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Nutrition > Nutrition and oral health > Flashcards

Nutrition and oral health Flashcards

1
Q

The dentition

A

Diet and nutrition may have an effect with respect to

  • developmental defects
  • caries
  • erosion
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2
Q

Developmental defects

A 
Nutritional deficiencies
-calcium and phosphates
-vitamin A
-vitamin D
-malnutrition
Nutritional excess
-fluoride tetracycline
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3
Q

Nutritional fluoride in caries prevention

A

Water supplies (1ppm, 10% of UK
pop)
Salt (2nd most important dietary vehicle. Has
been used in Switzerland since1955)
Occurs naturally in tea (200mg F/Kg) and
some oily fish
Added to children’s school milk (2.65 ppm)

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4
Q

Fluoride

A

At the right amount, 15-50% reduction in caries

With an excess, will cause dental fluorosis (GIT upset, respiratory arrest and death)

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5
Q

Tetracycline

A 
Broad spectrum
antibiotic used for
periodontal disease,
acne, chest infections
(cystic fibrosis patients)
If given during enamel
formation stage will
cause severe intrinsic
staining of enamel
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6
Q

Vitamin D - evidence for role in dental development

A

Historically, May Mellanby (early 1900s) found that dogs fed on diets deficient in vit D had:

  • delayed dental development
  • deficient (hypoplastic) enamel
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7
Q

Patients with Vit D resistant rickets (Hereditary hypophophatasia) may present with

A

Large pulp chambers
Large/ prominent pulp horns
Enamel hypoplasia
Clefts and tubular defects in dentine

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8
Q

Vitamin D resistant rickets - clinical significance

A

Due to thin enamel, prominent pulp horns and clefts in dentine - pxs may present may present with ‘spontaneous’ dental abscesses
Study (1991) found 25% of children with VDRR had experienced spontaneous abscesses of one or more of their primary teeth

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9
Q

Calcium and phosphates - evidence for role in dental development

A 
There was a significant < in
prevalence of enamel hypoplasia in children
(1929-1943) following introduction of:
-Cheap milk
-Cod liver oil for pregnant women and young
children
-Bread fortified with calcium
Pxs with disorders
of calcium &amp;
phosphate metabolism
(x-linked
hypophosphatasia,
hypoparathyroidism)
show significant
> in enamel
defects (hypoplasias)
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10
Q

Vitamin A - evidence for role in dental development

A 
Severe changes in
ameloblasts occurs in
rats fed with diet
deficient in vit A –
with resultant defective
enamel and dentine
formation
No evidence for role
of vit A in human tooth formation
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11
Q

Malnutrition - role in dental development

A

Nigerian study (1973) found following
dental defects in malnourished children (severe lack of protein)
-enamel hypoplasia (linear grooves) involving
primary incisors
-generalised enamel hypoplasias in 20% of
children
-delayed dental eruption

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12
Q

Hypoplasia

A

Enamel missing

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13
Q

Caries

A

Established role of non-milk extrinsic sugars in aetiology of dental decay - frequency rather than quantity

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14
Q

Erosion

A

Loss of dental hard tissues by chemical process that does not involve bacteria
Loss of tooth tissue into dentine in 25% of British 5 year olds (2013 child dental health survey)

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15
Q

Extrinsic causes of erosion

A

Acidic drinks - most fruit-flavoured or carbonated drinks
Acidic food - citrus fruits, yogurts
Vit C tablets
Pickled foods and vinegar

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16
Q

Erosion - dietary risk factors

A

> 2 citrus fruits daily
“Odd diets”
Vegetarianism?
4 carbonated drinks daily: 252% increased risk

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17
Q

Food consistency and periodontal health

A

In (some) animals there is evidence that fibrous diet will help < incidence of
plaque-related gingivitis &
perio disease

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18
Q

Food consistency

A

No real evidence that eating fibrous foods < plaque-related disease in humans - however
Eating fibrous foods may help to maintain supporting tissues of periodontium, and > salivary flow from eating fibrous foods may have some beneficial effects on oral health generally

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19
Q

PEG

A

Percutaneous endoscopic gastrostomy feeding tube

20
Q

Children who are PEG-fed

A

Seem to readily develop excessive calculus deposits on all tooth surfaces

21
Q

Food type and periodontal health

A 
Food type does have
effect on amount
of plaque formed –
> when there is
higher sugar content
However no real
evidence that there will then be >
perio disease
22
Q

Vit C and periodontal health

A

Clear evidence that vitamin C deficiency has detrimental effect on perio health

23
Q

Vit C deficiency associated with

A 
Disturbed collagen
formation
Bleeding &amp; swollen
gums, loose teeth
First seen in sailors (now seen in people with very deficient diets: homeless,
fussy teenagers!)
24
Q

Folic acid and periodontal health

A 
Most deficient nutrient in adults
Primarily concerned with DNA synthesis &amp; cell turnover
Probably plays role in
perio health by maintaining
epithelial integrity &amp; attachment
Folate mouthwashes &amp; supplements have been shown to
< pregnancy-related
gingivitis
25
Q

Nutrition and the oral mucosa - oral cancer

A

Nutritional and dietary factors may play role in aetiology of oral cancer (squamous cell carcinoma)

  • alcohol
  • tobacco
  • chillis and spices
  • additives and preservatives (sudan 1!)
26
Q

Nutrition and the oral mucosa - oral manifestations of nutritional deficiencies

A

Vit B12 (glossitis, fissured tongue, burning
mouth, erosive or ulcerative lesions)
Vit C (haemorrhage and swelling)
Vit K (gingival bleeding)
Folic acid (ulcers, burning mouth, depapillation of tongue)
Iron (ulcers, glossitis, burning mouth)
Protein deficiency/ kwashiokor (oedema of tongue, atrophy of papillae, circumoral hypopigmentation)

27
Q

Oral signs of nutritional deficiency

A

Ulcers
Angular cheleitis
Depapillation of tongue c/o burning sensation or altered taste

28
Q

Angular cheleitis

A

Common inflammatory condition affecting corners of mouth or oral commissures
Depending on underlying causes, may last few days or persist indefinitely
-can get secondary infection of candida

29
Q

Orofacial granulomatosis

A 
Any age affected
Probable delayed hypersensitivity reaction 
Agents identified:
-benzoates (E210-219)
-cocoa
-cinnamon
-carvone
30
Q

Geographic tongue

A

Also known as benign migratory glossitis
Inflammatory disorder that usually appears on top & sides of tongue
Typically, affected tongues have bald, red area of varying sizes surrounded, at least in part, by irregular white border

31
Q

Clinical signs Orofacial Granulomatosis

A 
Diffuse facial swelling
Lip enlargement + vertical fissuring
Angular cheilitis
Oedema of buccal mucosa
Mucosal tags
Aphthous-like ulceration
32
Q

Mucosal tagging

A

Looks like px has bitten their cheek, not smooth

33
Q

Investigations for OFG

A

Biopsy - non-caseating granulomata
Bloods
Patch-testing

34
Q

OFG management

A

Exclusion diet
Symptomatic relief (difflam, gengigel)
Immunosuppressants
Steroids (mouthwash, systemic)

35
Q

Approach for diet diary

A
  1. Identify and target at-risk pxs
  2. Ask them (or guardian) to keep written record of everything they eat and drink for 3 days
  3. Ask them to return it to you for appraisal
36
Q

Diet diary evidence

A

Fairly limited evidence that diet advice will change habits

37
Q

Diet analysis: step 1

A

Thank person for returning diet sheet and show genuine interest. Tell them that you would like to take some time to look at it before their next visit and give them some feedback

38
Q

Diet analysis: Step 2

A

Gain general idea of whether diet sheet has been completed thoroughly or not. Ask probing qus

39
Q

Diet analysis: Step 3

A

Find something positive/ good about diet history to feedback

40
Q

Diet analysis: Step 4

A

Identify (highlighter pen or cirle) all cariogenic/ erosive food or drinks taken outside of a mealtime. Count up how many episodes a day there are

41
Q

Diet analysis: step 5

A

Identify ‘hidden’ sugars if px appears not to be snacking but still is developing caries
Cereals, ketchup, flavoured crisps, fruit yogurts, dried fruit etc.

42
Q

Diet analysis: step 6

A

Provide written personalised feedback so that px can take away advice

43
Q

Diet analysis: feedback

A
  1. Say something nice
  2. Explain frequency of sugar ‘attacks
    ‘ need to be < to prevent decay
  3. Offer ‘safe’ alternative snacks/ drinks
  4. Advice against drinks for infants in bottle
  5. Recommend general healthy eating guidelines (5 a day)
  6. Reinforce need for toothbrushing with F toothpaste twice a day
44
Q

Diet analysis: feedback (erosion)

A
  1. Discourage freq and amount of acid drinks and food
  2. Promote chilling of drinks and limit soft drinks to mealtimes
  3. Use of straw
  4. Promote neutralising foods e.g. cheese after acid food/ drink
  5. Refrain from toothbrushing straight after acid attack (evidence says 1 hour)
45
Q

‘Safe snacks/ drinks’

A

Water/ milk/ tea with no sugar (or sweeteners for older pxs)
Fresh fruit/ veg
Cheese/ meat
Bread/ breadstick
Plain crisps
Nuts (for older pxs, with no nut allergy)

46
Q

Diet analysis: reinforcement

A

Repeat exercise at recall visit

Dietary habits and circumstances can change and thus so can caries risk status e.g. when child starts secondary school

Nutrition (13 decks)

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