Outcome 4 - Special nutritional needs for dental health within differing populations Flashcards
When does tooth formation of the fetus begin?
in the 6th week of pregnancy
When does calcification or hardening of the primary teeth begin?
At 4 months. The formation, but not calcification, of the permanent teeth, begins before the baby is born.
What is the recommended serving of milk products per day for pregnant women?
3-4 servings of milk products to meet calcium requirments
What is the DRI for calcium during pregnancy?
1000-1300 mg/day
What happens if a pregnant women’s diet is deficient in calcium & phosphorus?
the body will compensate for this by drawing calcium from bones - teeth will not be affected
What is the DRI for Vitamin D during pregnancy?
5 ug/day - this vitamin supports the sbsorption of CA and P. A good source of Vitamin D is sunshine, but also found in fortified milk and margarine
What ist he DRI for iron during pregnancy?
27 mg/day (an additional 9 mg of iron) to support the increased blood volume and to allow the fetus to store enough Fe to last for the first four to six months of life
Iron supplement recommended for pregnant women?
Iron requirment is often met with an iron supplement of 30-60 mg of elemental iron - especially in the 2nd and 3rd trimester.
What is the DRI for folate during pregnancy?
600 ug/day
This amount is needed to support the development of healty red blood cells as the blood volume in the mouther increases
What may a deficiency of folic acid result in for pregant women?
May result in neural tub defects (i.e spina bifida) in the infant
How much essensial fatty acids should pregnant women consume?
Should consume adequate amounts of EFAs daily for proper fetal neural and visual development
Recommended diet from birth to 6 months?
The Canadian Pediatric Society suggests exclusive breastfeeding or iron fortified formula until 6 months of age. Vitamin D supplements are also required (10 ug/day or 400 IU per day until the baby is drinking 7 oz of formula or whole milk per day). No supplements are necessary with infant formalas.
When is solid food introduced to infants?
6 months to 1 year
The order to introduce solid food is..
-infant cereals (single grains, then mixed) - these are iron-fortified, and rice cereal has the least potential of provoking a food alergy
-vegetables
-fruits, meats
-cheese & yogurt
How long to breast feed?
Breastfeeding or formula continues until at least 9-12 months when whole cow’s milk can be introduced. 2% or 1% or skim milk is not recommended until after 2 years of age
What happens at the Preschool stage?
The growth rate slows down after the first year, and the child increases muscle and bone mass and loses fat tissue. Enthusiasm for eating decreases and many children become picky eaters at this stage. Nutrition is extremely important so parents are encouraged to be patient and to create a positive atmosphere at meal and snack time.
How to teach children to like nutritious foods?
Children are beginning to develop food preferences and eating patterns that will last a lifetime. Teach children to like nutritious foods by offering them and limiting sweets. Foods should not be used as rewards. Repeated offerings are highly recommended, rather than accepting a food dislike.
Goals of Nutrition Care
to provide adequate energy and nutrients for optimal growth, development, and activity
to encourage the development of the child’s sense of taste, acceptance, and enjoyment of foods``
to promote positive, lifelong eating habit
The amount of food preschoolers need depends on:
-age
-body size
-activity level
-growth rate
-appetite
How much milk products should a preschooler consume?
Preschoolers should consume 500 mL (2 cups) of milk every day as well as one other child-size serving of milk products such as cheese or yogurt.
Total = 2-3 servings/day
How many meals per day for preschoolers?
Due to small stomach capacities and high energy needs, preschoolers require small frequent feedings to meet nutrient needs. 3 meals plus nutritious snacks between meals.
Dental (oral) health for preschoolers can be promoted by:
- Offering nutritous snacks chosen from the four food groups
-Reserving sticky foods (i.e. dried fruits, fruit leather, and sweet, sticky baked goods) for mealtimes or when chicken can brush their teeth afterward
-Avoid day long nibbling to prevent a steady food for acid producing bacteria; limit the number of snacks to 2-3 per day. If a bedtime bottle is given, only water should be offered.
-The need for fluroride supplementation varies with the age of the child and the level of fluoridation in the community water supply
What is ECC?
the development of early caries from the prolonged contact of fermentable CHO with the enamel. This can occur with bottlefed or breast fed infants
To prevent ECC, avoid…
-putting flavoured milk, juice, soda, or any sweetened substance in a baby bottle
-dipping the bottle nipple or pacifier in honey
-putting the child to sleep with a bottle containing milk or a sweetened substance
-delay weaning - it should be done no later than one year
-provide oral hygiene - baby’s teeth need to be cleaned
How to Provide Oral Hygiene in Infants
- Lie baby in a comfortable place
- Make sure you can see into the baby’s mouth
- Use a soft baby brush or wrap your finger with a clean, damp, washcloth to brush or wipe baby’s gums and teeth
- Do not use tooth paste until the child has erupted teeth
- Do not allow infant to swallow toothpaste
Common Feeding Concerns of Children
A Poor Appetite
The Cautious or “Picky” Eater
The Dawdler
Food Jabs
Vegetables - A Problem
The Overweight Child
Childs Appetites vary from day to day; some factors can be:
-overstimulated or overtired
-too many snacks
-distractions present
-new environment
A healthy, active child will eat what he/she needs.
When does a general decline of appetite happpen for children?
Energy needs decrease with time. A general decline of appetite occurs at 12 months and two years.
What is the average weight gain for two year olds and on?
The average weight gain for two years and on is approx four to six pounds per year
What to do for a Cautious or Picky Eater?
- continue to serve new foods frequently to ensure variety in the diet
- offer small amounts of the new food along with a favourite food
- remove the food if not accepted and try it again at another meal
- adults should set good examples for the child
What to do for a Dawdler?
- Give the child a reasonable amount of time (20-30 mins) to finish his meal and then remove his plate, quietly by firmly
- Remove any distractions present (Tv, radio, toys, pets)
- Start with small portions
- Do not force, bribe, or punish the child
What is Food Jags?
The same food is desired every daay for a period of time. The food desired is often the child’s favourite.
What to do for a Food Jag?
Serve the child the family meal along with a small portion of the “favourite” food. Be patient. Food jags are common in children and even adults. They wont last long if an issue is not made about it
Why are vegetables a problem with children?
- loss of colour and texture from overcooking
-learned from negative attitudes displayed by adults/siblings
-preference for sweet foods
Tricks to get child to eat vegetables?
-try vegetable juices
-cut them into different shapes
-serve them raw with dip
-grow a summer garden patch with the child
-put them in soups, omelets, and sandwiches
Vegetable preferences for children?
1-3 years: softer-cooked vegetables
4-6 years: raw vegetables with bright colours
What to do for Overweight Child?
- Do not serverly restrict childs intake - they require many nutrients in order to grow
- aim for maintaining their present weight as they grow in height (weight will slowly begin to suit their height)
-encourage activity
-limit or avoid foods that are low in nutrients but high in calories
-use low calorie, high-nutrient foods whenever posible (skim milk instead of whole)
Young children can easily choke on..
-peanut butter (by the spoonful)
-popcorn
-whole grapes and cherries
-whole beans
-hot dog pieces and chunks of meat
-hard candies and marshmellows
-nuts
-raw veggies (celery & carrots)
Modified Form of Unsafe Foods
Nuts & Seeds: chop finely
Whole Grapes: slice lengthwise
Hard Vegetable pieces: shred or chop
Fruits with pits: remove pits
Hard fruit pieces: shred or chop
Fish with bones: remove bones
Peanut butter: spread thinly
Summary of Food Tips for Children
- Maintain patience
- Provide variety
- Set a good example
- Dont make food an issue
- Keep it fun
What age do adolescents have growth spurts?
10-11 years of age for females
12-13 years of age for males
What are the Goals of Nutritional Care for Adolescents?
- to provide adequate nutrient intake for normal growth and development during puberty
-to maintain an adequate nutritional state that promotes health and prevents disease after physiological growth is complete
Factors that influence Adolescents eating patterns:
-independence
-busy schedules
-search for self-identifcation
-the desire for peer acceptance
-dissatifaction with body image
Typical eating patterns of adolescents include..
-increased tendency to skip meals
-eating more meals outside the home
-frequent snacking
-heavy reliance on convenience foods
-dieting
-vegetarian/fad diets
-frequent changes in eating habits
What is Anorexia Nervosa?
Is an illness characterized by self-imposed weight loss through starvation with a distorted attitude towards eating and body weight
-usually seen in girls shortly after puberty or in later adolescence
-results in a wide range of serious medical complications such as failure to develop normally, amenorrhea, muscular weakness, electrolyte imbalances that may cause sudden death, chronic cardiac disorders, and renal impairment
Treatment of Anorexia Nervosa?
Treatment includes psychological help to overcome the cause of the disorder and physiological help to help the patient gain weight
What is Bulimia Nervosa?
involves recurring episodes of binge eating followed by purging. Purging is the act of getting rid of the food just eating through self-induced vomiting, abusing laxitives, or excercise
-usually seen in young women
-associated with electrolye imbalances, which may cause heart failure, dehydration, and bowel probelms
-treatment includes psychological and behavioral help
What are the dental implications of bulimia?
Dental implications of bulimia are due to the recurrent vomiting which exposes the tooth surfaces to highly acidic contents of the stomach. This weakens the enamel surfaces of the teeth and brushing the teeth after vomitting seems to further damage the enamel. Throughly rinsing and flushing the mouth with water instead of brushing immediately after vomitting is recommended until the condition is under control
Aging Physiological Changes - Gastrointestinal
-decrease of hydrochloric acid secretion
-reduced secretion of enzymes
-less intrinsic factor secretion
-loss of muscle tone and reduced mobility of the GI tract
-changes in intestinal microflora
Aging Physiological Changes - Sensory & Ingestion
-reduced sense of taste, sell & sight
-ill fitting dentures, periodontal disease, tooth loss, less salivation, weakness of masseter and temporal muscles
Aging Physiological Changes - Metabolic
-slower metabolic rate (less than 15-30% with age)
-reduced organ funcion
-less physical activity
-sarcopenia
-loss of bone
Aging Physiological Changes - Stress and/or Illness
-reduced immune function
-drug use and abuse (prescripton and non-prescription
-persons over 65 take 3x as many prescription drugs as all other age groups combined
Nutritional Implications of Aging
-Decreased appetite; a decreased variety of foods eaten
-Increased risk for protein and iron deficiency
-Overall less nutrient absorption and bacterial growth causing GI upset
-Vitamin B12 deficiency
-Dehydration
-Susceptibility to food borne illness and infection
-Chewing difficullites resulting in avoidance of many foods; inadequate nutrient digestion
-Weight gain
-Require nutrient dense foods and fewer calories but same (or more) protein requirements
-Loss of calcium from bone
-Atrophy of muscle tissue
-Constipation
-Susceptibility to illness and greater need for nutritional adequacy to fight infection (especially protein, Vitamin A & C)
-Drug nutrient interactions affecting nutrient absoprtion and excretion
-Altered taste
Calorie/Energy Needs of Older Adults
-energy needs decrease with aging due to loss of LBM (decrease BMR) and reduced physical activity
-adult energy needs decrease an estimated 5% per decade - need to select nutrient-dense foods low in fat, sugar and alcohol
Protein Needs of Older Adults
-important to support a healthy immune system and prevent muscle wasting
-high-quality proteins emphasized
-recommend a daily intake of 1g protein/kg body weight
Fat Needs of Older Adults
-general guidelines of < 30% of total intake kcals from fat
-fat intake may have to be restricted to prevent weight gain
Carbohydrates & Fibre Needs of Older Adults
-emphasis on complex CHO and high fibre food choices
-drink adequate water to prevent constipation
Vitamin B12 Needs of Older Adults
- approx 15% of the elderly population is deficient in B12; people with atrophic gastritis or reduced secretion of intrinsic factor are particularly vulnerable
Vitamin D Needs of Older Adults
elderly are at risk for vitamin D deficiency due to reduced intake of fortified milk and their limited exposure to sunlight; aging also reduces the skin’s capacity to make Vitamin D and the kidney’s ability to convert it to its active form; DRI for vitamin D is 10 ug (51-70 years of age) and increases to 15ug for adults over 70
Calcium Needs of Older Adults
DRI for calcium for adults over 50 is 1200mg/day for maximum calcium retention and to compensate for decreased calcium absorption; many older adults avoid milk and milk products due to lactose intolerance
Iron Needs of Older Adults
Iron deficiency anemia may occur in older adults with low food energy intakes, chronic blood loss from diseases and medicines, and poor iron absoption due to reduced stomach acid secretion and antacid use
Water Needs of Older Adults
-Fluid recommendations: minimum of 2.7 L/day
-Lack of thirst and decreased total body water make dehydration likely
-Mild dehdration = confusion due to electrolyte imbalances
-Discourage caffeinated beverages
Bone Deposition & Resorption
From 18 - 30 years of age, bones are in a phase of active growth where they increase in length and width. Adult bone is constantly remodeled which means there is resorption (loss) of existing bone and deposition (growth) of new bone to replace that, which is removed. Between ages 30 and 40, resorption exceeds deposition, resulting in a net loss, and this carries on throughout life
What is Osteoporosis?
A condition of excessive loss of bone mass that results in weakening and brittle bones. This leads to fractures of the hip, wrist, ankle, or spine (dowager’s hump). Treatment usually involves medications, weight-bearing activity, and a high-calcium diet
Disparaties in Oral Health within Differing Global Populations
Oral diseases disproportionally affect the poor and socially disadvantaged members of society. There is a very strong and consistent association between socioeconomic status (income, occupation and educational level) and the prevalence and severity of oral diseases. This association exists from early childhood to older age and across populations in high-, middle- and low-income countries.
