1. Nutrition and Oral Health: What Dietitians Should Know January 16, 2014 Presenter: Wahida Karmally, DrPH, RD, CDE, CLS, FNLA Associate Research Scientist, Lecturer in Dentistry Director of Nutrition Irving Institute for Clinical and Translational Research Columbia University Moderator: James M. Rippe, MD – Leading cardiologist, Founder and Director, Rippe Lifestyle Institute Approved for 1 CPE (Level 2) by the Commission on Dietetic Registration, credentialing agency for the Academy of Nutrition and Dietetics. NUTRI-BITES ® Webinar Series Original recording of the January 16, 2014 webinar and PDF download of presentation available at: www.ConAgraFoodsScienceInstitute.com

2. Based on this webinar, learners should be able to:  Discuss the lifelong synergy between nutrition and oral health status in health and disease  Outline the role of nutrition in the development and integrity of the oral cavity and the progression of oral disease  Describe practical strategies dietitians can use to integrate oral health information with lifestyle/nutrition counseling 2 NUTRI-BITES ® Webinar Series Nutrition and Oral Health

3. Nutrition is an integral component of oral health Oral infectious diseases, as well as acute, chronic, and systemic diseases with oral manifestations, impact an individual's functional ability to eat and their nutrition status Nutrition and diet can affect the development and integrity of the oral cavity and progression of oral diseases. Academy of Nutrition and Dietetics's Position Paper "Oral Health and Nutrition - 2013” Journal of the Academy of Nutrition and Dietetics. (2013) 113:693-701.

5. Nutritional Deficiencies and Oral Problems Stomatitis : Niacin, folic acid &vitamin B12 Glossitis: Niacin, folic acid, B6 and B12 Xerostomia: Vitamins A* and B12 Cheilosis: Iron, B vitamins Gingival bleeding: Vitamins C and K Glossodynia: B vitamins, Zinc, Iron *Excessive intakes of vitamin A intake can impact soft and hard tissues Vitamin A toxicity can impair oral mucosal epithelium development.

6. Children's Oral Health Although dental caries (tooth decay) is largely preventable, it remains the most common chronic disease of children aged 6 to 11 years (25%), and adolescents aged 12 to 19 years (59%). Tooth decay is four times more common than asthma among adolescents aged 14 to 17 years (15%).

7. Factors Affecting Food Cariogenicity Frequency of consumption of fermentable carbohydrates Food form: liquid, solid, slowly dissolving Sequence of eating foods Combination of foods Nutrient composition of foods and beverages

8. Oral Health and Children Teeth decay is the #1 chronic disease in childhood! 3 Tips To Prevent Tooth Decay: 1. Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk 2. Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3. Brush teeth after breakfast and before bed Schedule regular dental visits!

9. Adult Oral Health Chronic disabling diseases such as jaw joint diseases (TMD), diabetes, and osteoporosis affect millions of Americans and compromise oral health and functioning. : Temporomandibular disorders TMD

10. The mouth is the telltale of diseases such as: Nutritional anemias Uncontrolled diabetes mellitus Eating disorders HIV infection Oral Cancer

11. Periodontal Disease Diabetes - types 1 and 2 Heart disease Stroke Pulmonary disease Obesity Osteoporosis Calcium and vitamin D

12. . Dietitians can use Oral Health information to integrate with lifestyle/nutrition counseling The International and Dietetic Nutritional Terminology includes diagnostic terms related to oral health. Proficiency and competency in examining the mouth to identify nutrient-deficiencies highly recommended Assess impact of chronic diseases and risk factors on oral health. Oral health screening should be a component of nutrition assessment. Clinical, Community and Research Settings

13. References: Position of the Academy of Nutrition and Dietetics: The impact of fluoride on health. Palmer CA, Gilbert JA; Academy of Nutrition and Dietetics. J Acad Nutr Diet. 2012 Sep;112(9):1443-53 Position of the Academy of Nutrition and Dietetics: Oral health and nutrition. Touger-Decker R, Mobley C; Academy of Nutrition and Dietetics. J Acad Nutr Diet. 2013 May;113(5):693-701 Diet, cardiovascular disease and oral health: promoting health and reducing risk. Touger-Decker R. J Am Dent Assoc. 2010 Feb;141(2):167-70. Review.