Nutrition and Oral Health What Dietitians Should Know

January 16 2014

PresenterWahida Karmally DrPH RD CDE CLS FNLA Associate Research Scientist Lecturer in Dentistry

Director of Nutrition Irving Institute for Clinical and Translational Research Columbia University

ModeratorJames M Rippe MD ndash Leading cardiologist Founder and Director

Rippe Lifestyle Institute

Approved for 1 CPE (Level 2) by the Commission on Dietetic Registration credentialing agency for the Academy of Nutrition and Dietetics

NUTRI-BITESreg

Webinar Series

Webinar logistics CEUs ndash a link to obtain your personalized Continuing

Education Credit certificate will be emailed within 2 days

A recording of todayrsquos webinar slides and summary PowerPoint will be available to download as a PDF within 2 days at wwwConAgraFoodsScienceInstitutecom

The presenter will answer questions at the end of this webinar Please submit questions by using the lsquoChatrsquo dialogue box on your computer screen

Webinar logistics CEUs ndash a link to obtain your personalized Continuing

Education Credit certificate will be emailed within 2 days

A recording of todayrsquos webinar slides and summary PowerPoint will be available to download as a PDF within 2 days at wwwConAgraFoodsScienceInstitutecom

The presenter will answer questions at the end of this webinar Please submit questions by using the lsquoChatrsquo dialogue box on your computer screen

ConAgra Foods Science Institute With a mission of

Promoting dietary and related choices affecting wellness

by linking evidence-based understanding

with practice

Todayrsquos Faculty

Wahida Karmally DrPH RD CDE CLS FNLA Associate Research Scientist Lecturer in DentistryDirector of Nutrition Irving Institute for Clinical and

Translational Research Columbia University

ModeratorJames M Rippe MD ndash Leading cardiologist Founder and Director Rippe Lifestyle Institute

Learning Objectives

Discuss the lifelong synergy between nutrition and oral health status in health and disease

Outline the role of nutrition in the development and integrity of the oral cavity and the progression of oral disease

Describe practical strategies dietitians can use to integrate oral health information with lifestylenutrition counseling

NUTRI-BITESreg

Webinar Series

6

Nutrition and Oral HealthWhat Dietitians should know

Wahida Karmally DrPH RDCDECLSFNLAAssociate Research Scientist

Lecturer in DentistryColumbia University

We are going to find ourselves at the leading edge of preventive

medicine

Reeves Juliette Br Dent J 2013 Dec 6215(11)589-91 doi 101038sjbdj20131184

bull Nutrition is an integral component of oral health

bull Oral infectious diseases as well as acute chronic and systemic diseases with oral manifestations impact an individuals functional ability to eat and their nutrition status

bull Nutrition and diet can affect the development and integrity of the oral cavity and progression of oral diseases

Academy of Nutrition and Dieteticss Position Paper Oral Health and Nutrition - 2013rdquo

Journal of the Academy of Nutrition and Dietetics (2013) 113693-701

Diet and Nutrition are major multifactorial environmental factors in the etiology and pathogenesis of craniofacial diseases and disorders

Surgeon Generalrsquos Report on ldquoOral Health in Americardquo2000

A National Call to Action to Promote Oral Health

The goals of the Call to Action are to

bull Promote oral healthbull Improve quality of life andbull Eliminate oral health disparities

CDC Report httpwwwcdcgovOralHealthpublicationsfactsheetsdental_carieshtm

Diet and nutrition play a key role in

mdash Tooth developmentmdash Gingival and oral tissue integritymdash Bone strengthmdash Prevention and management of diseases of the

oral cavity

Nutritional Deficiencies and Oral Problems

bull Stomatitis Niacin folic acid ampvitamin B12bull Glossitis Niacin folic acid B6 and B12bull Xerostomia Vitamins A and B12bull Cheilosis Iron B vitaminsbull Gingival bleeding Vitamins C and Kbull Glossodynia B vitamins Zinc IronExcessive intakes of vitamin A intake can impact soft

and hard tissuesVitamin A toxicity can impair oral mucosal

epithelium development

Childrens Oral Health

Although dental caries (tooth decay) is largely preventable it remains the most common chronic disease of children aged 6 to 11 years (25) and

adolescents aged 12 to 19 years (59)

Tooth decay is four times more common than asthma among adolescents aged 14 to 17 years (15)

DENTAL CARIES

Infectious disease of teeth in which organic acid metabolites lead to gradual demineralization of

enamel proteolytic destruction of tooth structure

Any tooth surface can be affected

Decay Process

bull Plaque formation sticky mix of microorganisms protein polysaccharides

bull Bacteria metabolizing fermentable carbohydrate produce acid

bull Acid production oral pHlt55 allows tooth demineralization

bull Saliva function rinses away food neutralizes acid promotes remineralization

Dental caries----

Streptococcus mutansmdashmost common bacteria involved

Factors Affecting Food Cariogenicity

bull Frequency of consumption of fermentable carbohydrates

bull Food form liquid solid slowly dissolving

bull Sequence of eating foods

bull Combination of foods

bull Nutrient composition of foods and beverages

Cariostatic Foods

Foods that do not contribute to decay-they are not metabolized by microorganisms in plaque and do not subsequently cause a drop in salivary pH tolt55 within 30 minutes

Includes protein foods eggs fish meat and poultry most vegetables fats sugarless gums

Anticariogenic Foods

Prevent plaque from recognizing an acidogenic food when it is eaten first

May increase salivation or have antimicrobial activity

Includes xylitol (sweetener in sugarless gum) and cheeses

Gummy vitamins rotten teeth

Control Your Sweet Tooth

Avoid sugars and carbohydrates that break down quickly to sugars

ndash Candyndash Cookiesndash Cakendash Juicesndash Sodandash Sweetened coffee beveragesndash Chipsndash Pretzels

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Early childhood caries related to feeding and eating behaviors

Also called ldquobaby bottle tooth decayrdquoNursing bottle cariesmdashputting baby to bed with a

bottle of sweetened liquid

Front teeth rapidly develop caries

Oral Health and ChildrenTeeth decay is the 1 chronic disease in childhood

3 Tips To Prevent Tooth Decay1 Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk2 Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3 Brush teeth after breakfast and before bed

Schedule regular dental visits

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Todayrsquos Faculty

Wahida Karmally DrPH RD CDE CLS FNLA Associate Research Scientist Lecturer in DentistryDirector of Nutrition Irving Institute for Clinical and

Translational Research Columbia University

ModeratorJames M Rippe MD ndash Leading cardiologist Founder and Director Rippe Lifestyle Institute

Learning Objectives

Discuss the lifelong synergy between nutrition and oral health status in health and disease

Outline the role of nutrition in the development and integrity of the oral cavity and the progression of oral disease

Describe practical strategies dietitians can use to integrate oral health information with lifestylenutrition counseling

NUTRI-BITESreg

Webinar Series

6

Nutrition and Oral HealthWhat Dietitians should know

Wahida Karmally DrPH RDCDECLSFNLAAssociate Research Scientist

Lecturer in DentistryColumbia University

We are going to find ourselves at the leading edge of preventive

medicine

Reeves Juliette Br Dent J 2013 Dec 6215(11)589-91 doi 101038sjbdj20131184

bull Nutrition is an integral component of oral health

bull Oral infectious diseases as well as acute chronic and systemic diseases with oral manifestations impact an individuals functional ability to eat and their nutrition status

bull Nutrition and diet can affect the development and integrity of the oral cavity and progression of oral diseases

Academy of Nutrition and Dieteticss Position Paper Oral Health and Nutrition - 2013rdquo

Journal of the Academy of Nutrition and Dietetics (2013) 113693-701

Diet and Nutrition are major multifactorial environmental factors in the etiology and pathogenesis of craniofacial diseases and disorders

Surgeon Generalrsquos Report on ldquoOral Health in Americardquo2000

A National Call to Action to Promote Oral Health

The goals of the Call to Action are to

bull Promote oral healthbull Improve quality of life andbull Eliminate oral health disparities

CDC Report httpwwwcdcgovOralHealthpublicationsfactsheetsdental_carieshtm

Diet and nutrition play a key role in

mdash Tooth developmentmdash Gingival and oral tissue integritymdash Bone strengthmdash Prevention and management of diseases of the

oral cavity

Nutritional Deficiencies and Oral Problems

bull Stomatitis Niacin folic acid ampvitamin B12bull Glossitis Niacin folic acid B6 and B12bull Xerostomia Vitamins A and B12bull Cheilosis Iron B vitaminsbull Gingival bleeding Vitamins C and Kbull Glossodynia B vitamins Zinc IronExcessive intakes of vitamin A intake can impact soft

and hard tissuesVitamin A toxicity can impair oral mucosal

epithelium development

Childrens Oral Health

Although dental caries (tooth decay) is largely preventable it remains the most common chronic disease of children aged 6 to 11 years (25) and

adolescents aged 12 to 19 years (59)

Tooth decay is four times more common than asthma among adolescents aged 14 to 17 years (15)

DENTAL CARIES

Infectious disease of teeth in which organic acid metabolites lead to gradual demineralization of

enamel proteolytic destruction of tooth structure

Any tooth surface can be affected

Decay Process

bull Plaque formation sticky mix of microorganisms protein polysaccharides

bull Bacteria metabolizing fermentable carbohydrate produce acid

bull Acid production oral pHlt55 allows tooth demineralization

bull Saliva function rinses away food neutralizes acid promotes remineralization

Dental caries----

Streptococcus mutansmdashmost common bacteria involved

Factors Affecting Food Cariogenicity

bull Frequency of consumption of fermentable carbohydrates

bull Food form liquid solid slowly dissolving

bull Sequence of eating foods

bull Combination of foods

bull Nutrient composition of foods and beverages

Cariostatic Foods

Foods that do not contribute to decay-they are not metabolized by microorganisms in plaque and do not subsequently cause a drop in salivary pH tolt55 within 30 minutes

Includes protein foods eggs fish meat and poultry most vegetables fats sugarless gums

Anticariogenic Foods

Prevent plaque from recognizing an acidogenic food when it is eaten first

May increase salivation or have antimicrobial activity

Includes xylitol (sweetener in sugarless gum) and cheeses

Gummy vitamins rotten teeth

Control Your Sweet Tooth

Avoid sugars and carbohydrates that break down quickly to sugars

ndash Candyndash Cookiesndash Cakendash Juicesndash Sodandash Sweetened coffee beveragesndash Chipsndash Pretzels

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Early childhood caries related to feeding and eating behaviors

Also called ldquobaby bottle tooth decayrdquoNursing bottle cariesmdashputting baby to bed with a

bottle of sweetened liquid

Front teeth rapidly develop caries

Oral Health and ChildrenTeeth decay is the 1 chronic disease in childhood

3 Tips To Prevent Tooth Decay1 Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk2 Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3 Brush teeth after breakfast and before bed

Schedule regular dental visits

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Learning Objectives

Discuss the lifelong synergy between nutrition and oral health status in health and disease

Outline the role of nutrition in the development and integrity of the oral cavity and the progression of oral disease

Describe practical strategies dietitians can use to integrate oral health information with lifestylenutrition counseling

NUTRI-BITESreg

Webinar Series

6

Nutrition and Oral HealthWhat Dietitians should know

Wahida Karmally DrPH RDCDECLSFNLAAssociate Research Scientist

Lecturer in DentistryColumbia University

We are going to find ourselves at the leading edge of preventive

medicine

Reeves Juliette Br Dent J 2013 Dec 6215(11)589-91 doi 101038sjbdj20131184

bull Nutrition is an integral component of oral health

bull Oral infectious diseases as well as acute chronic and systemic diseases with oral manifestations impact an individuals functional ability to eat and their nutrition status

bull Nutrition and diet can affect the development and integrity of the oral cavity and progression of oral diseases

Academy of Nutrition and Dieteticss Position Paper Oral Health and Nutrition - 2013rdquo

Journal of the Academy of Nutrition and Dietetics (2013) 113693-701

Diet and Nutrition are major multifactorial environmental factors in the etiology and pathogenesis of craniofacial diseases and disorders

Surgeon Generalrsquos Report on ldquoOral Health in Americardquo2000

A National Call to Action to Promote Oral Health

The goals of the Call to Action are to

bull Promote oral healthbull Improve quality of life andbull Eliminate oral health disparities

CDC Report httpwwwcdcgovOralHealthpublicationsfactsheetsdental_carieshtm

Diet and nutrition play a key role in

mdash Tooth developmentmdash Gingival and oral tissue integritymdash Bone strengthmdash Prevention and management of diseases of the

oral cavity

Nutritional Deficiencies and Oral Problems

bull Stomatitis Niacin folic acid ampvitamin B12bull Glossitis Niacin folic acid B6 and B12bull Xerostomia Vitamins A and B12bull Cheilosis Iron B vitaminsbull Gingival bleeding Vitamins C and Kbull Glossodynia B vitamins Zinc IronExcessive intakes of vitamin A intake can impact soft

and hard tissuesVitamin A toxicity can impair oral mucosal

epithelium development

Childrens Oral Health

Although dental caries (tooth decay) is largely preventable it remains the most common chronic disease of children aged 6 to 11 years (25) and

adolescents aged 12 to 19 years (59)

Tooth decay is four times more common than asthma among adolescents aged 14 to 17 years (15)

DENTAL CARIES

Infectious disease of teeth in which organic acid metabolites lead to gradual demineralization of

enamel proteolytic destruction of tooth structure

Any tooth surface can be affected

Decay Process

bull Plaque formation sticky mix of microorganisms protein polysaccharides

bull Bacteria metabolizing fermentable carbohydrate produce acid

bull Acid production oral pHlt55 allows tooth demineralization

bull Saliva function rinses away food neutralizes acid promotes remineralization

Dental caries----

Streptococcus mutansmdashmost common bacteria involved

Factors Affecting Food Cariogenicity

bull Frequency of consumption of fermentable carbohydrates

bull Food form liquid solid slowly dissolving

bull Sequence of eating foods

bull Combination of foods

bull Nutrient composition of foods and beverages

Cariostatic Foods

Foods that do not contribute to decay-they are not metabolized by microorganisms in plaque and do not subsequently cause a drop in salivary pH tolt55 within 30 minutes

Includes protein foods eggs fish meat and poultry most vegetables fats sugarless gums

Anticariogenic Foods

Prevent plaque from recognizing an acidogenic food when it is eaten first

May increase salivation or have antimicrobial activity

Includes xylitol (sweetener in sugarless gum) and cheeses

Gummy vitamins rotten teeth

Control Your Sweet Tooth

Avoid sugars and carbohydrates that break down quickly to sugars

ndash Candyndash Cookiesndash Cakendash Juicesndash Sodandash Sweetened coffee beveragesndash Chipsndash Pretzels

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Early childhood caries related to feeding and eating behaviors

Also called ldquobaby bottle tooth decayrdquoNursing bottle cariesmdashputting baby to bed with a

bottle of sweetened liquid

Front teeth rapidly develop caries

Oral Health and ChildrenTeeth decay is the 1 chronic disease in childhood

3 Tips To Prevent Tooth Decay1 Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk2 Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3 Brush teeth after breakfast and before bed

Schedule regular dental visits

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Nutrition and Oral HealthWhat Dietitians should know

Wahida Karmally DrPH RDCDECLSFNLAAssociate Research Scientist

Lecturer in DentistryColumbia University

We are going to find ourselves at the leading edge of preventive

medicine

Reeves Juliette Br Dent J 2013 Dec 6215(11)589-91 doi 101038sjbdj20131184

bull Nutrition is an integral component of oral health

bull Oral infectious diseases as well as acute chronic and systemic diseases with oral manifestations impact an individuals functional ability to eat and their nutrition status

bull Nutrition and diet can affect the development and integrity of the oral cavity and progression of oral diseases

Academy of Nutrition and Dieteticss Position Paper Oral Health and Nutrition - 2013rdquo

Journal of the Academy of Nutrition and Dietetics (2013) 113693-701

Diet and Nutrition are major multifactorial environmental factors in the etiology and pathogenesis of craniofacial diseases and disorders

Surgeon Generalrsquos Report on ldquoOral Health in Americardquo2000

A National Call to Action to Promote Oral Health

The goals of the Call to Action are to

bull Promote oral healthbull Improve quality of life andbull Eliminate oral health disparities

CDC Report httpwwwcdcgovOralHealthpublicationsfactsheetsdental_carieshtm

Diet and nutrition play a key role in

mdash Tooth developmentmdash Gingival and oral tissue integritymdash Bone strengthmdash Prevention and management of diseases of the

oral cavity

Nutritional Deficiencies and Oral Problems

bull Stomatitis Niacin folic acid ampvitamin B12bull Glossitis Niacin folic acid B6 and B12bull Xerostomia Vitamins A and B12bull Cheilosis Iron B vitaminsbull Gingival bleeding Vitamins C and Kbull Glossodynia B vitamins Zinc IronExcessive intakes of vitamin A intake can impact soft

and hard tissuesVitamin A toxicity can impair oral mucosal

epithelium development

Childrens Oral Health

Although dental caries (tooth decay) is largely preventable it remains the most common chronic disease of children aged 6 to 11 years (25) and

adolescents aged 12 to 19 years (59)

Tooth decay is four times more common than asthma among adolescents aged 14 to 17 years (15)

DENTAL CARIES

Infectious disease of teeth in which organic acid metabolites lead to gradual demineralization of

enamel proteolytic destruction of tooth structure

Any tooth surface can be affected

Decay Process

bull Plaque formation sticky mix of microorganisms protein polysaccharides

bull Bacteria metabolizing fermentable carbohydrate produce acid

bull Acid production oral pHlt55 allows tooth demineralization

bull Saliva function rinses away food neutralizes acid promotes remineralization

Dental caries----

Streptococcus mutansmdashmost common bacteria involved

Factors Affecting Food Cariogenicity

bull Frequency of consumption of fermentable carbohydrates

bull Food form liquid solid slowly dissolving

bull Sequence of eating foods

bull Combination of foods

bull Nutrient composition of foods and beverages

Cariostatic Foods

Foods that do not contribute to decay-they are not metabolized by microorganisms in plaque and do not subsequently cause a drop in salivary pH tolt55 within 30 minutes

Includes protein foods eggs fish meat and poultry most vegetables fats sugarless gums

Anticariogenic Foods

Prevent plaque from recognizing an acidogenic food when it is eaten first

May increase salivation or have antimicrobial activity

Includes xylitol (sweetener in sugarless gum) and cheeses

Gummy vitamins rotten teeth

Control Your Sweet Tooth

Avoid sugars and carbohydrates that break down quickly to sugars

ndash Candyndash Cookiesndash Cakendash Juicesndash Sodandash Sweetened coffee beveragesndash Chipsndash Pretzels

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Early childhood caries related to feeding and eating behaviors

Also called ldquobaby bottle tooth decayrdquoNursing bottle cariesmdashputting baby to bed with a

bottle of sweetened liquid

Front teeth rapidly develop caries

Oral Health and ChildrenTeeth decay is the 1 chronic disease in childhood

3 Tips To Prevent Tooth Decay1 Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk2 Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3 Brush teeth after breakfast and before bed

Schedule regular dental visits

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

We are going to find ourselves at the leading edge of preventive

medicine

Reeves Juliette Br Dent J 2013 Dec 6215(11)589-91 doi 101038sjbdj20131184

bull Nutrition is an integral component of oral health

bull Oral infectious diseases as well as acute chronic and systemic diseases with oral manifestations impact an individuals functional ability to eat and their nutrition status

bull Nutrition and diet can affect the development and integrity of the oral cavity and progression of oral diseases

Academy of Nutrition and Dieteticss Position Paper Oral Health and Nutrition - 2013rdquo

Journal of the Academy of Nutrition and Dietetics (2013) 113693-701

Diet and Nutrition are major multifactorial environmental factors in the etiology and pathogenesis of craniofacial diseases and disorders

Surgeon Generalrsquos Report on ldquoOral Health in Americardquo2000

A National Call to Action to Promote Oral Health

The goals of the Call to Action are to

bull Promote oral healthbull Improve quality of life andbull Eliminate oral health disparities

CDC Report httpwwwcdcgovOralHealthpublicationsfactsheetsdental_carieshtm

Diet and nutrition play a key role in

mdash Tooth developmentmdash Gingival and oral tissue integritymdash Bone strengthmdash Prevention and management of diseases of the

oral cavity

Nutritional Deficiencies and Oral Problems

bull Stomatitis Niacin folic acid ampvitamin B12bull Glossitis Niacin folic acid B6 and B12bull Xerostomia Vitamins A and B12bull Cheilosis Iron B vitaminsbull Gingival bleeding Vitamins C and Kbull Glossodynia B vitamins Zinc IronExcessive intakes of vitamin A intake can impact soft

and hard tissuesVitamin A toxicity can impair oral mucosal

epithelium development

Childrens Oral Health

Although dental caries (tooth decay) is largely preventable it remains the most common chronic disease of children aged 6 to 11 years (25) and

adolescents aged 12 to 19 years (59)

Tooth decay is four times more common than asthma among adolescents aged 14 to 17 years (15)

DENTAL CARIES

Infectious disease of teeth in which organic acid metabolites lead to gradual demineralization of

enamel proteolytic destruction of tooth structure

Any tooth surface can be affected

Decay Process

bull Plaque formation sticky mix of microorganisms protein polysaccharides

bull Bacteria metabolizing fermentable carbohydrate produce acid

bull Acid production oral pHlt55 allows tooth demineralization

bull Saliva function rinses away food neutralizes acid promotes remineralization

Dental caries----

Streptococcus mutansmdashmost common bacteria involved

Factors Affecting Food Cariogenicity

bull Frequency of consumption of fermentable carbohydrates

bull Food form liquid solid slowly dissolving

bull Sequence of eating foods

bull Combination of foods

bull Nutrient composition of foods and beverages

Cariostatic Foods

Foods that do not contribute to decay-they are not metabolized by microorganisms in plaque and do not subsequently cause a drop in salivary pH tolt55 within 30 minutes

Includes protein foods eggs fish meat and poultry most vegetables fats sugarless gums

Anticariogenic Foods

Prevent plaque from recognizing an acidogenic food when it is eaten first

May increase salivation or have antimicrobial activity

Includes xylitol (sweetener in sugarless gum) and cheeses

Gummy vitamins rotten teeth

Control Your Sweet Tooth

Avoid sugars and carbohydrates that break down quickly to sugars

ndash Candyndash Cookiesndash Cakendash Juicesndash Sodandash Sweetened coffee beveragesndash Chipsndash Pretzels

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Early childhood caries related to feeding and eating behaviors

Also called ldquobaby bottle tooth decayrdquoNursing bottle cariesmdashputting baby to bed with a

bottle of sweetened liquid

Front teeth rapidly develop caries

Oral Health and ChildrenTeeth decay is the 1 chronic disease in childhood

3 Tips To Prevent Tooth Decay1 Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk2 Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3 Brush teeth after breakfast and before bed

Schedule regular dental visits

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

bull Nutrition is an integral component of oral health

bull Oral infectious diseases as well as acute chronic and systemic diseases with oral manifestations impact an individuals functional ability to eat and their nutrition status

bull Nutrition and diet can affect the development and integrity of the oral cavity and progression of oral diseases

Academy of Nutrition and Dieteticss Position Paper Oral Health and Nutrition - 2013rdquo

Journal of the Academy of Nutrition and Dietetics (2013) 113693-701

Diet and Nutrition are major multifactorial environmental factors in the etiology and pathogenesis of craniofacial diseases and disorders

Surgeon Generalrsquos Report on ldquoOral Health in Americardquo2000

A National Call to Action to Promote Oral Health

The goals of the Call to Action are to

bull Promote oral healthbull Improve quality of life andbull Eliminate oral health disparities

CDC Report httpwwwcdcgovOralHealthpublicationsfactsheetsdental_carieshtm

Diet and nutrition play a key role in

mdash Tooth developmentmdash Gingival and oral tissue integritymdash Bone strengthmdash Prevention and management of diseases of the

oral cavity

Nutritional Deficiencies and Oral Problems

bull Stomatitis Niacin folic acid ampvitamin B12bull Glossitis Niacin folic acid B6 and B12bull Xerostomia Vitamins A and B12bull Cheilosis Iron B vitaminsbull Gingival bleeding Vitamins C and Kbull Glossodynia B vitamins Zinc IronExcessive intakes of vitamin A intake can impact soft

and hard tissuesVitamin A toxicity can impair oral mucosal

epithelium development

Childrens Oral Health

Although dental caries (tooth decay) is largely preventable it remains the most common chronic disease of children aged 6 to 11 years (25) and

adolescents aged 12 to 19 years (59)

Tooth decay is four times more common than asthma among adolescents aged 14 to 17 years (15)

DENTAL CARIES

Infectious disease of teeth in which organic acid metabolites lead to gradual demineralization of

enamel proteolytic destruction of tooth structure

Any tooth surface can be affected

Decay Process

bull Plaque formation sticky mix of microorganisms protein polysaccharides

bull Bacteria metabolizing fermentable carbohydrate produce acid

bull Acid production oral pHlt55 allows tooth demineralization

bull Saliva function rinses away food neutralizes acid promotes remineralization

Dental caries----

Streptococcus mutansmdashmost common bacteria involved

Factors Affecting Food Cariogenicity

bull Frequency of consumption of fermentable carbohydrates

bull Food form liquid solid slowly dissolving

bull Sequence of eating foods

bull Combination of foods

bull Nutrient composition of foods and beverages

Cariostatic Foods

Foods that do not contribute to decay-they are not metabolized by microorganisms in plaque and do not subsequently cause a drop in salivary pH tolt55 within 30 minutes

Includes protein foods eggs fish meat and poultry most vegetables fats sugarless gums

Anticariogenic Foods

Prevent plaque from recognizing an acidogenic food when it is eaten first

May increase salivation or have antimicrobial activity

Includes xylitol (sweetener in sugarless gum) and cheeses

Gummy vitamins rotten teeth

Control Your Sweet Tooth

Avoid sugars and carbohydrates that break down quickly to sugars

ndash Candyndash Cookiesndash Cakendash Juicesndash Sodandash Sweetened coffee beveragesndash Chipsndash Pretzels

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Early childhood caries related to feeding and eating behaviors

Also called ldquobaby bottle tooth decayrdquoNursing bottle cariesmdashputting baby to bed with a

bottle of sweetened liquid

Front teeth rapidly develop caries

Oral Health and ChildrenTeeth decay is the 1 chronic disease in childhood

3 Tips To Prevent Tooth Decay1 Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk2 Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3 Brush teeth after breakfast and before bed

Schedule regular dental visits

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Diet and Nutrition are major multifactorial environmental factors in the etiology and pathogenesis of craniofacial diseases and disorders

Surgeon Generalrsquos Report on ldquoOral Health in Americardquo2000

A National Call to Action to Promote Oral Health

The goals of the Call to Action are to

bull Promote oral healthbull Improve quality of life andbull Eliminate oral health disparities

CDC Report httpwwwcdcgovOralHealthpublicationsfactsheetsdental_carieshtm

Diet and nutrition play a key role in

mdash Tooth developmentmdash Gingival and oral tissue integritymdash Bone strengthmdash Prevention and management of diseases of the

oral cavity

Nutritional Deficiencies and Oral Problems

bull Stomatitis Niacin folic acid ampvitamin B12bull Glossitis Niacin folic acid B6 and B12bull Xerostomia Vitamins A and B12bull Cheilosis Iron B vitaminsbull Gingival bleeding Vitamins C and Kbull Glossodynia B vitamins Zinc IronExcessive intakes of vitamin A intake can impact soft

and hard tissuesVitamin A toxicity can impair oral mucosal

epithelium development

Childrens Oral Health

Although dental caries (tooth decay) is largely preventable it remains the most common chronic disease of children aged 6 to 11 years (25) and

adolescents aged 12 to 19 years (59)

Tooth decay is four times more common than asthma among adolescents aged 14 to 17 years (15)

DENTAL CARIES

Infectious disease of teeth in which organic acid metabolites lead to gradual demineralization of

enamel proteolytic destruction of tooth structure

Any tooth surface can be affected

Decay Process

bull Plaque formation sticky mix of microorganisms protein polysaccharides

bull Bacteria metabolizing fermentable carbohydrate produce acid

bull Acid production oral pHlt55 allows tooth demineralization

bull Saliva function rinses away food neutralizes acid promotes remineralization

Dental caries----

Streptococcus mutansmdashmost common bacteria involved

Factors Affecting Food Cariogenicity

bull Frequency of consumption of fermentable carbohydrates

bull Food form liquid solid slowly dissolving

bull Sequence of eating foods

bull Combination of foods

bull Nutrient composition of foods and beverages

Cariostatic Foods

Foods that do not contribute to decay-they are not metabolized by microorganisms in plaque and do not subsequently cause a drop in salivary pH tolt55 within 30 minutes

Includes protein foods eggs fish meat and poultry most vegetables fats sugarless gums

Anticariogenic Foods

Prevent plaque from recognizing an acidogenic food when it is eaten first

May increase salivation or have antimicrobial activity

Includes xylitol (sweetener in sugarless gum) and cheeses

Gummy vitamins rotten teeth

Control Your Sweet Tooth

Avoid sugars and carbohydrates that break down quickly to sugars

ndash Candyndash Cookiesndash Cakendash Juicesndash Sodandash Sweetened coffee beveragesndash Chipsndash Pretzels

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Early childhood caries related to feeding and eating behaviors

Also called ldquobaby bottle tooth decayrdquoNursing bottle cariesmdashputting baby to bed with a

bottle of sweetened liquid

Front teeth rapidly develop caries

Oral Health and ChildrenTeeth decay is the 1 chronic disease in childhood

3 Tips To Prevent Tooth Decay1 Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk2 Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3 Brush teeth after breakfast and before bed

Schedule regular dental visits

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

A National Call to Action to Promote Oral Health

The goals of the Call to Action are to

bull Promote oral healthbull Improve quality of life andbull Eliminate oral health disparities

CDC Report httpwwwcdcgovOralHealthpublicationsfactsheetsdental_carieshtm

Diet and nutrition play a key role in

mdash Tooth developmentmdash Gingival and oral tissue integritymdash Bone strengthmdash Prevention and management of diseases of the

oral cavity

Nutritional Deficiencies and Oral Problems

bull Stomatitis Niacin folic acid ampvitamin B12bull Glossitis Niacin folic acid B6 and B12bull Xerostomia Vitamins A and B12bull Cheilosis Iron B vitaminsbull Gingival bleeding Vitamins C and Kbull Glossodynia B vitamins Zinc IronExcessive intakes of vitamin A intake can impact soft

and hard tissuesVitamin A toxicity can impair oral mucosal

epithelium development

Childrens Oral Health

Although dental caries (tooth decay) is largely preventable it remains the most common chronic disease of children aged 6 to 11 years (25) and

adolescents aged 12 to 19 years (59)

Tooth decay is four times more common than asthma among adolescents aged 14 to 17 years (15)

DENTAL CARIES

Infectious disease of teeth in which organic acid metabolites lead to gradual demineralization of

enamel proteolytic destruction of tooth structure

Any tooth surface can be affected

Decay Process

bull Plaque formation sticky mix of microorganisms protein polysaccharides

bull Bacteria metabolizing fermentable carbohydrate produce acid

bull Acid production oral pHlt55 allows tooth demineralization

bull Saliva function rinses away food neutralizes acid promotes remineralization

Dental caries----

Streptococcus mutansmdashmost common bacteria involved

Factors Affecting Food Cariogenicity

bull Frequency of consumption of fermentable carbohydrates

bull Food form liquid solid slowly dissolving

bull Sequence of eating foods

bull Combination of foods

bull Nutrient composition of foods and beverages

Cariostatic Foods

Foods that do not contribute to decay-they are not metabolized by microorganisms in plaque and do not subsequently cause a drop in salivary pH tolt55 within 30 minutes

Includes protein foods eggs fish meat and poultry most vegetables fats sugarless gums

Anticariogenic Foods

Prevent plaque from recognizing an acidogenic food when it is eaten first

May increase salivation or have antimicrobial activity

Includes xylitol (sweetener in sugarless gum) and cheeses

Gummy vitamins rotten teeth

Control Your Sweet Tooth

Avoid sugars and carbohydrates that break down quickly to sugars

ndash Candyndash Cookiesndash Cakendash Juicesndash Sodandash Sweetened coffee beveragesndash Chipsndash Pretzels

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Early childhood caries related to feeding and eating behaviors

Also called ldquobaby bottle tooth decayrdquoNursing bottle cariesmdashputting baby to bed with a

bottle of sweetened liquid

Front teeth rapidly develop caries

Oral Health and ChildrenTeeth decay is the 1 chronic disease in childhood

3 Tips To Prevent Tooth Decay1 Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk2 Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3 Brush teeth after breakfast and before bed

Schedule regular dental visits

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Diet and nutrition play a key role in

mdash Tooth developmentmdash Gingival and oral tissue integritymdash Bone strengthmdash Prevention and management of diseases of the

oral cavity

Nutritional Deficiencies and Oral Problems

bull Stomatitis Niacin folic acid ampvitamin B12bull Glossitis Niacin folic acid B6 and B12bull Xerostomia Vitamins A and B12bull Cheilosis Iron B vitaminsbull Gingival bleeding Vitamins C and Kbull Glossodynia B vitamins Zinc IronExcessive intakes of vitamin A intake can impact soft

and hard tissuesVitamin A toxicity can impair oral mucosal

epithelium development

Childrens Oral Health

Although dental caries (tooth decay) is largely preventable it remains the most common chronic disease of children aged 6 to 11 years (25) and

adolescents aged 12 to 19 years (59)

Tooth decay is four times more common than asthma among adolescents aged 14 to 17 years (15)

DENTAL CARIES

Infectious disease of teeth in which organic acid metabolites lead to gradual demineralization of

enamel proteolytic destruction of tooth structure

Any tooth surface can be affected

Decay Process

bull Plaque formation sticky mix of microorganisms protein polysaccharides

bull Bacteria metabolizing fermentable carbohydrate produce acid

bull Acid production oral pHlt55 allows tooth demineralization

bull Saliva function rinses away food neutralizes acid promotes remineralization

Dental caries----

Streptococcus mutansmdashmost common bacteria involved

Factors Affecting Food Cariogenicity

bull Frequency of consumption of fermentable carbohydrates

bull Food form liquid solid slowly dissolving

bull Sequence of eating foods

bull Combination of foods

bull Nutrient composition of foods and beverages

Cariostatic Foods

Foods that do not contribute to decay-they are not metabolized by microorganisms in plaque and do not subsequently cause a drop in salivary pH tolt55 within 30 minutes

Includes protein foods eggs fish meat and poultry most vegetables fats sugarless gums

Anticariogenic Foods

Prevent plaque from recognizing an acidogenic food when it is eaten first

May increase salivation or have antimicrobial activity

Includes xylitol (sweetener in sugarless gum) and cheeses

Gummy vitamins rotten teeth

Control Your Sweet Tooth

Avoid sugars and carbohydrates that break down quickly to sugars

ndash Candyndash Cookiesndash Cakendash Juicesndash Sodandash Sweetened coffee beveragesndash Chipsndash Pretzels

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Early childhood caries related to feeding and eating behaviors

Also called ldquobaby bottle tooth decayrdquoNursing bottle cariesmdashputting baby to bed with a

bottle of sweetened liquid

Front teeth rapidly develop caries

Oral Health and ChildrenTeeth decay is the 1 chronic disease in childhood

3 Tips To Prevent Tooth Decay1 Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk2 Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3 Brush teeth after breakfast and before bed

Schedule regular dental visits

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Nutritional Deficiencies and Oral Problems

bull Stomatitis Niacin folic acid ampvitamin B12bull Glossitis Niacin folic acid B6 and B12bull Xerostomia Vitamins A and B12bull Cheilosis Iron B vitaminsbull Gingival bleeding Vitamins C and Kbull Glossodynia B vitamins Zinc IronExcessive intakes of vitamin A intake can impact soft

and hard tissuesVitamin A toxicity can impair oral mucosal

epithelium development

Childrens Oral Health

Although dental caries (tooth decay) is largely preventable it remains the most common chronic disease of children aged 6 to 11 years (25) and

adolescents aged 12 to 19 years (59)

Tooth decay is four times more common than asthma among adolescents aged 14 to 17 years (15)

DENTAL CARIES

Infectious disease of teeth in which organic acid metabolites lead to gradual demineralization of

enamel proteolytic destruction of tooth structure

Any tooth surface can be affected

Decay Process

bull Plaque formation sticky mix of microorganisms protein polysaccharides

bull Bacteria metabolizing fermentable carbohydrate produce acid

bull Acid production oral pHlt55 allows tooth demineralization

bull Saliva function rinses away food neutralizes acid promotes remineralization

Dental caries----

Streptococcus mutansmdashmost common bacteria involved

Factors Affecting Food Cariogenicity

bull Frequency of consumption of fermentable carbohydrates

bull Food form liquid solid slowly dissolving

bull Sequence of eating foods

bull Combination of foods

bull Nutrient composition of foods and beverages

Cariostatic Foods

Foods that do not contribute to decay-they are not metabolized by microorganisms in plaque and do not subsequently cause a drop in salivary pH tolt55 within 30 minutes

Includes protein foods eggs fish meat and poultry most vegetables fats sugarless gums

Anticariogenic Foods

Prevent plaque from recognizing an acidogenic food when it is eaten first

May increase salivation or have antimicrobial activity

Includes xylitol (sweetener in sugarless gum) and cheeses

Gummy vitamins rotten teeth

Control Your Sweet Tooth

Avoid sugars and carbohydrates that break down quickly to sugars

ndash Candyndash Cookiesndash Cakendash Juicesndash Sodandash Sweetened coffee beveragesndash Chipsndash Pretzels

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Early childhood caries related to feeding and eating behaviors

Also called ldquobaby bottle tooth decayrdquoNursing bottle cariesmdashputting baby to bed with a

bottle of sweetened liquid

Front teeth rapidly develop caries

Oral Health and ChildrenTeeth decay is the 1 chronic disease in childhood

3 Tips To Prevent Tooth Decay1 Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk2 Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3 Brush teeth after breakfast and before bed

Schedule regular dental visits

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Childrens Oral Health

Although dental caries (tooth decay) is largely preventable it remains the most common chronic disease of children aged 6 to 11 years (25) and

adolescents aged 12 to 19 years (59)

Tooth decay is four times more common than asthma among adolescents aged 14 to 17 years (15)

DENTAL CARIES

Infectious disease of teeth in which organic acid metabolites lead to gradual demineralization of

enamel proteolytic destruction of tooth structure

Any tooth surface can be affected

Decay Process

bull Plaque formation sticky mix of microorganisms protein polysaccharides

bull Bacteria metabolizing fermentable carbohydrate produce acid

bull Acid production oral pHlt55 allows tooth demineralization

bull Saliva function rinses away food neutralizes acid promotes remineralization

Dental caries----

Streptococcus mutansmdashmost common bacteria involved

Factors Affecting Food Cariogenicity

bull Frequency of consumption of fermentable carbohydrates

bull Food form liquid solid slowly dissolving

bull Sequence of eating foods

bull Combination of foods

bull Nutrient composition of foods and beverages

Cariostatic Foods

Foods that do not contribute to decay-they are not metabolized by microorganisms in plaque and do not subsequently cause a drop in salivary pH tolt55 within 30 minutes

Includes protein foods eggs fish meat and poultry most vegetables fats sugarless gums

Anticariogenic Foods

Prevent plaque from recognizing an acidogenic food when it is eaten first

May increase salivation or have antimicrobial activity

Includes xylitol (sweetener in sugarless gum) and cheeses

Gummy vitamins rotten teeth

Control Your Sweet Tooth

Avoid sugars and carbohydrates that break down quickly to sugars

ndash Candyndash Cookiesndash Cakendash Juicesndash Sodandash Sweetened coffee beveragesndash Chipsndash Pretzels

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Early childhood caries related to feeding and eating behaviors

Also called ldquobaby bottle tooth decayrdquoNursing bottle cariesmdashputting baby to bed with a

bottle of sweetened liquid

Front teeth rapidly develop caries

Oral Health and ChildrenTeeth decay is the 1 chronic disease in childhood

3 Tips To Prevent Tooth Decay1 Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk2 Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3 Brush teeth after breakfast and before bed

Schedule regular dental visits

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

DENTAL CARIES

Infectious disease of teeth in which organic acid metabolites lead to gradual demineralization of

enamel proteolytic destruction of tooth structure

Any tooth surface can be affected

Decay Process

bull Plaque formation sticky mix of microorganisms protein polysaccharides

bull Bacteria metabolizing fermentable carbohydrate produce acid

bull Acid production oral pHlt55 allows tooth demineralization

bull Saliva function rinses away food neutralizes acid promotes remineralization

Dental caries----

Streptococcus mutansmdashmost common bacteria involved

Factors Affecting Food Cariogenicity

bull Frequency of consumption of fermentable carbohydrates

bull Food form liquid solid slowly dissolving

bull Sequence of eating foods

bull Combination of foods

bull Nutrient composition of foods and beverages

Cariostatic Foods

Foods that do not contribute to decay-they are not metabolized by microorganisms in plaque and do not subsequently cause a drop in salivary pH tolt55 within 30 minutes

Includes protein foods eggs fish meat and poultry most vegetables fats sugarless gums

Anticariogenic Foods

Prevent plaque from recognizing an acidogenic food when it is eaten first

May increase salivation or have antimicrobial activity

Includes xylitol (sweetener in sugarless gum) and cheeses

Gummy vitamins rotten teeth

Control Your Sweet Tooth

Avoid sugars and carbohydrates that break down quickly to sugars

ndash Candyndash Cookiesndash Cakendash Juicesndash Sodandash Sweetened coffee beveragesndash Chipsndash Pretzels

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Early childhood caries related to feeding and eating behaviors

Also called ldquobaby bottle tooth decayrdquoNursing bottle cariesmdashputting baby to bed with a

bottle of sweetened liquid

Front teeth rapidly develop caries

Oral Health and ChildrenTeeth decay is the 1 chronic disease in childhood

3 Tips To Prevent Tooth Decay1 Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk2 Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3 Brush teeth after breakfast and before bed

Schedule regular dental visits

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Decay Process

bull Plaque formation sticky mix of microorganisms protein polysaccharides

bull Bacteria metabolizing fermentable carbohydrate produce acid

bull Acid production oral pHlt55 allows tooth demineralization

bull Saliva function rinses away food neutralizes acid promotes remineralization

Dental caries----

Streptococcus mutansmdashmost common bacteria involved

Factors Affecting Food Cariogenicity

bull Frequency of consumption of fermentable carbohydrates

bull Food form liquid solid slowly dissolving

bull Sequence of eating foods

bull Combination of foods

bull Nutrient composition of foods and beverages

Cariostatic Foods

Foods that do not contribute to decay-they are not metabolized by microorganisms in plaque and do not subsequently cause a drop in salivary pH tolt55 within 30 minutes

Includes protein foods eggs fish meat and poultry most vegetables fats sugarless gums

Anticariogenic Foods

Prevent plaque from recognizing an acidogenic food when it is eaten first

May increase salivation or have antimicrobial activity

Includes xylitol (sweetener in sugarless gum) and cheeses

Gummy vitamins rotten teeth

Control Your Sweet Tooth

Avoid sugars and carbohydrates that break down quickly to sugars

ndash Candyndash Cookiesndash Cakendash Juicesndash Sodandash Sweetened coffee beveragesndash Chipsndash Pretzels

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Early childhood caries related to feeding and eating behaviors

Also called ldquobaby bottle tooth decayrdquoNursing bottle cariesmdashputting baby to bed with a

bottle of sweetened liquid

Front teeth rapidly develop caries

Oral Health and ChildrenTeeth decay is the 1 chronic disease in childhood

3 Tips To Prevent Tooth Decay1 Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk2 Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3 Brush teeth after breakfast and before bed

Schedule regular dental visits

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Dental caries----

Streptococcus mutansmdashmost common bacteria involved

Factors Affecting Food Cariogenicity

bull Frequency of consumption of fermentable carbohydrates

bull Food form liquid solid slowly dissolving

bull Sequence of eating foods

bull Combination of foods

bull Nutrient composition of foods and beverages

Cariostatic Foods

Foods that do not contribute to decay-they are not metabolized by microorganisms in plaque and do not subsequently cause a drop in salivary pH tolt55 within 30 minutes

Includes protein foods eggs fish meat and poultry most vegetables fats sugarless gums

Anticariogenic Foods

Prevent plaque from recognizing an acidogenic food when it is eaten first

May increase salivation or have antimicrobial activity

Includes xylitol (sweetener in sugarless gum) and cheeses

Gummy vitamins rotten teeth

Control Your Sweet Tooth

Avoid sugars and carbohydrates that break down quickly to sugars

ndash Candyndash Cookiesndash Cakendash Juicesndash Sodandash Sweetened coffee beveragesndash Chipsndash Pretzels

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Early childhood caries related to feeding and eating behaviors

Also called ldquobaby bottle tooth decayrdquoNursing bottle cariesmdashputting baby to bed with a

bottle of sweetened liquid

Front teeth rapidly develop caries

Oral Health and ChildrenTeeth decay is the 1 chronic disease in childhood

3 Tips To Prevent Tooth Decay1 Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk2 Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3 Brush teeth after breakfast and before bed

Schedule regular dental visits

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Factors Affecting Food Cariogenicity

bull Frequency of consumption of fermentable carbohydrates

bull Food form liquid solid slowly dissolving

bull Sequence of eating foods

bull Combination of foods

bull Nutrient composition of foods and beverages

Cariostatic Foods

Foods that do not contribute to decay-they are not metabolized by microorganisms in plaque and do not subsequently cause a drop in salivary pH tolt55 within 30 minutes

Includes protein foods eggs fish meat and poultry most vegetables fats sugarless gums

Anticariogenic Foods

Prevent plaque from recognizing an acidogenic food when it is eaten first

May increase salivation or have antimicrobial activity

Includes xylitol (sweetener in sugarless gum) and cheeses

Gummy vitamins rotten teeth

Control Your Sweet Tooth

Avoid sugars and carbohydrates that break down quickly to sugars

ndash Candyndash Cookiesndash Cakendash Juicesndash Sodandash Sweetened coffee beveragesndash Chipsndash Pretzels

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Early childhood caries related to feeding and eating behaviors

Also called ldquobaby bottle tooth decayrdquoNursing bottle cariesmdashputting baby to bed with a

bottle of sweetened liquid

Front teeth rapidly develop caries

Oral Health and ChildrenTeeth decay is the 1 chronic disease in childhood

3 Tips To Prevent Tooth Decay1 Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk2 Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3 Brush teeth after breakfast and before bed

Schedule regular dental visits

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Cariostatic Foods

Foods that do not contribute to decay-they are not metabolized by microorganisms in plaque and do not subsequently cause a drop in salivary pH tolt55 within 30 minutes

Includes protein foods eggs fish meat and poultry most vegetables fats sugarless gums

Anticariogenic Foods

Prevent plaque from recognizing an acidogenic food when it is eaten first

May increase salivation or have antimicrobial activity

Includes xylitol (sweetener in sugarless gum) and cheeses

Gummy vitamins rotten teeth

Control Your Sweet Tooth

Avoid sugars and carbohydrates that break down quickly to sugars

ndash Candyndash Cookiesndash Cakendash Juicesndash Sodandash Sweetened coffee beveragesndash Chipsndash Pretzels

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Early childhood caries related to feeding and eating behaviors

Also called ldquobaby bottle tooth decayrdquoNursing bottle cariesmdashputting baby to bed with a

bottle of sweetened liquid

Front teeth rapidly develop caries

Oral Health and ChildrenTeeth decay is the 1 chronic disease in childhood

3 Tips To Prevent Tooth Decay1 Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk2 Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3 Brush teeth after breakfast and before bed

Schedule regular dental visits

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Anticariogenic Foods

Prevent plaque from recognizing an acidogenic food when it is eaten first

May increase salivation or have antimicrobial activity

Includes xylitol (sweetener in sugarless gum) and cheeses

Gummy vitamins rotten teeth

Control Your Sweet Tooth

Avoid sugars and carbohydrates that break down quickly to sugars

ndash Candyndash Cookiesndash Cakendash Juicesndash Sodandash Sweetened coffee beveragesndash Chipsndash Pretzels

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Early childhood caries related to feeding and eating behaviors

Also called ldquobaby bottle tooth decayrdquoNursing bottle cariesmdashputting baby to bed with a

bottle of sweetened liquid

Front teeth rapidly develop caries

Oral Health and ChildrenTeeth decay is the 1 chronic disease in childhood

3 Tips To Prevent Tooth Decay1 Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk2 Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3 Brush teeth after breakfast and before bed

Schedule regular dental visits

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Gummy vitamins rotten teeth

Control Your Sweet Tooth

Avoid sugars and carbohydrates that break down quickly to sugars

ndash Candyndash Cookiesndash Cakendash Juicesndash Sodandash Sweetened coffee beveragesndash Chipsndash Pretzels

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Early childhood caries related to feeding and eating behaviors

Also called ldquobaby bottle tooth decayrdquoNursing bottle cariesmdashputting baby to bed with a

bottle of sweetened liquid

Front teeth rapidly develop caries

Oral Health and ChildrenTeeth decay is the 1 chronic disease in childhood

3 Tips To Prevent Tooth Decay1 Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk2 Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3 Brush teeth after breakfast and before bed

Schedule regular dental visits

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Control Your Sweet Tooth

Avoid sugars and carbohydrates that break down quickly to sugars

ndash Candyndash Cookiesndash Cakendash Juicesndash Sodandash Sweetened coffee beveragesndash Chipsndash Pretzels

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Early childhood caries related to feeding and eating behaviors

Also called ldquobaby bottle tooth decayrdquoNursing bottle cariesmdashputting baby to bed with a

bottle of sweetened liquid

Front teeth rapidly develop caries

Oral Health and ChildrenTeeth decay is the 1 chronic disease in childhood

3 Tips To Prevent Tooth Decay1 Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk2 Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3 Brush teeth after breakfast and before bed

Schedule regular dental visits

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Early childhood caries related to feeding and eating behaviors

Also called ldquobaby bottle tooth decayrdquoNursing bottle cariesmdashputting baby to bed with a

bottle of sweetened liquid

Front teeth rapidly develop caries

Oral Health and ChildrenTeeth decay is the 1 chronic disease in childhood

3 Tips To Prevent Tooth Decay1 Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk2 Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3 Brush teeth after breakfast and before bed

Schedule regular dental visits

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Oral Health and ChildrenTeeth decay is the 1 chronic disease in childhood

3 Tips To Prevent Tooth Decay1 Provide bottles and sippy cups at mealtimes only - Avoid bottles at bedtime - bacteria feed on the sugars in milk2 Encourage children to drink from a regular cup by 12-15 months of age - prevents liquid from sitting around teeth 3 Brush teeth after breakfast and before bed

Schedule regular dental visits

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub 2013 Dec 9

A systematic review of studies in humans was conducted to update evidence on the association between the amount of sugars intake and dental caries and on the effect of restricting sugars intake to lt 10 and lt 5 energy (E) on caries to inform the updating of World Health Organization guidelines on sugars consumption

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

There is evidence of moderate quality showing that caries is lower when free-sugars intake is lt 10 E

With the lt 5 E cut-off a significant relationship was observed but the evidence was judged to be of very low quality

The findings are relevant to minimizing caries risk throughout the life course

Effect on Caries of Restricting Sugars Intake Systematic Review to Inform WHO Guidelines

Moynihan PJ Kelly SA J Dent Res 2014 Jan93(1)8-18 doi 1011770022034513508954 Epub2013 Dec 9

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Adult Oral Health

Chronic disabling diseases such as jaw joint diseases (TMD) diabetes and osteoporosis affect millions of Americans and compromise oral health and functioning

Temporomandibular disorders TMD

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Tooth Loss and Dentures

bull Tooth lossmdashdenture placementbull Food selections changebull Saliva production decreasesbull Reduced chewing abilitybull Lower calorie and nutrient intake occurs for

manybull Simple nutrition counseling MyPlate etc

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Daily nutritional intakes of energy protein fat ash calcium phosphorus and thiamine were decreased significantly in elderly with partial or full dentures compared with those with no prosthesis or with a fixed prosthesis (P lt 005)

Choi Y Park D Kim Y Relationship between prosthodontic status and nutritional intake in the elderly in Korea National Health and Nutrition Examination Survey (NHANES IV) J Dent Hyg 2013 Dec 19 doi 101111idh12066 [Epub ahead of print]

Tooth Loss and Dentures

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Use least restrictive diet possible individualize mix consistencies if appropriate

Take into consideration oral integrity systemic disease medications prescribed self-selected botanicals and presence of physical disabilities

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Every year more than 400000 cancer patients undergoing chemotherapy suffer from oral problemssuch as painful mouth ulcers impaired taste

and dry mouth

Patients with weakened immune systems such as those infected with HIV and other medical conditions (organ transplants)and who use some medications (eg steroids)

are at higher risk for some oral problems

Adult Oral Health

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Most older Americans take both prescription and over-the-counter drugs

Over 400 commonly used medications can be the cause of a dry mouth

Reduction of the flow of saliva increases the risk for oral disease since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria

About 5 percent of the elderlymdashtake an average of eight drugs each day

Poly Pharmacy and Oral Health

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

MNT for Mouth Pain Dry Mouth

Avoid acidic and spicy foods

Offer soft cold nutrient dense foods such as canned fruit low fat dairy products

For xerostomia try artificial salivas citrus unsweetened beverages sugar- free candies or gums to increase salivary flow

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

The mouth is the telltale of diseases such as

Nutritional anemiasUncontrolled diabetes mellitus

Eating disordersHIV infectionOral Cancer

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Eating disorders and Dental Health

bull Demineralization of tooth enamel

bull Teeth become painful and sensitive

bull Teeth may become severely decayed

bull Xerostomia

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Associations of Self-Reported Periodontal Disease With Metabolic

Syndrome and Number of Self-Reported Chronic Conditions

Lillian Bensley PhD Juliet VanEenwyk PhD Eric M Ossiander PhD Preventing Chronic Disease 8 (3) May 2011

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Periodontal Disease

bull Diabetes - types 1 and 2bull Heart diseasebull Strokebull Pulmonary diseasebull Obesitybull Osteoporosis

Calcium and vitamin D

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal

therapy associates with approximately a 04 reduction in HbA1C at 3 months a clinical

impact equivalent to adding a second drug to a pharmacological regime for diabetes

Diabetes and periodontal diseases consensus report of the Joint EFPAAP Workshop on Periodontitis and Systemic DiseasesChapple IL Genco R Working group 2 of joint EFPAAP workshopJ Clin Periodontol 2013 Apr40 Suppl 14S106-12 doi 101111jcpe12077

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Periodontal disease modulation of the inflammatory cascade by dietary n-3

polyunsaturated fatty acids

Fish oil is a possible modulator of inflammation and may reduce the severity of periodontal diseases Tentative animal and human studies have provided an indication of this effect Further human investigation is needed to establish the protective effects of fish oil in relation to periodontal disease

J Periodontal Res 2013 Jul 24 doi 101111jre12116 [Epub ahead of print]

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Periodontitis is associated with low serumplasma micronutrient levels which may result from dietary andor life-style factors as

well as nutrigenetic characteristics

Micronutritional approaches to periodontal therapyVan der Velden U Kuzmanova D Chapple ILJ Clin Periodontol 2011 Mar38 Suppl 11142-58 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Position of the Academy of Nutrition and Dietetics Oral Health and Nutrition JAND (2013) 113693-701

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Dang TS Walker M Ford D Valentine RAPeriodontol 2000 2014 Feb64(1)154-60 doi 101111prd12001

Nutrigenomics the role of nutrients in gene expression

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Type 2 diabetes and periodontaldisease a possible role for

nutrigenomics

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Diabetes Affects Oral Health

bull Gum disease which can be more severeand occur more often in people with diabetes

bull Fungal infections which can cause mouth sores and painful swallowing

bull Infection after dental surgery

bull Increased healing time after dental surgery

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Uncontrolled diabetes causes

1 Alveolar bone resorption2 Attachment loss3 Increased probing depths4 Increased tooth mobility5 Increased susceptibility to periodontal

abscess formation

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Good Bacteria in

Oral Health

Probiotics

Twetman S Are we ready for caries prevention through bacteriotherapyBraz Oral Res 201226 Suppl 164-70

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

Complementary and Alternative Medicine

Dietary supplements in primary care

Botanicals can affect surgical outcomes and follow-up

Ciocon JO Ciocon DG Galindo DJ Geriatrics 2004 Sep59(9)20-4 Review

JAMA- Editorial Nov 11 1998Alternative Medicine Meets Science

ldquo There is no alternative medicine ndashThere is only scientifically proven evidence-based medicine supported by solid data or unproven medicine for which scientific evidence is lackingrdquo

Phil B Fontanarosa MD George D Lundberg MD JAMA 1998280(18)1618-1619

Chew on thishellipLimit snacking between meals to 1-2 snacksday and make

healthful choices

Fruits and Vegetables

Unsalted Nuts and low fat cheese

Yogurt with active cultures Water

Tip Chew sugarless gum after

consuming a mealsnack to stimulate saliva production

Some nutritious foods are very acidic and can destroy tooth enamel

Tomatoes lemons and other citrus fruits should be eaten as part of a meal rather than by themselves

Oral Health and Wellness Influences How youhellip

LookFeel

TasteSpeak

ChewSwallow

Smile

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Dietitians can use Oral Health information to integrate

with lifestylenutrition counseling

bull The International and Dietetic Nutritional Terminology includes diagnostic terms related to oral health

bull Proficiency and competency in examining the mouth to identify nutrient-deficiencies highly recommended

bull Assess impact of chronic diseases and risk factors on oral health Oral health screening should be a component of nutrition assessment

Clinical Community and Research Settings

Oral health is an integral part of overall health and therefore oral health care is an essential component of comprehensive health care

Oral health promotion and disease prevention are essential to any strategies aimed at improving access to care

Partnerships among dietetic professionals and other healthcare professionals need to be establishedand strengthened in order to achieve excellence in patient care AND Position Statement 2013

IOMrsquos ldquoImproving Access to Oral Healthcare in Vulnerable Populationsrdquo report emphasizes the role of diet and nutrition in oral health

WHO addresses the role of dietitians in prevention of oral diseases

References

Position of the Academy of Nutrition and DieteticsThe impact of fluoride on healthPalmer CA Gilbert JA Academy of Nutrition and DieteticsJ Acad Nutr Diet 2012 Sep112(9)1443-53

Position of the Academy of Nutrition and DieteticsOral health and nutritionTouger-Decker R Mobley C Academy of Nutrition and Dietetics J Acad Nutr Diet 2013 May113(5)693-701

Diet cardiovascular disease and oral health promotinghealth and reducing riskTouger-Decker R J Am Dent Assoc 2010 Feb141(2)167-70 Review

Chew on thishellipLimit snacking between meals to 1-2 snacksday and make

healthful choices

Fruits and Vegetables

Unsalted Nuts and low fat cheese

Yogurt with active cultures Water

Tip Chew sugarless gum after

consuming a mealsnack to stimulate saliva production

Some nutritious foods are very acidic and can destroy tooth enamel

Tomatoes lemons and other citrus fruits should be eaten as part of a meal rather than by themselves

Oral Health and Wellness Influences How youhellip

LookFeel

TasteSpeak

ChewSwallow

Smile

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Dietitians can use Oral Health information to integrate

with lifestylenutrition counseling

bull The International and Dietetic Nutritional Terminology includes diagnostic terms related to oral health

bull Proficiency and competency in examining the mouth to identify nutrient-deficiencies highly recommended

bull Assess impact of chronic diseases and risk factors on oral health Oral health screening should be a component of nutrition assessment

Clinical Community and Research Settings

Oral health is an integral part of overall health and therefore oral health care is an essential component of comprehensive health care

Oral health promotion and disease prevention are essential to any strategies aimed at improving access to care

Partnerships among dietetic professionals and other healthcare professionals need to be establishedand strengthened in order to achieve excellence in patient care AND Position Statement 2013

IOMrsquos ldquoImproving Access to Oral Healthcare in Vulnerable Populationsrdquo report emphasizes the role of diet and nutrition in oral health

WHO addresses the role of dietitians in prevention of oral diseases

References

Position of the Academy of Nutrition and DieteticsThe impact of fluoride on healthPalmer CA Gilbert JA Academy of Nutrition and DieteticsJ Acad Nutr Diet 2012 Sep112(9)1443-53

Position of the Academy of Nutrition and DieteticsOral health and nutritionTouger-Decker R Mobley C Academy of Nutrition and Dietetics J Acad Nutr Diet 2013 May113(5)693-701

Diet cardiovascular disease and oral health promotinghealth and reducing riskTouger-Decker R J Am Dent Assoc 2010 Feb141(2)167-70 Review

Some nutritious foods are very acidic and can destroy tooth enamel

Tomatoes lemons and other citrus fruits should be eaten as part of a meal rather than by themselves

Oral Health and Wellness Influences How youhellip

LookFeel

TasteSpeak

ChewSwallow

Smile

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Dietitians can use Oral Health information to integrate

with lifestylenutrition counseling

bull The International and Dietetic Nutritional Terminology includes diagnostic terms related to oral health

bull Proficiency and competency in examining the mouth to identify nutrient-deficiencies highly recommended

bull Assess impact of chronic diseases and risk factors on oral health Oral health screening should be a component of nutrition assessment

Clinical Community and Research Settings

Oral health is an integral part of overall health and therefore oral health care is an essential component of comprehensive health care

Oral health promotion and disease prevention are essential to any strategies aimed at improving access to care

Partnerships among dietetic professionals and other healthcare professionals need to be establishedand strengthened in order to achieve excellence in patient care AND Position Statement 2013

IOMrsquos ldquoImproving Access to Oral Healthcare in Vulnerable Populationsrdquo report emphasizes the role of diet and nutrition in oral health

WHO addresses the role of dietitians in prevention of oral diseases

References

Position of the Academy of Nutrition and DieteticsThe impact of fluoride on healthPalmer CA Gilbert JA Academy of Nutrition and DieteticsJ Acad Nutr Diet 2012 Sep112(9)1443-53

Position of the Academy of Nutrition and DieteticsOral health and nutritionTouger-Decker R Mobley C Academy of Nutrition and Dietetics J Acad Nutr Diet 2013 May113(5)693-701

Diet cardiovascular disease and oral health promotinghealth and reducing riskTouger-Decker R J Am Dent Assoc 2010 Feb141(2)167-70 Review

Oral Health and Wellness Influences How youhellip

LookFeel

TasteSpeak

ChewSwallow

Smile

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Be Fit to BersquonersquoFitSM

NewYork-Presbyterian Hospital2006

Dietitians can use Oral Health information to integrate

with lifestylenutrition counseling

bull The International and Dietetic Nutritional Terminology includes diagnostic terms related to oral health

bull Proficiency and competency in examining the mouth to identify nutrient-deficiencies highly recommended

bull Assess impact of chronic diseases and risk factors on oral health Oral health screening should be a component of nutrition assessment

Clinical Community and Research Settings

Oral health is an integral part of overall health and therefore oral health care is an essential component of comprehensive health care

Oral health promotion and disease prevention are essential to any strategies aimed at improving access to care

Partnerships among dietetic professionals and other healthcare professionals need to be establishedand strengthened in order to achieve excellence in patient care AND Position Statement 2013

IOMrsquos ldquoImproving Access to Oral Healthcare in Vulnerable Populationsrdquo report emphasizes the role of diet and nutrition in oral health

WHO addresses the role of dietitians in prevention of oral diseases

References

Position of the Academy of Nutrition and DieteticsThe impact of fluoride on healthPalmer CA Gilbert JA Academy of Nutrition and DieteticsJ Acad Nutr Diet 2012 Sep112(9)1443-53

Position of the Academy of Nutrition and DieteticsOral health and nutritionTouger-Decker R Mobley C Academy of Nutrition and Dietetics J Acad Nutr Diet 2013 May113(5)693-701

Diet cardiovascular disease and oral health promotinghealth and reducing riskTouger-Decker R J Am Dent Assoc 2010 Feb141(2)167-70 Review

Dietitians can use Oral Health information to integrate

with lifestylenutrition counseling

bull The International and Dietetic Nutritional Terminology includes diagnostic terms related to oral health

bull Proficiency and competency in examining the mouth to identify nutrient-deficiencies highly recommended

bull Assess impact of chronic diseases and risk factors on oral health Oral health screening should be a component of nutrition assessment

Clinical Community and Research Settings

Oral health is an integral part of overall health and therefore oral health care is an essential component of comprehensive health care

Oral health promotion and disease prevention are essential to any strategies aimed at improving access to care

Partnerships among dietetic professionals and other healthcare professionals need to be establishedand strengthened in order to achieve excellence in patient care AND Position Statement 2013

IOMrsquos ldquoImproving Access to Oral Healthcare in Vulnerable Populationsrdquo report emphasizes the role of diet and nutrition in oral health

WHO addresses the role of dietitians in prevention of oral diseases

References

Position of the Academy of Nutrition and DieteticsThe impact of fluoride on healthPalmer CA Gilbert JA Academy of Nutrition and DieteticsJ Acad Nutr Diet 2012 Sep112(9)1443-53

Position of the Academy of Nutrition and DieteticsOral health and nutritionTouger-Decker R Mobley C Academy of Nutrition and Dietetics J Acad Nutr Diet 2013 May113(5)693-701

Diet cardiovascular disease and oral health promotinghealth and reducing riskTouger-Decker R J Am Dent Assoc 2010 Feb141(2)167-70 Review

Oral health is an integral part of overall health and therefore oral health care is an essential component of comprehensive health care

Oral health promotion and disease prevention are essential to any strategies aimed at improving access to care

Partnerships among dietetic professionals and other healthcare professionals need to be establishedand strengthened in order to achieve excellence in patient care AND Position Statement 2013

IOMrsquos ldquoImproving Access to Oral Healthcare in Vulnerable Populationsrdquo report emphasizes the role of diet and nutrition in oral health

WHO addresses the role of dietitians in prevention of oral diseases

References

Position of the Academy of Nutrition and DieteticsThe impact of fluoride on healthPalmer CA Gilbert JA Academy of Nutrition and DieteticsJ Acad Nutr Diet 2012 Sep112(9)1443-53

Position of the Academy of Nutrition and DieteticsOral health and nutritionTouger-Decker R Mobley C Academy of Nutrition and Dietetics J Acad Nutr Diet 2013 May113(5)693-701

Diet cardiovascular disease and oral health promotinghealth and reducing riskTouger-Decker R J Am Dent Assoc 2010 Feb141(2)167-70 Review

Partnerships among dietetic professionals and other healthcare professionals need to be establishedand strengthened in order to achieve excellence in patient care AND Position Statement 2013

IOMrsquos ldquoImproving Access to Oral Healthcare in Vulnerable Populationsrdquo report emphasizes the role of diet and nutrition in oral health

WHO addresses the role of dietitians in prevention of oral diseases

References

Position of the Academy of Nutrition and DieteticsThe impact of fluoride on healthPalmer CA Gilbert JA Academy of Nutrition and DieteticsJ Acad Nutr Diet 2012 Sep112(9)1443-53

Position of the Academy of Nutrition and DieteticsOral health and nutritionTouger-Decker R Mobley C Academy of Nutrition and Dietetics J Acad Nutr Diet 2013 May113(5)693-701

Diet cardiovascular disease and oral health promotinghealth and reducing riskTouger-Decker R J Am Dent Assoc 2010 Feb141(2)167-70 Review

References

Position of the Academy of Nutrition and DieteticsThe impact of fluoride on healthPalmer CA Gilbert JA Academy of Nutrition and DieteticsJ Acad Nutr Diet 2012 Sep112(9)1443-53

Position of the Academy of Nutrition and DieteticsOral health and nutritionTouger-Decker R Mobley C Academy of Nutrition and Dietetics J Acad Nutr Diet 2013 May113(5)693-701

Diet cardiovascular disease and oral health promotinghealth and reducing riskTouger-Decker R J Am Dent Assoc 2010 Feb141(2)167-70 Review

Questions

Based on this webinar learners should be able to Discuss the lifelong synergy between nutrition and oral

health status in health and disease Outline the role of nutrition in the development and

integrity of the oral cavity and the progression of oral disease

Describe practical strategies dietitians can use to integrate oral health information with lifestylenutrition counseling

NUTRI-BITESreg

Webinar SeriesNutrition and Oral Health

61

Nutri-Bitesreg Webinar details

A link to obtain your Continuing Education Credit certificate will be emailed within 2 days

Todayrsquos webinar will be available to download within 2 days at wwwConAgraFoodsScienceInstitutecom

For CPE information acontinellirippelifestylecom

Recorded CEU webinars archived at the ConAgra Foods Science Institute include Lifestyle Approaches to the Prevention and Treatment of Diabetes Food Safety at Home Work and Play Communicating Nutrition Information to Influence Consumer Behavior Exploring Myths and Trends of Frozen Foods Behavioral and Dietary Strategies for Weight Management

Based on this webinar learners should be able to Discuss the lifelong synergy between nutrition and oral

health status in health and disease Outline the role of nutrition in the development and

integrity of the oral cavity and the progression of oral disease

Describe practical strategies dietitians can use to integrate oral health information with lifestylenutrition counseling

NUTRI-BITESreg

Webinar SeriesNutrition and Oral Health

61

Nutri-Bitesreg Webinar details

A link to obtain your Continuing Education Credit certificate will be emailed within 2 days

Todayrsquos webinar will be available to download within 2 days at wwwConAgraFoodsScienceInstitutecom

For CPE information acontinellirippelifestylecom

Recorded CEU webinars archived at the ConAgra Foods Science Institute include Lifestyle Approaches to the Prevention and Treatment of Diabetes Food Safety at Home Work and Play Communicating Nutrition Information to Influence Consumer Behavior Exploring Myths and Trends of Frozen Foods Behavioral and Dietary Strategies for Weight Management

Nutri-Bitesreg Webinar details

A link to obtain your Continuing Education Credit certificate will be emailed within 2 days

Todayrsquos webinar will be available to download within 2 days at wwwConAgraFoodsScienceInstitutecom

For CPE information acontinellirippelifestylecom

Recorded CEU webinars archived at the ConAgra Foods Science Institute include Lifestyle Approaches to the Prevention and Treatment of Diabetes Food Safety at Home Work and Play Communicating Nutrition Information to Influence Consumer Behavior Exploring Myths and Trends of Frozen Foods Behavioral and Dietary Strategies for Weight Management

Culinary Competency to Enhance Dietetic Practice

Cathy Powers MS RD LD Culinary Nutrition Associates

Date March 13 20142-3 pm EDT1-2 pm CDT

wwwConAgraFoodsScienceInstitutecom

Next Nutri-BitesregWebinar

How are we doing

Stay on the line for a brief survey about this Nutri-Bitesreg webinar

Nutrition and Oral HealthWhat Dietitians Should Know

Thank you

• Nutrition and Oral Health What Dietitians Should Know will begin at the top of the hourAudio for todayrsquos presentation is being broadcast over your computer speakers so be sure they are turned on and the volume is upTodayrsquos presentation in handout form can be downloaded from httpbitlyhandout-1-16-14
• Nutrition and Oral Health What Dietitians Should KnowJanuary 16 2014
• Webinar logistics
• ConAgra Foods Science Institute
• Todayrsquos Faculty
• Learning Objectives
• Nutrition and Oral HealthWhat Dietitians should knowWahida Karmally DrPH RDCDECLSFNLAAssociate Research ScientistLecturer in DentistryColumbia University
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Slide Number 19
• Slide Number 20
• Slide Number 21
• Slide Number 22
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Control Your Sweet Tooth
• Early childhood caries related to feeding and eating behaviors Also called ldquobaby bottle tooth decayrdquoNursing bottle cariesmdashputting baby to bed with a bottle of sweetened liquid Front teeth rapidly develop caries
• Oral Health and Children
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• The mouth is the telltale of diseases such asNutritional anemiasUncontrolled diabetes mellitus Eating disordersHIV infectionOral Cancer
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45
• Slide Number 46
• Slide Number 47
• Slide Number 48
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• Chew on thishellip
• Slide Number 56
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• Slide Number 61
• Nutri-Bitesreg Webinar details
• Slide Number 63
• How are we doing