Preventative Dentistry

1. Nutrition
CHAPTER 5

2. Introduction
 Nutrition affects the entire body as well as the oral cavity
 It directly impacts how an individual feels and functions
through the day
 This chapter covers an overall basic understanding of
nutrients, including fats and lipids, proteins, vitamins,
minerals, and water
 Knowledge of nutrition provides the individual with the
information to make sound decisions

3. Nutrition
 To remain healthy, DA’s must first be knowledgeable about nutrition, the manner in which
foods are used to meet the body's needs
 DA’s also need to be able to help patients with diet, which is the food the individual eats
 You cannot sell health if you do not practice it yourself
 Everything that is taken into the mouth is the diet
 An adequate diet meets all the individuals nutritional needs
 People can eat large amounts of food and still be undernourished
 A disorder resulting from being undernourished is malnutrition
 this is often seen in individuals with alcoholism who may experience malnutrition due to the intake of
alcohol (they feel full and do not eat the food necessary for an adequate diet

4. Nutrition
 The U.S. Department of Agriculture (USDA) first developed a guide to a balanced
diet in 1992
 Presented in the shape of a pyramid
 Items at the top to be used sparingly and the items at the bottom to be consumed
in larger amounts
 Has undergone multiple revisions since it was originally developed
 MyPlate release in June 2011
 Uses a familiar visual, a place setting, to remind consumers to build a healthy meal

5. MyPlate
 Make half your plate fruits and
vegetables
 Make at least half your grains whole
grains
 Switch to fat free or low fat (1%) milk
 Visit choosemyplate.gov for tips and
interactive tools to help educate in
making smarter, healthier nutrition
choices

6. Nutrition
 More than 60% of Americans are over nourished, leading to obesity and the
diseases related to obesity
 Diabetes
 Heart disease and stroke
 High blood pressure
 Eating fast foods that are high in fat content
 Lack of exercise
 The overall population gains a minimum of a half pound a year

7. Nutrients
 Nutrients are defined as any chemical substance in food that provides the body tissues
and structures with the elements necessary for growth, maintenance, and repair
 40 plus essential nutrients are required by the human body
 Can be obtained from a diet comprised of foods from all the food groups
 Having a variety of foods daily helps ensure that essential nutrients are obtained and
the body's metabolism is maintained
 the chemical processes that occur within a living organism in order to maintain life
 There are 6 broad classifications of nutrients: carbohydrates, fats, proteins, vitamins,
minerals, and water

8. Carbohydrates
 Primarily come from fruits, grains, legumes (peas, beans, and lentils), and
some vegetable roots
 Encompasses sugars, starches, and fibers and provides quick energy
 People in athletic events normally take in carbohydrates before the events
to increase their energy levels

9. Carbohydrates
 DA’s will needs to advise patients on carbohydrates because they are potentially
cariogenic
 Cariogenic foods break down into simple sugars in the mouth that can be used by
bacteria to cause dental caries
 Most patients are aware of candies, soft drinks, and sweet desserts
 It will be the other carbohydrates that patients are unaware or that may cause decay,
such as raisins, crackers, fruits, and a few vegetables
 Fruits and vegetable intake is not normally a problem because they do not stick to the
teeth are not converted to simple sugars until they reach the stomach

10. Carbohydrates
 Evaluating cariogenic foods in patients’ diets is accomplished by having
the patients record their diets over several days
 The DA can review the diet and identify cariogenic foods with the patient
 Evaluation of each food in the patient’s diet provides a better
understanding of which types of foods are cariogenic

11. Carbohydrates
 The DA can discuss the number of times cariogenic foods are being
eaten, whether they are eaten with other foods, and at what time of day
the are eaten
 One other factor in the equation of decay is that the more often the teeth
are exposed to cariogenic food, the greater the probability of decay
 Example: the person who drinks a soft drink very slowly and allows the
sugar to soak on the teeth over and over will have a greater chance of
decay

12. Carbohydrates
 Eating cariogenic foods with other foods may offer some neutralization of the acid that
feeds the bacteria
 Eating cariogenic foods at bedtime, when the flow of saliva decreases, increases the
chance of decay
 Saliva is a buffer to the acid and, if the flow rate of the saliva is inadequate, the cariogenic
substances may not be washed away
 Suggest to patients that they choose carbohydrates that will not remain on the teeth for
long periods of time
 Cautions patients about medicines and mouth fresheners that have sugars in them
because they dissolve in the mouth, bathing the teeth with sugar for a long period of
time

13. Carbohydrates
 Fiber
 Obtained from fruits, vegetables, and the grain food groups
 Suggested 20 to 30 grams of fiber be eaten daily
 Recent evidence has shown that consuming greater amounts of fiber
can recue the occurrence of colon cancer and reduce blood
cholesterol levels

14. Fats and Lipids
 Share one commonality
 They are insoluble in water (incapable of being dissolved)
 Fats are derived form a solid, and lipids are the oils from a liquid
 Fat provides an alternate source of energy to carbohydrates
 Often called a backup source of energy
 Fat also insulates the body from heat loss, protects vital organs, and aids in the
transportation of the fat-soluble vitamins: A, D, E, and K

15. Fats and Lipids
 The fats in normal diets derive from plant and animal foods, and are identified and
triglycerides or neutral fats
 Everyone needs fat in their diet, but there is a widespread concern that Americans are
consuming too much fat
 The American Heart Association suggests that the diet contain 30 percent fat content, but
currently most Americans’ diets are 40 to 45 percent fat
 Excess fat has a direct correlation to cholesterol levels and heart disease
 Which is the number one cause of death of Americans over the age of 40

16. Fats and Lipids
 Even though people know fat consumption is a problem, they are drawn to foods that
have fat in them
 Food manufacturers are aware that fat enhances the taste and smell of food
 Read food labels
 Reduce the intake of fast-food products
 People need to know how to read food labels
 Reduced fat = fat is normally reduced about 25 percent from the original
 Light = fat is typically about 50 percent less than in the original

17. Proteins
 Found naturally in plants and animals
 Protein is essential for the growth and repair of body tissues
 Protein molecules are composed of a combination of 20 amino acids
 The quality of a protein is determined by the distribution and kinds of amino acids in
its structure
 Complete=all 10 essential amino acids
 Most animal proteins: eggs, milk and meat
 Incomplete=do not have all 10 essential amino acids
 Vegetable or grain proteins

18. Proteins
 Incomplete proteins can be combined to make complete proteins if
complementary foods are eaten at the same meal
 Corn with beans
 Macaroni with cheese
 Cereal with milk

19. Proteins: Amino Acids
 There are 10 essential amino acids that the
body cannot synthesize or produce in the
needed amounts, so they must come from
the individuals diet
 Nonessential amino acids can be produced,
or synthesized, by the body

20. Vitamins
 Vitamins are a class of nutrients that do not provide the body with
energy
 They perform other necessary functions
 First vitamins were discovered by a group of scientists in 1913
 First vitamin “A”, the second vitamin “B”, and so on
 Later they found that Vitamin B was not a single vitamin but several, so they added
numbers to the letter B ( B1, B2, and B3)
 Some other vitamins were given names, rather than letters or numbers

21. Vitamins
 All vitamins fall in one of two groups: fat soluble or water
soluble
 Fat-Soluble Vitamins
 Vitamins A, D, E, and K
 These Vitamins are stored in the fatty cells, especially the liver, and are
not easily carried in the bloodstream

22. Vitamin A
 Fat-soluble vitamin
 Two forms
 The plant form carotene
 Animal form retinol
 Essential for healthy skin and maintenance of mucous membranes
 Gives strength to epithelia tissue
 Aids in the continual rehashing of bone
 Best known for its contribution to vision

23. Vitamin A (carotene or retinol)
Food Sources Functions Deficiency Toxicity
Animal Dim light vision Night blindness Cessation of
menstruation
Liver Maintenance of mucous membranes Xerophthalmia Joint pain
Whole milk Growth and development of bones Respiratory infections Stunted growth
Butter Health skin Bone Growth Ceases Enlargement of liver
Cream
Cod Liver
Plants
Dark Green Leafy Vegetables
Deep yellow or orange fruit
Fortified margarine

24. Vitamin D
 Fat-soluble vitamin
 Can be manufactured by the body if exposed to ultraviolet rays
 Dark skinned people require additional sun exposure to manufacture
the same amount of Vitamin D
 Individuals need Vitamin D to ensure healthy bones and tooth
development
 Most milk is fortified with Vitamins A and D

25. Vitamin D
Food Sources Functions Deficiency Toxicity
Animal Bone growth Rickets Kidney stones
Eggs Healthy tooth development Osteomalacia Calcification of soft tissues
Liver Poorly developed teeth
Fortified milk Muscle spasms
Plants
None

26. Vitamin E
 Fat-soluble
 Protects nutrients from destruction by oxidation
 Effective in conditioning the skin

27. Vitamin E
Food Sources Functions Deficiency Toxicity
Animal Antioxidant Destruction of red blood cells Hypertension
None Skin conditioning
Plant
Margarines
Salad dressings

28. Vitamin K
 Fat-soluble
 Promotes the formation of prothrombin
 Responsible for blood clotting and coagulation (blood changing form
a liquid to a gel)
 Small amount is stored in the liver

29. Vitamin K
Food Sources Functions Deficiency Toxicity
Animal Blood clotting Prolonged blood clotting Hemolytic anemia
Egg yolk Jaundice
Liver
Milk
Plant
Green leafy vegetables
Cabbage

30. Vitamins
 Water-soluble vitamins
 Vitamin C, which is probably the most well-know vitamin, and the B-complex
vitamins fall into this group
 Body maintains the balance of water-soluble vitamins through the kidney
 Excess is excreted through urine
 Vitamin B6 or niacin can become toxic when intake is excessive because the
kidneys cannot easily eliminate the surplus

31. Vitamin C (Ascorbic Acid)
 Large number of people take this for everything from toothaches to cancer
 Tragic stories of individuals who developed scurvy (from Vitamin C deficiency) during
loge sea voyages, wars, and famines are widely known
 Acts to hold cells together
 Component of connective tissue
 Oral manifestations
 Improper tooth development, ulcerate gums, and slow healing processes
 Fruits and vegetables contain Vitamins C
 Especially citrus fruits and tomatoes

32. Vitamin C (ascorbic acid)
Food Sources Functions Deficiency Toxicity
Fruits Prevention of scurvy Scurvy Raise uric acid levels
All citrus Formation of collagen Muscle cramps Hemolytic anemia
Plants Healing of wounds Ulcerated gums Kidney stones
Broccoli Release of stress hormones Rebound scurvy
Tomatoes Absorption of iron
Brussels sprouts
Potatoes

33. Vitamin B Complex
 Even though all vitamins in the B classification are grouped together, each has distinct
functions
 B1 (thiamin), B2 (riboflavin), and B3 (niacin) work together in the production of energy, but
also have separate functions
 Oral manifestations of Vitamin B deficiency
 Angular chelosis (where lips become red and fissures develop in the corners of the mouth)
 Glossitis (inflammation of the tongue)
 Pellagra (where mucous membranes atrophy and ulcers develop)
 Vitamin B6 is essential in the synthesis and metabolism of protein, carbs, and fat
 Folic acid and B12 are important for the function of red blood cells and DNA

34. Angular Chelosis

35. Thiamin (Vitamin B1)
Food Sources Functions Deficiency Toxicity
Animal Coenzyme in oxidation of
glucose
Gastrointestinal tract and cardiovascular
system problems
None
Liver Prevention of beriberi
Eggs
Fish
Pork
Beef
Plants
Whole and enriched
grains
Legumes

36. Riboflavin (Vitamin B2)
Food Sources Functions Deficiency Toxicity
Animal Aids release of energy from food Angular chelosis None
Milk Help produce proteins Glossitis
Plants Aids in growth photophobia
Green vegetables
Cereals
Enriched bread

37. Pyridoxine (Vitamin B6)
Food Sources Functions Deficiency Toxicity
Animal Synthesis of nonessential amino acids Angular chelosis Liver disease
Pork Conversion of tryptophan to niacin Glossitis
Eggs Antibody production
Milk
Plants
Whole grain cereals
Legumes

38. Vitamin B12
Food Sources Functions Deficiency Toxicity
Animal Syntheses of red blood cells Degenerations of muscles None
Seafood Maintenance of muscles Pernicious anemia
Meat
Eggs
Milk
Plants
None

39. Niacin
Food Sources Functions Deficiency Toxicity
Animal Transfers hydrogen atoms for
syntheses of ATP
Pellagra Vasodilatation of blood vessels
Milk Prevents gastrointestinal problems
Eggs Prevents nervous system problems
Fish
Poultry

40. Folic Acid
Food Sources Functions Deficiency Toxicity
Animal Synthesis of red blood cells Glossitis None
None Macrocytic anemia
Plants
Spinach
Asparagus
Broccoli
Kidney Beans

41. Biotin
Food Sources Functions Deficiency Toxicity
Animal Coenzyme in carbohydrate and amino acid metabolism None None
Milk Niacin syntheses form tryptophan
Liver Energy metabolism
Plants
Legumes
Mushrooms

42. Pantothenic acid
Food Sources Functions Deficiency Toxicity
Animal Metabolism of carbohydrates, lipids, and proteins None None
Eggs Synthesis of acetylcholine
Liver Energy metabolism
Salmon
Yeast
Plants
Mushrooms
Cauliflower
Peanuts

43. Minerals
 Classified as major or trace
 A “major” classification indicates that the human body requires
larger amounts
 Minerals differ from vitamins in that they are elements rather than
complex molecules
 Electrolytes=minerals that are positive or negatively charged
 When a person is healthy, the electrolytes are in balance

44. Major Minerals
 Seven major minerals are in the body
 Calcium (Ca), phosphorus (P), potassium (K), sodium (Na),
chlorine (Cl), magnesium (Mg), and sulfur (S)

45. Major Minerals
 Calcium (Ca)
 makes up the largest quantity and is found in bones and teeth
 Functions in muscle contraction, the nervous system, and the blood
 Phosphorus (P)
 Found in bones and teeth and is involved in energy metabolism and maintenance of proper
pH balance in the blood
 Sodium (Na) and Potassium (K)
 Work together to regulate the electrolyte balance
 Sodium maintains fluid balance in the blood; potassium helps to release energy and synthesize
protein

46. Major Minerals
 Sulfur (S)
 Found in protein
 Involved in energy metabolism
 Magnesium (Mg)
 Involved in energy metabolism
 Involved in stabilizing components of bones and teeth once they are formed
 Chlorine (Cl)
 Maintains the correct pH balance in the blood

48. Trace Minerals
 Are present in smaller quantities, yet are equally as important as major minerals
 Copper, chromium, molybdenum, selenium, and manganese are important to our bodies in the
process of metabolism
 Iodine
 Found in the thyroid gland
 Regulates metabolism as well
 Iron
 Primarily functions to carry oxygen through the blood to the cells
 People who are deficient in iron become anemic
 Reduces their energy levels

49. Trace Minerals
 Zinc
 Aids in tissue growth and maintenance of the immune system
 Cobalt
 Helps in the functioning of red blood cells
 Fluorine
 Helps strengthen teeth
 Research indicates that it helps prevent osteoporosis
 A condition in which calcium deficiency makes the bones weak
and brittle

50. Water
 By far, the most abundant nutrient in the body
 Water makes up 60 to 70 percent of total body weight
 A person can go longer without food than without water
 Primary function is as a solvent for biochemical reactions
 Example
 A large part of the blood is composed of water, and this allows for transport and
necessary reactions to occur. This solvent action also serves to remove toxic
waste from the body

51. Water
 Water acts a lubricant, especially in the digestive system and the
joints
 Also helps control body temperature, releasing excessive heat
through perspiration, and dispersing heath evenly throughout the
body
 The body does not store water and it must be replenished daily
 Lost primarily through perspiration, urination, and fecal output

52. Water
 Eight glasses of water per day are recommended
 Coffee and alcohol cannot be counted as water intake
 They act is diuretics and cause the body to lose water through
increase urine output

53. Balancing Energy
 Ideally, people should take in enough nutrition to equal the amount of energy
used daily
 The amount of energy a substance can supply is measured in the form of
Calories
 One calorie of food energy is understood to mean one kilocalorie
 A kilocalorie is equivalent to one thousand true Calories
 Carbohydrate and protein grams yield 4 Calories per gram
 In contrast, 1 gram of fat yields 9 Calories

54. Balancing Energy
 Example
 5 grams of carbohydrates x 4 Calories = 20 Calories of
carbohydrates
 5 grams of proteins x 4 Calories = 20 Calories of proteins
 5 grams of fat x 9 Calories = 45 Calories of fat
 The total of all three categories would be 85 Calories
 Fats are more energy rich than carbohydrates or proteins

55. Balancing Energy
 Calories are taken into the body to use as energy for everything from
running to breathing
 The body uses what it needs and store the rest as fat
 Physical and chemical changes that take place in relations to the usage of
energy are called the metabolic rate
 If the rate of metabolism is less than the consumed Calories, then the person
will store fat
 If the rate of metabolism is more than the consumed Calories, the stored fat
will be used

56. Balancing Energy
 The energy that is used when a person is at rest is called the basal metabolic
rate (BMR)
 The BMR will be higher for pregnant women, children, and leaner individuals
because it takes more energy to fuel muscle that it does to store fat in the body
 Optimum energy balance would include the same amount of Calories taken into
the body as are used
 Ideally, most Calories would come from carbohydrates
 Fats and proteins should make up less than half the Calories taken in

57. Nutrition Labels
 For dental assistants to make good choices and be able to advise patients to
do the same, they must be knowledgeable about nutrition labels on food
products
 Information is provided on labels according to government standards
 Manufacturers of food products know that people are attracted to
descriptive words on the product packages
 ‘lite’ or ‘healthy’
 These terms may or may not describe the product, so it is important to read the details
on the nutrition label

59. Nutrition Labels
 Consumers are paying more attention to the Calories and fat
content when they compare two similar items
 Information such a preservatives (the chemicals added to food
to keep it fresh for a longer period) and artificial flavors and
colors is also found on the food label

61. Nutrition Labels
 Listed Items on Labels
 Standard information is listed on nutrition labels
 The government requires that the labels be easy for the consumer to read
 So it is most often listed in standard format
 The 1990 Nutritional Labeling and Education Act was passed by Congress and enacted
in ‘94
 Requires manufacturers to list all ingredients in the product
 Labels provide the serving size, percent of daily nutritional value, Calories, fat and
cholesterol, sodium, carbohydrate, and other information

62. Nutrition Labels
 Listed Items on Labels
 If the product packaging indicates that is organic or organically
grown, it must have been grown without the use of herbicides,
chemical pesticides, or fertilizers
Also, plant seeds must not have been prepared with the use of
hormone or any other enhancement

63. Nutrition Labels
 The serving size is listed on the label in a measurement or number of the
product
 Also give the total number of servings per package
 The ingredients and percent of daily value are also listed
 Daily value percent is based on a diet of 2,000 Calories per day for one adult
 So if the amount listed for total carbs is 15 grams, this indicates that it is 5 percent of
the daily value required according to calculations of the carbohydrate group

64. Nutrition Labels
 Total Calories per serving are noted along with specific Calories derived from fat
 Calories from fat should be less than 30 percent of total Calories
 Remember that this is the Calories in one serving and not the entire package
 Fat and Cholesterol notations are valuable to the consumer because of various health
concerns
 Including heart disease and weight control
 Some labels break down total fat as well as saturated fat
 Saturated fat primarily comes from animal sources
 Unsaturated fat primarily comes from vegetable sources
 Total cholesterol content for one serving is also noted on the label

65. Nutrition Labels
 Patients with heart disease or other disease on sodium-restricted
diets will want to watch the levels of sodium in foods
 Total amount of carbohydrate is also listed
 May be broken down into dietary fiber (complex carbohydrates) or sugar
(simple carbohydrates)
 Labels also show other information, such as the protein, vitamins,
and minerals in the product

66. Eating Disorders
 Seems everyone is either overeating or doing everything possible to stay thin
 The media and the fashion industry have brought forth the idea that all individuals should aspire
to be thin
 Advertisers repeatedly assert that taking this or that pill will allow for significant weight loss
within a very short time
 Eating disorders such as chronic dieting syndrome, compulsive overeating, bulimia, and anorexia
nervosa are widespread and can be very serious and even life-threatening
 They can have psychological, physical, and medical implications
 Population most affected if females, aged 12-30, and often from white, affluent families

67. Eating Disorders
 Chronic Dieting Syndrome
 Large number of people are ingesting pharmaceuticals and/or diet supplements to
control their weight
 This is important to DA’s because the drugs may cause problems in dental treatment
 The dieting may cause the heart to race or other chemical imbalances
 Adding the anxiety of dental treatment may be enough to cause problems for the
patient
 Paying special attention to patients’ medical and dental histories will be extremely
beneficial

68. Eating Disorders
 Bulimia
 Also called bulimia nervosa
 Disorder characterized by secretive bouts of gross overeating followed by
methods of weight control
 such as purging (self induced vomiting), laxative abuse, excessive
exercise, and overuse of diuretics (drugs that increase urine output)
 Quickly becomes obsessive
 Secretive and therefore difficult to diagnose

69. Eating Disorders
 Bulimia
 Individuals with bulimia may experience weight gains and losses, but normally
do not show extreme weight loss such as in anorexia nervosa
 The overeating is not caused by the desire for food but is a response to stress
or depression
 Eating brings about overwhelming happiness and or a euphoric feeling that is
quickly followed by the feeling of self-hatred and depression because of the
binging
 Individual experiences loss of control then begins the purging or other
behaviors

70. Eating Disorders
 Bulimia
 Number of systemic complications that can result from bulimia
 The vomiting can erode the tooth enamel, especially the lingual surface of the
teeth
 Vomit is highly acidic
 When the enamel has thinned or completely eroded, the teeth are more
susceptible to decay and are more sensitive to hot or cold
 The recurring vomiting can cause the parotid glands and the salvia glands to
become tender and swell, which can be very uncomfortable

72. Eating Disorders
 Anorexia Nervosa
 An eating disorder characterized by sever weight loss, an extreme
aversion to food, and an extreme fear of being fat
 Individuals with this disorder have a distorted body image, and see
themselves as fat even though they may be overly thin
 This psychological disorder centers on control, and behavioral
symptoms focus on the fear of putting on weight or eating foods that
contain fat or carbohydrates

73. Eating Disorders
 Anorexia Nervosa
 Individuals with this condition may have psychological, physical, and behavioral
symptoms such as…
 Flaky skin, brittle nails, thinning of hair on the head, amenorrhea, hearth
complications, kidney function issues, gastrointestinal complications, impaired
orang function, lanugo on the body, food obsession, extreme use of laxatives,
depression, social with drawl, and obsessive excising
 The individual often feels intensely hungry by will deny fulfillment of this need
 Obsessed with food and thinking of food
 May find it difficult to go out to eat with others

74. Eating Disorders
 Anorexia Nervosa
 Usually have eating rituals and may cut their food into small pieces and
arrange and rearrange it on their plate
 Typically anorexics know every Calorie in each bite consumed
 Individuals suffering form this disorder may prepare Calorie-laden foods
for others but would feel extreme distress if they had to eat it themselves
 Disorder is not focused on the weight loss or food intake but on control
and/or other fears relating to the body

75. Eating Disorders
 Anorexia Nervosa
 Treating this disease is very difficult
 Much easier to diagnose in the later stages because of extreme
thinness
 More complicated to diagnose in the earlier stages due to secrecy and
attempts to hide the disorder from others
 Numerous types of therapies that can be helpful
 Intravenous feeding may be recommended to treat the malnutrition

76. Eating Disorders
 Anorexia Nervosa
 Working with a nutritionist during any kind of therapy may enhance the outcome
 Even if the treatment is successful, relapses can easily occur because the slightest stress
triggers the disorder again
 1 in every 100 adolescent females has anorexic symptoms
 When in the dental office, they may be very uncomfortable lying back in the chair
 Oral cavity may show signs of the disorder
 Sore tissues resulting from poor periodontal health
 Erosion of the enamel surface
 Decay may progress more rapidly because calcium intake my be limited