LO 3

Question 1

What are the various life stages that have different nutritional requirements?

Answer 1

1. Pregnant women
2. Infants
3. Children
4. Adolescents
5. Adults
6. Seniors

Question 2

Describe creating health in pregnancy

Answer 2

1. A woman’s nutrition status both before conception & during pregnancy are primary factors in the outcome of her pregnancy.
2. Important to eat healthy and see a doctor prior to becoming pregnant.
3. Preconceptual obesity or underweight not only hampers fertility but also can set the stage for metabolic problems during pregnancy.

Question 3

Describe the factors that affect fetal development

Answer 3

1. Preconception Nutrition Status – “training” trimester – getting the body ready to go the distance
2. Avoiding Contaminants & Toxins - It is important to avoid food-borne illnesses such as salmonella; listeriosis (listeria bacteria) and toxoplasmosis (parasitic infection)
3. Unusual Dietary Patterns – pica: the consumption of non-nutritive substances- coal, soil, feces, chalk, paper, starches, ice cubes
4. Availability of Quality Healthcare/Education
5. Age – maternal & fetal risks increase with age – see chart as one example related to Down’s Syndrome
6. Weight - pregnancy weight gain in range of 25-35 lbs considered ‘healthy’ – this is an estimate!
7. Too little weight gain - can result in low birth weight which is associated with infant health problems
8. Oral Health - hormonal changes during pregnancy increase oral bacteria and make women more susceptible to gingivitis and periodontitis - dental hygiene is critical!
9. Medication - many medications may detrimentally affect the health of the fetus – patients should make risk/benefit decisions with their physicians.
10. Drugs - recreational drugs and alcohol cross the placenta and can dramatically affect the health status of unborn babies.
11. Oral contraceptives (the pill) - will increase the need for vitamins C, B6, B9 (folate) & B12 and minerals zinc & magnesium.
12. Artificial Sweeteners – According to your text, non-nutritive sweeteners (saccharin, aspartame, etc.) will not harm fetus if used in moderate amounts and are anti-cariogenic/cariostatic.

Question 4

What is the safe limit of alcohol?

Answer 4

When a pregnant woman drinks alcohol so does her unborn baby. There is no known safe amount of alcohol to drink during pregnancy

Question 5

Describe the relationship between nutrition and oral development

Answer 5

1. Nutrients are essential for achieving optimum genetic potential of tooth development & health
2. Tooth development begins by the 6th week of an embryo’s life – calcification of deciduous teeth around the 4th month of pregnancy.

Question 6

Describe how various nutrient deficiencies can affect tooth development

Answer 6

1. Protein - delayed tooth eruption, increased caries, dysfunctional salivary glands
2. Vitamin A - Disturbed keratin matrix, enamel hypoplasia, increased caries, decreased epithelial tissue development, dysfunction of tooth morphogenesis
3. Vitamin D - poor calcification/pitting
4. Calcium/phosphorus - hypomineralization
5. Ascorbic acid - disturbed collagen matrix of dentin, alterations of pulp
6. fluoride/iron/zinc - increased caries
7. Iodine - delayed tooth eruption
8. Magnesium - hypoplasia of enamel

Question 7

Nutrients supplied by the mother must be available for healthy development of _________

Answer 7

Pre-eruptive teeth and soft tissues

Question 8

Describe nutritional insult

Answer 8

1. Severe and irreversible damage may occur in the presence of nutrient deficiencies at critical times
2. After eruption, the tooth has no mechanism to repair itself. Severe nutrient deficiencies can result in malformations such as cleft palate, cleft lip, and shortened mandible

Question 9

___________ is one of the most common birth defect in Canada & the United States

Answer 9

Cleft Palate/cleft lip

Question 10

Neural tube defects occur within the first ___________ of pregnancy

Answer 10

four weeks (often before a woman even knows she’s pregnant)

Question 11

__________ can help prevent neural tube defects only if taken __________ months before conception

Answer 11

1. Folate
2. One to three

Question 12

What are the nutritional requirements during pregnancy?

Answer 12

1. Calories – stay same for 1st trimester, increase by 340 cal./day in 2nd trimester & by 452 in 3rd. Why extra energy? Building new tissue & need to support increased metabolic expenditure - this is a major ANABOLIC phase
2. Fat – Focus on the healthy fats especially Omega-3s that are vital to brain health and vision. Saturated fats should be limited because of minimal nutrition.
3. Protein – protein is the basic nutrient for growth – DRI requirement increases from .8g/per kg body weight/day to 1.1g/kg/day in pregnancy.
4. Protein – protein is the basic nutrient for growth – DRI requirement increases from .8g/per kg body weight/day to 1.1g/kg/day in pregnancy.
5. Vitamin A (10% increase)
6. B complex (25 to 50% increases)
7. Vitamin C (13% increase).
8. Folate – 600 micrograms (mcg)
9. Iron: (50% increase like folate) essential for production of RBC & placenta – also important to compensate for cord and blood loss at delivery
10. Zinc – (38% increase) critical early in pregnancy during formation of fetal organs and again in late pregnancy for fetal growth & development.

Question 13

Iron deficiency anemia is seldom seen in ___________ but will often be seen in ___________

Answer 13

1. full-term infants
2. Moms!

“The fetus acts as a parasite in that fetal requirements for RBCs occur at the expense of maternal iron stores.”

Question 14

What should you do if your client is a pregnant vegan or vegetarian?

Answer 14

If you are working with someone who is a vegetarian or vegan for cultural reasons - or for any other reason – encourage them to have blood levels monitored carefully - while respecting their choice

Question 15

Describe the first year for infants (food, growth, nutrient requirements)

Answer 15

1. Infants will normally thrive on breast milk for the first 6 months of life
2. Growth: birth weight of an infant doubles in first 4 months & usually triples by 1st year
3. Length & height also increase by about 50% by year 1
4. Nutrient Requirements: during this rapid growth phase, energy requirements are much higher per kilogram of weight – 85 cal/kg/day between 3 -12 months vs. 35 cal/kg/day for adults

Question 16

What should nursing moms take into consideration?

Answer 16

1. Dietary intake for breastfeeding mothers is very similar to that of pregnancy and post-natal multi is generally advised by their medical doctor. Remember our scope of practice does not allow dental hygienists to recommend supplements

Question 17

Infants breastfed for one year require ___________ less orthodontia than bottle fed infants

Answer 17

40%

Question 18

Describe the early feeding practices for infants

Answer 18

1. infants are generally fed on demand until 6 months After 6 months of age and with consultation from the health care provider, foods are introduced one at a time (helps identify allergy) with a waiting period of 5 to 7 days between new foods.
2. Recommendation starting with meat and meat alternatives and iron-fortified cereal.
3. High allergen foods - cow’s milk, peanut, eggs - and foods that are difficult to digest - cucumber, onion, cabbage, broccoli - are introduced after 1 year – New mothers should consult with the baby’s doctor first

Question 19

Describe oral health in early childhood

Answer 19

1. Tooth formation begins before birth and is not completed until about 12 years of age
2. Nutritional deficiency at this stage can affect size, formation, eruption and susceptibility to caries
3. Early Childhood Caries (ECC) is a leading health problem among children under age 3
4. Primary cause of ECC is cariogenic bacteria – ie: sugar

Question 20

What are the feeding recommendations for children 3+

Answer 20

1. Because children are unable to eat large quantities of food at any one time, encourage smaller, frequent meals with nutrient dense foods – if a child is really struggling with food, a liquid supplement may be indicated at this age.
2. The key message of dietary guidelines is to offer a variety of food in moderation and balance food choices. The main concerns with providing dietary guidelines is to provide adequate calories and nutrients to support growth and development and ensure genetic potential.
3. A second reason is to reduce risk of diet-related chronic diseases later in life
4. Parents should only give vitamin supplements through the advice of their child’s family doctor.
5. Nutrient inadequacies and excesses are more prevalent in children from households with lower incomes.

Question 21

What are feeding recommendations for children 4-6

Answer 21

1. Children are eating independently at this stage but may still be learning to use utensils – focus on what the child is doing right
2. Preschoolers may require repeated exposure to foods gently offer and never force feed a child – it often creates a negative relationship to food
3. Provide many options and empower the child by allowing them to make food choices.
4. The body uses food more effectively and energy levels are more consistent when children “refuel” every 2-4 hours.
5. Consider too that liquids interfere with appetite

Question 22

Describe feeding recommendations for children 7-12

Answer 22

1. Oral Consideration: this phase marks the exfoliation of all or most of the primary teeth and eruption of most of the permanent teeth
2. This is an important period for formation of good eating habits.
3. Habits established during this time will shape food-related perceptions and behaviours and contribute to lifelong healthy eating patterns.
4. New activities and friends begin to influence choices and broaden the child’s horizon.
5. Continue to involve your child at home as a way of educating, empowering and enforcing good habits
6. The child exposed to different foods and food patterns usually enjoys more foods
7. Planning menus around food groups is important to include all the necessary nutrients.

Question 23

What is key to keep in mind about adolescents?

Answer 23

1. Be mindful of key nutrient requirements: calcium/vitamin D; iron (particularly for menstruating adolescents)
2. It is estimated that only 9% of girls and 31% of boys between 12 – 19 get the required amount of calcium – yet 45% of skeletal mass is formed during adolescents
3. A daily intake of 1,300 mg/day of calcium, adequate vitamin D & exercise during this period is highly recommended for bone and muscle strength

Question 24

What are the different needs of seniors?

Answer 24

1. According to textbook, the most common nutritional disorder in older persons is obesity which contributes to many chronic conditions: CVD; diabetes and some cancers.
2. 2/3 of people over 65 do not exercise – issues?
3. Seniors tend to favour easily prepared, easily digested foods and therefore gravitate towards the carbohydrates: toast, cereal, soups. Protein often goes missing from the diet.
4. Encourage easily prepared and digested protein choices in the diet such as: sliced hard boiled egg; cottage cheese with banana; yogurt; sliced chicken breast; omega 3 fatty fish
5. Remaining physically active will help manage weight and strengthen muscle/bone - physical fitness also improves mood and can relieve symptoms of depression which is also present in this age group. Suggest simple, small steps: walking is a great place to start.
6. Encourage fresh fruits & vegetables for water content (improve salivary flow) and make dietary suggestions to ease transit, digestion and absorption.
7. In some cases, where insufficient nutrients are coming from food, supplementation may be indicated

Question 25

What are common oral health concerns for seniors?

Answer 25

1. Hypogeusia: loss of taste
2. Anosmia: loss of smell
3. Xerostomia: dry mouth – affects half of seniors (highly medicated population) this will compromise oral clearance of foods with loss of salivary flow giving rise to greater risk of caries and periodontal disease – chewing and swallowing are also more difficult – periodontal disease will in turn affect dietary intake
4. Dysphagia (difficulty swallowing)
5. Atrophic gastritis (stomach inflammation with decreased HCl production)