LO 6

Question 1

How does xerostomia impact nutritional intake?

Answer 1

1. Chewing difficulties because a bolus cannot be formed without additional moisture
2. Chewing is painful because the mouth is sore
3. Swallowing is difficult because of loss of lubrication from saliva
4. Food intake may decrease because of changes in taste perception.

Question 2

How do Gustatory & Olfactory Functions impact nutritional intake?

Answer 2

Taste & Smell – affect appetite and food intake. With loss of taste patient may take greater amounts of sodium and sugar than they need

Question 3

_________% of individuals over 65 years experience xerostomia.

Answer 3

30

Question 4

Describe iron deficiency anemia

Answer 4

Etiology (cause of disease)
1. Increased needs during growth periods such as infancy or pregnancy
2. Excessive bleeding

results in lack of oxygen to cells – oral manifestations of the disease may include a burning sensation of the tongue and dry mouth. Clinical symptoms include gingival & mucosal pallor and atrophy of papillae – this will in turn affect appetite.

Question 5

Describe the oral manifestations of iron deficiency anemia

Answer 5

1. Atrophic glossitis
2. Aphthous Ulcers
3. Gingival and mucosal pallor
4. Angular cheilosis
5. Candidiasis
6. May impair wound healing

Question 6

What are the dental hygiene considerations of iron deficiency anemia?

Answer 6

1. May need to postpone invasive nonsurgical periodontal therapy until IDA improves
2. Encourage iron-rich food (e.g., meat)
3. Encourage Vitamin C to enhance absorption
4. If iron supplement is liquid, dilute with water or juice and drink with straw to minimize tooth staining

Question 7

Describe pernicious anemia

Answer 7

Occurs when vitamin B12 is deficient in the diet, is not being absorbed or requirements are increased.
Oral Symptoms can include:
1. Angular Cheilosis
2. Recurrent apthous ulcers
3. Erythematous mucositis
4. Pale or yellow oral mucosa
5. Atrophic glossitis, beefy red color

Question 8

Describe megaloblastic anemia

Answer 8

Can include poor diet or medications that interfere with absorption of folate (e.g., phenytoin {anti-convulsive} or methotrexate {used to treat rheumatoid arthritis})
Oral manifestations can include:
1. Oral manifestations can include:
2. Atrophic glossitis
3. Ulcerations
4. Glossodynia (Burning of the tongue)
5. Angular chelitis
6. Fungal infections

Question 9

What are the dental hygiene considerations for pernicious and megaloblastic anemia?

Answer 9

1. Encourage folate-rich food sources and supplement to meet the RDA for folate(400 mg)
2. Large doses of folate can negate effects of anticonvulsants, so consultation with medical provider is necessary.
3. Encourage intake of foods from animal sources high in Vitamin B12 for pernicious anemia
4. Encourage vegans to eat fortified foods
5. Patients with permanent gastric or ileal damage need month B12 intramuscular or oral B12
6. Refer to a registered dietician

Question 10

Describe aplastic anemia

Answer 10

result from exposure to toxic chemicals which inhibit bone marrow production of RBCs – example: chemotherapy treatment- pallor of conjunctiva & oral mucous membranes may be present.

Question 11

Describe Neutropenia

Answer 11

The presence of abnormally small numbers of neutrophils (white blood cells) in the circulating blood.

Etiology
1. Drugs (e.g., chemotherapeutic)
2. Autoimmune disease (e.g., rheumatoid arthritis)
3. Hematologic disease (e.g., leukemia)
4. Nutritional deficiencies
5. Bacterial or viral infection

Question 12

What are the dental hygiene considerations for Neutropenia?

Answer 12

1. Invasive dental hygiene treatment contraindicated until white blood cell count rises
2. Palliative care such as non-alcohol chlorhexidine rinse may reduce bacterial load until patient can perform more thorough oral self-care
3. Stress importance of frequent oral prophylaxis and meticulous oral hygiene care once mucositis pain subsides
4. Refer to a registered dietician

Question 13

Describe Gastroesophageal Reflux Disease (GERD)

Answer 13

occurs when the lower esophageal sphincter (LES) is weakened or immature (in infants sometimes) thus allowing gastric content (acid, pepsin, etc.) to reflux back into the esophagus causing symptoms (heartburn, acid regurgitation, etc.) and mucosal inflammation and injuries

Other etiologies could be:
1. Hiatal hernia
2. Obesity
3. Pregnancy

Question 14

What are the dental hygiene considerations for GERD?

Answer 14

1. Clients should be guided to avoid irritating foods (fatty foods, fried foods, caffeine, alcohol, carbonated beverages, acidic fruits and their juices, tomato products which can all be problematic).
2. Focus clients instead on a diet of whole, live, natural foods & work on slowing down and chewing when eating (provides more surface area for digestive enzymes) when eating to improve digestion

Question 15

Describe malabsorption issues

Answer 15

1. Notably the Inflammatory Bowel Disorders: Crohn’s disease, ulcerative colitis, celiac disease (gluten intolerance) will interfere with absorption of nutrients (secondary nutritional deficiency) –
2. Oral ulcerations may be present as well as swelling of the lip – glossitis & cheilitis are often present with vitamin B deficiencies – metallic taste alterations may also occur making food intake even more difficult
3. Other oral conditions that can present is Diffuse pustular eruptions on buccal gingiva

Question 16

Describe the dental hygiene considerations for malabsorption

Answer 16

1. Consult with healthcare provider about patient’s need for supplemental steroids and prophylactical antibiotics before the dental appointment
2. Encourage patient to eat a nutrient-rich and balanced diet to enhance healing
3. Healthcare provider or registered dietician may recommend vitamin or mineral supplementation

Question 17

Describe the relevant cardiovascular conditions

Answer 17

1. Atherosclerosis (accumulation of fatty materials such as cholesterol on smooth inner walls of arteries) as plaque thickens arteries become narrow and rough and blood flow may be disrupted –
2. Hypertension: High Blood pressure – clients are counselled to limit dietary intake of sodium and to avail themselves of a host of potassium rich foods: banana, avocado, apricots, cantaloupe, kiwi, orange/carrot juice
3. Hyperlipidemia – Elevated Cholesterol – dietary strategies include: (as discussed under atherosclerosis)

Question 18

Describe the dental hygiene considerations for cardiovascular conditions

Answer 18

1. Monitor high blood pressure for each appointment
2. Manage medication-induced xerostomia
3. Recommend healthy diet with lots of fruits and vegetable, low sodium, reduced total fat, saturated fat and dietary cholesterol
4. Medication used to lower serum lipids may cause malabsorption of fat-soluble vitamins and folic acid

Question 19

Describe systemic bone diseases

Answer 19

(osteoporosis most common) impact the periodontium & cause systemic bone disturbances – changes in shape (morphology) of mandible (jawbone); mobility of individual teeth; pain or discomfort in the jaw; increased sensitivity of the teeth; changes in occlusion of the teeth (bite).

Question 20

Describe the etiology of systemic bone diseases

Answer 20

1. Osteoporosis which is treated with bisphosphonates and multiple myeloma increases risk for osteonecrosis (bone death in the jaw)
2. Hyperparathyroidism
3. Paget’s disease is a generalized skeletal disease. Bone resorption & formation are increased, leading to thick & soft bones.
4. Fibrous dysplasia of the jaw is giant cell lesions of the jaw.

Question 21

Describe oral manifestations of systemic bone diseases

Answer 21

1. Increase in size and alteration in contour of maxilla and mandible
2. Alteration in radiographic pattern
3. Mobility of individual teeth without significant periodontal disease
4. Increased sensitivity of teeth without obvious dental or periodontal disease
5. Changes in occlusion of teeth
6. Abnormal sequence of deciduous tooth loss or eruption of permanent molar is young

Question 22

Describe type 1 and type 2 diabetes

Answer 22

1. Type 1 diabetes (formerly called juvenile-onset or insulin-dependent diabetes), accounts for 5% to 10% of all people with diabetes. In type 1 diabetes, the body’s immune system destroys the cells that release insulin, eventually eliminating insulin production from the body. Without insulin, cells cannot absorb sugar (glucose), which they need to produce energy. This is an autoimmune disease. This is an irreversible condition.
2. Type 2 diabetes (formerly called adult-onset diabetes) can develop at any age.

Question 23

Describe the etiology and oral manifestations of Hypopituitarism

Answer 23

Etiology - Congenital, tumor, head trauma, stroke, radiation or brain infection

Oral manifestations
1. Decreased skeletal growth results in
2. disproportionate retardation of mandibular growth
3. Delayed eruption
4. Malocclusion

Question 24

Describe the etiology of Hypothyroidism

Answer 24

1. Inadequate consumption of iodine
2. Inborn error of metabolism
3. High intake of goitrogen foods (e.g., cabbage and rapeseed)
4. Treatment of hyperthyroidism
5. Thyroid gland disorder
6. Deficient secretion of Thyroid Stimulating 7. Hormone (TSH)

Question 25

Describe the oral manifestations of Hypothyroidism in children

Answer 25

1. Short stature
2. Intellectual disabilities
3. Delayed eruption
4. Severe malocclusion
5. Risk for caries
6. Macroglossia

Question 26

Describe Hyperparathyroidism

Answer 26

Hypersecretion of the parathyroid hormone (PTH), leading to alterations in calcium, phosphorus, and bone metabolism
Oral Manifestations:
1. Increased osteoclastic bone resorption
2. Brown tumors occur in the head and neck, especially the mandible
3. May affect ability to consume an adequate diet

Question 27

Describe type 2 diabetes

Answer 27

1. Risk factors include: weight; inactivity; family history
2. The incidence of type 2 diabetes in children is rising and this type of diabetes accounts for the vast majority of people with diabetes—90% to 95%. In type 2 diabetes, the body is either not producing sufficient insulin to remove the sugar from the blood or the cells of the body have become resistant to the insulin.
3. Excess sugar in the blood can, over time, damage the eyes, kidneys, nerves and heart.

Question 28

What are common symptoms associated with diabetes?

Answer 28

1. increased thirst
2. frequent urination
3. increased hunger
4. unusual weight loss
5. blurred vision
6. extreme fatigue
7. irritability.

Question 29

What oral conditions are associated with diabetes?

Answer 29

candida, stomatitis, moderate to severe gingivitis, inflammation and increased mobility of teeth

Question 30

What diet should be recommended for diabetic patients?

Answer 30

focus on low glycemic foods & incorporating those proteins and healthy fats with carbohydrates!

Question 31

Describe the impact of cancer on the oral cavity and nutrition

Answer 31

1. The disease and treatment may severely affect one’s ability to eat and compromise the immune system –when the immune system is run down, all manner of disease may set in including oral bacterial build-up and inflammation – gingivitis, etc.
2. Radiation therapy causes general lack of appetite, nausea and vomiting making intake very difficult
3. Chemotherapy with its rapid cell turnover rate can lead to stomatitis (inflammation of mucous lining), oral ulcerations, and decreased absorption capacity.

Question 32

__________ is the general symptom of decreased appetite (may be due to illness, disease, fatigue, drugs, etc.)

Answer 32

Anorexia

Question 33

__________ is an eating disorder in which food intake is deliberately restricted due to the obsessive fear of gaining weight

Answer 33

Anorexia Nervosa

Question 34

Describe the dental complications that result from eating disorders

Answer 34

Dental complications in advance stages of malnutrition are generally observed in clients with anorexia nervosa (this would be a primary nutritional deficiency) : glossitis , cheilitis, stomatitis, pallor of tongue from anemia; changes in morphology of bone, loose teeth - taste alterations may also occur from loss of papillae making food intake even more difficult.

Question 35

Describe bulimia

Answer 35

Bulimia is also an eating disorder but is not normally characterized by significant weight loss. It is characterized by intentional secret binges (periods of overeating) followed by purging (vomiting) as a way of maintaining weight – it’s this cycle of binge/purge that characterizes bulimia.

Question 36

Describe how bulimia impacts the oral cavity

Answer 36

1. causes erosion of tooth enamel, tooth sensitivity, increased caries and enlargement of parotid gland (exhausted salivary gland from chronic vomiting)
2. Xerostomia from chronic vomiting & sore throat
3. Other signs of malnutrition: thinning hair, always cold & tired, dehydration from excess vomiting
4. Psychological counselling is of foremost importance. Dietary counselling can complement or follow psychological counselling.