Theme III Flashcards
Why edentate patients have lower nutrition status
- Dentures decrease chewing function (objective and perceived), decreased biting force, social aspect, lose the enjoyment of eating
- Low in fibre due to avoiding hard fruit, veg, nuts
- Lower plasma concentration of vitamin C
- More saturated fat as it is softer to eat
- Avoid foods with pips and seeds because cause gum irritation if gets beneath the denture
- Low protein, energy, BMI
What % of over 75 year olds are edentulous
33%
What are the social aspects of denture wearing
- Dentures moving around and conscious about people noticing
- Uncomfortable
- Have to take them out before eating
- Awkward that they can only eat soups and risotto etc.
How could dentists advise edentulous patients to increase their fruit and veg
-Soups, smoothies, purees, mushy pees, mash, grate in salads, stewed fruit, a glass of juice a day
How to advise edentulous patients to increase their fibre intake
- Fruit and veg in soups etc.
- Porridge, topped with stewed fruit
- Lentil soup (good protein too)
- Pease pudding
- Dhal (good protein too)
How could dentists advise edentulous patients to increase intake of foods from meat and alternative groups
Fish is easier to chew
Minced meats e.g. turkey, chicken beef
Stews and slow cooked tender meat
Cooked pulses (dhal, soups, pease pudding, mushy peas, bean pate)
What is anthropometry and kinanthropometry. How it can be used
- scientific procedures and processes of acquiring anatomical dimensional measurements such as lengths, breadths, girths and skin folds with specialist equipment.
- Kinanthrometry = using anthropometric measures in relation to other scientific parameters such as human movement, physiology or applied health sciences
-Helps us compare info against a reference, provides an indication of risk
What is mass. Relation to weight
- quantity of mass in body
- M = W x Gravity
- weight is the force the matter exerts in the gravitational field
Pros and cons of weight measurements
- Pros : Quick, easy, non-invasive, low cost, easy to access
- Limitations: accuracy of scales. useless on its own, influenced by fluid retention, different between morning & night, clothing (diurnal variation), no indication of body composition, affected by menstrual cycle
Pros and cons of stature (measured vertex to inferior aspects of feet)
Pros: Quick, easy, non-invasive, easy perform, low cost
Cons: availability of accurate equipment, portability means less accurate, hair, headscarfs, Need standardisation (Frankfort plane- orbitale horizontal plane to tragion), diurnal variation (lose 1% over the day), decreases with age, spine curvature
Obesity/ overweight definition. What BMI value is for each
Excessive accumulation of fat in adipose tissue, to the extent that health may be adversely affected
Normal >18.5
Overweight >25
Obese >30
Pros and cons of BMI
-Pros: easy, non-invasive, more informative than weight or height alone (kg/m2), Permits meaningful comparisons of weight status within and between populations.
Makes it possible to identify individuals and groups at increased risk of morbidity and mortality, Enables priorities to be identified for intervention at individual and community levels, Provides a firm basis for the evaluation of interventions
-Cons: excess weight not always excess fat, does not consider fat distribution (visceral/ subcutaneous), body composition,
What should babies be eating: i) <6 months ii) from 6 months iii) by 9 months Iv) 9-12 months v) 12 months When is breast feeding stopped
I) exclusively breast milk/ formula
ii) complementary feeding introduced. High fat, low fibre, no added sugars. smooth purees, mashed food, spoon fed
iii) soft lumps. liquids in beaker or cup. Eating with fingers
iv) minced or chopped family foods. Self spoon feeding. No bottle feeding
v) cow’s milk allowed as a main source
-breast feeding and nutritionally adequate and safe complementary feeding (foods and liquids other than milk) up to 2 years
Effects of breast feeding to health
- Can reduce mortality in children by 19%
- greater protective effect against caries than bottle fed.
-However, children breastfed >12 months, those fed nocturnally, or more frequently have an increased caries risk
Reasons why are babies may be breastfed after 12 months
- delays maternal mensus
- for babies, it reduces diarrhoea, respiratory infection, shigellosis (from contaminated faeces/ food/ water)
- helps hydration when lack of clean water
- good nutrition if lack of adequate complementary food
What are the benefit of nocturnal breastfeeding
- Prolactin levels in nocturnal feeds are higher which keeps the milk supply steady for longer
- Contraceptive effect: Nocturnal breastfeeding extends the lactational amenorrhea
- Nocturnal feeding is associated with a lower risk of Sudden Infant Death Syndrome
- in very early life stomach volume is small and so frequent feeding helps achieve an adequate milk intake
- Important for babies with faltering weight as can contribute 20% of intake
- Serotonin in breast milk helps baby sleep and mothers who nurse nocturnally get more sleep
Benefits of on-demand infant feeding
- Recommended by WHO
- increases milk flow so helps nutritional adequacy
- reduced hunger upsets
- can help regulate baby’s body temperature and blood glucose
- boosts oxytocin = happier
Explain the different types of formula milk that are used instead of breast milk.
- hypoallergenic infant formula, low or lactose free, nutrient enriched post discharge formula, soya formula, follow on formula
- infant formula: does not protect babies against infection, but are based on breast milk composition and safety factors. Contain whey and casein
- hypoallergenic infant formula: for those lactose intolerant/ allergic. Fully hydrolysed cow’s milk proteins. Bizarre taste so sugars often added
- low or lactose free: no lactose or casein. Glucose and sucrose
- nutrient enriched post discharge formula: for babies born early
- soya formula: vegan. Soya protein and veg fat. Glucose and sucrose. Not recommend due to phytoestrogens
- follow on formula: >6 months. More protein and micronutrients. Higher sugar. Unnecessary. No advantage over infant formula
At what age is cows milk allowed and why What age when it can be the main source of milk
> 6months as babies unable to digest proteins in cow milk. Risk of allergy. Too high in protein
- Not as main source of milk before 12 months
- Semi-skimmed from 2 years if overweight
- Skimmed milk – not before age 5 years as children need more calories from fat than older children do.
Why parents might add sugar to infant feeds
[increases caries risk. especially when given at night]
- To treat constipation: although there are better ways of doing this such as increasing fluid intake by boiling and cooling water (<6 months), or give prunes, pear, peach, plums, apricots or peas (>6 months) to soften stools
- To aid digestion: no theory or evidence to support
- To help the baby sleep and or reduce pain (e.g. from colic or gas): Sugar water can relieve pain, however, human breastmilk also provides pain relief, so there is no added benefit of adding sugar
Complementary feeding. Things to promote and things to avoid
- low in free sugars including (fruit juices or concentrates)
- Unsweetened cereals, fruits and vegetables, and unsweetened yoghurts should be encouraged
- Milk and water should constitute the majority of drinks.
- From six months infants should be introduced to drinking from a cup and from one year drinking from a bottle should be discouraged
- Tap water boiled and then cooled is safe for infants. Weak immune systems so important there are no microbes
- Bottled mineral water may vary in composition and may be too high in some minerals and trace elements
- Fruit juices and herbal drinks unnecessary from a nutritional standpoint
- Drinks containing sugar substitutes are not recommended for infants and children under 3 years as they contain artificial sweeteners
- small frequent portions. Low fibre. High fat (50% for under 5s, 35% for over)
- sugar free supplements advised
What are periodontal diseases and give examples. Risk factors
- Spectrum of conditions affecting periodontal tissues
- Plaque induced gingivitis and periodontitis (most common). Necrotizing periodontal diseases. Drug induced diseases. Periodontal abscesses
Oral hygiene, medication, smoking, microbial, stress, nutrition, genetics, diabetes, obesity [Nutrition has direct link and indirect, as it can also increase diabetes, plaque, obesity for example.]
Effect of carbohydrates on periodontium
- Indirect: A high sucrose intake is associated with increased plaque volume due to the production of extracellular glucans, so increased plaque volume causes gingivitis
- Direct: no brushing for 4 weeks and low refined carbs diet caused increased dental plaque, but decreased gingival bleeding, so play a role in driving gingival inflammation
Effects of malnutrition on the periodontium
- Impairs innate and adaptive immune responses so reduced ability to respond to dental plaque. Associated with rapidly progressing and more severe forms of the disease
- Causes cellular depletion of antioxidant nutrients, promoting immunosuppression
- Can impair saliva host defence
- Malnutirion associated with overgrowth of periodontal pathogens and yeasts
