Trace elements and dental caries
Caries promoting elements : Selenium, magnesium, Cadmium, Platinum, Lead,
Silicon.
Elemen...
Fluoride :
 Water borne fluorides which originally were observed to cause
an unattractive discolouration and deformity to...
EDUARDO BERNABÉ ET AL. JOURNAL OF DENTISTRY 2016
 Data from 939 dentate adults who participated in the Health 2000
Survey...
Exploring the relation between body mass index, diet, and dental caries among 6-12-year-old
children
Elangovan A, Mungara ...
Diet and periodontal
disease
• Glucose and other carbohydrates are also used to produce
extracellular polysaccharides and, therefore, diets
containing ...
By interfering with the
A) integrity of gingival epithelial barrier.
B) tissue repair processes.
C) resistance mechanisms ...
Research studies using an experimental
gingivitis model have shown increased
levels of bleeding on probing when
participan...
 The epithelium of the gingival crevice or pocket adheres to the
tooth surface by physiochemical forces mediated by the p...
• Vitamin A deficiency produces hyperkeratosis and
hyperplasia of gingival tissue. There is a tendency
to periodontal pock...
• Step 1 :Ascertain the dental health diet score and if necessary,
demonstrate the method for keeping a food intake diary
...
 The National Health and Nutrition Examination Survey (NHANES) is a
program of studies designed to assess the health and ...
Conclusion
• Diet counselling makes the patient aware of the fact
that diet plays an important role in the treatment of
th...
References.
Abraham E. Nizel. The science of nutrition and its application in
clinical dentistry 2nd edition, W, B Saunder...
• Eduardo Bernabé et al. Sugar-sweetened beverages and
dental caries in adults: A 4-year prospective study . Journal of
de...
• Ireys HT, Nelson RP. New federal policy for children with special health care needs: Implications
for pediatricians. Ped...
• Friedlander AH, Yagiela JA, Mahler ME, Rubin R. The pathophysiology, medical management,
and dental implications of adul...
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diet counselling

  1. 1. DIET COUNSELLING DR JJ
  2. 2.  Introduction  Diet  Types of diet  Importance of balanced diet  Diet counselling  Diet chart  Dental health diet score  Communication techniques  Guidelines for diet counselling Contents
  3. 3. Diet & dental caries Dietary studies Non- cariogenic diet Diet & periodontal disease Conclusion References Previous year questions
  4. 4. Introduction • When man broke from the natural food chain, he developed new energy resources and applied technologies to food processing, since then our dietary habits have undergone major changes. Both the qualitative nature of our diet and pattern of eating has changed and are changing.
  5. 5. • The science which deals with the study of nutrient and foods and their effects on the nature & function of organism under different condition of age, health & disease. -NIZEL 1989 • Nutrients are defined as the constituents of food, which perform important functions in our body. Nutrition
  6. 6. • Nizel (1989): Total oral intake of a substance that provides nourishment & supply. BALANCED DIET : • One providing each nutrient in the (neither deficient nor excess) needed to maintain optimum health. - Stewart Diet
  7. 7. TYPES OF DIETS
  8. 8. Vegetarian diets • A vegetarian diet is one which excludes meat. • Fruitarian diet: A diet which predominantly consists of raw fruit. • Lacto vegetarianism: A vegetarian diet that includes certain types of dairy, but excludes eggs and foods which contain animal rennet.
  9. 9. • Lacto-ovo vegetarianism: A vegetarian diet that includes eggs and dairy. • Vegan diet: In addition to the requirements of a vegetarian diet, vegans do not eat food produced by animals, such as eggs, dairy products, or honey.
  10. 10. Semi-vegetarian diets • Flexitarian diet: A predominantly vegetarian diet, in which meat is occasionally consumed. • Kangatarian: A diet originating from Australia. In addition to foods permissible in a vegetarian diet, kangaroo meat is also consumed. • Pescetarian diet: A diet which includes fish but not meat. • Plant-based diet: A broad term to describe diets in which animal products do not form a large proportion of the diet.
  11. 11. Belief-based diets • Buddhist diet: While Buddhism does not have specific dietary rules, some buddhists practice vegetarianism based on a strict interpretation of the first of the Five Precepts. • Hindu and Jain diets: Followers of Hinduism and Jainism may follow lacto-vegetarian diets, based on the principle of Ahimsa (non-harming).
  12. 12. • Islamic dietary laws: Muslims follow a diet consisting solely of food that is halal – permissible under Islamic law. The opposite of halal is haraam, food that is Islamically Impermissible. • Haraam substances include alcohol, pork, and any meat from an animal which was not killed through the Islamic method of ritual slaughter (Dhabiha).
  13. 13. Diets followed for medical reasons • Best Bet Diet: A diet designed to help prevent multiple sclerosis, by avoiding foods with certain types of protein. • Colon cancer diet: Calcium, milk and garlic are thought to help prevent colon cancer. Red meat and processed meat may increase risk.
  14. 14. • Diabetic diet: An umbrella term for diets recommended to people with diabetes. There is considerable disagreement in the scientific community as to what sort of diet is best for people with diabetes. • Liquid diet: A diet in which only liquids are consumed. May be administered by clinicians for medical reasons, such as after a gastric bypass or to prevent death through starvation from a hunger strike.
  15. 15. Importance of balanced diet • A balanced diet is important because your organs and tissues need proper nutrition to work effectively. Without good nutrition, your body is more prone to disease, infection, fatigue, and poor performance.
  16. 16. COUNSELLING
  17. 17. • Optimal growth and development are the primary objectives of pediatric nutrition. • Food is merely a vehicle for nutrient delivery; the nutrients provide energy for growth, serve as structural components, and participate in all metabolic functions of the body. Food, however is more than just nutrients : sensory , emotional , social and cultural associations influence food choices.
  18. 18. • One of the key focuses with Dietary Counselling is making a step by step approach, so that changes are achievable in the long term. • Any changes that are made might be done over a number of weeks, so attaining your main goal is more manageable. Dietary counselling can help putting a healthy diet in place, for an individual and/or a family, losing weight, or simply feeling better by eating better.
  19. 19. Diet chart • A diet history concerning food intake patterns, diet adequacy, consumption of fermentable carbohydrates (including naturally occurring and added sugars), and the use of fluoridated toothpaste is a strategy for health professionals to use to determine the diet related caries risk habits of persons.
  20. 20. DENTAL HEALTH DIET SCORE • The dental health diet score gives points earned as a result of an adequate intake of food from each of the food groups plus points for ingesting foods especially recommended because they are the best sources of the ten nutrients essential for achieving and maintaining dental health. • From this sum points are substracted for frequent ingestion of foods that are overtly sweet – whose sweetness is derived from added refined sugar or concentrated natural sugars.The difference is the dental health diet score.
  21. 21. Instructions for Calculating a Dental Health Diet Score: • Step 1 > • To ascertain the average daily intake, list everything you eat and drink on an ordinary weekday including snacks. • Record the time when the meal or snacks were eaten, the amount ingested (in household measures), how the food was prepared, and the number of teaspoons of sugar added.
  22. 22. Step 2 • Circle the foods in the diary that have been sweetened with added sugar or are concentrated natural sweets (honey, raisins, figs, and so forth). Classify the uncircled foods or mixed food dishes into one or more ofthe appropriate food groups. • For each serving of these foods listed in the food intake dairy, place a check mark in the appropriate food group block. • Add the number of checks and multiply by the number shown. The maximum number of points credit for the milk and meat groups is 24 each and for the fruit vegetable and bread-cereal groups is 24 each. • Add the points. The sum is the Food Group Score (96 is the highest score).
  23. 23. Step 3 • How many of the foods listed contain one or more of the ten nutrients essential for dental-oral health? In the Nutrient Evaluation Chart are listed the foods that are good sources of the nutrients essential for good health in general and dental oral health in particular.
  24. 24. • In each of the eight columns of foods, check the one or more eaten on this usual weekday. If a food is checked, circle the number 7 beside the nutrient that heads this column. • The same food, such as broccoli, may be found in several columns. Also, in column more than one food may be checked. Regardless of the number of foods checked in the column, only seven points is given per nutrient (56 is a perfect score).
  25. 25. Step 4 • List the sweets and sugar-sweetened foods and the frequency with which they are consumed in a typical day. • Classify each sweet into either the liquid, solid and sticky, or slowly dissolving category. • Place a check mark in the frequency column for each item as long as they are eaten at least 20 minutes apart. • Add the number of checks. If the sweets are liquid, multiply by 5; if solid, multiply by 10; if slowly dissolving, and multiply by 15. • Write the products in the Points column and total them.
  26. 26. Step 5 • Now put it all together. Transfer the 4 Food Group Score and the Sweet Score to the Totaling the Scores page. • If the 4 Food Group Score is barely adequate or not adequate and lor the Sweet Score is in the "Watch Out" zone, nutrition counseling is indicated.
  27. 27. Communication Techniques :
  28. 28. Three rules 1. for motivating behavioural change. 2. verbal and nonverbal. 3. Personalization of the message is more likely to result in a sustained change in behaviour.
  29. 29. • Interviewing • Teaching • Counselling • Motivating
  30. 30. Interview • (1) the problem, • (2) the factors that contribute to it, and • (3) the personality of the patient.
  31. 31. Why should a dental health professional elicit information concerning the food and dietary intake and habits of patients?
  32. 32. • First, the dietary interview can serve as a valuable diagnostic aid. Food selection and eating habits may affect a person's dental or general health or both. • Appraisal of an individual's dietary status may provide a clue to potential difficulties.
  33. 33. • Second, knowledge of a person's daily routine is important for adapting the caries-preventive diet to an individual's lifestyle. • This adaptation may help a patient adhere to the newly prescribed diet, the basis for achieving the health goals and rewards for diet counseling.
  34. 34. • Third, many practical research contributions could be made if data from nutritional assessments could systematically be gathered to correlate dental, periodontal, or oral mucosal problems with such factors as food habits, dietary intake, physical conditioning factors, and socioeconomic status, among others.
  35. 35. Physical Setting :
  36. 36. THE DIET INTERVIEWER:
  37. 37. • Certainly nutritionists can readily qualify with some extra course work in the nature of dental caries and periodontal disease and in preventive dentistry.
  38. 38. • Ideally, as the professional authority, the dentist should be the diet interviewer, but it is probable that he or she will not be able to give adequate time to this phase of preventive services. • Consequently, clinical dental nutrition services probably will be assigned to a dental hygienist or a nutritionist. In any event, the dentist is the responsible professional who must reinforce the advice given by the dental hygienist or nutritionist at the check up visits.
  39. 39. Teaching and Learning:
  40. 40. • Even with these various aids available, teaching will not be effective if the information is not presented in small increment. • If the patient does not understand the explanation, it should be repeated. • The next level should not be attempted until the previous level is fully understood.
  41. 41. • The more the patient is involved in the educational process the greater is the extent of learning. People learn least well by hearing; they learn better what they can also see; and they learn best by doing, because they are totally involved. • Any time the patient participates in evaluating his or her diet and writes his or her own diet prescription with guidance from the counselor, optimal learning and adherence to the new regimen will result.
  42. 42. Counseling :
  43. 43. GUIDELINES FOR COUNSELING: 1. Gather information- Personal identifying data, likes and dislikes, and the patient's perception as to the cause(s) of the problem. 2. Evaluate and interpret information – relative adequacy of the diet, eating habits, and the indirect environmental or systemic factors that contribute to the dietary problem - to find the reasons for the patient's dental problem.
  44. 44. • 3. Develop and implement a plan of action - a patient is prescribed diet consisting primarily of gradual, qualitative modifications of the diet using acceptable food exchanges. Be realistic in the types and amounts of changes made initially. The dietary frequency chart may help in determining what changes might be made. • 4. Seek active participation • 5. Follow up
  45. 45. MOTIVATION • Motivation stimulates or is an incentive for action. To modify a patient's diet, the clinician can only seen and encourage the patient's own motivation. • However, the counselor's positive attitude and conviction as to the necessity and effectiveness of nutrition counseling can stimulate the patient to initiate an improved dietary pattern.
  46. 46. • According to Garn, the basic factors that motivate people are self preservation, recognition, love, and money. The order of importance varies from one individual to another, but all four factors influence the desires of each person. • If clinicians can help patients understand that a healthy mouth and teeth and a nice looking smile can help them achieve one or more of these four goals, patients will be inclined to adopt a diet that will promote better oral health.
  47. 47. MOTIVATING PATIENTS TO MODIFY FOOD HABITS: 1. Awareness 2. Interest 3. Involvement 4. Action 5. Habit
  48. 48. 1. Awareness 2. Interest 3. Involvement 4. Action 5. Habit
  49. 49. DIET AND DENTAL CARIES
  50. 50. Process of caries formation
  51. 51. 1. Frequency of eating: • Vipeholm study showed that frequency of consumption of sugars and the oral clearance time for sugars are important factors affecting cariogenicity. • In a study of more than 1000 children in USA, indicated that the frequency or between meal snacks of candies, cookies, chewing gum or carbonated beverages correlated with the DMF rates (Weiss et al 1960). FACTORS INFLUENCING CARIOGENICITY OF SUCROSE IN DIETS
  52. 52. • A significant correlation was found between a high sugar concentration in saliva with a prolonged clearance time and caries activity (Lundquist, 1952). • This finding implies that retentive, sticky, sweet foods with little detergency or self cleaning properties may be potentially more cariogenic than foods that detergent and rapidly clear the oral cavity. Oral clearance rate
  53. 53. • The availability of sucrose for support of bacterial metabolism in plaque which is influenced by the texture, consistency of food, the stimulation of saliva by chewing and the rapidity of clearance of the substrate. • With the advent of highly concentrated processed canned sugar the level of sucrose consumption as well as concentration of sucrose in food item increased dramatically. Effective concentration of sucrose
  54. 54. Dietary studies in human population
  55. 55. HOW TO ASSIST THE PATIENT TO SELECT AN ADEQUATE NONCARIOGENIC DIET:
  56. 56. Step 1 • Commend the patient. It is important to commence a counseling procedure on a positive note. Patients do not like to be criticized at the very outset. • Since the food evaluation chart will probably show that the recommended allowances were met in at least one or two food groups, a good starting point is to commend the patient for this and urge continuance of this good practice.
  57. 57. Step 2 • Allow the patient to suggest improvements and write his or her own diet prescription. Again refer to the evaluation chart. It can readily be seen that an intake of only two or three food groups is insufficient. • For improvement, positive recommendations for increasing the amounts to the recommended levels in order to achieve an adequate diet should be made.
  58. 58. Step 3 • Allow the patient to delete from the diet plaque-forming, sugar- sweetened foods. • By reexamining the sweets intake chart, the patient will note the grand total of the number of exposures to sweets, the type of sweets most often consumed, and the frequency with which they were eaten. • Since the form of sweets and the frequency of their use are the two most pressing factors in caries production, it must be emphasized that there can be absolutely no compromise with respect to the deletion from the diet of sweets that tend to be retained in the mouth.
  59. 59. Step 4 • Allow the patient to select non-plaque promoting snack substitutes. If snacking is a habit of long standing, realize that it is futile and unrealistic to expect total immediate abandonment of between meal nibbling. Acceptable alternatives include raw fruits, raw vegetables, cheddar cheese, or nuts. • However, if the patient is consistently reminded that increasing the total food intake at each meal will satisfy appetite and hunger, it is possible that the number of between meal snacks will eventually be reduced.
  60. 60. Step 5 • Allow the patient to select menus. • Starting with the existing menu as a nucleus, encourage the patient to examine each meal and make deletions, substitutions, or additions with which he or she can comfortably live. • The rule is to improve the quality, not the quantity of the food so that acceptance will be more likely.
  61. 61. Reinforcement by Follow-up Reevaluation: • Schedule a follow up visit for 2 weeks later. The patient is asked to complete a second 5 day food diary in the same manner first just before returning. • Evaluate the new food diary and compare the results with the original plan to note whether recommendations have been followed. Discuss misinterpretations, misunderstandings, and problems that have arisen during this period. • Menu changes are recommended if necessary.
  62. 62. Effect of diet on oral health Systemic mechanism Absorption and circulation of nutritents to cells and tissues These effects are mediated locally Local mechanism Development of teeth, quality and quantity of salivary secretion Influence the metabolism of oral flora
  63. 63. Artificial sugar substitutes Sorbital Xylitol Aspartame Saccharine Cyclamate REDUCING THE CARIOGENICITY OF THE DIET
  64. 64.  Caries in rodents have been reduced significantly by adding casein to an otherwise cariogenic diet. Since casein is a phospho-protein, it is possible that phosphate in this protein compound may have exerted some anti cariogenic effect.  Several animal studies show that the aminoacids such as lysine and glycine help prevent caries. * (Nizel et al 1970 ; McClure et al 1955; Harris et al 1967). Protein and dental caries
  65. 65.  There is indirect evidence that dietary fats may help prevent caries in humans.  For example those Eskimos whose diets are almost solely of animal origin and furnish about 70-80% of their total calories as fat experience less decay. It is only when the fat content of the diet is reduced to 25% or less that decay starts to appear. Fats and dental caries
  66. 66.  In Vitamin A deficient animals, atrophic changes in the ameloblasts, subsequent abnormalities in tooth morphology has been observed.  In man, severe Vitamin A deficiency during tooth formation does not necessarily lead to defective enamel.  The only member of the Vitamin B complex which has been associated with caries is pyridoxine (Vitamin B6) very high doses (10 times > than normal) have been reported in two small scale experiments in human subjects (pregnant and school children) to reduce caries. * (Cole et al 1980). Vitamins and dental caries
  67. 67. Trace elements and dental caries Caries promoting elements : Selenium, magnesium, Cadmium, Platinum, Lead, Silicon. Elements that are mildly cariostatic : Molybdenum, Vanadium, Strontium, Calcium, Boron, Lithium, Gold. Elements with doubtful effect on caries : Beryllium, Cobalt, Manganese, Tin, Zinc, Bromine, Iodine. Caries inert elements : Barium, aluminium, nickel, iron, palladium, titanium. Elements that are strongly cariostatic : Fluorine, phosphorous. Kum Sun Lee, Nam-Joong Kim, Eun-Hee Lee, Ja-Won Cho. Cariogenic Potential Index of Fruits according to Their Viscosity and Sugar Content. Int J Clin Prev Dent 2014;10(4):255-258
  68. 68. Fluoride :  Water borne fluorides which originally were observed to cause an unattractive discolouration and deformity to tooth enamel, when ingested at level above 2 ppm, later were proved to be essential of dental health because they reduced the incidence of dental decay when ingested daily at optimum levels of 1 ppm. Trace elements and dental caries
  69. 69. EDUARDO BERNABÉ ET AL. JOURNAL OF DENTISTRY 2016  Data from 939 dentate adults who participated in the Health 2000 Survey and the Follow-Up Study of Finnish Adults’ Oral Health showed a Adults drinking 1–2 and 3+ sweetened beverages daily had, respectively, 31% and 33% greater net DMFT increments than those not drinking any sugar sweetened beverages.  Clinical significance: in adults.
  70. 70. Exploring the relation between body mass index, diet, and dental caries among 6-12-year-old children Elangovan A, Mungara J, Joseph E Department of Pedodontics and Preventive Dentistry, RagasDental College and Hospital, Chennai, Tamilnadu, India 2015 Aim: The aim of the present study was to determine if there is an association between BMI-for-age and dental caries in children and to find out the role of diet with respect to BMI-for-age and dental caries. Materials and Methods: Demographics and anthropometric measurements were obtained for 600 children and BMI-for-age was calculated. Clinical examination for dental caries was carried out following WHO criteria. A diet recording sheet was prepared and children/parents were asked to record the dietary intake for 3 days. Data obtained were statistically analyzed using Chi-square, analysis of variance (ANOVA), and multiple linear regression. Results: After excluding improperly filled diet recording sheets, 510 children were included in the study. Caries prevalence was more in obese children than in other BMI groups. Caries scores increased as BMI-for-age increased, though this was not statistically significant. Consumption of fatty foods and snacks was more with obese children compared to other groups. A correlation was found between caries and snacks. Conclusion: Dental caries scores showed no relationship between BMI-for-age in children. Both snacks and fatty food items were consumed more by obese children, which seeks attention.
  71. 71. Diet and periodontal disease
  72. 72. • Glucose and other carbohydrates are also used to produce extracellular polysaccharides and, therefore, diets containing sucrose, glucose and other disaccharides can increase the plaque mass and facilitate the retention and colonization of the plaque biofilm which forms a substrate for bacteria to grow leading to periodontal diseases. -Boyd (2003) Effect of diet on periodontal health
  73. 73. By interfering with the A) integrity of gingival epithelial barrier. B) tissue repair processes. C) resistance mechanisms of the body. Nutritional deficiencies contributes to periodontal disease
  74. 74. Research studies using an experimental gingivitis model have shown increased levels of bleeding on probing when participants were fed with a diet high in carbohydrates when compared to those on a low sugar diet. Carbohydrates and periodontal health
  75. 75.  The epithelium of the gingival crevice or pocket adheres to the tooth surface by physiochemical forces mediated by the proteins and glycoproteins in the gingival fluid.  When a foreign body is introduced into the periodontal pocket in a protein – deficient animal, the resorption of alveolar crest, the down growth of the epithelial attachment, and the inflammatory exudate are increased. Role of protein on periodontal tissue
  76. 76. • Vitamin A deficiency produces hyperkeratosis and hyperplasia of gingival tissue. There is a tendency to periodontal pocket formation. • A suitable antimetabolite of vitamin K might interfere with the growth of Bacteroides Melaninogenicus and consequently, prevent the occurrence of periodontal disease. • The characteristic oral sign of Vitamin C deficiency is scurvy which results in enlargement of the marginal gingivae that envelopes and almost completely conceals the teeth. Effects of vitamin deficiency on Periodontium
  77. 77. • Step 1 :Ascertain the dental health diet score and if necessary, demonstrate the method for keeping a food intake diary • Step 2 :explain the nutrition-periodontal relationship • Step 3 : Assess nutritional status • Step 4 : Prescribe a diet –improve adequacy of diet • Emphasize foods that are particularly beneficial to periodontal tissue-proteins, vit C, A, folic acid, calcium, iron and zinc. • Encourage the elimination of plaque forming sweets and substitution of fibrous foods. Nutrition counselling for a patient with chronic periodontitis
  78. 78.  The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States.  NCHS (national centre for health statistics) is part of the Centers for Disease Control and Prevention (CDC) and has the responsibility for producing vital and health statistics for the Nation.  The NHANES interview includes demographic, socioeconomic, dietary, and health-related questions.  The examination component consists of medical, dental, and physiological measurements, as well as laboratory tests. Epidemiological surveys
  79. 79. Conclusion • Diet counselling makes the patient aware of the fact that diet plays an important role in the treatment of the disease. • With today’s emphasis on prevention of disease, diet counselling helps to reduce the risk of some illness by appropriate counselling.
  80. 80. References. Abraham E. Nizel. The science of nutrition and its application in clinical dentistry 2nd edition, W, B Saunders Company, Philadelphia 1966. Paula J. Moynihan. The role of diet and nutrition in the etiology and prevention of oral diseases .Bulletin of the World Health Organization (BLT). Volume 83, Number 9, September 2005, 641- 720 Moynihan P, Petersen PE. Diet, nutrition and the prevention of dental diseases. Public Health Nutrition. 7(1A): 201–26 Elangovan A, Mungara J, Joseph . Exploring the relation between body mass index, diet, and dental caries among 6-12-year-old
  81. 81. • Eduardo Bernabé et al. Sugar-sweetened beverages and dental caries in adults: A 4-year prospective study . Journal of dentistry 2014. • Kum Sun Lee, Nam-Joong Kim, Eun-Hee Lee, Ja-Won Cho. Cariogenic Potential Index of Fruits according to Their Viscosity and Sugar Content. Int J Clin Prev Dent 2014;10(4):255-258 • Paula J. Moynihan. The role of diet and nutrition in the etiology and prevention of oral diseases . Bulletin of the World Health Organization (BLT). Volume 83, Number 9, September 2005, 641-720
  82. 82. • Ireys HT, Nelson RP. New federal policy for children with special health care needs: Implications for pediatricians. Pediatrics 1992;90:321-7. • Baer MT, Harris AB. Pédiatrie nutrition assessment: Identifying children at risk. J Am Diet Assoc 1997;97: S107-15 • Kozlowski B, Powell J. Position of the American Dietetic Association: Nutrition services for children with special health needs. J Am Diet Assoc 1995;95:809-12. • Roth-Isigkeit A, Thyen U, Stoven H, Schwarzenberger J, Schmucker P. Pain among children and adolescents: Restrictions in daily living and triggering factors. Pediatrics 2005;l 15:el52-62. • Kalinyak K, Ora I. Children with Cancer. In: Ekvall S, Ekvall V, eds. Pédiatrie Nutrition in Chronic Diseases and Developmental Disorders. 2"'' ed. New York, NY: Oxford University Press, Inc; 2005:225-28. • Türkei S, Pao M. Late consequences of chronic pédiatrie illness. Psychiatr Clin North Am 2007;30:819-35. • Vaisman N, Pencharz PB, Corey M, Canny CJ, Hahn E. Energy expenditure of patients with cystic fibrosis. J Pediatr 1987;111:496-500. • Howell RB, Jandinski J, Palumbo P Shey Z, Houpt M. Dental caries in HIV-infected children. Pediatr Dent 1992;14:37O-1. • Cuggenheimer J, Moore PA. Xerostomia: Etiology, recognition, and treatment. J Am Dent Assoc 2003; 134: 61-9; quiz 118-9. 85
  83. 83. • Friedlander AH, Yagiela JA, Mahler ME, Rubin R. The pathophysiology, medical management, and dental implications of adult attention-deficit/hyperactivity disorder. J Am Dent Assoc 2007; 138:475-82. • Boyd LD, Palmer C, Dwyer JT. Managing oral health related nutrition issues of high risk infants and children. J Clin Pediatr Dent 1998;23:31-6 • Donaldson SS, Wesley MN, DeWys WD, Suskind RM, JafFe N, vanEys J. A study of the ntitritional status of pediatric cancer patients. Am J Dis Child 1981;135:1107-12. • Fayle SA, Duggal MS, Williams SA. Oral problems and the dentist's role in the management of paediatric oncology patients. Dent Update 1992; 19:152-6, 58-9. • Colecraft E. HIV/AIDS: Nutritional implications and impact on human development. Proc Nutr Soc 2008;67: 109-13. • Eldridge K, Gallagher JE. Dental caries prevalence and dental health behaviour in HIV-infected children. Int J Paediatr Dent 2000; 10:19-26. • Madigan A, Murray PA, Houpt M, Catalanotto F, Feuerman M. Caries experience and cariogenic markers in HIV-positive children and their siblings. Pediatr Dent 1996; 18:129-36. • Rother KI. Diabetes treatment: Bridging the divide. N EngI JMed2007;356:1499-501. • Twetman S, Johansson I, Birkhed D, Nederfors T. Caries incidence in young type 1 diabetes meilitus patients in relation to metabolic control and caries-associated risk factors. Caries Res 2002;36:31-5. • Lopez ME, CoUoca ME, Paez RG, Schallmach JN, Koss MA, Chervonagura A. Salivary characteristics of diabetic children. Braz Dent J 2003; 14:26-31. • Cederbaum S. Phenylketonuria: An update. Curr Opin Pediatr 2002; 14:702-6. 86

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