oral health

why can problems in the mouth can impact diet and nutrition status

because the oral cavity is the pathway to the rest of the body

nutrition and oral health have what type of relationship

synergistic

how do nutrition and oral health have a synergistic relationship? (3)

• Adequate nutrition is essential for all tissues

• Oral disease can impact ability to eat

• Poor nutrition status can increase risk for oral disease

health issues effected by gingivitis and periodontitis? (5)

• CVD

• stroke

• Endocarditis (inflammation of the heart inner lining)

• Pneumonia

• Premature birth and low birth weight

interrelationship between nutrition and oral health

development of oral cavity (gestation)

• Primary teeth develop around 6 weeks gestation

• Mineralization begins around 3-4 months' gestation

development of oral cavity (infancy/childhood)

• Tooth eruption varies, usually around 6 months of age

• Majority of primary teeth erupt by 2-3 years

development of oral cavity (adolescents)

Most permanent teeth erupt by 16 years of age

what are the parts of the tooth

• enamel

• dentin

• pulp and nerve supply

what is enamel

hard mineralized surface of the tooth

what is dentin

boddy tissue forming the bulk of the tooth beneath the enamel

what are dentin and enamel made of?

hydroxyapatite (calcium and phosphorus crystalline structure)

what is more resistant than hydroxyapatite

fluorapatite (forms when fluoride is available)

what deficiencies/conditions are associated with hypomineralization and enamel hypoplasia

vit D, vit A, and malnutrition

what deficiencies/conditions are associated with salivary gland atrophy

vit A deficiency and malnutrition

salivary gland atrophy can impact what

health of teeth

poor oral health can impact what (3)

• food choices

• nutrition status

• overall health

mouth pain can lead to what

decreased intake

mouth pain can lead to decreased intake why? what do most do?(2)

• opt for foods that are easier to chew

• foods low in nutritional quality

oral tissue turnover (how long)

3-7 days

where to we see the earliest clinical manifestations of nutrition/health issues (where in the body)

in the oral cavity first

which deficiencies are seen more readily in the oral cavity?

water-soluble vitamins, protein, iron

lip, tongue, gum signs and what they indicate? (graph)

angular fissures are what

cheilosis is what

DENTAL CARIES (CAVITIES)

dental caries is most common what? (2)

• one of the most common infectious diseases

• most common chronic disease of childhood

dental caries form how? why? (simple)

slow progression and is multifactorial

caries impact life how long?

lifetime burden as once a tooth is infected, it requires restoration and maintenance throughout life

model of etiologies of dental carries (host, environmental, agent)

• host is the susceptible tooth

• agent is the cariogenic bacteria

• environmental factors is diet and saliva

what does cariogenic bacteria cause

plaque

what causes caries generic)

multifactorial

caries form due to interaction between what 3 things

• Host (tooth)

• Agent (plaque)

• Environment (diet and saliva)

what is plaque

colonized bacteria on tooth surfaces

what does plaque do

causes enamel to demineralize (because it is on the enamel surface)

how does plaque impact teeth (what does it cause and how)

the cariogenic bacteria in the plaque metabolized fermentable CHO —> acid is produced—> pH below 5.5—→ demineralization of enamel

what pH is risk for teeth

5.5 or below

pH of 5.5 of below causes what

demineralization of enamel —→ removes minerals from tooth—> can penetrate into bloodstream

steps in carie formation (2)

1. demineralization of enamel (reversible)

2. bacterial invade the tooth (not reversible)

demineralization of enamel, if halted can be

reversed

define remineralization

body’s natural repair process in which calcium and phosphorus from saliva rebuild the enamel

where does the calcium and phosphorus come from?

saliva (which is why it so important)

once bacteria invade tooth, what must occur

tooth restoration is required

demineralization and remineralization process

1. crystal enamel

2. acid is produced —> demineralization

3. partially dissolved enamel crystals —→ tooth caries OR

4. fluoride source, saliva, plaque control, and diet mods —→ remineralization

5. reformed enamel crystals and new flourapatite-like coating on crystals

6. healthy tooth enamel

etiology of dental caries (what is the root causes)- 4

• susceptible tooth

• microorganisms

• substrate- dietary factors

• foods

how can foods be etiology to dental caries (what factors does it depend on)

• composition of the food (cariogenic foods)

• amount

• frequency and duration of exposure

• form and consistency

• food combinations

when we talk about a susceptible tooth, what do we look at (4)

• composition of the tooth and enamel

• tooth location

• pits and fissures in tooth crown

• quantity of saliva

microorganisms do what that is at risk for caries

metabolize fermentable CHOw

what 3 bacteria metabolize fermentable CHO

• streptococcus mutans

• streptococcus sanguis

• lactobacillus

when we talk about dietary factors, what is of concern

carcinogenicity

carcinogenicity refers to what?

caries-promoting properties of a diet or food

what does carcinogenicity depend on (4)

• composition of food

• amount of CHO consumed

• frequency and duration of CHO exposure

• form and consistency of food consumed

what are cariogenic foods

food with fermentable CHO

what type of foods are low in carcinogenicity

starch foods

when is caries promoting potential increased (based on food) (3)

when finely ground, heat treated, high in sucrose

examples of cariogenic foods

• Examples: pretzels, crackers, white bread, chips, and crackers (sticky-can stay in mouth)

• Fruit drinks, soda, sweetened teas, sugar-sweetened beverages, and sweetened dairy product

why are some starchy foods or sweet foods cariogenic, and others are less?

cariogenic bacteria metabolize ALL SIMPLE CHO but time retained in the mouth INCREASES CARIOGENICITY of ALL CHO containing foods

when can fruits be of lower carcinogenicity

• if part of a mixed meal

• if high water content (watermelon < banana)

role of dietary fiber

can stimulate the production of saliva (decreases time in contact with tooth)

role of non-carb components of food

can modulate the cariogenic potential of food

what is cariostatic foods

those that

• do not contribute to decay

• not metabolized by microorganisms

• do not cause pH drop to <5.5 in 30 minutes

examples of cariostatic foods (3 categories)

• protein foods

• fats and oils

• nonnutritive sweeteners

what are anti-cariogenic foods

those that PREVENT plaque from recognizing cariogenic foods

examples of anti-cariogenic foods (3 main categories)

• cow’s milk and aged cheese (dairy)

• xylitol (inhibit streptococcus mutans)

• chewing gum

cows milk and aged cheese role in caries

prevent due to casein, calcium, and phosphorus content

xylitol prevents plaque/caries how

inhibits streptococcus mutans

food amount and caries

strong association between amount of sugar and caries risk

frequency and duration of exposure AND caries

• Foods retained in the mouth for longer increase caries risk

• Foods that are quickly eliminated from the mouth are less damaging

food combinations role is caries

certain combinations can enhance or prevent caries

remineralization is enhanced when cariogenic foods are eaten with

dairy products

Cariogenic foods and beverages are less cariogenic when consumed with

anticariogenic foods or consumed with a meal

how does sequence of food impact caries risk

eating acidogenic foods between cariostatic or anticariogenic foods can lower risk

• so eating protein —> carb/sugar —> protein/fat (example)

what 6 things can increase caries risk (table)

• frequent or prolonged meal snacking

• frequent of prolonged between meal-sipping (sweetened drinks)

• frequent in-between meal use of cariogenic foods (desserts)

• chewing sugar sweetened gum

• slowly dissolved hard candies (breath mints, cough drops, jolly ranchers)

• eating sticky foods like dried fruits or fruit rolls ups

what 6 things can decrease caries risk

• limiting snacking to 2-3 times a day

• drinking sweetened or acidic beverages instead of sipping (limit carbonated drinks to meal times only)

• having sweets with meals rather than between meals

• chewing sf gum (xylitol)

• consuming fruits, vegetables, dairy products, and nuts as snacks

• using water frequently to clean mouth of food debris

we can do what to our diet to reduce caries risk

manage it

how can we manage our diet to reduce caries risk (like what would diet look like)

• balanced diet

• modify fermentable CHO

• snack on cariostatic or anticariogenic foods

• chew sf gum

• have sweets with meals

how can we control plaque

brush and floss teeth daily

what mineral can be used to aid oral health

flouride

basic oral hygiene is linked to

whole body health

diseases/condition linked to oral health problems

diabetes, osteoporosis, HIV/AIDS, Alzheimer's disease, others

components of good oral hygeine (4)

• brush teeth 2x a day for 2 mins —> flouridated toothpaste and soft brush

• interdental cleaning (flossing) 2x day

• brush tongue

• visit dentist regularly

what has been seen to help reduce caries in 5-16 year olds

supervised consumption of chewing gum sweetened with sucrose-free polyol (xylitol only or polyol combinations) for 10-20 minutes after meals

how does fluoride prevent and control dental caries (4)

• Inhibit tooth demineralization

• Enhances tooth remineralization

• Is released from plaque in response to lower mouth pH

• Fluoride in dental plaque interferes with acid production by inhibiting essential enzyme activity

what is systemic flouride?

Occurs through supplements or dietary intake of fluoride (absorbed into blood and deposited to bones and teeth)

when is systemic fluoride seen to be beneficial to

from birth until all teeth erupted

benefits children

what is topical fluoride

fluoride added directly onto teeth

when is topical fluoride most effective for

after teeth have erupted

adults and children benefit

fluoride sources

• fluoride containing toothpaste, oral fluoride rinses, gels, and foams

• Fluoridates drinking water and toothpaste are the most fluoride sources

water and fluoride

Community water fluoridation reduces childhood dental caries by up to 40%

when should one recommend dietary fluoride supplements

• ONLY for children at high risk for caries development AND whose primary water source is not fluoridated

  • done under pediatric dentist supervision

what to consider before recommending fluoride supps

• Determination of fluoride level of primary drinking water

• Potential sources of dietary fluoride

• Caries risk

what is fluorosis

ingestion of excessive fluoride when teeth are still developing which can lead to defective mineralization

• why children should not eat toothpaste :)

PERIODONTAL DISEASE

what is periodontal disease

gum disease ; chronic infection of the hard and soft tissue supporting the teeth

periodontal disease is characterized by

gingival recession and bleeding, formation of deep pockets, and loss of bone-supporting teeth (inflammatory process)

what are the 2 types of periodontal disease

gingivitis and periodontitis

what is gingivitis

• Common, mild, and reversible from of periodontal disease

• Characterized by infected, red, swollen, and bleeding gums

what is periodontitis

• Chronic inflammatory disease of supportive tissue of the teeth

• Characterized by red, swollen, bleeding gums, teeth with exposed tooth surfaces, and bone loss

what are the factors that cause periodontal disease (3)

• microbial

• genetic

• lifestyle

microbial factors do what (periodontal disease)

• Oral bacteria colonize the subgingival pocket and form dental plaque

• Progression and severity depend on the virulence of the plaque bacteria and host immune response