4/14/2015 DISCLOSURE. Position of the Academy of Nutrition and Dietetics: Oral health and nutrition

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1 Welcome to the COPE Webinar Series for Health Professionals! MacDonald Center for Obesity Prevention and Education (COPE) Goals April webinar There s More to it than Candy and Soda: important interrelationships between oral health, diet and nutrition. What health professionals need to know. Provide Continuing Education Partner with agencies and organizations Time: Moderator: 12 noon 1 PM EST Rebecca Shenkman, MPH, RDN, LDN Interim Director MacDonald Center for Obesity Prevention & Education Participate in Research Enhance Education Handouts of the slides are posted at: There s More to it than Candy and Soda: important interrelationships between oral health, diet and nutrition. DISCLOSURE Carole A. Palmer, EdD, RD, LDN Neither the planners nor the faculty have any conflicts of interest to disclose. Objectives: The learner will be able to: 1. Review the pathophysiology of common oral conditions. 2. Discuss the impact oral health can have on general health and the implications with overweight and obesity. 3. Describe how the oral condition can affect diet and nutrition and vice versa. 4. Discuss appropriate dietary management strategies for common oral conditions. Credits: Notice: This webinar awards 1 contact hour for nurses,1 CPEU for dietitians. Suggested CDR Learning Need Code: 5000,4040,3050; Level 2. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center Commission on Accreditation. Villanova University College of Nursing Continuing Education/COPE is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration. Position of the Academy of Nutrition and Dietetics: Oral health and nutrition.nutrition is an integral component of oral health. The ADA supports the integration of oral health with nutrition services, education, and research. Collaborations between dietetics and dental professionals is recommended for oral health promotion and disease prevention and intervention JAND 113:5, May 2013, pp

2 Health Implications of Oral Problems Severe caries in children requires surgery under general anesthesia Severe caries in adults due to radiation/chemo can result in osteoradionecrosis Poor oral hygiene can cause VAP (ventilator-associated pneumonia) Periodontal disease is assoc. with preemies Edentulousness is major risk for choking and malnutrition Associations between obesity, diabetes and periodontal disease Teeth Should Last a Lifetime Common Oral Problems Dental Caries (tooth decay) Periodontal disease (gum disease) Tooth Loss Dental problems are preventable!!! Oral Infections Oral Problems are Preventable Nutrition/Oral Health Interrelationships Fluoride Anti-microbial rinses Eating impairment affects food choices Poor Food Choices =Diet/nutrition problems Systemic nutrition Oral soft tissue bone problems or Tooth problems 2

3 How Periodontal Disease occurs Nutrition & Perio Disease Also called gingivitis, pyorrhea Plaque bacteria infect gums Gums recede Bacteria infect jaw bone Jaw bone recedes Significant Relationship between Periodontal Disease and Heart Disease in Humans* This relationship has long been known in dogs Nutrition & Perio Disease Poor diet decreases resistance to infection and reduces healing Strong assoc. with vitamin C and calcium: Vitamin C: collagen and antioxidant roles (those eating < 60 mg vit. C/day had 1 1/2x chance of having gingivitis than those with 180 mg/day) Calcium & Vit. D: may increase clinical attachment loss and tooth loss Chronic PD lowers HDL and raises C-reactive protein (inflammation marker) Relationships between Metabolic Syndrome and PD may be explained by Oxidative stress leading to inflammation may explain associations found with heart disease, obesity, diabetes ) Diabetes increases PD risk, and vice versa. Period tmt = better DM control Loesche, Compendium 15 (8) l994 Tooth Decay (Dental Caries) is an Infectious Disease 1-2 Plaque bacteria (S Mutans et. al) on enamel turns dietary sugars to acids 3. Acid irritates gums and destroys tooth enamel 4-6 Bacteria & acid enter area under enamel and destroy tooth Dental Caries Process Bacterial plaque colonize in protected areas Metabolize simple sugars to acid Acid demineralizes enamel Bacteria and acid invade dentin Bacteria can invade pulp and migrate throughout the body Abscess 3

4 How Tooth Decay Occurs Personal Oral Care quality trumps quantity Soft, multitufted nylon bristle brushes to avoid toothbrush abrasion 45 degree angle into gum line Once removed, plaque takes hrs. to recolonize to harmful levels Fluoride- topical s best Fluoridated toothpaste Fluoride rinses Fluoridated water Systemic & topical Greatest effect is topical throughout life Systemic Nutrition Affects the Oral Cavity Teeth: Pre-eruptive malnutrition can result in enamel defects Bone & Soft Tissue: Slowed healing/rapid tissue turnover rate Decreased resistance to oral infections Ultimately may result in increased tooth loss How Diet Effects Teeth: (Like politics: all effects are local) Demineralization: most common with xerostomia Regular & diet sodas both cause demineralization (sugar content not relevant) Overnutrition (supplements) - developmental defects (vitamin D toxicity) -tissue regeneration (vitamin A toxicity) acid: lemons acid bevs: soda & diet soda vitamin C tablets eating disorders non-colas & iced tea were worst Von Fraunhofer, General Dentistry July-August 2004, pp

5 Reduced Salivary Function = Xerostomia Fats are Non-Cariogenic Saliva Functions: Carries amylase Prepares food for mastication, swallowing, taste Lubricates, protects oral tissues Cleans mouth Direct antibacterial function and reduces aggregation Antifungal/antiviral Maintains ph, buffers acids Cleans mouth/teeth Remineralizes via Ca,P,F May coat plaque Not a bacterial food source Proteins are Non-Cariogenic Not a bacterial food source The AMOUNT of sugars eaten or drunk (drank, drinked??) is NOT the most important factor the relative cariogenicity of a food is NOT correlated with its carbohydrate content (Kandelman, D 1997) Factors Increasing Risk Factors Decreasing Risk Eaten or sipped often Consumed infrequently Eaten or sipped for prolonged periods Highly retentive in mouth Consumed fast Liquid or fast removal from mouth No rinsing or brushing after Oral hygiene after Xerostomia No xerostomia 5

6 Major Diet Factors in Dental Caries Factors: Freq. CHO intake Between meals Slowly dissolving worst Freq. Sipping also Food Characteristics that can affect Cariogenicity Fiber content Water content Retention around tooth surfaces Mineralizing minerals (Ca, P, Fl) Usage patterns Betcha Can t Eat One 6

7 IS BEER Cariogenic? It Depends! Considered Safe Meal Pattern 3 meals No more than 3 snacks remember: kids need snacks diabetics need snacks Van loveren,duggal, Caries Research: vol 38 (suppl 1),2004 7

8 Caries Protective Foods Oral Complications of Eating Disorders Xylitol Gum Eating for Oral Health Xylitol interferes with Strep Mutans: inhibits their ability to produce acids. Interferes with their ability to colonize and stick to oral tissues. chewing action stimulates salivary flow Sugar-Free Gum Stimulates salivary flow Minimize use of sugar-containing foods and beverages between meals AVOID: hard candies & breath mints Pregnancy Oral bacteria are transmitted to child, usually from mother Children's teeth start developing during the 3 rd month of pregnancy; 20% of primary teeth calcification occurs before birth Periodontal disease in pregnancy associated with preemies & LBW JADentA, 2001;132(7) JDentRes (5) 8

9 Children should see Dentist by age 1 The Sippy & Juice Issue Consumed constantly Considered nutritious Contributes to ECC Contributes to childhood obesity Soda Stats Soft drink intake up 500 % in past 50 yrs. 40% of preschoolers have up to 8.9 oz of soft drinks/day 11.7% have 9+ oz/day Sugar-free drinks cause demineralization as well from the acid content! Best Oral Health/Nutrition Messages for Kids Balanced diet high in fruits & veggies Have sweets with meals Stay away from slowly dissolving candies and lozenges No overnight bottle unless H 2 O Limit juice to 6 oz/day Limit sippy cup, and sodas any time Limit the frequency of snacks to no more than 2 9

10 Eating Disorders Oral Complications Xerostomia Enamel erosion Increased caries Sensitivity Swollen salivary glands (esp. parotid) Adults: See your dentist Even if you don t think you have a problem (cancer screening, etc.) Eating for Oral Health Minimize use of sugar-containing foods and beverages between meals AVOID: hard candies & breath mints Maintain diet quality- adapt to oral ability Summary: Common Myths Debunked Expect dentures by middle age Fluoride is only important for kids Only sucrose causes tooth decay How much sugar you eat is the most important factor A hard toothbrush is best 10

11 Resources Academy of Nutrition and Dietetics Position Papers: Position of the Academy of Nutrition and Dietetics: oral health and nutrition. J Acad Nutr Diet May;113(5): Position of the Academy of Nutrition and Dietetics: the impact of fluoride on health. J Acad Nutr Diet Sep;112(9): Palmer, C. Diet, Nutrition, and Oral Health, 2007, Pearson/ Prentice Hall Evaluations and CE Certificates COPE s April Professional Webinar Everyone who has completed the webinar will be ed a link to the evaluation. The will be sent to the address that you used to register for the webinar. Colleen Spees, PhD, MEd, RDN, FAND Assistant Professor, Medical Dietetics & Health Sciences The Ohio State University College of Medicine Please complete the evaluation soon after you receive the . The evaluation does expire after 3 weeks. Once expired, you cannot obtain a certificate. Once the evaluation is completed, the CE certificate will be ed separately within 2 business days. CARE Connect: Multidisciplinary Preventive Health Care Outcomes in an Urban at-risk Population Date: Wednesday May 20 Time: 12:00PM - 1:00PM EST CE Credit : 1.0 contact hour, 1.0 CPEU Save the Date! Questions and Answers! The MacDonald Center for Obesity Prevention and Education and Philadelphia Dietetics Association are proud to co-host: EPIC : Pediatric Obesity Evaluation Treatment and Prevention in Community Settings Date: Location: Time: CE Credit : Tuesday May 19 th Driscoll Hall, Villanova University 5PM - 7PM EST 0.15 CEU, 1.5 CPEU, 1.5 CME Moderator: Rebecca Shenkman, MPH, RDN, LDN cope@villanova.edu Web site: villanova.edu/cope To receive monthly s on upcoming COPE events, please join COPE s Contacts on our website. Thank you for your time and interest. 11