This document discusses diet counselling and provides guidelines for diet interviews and counselling. It covers the following key points: - The importance of a balanced diet for health and the goals of pediatric nutrition to support growth and development. - Diet counselling aims to help individuals and families establish healthy long-term eating habits through a step-by-step approach. - Conducting a diet interview can provide diagnostic information, help adapt recommendations to a person's lifestyle, and contribute to research. The dental professional should elicit information on food and dietary intake and habits. - Calculating a dental health diet score evaluates food group intake, essential nutrient sources, and sugar consumption to determine counseling needs. Effective communication techniques are

1. DIET COUNSELLING
DR JJ

2.  Introduction
 Diet
 Types of diet
 Importance of balanced diet
 Diet counselling
 Diet chart
 Dental health diet score
 Communication techniques
 Guidelines for diet counselling
Contents

3. Diet & dental caries
Dietary studies
Non- cariogenic diet
Diet & periodontal disease
Conclusion
References
Previous year questions

4. Introduction
• When man broke from the natural food chain, he
developed new energy resources and applied
technologies to food processing, since then our
dietary habits have undergone major changes. Both
the qualitative nature of our diet and pattern of eating
has changed and are changing.

5. • The science which deals with the study of nutrient and foods
and their effects on the nature & function of organism under
different condition of age, health & disease.
-NIZEL 1989
• Nutrients are defined as the constituents of food, which
perform important functions in our body.
Nutrition

6. • Nizel (1989): Total oral intake of a substance that provides
nourishment & supply.
BALANCED DIET :
• One providing each nutrient in the (neither deficient nor excess)
needed to maintain optimum health.
- Stewart
Diet

7. TYPES OF DIETS

8. Vegetarian diets
• A vegetarian diet is one which excludes meat.
• Fruitarian diet: A diet which predominantly consists of raw
fruit.
• Lacto vegetarianism: A vegetarian diet that includes certain
types of dairy, but excludes eggs and foods which contain
animal rennet.

9. • Lacto-ovo vegetarianism: A vegetarian diet that includes eggs
and dairy.
• Vegan diet: In addition to the requirements of a vegetarian diet,
vegans do not eat food produced by animals, such as eggs,
dairy products, or honey.

10. Semi-vegetarian diets
• Flexitarian diet: A predominantly vegetarian diet, in which meat
is occasionally consumed.
• Kangatarian: A diet originating from Australia. In addition to
foods permissible in a vegetarian diet, kangaroo meat is also
consumed.
• Pescetarian diet: A diet which includes fish but not meat.
• Plant-based diet: A broad term to describe diets in which animal
products do not form a large proportion of the diet.

11. Belief-based diets
• Buddhist diet: While Buddhism does not have specific dietary
rules, some buddhists practice vegetarianism based on a strict
interpretation of the first of the Five Precepts.
• Hindu and Jain diets: Followers of Hinduism and Jainism may
follow lacto-vegetarian diets, based on the principle
of Ahimsa (non-harming).

12. • Islamic dietary laws: Muslims follow a diet consisting solely
of food that is halal – permissible under Islamic law. The
opposite of halal is haraam, food that is Islamically
Impermissible.
• Haraam substances include alcohol, pork, and any meat from
an animal which was not killed through the Islamic method of
ritual slaughter (Dhabiha).

13. Diets followed for medical reasons
• Best Bet Diet: A diet designed to help prevent multiple
sclerosis, by avoiding foods with certain types of protein.
• Colon cancer diet: Calcium, milk and garlic are thought to help
prevent colon cancer. Red meat and processed meat may
increase risk.

14. • Diabetic diet: An umbrella term for diets recommended to
people with diabetes. There is considerable disagreement in
the scientific community as to what sort of diet is best for
people with diabetes.
• Liquid diet: A diet in which only liquids are consumed. May
be administered by clinicians for medical reasons, such as after
a gastric bypass or to prevent death through starvation from a
hunger strike.

15. Importance of balanced diet
• A balanced diet is important because your organs
and tissues need proper nutrition to work effectively.
Without good nutrition, your body is more prone to
disease, infection, fatigue, and poor performance.

16. COUNSELLING

17. • Optimal growth and development are the primary objectives of
pediatric nutrition.
• Food is merely a vehicle for nutrient delivery; the nutrients
provide energy for growth, serve as structural components, and
participate in all metabolic functions of the body. Food,
however is more than just nutrients : sensory , emotional ,
social and cultural associations influence food choices.

18. • One of the key focuses with Dietary Counselling is making a
step by step approach, so that changes are achievable in the long
term.
• Any changes that are made might be done over a number of
weeks, so attaining your main goal is more manageable. Dietary
counselling can help putting a healthy diet in place, for an
individual and/or a family, losing weight, or simply feeling better
by eating better.

19. Diet chart
• A diet history concerning food intake patterns, diet
adequacy, consumption of fermentable carbohydrates
(including naturally occurring and added sugars), and
the use of fluoridated toothpaste is a strategy for
health professionals to use to determine the diet
related caries risk habits of persons.

20. DENTAL HEALTH DIET SCORE
• The dental health diet score gives points earned as a result of an
adequate intake of food from each of the food groups plus points for
ingesting foods especially recommended because they are the best
sources of the ten nutrients essential for achieving and maintaining
dental health.
• From this sum points are substracted for frequent ingestion of foods
that are overtly sweet – whose sweetness is derived from added
refined sugar or concentrated natural sugars.The difference is the
dental health diet score.

21. Instructions for Calculating a Dental
Health Diet Score:
• Step 1 >
• To ascertain the average daily intake, list everything you eat and
drink on an ordinary weekday including snacks.
• Record the time when the meal or snacks were eaten, the amount
ingested (in household measures), how the food was prepared, and
the number of teaspoons of sugar added.

22. Step 2
• Circle the foods in the diary that have been sweetened with added
sugar or are concentrated natural sweets (honey, raisins, figs, and so
forth). Classify the uncircled foods or mixed food dishes into one or
more ofthe appropriate food groups.
• For each serving of these foods listed in the food intake dairy, place a
check mark in the appropriate food group block.
• Add the number of checks and multiply by the number shown. The
maximum number of points credit for the milk and meat groups is 24
each and for the fruit vegetable and bread-cereal groups is 24 each.
• Add the points. The sum is the Food Group Score (96 is the highest
score).

24. Step 3
• How many of the foods listed contain one or more of the ten
nutrients essential for dental-oral health? In the Nutrient
Evaluation Chart are listed the foods that are good sources of
the nutrients essential for good health in general and dental
oral health in particular.

25. • In each of the eight columns of foods, check the one or more
eaten on this usual weekday. If a food is checked, circle the
number 7 beside the nutrient that heads this column.
• The same food, such as broccoli, may be found in several
columns. Also, in column more than one food may be checked.
Regardless of the number of foods checked in the column,
only seven points is given per nutrient (56 is a perfect score).

26. Step 4
• List the sweets and sugar-sweetened foods and the frequency
with which they are consumed in a typical day.
• Classify each sweet into either the liquid, solid and sticky, or
slowly dissolving category.
• Place a check mark in the frequency column for each item as
long as they are eaten at least 20 minutes apart.
• Add the number of checks. If the sweets are liquid, multiply by 5;
if solid, multiply by 10; if slowly dissolving, and multiply by 15.
• Write the products in the Points column and total them.

28. Step 5
• Now put it all together. Transfer the 4 Food Group Score and
the Sweet Score to the Totaling the Scores page.
• If the 4 Food Group Score is barely adequate or not adequate
and lor the Sweet Score is in the "Watch Out" zone, nutrition
counseling is indicated.

30. Communication Techniques :

31. Three rules
1. for motivating behavioural change.
2. verbal and nonverbal.
3. Personalization of the message is more likely to result
in a sustained change in behaviour.

32. • Interviewing
• Teaching
• Counselling
• Motivating

33. Interview
• (1) the problem,
• (2) the factors that contribute to it, and
• (3) the personality of the patient.

34. Why should a dental health professional elicit
information concerning the food and dietary
intake and habits of patients?

35. • First, the dietary interview can serve as a valuable diagnostic
aid. Food selection and eating habits may affect a person's
dental or general health or both.
• Appraisal of an individual's dietary status may provide a clue
to potential difficulties.

36. • Second, knowledge of a person's daily routine is important for
adapting the caries-preventive diet to an individual's lifestyle.
• This adaptation may help a patient adhere to the newly
prescribed diet, the basis for achieving the health goals and
rewards for diet counseling.

37. • Third, many practical research contributions could be made if
data from nutritional assessments could systematically be
gathered to correlate dental, periodontal, or oral mucosal
problems with such factors as food habits, dietary intake,
physical conditioning factors, and socioeconomic status,
among others.

38. Physical Setting :

39. THE DIET INTERVIEWER:

40. • Certainly nutritionists can readily qualify with some
extra course work in the nature of dental caries and
periodontal disease and in preventive dentistry.

41. • Ideally, as the professional authority, the dentist should be the
diet interviewer, but it is probable that he or she will not be
able to give adequate time to this phase of preventive services.
• Consequently, clinical dental nutrition services probably will
be assigned to a dental hygienist or a nutritionist. In any event,
the dentist is the responsible professional who must reinforce
the advice given by the dental hygienist or nutritionist at the
check up visits.

42. Teaching and Learning:

43. • Even with these various aids available, teaching will not be
effective if the information is not presented in small increment.
• If the patient does not understand the explanation, it should be
repeated.
• The next level should not be attempted until the previous level
is fully understood.

44. • The more the patient is involved in the educational process the
greater is the extent of learning. People learn least well by
hearing; they learn better what they can also see; and they
learn best by doing, because they are totally involved.
• Any time the patient participates in evaluating his or her diet
and writes his or her own diet prescription with guidance from
the counselor, optimal learning and adherence to the new
regimen will result.

45. Counseling :

46. GUIDELINES FOR COUNSELING:
1. Gather information- Personal identifying data, likes and
dislikes, and the patient's perception as to the cause(s) of the
problem.
2. Evaluate and interpret information – relative adequacy of the
diet, eating habits, and the indirect environmental or systemic
factors that contribute to the dietary problem - to find the
reasons for the patient's dental problem.

47. • 3. Develop and implement a plan of action - a patient is
prescribed diet consisting primarily of gradual, qualitative
modifications of the diet using acceptable food exchanges. Be
realistic in the types and amounts of changes made initially. The
dietary frequency chart may help in determining what changes
might be made.
• 4. Seek active participation
• 5. Follow up

48. MOTIVATION
• Motivation stimulates or is an incentive for action. To modify
a patient's diet, the clinician can only seen and encourage the
patient's own motivation.
• However, the counselor's positive attitude and conviction as to
the necessity and effectiveness of nutrition counseling can
stimulate the patient to initiate an improved dietary pattern.

49. • According to Garn, the basic factors that motivate people are
self preservation, recognition, love, and money. The order of
importance varies from one individual to another, but all four
factors influence the desires of each person.
• If clinicians can help patients understand that a healthy mouth
and teeth and a nice looking smile can help them achieve one
or more of these four goals, patients will be inclined to adopt a
diet that will promote better oral health.

50. MOTIVATING PATIENTS TO MODIFY FOOD
HABITS:
1. Awareness
2. Interest
3. Involvement
4. Action
5. Habit

51. 1. Awareness
2. Interest
3. Involvement
4. Action
5. Habit

52. DIET AND DENTAL CARIES

53. Process of caries formation

54. 1. Frequency of eating:
• Vipeholm study showed that frequency of consumption of sugars
and the oral clearance time for sugars are important factors
affecting cariogenicity.
• In a study of more than 1000 children in USA, indicated that the
frequency or between meal snacks of candies, cookies, chewing
gum or carbonated beverages correlated with the DMF rates
(Weiss et al 1960).
FACTORS INFLUENCING CARIOGENICITY OF
SUCROSE IN DIETS

55. • A significant correlation was found between a high sugar
concentration in saliva with a prolonged clearance time and caries
activity (Lundquist, 1952).
• This finding implies that retentive, sticky, sweet foods with
little detergency or self cleaning properties may be potentially
more cariogenic than foods that detergent and rapidly clear the
oral cavity.
Oral clearance rate

56. • The availability of sucrose for support of bacterial metabolism
in plaque which is influenced by the texture, consistency of
food, the stimulation of saliva by chewing and the rapidity of
clearance of the substrate.
• With the advent of highly concentrated processed canned sugar
the level of sucrose consumption as well as concentration of
sucrose in food item increased dramatically.
Effective concentration of sucrose

57. Dietary studies in human population

58. HOW TO ASSIST THE PATIENT TO
SELECT AN ADEQUATE
NONCARIOGENIC DIET:

59. Step 1
• Commend the patient. It is important to commence a
counseling procedure on a positive note. Patients do
not like to be criticized at the very outset.
• Since the food evaluation chart will probably show
that the recommended allowances were met in at least
one or two food groups, a good starting point is to
commend the patient for this and urge continuance of
this good practice.

60. Step 2
• Allow the patient to suggest improvements and write his or her
own diet prescription. Again refer to the evaluation chart. It
can readily be seen that an intake of only two or three food
groups is insufficient.
• For improvement, positive recommendations for increasing
the amounts to the recommended levels in order to achieve an
adequate diet should be made.

61. Step 3
• Allow the patient to delete from the diet plaque-forming, sugar-
sweetened foods.
• By reexamining the sweets intake chart, the patient will note the
grand total of the number of exposures to sweets, the type of sweets
most often consumed, and the frequency with which they were
eaten.
• Since the form of sweets and the frequency of their use are the two
most pressing factors in caries production, it must be emphasized
that there can be absolutely no compromise with respect to the
deletion from the diet of sweets that tend to be retained in the
mouth.

62. Step 4
• Allow the patient to select non-plaque promoting snack
substitutes. If snacking is a habit of long standing, realize that it is
futile and unrealistic to expect total immediate abandonment of
between meal nibbling. Acceptable alternatives include raw fruits,
raw vegetables, cheddar cheese, or nuts.
• However, if the patient is consistently reminded that increasing the
total food intake at each meal will satisfy appetite and hunger, it is
possible that the number of between meal snacks will eventually
be reduced.

63. Step 5
• Allow the patient to select menus.
• Starting with the existing menu as a nucleus, encourage the
patient to examine each meal and make deletions,
substitutions, or additions with which he or she can
comfortably live.
• The rule is to improve the quality, not the quantity of the food
so that acceptance will be more likely.

64. Reinforcement by Follow-up Reevaluation:
• Schedule a follow up visit for 2 weeks later. The patient is
asked to complete a second 5 day food diary in the same
manner first just before returning.
• Evaluate the new food diary and compare the results with the
original plan to note whether recommendations have been
followed. Discuss misinterpretations, misunderstandings, and
problems that have arisen during this period.
• Menu changes are recommended if necessary.

65. Effect of diet on oral health
Systemic mechanism
Absorption and
circulation of nutritents to
cells and tissues
These effects are mediated
locally
Local mechanism
Development of teeth,
quality and quantity of
salivary secretion
Influence the metabolism
of oral flora

66. Artificial sugar substitutes
Sorbital
Xylitol
Aspartame
Saccharine
Cyclamate
REDUCING THE CARIOGENICITY OF THE DIET

67.  Caries in rodents have been reduced significantly by adding
casein to an otherwise cariogenic diet. Since casein is a
phospho-protein, it is possible that phosphate in this protein
compound may have exerted some anti cariogenic effect.
 Several animal studies show that the aminoacids such as lysine
and glycine help prevent caries.
* (Nizel et al 1970 ; McClure et al 1955; Harris et al 1967).
Protein and dental caries

68.  There is indirect evidence that
dietary fats may help prevent caries
in humans.
 For example those Eskimos whose
diets are almost solely of animal
origin and furnish about 70-80% of
their total calories as fat experience
less decay. It is only when the fat
content of the diet is reduced to
25% or less that decay starts to
appear.
Fats and dental caries

69.  In Vitamin A deficient animals, atrophic changes in the
ameloblasts, subsequent abnormalities in tooth
morphology has been observed.
 In man, severe Vitamin A deficiency during tooth
formation does not necessarily lead to defective
enamel.
 The only member of the Vitamin B complex which has
been associated with caries is pyridoxine (Vitamin B6)
very high doses (10 times > than normal) have been
reported in two small scale experiments in human
subjects (pregnant and school children) to reduce
caries. * (Cole et al 1980).
Vitamins and dental caries

70. Trace elements and dental caries
Caries promoting elements : Selenium, magnesium, Cadmium, Platinum, Lead,
Silicon.
Elements that are mildly cariostatic : Molybdenum, Vanadium, Strontium,
Calcium, Boron, Lithium, Gold.
Elements with doubtful effect on caries : Beryllium, Cobalt, Manganese, Tin,
Zinc, Bromine, Iodine.
Caries inert elements : Barium, aluminium, nickel, iron, palladium, titanium.
Elements that are strongly cariostatic : Fluorine, phosphorous.
Kum Sun Lee, Nam-Joong Kim, Eun-Hee Lee, Ja-Won Cho. Cariogenic Potential Index of Fruits according to Their Viscosity and Sugar Content. Int J
Clin Prev Dent 2014;10(4):255-258

71. Fluoride :
 Water borne fluorides which originally were observed to cause
an unattractive discolouration and deformity to tooth enamel,
when ingested at level above 2 ppm, later were proved to be
essential of dental health because they reduced the incidence
of dental decay when ingested daily at optimum levels of 1
ppm.
Trace elements and dental caries

72. EDUARDO BERNABÉ ET AL. JOURNAL OF DENTISTRY 2016
 Data from 939 dentate adults who participated in the Health 2000
Survey and the Follow-Up Study of Finnish Adults’ Oral Health
showed a
Adults drinking 1–2 and 3+ sweetened beverages
daily had, respectively, 31% and 33% greater net DMFT
increments than those not drinking any sugar sweetened
beverages.
 Clinical significance:
in adults.

73. Exploring the relation between body mass index, diet, and dental caries among 6-12-year-old
children
Elangovan A, Mungara J, Joseph E Department of Pedodontics and Preventive Dentistry, RagasDental
College and Hospital, Chennai, Tamilnadu, India 2015
Aim: The aim of the present study was to determine if there is an association between BMI-for-age and dental caries in
children and to find out the role of diet with respect to BMI-for-age and dental caries.
Materials and Methods: Demographics and anthropometric measurements were obtained for 600 children and
BMI-for-age was calculated. Clinical examination for dental caries was carried out following WHO criteria. A diet
recording sheet was prepared and children/parents were asked to record the dietary intake for 3 days. Data obtained were
statistically analyzed using Chi-square, analysis of variance (ANOVA), and multiple linear regression.
Results: After excluding improperly filled diet recording sheets, 510 children were included in the study. Caries
prevalence was more in obese children than in other BMI groups. Caries scores increased as BMI-for-age
increased, though this was not statistically significant. Consumption of fatty foods and snacks was more with obese
children compared to other groups. A correlation was found between caries and snacks.
Conclusion: Dental caries scores showed no relationship between BMI-for-age in children. Both snacks and fatty food
items were consumed more by obese children, which seeks attention.

74. Diet and periodontal
disease

75. • Glucose and other carbohydrates are also used to produce
extracellular polysaccharides and, therefore, diets
containing sucrose, glucose and other disaccharides can
increase the plaque mass and facilitate the retention and
colonization of the plaque biofilm which forms a
substrate for bacteria to grow leading to periodontal
diseases.
-Boyd (2003)
Effect of diet on periodontal health

76. By interfering with the
A) integrity of gingival epithelial barrier.
B) tissue repair processes.
C) resistance mechanisms of the body.
Nutritional deficiencies contributes to periodontal disease

77. Research studies using an experimental
gingivitis model have shown increased
levels of bleeding on probing when
participants were fed with a diet high in
carbohydrates when compared to those on
a low sugar diet.
Carbohydrates and periodontal health

78.  The epithelium of the gingival crevice or pocket adheres to the
tooth surface by physiochemical forces mediated by the proteins
and glycoproteins in the gingival fluid.
 When a foreign body is introduced into the periodontal pocket in
a protein – deficient animal, the resorption of alveolar crest, the
down growth of the epithelial attachment, and the inflammatory
exudate are increased.
Role of protein on periodontal tissue

79. • Vitamin A deficiency produces hyperkeratosis and
hyperplasia of gingival tissue. There is a tendency
to periodontal pocket formation.
• A suitable antimetabolite of vitamin K might
interfere with the growth of Bacteroides
Melaninogenicus and consequently, prevent the
occurrence of periodontal disease.
• The characteristic oral sign of Vitamin C
deficiency is scurvy which results in enlargement
of the marginal gingivae that envelopes and
almost completely conceals the teeth.
Effects of vitamin deficiency on Periodontium

80. • Step 1 :Ascertain the dental health diet score and if necessary,
demonstrate the method for keeping a food intake diary
• Step 2 :explain the nutrition-periodontal relationship
• Step 3 : Assess nutritional status
• Step 4 : Prescribe a diet –improve adequacy of diet
• Emphasize foods that are particularly beneficial to periodontal
tissue-proteins, vit C, A, folic acid, calcium, iron and zinc.
• Encourage the elimination of plaque forming sweets and
substitution of fibrous foods.
Nutrition counselling for a patient with chronic
periodontitis

81.  The National Health and Nutrition Examination Survey (NHANES) is a
program of studies designed to assess the health and nutritional status of
adults and children in the United States.
 NCHS (national centre for health statistics) is part of the Centers for
Disease Control and Prevention (CDC) and has the responsibility for
producing vital and health statistics for the Nation.
 The NHANES interview includes demographic, socioeconomic, dietary,
and health-related questions.
 The examination component consists of medical, dental, and
physiological measurements, as well as laboratory tests.
Epidemiological surveys

82. Conclusion
• Diet counselling makes the patient aware of the fact
that diet plays an important role in the treatment of
the disease.
• With today’s emphasis on prevention of disease, diet
counselling helps to reduce the risk of some illness by
appropriate counselling.

83. References.
Abraham E. Nizel. The science of nutrition and its application in
clinical dentistry 2nd edition, W, B Saunders Company,
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Paula J. Moynihan. The role of diet and nutrition in the etiology
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dental diseases. Public Health Nutrition. 7(1A): 201–26
Elangovan A, Mungara J, Joseph . Exploring the relation between
body mass index, diet, and dental caries among 6-12-year-old

84. • Eduardo Bernabé et al. Sugar-sweetened beverages and
dental caries in adults: A 4-year prospective study . Journal of
dentistry 2014.
• Kum Sun Lee, Nam-Joong Kim, Eun-Hee Lee, Ja-Won
Cho. Cariogenic Potential Index of Fruits according to Their
Viscosity and Sugar Content. Int J Clin Prev Dent
2014;10(4):255-258
• Paula J. Moynihan. The role of diet and nutrition in the
etiology and prevention of oral diseases . Bulletin of the World
Health Organization (BLT). Volume 83, Number 9, September
2005, 641-720

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