Learning Objectives Nutrition and Oral Health for Children Beth Ogata, MS, RD Nutrition 527 April 4, 2006 Describe oral health problems for children List nutrition-related risk factors for oral health Describe risk factors for oral health problems associated with special health care needs Describe prevention strategies Access resources related to nutrition and oral health ORAL HEALTH: THE PROBLEM The Oral Health Epidemic 5-10% of preschoolers have early childhood caries 19% of 2-5 year olds have untreated caries 45% of school-aged have caries in permanent teeth 94% of adults have caries in permanent teeth ORAL HEALTH: THE PROBLEM Why Should We Care? Effects on nutritional status Inadequate nutrient intake Effects on overall health Infection (and effects of infection) Speech/communication delay Self-image, social function Sleep Psychological status Learning and school performance WHAT IS GOOD ORAL HEALTH? Structures and Normal Development Calcification of upper incisors begins at 3-4 months in utero, crowns completed by 4-5 months of age Development of first molars begins at 5 months in utero, completed by 6 months of age WHAT IS GOOD ORAL HEALTH? Nutrients Needed for Oral Health Protein/energy Vitamin A Vitamin D, calcium, phosphorus Ascorbic acid Fluoride Iodine Iron 1
What are they & how do they happen? Dental Caries Early Childhood Caries Other Oral Health Problems Dental Caries Caries = diet-dependent bacterial infectious disease frequency of eating time saliva (or lack of) Dental Caries Early Childhood Caries a.k.a. nursing caries, nursing bottle caries, baby bottle tooth decay Occurs in 10% of 2 year old children Exposure to sugary liquids Fall asleep with bottle Carry bottle or sippy cup with sweetened liquids Treatment of Caries composite fillings antibiotics Other Problems with Nutrition Implications Periodontal disease decreased intake, swallowing problems Gingivitits Herpes simplex Candidiasis/Thrush crowns 2
Risk Factors for OH Problems Diet-related Sugar Other CHO Acidic foods Milk and water Textures Eating patterns Non-diet related Nutritional status S. mutans Previous caries Structural indicators Perceived risk Special health care needs Socio-economic status and access to care Diet-related Risk Factors Sugar Classic studies: d caries prevalence and incidence with d frequency and intake of sucrose Recent studies: relationship only teeth brushed <2 times/day Other CHO Varying cariogencity Starch Diet-related Risk Factors Acidic foods (beverages, vinegar, citrus fruit, citric/other acids, chewable vitamin C tablets) intake, long-term risk Milk and water intake risk Diet-related Risk Factors Textures Dissolve slowly Sticky Length of time on teeth Eating patterns Swishing, holding beverages Breast-/bottle-feeding at will through night Frequency Non-diet-related Risk Factors Nutritional status S. mutans Previous caries or family member with high caries rate Structural indicators white spot lesions visible plaque enamel defects Non-diet-related Risk Factors Perceived risk Socio-economic status and access to care Income <300% FPL Parent <30 years old Black or Hispanic Barriers to care Dentists: Children are too young, payments are insufficient, too busy to see young children Families: Long wait for initial visit, distance to dental office 3
Non-diet-related Risk Factors Special health care needs Physiologic risk factors structural anomalies oral-motor problems Secondary conditions and/or therapies e.g., feeding problems requiring frequent meals and snacks medications Barriers to appropriate dental care ORAL PROBLEMS Influence of Special Health Care Needs Intrauterine malnutrition Early malnutrition Craniofacial malformations Susceptibility to oral infections Abnormal food-related behaviors Feeding Problems Feeding Problems with Dental Implications ORAL PROBLEMS Influence of Special Health Care Needs Prolonged use of bottle Low fluid intake GER Gagging, vomiting, rumination Oral hypersensitivity Low energy intake Extended eating time Disruptive mealtime behavior Refusal to consume specific foods Faine, 2001 VLBW and surface defects Medications Vitamin D Folate saliva ORAL PROBLEMS Influence of Special Health Care Needs How does the disorder affect: (e.g., cerebral palsy) Development of oral structures? May have forward tongue thrust open bite, malocclusion Saliva production? Some medications saliva production Frequency of eating? Oral-motor problems, d energy needs frequent meals and snacks (and may prevent oral hygiene) Types of foods consumed? Oral-motor problems cariogenic foods Other considerations? Reflux, anti-seizure medications What works? Early identification and targeted intervention Anticipatory guidance: Nutrition education and counseling Tooth-brushing with fluoride-containing toothpaste Dental care Systemic fluoride supplements 4
Early Identification & Targeted Intervention Anticipatory Guidance: Healthy diet Adequate intake Including fluoride Appropriate habits Timing Cariogencity of foods offered Assessment by Non-dental Professionals Anticipatory Guidance: Healthy diet Cariogenic potential depends on: Amount/type of fermentable CHO Length of time food is in the mouth Protective components phytate/fiber protein neutral agents with buffering capacity calcium, fluoride Processing Cariogenic Potential of Foods Noncariogenic: nuts, seeds, popcorn, tuna, chicken, eggs, cheese, vegetables, seltzer water, plain yogurt Low cariogenicity: milk, fresh fruits, whole grain products High cariogenicity: cookies, cake, candy, dried fruit, fruit rolls, breakfast bars, doughnuts, soda crackers, pretzels, sweetened dry cereals, granola bars Anticipatory Guidance: Oral hygiene Dental visits Daily oral care Topical fluoride Anticipatory Guidance: Oral hygiene Daily oral care Dental visits Topical fluoride fluoride varnish fluoride foam 5
8 year old with CP OT for feeding skills Oral hypersensitivities Soft foods; avoids hard, crunchy, chewy foods 6-8 meals/snacks for appropriate weight gain Meds: phenobarbitol, glycopyrrolate CASE EXAMPLE: Eric Identifying Risk 8 year old with CP OT for feeding skills Oral hypersensitivities Soft foods; avoids hard, crunchy, chewy foods 6-8 meals/snacks for appropriate weight gain Meds: phenobarbitol, glycopyrrolate CASE EXAMPLE: Eric Identifying Risk Adequate hygiene? Types of foods cariogenic? Frequency of eating DNI: vitamin D/Ca, folate, saliva production CASE EXAMPLE: Eric Nutrition Interventions 8 year old with CP OT for feeding skills Oral hypersensitivities Soft foods; avoids hard, crunchy, chewy foods 6-8 meals/snacks for appropriate weight gain Meds: phenobarbitol, glycopyrrolate Regular dental visits Questions about types of foods, access to oral care Offer foods w/low cariogenicity when no access (cheese vs. sweetened cereal bar) Adequate Ca, vitamin D, folate intake Work with OT to help oral hypersensitivity 5 Things You Can Incorporate Recommend eating patterns that promote good oral health (meals/snacks vs. grazing/sipping) Suggest snacks with low cariogenicity Encourage water after cariogenic foods when tooth-brushing isn t possible Know how a child s special health care needs affects his risk for oral health problems Know how to access resources when oral health problems are present RESOURCES Pac West MCH Distance Learning Network Nutrition Focus reprint Resource List in handouts 6