1. CHAPTER 19 NUTRITIONAL ASPECTS OF GINGIVITIS AND PERIODONTAL DISEASE Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

2. 2 Introduction Nutrient deficiencies, excesses, or imbalances do not initiate periodontal disease, nor do megadoses of supplements cure or prevent periodontal disease Nutrition may alter development, resistance, and/or repair of the periodontium From Bird DL, Robinson DS: Modern Dental Assisting, ed 11. St. Louis: Saunders, 2015. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

3. 3 Physical Effects of Food on Periodontal Health Food composition Food composition An imbalance of one or more nutrients can be a factor in disruption of tissue integrity and immune response An imbalance of one or more nutrients can be a factor in disruption of tissue integrity and immune response Normal growth and development of periodontal and oral mucosal tissues depend on sufficient vitamin A (salivary glands, epithelial tissue), vitamin C (collagen, connective tissue), and vitamin B-complex (epithelial, connective tissue) Normal growth and development of periodontal and oral mucosal tissues depend on sufficient vitamin A (salivary glands, epithelial tissue), vitamin C (collagen, connective tissue), and vitamin B-complex (epithelial, connective tissue) Calcification of alveolus and cementum requires amino acids, calcium, phosphorus, vitamin D, and magnesium Calcification of alveolus and cementum requires amino acids, calcium, phosphorus, vitamin D, and magnesium Maintenance of oral tissues and integrity of host immune and repair responses, requires adequate vitamins A, C, and D; proteins; carbohydrates; calcium; iron; zinc and folic acid Maintenance of oral tissues and integrity of host immune and repair responses, requires adequate vitamins A, C, and D; proteins; carbohydrates; calcium; iron; zinc and folic acid Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

4. 4 Physical Effects of Food on Periodontal Health Food consistency Chewing firm, coarse, and fibrous foods, such as raw fruits and vegetables, stimulates saliva flow The increase in saliva will enhance oral clearance of food and reduce food retention Plaque biofilm is not physically removed by eating firm foods Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

5. 5 Nutritional Considerations for Periodontal Patients Increased nutrients and energy are required by periodontal patients experiencing stress, tissue catabolism, and/or infection Medical and social history can indicate whether patient at risk for nutrient deficiencies Dietary counseling of all periodontal patients enhances tissue repair and wound healing, improves resistance to infection, and reduces number/severity of complications Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

6. 6 Gingivitis In combination with local factors, systemic factors, including an immunocompromised system (AIDS); certain medications; hormonal changes (pregnancy, puberty); and vitamin C deficiency can be elements in the development of gingivitis A lack of nutrients does not cause gingival inflammation but may be a predisposing factor in that it disrupts the process of tissue repair Encourage vitamin C–rich foods and well-balanced, nutrient-dense diet using MyPyramid as a guide Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

7. 7 Chronic Periodontitis Initiation and progression of periodontitis do not occur unless plaque biofilm is present Excess glucose and sucrose also results in an increased rate of bacterial growth in early stages of biofilm development Certain types of food (soft, retentive, and/or a fermentable carbohydrate) can enhance food retention and severity of gingival inflammation Systemically nutritional status determines the immunocompetence of the periodontium Maintain nutritional diet; avoid retentive foods Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

8. 8 Chronic Periodontitis: Periodontal Surgery Preoperative Conduct preliminary assessment of patient for adequate nutrient reserves An elective surgery may need to be postponed for 1 or 2 weeks to allow nutritional status to be improved in a patient with poor nutrition Medically compromised patient should be referred to a registered dietitian Patient should be given tailored meal plan listing nutrient-dense foods and beverages to choose/consume during recovery Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

9. 9 Chronic Periodontitis: Periodontal Surgery Postoperative Because of blood loss, increased catabolism, tissue regeneration, and host defense activities following periodontal surgery, adequate nutrient intake by the patient is required Dietary intake can be influenced by complications of anorexia, nausea, dysphagia, and oral discomfort Full liquid diet Used when patient unable to chew Mechanical soft diet Used when chewing is compromised Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

10. 10 Necrotizing Periodontal Diseases Nutrient deficiencies, such as protein or vitamin C and/or B-complex deficiency, are contributing factors to NUG because of lowered host resistance Those with NUG may lose the desire to eat because of pain or may choose soft foods that are easier to eat Severity of NUG determines initial dietary recommendations Liquid nutrition supplements may be needed until a regular diet can be resumed From Perry DA, Beemsterboer P: Periodontology for the Dental Hygienist, ed 2. St. Louis: Saunders, 2007. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

11. 11 Necrotizing Periodontal Diseases Dental hygiene considerations While ulcerations are present, encourage bland, soothing foods (such as gelatin, pudding) and avoidance of spicy and acidic foods (such as citrus fruits and tomatoes) A liquid diet may be needed initially with advancement to a mechanical soft diet, followed by a regular diet, depending on the patient’s tolerance and comfort Cooler-temperature foods are more soothing when ulcerations are present Referral to an RD may be indicated Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

12. HEALTH APPLICATION Tobacco Cessation Discuss epidemiological statistics regarding number of tobacco users in US Discuss composition/impacts of cigarettes, tobacco products, and cigarette smoke Consider various systemic & oral diseases associated with tobacco use Discuss dental hygienists’ role in tobacco cessation as part of patient education 12 Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.