research article work description

1. DIET COUNSELLING: A
PRIMORDIAL LEVEL OF
JOURNAL CLUB

2. TEXT
CONTENTS
▸Introduction
▸Current concepts of caries ethology
▸Counselling
▸Dental caries and diet
▸Basic requisites for diet counselling
▸Instructions for calculating diet score
▸Conclusion
▸References

3. TEXT
INTRODUCTION
Man’s need to develop food processing leading to dietary change
Oral health is directly related to the kind of diet being taken
Metabolism is affected , along with local influence on salivary secretion and improved host resistance

4. TEXT
▸Inadequate nutrition can affect the oral health including dental caries, periodontal diseases,
diseases of oral mucosa and infectious diseases.
▸Compromised oral health can alter food choices and negatively impact food intake leading to
suboptimal nutritional status which can lead to chronic systemic diseases
▸Gondivkar SM, Gadbail AR, Gondivkar RS, Sarode SC, Sarode GS, Patil S, Awan KH.
Nutrition and oral health. Disease-a-Month. 2019 Jun 1;65(6):147-54.

5. TEXT
CARIES AS NUTRITIONAL DEFICIENCY
▸Caries as nutritional deficiency due to insufficient phosphate intake or improper calcium
phosphate ratio
▸Numerous rodent studies have proposed that phosphate salts retard caries.
▸Luoma et al phosphate was taken up by plaque bacteria during metabolism of
carbohydrates.
▸Steady state equilibrium exists between inorganic phosphate saliva and enamel.
▸Insufficient phosphate intake could also contribute to caries
▸Both theories remain conjectural

6. TEXT
▸Found a statistically significant association between the frequency of active caries and the
concentration of phosphate in gingival crevicular fluid of teeth with caries
▸As well as between the severity of caries with buffering capacity and the concentration
of phosphate in the gingival crevicular fluid of teeth with caries.
▸ Velásquez N, Pérez-Ybarra L, Urdaneta CJ, Pérez-Domínguez M. Sialometry and concentration of phosphate and
calcium in stimulated whole saliva and gingival crevicular fluid and its association with dental caries in
schoolchildren. Biomédica. 2019 Mar;39(1):157-69.

7. TEXT
CURRENT CONCEPTS
▸Caries activity is a reversible and dynamic process
▸Multifactorial causation
▸Demineralisation and remineralisation co exist
▸Demineralisation is limited by fluoride

8. TEXT
▸Fluoride has the potential to exert an anti-caries benefit largely through three mechanisms;
▸ Inhibition of demineralisation
▸Promotion of remineralisation
▸ Interference with bacterial growth and metabolism
▸Reductions in caries resulting from the use of fluoride toothpastes can be linked to modification of
the demineralisation/remineralisation balance by direct effects on dental mineral exerted topically
by low levels of fluoride.
▸Lynch RJ, Navada R, Walia R. Low‐levels of fluoride in plaque and saliva and their effects on the
demineralisation and remineralisation of enamel; role of fluoride toothpastes. International dental
journal. 2004 Oct;54(S5):304-9

9. TEXT
▸Thylstrup and fejerskov :

10. TEXT
▸A study conducted on 49 unerupted third molars was conducted to check for the
difference between demineralisation amongst flurotic and non flurotic teeth
▸A higher severity of fluorosis makes enamel less resistant to the caries process due to its
greater subsurface mineral area exposed to demineralization and deeper acid diffusion
through the enamel
▸Marín LM, Cury JA, Tenuta LM, Castellanos JE, Martignon S. Higher fluorosis severity
makes enamel less resistant to demineralization. Caries research. 2016;50(4):407-13

11. TEXT
CARIES BALANCE
▸Risk of developing caries exists throughout life
▸Balance between risk and protective factors has to be maintained
Risk factors
Frequent exposure to
sugars
Cariogenic bacteria
Reduced salivary flow
rate
Protective factors
Plaque control
Saliva
Antimicrobials

12. TEXT
▸Dental caries, therefore, is not an example of a classic infectious disease but is a
consequence of an ecological shift in the balance of the normally beneficial oral
microbiota, driven by a change in lifestyle and oral environment.
▸The regular exposure of plaque to fermentable dietary sugars results in repeated
conditions of low pH in the biofilms which will favour the growth and metabolism of
acid-tolerating bacteria while inhibiting beneficial organisms that preferentially grow at
neutral pH
▸Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F, Tagami J,
Twetman S, Tsakos G, Ismail A. Dental caries. Nature reviews Disease primers. 2017
May 25;3(1):1-6.

13. TEXT
DIET IN PAEDIATRIC DENTISTRY
▸Child’s diet and nutrition affect’s cognitive growth and development along with emotional
and behavioural development
▸Food is merely a vehicle for nutrient delivery
▸Sensory , emotional ,cultural associations influence food choices

14. TEXT
▸Little is known about the role of food and diet from the perspectives of pediatric patients
and their parents.
▸This study aimed to explore how children and adolescents with IBD and their parents
coped with the illness through food and diet in their daily lives.
▸Personalized nutritional counselling and ongoing nutritional assessment were found to be
instrumental in helping the families cope
▸Chuong KH, Haw J, Stintzi A, Mack DR, O’Doherty KC. Dietary strategies and food
practices of pediatric patients, and their parents, living with inflammatory bowel disease: a
qualitative interview study. International journal of qualitative studies on health and well-
being. 2019 Jan 1;14(1):1648945.

15. TEXT
DIETARY SCREENING AND EDUCATION
▸Screening of patients to be done for assessing in diet in caries risk and management
▸Referral to nutritionists can be done post screening
▸Respecting the patients choice is a must
▸Authoritative terms as must not , not allowed should be avoided
▸Whereas an understanding about nutritive health should be achieved

16. TEXT
▸Dental erosion occurs after exposure to intrinsic or extrinsic acids.
▸Exposure to intrinsic gastrointestinal acids is associated with anorexia nervosa, bulimia
nervosa, rumination syndrome, or gastroesophageal reflux
▸Identification prevents erosion and diagnosis of underlying systemic conditions
▸Marshall TA. Dietary assessment and counseling for dental erosion. The Journal of the
American Dental Association. 2018 Feb 1;149(2):148-52.

17. TEXT
OBJECTIVES
▸Caries prevention
▸Assessment with dietary recommendations is a must.
▸Changing the parent and child’s attitude towards nutrition
▸Dietary recommendations must be given in view to the pattern of diet of the family
▸Should not be unrealistic

18. TEXT
ART OF COUNSELLING
▸Counselling is one on one basis
▸To be effective it should be in form of dialogues
▸Face to face ,interview with good eye contact
▸Both verbal and non verbal actions can be influential
▸A combination of interviewing , teaching ,counseling and motivating is used
▸Antoine lavoisier : father of nutrition

19. TEXT
▸Individual counseling is the most common type of counseling that focuses on the growth
and mental health of an individual.
▸Couples or marriage counseling focuses on assisting couples in overcoming conflict and
working towards a stronger relationship.
▸Family counseling involves the different familial dynamics and how they affect the family
structure.
▸Group counseling is the use of group interaction to facilitate growth.
▸Burnes TR, Singh AA, Harper AJ, Harper B, Maxon-Kann W, Pickering DL, Hosea JU.
American Counseling Association: Competencies for counseling with transgender clients.
Journal of LGBT Issues in Counseling. 2010 Jul;4(3-4):135-59.

20. TEXT
▸Process of counselling
▸Opening up to the person
▸Exploring understanding
▸Building
▸Intervention
▸Exploring problems
▸Empower to create own solutions
▸Burnes TR, Singh AA, Harper AJ, Harper B, Maxon-Kann W, Pickering DL, Hosea JU.
American Counseling Association: Competencies for counseling with transgender clients.
Journal of LGBT Issues in Counseling. 2010 Jul;4(3-4):135-59.

21. TEXT
BASIC REQUISITES
▸PURPOSE : educate parents about dental disease and prevention. Strengthen and prepare
the child and provide a suitable environment for the child
▸METHODS: education concerning development, demonstration of oral hygiene habits
▸CONTENT :
▸External (parents)
▸Internal (parents and child): lifestyle, diseases, sweets, nutrition, calcium ,nutrients ,
hygiene

22. TEXT
▸Self-regulatory behaviours of parents for supervising their children's toothbrushing using
the health action process approach.
▸Parents who showed active interest and instilled self checks and measures on their own
lifestyles showed considerable decrease in caries development
▸Self-efficacy, planning, and action control are key self-regulatory skills for behaviour
change
▸Hamilton K, Cornish S, Kirkpatrick A, Kroon J, Schwarzer R. Parental supervision for
their children's toothbrushing: Mediating effects of planning, self‐efficacy, and action
control. British journal of health psychology. 2018 May;23(2):387-406.

23. TEXT
▸During prenatal counselling teething should be mentioned. Teething can present signs of
systemic distress
▸Rise in temperature , diarrhoea, dehydration and gastrointestinal disturbances
▸Increased fluid consumption, a non aspirin analgesic, teething rings to reduce any lancing
of tissues
▸Providing knowledge for first dental visit (3-5 yers of age )
▸Bright futures lays down guidelines and recommends 12 months as the time for first
dental visit
▸Early dental visit , helps the dentist to assess the risk factors and make a comprehensive
preventive plan.

24. TEXT
DISCUSSION
▸The five W and one H of diet consultation
▸Who
▸What
▸Why
▸When
▸Where
▸How

25. TEXT
DENTAL HEALTH DIET SCORE
▸A scoring procedure to assess a dietary problem
▸Points are given for an adequate diet intake from all food groups
▸Extra points for nutritive food and points are subtracted based on overtly sweet food
▸Score of 60-100 is adequate , <56 is indicated along with preventive treatments

26. TEXT
INSTRUCTIONS
▸List everything you eat on a normal day , even snacks and record the time, amount of food
and the number of teaspoons of sugar added
▸Circle the foods that have sugar added.
▸Classify the encircled foods into appropriate food groups
▸Place a check mark for each serving taken
▸Milk and meat group -24.
▸Vegetables and bread - 24
▸Nutrients 7

27. TEXT
▸Sweet score is based on solid, liquid and slowly dissolving
▸Scores 0f 5, 10 and 15 are given respectively
▸72-96 excellent
▸64-72 adequate
▸56-64 barely adequate
▸56 or less not adequate
▸Assessment questionnaire are submitted to better understand the needs and problems
related to the patient , prior to counselling

28. TEXT

29. TEXT
▸Portion size measurement is relative to the energy basis of the food group
▸Half a serving of yoghurt shall be equivalent to a full serving of muesli
▸Mixed foods and composites shall require proper analysis of all constituents
▸For a sandwich , the bread, meats and vegetables shall all be accounted for separately
▸Steenhuis IH, Vermeer WM. Portion size: review and framework for interventions.
International Journal of Behavioral Nutrition and Physical Activity. 2009 Dec;6(1):58.

30. TEXT
DIETARY ADVICE
▸Understanding the role of food in society and the person’s life
▸Changing one’s eating habits is by far the most difficult due to dependancy and taste
patterns
▸It has to be an overall holistic change and not a short sighted commitment.

31. TEXT
▸Suggested use of new mediums of food like probiotic milk, ingestion of complex fibres
▸As time progresses new dietary supplements ought to be introduced with consultation of a
physician and nutritionist
▸The study also described the concept of “ eat the rainbow” wherein the most number of
colourful ingredients in a diet shall help in fighting of inflammation and most cancers.
▸Ethical and food drug standards were considered must for clearance of such foods.
▸Verbanac D, Maleš Ž, Barišić K. Nutrition–facts and myths. Acta Pharmaceutica. 2019
Dec 31;69(4):497-510.

32. TEXT
CONCLUSION
▸Dental caries being a diet related disease has to be dealt with modifications to diet and that
can be possible only through patient education.
▸Reduction in exposure to refined carbohydrates and plaque control shall play a
momentous role.
▸Social situation and lifestyle of the patient should be taken into account while counselling.

33. TEXT
REFERENCES
▸ Velásquez N, Pérez-Ybarra L, Urdaneta CJ, Pérez-Domínguez M. Sialometry and concentration of phosphate and
calcium in stimulated whole saliva and gingival crevicular fluid and its association with dental caries in
schoolchildren. Biomédica. 2019 Mar;39(1):157-69.
▸Gondivkar SM, Gadbail AR, Gondivkar RS, Sarode SC, Sarode GS, Patil S, Awan KH. Nutrition and
oral health. Disease-a-Month. 2019 Jun 1;65(6):147-54.
▸Lynch RJ, Navada R, Walia R. Low‐levels of fluoride in plaque and saliva and their effects on the
demineralisation and remineralisation of enamel; role of fluoride toothpastes. International dental
journal. 2004 Oct;54(S5):304-9

34. TEXT
▸Marín LM, Cury JA, Tenuta LM, Castellanos JE, Martignon S. Higher fluorosis severity
makes enamel less resistant to demineralization. Caries research. 2016;50(4):407-13
▸Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F, Tagami J,
Twetman S, Tsakos G, Ismail A. Dental caries. Nature reviews Disease primers. 2017
May 25;3(1):1-6.
▸Chuong KH, Haw J, Stintzi A, Mack DR, O’Doherty KC. Dietary strategies and food
practices of pediatric patients, and their parents, living with inflammatory bowel disease: a
qualitative interview study. International journal of qualitative studies on health and well-
being. 2019 Jan 1;14(1):1648945.

35. TEXT
▸Marshall TA. Dietary assessment and counseling for dental erosion. The Journal of the
American Dental Association. 2018 Feb 1;149(2):148-52.
▸Burnes TR, Singh AA, Harper AJ, Harper B, Maxon-Kann W, Pickering DL, Hosea JU.
American Counseling Association: Competencies for counseling with transgender clients.
Journal of LGBT Issues in Counseling. 2010 Jul;4(3-4):135-59.
▸Hamilton K, Cornish S, Kirkpatrick A, Kroon J, Schwarzer R. Parental supervision for
their children's toothbrushing: Mediating effects of planning, self‐efficacy, and action
control. British journal of health psychology. 2018 May;23(2):387-406.

36. TEXT
▸Verbanac D, Maleš Ž, Barišić K. Nutrition–facts and myths. Acta Pharmaceutica. 2019
Dec 31;69(4):497-510.
▸ASteenhuis IH, Vermeer WM. Portion size: review and framework for interventions.
International Journal of Behavioral Nutrition and Physical Activity. 2009 Dec;6(1):58.