Darby Biochemistry, Nutrition, and Nutritional Counseling

1. All the following are disaccharides EXCEPT one. Which one is the EXCEPTION?

a. Glucose

b. Sucrose

c. Lactose

d. Maltose

a. Glucose-its a monosaccharide

2. Oligosaccharides are composed of how many monosaccharide units?

a. More than six identical monosaccharide units

b. Two to six monosaccharide units

c. Two monosaccharide units

d. One monosaccharide unit

b. Two to six monosaccharide units

3. In the mouth, salivary amylase initiates the enzymatic hydrolysis of starch. Salivary amylase also activates pepsin and denatures proteins in the mouth.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE; the second statement is FALSE

d. The first statement is FALSE; the second statement is TRUE

c. The first statement is TRUE; the second statement is FALSE

4. Which of the following emulsifies fat during the digestive process?

a. Pancreatic enzymes

b. Bile salts

c. Brush-border enzymes

d. Salivary enzymes

b. Bile salts

5. All the following are monosaccharides EXCEPT one. Which one is the EXCEPTION?

a. Galactose

b. Sucrose

c. Glucose

d. Fructose

b. Sucrose

-its a disaccharide (glucosie + fructose)

6. Quantity of sucrose or carbohydrate eaten is less cariogenic than the frequency consumed. Sucrose eaten with a meal is less cariogenic than when consumed in between meals.

a. The first statement is TRUE; the second statement is FALSE

b. The first statement is FALSE; the second statement is TRUE

c. Both statements are TRUE

d. Both statements are FALSE

c. Both statements are TRUE

7. One of the end products of glycolysis is

a. Carbon dioxide

b. Adenosine triphosphate

c. Lactic acid

d. Water

c. Lactic acid

8. What is the process called in which glycogen is the short-term storage form of glucose in the liver and muscle?

a. Glycogenolysis

b. Gluconeogenesis

c. Glycogenesis

d. Glyconeogenesis

c. Glycogenesis

9. Anabolic hormones raise the blood glucose levels. Catabolic hormones lower the blood glucose level.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE; the second statement is FALSE

d. The first statement is FALSE; the second statement is TRUE

b. Both statements are FALSE

10. Anabolic hormones are metabolic regulators of all the following EXCEPT one. Which one is the EXCEPTION?

a. Lower blood glucose level

b. Stimulate gluconeogenesis

c. Increase glycogenesis

d. Increase lipogenesis

b. Stimulate gluconeogenesis

-Catabolic hormones are metabolic regulators of gluconeogenesis. Steroid hormones stimulate the synthesis of glucose from noncarbohydrate substances.

11. Which of the following is an example of a soluble fiber?

a. Oat bran

b. Cellulose

c. Hemicellulose

d. Lignin

a. Oat bran

12. All the following are biologic roles of carbohydrates EXCEPT one. Which one is the EXCEPTION?

a. Provides an energy source of 4 kcal/g

b. Protein sparing

c. Structural component of cell membrane

d. Precursors of structural and functional molecules

c. Structural component of cell membrane

13. The congenital absence of lactase enzyme is considered a primary lactose intolerance. Temporary or permanent loss of lactase enzyme activity as a result of injury or illness is considered a secondary lactose intolerance.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE; the second statement is FALSE

d. The first statement is FALSE; the second statement is TRUE

a. Both statements are TRUE

14. Which of the following nonnutritive sweeteners should be avoided by patients who have phenylketonuria?

a. Saccharin

b. Acesulfame-K

c. Sucralose

d. Aspartame

d. Aspartame

CASE A

Cecilia recently reported to the dentist for her 6-month recall appointment. During the dental exam, four new areas of interproximal decay were noted. The hygienist questioned Cecilia about changes in her oral hygiene or dietary patterns. Cecilia told the hygienist that she was a full-time student at the local community college. She also commented that she had taken a part-time job to help her parents with college expenses. Due to her busy academic and work schedule, she doesn’t have time to eat regular meals so she packs snacks such as baked chips, pretzels, and trail mix to eat during the day. She also consumes energy drinks frequently throughout the day to keep her going.

15. Which of the following dietary factors could contribute to Cecilia’s new areas of decay?

a. Frequency of intake

b. Form and consistency

c. Timing

d. A and C only

e. A, B, and C

e. A, B, and C

CASE A

Cecilia recently reported to the dentist for her 6-month recall appointment. During the dental exam, four new areas of interproximal decay were noted. The hygienist questioned Cecilia about changes in her oral hygiene or dietary patterns. Cecilia told the hygienist that she was a full-time student at the local community college. She also commented that she had taken a part-time job to help her parents with college expenses. Due to her busy academic and work schedule, she doesn’t have time to eat regular meals so she packs snacks such as baked chips, pretzels, and trail mix to eat during the day. She also consumes energy drinks frequently throughout the day to keep her going.

16. What dietary advice would be helpful for Cecilia in regard to the consumption of her energy drinks?

a. Encourage her to switch to caffeinated soft drinks for energy

b. Encourage her to sip on the energy drink rather than consuming a large amount at once

c. Encourage her to pair with a starchy food to decrease risk of demineralization

d. Encourage her to consume the energy drink all at once within 30 minutes

e. Encourage her to avoid energy drinks and consume carbonated water

d. Encourage her to consume the energy drink all at once within 30 minutes

CASE A

Cecilia recently reported to the dentist for her 6-month recall appointment. During the dental exam, four new areas of interproximal decay were noted. The hygienist questioned Cecilia about changes in her oral hygiene or dietary patterns. Cecilia told the hygienist that she was a full-time student at the local community college. She also commented that she had taken a part-time job to help her parents with college expenses. Due to her busy academic and work schedule, she doesn’t have time to eat regular meals so she packs snacks such as baked chips, pretzels, and trail mix to eat during the day. She also consumes energy drinks frequently throughout the day to keep her going.

17. All of the following are factors that may influence Cecilia’s food choices and may need to be addressed during nutrition counseling by the dental hygienist EXCEPT one. Which is the EXCEPTION?

a. Environmental influences

b. Social influences

c. Physiological influences

d. Psychological influences

c. Physiological influences

Case B

Mr. Farmer is a single, semiretired 76-year-old Caucasian male with carious lesions on tooth #s 8-M, #9-M, #3-MO, and #19-D. He has moderate supragingival calculus and slight to moderate subgingival calculus. He has generalized bleeding with more than 20 periodontal pocket sites that measure 4 mm. He has a 5 mm periodontal pocket on four distal surfaces of posterior teeth. He is currently taking clonazepam and Vitamin D. He says his mouth feels dry so he frequently keeps cinnamon hard candies in his mouth to stimulate his saliva. Throughout the day, he sips on Dr. Pepper or coffee containing 2 T sugar and Almond Joy creamer to keep his mouth moist. Mr. Farmer lives alone and his cooking skills are minimal. He snacks frequently throughout the day on granola bars, pretzels, and trail mix with raisins, nuts, and banana chips. Breakfast usually consists of a cinnamon raisin bagel, instant brown sugar oatmeal, or a store-bought muffin. Lunch is typically a sandwich of some sort with a bowl of soup. When arriving home at the end of his workday, he drinks one glass of red wine to unwind from his long commute home in traffic. He admits he often skips the evening meal because he doesn’t have the energy or desire to cook. If he does eat dinner, he eats a microwavable frozen dinner. To take the edge off his hunger before he goes to bed, Mr. Farmer often snacks on peanut butter crackers or his personal favorite—a bowl of chunky monkey chocolate banana ice cream.

18. The forms of foods that Mr. Farmer consumes does not put him at increased risk for dental caries; however the frequency and timing of his snacks and beverages are risk factors.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE; the second statement is FALSE

d. The first statement is FALSE; the second statement is TRUE

d. The first statement is FALSE; the second statement is TRUE

Case B

Mr. Farmer is a single, semiretired 76-year-old Caucasian male with carious lesions on tooth #s 8-M, #9-M, #3-MO, and #19-D. He has moderate supragingival calculus and slight to moderate subgingival calculus. He has generalized bleeding with more than 20 periodontal pocket sites that measure 4 mm. He has a 5 mm periodontal pocket on four distal surfaces of posterior teeth. He is currently taking clonazepam and Vitamin D. He says his mouth feels dry so he frequently keeps cinnamon hard candies in his mouth to stimulate his saliva. Throughout the day, he sips on Dr. Pepper or coffee containing 2 T sugar and Almond Joy creamer to keep his mouth moist. Mr. Farmer lives alone and his cooking skills are minimal. He snacks frequently throughout the day on granola bars, pretzels, and trail mix with raisins, nuts, and banana chips. Breakfast usually consists of a cinnamon raisin bagel, instant brown sugar oatmeal, or a store-bought muffin. Lunch is typically a sandwich of some sort with a bowl of soup. When arriving home at the end of his workday, he drinks one glass of red wine to unwind from his long commute home in traffic. He admits he often skips the evening meal because he doesn’t have the energy or desire to cook. If he does eat dinner, he eats a microwavable frozen dinner. To take the edge off his hunger before he goes to bed, Mr. Farmer often snacks on peanut butter crackers or his personal favorite—a bowl of chunky monkey chocolate banana ice cream.

19. Which of the following dietary factors put Mr. Farmer at the greatest risk for caries?

a. Banana chips

b. Cinnamon candy

c. Cinnamon raisin bagel

d. Peanut butter crackers

e. Chocolate banana ice cream

b. Cinnamon candy

Case B

Mr. Farmer is a single, semiretired 76-year-old Caucasian male with carious lesions on tooth #s 8-M, #9-M, #3-MO, and #19-D. He has moderate supragingival calculus and slight to moderate subgingival calculus. He has generalized bleeding with more than 20 periodontal pocket sites that measure 4 mm. He has a 5 mm periodontal pocket on four distal surfaces of posterior teeth. He is currently taking clonazepam and Vitamin D. He says his mouth feels dry so he frequently keeps cinnamon hard candies in his mouth to stimulate his saliva. Throughout the day, he sips on Dr. Pepper or coffee containing 2 T sugar and Almond Joy creamer to keep his mouth moist. Mr. Farmer lives alone and his cooking skills are minimal. He snacks frequently throughout the day on granola bars, pretzels, and trail mix with raisins, nuts, and banana chips. Breakfast usually consists of a cinnamon raisin bagel, instant brown sugar oatmeal, or a store-bought muffin. Lunch is typically a sandwich of some sort with a bowl of soup. When arriving home at the end of his workday, he drinks one glass of red wine to unwind from his long commute home in traffic. He admits he often skips the evening meal because he doesn’t have the energy or desire to cook. If he does eat dinner, he eats a microwavable frozen dinner. To take the edge off his hunger before he goes to bed, Mr. Farmer often snacks on peanut butter crackers or his personal favorite—a bowl of chunky monkey chocolate banana ice cream.

20. Which of the following methods would be the best choice to further assess and provide a more accurate account of Mr. Farmer’s dietary intake?

a. 24 hour dietary recall

b. 3-to 7-day food record or diary

c. Dietary Intake Questionnaire

d. 24 hour dietary recall combined with 3- to 7-day food record.

e. 24 hour dietary recall and Dietary Intake Questionnaire

d. 24 hour dietary recall combined with 3- to 7-day food record.

21. What is the recommended daily allowance (RDA) for digestible carbohydrate for adults and children?

a. 50 g

b. 65 g

c. 100 g

d. 130 g

d. 130 g

22. All the following are TRUE about patients with type 2 diabetes EXCEPT one. Which one is the EXCEPTION?

a. A specialized diet is recommended to maintain blood glucose control

b. Daily injections of insulin are needed

c. Routine blood testing to monitor blood sugar levels is recommended

d. Medication is often prescribed to facilitate glucose metabolism

b. Daily injections of insulin are needed

23. All the following signs and symptoms of diabetes mellitus EXCEPT one. Which one is the EXCEPTION?

a. Recurring gingival infections

b. Excessive thirst

c. Poor appetite

d. Frequent urination

c. Poor appetite

24. Alcoholism can cause B-vitamin depletion. It can also depress antidiuretic hormone, resulting in a loss of magnesium, potassium, and zinc in urine.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE; the second statement is FALSE

d. The first statement is FALSE; the second statement is TRUE

a. Both statements are TRUE

25. Essential amino acids can be synthesized by the body and do not need to be provided by the diet. Nonessential amino acids are found in food of animal origin.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE; the second statement is FALSE

d. The first statement is FALSE; the second statement is TRUE

b. Both statements are FALSE

26. Although an ovolactovegetarian diet can provide essential amino acids that are inadequate in incomplete plant proteins, which of the following nutrients might an ovolactovegetarian be deficient?

a. Iron

b. Vitamin B12

c. Calcium

d. Zinc

a. Iron

27. The linear sequence of the components of amino acids is referred to as which type of structure?

a. Primary

b. Secondary

c. Tertiary

d. Quaternary

a. Primary

28. Absorption of proteins occurs at the brush border of the microvilli of the small intestine. Absorption occurs only by active transport at specific amino acid sites.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE; the second statement is FALSE

d. The first statement is FALSE; the second statement is TRUE

c. The first statement is TRUE; the second statement is FALSE

29. All the following are used for de novo synthesis of proteins EXCEPT one. Which one is the EXEPTION?

a. Deoxyribonucleic acid

b. Alpha keto acid

c. Messenger ribonucleic acid

d. Ribosomal ribonucleic acid

b. Alpha keto acid

30. Positive nitrogen balance is the normal situation for building protein-containing tissue. Negative nitrogen balance indicates net protein breakdown.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE; the second statement is FALSE

d. The first statement is FALSE; the second statement is TRUE

a. Both statements are TRUE

31. All the following are examples of anabolic hormones EXCEPT one. Which one is the EXCEPTION?

a. Growth hormone

b. Adrenocortical hormones

c. Insulin

d. Thyroid hormone

b. Adrenocortical hormones

32. The cariogenic potential of foods:

a. Can be affected by the amount of sugar in food

b. Is related to the retentive quality of the food

c. Is related to the time foods are beverages are in the mouth

d. All the above

e. Both b and c

d. All the above

33. Which of the following anthropometric measures is sensitive indicator of muscle mass reflective of protein stores?

a. Bioelectrical impedance

b. Arm muscle circumference

c. Skinfold thickness measurement

d. Dual energy x-ray absorptiometry (DEXA)

b. Arm muscle circumference

34. Nutrients needs are often lower for patients undergoing treatment for oral cancer; diet modifications are often necessary due to complications from cancer or cancer treatments.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE; the second statement is FALSE

d. The first statement is FALSE; the second statement is TRUE

d. The first statement is FALSE; the second statement is TRUE

35. Which of the following eating disorders is most often found in middle income and upper income adolescent females?

a. Obesity

b. Anorexia

c. Bulimia

d. Other Specified Eating or Feeding Disorder

b. Anorexia

36. Which of the following can occur as a result of nutritional deficiencies that affect the papilla and/or tongue?

a. Stomatitis

b. Cheilosis

c. Glossitis

d. Necrotizing ulcerative gingivitis

c. Glossitis

37. All the following are TRUE about water-soluble vitamins EXCEPT one. Which one is the EXCEPTION?

a. They are sensitive to heat, light, and oxygen

b. They are absorbed into the blood by both active and passive transport

c. Deficiency symptoms are slow to develop

d. They are transported free and unbound

c. Deficiency symptoms are slow to develop

38. Vitamins are inorganic substrates that are essential to life. Minerals are organic substrates that are essential to life.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE; the second statement is FALSE

d. The first statement is FALSE; the second statement is TRUE

b. Both statements are FALSE

39. Which of the following have cariostatic properties, providing a coating on the tooth’s surface and forming a protective pellicle on the tooth?

a. Proteins

b. Carbohydrates

c. Lipids (fats)

d. Vitamins

c. Lipids (fats)

40. All the following are examples of fat-soluble vitamins EXCEPT one. Which one is the EXCEPTION?

a. Vitamin A

b. Vitamin C

c. Vitamin D

d. Vitamin K

b. Vitamin C

41. The energy required to digest, absorb, and metabolize food is known as which of the following?

a. Basal metabolic rate

b. Kilocalories

c. Thermic effect of food

d. Adenosine triphosphate

c. Thermic effect of food

42. What is a more accurate method of determining central or abdominal obesity?

a. Body mass index

b. Ideal body weight

c. Waist circumference

d. Weighing on a scale

c. Waist circumference

43. Which of the following statements is TRUE regarding the diet of individuals who are edentulous or who have limited mastication due to loss of teeth?

a. There is a reduced intake of dairy products

b. There is a reduced intake of grain products

c. There is reduced intake of meats

d. More fruits and vegetables are consumed

c. There is reduced intake of meats

44. All the following are important posteruptive effects of carbohydrate on the teeth EXCEPT one. Which one is the EXCEPTION?

a. Streptococcus mutans synthesizes polysaccharides from sucrose, which enhances bacterial biofilm formation

b. Carbohydrates provide an energy source for oral bacteria

c. Lactic acid, pyruvic acid, or acetyl–coenzyme A are the end products of glycolysis for acidogenic bacteria

d. Carbohydrates contribute to enamel remineralization

d. Carbohydrates contribute to enamel remineralization

45. Increased caries rate is attributed to a deficiency of vitamin D. Pulp calcification can occur if there is an excess of vitamin D.

a. The first statement is TRUE; the second statement is FALSE

b. The first statement is FALSE; the second statement is TRUE

c. Both statements are TRUE

d. Both statements are FALSE

c. Both statements are TRUE

Case C

Margaret is a 56-year-old patient who presents to the dental clinic for her 4-month recare appointment. As a divorced mother, she has been struggling to support her three children in college. She is currently self-employed and cleans homes and babysits for a living. Her chief complaint is sensitivity to hot and cold when eating. She also complains of dry mouth and states she sips on citrus-flavored water throughout the day.

Margaret’s medical history reveals she is currently being treated by a physician for type 2 diabetes, hyperlipidemia, hypertension, and gastroesophageal reflux disease (GERD). Her medications include 1000 mg of metformin, 15 mg of atorvastatin, 30 mg of atenolol, 20 mg of Prilosec, 81-mg aspirin tablet, 600 mg of calcium twice daily, and a multivitamin. Her height is 5 feet, 2 inches, and she weighs 150 pounds. Her BMI is 27.43 and her waist circumference is 37. She reports brushing her teeth morning and night, and she tries to floss but is not very compliant. Her biofilm score is 43%. She has several “watches” that were noted on previous dental charting. New bitewing radiographs were taken at this appointment. Secondary decay was identified on the distal of tooth #19 and mesial of tooth #30. Her periodontal assessment reveals isolated probing depths of 4 to 5 mm on the maxillary and mandibular posterior teeth.

The dental hygienist questions Margaret about her diet. She reports she eats small meals throughout the day and states that she “would rather snack than eat full meals.” She is also lactose intolerant, so she avoids dairy products. She likes fruits and vegetables but thinks it is time-intensive to have to prepare them, so she has developed a new habit of juicing fruits and vegetables and having a morning “smoothie” with fresh fruit and kale or spinach. Margaret states she also consumes energy drinks each day because she believes they give her “an extra boost” to get through her day. Additionally, she likes to snack on Baked Cheetos and Wheat Thins throughout the day.

46. The secondary decay is most likely caused by all the following EXCEPT:

a. GERD

b. Lactose intolerance

c. Energy drink consumption

d. Flavored-water consumption

e. Juicing with fresh fruits and vegetables

b. Lactose intolerance

Case C

Margaret is a 56-year-old patient who presents to the dental clinic for her 4-month recare appointment. As a divorced mother, she has been struggling to support her three children in college. She is currently self-employed and cleans homes and babysits for a living. Her chief complaint is sensitivity to hot and cold when eating. She also complains of dry mouth and states she sips on citrus-flavored water throughout the day.

Margaret’s medical history reveals she is currently being treated by a physician for type 2 diabetes, hyperlipidemia, hypertension, and gastroesophageal reflux disease (GERD). Her medications include 1000 mg of metformin, 15 mg of atorvastatin, 30 mg of atenolol, 20 mg of Prilosec, 81-mg aspirin tablet, 600 mg of calcium twice daily, and a multivitamin. Her height is 5 feet, 2 inches, and she weighs 150 pounds. Her BMI is 27.43 and her waist circumference is 37. She reports brushing her teeth morning and night, and she tries to floss but is not very compliant. Her biofilm score is 43%. She has several “watches” that were noted on previous dental charting. New bitewing radiographs were taken at this appointment. Secondary decay was identified on the distal of tooth #19 and mesial of tooth #30. Her periodontal assessment reveals isolated probing depths of 4 to 5 mm on the maxillary and mandibular posterior teeth.

The dental hygienist questions Margaret about her diet. She reports she eats small meals throughout the day and states that she “would rather snack than eat full meals.” She is also lactose intolerant, so she avoids dairy products. She likes fruits and vegetables but thinks it is time-intensive to have to prepare them, so she has developed a new habit of juicing fruits and vegetables and having a morning “smoothie” with fresh fruit and kale or spinach. Margaret states she also consumes energy drinks each day because she believes they give her “an extra boost” to get through her day. Additionally, she likes to snack on Baked Cheetos and Wheat Thins throughout the day.

47. Based on her calculated body mass index (BMI) of 27.43, Margaret would be classified in which of the following categories?

a. Obesity

b. Overweight

c. Underweight

d. Normal weight

e. Extreme obesity

b. Overweight

Case C

Margaret is a 56-year-old patient who presents to the dental clinic for her 4-month recare appointment. As a divorced mother, she has been struggling to support her three children in college. She is currently self-employed and cleans homes and babysits for a living. Her chief complaint is sensitivity to hot and cold when eating. She also complains of dry mouth and states she sips on citrus-flavored water throughout the day.

Margaret’s medical history reveals she is currently being treated by a physician for type 2 diabetes, hyperlipidemia, hypertension, and gastroesophageal reflux disease (GERD). Her medications include 1000 mg of metformin, 15 mg of atorvastatin, 30 mg of atenolol, 20 mg of Prilosec, 81-mg aspirin tablet, 600 mg of calcium twice daily, and a multivitamin. Her height is 5 feet, 2 inches, and she weighs 150 pounds. Her BMI is 27.43 and her waist circumference is 37. She reports brushing her teeth morning and night, and she tries to floss but is not very compliant. Her biofilm score is 43%. She has several “watches” that were noted on previous dental charting. New bitewing radiographs were taken at this appointment. Secondary decay was identified on the distal of tooth #19 and mesial of tooth #30. Her periodontal assessment reveals isolated probing depths of 4 to 5 mm on the maxillary and mandibular posterior teeth.

The dental hygienist questions Margaret about her diet. She reports she eats small meals throughout the day and states that she “would rather snack than eat full meals.” She is also lactose intolerant, so she avoids dairy products. She likes fruits and vegetables but thinks it is time-intensive to have to prepare them, so she has developed a new habit of juicing fruits and vegetables and having a morning “smoothie” with fresh fruit and kale or spinach. Margaret states she also consumes energy drinks each day because she believes they give her “an extra boost” to get through her day. Additionally, she likes to snack on Baked Cheetos and Wheat Thins throughout the day.

48. The direct-approach counseling technique would be best used to address Margaret’s dietary concerns in relation to her oral disease risk. The counselor (dental hygienist) should provide information on the causes of the dental disease, the role of the diet, and the use of dietary assessment tools, with the patient (Margaret) as an active participant.

a. Both statements are TRUE

b. Both statements are FALSE

c. The first statement is TRUE; the second statement is FALSE

d. The first statement is FALSE; the second statement is TRUE

d. The first statement is FALSE; the second statement is TRUE

Case C

Margaret is a 56-year-old patient who presents to the dental clinic for her 4-month recare appointment. As a divorced mother, she has been struggling to support her three children in college. She is currently self-employed and cleans homes and babysits for a living. Her chief complaint is sensitivity to hot and cold when eating. She also complains of dry mouth and states she sips on citrus-flavored water throughout the day.

Margaret’s medical history reveals she is currently being treated by a physician for type 2 diabetes, hyperlipidemia, hypertension, and gastroesophageal reflux disease (GERD). Her medications include 1000 mg of metformin, 15 mg of atorvastatin, 30 mg of atenolol, 20 mg of Prilosec, 81-mg aspirin tablet, 600 mg of calcium twice daily, and a multivitamin. Her height is 5 feet, 2 inches, and she weighs 150 pounds. Her BMI is 27.43 and her waist circumference is 37. She reports brushing her teeth morning and night, and she tries to floss but is not very compliant. Her biofilm score is 43%. She has several “watches” that were noted on previous dental charting. New bitewing radiographs were taken at this appointment. Secondary decay was identified on the distal of tooth #19 and mesial of tooth #30. Her periodontal assessment reveals isolated probing depths of 4 to 5 mm on the maxillary and mandibular posterior teeth.

The dental hygienist questions Margaret about her diet. She reports she eats small meals throughout the day and states that she “would rather snack than eat full meals.” She is also lactose intolerant, so she avoids dairy products. She likes fruits and vegetables but thinks it is time-intensive to have to prepare them, so she has developed a new habit of juicing fruits and vegetables and having a morning “smoothie” with fresh fruit and kale or spinach. Margaret states she also consumes energy drinks each day because she believes they give her “an extra boost” to get through her day. Additionally, she likes to snack on Baked Cheetos and Wheat Thins throughout the day.

49. During nutrition counseling with Margaret, it is important for the dental hygienist to:

a. Assess patient knowledge of information provided

b. Tell the patient which diet to follow

c. Include the patient in the diet planning

d. All the above

e. Both a and c

e. Both a and c

Case C

Margaret is a 56-year-old patient who presents to the dental clinic for her 4-month recare appointment. As a divorced mother, she has been struggling to support her three children in college. She is currently self-employed and cleans homes and babysits for a living. Her chief complaint is sensitivity to hot and cold when eating. She also complains of dry mouth and states she sips on citrus-flavored water throughout the day.

Margaret’s medical history reveals she is currently being treated by a physician for type 2 diabetes, hyperlipidemia, hypertension, and gastroesophageal reflux disease (GERD). Her medications include 1000 mg of metformin, 15 mg of atorvastatin, 30 mg of atenolol, 20 mg of Prilosec, 81-mg aspirin tablet, 600 mg of calcium twice daily, and a multivitamin. Her height is 5 feet, 2 inches, and she weighs 150 pounds. Her BMI is 27.43 and her waist circumference is 37. She reports brushing her teeth morning and night, and she tries to floss but is not very compliant. Her biofilm score is 43%. She has several “watches” that were noted on previous dental charting. New bitewing radiographs were taken at this appointment. Secondary decay was identified on the distal of tooth #19 and mesial of tooth #30. Her periodontal assessment reveals isolated probing depths of 4 to 5 mm on the maxillary and mandibular posterior teeth.

The dental hygienist questions Margaret about her diet. She reports she eats small meals throughout the day and states that she “would rather snack than eat full meals.” She is also lactose intolerant, so she avoids dairy products. She likes fruits and vegetables but thinks it is time-intensive to have to prepare them, so she has developed a new habit of juicing fruits and vegetables and having a morning “smoothie” with fresh fruit and kale or spinach. Margaret states she also consumes energy drinks each day because she believes they give her “an extra boost” to get through her day. Additionally, she likes to snack on Baked Cheetos and Wheat Thins throughout the day.

50. Margaret has a 43% biofilm score. Supragingival biofilm formation is influenced by frequent intake of which of the following in the diet?

a. Dietary monosaccharides and disaccharides

b. Fiber-rich foods

c. Protein-rich foods

d. Fat-rich foods

a. Dietary monosaccharides and disaccharides

Frequent dietary intake of monosaccharides and disaccharides influences supragingival biofilm or plaque formation.