Although caries control cannot rely solely on dietary interventions; dietary factors must be modified to reduce the risk of caries. Dietary recommendations for caries prevention need to cover the following dietary factors:
(1) Frequency of eating meals and snacks.
(2) Oral retentiveness of foods.
(3) Length of interval between eating events.
(4) Sequence of food consumption.
(5) Amount of fermentable carbohydrate consumed.
(6) Sugar concentration of the food or drink item.
(7) Physical form of the carbohydrate.
(8) Proximity of eating to bedtime.
CHANGES AND RELATION OF NUTRITIONAL AND DENTAL REQUIREMENTS IN LIFE CYCLE
During the life cycle a number Of vulnerable periods, as well as conditions and diseases, occurs that give rise to special oral health risks or nutritional needs. The dental professionals should be aware to identify patients at high nutritional and oral health risk in order to provide early intervention.
Many pregnant women suffer significant nausea and vomiting early in the first trimester, which may result in an increase in decay. The repeated vomiting exposes the teeth to gastric acid and this causes enamel demineralization.
Some experts feel brushing should immediately follow a vomiting incident, while others feel that brushing in the presence of increased acidity will enhance the enamel destruction (Altshuler, 1990). If vomiting occurs frequently during pregnancy, the patient can be told to rinse immediately after vomiting with sodium bicarbonate to neutralize the gastric acid (Altshuler, 1990). The traditional dietary recommendations for nausea are to nibble on soda crackers and dry cereal; however, both are highly retentive fermentable carbohydrates. Oral hygiene procedures may also cause nausea in some pregnant women. Brushing with a child’s size toothbrush using only water, followed by fluoride rinses, helps some.
Pregnant women often have cravings for high carbohydrate type foods. They should be encouraged to choose healthy snacks.
(I) Less cariogenic snacks such as fresh fruit, vegetables, and dairy products should be encouraged as soon as the nausea has passed.
(II) Encourage healthy snacks like yogurt, cheese, popcorn, fruit, and vegetables for pregnancy cravings.
(Ill) If she feels she must have crackers, try to brush after eating them to remove the retained food from her teeth.
(2) Infants and Children
During infancy and early childhood systemic and local factors can affect tooth development and health of both the primary and permanent teeth. Children with special needs are a group at high risk for oral health problems.
Early Childhood Caries
The biggest dental nutrition concern for infants and young children is in preventing early childhood caries. This condition has been called many things over the years including: nursing bottle caries, baby bottle tooth decay (BBTD), nursing caries, and milk bottle syndrome. 20% of children are at high risk for early childhood caries (Kaste, 1995). Infants and children should never be put to bed with a bottle containing anything other than water. Infants, as young as six months, can begin to learn to drink from a cup. By one year, the infant should be weaned from a bottle to a cup. Dental professionals can help to educate pregnant women before children are born on appropriate use of the bottle.
Special Needs Children
(I) Failure to Thrive (FiT). Parents of the PH’ child often feed them very frequently, sometimes as often as every two hours, in an attempt to provide adequate nutrition to meet their needs. The rich carbohydrate diet with higher frequency of intake, make these patients more susceptible to dental caries.
(II) Developmental Delayed Children. Developmentally delayed children have the greatest variation in needs both nutritionally and dentally. These children may have enamel hypoplasia due to medications, fevers, and other medical and congenital conditions. This places them at increased risk of caries; the use of systemic and topical fluorides is helpful in many of such children. Developmental delayed children often have oral sensitivity.
Some special needs children with developmental delays continue to bottle feed because of delays in learning to chew, spoon feed, and eat independently. These children may require a long period of time to eat resulting in an increased length of time the teeth are exposed to cariogenic foods. Often medications used by children are in sucrose-sweetened syrups; these may increase the risk of caries and also cause dry mouth, which further increases caries risk.
The special needs child requires intensive preventive dental therapy with frequent prophylaxis, through home care by parents, and the use of systemic and topical fluorides.
80% of an individual’s average caries incidence occurs during the teen years. This is an important time to instill preventive nutrition and dental routines to prevent caries. Yet, adolescence is a time of change for young people when they begin to exert their newfound independence in many ways including choosing the foods they eat, and whether to brush or floss their teeth. They often choose foods low in vitamins, and high in fat and sugar. Teen meals are irregular and frequently consist of fast foods and ready-to-eat snack foods high in fermentable carbohydrates.
Eating disorders are one of the most prevalent psychialric/behavior disturbances affecting young generation. There is a spectrum of eating disorders, which include anorexia nervosa, bulimia nervosa, and binge eating disorder. These are quite complex and require a multidisciplinary team to manage. They often occur in the adolescent and young adult who is struggling with his or her changing body image. The dentist or dental hygienist may be the first to recognize the oral manifestations of an eating disordet The dental team may be instrumental in linking the patient suffering from eating disorders with needed medical intervention.
(I) Anorexia Neiwosa. These patients may have angular cheilitis due to multiple nutrient deficiencies as well as from dehydration of the skin and mucous membranes. There may also be parotid gland dysfunction resulting in xerostomia or dry mouth, which in turn may result in an increased incidence of decay. Approximately 50% of anorexia nervosa patients also practice bulimia, so the dental erosions normally seen in bulimics who practice self-induced vomiting, may also be seen in anorexia.
(II) Bulimia Nervosa. Many more oral manifestations are seen in the patient with bulimia because of the recurrent self- induced vomiting that characterizes the condition. These patients indulge in binging behaviors eating large quantities of high calorie, carbohydrate-rich foods over short periods of time. Average intake of food during a binge-eating episode is 3,400 calories over an houL Purging either by self-induced vomiting, using laxatives, diuretics, restrictive dieting, or vigorous exercise usually follows the binge-eating episode.
The dental complaint that usually brings these patients to the dental office is “sensitive teeth”. This results from the chronic exposure of the tooth to gastric acids during vomiting. The classic oral manifestation is enamel erosion on the lingual surfaces of the maxillary anterior teeth. These patients often have a callous or scar near the first knuckle of the index fmger from inducing vomiting by sticking the finger down the throat. The object used to cause vomiting may inifict traumatic palatal injuries or bruising. There may also be xerostomia in these patients due to dehydration from vomiting and laxative use. Caries is also a problem, one study indicated a 29% increase in caries rate among this population because of the large amounts of fermentable carbohydrates eaten during binges, vomiting, and xerostomia. The severity of the caries will depend on the frequency of binges, the cariogenicity of the diet, and oral hygiene practices. Brushing immediately after vomiting is not recommended. Instead, advise rinsing with sodium bicarbonate to neutralize the gastric acid after vomiting. After initiating medical intervention, the dental team will need to begin intensive preventive oral hygiene routines to prevent caries.
(III) Binge Eating Disorder (BED). BED is characterized by the binge eating behaviors in the bulimic patient, but there is no purging either by vomiting, diuretic, or laxative use. This patient is often overweight or obese.
The main oral health concern in these patients is the high risk of caries due to the frequent exposure to fermentable carbohydrates.
With the increase of obesity in our society, the incidence and prevalence of chronic diseases is increasing. This development has many implications for nutrition and the management of dental diseases. Other chronic diseases including cancer and gastrointestinal problems have nutritional and oral health connotations as well. The many medications used to treat these conditions also affect the nutrition and oral health status of these patients.
(I) Diabetes Mellitus. Probably the most common chronic disease seen in dental offices is Type 2 Diabetes Mellitus (or Non-Insulin Dependent Diabetes MeffitusMDDM). Patients with diabetes are at high risk for periodontal disease, and they
also exhibit impaired wound healing.
(II) Drug/Nutrient Interactions. As now a day dental patients are taking more and more
medications, some medications increase the need for certain nutrients or interfere with their absorption. Of even more concern is the number of medications that cause xerostomia as a side effect of use, which results in an increased caries risk.
(III) Cancer. As medical science advances, patients with cancer are living longer and often undergoing multiple types of treatment. These cancer therapies often have considerable impact on the oral cavity which also affects their nutritional habits.
The term “elderly” has been traditionally used for those persons who are above 65 years of age. The physiologic changes observed in aging among the healthy elderly that may affect oral health and nutrition are sensory changes, gastrointestinal changes, and immune system alterations. Many elderly persons also suffer from multiple chronic diseases and take multiple medications for these conditions, which in turn more likely to cause xerostomia and place the elderly at increased risk for root caries.
Over 95% of people 65 and older have some loss of periodontal attachment. Moderate to severe periodontal disease, over time, results in gingival recession and exposure of the root surface, which is more susceptible to caries. Loss of the caries protective qualities and immunologic functions of the saliva contribute to the increase in periodontitis and caries incidence.
• Carry a water bottle to sip on to help relieve dry mouth.
• Use sugar-free breath mints or candies to stimulate saliva.