Prof. R.Kabaktchieva - 2014

1. Prof. R.Kabaktchieva - 2014 Nutrition, Diet in prevention of oral conditions. The role of nutritive substances in the development of hard dental structures. The role of nutritive substances in development of mucosa and periodontal tissue .

2. Oralhealth, Diet, Nutritionalstatusand General health arecloselylinked

3. Nutritionisessentialforthegrowth, development, andmaintenanceoforalstructuresandtissues. • Duringperiodsofrapidcellulargrowth, nutrientdeficienciescanhaveanirreversibleeffectonthedevelopingoraltissues.

4. Beforetootheruption, nutritionalstatuscaninfluencetoothenamelmaturation , chemicalcomposition, toothmorphologyandsize.

5. Earlymalnutritionincreases a child'ssusceptibilitytodentalcariesintheprimaryteeth. Throughoutlife, nutritionaldeficienciescanaffecthostresistance, healing, oralfunction, andoral-tissueintegrity.

6. Aftertootheruption, dietaffectsthedentitiontopicallyratherthansystemically.

7. Dietaryfactorsandeatingpatternscan: initiate, exacerbate, orminimizedentaldecay. Fermentablecarbohydratesareessentialfortheimplantation, colonization, andmetabolismofbacteriaindentalplaque. Factorssuchaseatingfrequencyandcarbohydrateretentivenessonthedentitioninfluencetheprogressionofcariouslesions, whilefoodscontainingcalciumandphosphorus, suchascheese, enhanceremineralization. Frequentintakeofacidicfoodsorbeveragescancauseenamelerosion.

8. DietAssessmentandCounselinginDentalCare Themoderndentalpractitionerisconcernednotonlywitheducatingpatientsforthepreventionofcariesandperiodontaldisease, butalsoplaysanimportantroleinscreeningpatientsforsomehealthrisks. a dietaryassessmentandscreeningcanhelp identifypotentialnutritionalproblemsthatmayaffect, orbeaffectedby, dentalcare.

9. Theroleofthedentalprovidershouldbe toscreenpatientsfornutritionalrisk, providedietaryguidancerelatedtooralhealth, andreferpatientstonutritionprofessionalsfortreatmentofothernutrition-relatedsystemicconditions.

10. = PrimaryPrevention • Example: “Adolescents are atriskofcariesbecause they havehighintakeofsoftdrinksandsnackfoods” • Usingcurrentdietpatternspatientsshouldbetaught: • theroleofdietincaries, • whatarecariogenicandnoncariogeniceatingpatterns, • howtoadaptthecurrentdiettolowercariogenicrisk.

11. SecondaryPrevention • Thisstrategytargetsindividualsshowingearlydangersignsofcaries, suchasextensivecervicaldemineralization. Examples: • Adolescentswithcervicaldemineralizationafterremovaloforthodonticappliances. • Adolescentswithdemineralizationduetogastroesophagealrefluxdisease.

12. Theseindividualsneed from more-detailedguidanceonhowtoreducecariogenicityoftheircurrentdiet. • Thеguidancewouldinvolvedeterminingthefactorsinfluencingcurrenthabits, • Have to workwiththepatienttodevelopappropriateandacceptablestrategiesforimprovement.

13. TertiaryPrevention • Thisstrategyprovidessupportiveandrehabilitativeservicestomaximizethequalityoflife. Example: • Pacients with a historyofcariesandmanyrestorations This level of prevention should provide dietary advices to promote long-term change to prevent recurrence of caries.

14. Example: • Childrenwithneworthodontic devices. Thislevelofpreventionmayrequiredietarycounselingtoidentifymethodsofpreparingfoodstofacilitateconsumptionof a healthydietwhenchewingmaybecompromisedbytoothlossornew orthodontic devices.

15. TheBasisfor a HealthyDiet “DietaryReferenceIntakes” Dailyfoodintake • mustmeetmetabolicrequirementsforenergy (calories); • Have to providetheessentialnutrientsthatthebodycannotsynthesizeinsufficientquantitiestomeetphysiologicneeds.

16. TheDietaryReferenceIntakes (DRIs)are quantitative estimationsofnutrientvaluestobeusedforplanningandassessingdietsforhealthypeople. Thesereferencevaluesvarybygenderandlifestagegroup.

17. TheDietaryReferenceIntakes/DRIs/consist : - EstimatedAverageRequirement (EAR) - RecommendedDietaryAllowance (RDA) - AdequateIntake (AI) - ТolerableUpperIntakeLevel (UL)

18. TypesofDailyReferenceIntakes (DRI) • EstimatedAverageRequirement (EAR) • RecommendedDietaryAllowance (RDA) Thedailynutrientintakevalueestimatedtomeettheneedsofhalf (50%) ofallhealthypeoplein a lifestageandgendergroup. Theaveragedailynutrientvalueconsideredadequatetomeetthenutrientneedsofnearlyall (97%-98%) healthypeoplein a lifestageandgendergroup.

19. Anintakevalueassumedtobeadequateforhealthypeopleineachlifestageandgendergroupwhenthereisnotenoughdatatodeterminean RDA. • AdequateIntake (AI) • ТolerableUpperIntakeLevel (UL) The highest level of daily nutrient intake, what not cause adverse health risks for individuals in a life stage and gender group. Theriskofadverseeffectsincreaseswithintakesabovethe UL.

20. DietaryGuidelines • Dietary Guidelinesinclude 9 interrelated focus areas. • Each of the focus areas has several recommendations. • The Guidelines place emphasis on consuming a nutrient-dense diet that does not exceed energy needs, having regular physical activity, and maintaining a healthy weight.

21. DietaryGuidelines 1. AdequateNutrientswithinCalorieNeeds • Consume a varietyofnutrient-densefoodsandbeveragesinthebasicfoodgroups • Choosfoodsthatlimittheintakeofsaturatedfats, cholesterol, addedsugars, salt, andalcohol. • Choose a balanced eating pattern within energy needs

22. 2. WeightManagement DietaryGuidelines • Tomaintainbodyweightin a healthyrange, have to balancecaloriesfromfoodsandbeverageswithcaloriesexpended. makesmalldecreasesinfoodandbeveragecalories andincreasephysicalactivity.

23. 3. PhysicalActivity DietaryGuidelines recommend • Engageinregularphysicalactivity andreducesedentaryactivitiestopromotehealth, psychologicalwell-being, and a healthybodyweight. • Through physicalfitness achievemusclestrengthandendurance.

24. 4. FoodGroupstoEncourage DietaryGuidelines recommend • Consume a sufficientamountoffruitsandvegetableswithinenergyneeds. • Choose a varietyoffruitsandvegetableseachday. • Consume 3 ormoreounceofwhole-grainproductsperday. • Consume 3 cupsperdayoffat-freeorlow-fatmilkorequivalentmilkproducts.

25. DietaryGuidelines recommend 5. Fats • lessthan 10% ofcaloriesto be fromsaturatedfattyacidsandlessthan 300 mg/dayofcholesterol. • totalfatintakehave to be 20% - 35% ofcalories; Mostfatscomingfromsourcesofpolyunsaturatedandmonounsaturatedfattyacids. • Whenselectingandpreparingmeat, poultry, drybeans, andmilkormilkproducts, makechoicesthatare with, low-fat, orfat-free. • Limitintakeoffatsandoilshighinsaturatedfattyacids, andchooseproductslowinsuchfatsandoils.

26. 6. Carbohydrates DietaryGuidelines recommend • Choosefiber-richfruits, vegetables, andwholegrainsoften. • Chooseandpreparefoodsandbeverageswithlittleaddedsugarsorcaloricsweeteners. • Reducetheincidenceofdentalcaries bypracticinggoodoralhygieneandconsumingsugar- andstarch-containingfoodsandbeverageslessfrequently.

27. 7. SodiumandPotassium DietaryGuidelines recommend • Consumelessthan 2,300 mg (approximately 1 teaspoonofsalt) ofsodiumperday. • Chooseandpreparefoodswithlittlesalt.

28. DietaryGuidelines recommend 8. AlcoholicBeverages does not apply to children !!!

29. 9. FoodSafety DietaryGuidelines recommend Toavoidmicrobialfoodborneillness: • Cleanhands, foodcontactsurfaces, andfruitsandvegetables. Meatandpoultryshouldnotbewashedorrinsed. • Separateraw, cooked, andready-to-eatfoodswhileshopping, preparing, orstoringfoods. • Cookfoodsto a safetemperaturetokillmicroorganisms. • Refrigerateperishablefoodpromptlyanddefrostfoodsproperly. • Avoidraw (unpasteurized) milkoranyproductsmadefromunpasteurizedmilk, raworpartiallycookedeggsorfoodscontainingraweggs, raworundercookedmeatandpoultry, unpasteurizedjuices, andrawsprouts.

30. MyPyramid MyPyramid is based on the Dietary Guidelines and the DailyReferenceIntakes(DRIs). It translates this information into a diet that meets individual nutrition needs and urges moderation of dietary components that are commonly consumed in excess.

31. Food pyramid - guide for rational nutrition Created in collaboration with the Health Ministry of USA.

32. “MyPyramid “is a symbol to the 6 food categories represented as vertical bands. • The new pyramid has a symbol - “a person climbing the side of the pyramid” - it indicate the need for being physically active every day

33. Foodsaregroupedaccordingtosimilarnutrientcomposition. • Thefoodcategoriesare: - wholegrains, - vegetables, - fruits, - milk, - meats,beans - oils

35. Varietyisessentialtoensureadequatenutrition, becauseeachgroupprovidessome, butnotall, essentialnutrients. • Itisrecommendedpeopletoeatmoreofsomefoods (fruits, vegetables, wholegrains, andfat-freeorlow-fatmilkproducts) andlessofotherfoods (saturatedandtransfats, addedsugars, cholesterol, salt, andalcohol)

36. The narrowest part of the pyramid indicates foods that should be minimized because they contain more added sugars and fat.

38. TipstoGetStarted • Make half your grains whole. • Vary your veggies. • Focus on fruit. • Get your calcium-rich foods. • Go lean with protein. • Find your balance between food and physical activity.

39. NutritionalFactorsAffectingtheOralCavity • Nutritionplaysanimportantroleintheinitialgrowthanddevelopmentoforaltissuesandintheircontinuousintegritythroughthelife-span. • Optimalnutritionduringperiodsofhardandsofttissuedevelopmentallowthesetissuestoreachtheiroptimalpotentialforgrowthandresistancetodisease.

40. Malnutrition, over- or undernutrition, during critical periods of organogenesis can have irreversible effects on developing tissues. • Examples of this effect can be seen in - the tetracycline staining of teeth, - dental fluorosis, • enamel defects in children born prematurely, • the fever-induced enamel hypoplasia seen in the primary teeth.

41. clinical cases

42. Nutrients for which deficiencies or excesses have been directly associated with oral conditions are : - calories; - protein; - calcium; • phosphorus; • vitamins C, A, and D; • iodine; • fluoride.

43. A summary of the oral symptoms of nutrient deficiencies can be found in Table .

46. Protein/CalorieMalnutrition • Protein,themostabundantorganiccompoundinthebody, isrequiredforthesynthesisofvirtuallyallbodytissuesandstructures. • Proteinsaccountforthestructureof DNA, thetensilestrengthofcollagen, andtheviscosityofsaliva. • Thus, aberrationsinproteinnutritioncanhavefar-reachingoralandsystemiceffects.

47. Thenormalturnoverofepithelialtissueintheoralcavityrequires a continualsupplyofnutrients. • Forexample, every 3 to 6 days, thebasalepitheliumofthegingivaundergoesrenewal. Thus, anyseveredeficiencyofprotein/calorieintakewillresultin a decreaseinmitoticactivityinthecrevicularepithelium, aswellaselsewherethroughoutthebody.

48. Inchronicallymalnourishedchildren, studieshaveshowndelaysintootheruptionandincreasedtoothenamelsolubility, leadingtoincreasedcariessusceptibility. • Thelinearhypoplasiareportedintheenamelofprimaryteethtoberelatedtotheseverityofthemalnutrition.

49. TheglycoproteinsthatresultinaggregationofbacteriaarisefromthesalivaryglandsTheglycoproteinsthatresultinaggregationofbacteriaarisefromthesalivaryglands • Оraldefensemechanismsofsalivadependonanadequatesupplyofproteins. Lysozyme, salivaryperoxidase, andlactoferrinarealsoglycoproteins. Secretoryimmunoglobulin A (sIgA) arisesmainlyfromthelabialandbuccalglands Thecelltypesinvolvedincellularimmunity, polymorphonuclearlymphocytes , macrophagesand theenzymesusedinphagocytosis, alsorequireproteinfortheirproduction.

50. Severe effectsofprotein/caloriedeficiencyare decrease ofthecellularandimmuno-cellulardefensesofboththeoralandtheconnectivesidesofthebarrierepithelialcellsliningthegingivalcrevice. • Theseverityoftheimpairedimmunologicresponseparallelstheseverityoftheproteinorcaloriedeficiency.