Nutrition and Malnutrition

Dental Hygiene

By:Kevin T. KatadaElisa Marylle Hucal

• According to WHO, nutrition is an input to and foundation for health and development. It means that the food we take is like an investment to our health and physical development. Our health status mostly depends on our lifestyle which includes our diet.

Introduction

Nutrition is a major department in School Health Nursing, because the school age period is the crucial time for physical and mental development. The nurse's responsibility is to guide one through concepts on nutrition and on prevention of disorders related to nutrition/malnutrition.

Definition Of Terms

Nutrition

- is the study of food in relation to health of an individual, community or society and the process through which food is used to sustain life and growth.- is the science of food and nutrients and other substances therein, their action, interaction and balance in relation to health and disease and the processes by which an organism ingests, digests, absorbs, transports, utilizes and excretes food substances.

Body Mass Index

- The body mass index (BMI), or Quetelet index, is a statistical measure of body weight based on a person's weight and height

Food Faddism

-usually refers to idiosyncratic diets and eating patterns. They are diets that claim to promote weight loss or treat obesity by mechanisms other than calorie restriction.

Beri Beri

a disease caused by deficient thiamin, this refers to changes in the nervous system, cardiovascular system and gastrointestinal tract. Untreated, beriberi is often deadly. With treatment, symptoms usually improve quickly. Heart damage is usually reversible, and a full recovery is expected.

However, if acute heart failure has already occurred, the outlook is poor. Nervous system damage is also reversible, if caught early. If it is not caught early, some symptoms (such as memory loss) may remain even with treatment.

2 TYPES OF BERI-BERI

1. Wet- is evident by edema or water retention especially of lower extremities. The abdominal cavity and chest can be severely edematous. The heart is enlarged and breathing becomes difficult.

2. Dry- does not show much edema, but the “peripheral nerves are in pins and needles” (parasthesia). There is gradual loss of touch sensation, general muscle weakness and finally paralysis. The reflexes in the leg, ankle and knees are reduced; the toes and wrist lose their positional sense (toe-drop and wrist-drop) muscles are tender and atrophied.

Malnutrition

2 TYPES OF MALNUTRITION

1. Undernutrition- is a pathological state resulting from the consumption of inadequate quantity of food over an extended period of time.

2. Overnutrition- occurs when food intake exceeds the body’s nutrient requirements for physical and mental activity as well as growth thus resulting to accumulation of nutrients (i.e. excess fat stored as adipose tissue).

Pica- is a medical disorder characterized by an appetite for substances largely non-nutritive (e.g. metal (coins, etc), clay, coal, soil, feces, chalk, paper, soap, mucus, ash, gum, etc.) or an abnormal appetite for some thingsthat may be considered foods, such as food ingredients (e.g., flour, raw potato, raw rice, starch, ice cubes, salt).

Note:

In order for these actions to be considered pica, they must persist for more than one month at an age where eating such objects is considered developmentally inappropriate.

Marasmus

- a form of Protein-Energy Malnutrition (PEM) that is characterized by wrinkling of facial skin, thinning of muscles and fat and severe weight loss.

Kwashiorkor

- is another form of Protein-Energy Malnutrition (PEM) that is characterized by hair changes, misery, moon face, thinning of muscles but with fat present, edema especially in the lower extremities and weight loss.

Comparison between Kwashiorkor and Marasmus

• Both have skeletal muscle losses, but much more in marasmus

• Serum proteins are more significantly decreased in kwashiorkor and have pronounced edema.

• There is more significant weight loss of adipose tissues in marasmus so that skin is wrinkled and thin (old man’s face).

• Body weight loss in kwashiorkor is not significantly partly due to edema and partly because there is some adipose tissue left.

(Claudio, V.S. & Dridge, O.V. (2002). Basic nutrition for Filipinos,5th ed. Manila: Meriam & Webster Bookstore)

Basic Nutrients And Functions

Basic Nutrients and Functions

1. Macronutrients

2. Micronutrients• Vitamins

• Minerals

3. Water

Macronutrients

A. Fats

- are organic compounds chemically called lipids which are insoluble in water, but soluble in fat solvents. A fat molecule has the elements: carbon, hydrogen and oxygen, in glyceride linkage. To the nutritionist, fats are necessary components of tissues and to regulate certain life processes.

Macronutrients

B. Carbohydrates

- carbohydrates are organic compounds of carbon, hydrogen, and oxygen that are stored in muscles and in the liver and can be converted quickly when the body needs energy.

Carbohydrates

Carbohydrates are classified according to the number of sugar units, or saccharides, that make up their structure: simple carbohydrates are sugars with simple structure of one (monosaccharides) or two (disaccharides) sugar units. Complex carbohydrates, or starches, consist of many sugar units (polysaccharides).

Functions of Carbohydrates include:

• Conserving protein during energy production.

• Helping to burn fats more efficiently and completely.

• Providing a quick source of energy (glucose).

• Aiding the normal functioning of the intestines (fiber).

• Providing laxative action and aiding in the absorption of calcium (lactose).

Macronutrients

C. Protein

- proteins which are components of every living cell, are large, complex molecules composed of individual building blocks known as amino acids. Like carbohydrates, amino acids are organic compounds made from carbon, hydrogen and oxygen atoms.

Protein

Unique to amino acids is their nitrogen components, which distinguishes them from other energy nutrients. Proteins come in various sizes and shapes and are composed of different amino acids joined in various proportions and sequences. The shape of a protein molecule determines how it functions.

Protein

Protein is required for normal growth and development. It’s broken down by the body as a source of energy when the supply of carbohydrates and fats is inadequate. Protein is stored in the muscle, bone, blood, skin, cartilage and lymph.

Protein

Protein can be found in plant and animal sources. Based on the food guide pyramid, plant sources of protein are found in bread, cereal, rice and pasta group (oatmeal, crackers, whole grain bread). Vegetable group (dark green and deep yellow vegetables). Milk, yogurt and cheese group (cottage cheese, yogurt, hard cheese). Meat, poultry, fish, dry beans, eggs and nut group (chicken, steak, dry beans, peanut butter).

Functions of Protein

• The primary function of a protein is the growth, repair and maintenance of body structures and tissues.

• The body’s cells are always making proteins to replace those that are broken down from normal wear.

• Proteins are involved in the manufacture of hormones such as insulin and epinephrine.

• Proteins may act as enzymes that help bring about certain chemical reactions such as digestion or protein synthesis.

Functions of Protein

• Plasma proteins (such as albumin) aid in the maintaining fluid and electrolyte balance by attracting water and causing changes in osmotic pressure.

• Amino acids contain an acid and a base; therefore, they can neutralize excess of either acids or bases in the body, thereby maintaining a normal pH.

• Proteins help transport other substances through blood. For example, hemoglobin transports oxygen and lipoprotein transport lipids.

Functions of Protein

• Proteins function within the immune system by helping to create lymphocytes and antibodies that protect the body from infection and disease.

• Protein is a component of numerous body compounds, including thrombin, which helps blood to clot.

• Proteins can be used as a source of energy (providing 4cal/g) when intake of carbohydrates and fats is inadequate.

Classification Of Protein

Food proteins are classified as complete or incomplete. This classification depends on their amino acid compositions.

Complete Protein: Complete proteins are foods that contain all of the essential amino acids to meet the body’s needs. Meat, milk, cheese and eggs are considered a complete protein.

Classification Of Protein

Incomplete Protein: if the food is deficient or has limited amounts of one or more essential amino acids, it’s considered an incomplete protein. With the exception of soybeans, all plant proteins are incomplete.

Micronutrients

A. Vitamins

Vitamins are organic compounds of carbon, hydrogen, oxygen and occasionally, nitrogen or other elements that are needed in small quantities for normal metabolism, growth and development. Because they’re needed only in small quantities, they’re referred to as micronutrients.

Vitamins

Contrary to popular belief, vitamins don’t directly provide energy to the body. As catalysts, they’re part of the enzymes system that’s required to release energy from protein, fat, and carbohydrates.

Vitamins are also necessary for the formation of red blood cells, hormones and genetic material and to maintain proper functioning of the nervous system.

Vitamins functions as antioxidants, coenzymes, food additives, pharmacologic agents.

Vitamins

Vitamins are classified as either water soluble or fat soluble.

Water Soluble Vitamins are absorbed into the bloodstream directly and more freely within cells. Because there’s no storage of these vitamins, they must be consumed daily in the diet. They’re found in the watery portion of foods. When excess amounts are consumed, they’re excreted in urine.

Water-soluble vitamins include Vitamin B1 (thiamine), Vitamin B2 (riboflavin), Vitamin B3 (niacin), Vitamin B6 (pyridoxine), Vitamin B12 (cobalamin), Vitamin C (ascorbic acid), Biotin, Folate (folic acid), Pantothenic Acid.

Vitamins

Fat Soluble Vitamins are absorbed with fat into the lymphatic system and the bloodstream. Once in the bloodstream, these vitamins need to attach to lipoproteins to be transported. Excess amounts of fat-soluble vitamins are stored in the liver and adipose tissue, therefore, these vitamins don’t need to be consumed daily in the diet.

The fat soluble vitamins are Vitamin A (retinol), Vitamin D (calciferol), Vitamin E (tocopherol), Vitamin K (menadione).

Sources of Vitamins

• Bread, cereal, rice and pasta may be enriched with niacin, riboflavin and thiamine and fortified with folic acid. Whole grain items also contain Vitamin E.

• Fruits and fruit juices, particularly orange and grapefruit juices are high in Vitamin C and beta-carotene and are also significant sources of folate. Some juices are also fortified with calcium juices that contain 100% fruit juice are recommended

Sources of Vitamins

• Vegetables are good sources of beta-carotene, Vitamin C, folic acid, and Vitamin K. because cooking and soaking can destroy vitamins, minimal preparation of vegetable is recommended.

• Milk, yogurt and cheese may contain riboflavin, some B vitamins and vitamins A and D. Meat contains niacin, riboflavin and Vitamins B6 and B12; pork is also rich in Thiamine.

• Dry beans contain folate, nuts and seeds supply Vitamin E, and eggs are good sources of Vitamin A.

Sources of Vitamins

• Vegetable oils supply Vitamin E.

• Margarine contains Vitamins A, D and E.

Micronutrients

B. Minerals

Minerals are found in unrefined foods mostly in combination with each other and with organic constituents. Like any food, it forms part of the total composition of the body. Of this, the mineral elements or inorganic portion comprise about 4-6% of the total body weight.

Minerals

The rest of the components of the body consist of the organic constituents, carbohydrate, protein, fat, and water.

Minerals are non-caloric and remains as ash when a food or an organic compound is completely burnt unlike carbohydrate, protein, and fat which can be oxidized to carbon dioxide and water with the release of energy.

CLASSIFICATION OF MINERALS

Minerals are classified as major minerals (macrominerals) or trace minerals (microminerals).

Major minerals are present in the body in amounts larger than 5g or the equivalent to 1tsp and are needed in large quantities.

Trace minerals are present in the body in amounts less than 5g and are only needed in small amounts.

7 major minerals: Calcium, Chloride, Magnesium, Phosphorus, Potassium, Sodium and Sulfur

CLASSIFICATION OF MINERALS

Trace Minerals: Chromium, Cobalt, Copper, Fluorine, Iodine, Iron, Manganese, Molybdenum, Selenium and Zinc

Water

Most authors would classify water both as a food and as a nutrient. It constitutes about 60-70% of the total body weight so that a body deprived of water by as much as 10% will already result in illness and a 20% loss of body water may cause death. It is next to oxygen in importance for the maintenance of life.

Water

Water found in the body totals 45 liters in a normal adult. Two- thirds of this is found inside or within the cells.

Water is a vital component of tissues, muscle, glycogen, etc. and is vital for growth. Water acts as a lubricant of the joints and the viscera in the abdominal cavity; thus, can protect a sensitive tissue. It is also a regulator of body temperature through its ability to conduct heat.

FOOD GROUPS

Food Groups

• Go (Energy-giving foods)

• Grow (Body-Building foods)

• Glow (Body-regulating foods)

Go Foods

- our basic source of carbohydrates

This group includes bread, pasta, rice and mashed potatoes. These foods have a high starch concentration that is converted to energy. A healthy serving of Go foods for breakfast will keep us going the whole day.

Go Foods

A medifast diet contains an ample amount of Go food that can supply our bodies with the needed energy to go about our way.

Just the right amount is necessary because over indulgence would mean more starch and energy.

If the body cannot expend this energy, it will be stored in the form of fat.

The more fat in us, the more added weight we’ll have.

Grow Foods

Grow foods are referred to as such because it helps with muscle growth and strength development.

Most misconceptions with adults is that muscle development stops at a certain age. This of course is wrong.

We should carefully watch our intake of Grow foods because it can cause major weight problems.

Grow Foods

Pork, beef, chicken, and fish are examples of grow foods. A daily eating binge on these types of food can actually add muscle mass. Good in some way but coupled with layers of fat, it can cause health issues. Also, the more muscle we have on our bodies, the more it would be necessary for us to exercise.

Glow Foods

Glow foods is also part of the medifast diet. This food group is responsible for providing that certain radiance on our skin as well as gives that rosy glow on our cheeks.

This food group also has the least amount of bad effects on our bodies since it is mostly composed of fruits and vegetables.

Glow Foods

Most weight watchers or people undergoing diet regimes often have huge amounts of glow foods as part of their daily intake.

Food Pyramid

BMI (Body Mass Index)

BMI

BMI- The body mass index (BMI), or Quetelet index, is a statistical measure of body weight based on a person's weight and height. Though it does not actually measure the percentage of body fat, it is used to estimate a healthy body weight based on a person's height. Due to its ease of measurement and calculation, it is the most widely used diagnostic tool to identify weight problems within a population, usually whether individuals are underweight, overweight or obese.

BMI

A frequent use of the BMI is to assess how much an individual's body weight departs from what is normal or desirable for a person of his or her height. The weight excess or deficiency may, in part, be accounted for by body fat (adipose tissue) although other factors such as muscularity also affect BMI significantly (see discussion below and overweight).

BMI

The WHO regard a BMI of less than 18.5 as underweight and may indicate malnutrition, an eating disorder, or other health problems, while a BMI greater than 25 is considered overweight and above 30 is considered obese. These ranges of BMI values are valid only as statistical categories when applied to adults, and do not predict health.

(Cataldo, C.B. (2003) Nutrition and diet therapy: principles and practice. 5th ed. Australia: Wadsworth Thomson)

Imperial formula

Metric or Standard Formula

Simple BMI Scale (Weight Status Categories)

Note: Different nations, organizations and institutions use different BMI ranges to classify weight status.

BMI Weight Status

Below 18.5 Underweight

18.5 -24.9 Normal

25 - 29.9 Overweight

30 & Above Obese

Factors Affecting Behavior in School Age Children 6-12

years old

Factors Affecting Behavior in School Age Children 6-12 years old

1. Family - food preferences begin at home so food choices are governed the experience with the food served by the family especially the mother and how they knew and incorporated into the menu about nutrition and health.

2. Friends - children are easily influenced by their peers in relation to the preference of foods. As with their stage in life they wanted to belong to the group.

Factors Affecting Behavior in School Age Children 6-12 years old

3. School - food preferences were also laid with what was on the menu of the school’s cafeteria. Yet, school age children can be easily influenced to opt to buy outside foods which is commonly unhealthy. School-teacher-student relationship can do much towards achieving the child’s needs on one hand and challenging him on the other. The school can incorporate nutrition in subjects like Social Studies, Science, Mathematics and Character Education.

Factors Affecting Behavior in School Age Children 6-12 years old

4. Fads- school-age children can be attracted to what is advertised and for them foods are very attracting though it is not healthy for them to eat those kinds of foods which are commonly advertised especially junk foods.

5. Media- media also possess a great influence to children especially in advertising fast foods. They use kids as the model for advertising the product to persuade other children to buy their products. As to the kids watching this kind of advertisement, they want to buy and belong to what is usually eaten by other people.

Malnutrition

Marasmus

Assessment:

Initial assessment includes assessment of the fat and muscle mass loss that can be clinically performed by measuring the arm circumference or skinfold thickness, such as triceps skinfold. Furthermore, assess for dry skin, loose skin folds hanging over the glutei, axillae etc. Drastic loss of adipose tissue from normal areas of fat deposits like buttocks and thighs, fretfulness, irritability and voracious appetite. There may be alternate bands of pigmented and depigmented hair (flag sign) and flaky paint appearance of skin due to peeling.

Marasmus

Nursing Diagnosis: Impaired skin integrity related to desquamation (peeling) of skin secondary to marasmus

Treatment: Treatment is done by gradually reintroducing food. Intravenous feeding may be done. Supplementation of calories and fats are done. Carbohydrates are usually given first for energy. Vitamin B supplementation is also given to suffice for nutritional deficiencies.

Marasmus

Nursing Responsibilities:

The nurse practitioner should follow-up on medication regimen and make sure that the parents are consistently assessing for weight and the progress of the treatment, provided they are already taught in getting the BMI. (if not, do proper health teaching) The nurse may schedule visits to have intravenous nutrient supplementation as prescribed by the doctor.

Kwashiorkor

Assessment:

Assess for changes in skin pigmentation, decreased muscle mass, diarrhea, failure to gain weight and grow, fatigue, hair changes (change in color or texture), increased and more severe infections due to damaged immune system, irritability, large belly that sticks out (protrudes), lethargy or apathy, loss of muscle mass, rash (dermatitis), shock (late stage), edema.

Kwashiorkor

The physical examination may show an enlarged liver (hepatomegaly) and general swelling.

Tests may include: • Arterial blood gas

• BUN

• Complete blood count (CBC)

• Creatinine clearance

• Serum creatinine

• Serum potassium

• Total protein levels

• Urinalysis

Kwashiorkor

Nursing Diagnosis:

Nutrition: altered, less than body requirements r/t insufficient intake for protein & energy requirement due to lack of financial resources; poverty

Kwashiorkor

Treatment:

Getting more calories and protein will correct kwashiorkor, if treatment is started early enough. However, children who have had this condition will never reach their full potential for height and growth. Treatment depends on the severity of the condition.

Kwashiorkor

Patients who are in shock need immediate treatment to restore blood volume and maintain blood pressure. Calories are given first in the form of carbohydrates, simple sugars, and fats. Proteins are started after other sources of calories have already provided energy. Vitamin and mineral supplements are essential.

Kwashiorkor

Nursing Responsibilities:

The nurse practitioner must make sure the diet has enough carbohydrates, fat (at least 10 percent of total calories), and protein (12 percent of total calories) in order to suffice growth and development. Remind also that food should be reintroduced slowly as nutrients may not be easily absorbed and resulting in indigestion or gastric problems. Provide nutritional information and knowledge on protein supplementation.

Kwashiorkor

Educate parents on how to assess for regression of symptoms to pinpoint if treatment is working and was started early enough. The nurse should also schedule clinical visits in order to note for the status of the liver and the kidneys noting for hepatomegaly and renal failure.

Beri-beri

Assessment: Assess for symptoms of :

Dry beri-beri : Difficulty walking, Loss of feeling (sensation) in hands and feet, Loss of muscle function or paralysis of the lower legs, Mental confusion/speech difficulties, Pain, Strange eye movements (nystagmus), Tingling and Vomiting

Wet beri-beri : Awakening at night short of breath, Increased heart rate, Shortness of breath with activity, Swelling of the lower legs

Beri-beri

A physical examination may show signs of congestive heart failure, including:

• Difficulty breathing with neck veins sticking out

• Enlarged heart

• Fluid in the lungs

• Rapid heartbeat

• Swelling in both lower legs

Beri-beri

A person with late-stage beriberi may be confused or have memory loss and delusions. The person may be less able to sense vibrations.

A neurological exam may show signs of:• Changes in the walk

• Coordination problems

• Decreased reflexes

• Drooping of the eyelids

Beri-beri

The following tests may be done:

• Blood tests to measure the amount of thiamine in the blood

• Urine tests to see if thiamine is passing through the urine

Beri-beri

Nursing Diagnosis: Ineffective breathing pattern r/t congestive heart failure secondary to beri-beri, lack of enough thiamine (vitamin B1) in the body

Treatment: The goal of treatment is to replace the thiamine your body is lacking. This is done with thiamine supplements. Thiamine supplements are given through a shot (injection) or taken by mouth. Other types of vitamins may also be recommended.

Beri-beri

Blood tests may be done after you are given thiamine supplements to see how well you are responding to the medicine.

Beri-beri

Nursing Responsibilities: The nurse practitioner must ensure that the child is eating a proper diet that is rich in thiamine and other vitamins, which will prevent and help treat beri-beri. The nurse should make sure that mothers supervise their child’s diet and that it contains all vitamins and be sure that infant formulas contain thiamine. People who drink alcohol heavily should try to cut down or quit, and take B vitamins to make sure their body is properly absorbing and storing thiamine.

Iron Deficiency Anemia

Assessment: Assess for blue color to whites of the eyes, brittle nails, decreased appetite (especially in children), fatigue, headache, irritability, pallor, shortness of breath, sore tongueand weakness. Also assess if the patient is female and if she is having her menstruation. There may be no symptoms if the anemia is mild.

Iron Deficiency Anemia

Exams and Tests:

• Fecal occult blood test

• Hematocrit and hemoglobin (red blood cell measures)

• Iron binding capacity (TIBC) in the blood

• RBC indices

• Serum ferritin

• Serum iron level

Iron Deficiency Anemia

Nursing Diagnosis: Activity intolerance r/t weakness due to inadequate oxygen delivery to the tissues secondary to anemia

Treatment: The cause of the iron deficiency must be found, especially in older patients who face the greatest risk for gastrointestinal cancers.

Iron Deficiency Anemia

Iron supplements (ferrous sulfate) are available. For the best iron absorption, take these supplements with an empty stomach. However, many people cannot tolerate this and may need to take the supplements with food.

Iron Deficiency Anemia

Iron-rich foods include: Eggs (yolk), Fish, Legumes (peas and beans), Meats (liver is the highest source), Poultry, Raisins, Whole-grain bread.

With treatment, the outcome is likely to be good. Usually, blood counts will return to normal in 2 months.

Iron Deficiency Anemia

Nursing Responsibilities: Follow-up on the dietary supplementation of iron (ferrous sulfate) tablets, also informing the patient that intake of such may cause bowels to appear darker or black in color. Educate client about iron absorption and that it can be hastened by Vitamin C, which can also be taken through supplemental tablets (Potencee), or Vit. C-rich foods (citrus fruits, etc.) (Dudek,S (2006) Nutrition Essentials for nursing practice. 5th ed. Philadelphia, P.A.. Lippincott Williams and Wilkins.)

Other Problems Related to Nutrition

Obesity

A term used to describe an excess of body fat. Although weight alone does not indicate the degree of body fat, an individual is still classified by many health professionals as obese if weight is 20% or more than the standard weight for height; morbid obesity is when one weighs in excess of 30 % of the standard.

Lactose Tolerance

A. Congenital, or primary refers to the inability to digest milk sugar (lactose). It is caused by a low amount of the enzyme lactase, which is necessary for converting lactose into glucose and galactose in the gastrointestinal tract. Symptoms include bloating, flatulence, cramping, and diarrhea. Different populations show variations in degrees of lactase deficiency usually occuring after 5 years of age.

Lactose Tolerance

B. Acquired lactase deficiency, also referred to as secondary lactose intolerance, is associated with chronic gastrointestinal disease and disorders such as gluten-sensitive enteropathy, Crohn's disease, and other conditions leading to atrophy of the villi of the intestines.

Allergies

a condition wherein a person develops a hypersensitivity to certain proteins found in food. It is an immune response that can be mildly annoying or severe enough to induce death through anaphylactic shock (a life-threatening condition in which the breathing passages can be blocked).

e.g. Peanuts, tree nuts, seafood and seeds, as well as milk and eggs

Allergies

With food allergies, the body reacts to certain food proteins as if they were harmful substances. For this immune response to be avoided, the offending foods need to be reduced or entirely eliminated from the diet.

Allergies

Food allergens/antigens are the proteins or other large molecules from food that induce an immune response. The immunoglobulin (IgE) antibody is produced in response to these “foreign “ substances in an attempt to rid the body of them. IgE causes the typical allergy symptoms. Symptoms affect the skin, nasal mucosa, respiratory or gastrointestinal tract

Breakfast Skipping

is the habit of some people wherein they eat less or mostly don't eat at all to save time in the morning. Some even may see this as a way of losing weight but it is quite the contrary. Studies show that hose who miss breakfast are more likely to get fat because they tend to eat unhealthy mid-morning snacks to boost their energy levels.

Increased Consumption of Soft Drinks

Soda is one of society’s favorite beverages. Drinking soda has been shown to contribute to tooth decay. The sugar content is responsible for this, and the acid in sodas have been shown to erode tooth enamel, leading to dental cavities as well.

Increased Consumption of Soft Drinks

Another health-threatening effect of sodas is the weakening of the bones. Phosphorus in sodas leaches calcium out of the bones. People resort to drinking diet sodas instead of regular sodas, thinking that it is much healthier, however this is not the perfect solution. Diet soda drinkers are still vulnerable to the acidic effects of soda. The artificial sweeteners added that replace the sugar content may pose serious health issues to the body as well.

Dental Problemsand

Hygiene

Common Teeth and Gum Problems

A. Toothaches

Sometimes you may have tooth pain when you touch a tooth or when you eat or drink foods that are hot, cold, sweet, or sour (a sensitive tooth). Mild sensitivity can be caused by shrunken (receded) gums or a worn-down tooth. Moderate to severe sensitivity can mean a tooth has cracked, a dental cavity is present, or a filling has been lost. Seeing a dentist for treatment can prevent the tooth from dying.

Toothaches

The most common cause of a toothache is tooth decay , although toothache may not be present in the early stages of decay.

Other reasons for a toothache might include:

• An infection of or around the tooth (abscess ). A red, swollen, painful bump may be found near or on the side of the sore tooth. The tooth may especially hurt when you bite down.

• A tooth that has not broken through the gum (impacted tooth). Gums may be red, swollen, and sore. The area around this tooth can ache, throb, and be quite painful.

• Problems with or injury to the nerves in the center of the tooth (pulp), which can be caused by an injury to the face or from grinding or gnashing the teeth.

Common Teeth and Gum Problems

B. Gum problems

Early-stage gum disease (gingivitis) causes red, swollen gums that bleed easily when brushed. Because gingivitis usually doesn't cause pain, many people delay treatment. If not treated, gum disease can cause more serious problems with the gum tissue. As gum disease gets worse, the gums pull away from the teeth, leaving deep pockets where plaque can hide and cause further damage.

Gum Problems

Teeth and gum problems affect appetite and if not treated, may cause malnutrition. For children this could be very frustrating and distracting, some may even not tolerate the pain and end up not going to school, skipping class or just being inattentive since the pain is deviating their concentration.

Mouth and Teeth Hygiene

Dental hygiene is the key to keeping gums healthy, teeth strong and fresh breath. Yet some don't even have the knowledge of the importance of not only brushing one's teeth but also gargling, and flossing. It is a serious problem when you don't allot the time to brush and keep your mouth clean. Scheduling a visit to the dentist every 6 months may not even be a routine to some yet is very crucial in detecting teeth or gum problems.

School Health Nursing and Nutrition Programs in the

Philippine Setting. • Health and Nutrition Education

Support instructional materials has been developed and are integrated in appropriate subject areas in the elementary and secondary level of education for the following programs and projects.

1. School-Based AIDS Education Project

2. School-Based Prevention and Control of Cardio-Vascular Diseases

3. Feminine Hygiene Educational Program

4. Oral Health Education (BSBF) Program

5. National Drug Education Program

6. Teacher-In-Child-Parent (TCP) Approach

7. Preventive Nephrology Project

School Health Nursing and Nutrition Programs in the

Philippine Setting. • National Drug Education Program It aims to prevent drub abuse among students

through the development of desirable values, attitudes and practices.

• Health Services

• Medical, Dental and Nursing

-The program aims to promote, protect and maintain the health status of schoolchildren/personnel through the provision of various health services in the schools.

• TB Prevention and Control Program It aims to reduce the prevelance of pulmonary tuberculosis among teachers and non-teaching personnel through chest x-ray examination and treatment of positive cases to improve teaching performance.

School Health Nursing and Nutrition Programs in the

Philippine Setting. • School Milk Project

-To supplement the diet of undernourished school children all Grade I pupils in selected schools are served chocolate flavored milk for 120 feeding days developing in them the mild drinking habit and improved nutritional status.

• Breakfast Feeding Program

-It aims to improve the active learning capabilities of school children through provision of breakfast among Grade I pupils in selected schools in the form of specially formulated noodles containing 300 kilo calories, 10 grams, protein and 800 IU beta carotene, fortified with iodine.

Thank You For Listening!!

References

Claudio,V.S. & Dirige,O.V. (2002). Basic Nutrition For Filipinos. 5th Ed. Manila: Merriam & Webster Bookstore, Inc.

Pilliteri,A. (2003). Maternal and Child Care of the Childbearing & Childrearing Family.5th Ed. Philadelphia; Lippincott, Williams and Wilkins.cataldo,C.B. (2003). Nutrition and Diet therapy: principles and practice. 6th ed. Australia: Wadsworth Thomson.

Dudek,S. (2006). Nutrition Essentials for nursing practice.5th Edition. Philadelphia,P.A: Lippincott Williams & Wilkins.

Shilling McCann,L. eta.al. (2003). Nutrition made Incredibly easy! Philadelphia, P.A. Lippincott Williams and Wilkins.