1. CHAPTER 20 NUTRITIONAL ASPECTS OF ALTERATIONS IN THE ORAL CAVITY Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

2. 2 Orthodontics Increased risk for: Decalcification Gingival inflammation Soft tissue trauma from orthodontic appliances Root resorption Accumulation of food debris in brackets/wires Chaotic meal patterns and snack habits Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

3. 3 Orthodontics Dental hygiene considerations After initial placement, adjustments or repair of orthodontics may require a liquid or mechanical soft diet for 1 to 2 days Emphasize importance of oral self-care, daily fluoride use, and possibly an alcohol-free antimicrobial rinse Soft drinks, energy drinks, and sports drinks with fermentable carbohydrate, along with citric acid, should be avoided to minimize enamel decalcification Adequate nutritional intake is indispensable for maintenance and repair of hard and soft tissue to withstand stresses of tooth movement Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

4. 4 Xerostomia Common factors contributing to xerostomia Drug-induced More than 400 commonly used drugs can cause xerostomia Diseases Autoimmune diseases: Sjögren’s syndrome, SLE (lupus), rheumatoid arthritis Chronic diseases: diabetes mellitus Psychogenic causes: depression, anxiety, stress, or fear Head and neck radiation From Ibsen OAC, Phelan JA: Oral Pathology for the Dental Hygienist, ed 5. St. Louis: Saunders, 2009. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

5. 5 Xerostomia Dental hygiene considerations Carefully assess adequacy of overall diet with particular attention to intake of vitamins A, B 6, and C, fluid, fiber, potassium, iron, calcium, zinc, and protein Counsel the patient about techniques/products to relieve symptoms of xerostomia Avoid dry (saltines), crumbly (whole wheat muffins), sticky (peanut butter), and spicy (chili) food; alcohol; commercial mouthwashes containing alcohol; tobacco Use gravies and sauces to moisten dry foods Choose nutrient-dense, soft, moist foods (macaroni and cheese, cottage cheese, applesauce) Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

6. 6 Root Caries and Dentin Hypersensitivity Root caries Particularly susceptible to decay is area around the CEJ, because it has anatomically thin layer of enamel, and cementum, which is thinner and contains fewer minerals than enamel Dentin hypersensitivity Erosion is major cause and often occurs as result of exposure to acids such as those in food and beverages, as well as acid from GERD From Bird DL, Robinson DS: Torres and Ehrlich Modern Dental Assisting, ed 9. St. Louis: Saunders, 2009. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

7. 7 Root Caries and Dentin Hypersensitivity Dental hygiene considerations Recommend 3-month recall, meticulous oral self-care, topical fluoride application at home, fluoridated water Brush before consuming acidic foods to neutralize the pH of saliva Use a straw for acidic drinks Avoid foods that cause sensitivity (hot coffee or ice water) Decrease frequency of intake of fermentable carbohydrates or follow with a chewing gum containing xylitol or a noncariogenic food (cheese or milk) Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

8. 8 Dentition Status Approximately 80% of people retain all or most of their natural teeth Many mistakenly believe tooth loss is normal element of aging; education level is the strongest determinant of tooth loss Compromised nutritional intake may be a result of tooth loss, tooth mobility, edentulous status, and discomfort from removable appliances With dentures may have approximately one fifth of the chewing ability Number of teeth and presence of advanced mobility determine food choices Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

9. 9 Dentition Status Dental hygiene considerations During appointment preceding placement of new denture, counsel about the initial days of adaptation so appropriate foods can be available for that period Swallowing foods may be challenge to new denture wearers Encourage intake of dairy products fortified with vitamin D to slow rate of bone loss Liquid nutritional supplement may be needed to meet caloric and nutrient needs to promote healing from extractions and/or sore spots Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

10. 10 Oral and Maxillofacial Surgery Assess nutritional needs for patients prior to surgical procedure to better cope with postsurgical demands and minimize complications Patients who are malnourished due to variety of chronic disease and conditions, such as anorexia nervosa, chemotherapy, or alcoholism, are at increased risk because they are likely to be immunosuppressed May need to refer to registered dietitian for medical nutrition therapy prior to the procedure Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

11. 11 Oral and Maxillofacial Surgery Dental hygiene considerations If the patient loses weight unintentionally, healing appears delayed and patient should be referred to a healthcare provider or dietitian Emphasize meeting recommendations of MyPyramid Key factor for optimal healing during the recovery process is adequate intake of kilocalories, carbohydrates, protein, fat, vitamins, minerals, and fluids Frequent small meals with nutrient-dense foods help meet nutrient needs Liquid nutritional supplement or multivitamin with minerals may be necessary Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

12. 12 Loss of Alveolar Bone Several factors, including poor calcium intake over a lifetime, create a physiological negative calcium balance Following tooth extractions, accelerated atrophy of alveolar bone occurs (within months) Education in masticatory efficiency, as occurs in persons with dentures, increases resorption, loss of bone mass, or alveolar osteoporosis Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

13. 13 Glossitis Etiology Bacterial, fungal, and viral infection Drugs Psychological stress Allergic reactions Nutrient deficiencies (B vitamins, iron, etc.) Dental hygiene considerations: Choose soft, nutrient- dense foods (tuna salad, cream soups, cottage cheese) Liquid nutritional supplements, such as instant breakfast, may help provide adequate nutrients From Ibsen OAC, Phelan JA: Oral Pathology for the Dental Hygienist, ed 5. St. Louis: Saunders, 2009. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

14. 14 Temporomandibular Disorder Etiology Clenching Grinding Stress Malocclusion Injury and/or bone abnormalities Dental hygiene considerations Limit opening when taking a bit of food Choose foods that are not too hard to chew Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

15. HEALTH APPLICATION Functional Foods Discuss how functional foods are defined in the US, and recognize global differences Discuss similarities & differences of phytochemicals and antioxidants Discuss use of functional foods as PART of a well-balanced diet 15 Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.