chapter 19 nutritional aspects of gingivitis and periodontal disease copyright 2015, 2010, 2005,...
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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.TRANSCRIPT
CHAPTER 19CHAPTER 19
NUTRITIONAL ASPECTS OF NUTRITIONAL ASPECTS OF GINGIVITIS AND PERIODONTAL GINGIVITIS AND PERIODONTAL
DISEASEDISEASE
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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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 From Bird DL, Robinson DS: Modern Dental Assisting, ed 11. St. Louis: Saunders, 2015.Assisting, ed 11. St. Louis: Saunders, 2015.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Physical Effects of Food on Periodontal Health
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Physical Effects of Food on Periodontal Health
Food consistencyChewing 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.
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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 indicatewhether patient at risk for nutrientdeficiencies
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.
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GingivitisIn combination with local factors,
systemic factors, including animmunocompromised 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.
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Chronic PeriodontitisInitiation and progression of periodontitis do not
occur unless plaque biofilm is presentExcess 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 foodsCopyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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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.
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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 discomfortFull liquid diet
Used when patient unable to chewMechanical soft diet
Used when chewing is compromised
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Necrotizing Periodontal DiseasesNutrient deficiencies, such as protein or vitamin
C and/or B-complex deficiency, are contributing factors to NUG because of lowered host resistanceThose with NUG may lose the desire to eat because of
pain or may choose soft foods that are easier to eatSeverity of NUG determines initial dietary
recommendationsLiquid nutrition supplements may be
needed until a regular diet can beresumed
From Perry DA, Beemsterboer P: Periodontology From Perry DA, Beemsterboer P: Periodontology for the Dental Hygienist, ed 2. St. Louis: for the Dental Hygienist, ed 2. St. Louis:
Saunders, 2007.Saunders, 2007.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
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Necrotizing Periodontal DiseasesDental 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.
HEALTH APPLICATIONTobacco 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
12Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.