NUTRITION FINAL EXAM

Ketodacidosis Hyperlipidemia Fat accumulation in liver

*The body cannot metabolize excessive quantities of fat without side effects. What side effects occur when the body is trying to metabolize excessive fats?

Body Mass Index (BMI)

*The currently preferred method of defining healthy weight in the US is__?

-Provide energy -Store energy -Constituent of amino acids, collagen, nerve tissue -Spare protein -Normal fat metabolism -Gastrointestinal motility

*The function(s) of dietary carbohydrates include:

Dysgeusia

*The medical term used referring to persistent, abnormal distortion of taste is called:

Xerostomia

*The medical term used referring to persistent, dry mount from inadequate salivary section is called:

Transform Acquire Store Use energy

*The process of metabolism is how cells complete what functions?

Sarcopenia

*The progressive loss of muscle mass and strength typically associated with the process of aging

Forces feces into the rectum

*The purpose of peristalsis in the large intestine is?

Bioavailability

*The term used when considering the amount of a nutrient available physiologically based on its absorption rate is?

Ionic bond

*The type of bond formed by a positively charged metal ion and negatively charged nonmetal ion is a(n) __.

Bland diet

*This type of diet has the following characteristics: well balanced and avoids certain foods and fluids, including alcohol, pepper, acidic foods, peppermint, and chocolate.

Mechanical soft diet

*This type of diet has the following characteristics: well balanced; soft in texture/consistency; and foods generally tender, finely chopped, ground, or pureed, although very soft whole foods may be tolerated.

-Modify behavior -Exercise regularly -Make wise food choices

*Weight management requires a lifetime commitment to changing lifestyles. The following are required for successful weight management:

-Meets all nutritional needs -Suits tastes/habits -Minimizes hunger, fatigue -Is accessible and socially acceptable -Encourages changes in eating patterns -Favors improvement in overall health

*Weight-reduction diets are required to satisfy the following criteria:

Dental fluorosis

*When teeth appear to have whitish opaque flecks, white or brown staining, or severe secondary, extrinsic, brownish discoloration and varying degrees of enamel pitting, this is a result of:

Small intestive

*Where does the majority of chemical digestion and absorption take place?

Triglycerides

*Which biomolecule consists of a three-carbon glycerol backbone with three attached fatty acids?

Proteins

*Which biomolecule is composed of amino and carboxyl groups with varying side chains?

Monosaccarides

*Which carbohydrate has a linear structure that undergoes oxidation-reduction reactions forming sugar alcohols?

Lactose

*Which disaccharide is found in milk?

-Presence of fermentable carbohydrates -Microorganisms in mouth -Susceptible host

*Which factors are involved in the development of dental caries?

Fructose

*Which monosaccharide is typically found in honey and many fruits?

Fermentable carbohydrates Processed starches

*Which of the following are cariogenic in nature?

Arginine Leucine Lysine Tryptophan

*Which of the following are essential amino acids?

-Genetics -Race or ethnic group -Food selection -Dietary patterns -Income

*Which of the following are important considerations in relation to the host forming dental caries?

Alanine Aspartic acid Cysteine Proline

*Which of the following are nonessential amino acids? Alanine Aspartic acid Cysteine Leucine Lysine Proline

Ovolactovegetarian

-Diet is supplemented with milk, cheese, and eggs. -Only meat, poultry, and fish are excluded. -If adequate quantities of eggs, milk, and milk products are consumed, all nutrients are likely to be provided in sufficient quantities.

Keto acidosis

-build up of ketone bodies leads to acidic state -Rapid breakdown of adipose tissue sometimes along with decreased carbohydrate intake -Uncontrolled diabetes (burning fat rather than carbohydrates)

RDA ◦ Children: 0.9 - 1.8 micrograms per day ◦ Men and women: 2.4 micrograms per day Can accumulate in the liver Serum levels decrease with age due to lower absorption rates No UL established

B12 requirements

AI ◦ Children: 2 - 4mg/day ◦ Men and women: 5mg/day UL has not been established

B5 requirements

Beef liver Eggs Avocado Canned mushrooms Milk Chicken Cooked soybeans Peanut butter Banana Orange Cooked collard greens Potato Cooked broccoli Brown rice White rice Cantaloupe Whole wheat bread Wheat germ White bread

B5 sources

DRI ◦ Based on protein intake ◦ 0.016 mg/gram of protein RDA ◦ Children: 0.5 - 1mg/day ◦ Men 50+: 1.3mg/day ◦ Men over 50: 1.7mg/day ◦ Women under 50: 1.2 - 1.3mg/day ◦ Women 50+: 1.5mg/day UL ◦ 30-100mg/day

B6 requirements

Banana Avocado Hamburger Chicken Fish Potato Collard greens Cooked spinach Brown rice Green peas Walnuts Peanut butter Wheat germ

B6 sources

AI ◦ Children: 8 - 25 micrograms per day ◦ Men and women: 30 micrograms per day No UL has been set

B7 biotin requirements

The body breaks down carbohydrates →monosaccharides transported through the portal vein → to the liver → glycogenesis occurs → end product is stored as glycogen

Carbohydrate metabolism

Minimal level to support brain activity RDA: 130g/day DRI recommendations -AMDR for CHO: 45-65% -Focus on whole grainsm legumes, vegetables, fruits, and low fat dairy

Carbohydrate recommendations

sugar

Carbohydrates are a type of ___

-Nondigestible by the GI tract -Includes polysaccharides, lignin, whole grains, legumes, vegetables, fruits, seeds and nuts -Accelerate intestinal transit time

Dietary fiber

-Root caries are common -Exposed dentin from gingival recession and associated changes in the oral mucosa and periodontium -Changes in teeth and masticatory function affect dietary intake that can alter the risk for caries -Eating more cariogenic foods; foods that are easier to chew -Changes in texture and consistency of foods -Tooth loss -Affects foods eaten, chewing patterns

Elderly caries risk

The body contains between 3 and 5 grams (less than 1 tsp.) of iron, primarily in two forms ◦ Functional form (hemoglobin, enzymes) ◦ Transport and storage forms (transferrin, ferritin, hemosiderin) Most of the body iron is present in blood as hemoglobin

Iron

Men: 16mg/day Women: 14mg/day UL: 35mg/day ◦ For treating clinical deficiency, 40-250mg is considered safe

Niacin requirements

Chicken Salmon Beef Peanut butter Cereal Green peas Potato Brewer's yeast Milk

Niacin sources

Meat, poultry, seafood, dry beans & peas, eggs, nuts, & seeds Important sources of protein, iron and essential trace minerals 5-6.5 ounces/day

Protein

-Lubricates soft tissues -Maintains functional integrity of taste buds -Dissolves food -Antimicrobial -Acts as a buffer to maintain oral pH ◦ Unstimulated = pH: 6.1 ◦ Heavy flow = pH: 7.8

Saliva functions

calcium

Saliva is supersaturated with:

1-1.5L/daily

Saliva production

3,000

Small intestine- 15 feet long - but a surface area of ____ square feet

3-10hr

Small intestive means of transport (____ transit time)

◦ AI - 1500 mg/day ◦ UL - 2300 mg/day for adults ◦ Minimum daily intake 500 mg/day ◦ American Heart Association rec. no more than 2,400mg/day

Sodium requirements

-Fluoridated water -Brewed tea -Ocean fish w/bones (salmon, herring, sardines)

Sources of fluoride

Eggs Dairy Meat Fish Poultry - NOT gelatin

Sources of high quality proteins

Legumes Nuts Grains

Sources of low quality proteins

Meat, milk products, soy -1/4 of the plate 3x daily

Sources of protein

1. cracker- retentive, melts in mouth 2. cookie- has lots of added sugar 3. cookie- retentive while jelly bean is not

Which is worse: 1. caramel or a cracker? 2. cookie or potato chip? 3. jelly bean or cookie?

Folate

Which of the following has an important role in synthesis of RNA and DNA?

Thiamin (B1)

While this vitamin deficiency is seldom seen in patients in the United States, anorexia, heaviness or weakness in the legs, beriberi, and Wernicke-Korsakoff syndrome are all representative of the lack of this vitamin:

proteins turn into...

amino acids

coenzyme

an enzyme that needs vitamins to be activated

glycyrrhiza

anti-cariogenic active ingredient in licorice

-sugar alcohols -nonnutritive sweeteners -protein and fat -phosphorus and calcium -dairy products (casein) -cocoa factor -*glycyrrhiza*

anti-cariogenic properties of food

Nonverbal communication

facial expressions, eye contact, body movements, personal distance, head nodding, vocal cues

Nonheme iron

iron absorption is dependent on the body's need, meal composition and intraluminal composition, comes from nonanimal sources

Heme iron

iron readily absorbed, comes from animal sources

Ketonuria

ketones excreted in the urine

patient's Motivations

lack of time financial resources, health literacy knowledge

Summaries

link and reinforce what has been discussed move the conversation in a new direction tie different elements of the conversation together

Megadoses

very large doses, 10x the DRI or more - are not recommended

coenzymes

vitamin

cofactor

mineral or electrolyte

molybdenum, vanadium, and strontium

minerals that can protect against caries

selenium and lead

minerasls that may promote caries

Fortified

process of adding nutrients not originally present in a food or increasing the amount of a nutrient in a product

Oxidation

process of hydrolyzing triglycerides to enter Krebs cycle for energy production

False: The IOM has established an AI for total fluid requirements to be 15 to 16 cups per day for men and 11 to 12 cups per day for women

T/F: Normal fluid requirements are with 8-oz cups of total water daily

False: Oral pallor is a sign of iron deficiency anemia

T/F: Oral pallor is associated with iodine deficiency

FALSE. Parents CAN pass bacteria from their mouth to their child's mouth.

T/F: Parents *cannot* pass the bacteria from their mouth to their child's mouth.

False: Potassium is principally within the cells (intracellular)

T/F: Potassium is principally found in extracellular fluid

True because it is granulated and fine

T/F: Powdered sugar is more cariogenic than granulated sugar

False: more often in older adults with periodontal disease

T/F: Root caries are frequently seen in adolescents

True

T/F: Starch when eaten w/sucrose is more cariogenic than either one alone

True

T/F: Taste alteration is a symptom of zinc deficiency

True

T/F: The fetus is nourished from the mother's nutrient stores

True

T/F: The first sign of nutritional deficiency ofter occur in the oral cavity

False: The minimum requirement for sodium is 500 mg per day for adults, but no RDA has been established for sodium

T/F: The recommended dietary allowance for sodium is 5000 mg/day

True

T/F: Thiamin requirement is determined by one's energy requirment

True

T/F: Thirst is a primary regulator of fluid intake

True

T/F: To maintain a normal serum calcium level, calcium is obtained from the alveolar process when the patient is in negative calcium balance.

True

T/F: Vegans may be prone to vitamin B12 deficiency

F

T/F: Vitamins supply energy

Dental history

*Knowing how patients perceive or value oral health can assist the dental professional in developing educational strategies. Which part of the history does this fall under?

Grains Vegetables Legumes

*Low-quality proteins support life, but not normal growth. Some sources of low-quality proteins include:

-Hypertension; heart disease -Osteoarthritis -Elevated blood cholesterol or triglyceride levels -Diabetes -Sleep apnea and respiratory problems -Cancers

*Maintaining a healthy weight is a major goal for reducing the burden of illness and its consequent reduction in quality of life and life expectancy. What chronic diseases are associated with being overweight/obese?

Oxidation-reduction Condensation Hydrolysis

*Molecules that have similar functional groups have similar properties. Functional groups in biochemistry can be converted into other functional groups through which of the following processes?

-Balance in food choices -Consuming a variety of foods -Certain foods should be consumed in moderation -Adequate nutrient consumption

*MyPlateis a visual guide for helping people stay healthy by choosing a healthy diet while promoting the concept of healthy food choices. The main message(s) of the plate graphic to consumers is__?

Milk Fruits Vegetables Grains

*Which of the following food groups are dietary sources of carbohydrate?

-Cheese -Cocoa -Cranberries

*Which of the following foods demonstrate anticariogenic properties?

-Amount of carbohydrate unrelated to caries forming potential -Natural sugars are as potentially cariogenic as sucrose -Sugar alcohols are less likely to promote caries -Using a straw with beverages may lessen caries risk

*Which of the following statements are TRUE relating to the role of carbohydrates in the caries process?

Starch

*Which polysaccharide is typically found in cereal grains, roots, vegetables, and legumes?

-Based on body size and rate of growth -Need more for infants, children, and during pregnancy and lactation -Established to be 0.8 g/kg daily for adults -Calculate your daily protein need: ___pounds ÷ 2.2 = ___kg ___ kg × .8 = ___g of protein/day

RDA for protein

-protein, casein (principal protein in milk), phosphorus and calcium in cheese or milk -other elements in milk and milk products have anticariogenic properties except lactose.

noncariogenic dairy products

Prebiotics

nondigestible food ingredients that stimulate the growth or activity of probiotics in the colon, increase mineral absorption from the foods that contain prebiotics

70-100mg/dL

normal blood glucose for nondiabetic

viscous saliva

not as effective as fluid saliva at rinsing the teeth

nonnutritive sweeteners

not metabolized by microorganisms, do not promote caries.

Primary deficiency

nutritional deficiency due to a decreased intake of nutrients

Normal body pH: 7.35 - 7.45 Homeostatic mechanisms for pH balance: ◦ Dilution ◦ Buffering ◦ Lung respiration ◦ Kidney excretion (bicarbonate) Respiratory or metabolic abnormalities may lead to alkalosis or acidosis

pH balance

Dysgeusia

persistent, abnormal distortion of taste

Enriched

products that put back the iron, thiamin, riboflavin, folic acid and niacin that were removed during the processing of the product

3-10

Taste bud turn over approximately every ____ days

peristalsis

The GI tract from the esophagus to the rectum undergoes ____

begin mechanical digestion process

The obvious role of teeth

-Combined effect of the acidogenic medium with sucrose accelerates erosion and caries -Combined use of sugar-free gum and periodic sports drinks may be appropriate

Tooth erosion is associated with prolonged use of sports drinks by athletes

Chloride toxicity

Toxicity usually occurs as a result of dehydration, excessive intake of salt, renal failure, diarrhea & Cushing's syndrome

True- deficiency can resemble an overdose

True or False-A deficiency can resemble an overdose

24-hour-recall

allows the dental professional to collect data on food consumed during a single day

Metabolism

continuous process of living things to convert nutrients into energy, body structure and waste

Lipogenesis

converts glucose to fat

-enamel demineralization begins -pH drop occurs within seconds -can reach 5.5 in a little at 5 minutes -demineralization continues until mouth pH returns to 7.

critical pH 5.5

bacteria + carbohydrate = *acid demineralization*

caries equation

protein & fat

cariostatic b/c they do not lower plaque pH

Secondary deficiency

caused by inadequate absorption, or utilization, increased requirements, excretion, or destruction

Pancreatice Enzymes

hydrolyze carbohydrates, proteins and fats

unsaturated fatty acid

double bond

insulin is a signal for ...

full

liver monitors

glucose levels

Minerals

inorganic elements that have many physiological functions, account for only about 4% of total body weight

Carb Metabolism

insulin is hormone that lowers blood sugar

Protein Metabolism

liver is an aminostate which monitors amino acids, catabolism and anabolism

Lipid Metabolism

liver regulates fat, excess amounts of fats are oxidized ketones=ketosis

Dextrins

long glucose chains split into shorter ones or intermediate products of the digestive enzymes on the starch molecules; produced when you toast bread

Anosmia

loss of smell

Hypogeusia

loss of taste

condensation

makes new molecule

Gustatory

sense of taste

saturated fatty acid

single bond

BMR

sleep age preg/lactation surface area body comp gender endrocine gland temp fasting or starvation

Catabolism

splitting complex substances into simpler substances

glucagon is a signal for

starved

Bioavailability

the amount of nutrient available to the body following absorption

Thermic Effect of Food

the number of kcal needed to digest food

glycosidic bond

two monosaccharides into a disaccharide

Anabolism

using absorbed nutrients to build or synthesize more complex compounds

Collagen

*What connective tissue is present in bones and teeth?

esophagus

No digestion occurs in ___

RDA: Recommended Dietary Allowance:

Sufficient amount of nutrients to meet requirements of nearly all (97%-98%) healthy individuals

6 Major Nutrients:

1) Water 2)Proteins ** 3)Carbohydrates ** 4)Fats ** 5)Minerals 6)Vitamins

-Numeric ranking system for carbohydrates based on immediate effect of food on blood glucose levels -Carbohydrates that have rapid breakdown are at the high end and those that take longer to digest are at the low end

Glycemic index

True

T/F: Masticatory efficiency, or chewing, is a factor in providing a well-structured, alveolar process.

True

T/F: Meats are more than half water

Grain products: wheat, rice ,oats, corn Can be labeled as whole grain, refined, enriched or fortified 5-8oz/day

Grains: Bread, cereals, rice and pasta

True

T/F: Milk is a good source of potassium

three-component model

1. patient behavior must be explored > asking open ended questions 2. guide > inquire about patient's own motivation rather then imposing ideas 3. choose > assist the patient to build an action plan

True

T/F: Milk is a good source of riboflavin

-Sickle cell anemia -Smokers -Those on extremely low-fat diets

Groups at risk for Vitamin E deficiency

-Children of low SES -Chronically ill -Hospitalized patients -Elderly living alone or institutionalized

Groups at risk for protein deficiency

True

T/F: Most women should gain 25-35 lb during a pregnancy

-Elderly -Low income -Strict vegetarians -Uneducated or unwilling to shop for right foods -Chronically ill (cancer, HIV, anorexia)

Groups that may not get enough protein

three step process for delivering information and advice in an MI consistent manner

1.Elicit-enquiring what the pt. already knows 2.Provide-providing relevant information and advice 3. Elicit-checking back with the pt. to see what they have taken from the information or advice provided

-Very rare -Seen in infants given sulfa drugs -The protein, avadin, in raw egg white, binds to biotin and makes it unavailable for absorption -Overconsumption of eggs whites (12-24/day) can result in: ◦ Anorexia, nausea, vomiting, dermatitis, depression, glossitis and pallor -Antibiotics reduce biotin production by intestinal bacteria

Biotin deficiency

Brewer's yeast Beef liver Almonds Cooked soybeans Canned clams Peanut butter Cooked egg Salmon Oat bran

Biotin sources

3

Blood glucose levels peak 30-60 minutes after eating and return to normal about ___ hours later

bacterial

Healthy Immune System Sends an arsenal of defense organisms to limit ___ attack

phospholipid

The molecule that has a polar phosphate group and two fatty acid tails is called a _____ molecule.

Vitamin E

The most important fat soluble antioxidant

Water

Deficiency-Dehydration and fragility of epithelial tissue; decreased muscle strength for chewing; xerostomia; burning tongue

1. presence of specific bacteria (S. mutans and lactobacillus species) 2. Susceptible tooth structure (already compromised by demineralization, acid attack) 3. Carbs in the diet 4. Salivary gland function (flow, composition)

4 factors affecting caries

Vitamin K

Deficiency-Increased risk of bleeding and candidiasis

Fat soluble v. Water soluble

Fat can be stored in larger amounts by body A and D stored for longer periods A can be stored for 1 year deficiency not noticed until in an advanced state

Panthothenic acid (B5)

A deficiency of this vitamin is rare; however, symptoms include burning feelings of the feet, depression, fatigue, insomnia, and weakness. This vitamin may help wound healing, so encouraging patients who are undergoing oral or periodontal surgery to eat a well-balanced diet is encouraged. What is this vitamin?

immune system

A diet deficient in vitamins A, C, D, calcium, protein, and complex carbohydrate can weaken the _____ and complicate or worsen the disease process

Catabolism

Fat oxidation Krebs cycle

Complete protein/High quality protein

A food with all the essential amino acids present Able to maintain nitrogen balance & permit growth

Nitrogen balance

A measure of how much nitrogen is in the body at the present time. The amount of nitrogen taken = amount excreted

1. Helps maintain acid-base balance of body fluids 2. Major anion of gastric juice 3. Lung function depends on chloride ion exchange during oxygen and carbon dioxide exchange

Fluoride functions

Alcohol Metabolism

7 kcal/g, metabolized by the liver

Teeth and bones

99% of calcium is found in:

Requirements: ◦ AI is 2,300 milligrams/day 2,000 mg/day ages 50-70 1,800 mg/day 71 & older ◦ UL is 3,600 milligrams/day

Fluoride requirements

progression

Overall nutritional status of an individual can secondarily affect the host susceptibility and influence disease _____

Niacin (B3)

A new patient from Latin America presents in your office. During the medical/dental history, the patient reports a diet that is heavily corn based. This person also has a strikingly rough, reddish, hide-like appearance to their skin, and reports having been tired and depressed. During initial oral inspection, the following signs/symptoms were observed:A. Nonspecific burning sensation through the oral cavity B. Smooth, shiny, bright-red tongue swollen at the tip and lateral margins C. Stomatitis; red and inflamed marginal and attached gingivaWhich B vitamin might this person be deficient in?

Pyridoxine (B6)

A patient presents for treatment. She is a woman of childbearing age and uses oral contraceptives. She reports primarily eating a vegetarian diet. Deficiency-induced glossitis is noted, accompanied by pain, edema, and papillary changes. The patient reported that initially her tongue had a scalded sensation, followed by reddening and hypertrophy of the filiform papillae at the tip, margins, and dorsum. The vitamin deficiency most likely causing these oral complications is?

Riboflavin (B2)

A patient presents with burning, itchy eyes, loss of visual acuity, dermatitis, glossitis, and angular cheilosis. Which B vitamin might be lacking in their diet and contributing to these symptoms?

single bonds

A saturated fatty acid has only _____ in its structure

Large intestine

About 1/20 of the food you eat ends up in the _____

Alimentary canal

About 30 feet long Lined w/mucous membrane Mouth - rectum

microvilli

Absorbable nutrients pass through the ____

-Absorption regulated by hormones (parathyroid, estrogen, glucocorticoids, thyroid) -Best absorbed when consumed in smaller amounts and ingested several times during the day Factors decreasing absorption: -Oxylates and phytates in grains, vegetables -Reduced gastric acidity -Excessive fiber -Low-protein, low-phosphorus diets

Absorption: Calcium

-Carrier systems require energy, e.g., intrinsic factor -Pumps require energy, e.g., absorption of glucose, Na, K, Mg, P, I, Ca, Fe, and amino acids -Pinocytosis: engulfing of small drops of intestinal contents -Allows for absorption of whole proteins, such as immunoglobulins in breast milk

Active transport

Dietary reference intakes Maximal intake 25% of energy intake As intake of added sugars, intake of vitamins A, Fe+, Ca, Zn Age groups most likely to exceed 25% are 9-18 year olds Americans consume 30tsp of added sugar daily!!!

Added sugar

Bolus

After food is chewed

96% of human body is made up of:

Oxygen Carbon Nitrogen Hydrogen

Supplies 7 kcal/g of energy Metabolized by the liver Has effect on blood pressure & risk of hypertension When alcohol is present, it is oxidized instead of fat. This can cause lipid accumulation in the liver. In addition to liver damage, alcohol can interfere with the transport, activation, and catabolism of almost every nutrient. Quickly appears in the bloodstream Oxidized at a rate determined by concentration and activity of liver enzymes Alcohol abusers at risk for poor nutrition Body oxidizes alcohol instead of fat that may result in a build up of lipids in the liver Too much alcohol + a balanced diet = weight gain Too much alcohol + unbalanced diet = appetite suppression and weight loss Alcohol interferes with the transport, activation, catabolism, and storage of almost every nutrient

Alcohol metabolism

sweet

All carbohydrates are not ____ like table sugar

sugars

All foods and beverages that contain _____ have the potential to cause dental caries

-Act as gatekeepers -Allow food to adequately mix with digestive juices -Regulate amount of food in each segment -Prevent food from backing up into the area that it came from

Along GI tract - sphincter valves

Carboxyl group - COOH Amino group - NH2 Radical group = a side chain which can have a combination of carbon and hydrogen

Amino acids (the basic building blocks of protein), are composed of:

EAR: Estimated Average Requirement

Amount of a nutrient estimated to meet the needs of half of the healthy individuals in a specific age and gender group (used for group situations)

Iodine

An imbalance in this nutrient can result in the following: delayed eruption of primary and secondary teeth, enlarged tongue, stillbirths, altered craniofacial growth, sensitivity to cold, dry skin, depression, and goiter.

double bond

An unsaturated fatty acid has at least one or more ____

K

Antibiotic therapy inhibits vitamin ____-producing intestinal microflora

Dentition status

Approximately 75% of people retain all or most of their natural teeth Education level is the strongest determinant of tooth loss Compromised nutritional intake may be a result of: Tooth loss Tooth mobility Edentulous status Discomfort from removable appliances Edentulous have decreased chewing ability Number of teeth and presence of advanced mobility determine food choices

Vitamin Facts

Are catalysts for all metabolic reactions using protein, fat and carbs for energy without vitamins, energy from proteins, fats, energy could not be used vitamins come in a variety of forms and preform different tasks vital for life, only need small amount either can't be produced by body or can't be produced in adequate amounts

Vitamin B1 (Thiamin) Vitamin B2 (Riboflavin) Vitamin B3 (Niacin) Vitamin B6 (Pyridoxine) Folate Vitamin B12 (Cobalamin) Biotin Pantothenic Acid

B complex vitamins

thiamin, riboflavin, niacin

B vitamins needed for Krebs cycle:

-Lean meats and poultry -Whole grain or enriched breads and cereals -Egg yolk -Average US intake 2 mg/day

B1 sources

Seldom seen in US because of enriched grains in foods, except in alcoholics ◦ Seen predominantly in countries using refined, polished rice as major dietary staple Early symptoms ◦ Anorexia, indigestion, constipation ◦ Malaise ◦ Heaviness and weakness of legs -Calf muscle tenderness -Increased pulse rate and palpitations Beriberi (I cannot) ◦ Peripheral neuropathy and muscle wasting ◦ Cardiovascular symptoms include tachycardia and enlarged heart -Wernicke-Korsakoff syndrome ◦ Mental confusion -3rd leading cause of dementia in US ◦ Nystagmus (involuntary rapid movement of the eyeball) ◦ Ataxia (a gait with uncoordinated muscle movements) ◦ 50-100 mg/day commonly prescribed for recovering alcoholics

B1/Thiamin deficiency

sIgA levels

In malnourished children, ______ levels are depressed. sIgA is the predominant antibody in oral, nasal, intestinal and other mucosal secretions. It provides the first line of defense in the oral cavity. Low sIgA levels probably play a role in their increased susceptibility to mucosal infections.

Primary deficiency from: lack of intrinsic factor, R-binder or an enzyme needed for absorption of B12 Inadequacy can result from: ◦ Lack of stomach acid (achlorhydria) ◦ Interference with absorption, as in intestinal surgery ◦ Insufficient dietary sources -Dietary deficiency is rare, but may occur in those following a strict vegan diet over a prolonged period Symptoms: ◦ Impaired neurological function, confusion, gait disturbance, position sense impairment, absent ankle reflexes, reduced erythropoiesis Pernicious anemia- or Macrocytic (megaloblastic) anemia ◦ Occurs due to achlorhydria and decreased synthesis of intrinsic factor

B12 deficiency

-Coenzyme with folate metabolism in nucleic acid synthesis -Catabolism of amino acids & fatty acids -Essential for making RBC -Essential for myelin sheath synthesis

B12 functions

Beef liver Canned clams Canned oysters Tuna Yogurt Nonfat milk Halibut Egg Chicken Cheddar cheese

B12 sources

voluntary

Bolus passes into the pharynx under _____ control. Process then becomes involuntary

-Calcified structures- bones and teeth -Collagen & bone undergo constant remodeling -Organic matrix of bone is 90%-95% collagen fibers -Formation of collagen requires protein, vitamin C, iron, copper, and zinc -Once collagen is formed, mineralization begins -Calcium, phosphorus, magnesium, sodium, potassium, and carbonate ions form mineral matrix -Calcium reserve: 0.4%-10% of total bone calcium in shapeless (amorphous) form

Bone Mineralization and Growth

Mechanical actions

Break up and mix foods, permitting better blending with chemicals Chewing Peristalsis Sphincter muscles

first

Building healthy oral tissue and keeping it healthy is the body's _____ line of defense against periodontal disease

-Bone health -Blood clotting -Transmit nerve impulses -Muscle contraction and relaxation -Membrane permeability -Activate certain enzymes -Salivary calcium acts as buffer

Calcium functions

Caloric Value of Liquor: __oz of drink × ___proof × .8kcal/proof/1oz = __kcal Caloric Value of Beer & Wine ___oz of drink × ___% of alcohol × 1.6= ____kcal

Calculation of Energy Value of Alcohol

Per Serving: Grams of Carbs - Grams of Fiber = Actual Total Carb per serving x 4kal/gram= Total Calories from Carbs

Calories from Carbohydrates

-Pts with xerostomia need to be counseled about eating and drinking habits to maintain adequate nutrition levels -Denture patients should be monitored for eating habits for the same reason -Assess nutritional status of patients with gustatory, masticatory, swallowing, or olfactory disorders for changes in dietary habits (can lead to anorexia) -Monitor quality and quantity of food intake for patients with difficulty chewing and swallowing food -Lactose intolerance can create problems with bone density -Watch for signs of chronic vomiting or reflux -Can result in sensitive teeth and superficial or deep tooth erosion especially on lingual and occlusal surfaces

Clinical considerations

increased

Constant trauma = Immediate tissue needs for nutrients are ____ in the oral cavity

vulnerable to malnutrition

Continuous renewal process makes the sense of taste particularly _________

cariogenic

Crackers, cookies, potato chips are more ____ than caramels and jelly beans

Requirements: ◦ AI of 4700 milligrams/day for all adults ◦ No UL has been set ◦ Approx 80% of potassium is excreted in the urine

Potassium requirements

nucleic acids

DNA-RNA-Protein have phosphate group, sugar attached to nitrogenous base

declines

Decreased ability to taste and/or smell food can cause major ____ in appetite and ultimately to malnutrition

◦ Gingiva ◦ Mucosal linings of cheeks, lips, soft palate ◦ Papillae: filiform, fungiform, foliate, circumvallate ◦ Epithelium of tongue, hard palate, gingiva

Deficiencies of B, C, K, Fe+, and protein can present oral changes affecting:

Vitamin A

Deficiency of this vitamin during preeruptive stages of tooth development leads to enamel hypoplasia and defective dentin formation. It is also involved with normal teeth spacing and promotes osteoblast function of the alveolar bone

Vitamin D

Deficiency of this vitamin results in loss of lamina dura around the roots of teeth

Total estimated energy requirement — Essential calories Discretionary calories* may be used to: -Increase amount of food selected from a food group -Consume foods that are not in the lowest fat form—such as 2% milk or items that contain added sugars -Add oil, fat, or sugar to foods -Consume alcohol (for those who consume alcohol)

Discretionary calories

-Electrolytes -Minerals (Fe, Ca, Mg, Zn)

Duodenum absorbs:

A, E, D, and K

Fat soluble vitamins

carbohydrates

Fats and proteins do not cause rise in blood sugar levels like _____

-Improves fecal bulk -Can accelerate (dietary or functional fiber) or decrease (viscous fiber) colonic transit rate -In the past was divided into soluble and insoluble -Now divided into Dietary Fiber and Functional Fiber -Stool softening (prevents constipation)

Fiber

AI for fiber intake -Men 19-50 yr: 38 g/day -Women 19-50 yr: 25 g/day How much fiber? -Apple (4 g) -1½ cups salad greens (2 g) -1 slice white bread (0.5 g) vs. 1 slice whole wheat bread (2 g) -½ cup cooked beans (7.5 g)

Fiber recommendations

Encourage nutrient-dense eating choices Intake of adequate fluids Discourage strict weight loss diets Minimize intake of caffeine, alcohol MyPlate for Moms provides individualized guidance Repletion of iron stores may be necessary Continued avoidance of medications, OTC drugs, and herbals

Lactation: Dental Hygiene Interventions

Taste Smell Reaction to irritants Texture Temperature Color and appearance ...all working together

Flavor is determined by:

Nervous system ◦ Sends thirst signals to the brain Kidneys ◦ Conserve or excrete water Cardiovascular system ◦ Modulates the volume of fluid transferred Hormones (renin, vasopressin, aldosterone) ◦ Modulate retention or excretion of K+ and H+ ions causing blood pressure to rise or fall -Water is lost via a variety of routes 1. Urination 2. Perspiration 3. Expiration 4. Defecation -When as little as 2% of body water is lost, osmoreceptors are stimulated, creating a physiological desire to ingest liquids -Osmoreceptors (neurons in hypothalamus) are stimulated when serum water levels change→sensation of thirst→release of ADH (antidiuretic hormone) from the pituitary gland→body retains fluid -Excess of serum water causes ADH inhibition

Fluid balance mechanisms

Dehydration ◦ Thirst is first sign Hypodipsia (decreased thirst) Characteristic Signs of Prolonged Dehydration: ◦ Weight loss ◦ Confusion ◦ Fatigue ◦ Sunken eyes ◦ Hypotension ◦ Orthostatic hypotension

Fluid volume deficit

-Forms *fluorapatite*, which is more caries resistant -Systemic fluoride results in changes to tooth morphology; *increases tooth's resistance* to adherence of plaque biofilm -Fluoride in saliva also *interferes with demineralization* -Higher concentrations of fluoride *inhibit* Streptococcus mutans, Streptococcus sobrinus, and Lactobacillus species -Stimulates *osteoblast proliferation* and increases *new mineral deposition* in cancellous bone

Fluoride

No known metabolic function -Benefits to dental and bone health Fluoride ions can *replace hydroxyl ions* in the hydroxyapatite crystal lattice = more resistant to caries -Natural element found in all drinking water and soil -Present in trace amounts in the body -Deposited in calcified structures of the body (bones and teeth) -Body content depends on intake *Not essential for overall health*- important for dental health

Fluoride

-Fluoride supplements may be indicated for children without access to fluoridated water -Concentration of fluoride in *breast milk* is very low -There is little indication that the use of fluorides prenatally will confer meaningful systemic benefits to the developing fetus

Fluoride Supplementation

stomach

Fluoride absorption occurs in the ____

RDA Men: 90 mg/day Women: 75 mg/day *Smokers +35 mg/day* UL - 2 g/day

Requirements : Vitamin C (Ascorbic Acid)

-Provide vitamins, minerals, and other beneficial substances and relatively few calories without • Solid fats in the food or added to it • Added sugars • Added refined starches • Added sodium -Retain naturally occurring components, such as dietary fiber -All vegetables, fruits, whole grains, seafood, eggs, beans and peas, unsalted nuts and seeds, fat-free and low-fat dairy, and lean meats and poultry when prepared without solid fats or sugars

Nutrient-dense foods and beverages:

small intestine

Nutrients leach out from the ______________ into the blood stream travelling to all parts of the body supplying it with fuel and the nutrients needed for metabolic processes.

90% of all foods required to have a label Added in 2012: ground, whole, raw, chopped meat and poultry Labels can be confusing when comparing two different sizes of the same product Contain nutrient content and health claims Ingredients listed on a product give some insight FYI: 4 grams of sugar = 1 teaspoon A product's nutrient profile is based on the percentage of Daily Reference Values (DRV) that are levels of nutrients considered desirable for health Daily reference values Based on 2000-calorie diet % DV helps determine if a serving of food is high or low in a nutrient

Nutrition labels

alter

Nutrition may ___ development, resistance and/or repair of the periodontium

◦ Flow ◦ pH ◦ Consistency

Nutritional deficiencies/toxicities affect saliva's:

Protein digestibility corrected amino acid score (PDCAAs)

Official method of evaluating protein quality for people

-Preventive oral care is important for the mother and the fetus -Nutritional requirements are increased during pregnancy, lactating and breastfeeding -Vomiting, acid reflux and pica may occur during pregnancy and negatively affect the oral cavity -Oral contraceptives may interfere with nutrient absorption -Hormonal changes during menopause affect nutritional status

Pregnancy summary

Bile

Presence of ____ is required for Vitamin K absorption

high, low

Prevalence is ________ in develop*ed* countries, and ________ in develop*ing* count

Chemical actions - Enzymes

Reduce foodstuffs to absorbable molecules

large intestine

Remnants of food that didn't digest become waste and move on into the _______________. Water is absorbed from the waste.

Phosphorus

Second most abundant mineral in the body; about 85% in the skeleton and teeth

1 bagel: size of a CD Medium apple: size of a tennis ball ¼ cup of dry fruit: size of a golf ball 1 cup of vegetables: size of a fist 1 oz of cheese: size of 2 dominos 2 Tbsp peanut butter: size of a ping-pong ball 3oz meat: size of a deck of cards

Serving sizes

Flexitarian

Self-described vegetarians, not true vegetarians, occasionally eat fish and poultry

trigeminal

The ____ nerve branches running between the brain, nose, and mouth detect irritants such as hot chili, pepper, mint and carbonation

electrolyte

The body's hydration status depends on ___ balance of equal amounts of cations and anions

flavor

The chemical arrangement of the carbohydrate determines the ___

hydrophobic

The fact that lipids don't like water is known as ____

wax

The feathers and fur of penguins and polar bears are covered with a type of lipid called ____

chyme

The food bolus, along with the enzymes, bile, and acids have become a mixture called ____ which continues on into the small intestines.

Cobalamin (B12)

The lack of which B vitamin is associated with development of pernicious anemia, glossopyrosis, glossitis, and cheilosis?

Other nutrients needed in larger quantities while breastfeeding than during pregnancy include vitamins A, E, C, riboflavin, B6, and B12, and the minerals copper, zinc, iodine, and selenium.

What vitamins are needed in larger quantities for lactating women than during pregnancy?

to investigate the *relationship* of sugar to caries, the *form* of sugar, the effect of chocolate on caries, and the *frequency* of eating sugar and the effect on caries

What was the purpose of the Vipeholm study?

when the rate of *de*mineralization *exceeds* the rate of *re*mineralization over an extended period of time

When does a carious lesion occur/result?

ketones

When too much fat is oxidized the liver is overwhelmed and ____ are formed

monosaccharides and disaccharides

Which "saccharides" are the most cariogenic?

-Normal growth, development, wound healing, sexual maturation, fertility, reproduction,and immunity -Synthesis of DNA, RNA, and proteins -Antioxidant activity -Night vision, taste and smell sensitivity -Bone growth & mineral metabolism -Zinc containing enzymes important in collagen synthesis and bone resorption & remodeling

Zinc functions

◦ Vomiting and diarrhea ◦ Epigastric pain ◦ Lethargy ◦ Fatigue ◦ Renal damage ◦ Pancreatitis ◦ Death ◦ Reduces copper status ◦ Alters iron function ◦ Decreases immune function ◦ Decreases high-density lipoprotein (HDL)

Zinc hyperstates

◦ Thickening of epithelium ◦ Impaired keratinization of epithelial cells ◦ Increased susceptibility to periodontal disease ◦ Flattened filiform papillae ◦ Loss of taste and smell acuity ◦ Poor appetite ◦ Impaired wound healing ◦ Cleft palate and lip Groups at risk of deficiency -Those whose zinc requirements are relatively high (such as during periods of rapid growth) -Older adults -Vegans -Severe malabsorption (diarrhea) or other chronic health problems

Zinc hypostates

DRI ◦ Males: 11mg/day ◦ Females: 8mg/day UL ◦ 40mg/day Requirements are higher for vegans because most zinc from meat sources. Zinc supplements interfere w/utilization of iron & copper, adversely affects HDL levels 25 - 40% of zinc is absorbed from a mixed diet

Zinc requirements

Oysters Organ and muscle meats Dark meat of poultry Eggs Dark green and deep yellow vegetables Peanuts

Zinc sources

Lysozyme

___ begins to break down the cell wall of ingested bacteria

hydrolysis

breaks up molecule by adding water

-bacteria that use dietary sugars as an energy source, produce acid, and are associated with caries development -*not all acidogenic bacteria are cariogenic*

acidogenic bacteria

Insulin

a hormone that lowers blood glucose levels

Biological value

a measure of 1-100 of how well proteins from a food can be converted into body proteins

secretory leukocyte protease inhibitor (SLPI)

a protein in saliva that has antiviral, anti-fungal, and antibacterial properties

motivational interviewing (MI)

a respectful, collaborative conversation about change. a patient-centered counseling style for addressing the common problem of ambivalence about change. used to explore ambivalence or pros and cons of change that the patient sees

Diet History

a review of usual patterns of food intake and various factors that determine food selection

Essential

a substance that is not synthesized by the body in a quantity sufficient for normal health and growth

Pica

abnormal consumption of specific foods or nonfood substances (paint chips, dirt, clay)

AMOR

acceptable macronutrient distribution range...sufficient intake of fat, carb, protein, 2 polyunsaturated fatty acits

Ketones

acidic metabolic products that are formed when excessive amounts of fat are oxidized for energy. They are not oxidized in the liver, but carried to the skeletal and cardiac muscles, where under normal circumstances, they are rapidly metabolized

Food Diary

based on 3-7 days including a weekend day most effective method of obtaining dietary information

Nutrients

biochemical substances that provide energy, supplied only in adequate amounts from an outside source

Basal Energy Expenditure

calories needed to maintain BMR, thermal effect (digestion), voluntary movement, catabolic and anabolic reactions all within 24 hours

follow up

can be used to listen, reassess the plan, identify new needs, and formulate new goals

calcium and phosphate

can repair demineralized areas

Overall goal of diet history

determine usual dietary habits individualize recommendations and suggest minor changes improving the dietary quality

EER: Estimated Energy Requirement

dietary intake that will maintain energy balance in healthy normal weight individuals of a defined age, gender, weight, height and physical activity level

hypothalamus

feeding center

antioxidants

prevent oxidation which helps prevent food from going bad

glycemic effect

rate at which glucose rises in the blood stream after food is eaten

Liver

regulates fat metabolism

-Chloride, bicarbonate, and phosphate -Principal anion in plasma and interstitial fluid is chloride -Important in water balance and acid—base (pH) balance

◦ Anion (negative charge)

Retinoic acid

_____ is the most biologically active form of Vitamin A

Water

_____ is the vehicle for dispersing electrolytes throughout the body

Fat soluble

_____ nutrients transported into the lymphatic system which takes them to the left subclavian and internal jugular vein

Cooking

_____ proteins sometimes makes them more easily digested and used

Rectum

_____ stores the feces until our brain gets the. signal to eliminate it

Water soluble

______ nutrients transported through the portal vein directly to the liver (enter portal circulation)

Mucin

____________ from saliva mixes with food to make it easier to begin the journey into the pharynx and esophagus

Taste

_____________ is the only sensory system, with the exception of pain, that is fully developed at birth

Hypergeusia

heightened taste perception

"westernization"

higher sugar consumption; results in increased caries incidence

Diabetes

insulin lowers blood sugar TYPE 1-no insulin production TYPE 2-insulin resistance African Americans, Hispanics, Native Americans are more prone need to monitor blood sugar, healthy diet, and medications to regulate (insulin shots)

Kidneys do...WHAT?

removes waste from blood, along with liver controls level of nutrients in the blood, filters and reabsorbs

AMDRs: Acceptable Macronutrient Distribution Ranges

sufficient intake levels of essential nutrients -Macronutrients, fat, carbohydrates, protein, two polyunsaturated fatty acids

-fermented slower than mono & disaccharides -buffering effects of saliva neutralize destructive acids produced by plaque biofilm -*oral flora do not contain enzymes to ferment xylitol* - inhibits S. mutans

sugar alcohols

AI: Adequate Intake

the average amount of a nutrient that appears to maintain a defined nutritional state

cariogenic bacteria

-bacteria capable of causing caries (Strep mutans, Strep sobrinus, and lactobacilli)

1/4

*According to the MyPlate guidelines, approximately what percentage of the plate should hold protein?

25

*An upper limit of healthy weight for healthy Body Mass Index (BMI) typically is?

80-90%

*Approximately what percentage of fluid is absorbed through the small intestine through osmosis?

Vitamin A Vitamin B12 Copper Zinc Niacin Nickel

*Assessment of patients for possible dietary deficiencies is important. What dietary deficiencies could result in gustatory abnormalities?

Molecular

*Biochemistry focuses study of life on which level?

Carbohydrates Proteins Lipids

*Biomolecules are produced by living cells or organisms. Biomolecules include:

Enamel hypoplasia

*Deficiencies of vitamin A during oral development may result in the following:

Carbohydrates

*During metabolism, what is the body's preferred fuel?

Muscle loss Psychological disorders Malnutrition Metabolic imbalances

*Effects of inadequate energy intake may include:

Kilocalorie intake equals amount of energy needed for body processes and physical activity

*Energy balance is maintained when:

-Amount of nutrients consumed -Physiological need -Condition of digestive tract -Level of circulating hormones -Presence of other nutrients/drugs that may enhance/interfere with absorption -Presence of amount of digestive enzymes

*Factors affecting digestion and absorption that are as important to nutritional status as adequate intake include which of the following?

Water-soluble vitamins function as coenzymes

*Fat- and water-soluble vitamins differ in the following ways:

Protecting consumers from false or misleading claims

*Food labels cannot include either an explicit or implied nutrient content claim unless it uses specific terms defined by the FDA. The purpose of this requirement is:

-Metabolic diseases -Disruption of tissue repair -Vitamin deficiencies -Etiological factors

*Gingival diseases may be indicators of what other health factors?

-Provides energy to cells -Principle product produced by the breakdown of disaccharides and polysaccharides -Transported through body via the bloodstream for nourishing all cells

*Glucose can be used by the body for which of the following processes?

-Buffers by neutralizing acids -Increases salivary flow

*How does saliva provide protection against caries formation?

-Patients dietary intake must be adequate -Assessment by an RD for medically compromised patients -Recommendation of nutritional supplements or multivitamins -High-protein, high-kilocalorie fluids or semi-solid foods

*If a patient's case indicates the need for periodontal surgery, what nutritional elements are important for optimizing healing and preventing or minimizing infections?

Phosphorus deficiency

*Incomplete calcification of teeth, failure of dentin formation, and increased susceptibility to caries may be the result of:

-Development of disease -Severity of disease -Repair of the periodontium

*Indirectly, nutrition may alter __ in periodontal disease?

Teeth Salivary glands Periodontium

*Insufficient intake of protein affects which oral tissues?

-Break down substances human enzymes are unable to digest -Synthesize vitamins required by humans -Boost the immune system, providing protection against infection -Inhibition of pathogenic bacteria

*Microflora living in the large intestine have several important roles. What are these roles?

Magnesium

*Neuromuscular dysfunction, personality changes, disorientation, muscle spasms, seizures, tremors, anorexia, nausea, apathy, and cardiac arrhythmias are all symptoms of a lack of which mineral?

-Nutritional deficiences -Poor healing -Fecal impaction

*Nutrients may not be absorbed as a result of alterations in digestion and absorption if the alimentary tract is not functioning properly. This can result in what outcomes for patients?

-Assuring enough vitamin C in diet -Intake of nutrients beyond recommended daily amounts -Assuring sufficient amounts of vitamin D -Assuring sufficient amounts of calcium and phosphorous

*Nutritional status impacts recovery from periodontitis. Patients can enhance recovery dietarily by:

4 grams

*One level teaspoon of sugar is equivalent to how many grams?

Obesity Fluid imbalances Increased risk of CHD and stroke

*Overconsumption of protein may result in which health effects?

-Recommendation of consumption of milk, yogurt, or cheese -Consume sugar in moderation and with meals -Brush teeth after eating, or chew a xylitol, sorbitol or xylitol-sorbitol chewing gum -Rinse mouth with water after consuming acidic beverages

*Patient recommendations concerning carbohydrate consumption to reduce risk for dental caries formation might include which of the following?

Psychosocial history

*Personal, environmental, or economic influences can imply nutritional problems. Which part of the history is used for gathering this information?

Tissue generation and repair Collagen production Fluid regulation Disease resistance

*Proteins are an essential part of the diet and perform important physiological roles, including:

Amine group

*Proteins are composed of amino acids. Biochemically, what is the distinguishing feature of amino acids?

-Laxation effect -Normalization of blood lipid concentrations -Attenuation of blood glucose response

*Roles of dietary fiber include the following:

Vitamin C

*Scurvy, the oral disease characterized by spontaneous gingival hemorrhaging, perifollicular petechiae, follicular hyperkeratosis, diarrhea, fatigue, depression, and cessation of bone growth is caused by a deficiency of what vitamin?

Meat Fish Milk

*Some sources of high-quality proteins include:

Excessive calcium intake

*Symptoms including dizziness, flushing, nausea or vomiting, constipation, kidney stone formation, irregular heartbeat, tingling sensations, xerostomia, fatigue, and high blood pressure may be the result of:

Sweet Salty Sour Bitter

*Taste buds are essential for maintaining food intake for meeting physiological needs. The four basic taste sensations interpreted include:

Developing rapport Encouraging patients Being nonjudgmental and noncritical Active listening Appropriate nonverbal communication

*Well-developed interpersonal communication skills should be able to help patients relax and feel more comfortable revealing accurate information while cooperating to working toward a goal. What skills are important to develop in achieving good facilitative communication skills?

-Decrease demineralization -Increase salivary flow -Enhance remineralization -Buffering salivary effects

*What are characteristics of foods having noncariogenic or cariostatic properties?

-Monosaccharides -Disaccharides -Polysaccharides

*What are the major types of carbohydrates the body uses?

-Motivate and encourage patients to make positive behavioral changes -Provide accurate, evidence-based information

*What are the purposes of nutritional education during dental hygiene patient care?

energy input reduction of metabolites biosynthesis of complex biomolecules to simple precursors

*What are the three characteristics of anabolism?

Nucleic acids

*What biomolecule is responsible for storage and transfer of genetic information?

-Soft foods -Retentive foods -Moist foods

*What does a mechanically altered diet consist of?

-Enough information to determine nutritional status -Provides information alerting provider to nutritional factors impeding response/recovery -Identifies level of patient readiness for treatment acceptance

*What does the assessment of patients' nutritional status provide the dental professional?

Stimulate salivary flow Reduce food retention

*What effects do chewing firm, coarse, or fibrous foods have on periodontal health?

Systemic and oral effects

*What effects does poor nutrition play on the periodontium?

Age Surface area Pregnancy and lactation, State of health

*What factors affect basal metabolic rate?

-Cariogenic potential -Physical form -Timing of consumption -Preventive practices

*What factors influence cariogenicity other than amount and type of carbohydrate consumed?

Smoking & alcohol use Stress Rapid growth Health status Age and gender

*What factors may modify an individuals' dietary reference intake (DRI) for various amounts of vitamins?

Vitamins and minerals

*What is required for the metabolism of carbohydrates, proteins, and fat?

Urea

*What is the major waste product of protein catabolism?

-Identify health-related considerations -Identify medications that may place a patient at nutritional risk -Identify medications that may place a patient at health risk -Provide a foundation for developing a treatment/dietary education plan

*What is the primary purpose of reviewing and gathering health history data?

Set a concrete standard for change

*What is the purpose of goal setting for changing behaviors?

-Interferes with demineralization -Produces acids with harmful properties -Composition is altered as it matures -Decreases oral pH

*What is the role of plaque biofilm in caries formation?

Carbohydrates Proteins Fats

*What macronutrients are used by the body for supplying physiological energy?

Glucose, fatty and amino acids

*What micronutrients are used by the body for supplying physiological energy?

Protects integrity of cellular membranes

*What physiological role does Vitamin E play in the body?

Blood clotting, transmission of nerve impulses, muscle contraction, and relaxation

*What physiological role does calcium play in the body?

No known metabolic function, caries-preventing properties

*What physiological role does fluoride play in the body?

Calcium homeostasis; structural integrity of heart muscle

*What physiological role does magnesium play in the body?

ATP energy release; metabolism of fats, carbohydrates, proteins; regulates acid-base balance

*What physiological role does phosphorus play in the body?

Transcribing DNA to RNA

*What physiological role does vitamin A play in the body?

Collagen production for wound healing

*What physiological role does vitamin C play in the body?

Absorption and regulation of calcium

*What physiological role does vitamin D play in the body?

Catalyst for synthesis of blood clotting factors

*What physiological role does vitamin K play in the body?

Amino acids

*What product is primarily catabolized in the liver, even with metabolism occurring to some extent in kidney and muscle?

-Discuss role of diet in caries formation and progression -Consider application of sealants

*What recommendations should a dental hygienist consider making to patients about preventing caries formation?

-Soft foods -Retentive foods -Fermentable carbohydrates

*What types of foods exacerbate initiation or progression of periodontitis when plaque biofilm is present?

Secondary deficiency

*When adequate amounts of vitamins are unavailable to sustain biochemical functions, nutritional deficiencies occur. The result of inadequate absorption or use is known as:

-Caries Management by Risk Assessment (CAMBRA) -Goals -Education

*When developing a dental plan, nutritional information is an essential component of the preventive treatment plan. What steps are required to be complete in developing a dental plan incorporating steps for caries prevention?

Clinical Observation: Physical appearance Clinical Observation: Anthropometric evaluation Diet Diet History: Food diary Laboratory testing

*Which type(s) of assessment(s) might be best used for a patient who demonstrates gait and posture irregularities, appears to be extremely overweight, and reports not eating much?

Clinical Observation: physical appearance Clinical Observation: Extra/Intraoral assessment Diet History: Food diary Laboratory testing

*Which type(s) of assessment(s) might be best used for a patient whom seems underweight, while having excessively dry eyes, cracked fingernails, and multiple bruises combined with pallor?

-Treatment plan may be detrimental to patient's overall health -Provides a comprehensive picture -Provides for effective education

*Why is a comprehensive medical history, including health, social, and dental histories, important for patient evaluation?

Lactovegetarian

-Dairy products are consumed in addition to plant proteins. -Meat, poultry, fish, and eggs are excluded. -Milk and cheese products which complement plant foods and enhance the amino acid content are included.

Diseases Associated With Poor Nutrition

-Diabetes -Cardiovascular disease -Hypertension -Dental caries -Obesity -Cancer: Colon, Breast, Reproductive, Many others

Hormones

-"messengers" produced by a group of cells that stimulate or retard the function of other cells. -control different metabolic functions that affect growth and secretions.

Vipeholm Study

-1945 to 1953 -involved 436 residents at a mental institution in Vipeholm, Sweden placed on basal diet

Mechanical digestion

-Begins w/biting and chewing food -Smaller food pieces provide more surface area for digestive enzymes to function -Mucin from saliva allows food to stick together into a bolus; lubricates the mass for swallowing

Nonessential amino acids

-Can be made in the body from essential amino acids, are essential for the body -Are made only under the right conditions (nitrogen present, enough calories present)

Ovovegetarian

-Diet consists of protein foods from plants with the addition of eggs. -Meat, poultry, fish, and dairy products are excluded.

Destruction of thiamin

-Enzyme in raw fish, thiaminase, destroys thiamin ◦ Cooking deactivates thiaminase -Baking soda when added to cooking water -Overcooking & high temperatures -Antacids reduce utilization of thiamin -Some diuretics increase excretion

Protein energy malnutrition: (PEM)

-Excessive protein losses -May be caused by impaired digestion or absorption or other physiological conditions -Uncommon in the U.S.

Factors affecting nutrient requirements

-Foods eaten -Stage of growth and development -Sex -Body size -Weight -Physical activity -State of health

Sodium

-Found in every cell of the body -The major extracellular electrolyte -Half of the total body sodium is in the extracellular fluid, 40% in bone, and about 10% in intracellular fluid -1 tsp of table salt=2100mg of sodium

Role of RDH

-Identify changes in oral cavity that may be related to dietary intake -Identify harmful dietary habits that may initiate oral disease -Promote health and wellness as a health professional -Opportunity to see patients on a more regular basis than many other health professionals -Support interventions initiated by other health care professionals -Identify patients needing referral to a licensed professional for complex nutrition needs arising dentally or medically that may ultimately affect general health -Nutritionist -Registered dietitian (RD) -Tooth loss can lead to change in diet -Systemic conditions can complicate the situation

Summary

-Important to recognize signs & symptoms of xerostomia & glossitis & to make recommendations accordingly -Counsel patients with newly placed orthodontics or dentures on foods they can expect to eat and reduce or eliminate from their diet -Surgical patients & TMJ patients will have limited opening- food choices will be limited

Electrolytes

-Maintain the body's osmotic pressure and fluid and balance -The kidneys play the gatekeeper role in fluid, electrolyte, and acid-base balance by controlling the retention and excretion of ions and fluids

Positive nitrogen balance

-More nitrogen being absorbed and accumulated than going out -Occurs during periods of growth, pregnancy, muscle building and repair of tissue after injury

Negative nitrogen balance

-More nitrogen going out than staying in -Occurs during: Rapid weight loss, Illness, Fever, Starvation, Prolonged metabolic or emotional stress, Protein deficient diets

Vitamins

-Organic substances found in most foods in small amounts -Necessary for normal metabolic functioning -Cannot be synthesized by humans

Chemical digestion

-Salivary amylase -Allows large molecule carbohydrates to be hydrolyzed into shorter chains that are fermentable

Glycogen

-Storage form of glucose -Stored in the liver and muscles as a readily available source of glucose

Vegan

-Strict vegetarian -Diet contains only food from plants, including vegetables, fruits and grains. -No foods of animal origin allowed.

Food choices are limited by:

-Tastes -Budget -Environment -Cultural attitudes

Hyperglycemia

-high blood glucose -Insulin is secreted to lower the level of glucose in the blood

Hypoglycemia

-low blood glucose -Thyroid hormone, epinephrine, glucagon and growth hormones are released to increase blood glucose -Symptoms: weakness, light-headed, sweating, shaking, confusion, raid shallow breathing

nutrition treatment plan

-patient should be involved in as many processes as possible -accommodating factors affecting food intake -food preferences, habits, and behaviors, allergies -changes need to be minimal or deviate as little as possible from normal pattern

salivary flow

-slows at night (cariogenic snacks before bed can lead to increased caries risk) -inadequate -heavy -viscous

cytosol

Anabolism and catabolism are occuring at the same time within a cell, they are occuring in different pathways. While one could happen in the mitochondria, the other can be occuring in the ____

nutrient deficiences

Angular cheilitis and glossitis are commonly associated with ________

-more than 700 species present -only a small portion are acidogenic -not all acidogenic bacteria are cariogenic

Bacteria in the Mouth

Sleep: BMR is lowest after few hrs of sleep-muscles are relaxed Age. BMR ↓ with age. After age 20 it ↓ about 2% per decade Pregnancy & Lactation: Pregnancy: ↑ 15-30% during last trimester Lactation: ↑ 40% Body Surface Area. The greater your Body Surface Area factor, the higher your BMR. Tall, thin people have higher BMRs State of Health: when health is compromised BMR can ↑ or ↓ Diet. Starvation, restrictive low-calorie or serious abrupt calorie-reduction = 20-30%. drop in BMR Body Composition/Gender Low body fat percentage = Low BMR The lower body fat percentage in the male body is one reason why men generally have a 10-15% faster BMR than women. High muscle mass = High BMR Ex: the metabolic rate of obese women is 25 percent lower than the metabolic rate of a thin lean woman. Temperature: Temperature inside/outside the body: Exposure to cold temperature = ↑ BMR, Prolonged exposure to heat or during a fever = ↑ BMR. For every increase of 0.5C in internal temperature of the body, the BMR increases by about 7%. Endocrine Glands: Thyroxine - speed up or slow down BMR Adrenal glands - fight or flight Pituitary gland: ↑ BMR during growth

Basal Metabolic Rate Affected By:

Energy required for involuntary physiological functions to maintain life, including respiration, circulation, maintenance of muscle tone, and body temperature when the body is in a postabsorptive state (when digestion and absorption are minimal)

Basal metabolic rate (BMR)

-Supply body with energy (4kcal/g) -Excessive amount ingested are stored as fat (lipogenesis) -Monosaccharides play a part in regulating metabolism -Part of the carbon framework is used by the liver to produce nonessential amino acids -Maintain blood glucose levels -Spare protein from being used for energy -Burn fat for fuel -Provide bulk in the diet -Provides heat to maintain body temp -Undigestible fibers are used by microflora of the large intestine -Source of energy for the brain, CNS, RBC and lens of the eye -Continue brain and nervous system function while sleeping

Benefits of Carboyhydrates

Emulsification

Bile salts allow insoluble molecules to be divided into smaller particles

Vitamin E

Deficiency-Muscle weakness, abnormal eye movements, vision problem

BMR = 655 + ( 4.35 x weight in pounds ) + ( 4.7 x height in inches ) - ( 4.7 x age in years ) Men: BMR = 66 + ( 6.23 x weight in pounds ) + ( 12.7 x height in inches ) - ( 6.8 x age in year ) Unless the amount of physical activity is above average, the BMR can be used to evaluate the adequacy of caloric intake BMR range for healthy men: 1,580-1,870 kcal/day BMR range for healthy women: 1,150-1,440 kcal/day BMR is the largest portion of a person's calorie demand

Calculating BMR

Essential amino acids

Cannot be made by the body Are not stored in the body Must be obtained from food Very important to protein synthesis

Components of fat

Carbon Carboxyl group Methyl group

Components of carbohydrates

Carbon Hydrogen Oxygen

Components of protein

Carbon Hydrogen Oxygen Nitrogen

rising

Caries and root caries have been ____ with age, even though the U.S. is seeing a decrease in caries.

1. Physical form of food - liquids clear the oral cavity 2x as fast as solid food, sticky foods hang around the longest 2. Frequency of eating- a carbohydrate food or beverage consumed 20 minutes on either side of a meal 3. Sequence in which foods are eaten- sequence can minimize effects of acid attack 4. Fats eaten in the meal can lay a protective fatty coating on teeth protecting them from sugars eaten later 5. Consuming dairy products keeps saliva rich in calcium & phosphorus offering remineralization 6. Cheese eaten after sugar prevents the pH from dropping below 5.5

Cariogenic Properties of Carbohydrates

energy

Catabolism of all the nutrients involves oxidation through the Krebs cycle to produce ___

-Sodium, potassium, calcium, and magnesium -Principal cation in plasma and interstitial fluid is sodium

Cation (positive charge)

Extracellular fluid (ECF) ◦ Fluid located outside the cells ◦ 1/3 of body water ◦ Circulation (blood and lymph) ◦ Fluid between cells or tissues (interstitial fluid) Intracellular fluid (ICF) ◦ Fluid located within the cells ◦ Remains fairly constant ◦ 2/3 of body water

Cellular distribution of water

-Called fat-soluble because they dissolve in lipid and fat solvents rather than water -Fairly stable to heat, as in cooking -Organic substances (contain carbon) -Absorbed in intestine along with fats and lipids in foods -Require bile for absorption -Transported via the lymphatic system -Stored in liver and adipose tissues

Characteristics of Fat-Soluble Vitamins

-Includes B-vitamins and vitamin C -Organic substances -B-vitamins contain nitrogen -Act as coenzymes -Readily absorbed in the jejunum -Body stores very small amounts -Daily intake necessary

Characteristics of Water-Soluble Vitamins

salivary amylase

Chemical process of digestion= _____ begins breaking down carbohydrates

balance

Chewing hard foods helps to ____ alveolar bone resorption and new bone formation

40

Chewing with a denture = __ pounds of pressure or less (or 25% of the force of someone with a full dentition)

-Ion form of chlorine -Major anion of the extracelluar fluid, connected to sodium Found in GI secretions-important for: ◦ Protein digestion ◦ Creating acidic environment to inhibit bacterial growth ◦ Enhance absorption of iron, calcium & vitamin B12

Chloride

Deficiency is rare, but may occur with vomiting, diarrhea, gastric suctioning, or excessive sweating

Chloride deficiency

-Table salt (sodium chloride) -Salt substitute (potassium chloride) -Water -Same as those for sodium

Chloride sources

-Severity of bone loss affected by calcium, phosphorus and vitamin D -Vitamin C helps repair wounds to gingiva -To help slow the disease, need a nutritionally adequate diet

Chronic Periodontitis

Potassium

Chronic deficiency of this is often unrecognized; however, health problems include hypertension, heart attack, stroke, kidney stones, and loss of bone minerals, leading to osteoporosis. Patients may feel tired, weak, and irritable while being unable to pinpoint why. What nutrient is missing in their diet?

-Irritate the stomach lining -Lower the pressure at the junction between the stomach and the esophagus, causing acid reflux -Heartburn or acid reflux affect the dentition

Cigarettes & alcohol

TMD

Clenching Grinding Stress Malocclusion/elevated restorations Injury and/or bone abnormalities Limit opening when taking a bite of food Cut food into smaller pieces Choose foods that require less masticatory force to chew Eliminate chewing gum, taffy, caramel

periodontal disease

Clients with ____ should be counseled on nutrition and diet.

Phosphorus

Deficiency- Sprue; Incomplete mineralization of teeth, increased susceptibility to caries if deficient during tooth formation; increased susceptibility to periodontal disease due to effects on alveolar bone

Vitamin D

Deficiency-Abnormal bone regeneration osteoporosis; osteomalacia; incomplete mineralization of teeth and alveolar bone; rickets Excess-pulp calcification and enamel hypoplasia

Magnesium

Deficiency-Alveolar bone fragility; gingival hypertrophy

Folic acid

Deficiency-Angular cheilosis, mucositis; stomatitis; sore or burning mouth; increased risk of candidiasis; inflamed gingiva; glossitis or al pain; ulceration; ulcerative gingivitis; denuded tongue; glossitis; glossodynia; trip or borders of tongue red and swollen; slick bald pale; pathos ulcer

Vitamin B6 PYRIDOXINE

Deficiency-Angular cheilosis, sore or burning mouth, glossitis, glossodynia

Vitamin B12 CYANOCOLBALAMIN

Deficiency-Angular cheilosis; mucositis; stomatitis; sore or burning mouth; hemorrhage gingiva; halitosis; epithelial dysplasia of oral mucosa; oral paresthesia; detachment of periodontal fibers; loss or distortion of last; glossitis oral pain; ulceration; ulcerative gingivitis; denuded tongue; glossitis; glossodynia; tongue is "beefy", red smooth and glossy; delayed wound healing; xerostomia; bone loss; pathos ulcers

Fats

Deficiency-Angular cheilosis; pallor of lips and oral mucosa; sore burning tongue; atrophy/denudation of fillip form papillae; increased risk of candidiasis; glossitis Excess-No direct effect but fats may coat and protect the teeth from cariogenic agents

Iron

Deficiency-Angular cheilosis; pallor of lips and oral mucosa; sore, burning tongue; atrophy/denudation of filiform papillae; increased risk of candidiasis; glossitis

Vitamin B2 RIBOFLAVIN

Deficiency-Ariboflavinosis; Angular cheilosis; atrophy of filiform papillae; enlarged fungiform papillae; shiny red lips; magenta tongue; sore tongue

Vitamin B1 Thiamin

Deficiency-Beriberi (I can't)

Vitamin A-Retinol and Carotene

Deficiency-Bitot's spots; Inadequate cell differentiation-impaired healing and tissue regeneration; desquamation of oral mucosa; keratosis; increased risk of candidiasis; gingival hypertrophy and inflammation; leukoplakia; decreased taste sensitivity; xerostomia; disturbed or arrested enamel development; irregular tubular dentine formation and increased caries risk Excess-Impairs cell differentiation and epitheliatisation-imparied healing

Carbohydrate

Deficiency-Caries rate generally decreases when carbs intake decreases Excess-Increased frequency of carbs is a causative risk factor for caries

Copper

Deficiency-Decreased trabecular of alveolar bone; decreased tissue vascularity; increased tissue fragility

Protein

Deficiency-Defects in tooth composition, eruption pattern and resistance to decay; increased susceptibility to soft tissue infection poor healing and tissue regeneration

Zinc

Deficiency-Loss or distortion of taste and smell acuity; loss of tongue sensation; delayed wound healing; impaired keratinization of epithelial cells; epithelial thickening; atrophic oral mucosa, increased susceptibility to periodontal disease, candidiasis, xerostomia and caries if deficient during tooth formation

Vitamin B3 NIACIN

Deficiency-Pellagra (dermatitis, diarrhea, depression, dementia, death); Angular cheilosis; mucositis; stomatitis; oral pain; ulceration; ulcerative gingivitis; denuded tongue; glossitis; glossodynia; tip of tongue is red and swollen; dorm is dry and smooth

Vitamin B5 PANTOTHENIC ACID

Deficiency-Rare, dysfunctional lipid synthesis and energy production; burning in feet, depression, fatigue, insomnia, weakness

Vitamin C

Deficiency-Scurvy-red swollen gingiva; gingival friability; periodontal destruction; increased tooth mobility & exfoliation; sore burning mouth; soft tissue ulceration; increased risk of candidiasis; malformed teeth (inadequate dentine)

Folate

Deficiency-Spina Bifida; Cleft lip; cleft palate

Calcium

Deficiency-Tetany (neuromuscular disorder), Incomplete mineralization of teeth, rickets; osteomalacia; osteoporosis; excessive bone resorption and bone fragility; increased tendency to hemorrhage; increased tooth mobility and premature loss

Fluoride

Deficiency-increased resistance to caries Excess-Disturbed amelogenesis; molted and stained enamel; enamel hypoplasia

Vitamin B7 BIOTIN

Deficiency-ingestion of avidin (protein in egg whites); pallor of tongue and patchy atrophy of lingual papillae

-Encourage use of fluoridated water for those >6 months of age and topical fluorides for adults and children -Encourage low-fat dairy, *whole grains, and vegetables for calcium* and magnesium sources -Evaluate use of supplements and refer to a medical provider and/or registered dietitian as needed -Stress need to *minimize use of antacids* and seek medical care for chronic heartburn -Dental team members should help patients achieve optimal mineralization of teeth -Educate them about the importance of calcium, phosphorus, and magnesium to general and dental health -Provide information on good food sources for minerals, including alternatives to dairy products when needed -Encourage parents to help children increase calcium-rich beverages such as milk-based drinks in place of carbonated beverages -Educate patients of all ages on the benefits of topical fluoride in caries prevention throughout life -Inform patients how to avoid excess fluoride consumption -Warn against arbitrary mineral supplementation

Dental Hygiene Interventions

Assessment Gather information about the quality of the patient's meal pattern and eating habits with a 24-hour diet recall or 3- to 7-day food record Use MyPlate as a guide to assess adequacy of food intake with cooperation of the patient Have the patient highlight all the fermentable carbohydrates and note form, frequency, and when eaten Estimate amount of time teeth are exposed to cariogenic foods More than 2 hours of acid exposure generally considered high Goals Help patient develop realistic goals Goals need to be flexible to meet the patient's needs, preferences, and lifestyle Education Education alone does not guarantee behavioral change Assessment and goals are the basis for any recommendations Dispel myths, redirect inappropriate habits, and provide new ideas

Dental Hygiene Plan

Good nutrition should be encouraged to promote anabolism for growth and healing Elevated or depressed blood glucose levels may cause poor wound healing or increased risk of infection Kidneys can be affected by medications causing a decrease in absorption of nutrients A diet poor in carbohydrate intake will have decreased energy reserves and prone to prolonged healing Excellent resource for diabetic patients pg 143

Dental considerations

Signs and symptoms the same as folate EXCEPT that burning tongue pain is experienced before physical signs are seen -Megadoses of vitamin C destroys B12 -Some anti-ulcer medications inhibit the absorption -Strict vegans will not get enough, should be supplemented

Dental considerations for B12

Assessment ◦ Physical: medical, dental, clinical findings ◦ Dietary: adequacy of intake, special/fad diets, pica Interventions ◦ Be familiar with cultural beliefs ◦ Refer to healthcare provider if concerns are identified ◦ Encourage nutrient-dense foods rich in folate, iron, calcium ◦ Encourage oral self-care and preventive dental care ◦ Counsel on oral care post-vomiting, acid reflux, effects of pica ◦ Alcohol use/abuse

Dental hygiene considerations

-Essential electrolyte for maintaining fluid equilibrium -Deficiency is rare -↑Na+ = ↑risk of xerostomia -Most sodium consumed is added during cooking, at the table, or in processed foods -Those who are "salt sensitive" need to be concerned about sodium consumption as a risk factor for hypertension -Everyone should limit sodium to 2300mg/day

Dental implications - Sodium

-Primary deficiency uncommon, seen when multiple nutrient deficiencies are present -Angular cheilitis -Angular stomatitis (Inflammation of the corners of the mouth) -Red, smooth lips -Glossitis -Edema of oral and pharyngeal mucous membranes -Dermatitis -Anemia -Purplish-red or magenta colored swollen tongue (glossitis) -Fungiform papillae swell and slightly flatten, become mushroom shaped -Tongue may have a pebbly or granular appearance In severe chronic deficiencies: ◦ Progressive papillary atrophy ◦ Patchy, irregular denudation In advanced cases: tongue may be atrophic & smooth

Dental implications - too little riboflavin

-Possible oral manifestations of thiamin deficiency ◦ Taste loss ◦ Burning tongue ◦ Increased sensitivity of the oral mucosa ◦ Flabby, red, edematous tongue ◦ Enlargement of and hyperemic (filled with excess blood) fungiform papillae ◦ Gingiva may have the color of an old rose These symptoms can result from other B-complex deficiencies -Thiamin deficiency alone is rare

Dental implications of Thiamin deficiency

plaque biofilm

Develops at gingival 1/3 and as colonies mature spreads coronally and apically

oral cavity

Diet and nutrition affect, and are affected, by the condition of the _____

Issued by USDA and HHS; updated every 5 years -Advice for people 2 yrs and older about how good dietary habits can promote health and reduce risk for major chronic diseases -Maintain calorie balance over time to achieve and sustain a healthy weight -Focus on consuming nutrient-dense foods and beverages

Dietary Guidelines for Americans 2010

Weight Management: Adequate Nutrients Within kcal Needs -Calories consumed should be nutrient dense Body Mass Index to determine health risks -Weight ÷ height= X then X ÷ height = Y then Y x 703 = BMI BMI = 24 or less healthy BMI = 25-29= overweight BMI = 30+ = obese **Waist measurement Physical Activity -A variety of physical activity - cardio, weight bearing, resistance 10 minutes of moderate intensity 3-6x/day Food and Beverage Intake

Dietary Guidelines: Calorie Balance

-Reduce caries by reducing exposure to fermentable carbohydrates -Alcohol consumption on a regular basis may contribute/cause oral cancer -Food safety of concern for older adults -Diet habits can be changed (sugar, salt, fat intake) -Never make supplement recommendations -Stay within the scope of DH practice when making recommendations

Dietary Guidelines: Dental Hygiene Considerations

Sodium -75% of salt in processed foods -<2300 mg of sodium/day = 1 tsp of salt/day Fats -Type and amount is key ->35% of calories should come from fat Needed to maintain vitamins and essential nutrients Solid fats: >saturated and trans fatty acids Added Sugars -Limit intake Decrease caries risk Refined Grains

Dietary Guidelines: Reduce

-Published by the government -Intended for healthy people, NOT for malnourished or people with a disease Provided for the purpose of: 1) Estimating amounts of required nutrients to improve the long term health and well being of Americans by reducing the risk of chronic diseases affected by nutrition 2) Establishing maximum safe levels of tolerance for particular nutrients

Dietary Reference Intakes

Women on vegan diets frequently consume inadequate amounts of vitamin B12 and are at increased risk of inadequate intake of iron and vitamin D

Dietary reference intakes (DRIs) during pregnancy differ from when women are not pregnant. For women who are also vegans, they are also at risk for not consuming adequate amounts of what nutrients?

hydrolysis

Digestive enzymes within the small intestine complete ____ process

Two simple sugars: 12 carbon atoms *Sucrose: glucose + fructose = table sugar *Maltose glucose + glucose = flavoring, breakdown product of starch *Lactose glucose + galactose= milk disaccharide

Disaccharides

Toxic effects not seen from food sources Result from supplements to treat heart disease (3000mg or greater) ◦ Beneficial effects: decreased total cholesterol, decreased LDLs and increased HDLs ◦ Harmful effects: flushing and redness of the skin, heartburn, gastric ulcers, elevated blood glucose levels Body stores some niacin ◦ larger doses associated with supplements may lead to serious problems including abnormal liver function and gout

Effects of excess niacin

Usually associated with a corn diet (corn lacks tryptophan) or alcoholics Pellagra: the progressive "4 Ds" ◦ Dermatitis ◦ Depression or dementia ◦ Diarrhea ◦ Death ◦ From the Latin for animal hide: Skin may be rough & look like goose flesh ◦ Bilateral red skin rash on face, hands or feet ◦ Without treatment, ultimate outcome is death

Effects of too little Niacin

Seen with other B vitamin deficiencies CNS abnormalities Convulsions Dermatitis w/cheilosis & glossitis ◦ Pain, edema & papillary changes of the tongue ◦ Tongue has a scalded sensation then becomes red and hypertrophic -Impaired immune response -Anemia

Effects of too little pyroxidine

↓ catabolism, ↑anabolism

During periods of growth & pregnancy

↑ catabolism, ↓ anabolism

During periods of illness-

manifest in or around the mouth

Earliest clinical signs of most nutritional deficiences and toxicities =

Phosphate

Electrolyte distribution differs in ICF/ECF compartments. The principle anion in ICF is:

Chloride

Electrolyte distribution differs in ICF/ECF compartments. The principle anion in plasma and interstitial fluid is:

Potassium

Electrolyte distribution differs in ICF/ECF compartments. The principle cation in ICF is:

Sodium

Electrolyte distribution differs in ICF/ECF compartments. The principle cation in plasma and interstitial fluids are:

-Electrolytes are compounds such as salts, acids, and bases 1. Facilitate chemical reactions like electrical signals 2. Control osmotic pressure between body fluid compartments 3. Maintain acid/base balance in the body

Electrolyte functions

Energy consumption has increased over the past 30 years yet activity levels have decreased or stayed the same. If more kilocalories are consumed than the body needs, then the body stores the extra as fat. To lose weight, either have to reduce the caloric intake or increase activity level. To lose 1lb= reduce kilocalories by 3500 500cal/day x 7days = 3500cal State of mind can control our appetite: depression, happiness, boredom, stress

Energy balance

Metabolism results in the production of cellular energy that is stored as ATP that provides cellular energy for: Mechanical work Transport of nutrients and waste products Synthesis of chemical compounds from the Krebs cycle ATP can be metabolized without oxygen (anaerobic)

Energy production

4 processes of motivational interviewing

Engage focusing evoking planning

raw fish

Enzymes in ___ can destroy thiamin

Phenylalanine Valine Threonine Tryptophan Methionine Histidine ** Isoleucine Lysine Leucine

Essential amino acids

Dietary energy intake needed to maintain energy balance in a healthy person of a specific age, gender, weight, height and level of physical activity. The energy levels are to allow a person to stay in a healthy BMI range of 18-25

Estimated Energy Requirements (EER)

(1) to build new tissues (including added maternal tissues and growth of the fetus and placenta), (2) to support increased metabolic expenditure, and (3) to enable physical movement of additional weight.

Estimated energy requirements (EERs) increase during the second and third trimester of pregnancy. This additional energy is necessary for:

Review

Evaluation - on going process that occurs in all stages Documentation

PEM

Even a single event of ___ in the first year of life can lead to delayed deciduous tooth eruption, delayed loss of primary teeth, and increased number of caries

Folate

Excessive amounts of this nutrient can cause kidney damage and mask symptoms of vitamin B12 deficiency, resulting in neurological and cognitive symptoms. This nutrient can also protect against some common cancers, especially development of colorectal cancer. What is this vitamin?

K

Excessive amounts of vitamin E or A have a detrimental effect on vitamin ____ absorptoon

Excessive weight gain during pregnancy can increase the risk of gestational diabetes, pregnancy-induced high blood pressure, miscarriage or stillbirth, large-for-gestational-age infants, difficulties during delivery requiring cesarean delivery, and postpartum hemorrhage

Excessive weight gain during pregnancy increases the risks of:

-Amount of nutrient consumed -The physiological need -The condition of the digestive tract -Level of circulating hormones -Drugs or nutrient levels that interfere with absorption -Having enough digestive enzymes around

Factors Affecting Digestion

Aging -four-fold decrease in production in those >65 yr Malabsorption conditions - Sprue, Crohn's disease, cystic fibrosis, Kidney failure Exposure to sunlight -Use of sunscreen -increase skin melanin pigmentation -Latitude, time of day, season of year -Homebound or institutionalized elderly -Religious/cultural habits requiring covering the body

Factors Affecting Vitamin D Requirements

1. The vitamin content of the foods eaten 2. Physiological status - As body stores decrease, absorption increases 3. Food preparation/cooking can radically affect vitamin availability 4. Vitamins are easily destroyed by *heat*, *oxidation* and *chemical processes* used to extract them 5. Compounds found naturally in foods can enhance or inhibit vitamin availability

Factors Affecting Vitamin Status

Severe nutrient deficiencies result in ◦ Cleft palate ◦ Cleft lip ◦ Shortened mandible Nutrient availability affects whether teeth achieve their optimum genetic potential ◦ Arrangement ◦ Eruption sequence ◦ Pits and fissure development 6th week ◦ Tooth development begins By 4th month of pregnancy ◦ Calcification of deciduous teeth begins ◦ 60% development of combined dentitions initiated ◦ Mandible is calcified Gravida + Fever = Ca+ & P disrupted = decreased mineralization of enamel & dentin Deficiencies: ◦ Dentin and enamel: Vitamin C: formation of collagen matrix Calcium, magnesium, phosphorus, and vitamin D: mineralization If mother began pregnancy vit D deficient: ↑ risk of enamel defects Vitamin A: formation of keratin in enamel Fluoride supplements: ◦ Minimal amount crosses the placenta ◦ Minimal benefits for the fetus ◦ Not recommended

Factors affecting oral development

Preconceptional nutritional status Unusual dietary patterns - Pica Health care Age Weight gain Oral health Drugs and medications Artificial sweeteners Food safety Preconceptual nutrition status ◦ Most important time for prenatal care-before pregnancy -Weight needs to be addressed to prevent health complications (e.g., preeclampsia) -Inadequate intake of folic acid prior to pregnancy and in the first weeks of gestation can result in neural tube defects -Low levels of iron and folic acid linked to premature births and stunted growth -Inadequate iron and calcium intake can deplete the mother's stores and lead to infant's store being suboptimal at birth Health care access ◦ Inadequate prenatal care leads to problems for mother and fetus ◦ May be related to chronic health problems in later life Age -Adolescent pregnancy results in increased risk for LBW -Majority have inadequate intake of calcium, iron, vitamins A and D, niacin, and kilocalories -1 in 3 teenage mothers shows signs of significant bone loss Pregnancy after age 35 -Maternal risks include diabetes, hypertension and cardiovascular disease -Increase in the number of myocardial infarctions Weight gain ◦ For women in normal BMI range, weight gain should be 1 lb weekly during the second and third trimesters with a total weight gain of 25 to 35 lb -Inadequate weight gain associated with LBW -Excess weight gain associated with high blood pressure, miscarriage or stillbirth, and difficult deliveries -Children are more likely to be overweight at age 3 if the mother gained excess weight Oral health ◦ 49%-58% of women receive dental care during pregnancy ◦ Attitudes and behaviors about dental care during pregnancy may be influenced by fear of harm to the fetus -Routine dental care during 2nd trimester (gestational weeks 13 to 21) was not associated with increased risk of serious medical events, preterm deliveries, spontaneous abortions, or fetal deaths or anomalies ◦ Nausea, vomiting and gastroesophageal reflux disease (GERD) are common -Strong association between GERD and dental erosion -Hormonal changes (estrogen and progesterone) contribute to increased susceptibility to gingivitis and periodontitis -Studies indicate periodontal disease during pregnancy is significant risk factor for preeclampsia and/or delivering premature or LBW infant Drugs and medication ◦ Caffeine (e.g., more than 7 cups/day of coffee) is associated with LBW and risk of miscarriage -American Dietetic Association maintains pregnant women should not consume more than 300 mg of caffeine (less than 2 cups of coffee) per day ◦ Alcohol is a folic acid antagonist May lead to fetal alcohol syndrome ◦ Should consult health care provider before taking any prescription over-the-counter medication or herbals Artificial sweeteners ◦ Non-nutritive sweeteners that are classified as generally recognized as safe (GRAS) can be used Saccharin, acesulfame potassium, aspartame, sucralose, and neotame are considered safe in acceptable amounts Food safety ◦ Women are at high risk for food-borne illness Food-borne illness such as listeriosis can cause miscarriage, premature birth, stillbirth, or acute illness in the newborn Avoid unpasteurized juices, milk and milk products; raw sprouts; and raw or undercooked meat, poultry, eggs, fish, and shellfish

Factors affecting prenatal development

Drug-induced More than 400 commonly used drugs can cause xerostomia Diseases Autoimmune diseases: Sjögren's syndrome, SLE (lupus), rheumatoid arthritis Chronic diseases: diabetes mellitus Psychogenic causes: depression, anxiety, stress, or fear Head and neck radiation

Factors contributing to xerostomia

-Prolonged use of baby bottles containing highly fermentable sugars -Pacifiers dipped in sweet agents -Other high frequency sugar exposures - Snacking on sugary foods

Factors most implicated in early childhood caries:

◦ Exercise, high temperature, low humidity, high altitude, high-fiber diet, increased fluid losses (urination, perspiration, expiration, defecation) -Caffeinated and alcoholic beverages increase urinary losses ◦ Can contribute to dehydration ◦ Extra half-cup of water should be consumed for every cup of these beverages Pregnancy - need at least 1 extra cup/per day -Elderly -ability to detect thirst is decreased ◦ Recommended to drink water periodically throughout the day ◦ Do not rely exclusively on thirst symptoms -Breastfeeding requires an additional 3-4 cups of water per day

Factors that increase fluid needs

Gravida: Pregnant woman Primary factors for successful pregnancy are: ◦ Nutritional status before conception ◦ Appropriate weight gain ◦ Adequate intake of essential nutrients during pregnancy The rate of mortality among infants born before 37 weeks of gestation has been rising ◦ At least 75% of infant deaths are attributed to being born premature

Healthy pregnancy

-Discovered as an anti-anemic factor for treating anemia in pregnant women -Found to exist in green leaves, hence the term folic (foliage) -May be called folate (natural form) folic acid (synthetic form) or folacin -Synthetic is significantly more bioavailable than food sources -Vitamin C prevents deterioration of folate

Folate

Toxicity ◦ Excess intakes may mask vitamin B12 deficiency ◦ Kidney damage

Folate hyper states

DRI ◦ Children: 150 - 300 micrograms per day ◦ Men and women: 400 micrograms per day ◦ Pregnancy: 600 micrograms per day ◦ Lactation: 600 micrograms per day UL ◦ 300 - 1000 micrograms per day (by supplements only, not food sources)

Folate requirements

Brewer's yeast Beef liver Raw spinach Cooked spinach Orange juice Romaine lettuce Iceberg lettuce Cooked beets Avocado Cooked broccoli Wheat germ Cooked red beans Banana Brussel sprouts Whole wheat bread White bread

Folate sources

Crunchy, fibrous foods: -Increase salivary flow -Exercise for the periodontal ligaments which increases bone density surrounding roots of teeth -The act of chewing fibrous foods will not increase gingival keratinization -There are no "detergent" foods -The healthier and stronger the periodontal structures, the less restricted the diet = better nourished and healthier overall

Food Texture Affects Periodontium

-Sight -Smell -Taste

Food choices influenced by three sensory perceptions:

-Hypervitaminosis A -Birth defects in children of women taking 13-cis retinoic acid (isotretinoin) for skin conditions during pregnancy -Catabolism of collagen and bone resorption by osteoclasts -Diplopia -Alopecia -Dry, rough skin and mucosa -Reddened gingiva -Cracked lips -Thinning of epithelium -Carotene excess -Hypercarotenemia: skin turns deep yellow, especially on palms and soles

Hyperstates: Vitamin A

While staying within calorie needs, increase intake of • Vegetables • Fruits • Whole grains • Milk & milk products • Protein: seafood, in place of some meat/poultry new • Oils Nutrients of public health concern • Potassium • Fiber • Calcium • Vitamin D • Vitamin B12

Foods and Nutrients to Increase

alcohols

Foods containing sugar ___ are recommended as sugar substitutes for high caries risk patients

-solid food/sugar = 40 mins -liquid sugars = 20 mins -Retentive factor

Form and Consumption of Sugar

-Crystalline structure of enamel is one of the most *insoluble* and *resistant* proteins known -Comparable to hardness of quartz -Dentin contains the *same constituents* as bone, but its structure is *more dense* -Cementum = contains *fewer minerals* = *softer* than bone

Formation of Teeth

carbohydrates

Frequent consumption of ___ has a detrimental effect on teeth

Hyperphosphatemia (serum level above 2.6 mg/dl) may occur in: -Hypoparathyroidism -Renal insufficiency Excessive amounts of phosphorus bind with calcium, resulting in tetany and convulsions

Hyperstates: Phosphorus

fructose

Fruit juices are concentrated with ____ = food for bacteria

low

Fruits have a ___ cariogenicity (not as detrimental as sucrose because of water dilution)

-Added by manufacturing process -Non-digestible carbohydrates that have physiological benefits -Come from modifying naturally occuring fiber or are commercially produced -Examples: • Carrageenan • Guar gum

Functional fiber

cofactor

Functions in the same way as coenzymes, but the molecule required is a mineral or electrolyte.

-Constituent of the coenzyme pyridoxal phosphate (PLP) ◦ Nitrogen and protein metabolism -Conversion of tryptophan to niacin -Hemoglobin synthesis -Synthesis of unsaturated fatty acids from essential fatty acids -Energy production from glycogen -Antibody and immune cell production -Proper functioning of the nervous system, synthesis of neurotransmitters

Functions of B6/Pyroxidine

-Functions in approximately 20 coenzyme systems -DNA & RNA synthesis and cell division -Maintains normal levels of mature red blood cells by working with B12 & C ◦ Works with B12 to synthesize purine, pyrimidine, methionine, & choline

Functions of Folate

1. Maintains intercellular fluid balance 2. Regulates acid/base balance 3. Normal contractions of all muscles 4. Transmission of nerve impulses

Functions of potassium

GMR - Growth, Maintenance, Repair -Generates new body tissues -Repair of body tissues -Produces essential compounds -Regulates fluid balances -Provides resistance to disease -Act as transport mechanisms -Used for energy - 4 kcal/g

Functions of proteins

1. Affects the concentration, excretion & absorption of potassium, chloride & water distribution 2. Regulating acid/base balance 3. Facilitating impulse transmission in nerve & muscle fibers

Functions of sodium

-Formation of collagen: deficiency can lead to gingivitis & poor wound healing -Protects soft tissues from infection by bacterial toxins & antigens -Protects enamel from plaque -Protects vitamins A and E and polyunsaturated fatty acids from excessive oxidation -Quenches free radicals involved in aging -May prevent age-related opacities in the eye -Facilitates calcium and nonheme iron absorption -Involved in synthesis of leukocytes and other immune system components -Detoxifies carcinogens or interferes with the carcinogenic processes via free radical scavenging and enhancing immunocompetence

Functions of vitamin C

adipose tissue

Most excess energy, no matter what form it entered the body in, is stored as _____

Bacterial, fungal, and viral infection Drugs Psychological stress Allergic reactions Nutrient deficiencies (B-vitamins, iron, etc) Soft, nutrient-dense foods (tuna salad, cream soups, cottage cheese) Liquid nutritional supplements, instant breakfast

Glossitis

-Industrially produced carbohydrate supplements - made of glucose, maltose and dextrins -Used to increase energy intake

Glucose polymers

-Issued by the U.S. Department of Health and Human Services every 10 years -Identifies public health goals to improve overall health of the nation -Goal: Prevent and control oral and craniofacial diseases, conditions, and injuries, and improve access to preventive services and dental care Targets: -Dental caries -Periodontal disease -Cleft lip/palate -Oral and pharyngeal cancers -Tobacco/alcohol use -Poor dietary choices Objectives involving oral health and nutrition -Reduce proportion of children and adolescents who have dental caries and periodontal disease -Increase the proportion of adults who are tested or referred for glycemic control from a dentist or dental hygienist in the past year

Healthy People 2020

turnover

Healthy epithelial lining of the sulcus is necessary to prevent periodontal disease, one of the fastest ____ rates in the body

-Toxic effects occur in adults receiving 2500 µg (100,000 IU)/day for several months -Anorexia, nausea, and vomiting initially -Followed by polyuria, polydipsia, weakness, nervousness, and pruritus Hypercalcemia -Calcification of renal and cardiac tissues

Hyperstates: Vitamin D

Energy/kilocalories ◦ 1st trimester: Needs do not increase ◦ 2nd trimester: +340 kcal ◦ 3rd trimester: +452 kcal Nutrient-dense foods vs. Junk food Fat ◦ Serum cholesterol and triglycerides become significantly elevated during 2nd trimester Protein ◦ +21 g of protein or a total of 67 g daily ◦ Accomplished with additional 3 oz of meat or meat substitute (21 g protein) or by adding 2 oz meat and 8 oz milk (24 g protein) Ca+ and vitamin D ◦ The body adjusts to increase absorption of Ca+ and vitamin D: additional intake not recommended except for teens Vit D: infant growth, bone ossification, enamel formation & neonatal Ca+ homeostasis B-vitamins ◦ Folate: RDA is 600 µg 50% to 70% of neural tube defects can be prevented with adequate folate FDA requires all grain products fortified w/folate Absorption from supplements is better than naturally occuring folate Iron ◦ RDA: 27 mg/day ◦ Higher intake of iron during gestation needed: For production of RBC and the placenta To compensate for cord and blood loss at delivery ◦ Supplementation is recommended ◦ Absorption increases from 10%-20% to approximately 25% ◦ Better absorbed in the presence of acid (vit C, hydrocholoric acid) Zinc ◦ RDA: 12 mg/day ◦ Early pregnancy : organ formation ◦ Late pregnancy: growth & development Iodine ◦ RDA: 220µg ◦ Public Health Committee of the American Thyroid Association rec. daily supplementation ◦ Found in iodized table salt Vitamin-mineral supplements ◦ IOM subcommittee concluded iron is only nutrient warranting global supplementation during pregnancy ◦ Supplement composition should be based on an identified nutritional need ◦ High-risk, needing supplementation: Adolescent pregnancy Carrying more than one fetus Use of cigarettes, alcohol, or other drugs

Healthy pregnancy nutrition requirements

-MyPlate for Moms can be personalized -Low-income women may benefit from referral to WIC -Identify fad dieting, pica, and other risk factors for poor nutrition

Healthy pregnancy: dietary intake

ketone

High ___ levels may be associated with starvation or high protein , low carb, low calorie diets

bone loss

High protein diets are usually high in fat and may increase calcium excretion, which may lead to ____

Free Radicals

Highly unstable reactive molecular fragments. 1 or more unpaired electrons, damage body cells, antioxidants donate electron to make stable

Small intestine

Includes the duodenum, jejunum and ileum

-By keeping the immune system healthy -Building healthy soft and hard periodontal tissues -Assisting with wound healing

How Does Nutrition Prevent Periodontal Disease?

-Inadequate intake of nutrients affects strength and development of the teeth (enamel & dentin) -can cause inadequate mineralization problems

How can pre-eruption influence caries?

Cations and anions must be equally balanced

How do electrolytes affect hydration status?

3 hours after brushing

How long are salivary fluoride levels elevated for *after* using fluoridated toothpaste?

10,000

Humans born with about ____ taste buds

pheromones

Humans can detect from 10,000 to over 100,000 different odors and ______ (which elicit hormonal or behavioral responses)

Calcium excess has not been observed in healthy people Toxic signs are associated with -Hyperparathyroidism -Some bone diseases -Cancer -Excess vitamin D -Kidney diseases -Excess milk consumption -Excessive calcium intake results in: -Dizziness, flushing, nausea/vomiting, severe constipation, kidney stone formation, irregular heartbeat, tingling sensations, xerostomia, fatigue and high blood pressure -May inhibit iron and zinc absorption

Hypercalcemia

-Blood glucose level above 120mg/dl -Excessive intake of added sugars, above 25% of total energy can result in inadequate intake of micronutrients -DRI = 25% or less of energy from added sugars

Hyperglycemia

-Dental *fluorosis* (hypomineralization of enamel) directly related to fluoride exposure during tooth development -Varies from white flecks, to white or brown staining, to brownish discoloration and varying degrees of enamel pitting -Ingestion of *large amounts* of fluoride in adults can result in *adverse effects on skeletal tissue and kidney function*

Hyperstates: Fluoride

-No evidence of overconsumption of magnesium from food sources -*Kidney regulates magnesium* and toxicity may cause kidney failure Symptoms: -Diarrhea -Nausea -Cramping

Hyperstates: Magnesium

-Supplementation may significantly increase risk of mortality -Occasionally, muscle weakness, fatigue, nausea, and diarrhea have occurred in persons taking 800 to 3200 mg/day -Most significant effect at >1000 mg/day is antagonism to vitamin K action and enhancement of the effect of oral anticoagulants (warfarin)

Hyperstates: Vitamin E

People at risk for deficiency: -Insufficient calcium intake -Milk allergies -Lactose intolerance -Malabsorptive conditions -Strict vegetarian diets Immobilization, lack of weight-bearing physical activity -Increased risk of calcium loss from bone leads to osteoporosis Tetany - neuromuscular disorder of uncontrolled cramps and tremors May be caused by hypoparathyroidism

Hypocalcemia

Blood glucose level below 70mg/dl

Hypoglycemia

Rickets -Inadequate amount of Ca+ deposits in bone during childhood -Poor absorption of Ca+ due to lack of vit D Inadequate calcium intake and periodontal disease -Study of NHANES data suggests a 56% increased risk of periodontal disease with calcium intakes lower than 500 mg/day -27% greater risk for those women consuming from 500 to 800 mg/day of calcium

Hypostates: Calcium

-Deficiency rare in healthy people -Can occur w/prolonged vomiting, malabsorption, kidney disease, intestinal surgery, excessive use of OTC and medications (corticosteroids, diuretics) -Present in nearly all chronic alcoholics Symptoms of deficiency: -Fragility of alveolar bone and gingival hypertrophy -Neuromuscular hyperexcitability -Depletion is associated with cardiac arrhythmias, atrial fibrillation, and ventricular tachycardia

Hypostates: Magnesium

Long-term ingestion of aluminum hydroxide antacids Stress conditions in calcium-to-phosphorus balance Malabsorption conditions -celiac disease Deficiency is more likely in -Alcoholics -Older clients with inadequate dietary intake -Eating disorders -Inappropriate weight loss -Long term diarrhea -Misuse or long term use of diuretics

Hypostates: Phosphorus

-Growth restriction in children -Impaired dark adaptation and night blindness -Keratinization of lung, GI tract, and urinary tract epithelia -Susceptibility to infections -Follicular hyperkeratosis of the skin -Sometimes death -Enamel hypoplasia -Xerophthalmia, keratomalacia and Bitot's spots in advanced deficiency

Hypostates: Vitamin A

-Delayed wound healing -Poor bone and tooth development -Scurvy - *20 days* -Red, swollen gingiva -Sore, burning mouth -Gingival friability, spontaneous bleeding -Periodontal destruction/tooth mobility risk of candidiasis and susceptibility to infection -Malformed enamel and inadequate dentin -Easy bruising, hemorrhaging of the skin (perifollicular petechiae) -Joint pain and disruption of cartilage -decreased intake results in 1.2 times greater risk of PD -decreased intake in smokers results in a 1.6 times greater risk *Deficiency does not CAUSE gingivitis or periodontal disease, but may be a contributing factor*

Hypostates: Vitamin C

Osteoporosis -Vitamin D deficiency interferes with mineralization decreased bone density and increased risk for fracture Cancer and cardiovascular risk -Vitamin D may protect against some cancers -Higher levels in blood associated with reduced colon and colorectal cancers -In animal studies, tumor growth has been decreased with vitamin D supplementation -Low levels may increase risk for heart attack

Hypostates: Vitamin D

Vitamin D deficiency a pandemic problem in 40%-60% of adults and teens Rickets -Most visible lower ends of radius and ulna -Characteristic deformities result from bones bending at the cartilage-shaft junction -Enamel hypoplasia Osteomalacia -Decreased bone mineralization or softening; leads to deformities of limbs, spine, thorax, and pelvis -Symptoms are skeletal pain and muscle weakness -Loss of the lamina dura

Hypostates: Vitamin D

-Mild hemolytic anemia associated with increased erythrocyte hemolysis -Peripheral neuropathy -Subsequent decline in physical function

Hypostates: Vitamin E

-Disease or drugs may cause deficiency -Conditions blocking bile flow (celiac disease, sprue) -Diarrheal diseases (ulcerative colitis) -Hemorrhagic disease of the newborn -Adults with marginal dietary intake who have undergone trauma, extensive surgery, or long-term parenteral nutrition with or without treatment with broad-spectrum antibiotics -Drugs, including anticonvulsants, anticoagulants, certain antibiotics (particularly cephalosporins), salicylates, and megadoses of vitamin A or E

Hypostates: Vitamin K

Controls hunger & satiety Body sends signals to the hypothalamus to suppress the feeding center: (puts the brakes on desire to eat more) distended belly release of cholecystokinin in response to fat in the duodenum secretion of insulin & glucagon due to food in the belly If satiety center is destroyed,=unstoppable appetite, same result if the feeding center is stimulated If satiety center is stimulated= full and do not want to eat any more When stored nutrients are low, the feeding center sends the hunger signal. Reverse is also true: when nutrients are plentiful -feel full. Is responsive to body temperature Cold temperatures: increase food intake Results in higher metabolic rate and more fat stored for insulation (think winter weight gain) If hypothalamus becomes damaged (head injury, stroke) feeding and hunger are altered.

Hypothalamus

1:1

Ideal calcium/phosphorus ratio for adults is

phosphorus

If calcium levels go up _______ level goes down, vice versa

ketone

If the liver is overwhelmed, glucose supply may be reduced and the body cannot use ____ bodies

-Protein -Fat-soluble vitamins -Fat/cholesterol -Vitamin B12

Ileum absorbs:

-Works in tandem with calcium -*Easily obtained* if the diet contains plenty of *fresh foods and whole grains* -Deficiency and toxicity are uncommon and most often related to *kidney dysfunction* -Patients should be cautioned to avoid overdose of magnesium via supplements or drugs

Implications for Dentistry of Magnesium

-Essential for formation and function of all tissues -Formation of bone, soft tissue, teeth -Needed for collagen formation,wound healing -Needed for timely recovery after oral surgery -Deficiency rare but seen in people with poor diets

Implications for dentistry of vitamin C

Vitamin C ◦ Improving the host defense mechanism ◦ Role in collagen formation and optimal wound healing Vitamin A ◦ Plays a role in development & maintenance of salivary glands ◦ Maintaining integrity of epithelial tissues ◦ Deficiency: Oral & oropharyngeal cancers Vitamin E ◦ Antioxidant to neutralize free radicals and promote integrity of cell membranes of the mucosa

Important functions in soft oral tissues: other vitamins

erosion, abrasion, dentin hypersensitivity

In addition to root caries, what are some additional problems that patients may face associated with gingival recession?

Large intestine

Includes cecum, colon and rectum

food additives (colas)

Intake of phosphates may become excessive due to phosphates used as _____

-Exists mainly as the iodide ion -Most iodine is located in the thyroid gland as part of the hormone thyroxine -Lesser amounts are found in the skin, skeleton, endocrine glands, salivary glands, and stomach

Iodine

Regulate BMR and metabolic processing of macronutrients Necessary for normal physical and mental development

Iodine functions

◦ DRI: 150 micrograms/day ◦ UL: 1,100micrograms/day ◦ Increased during periods of growth, pregnancy & lactation

Iodine requirements

Seafood Plants grown along the seacoast Iodized salt Molasses Yogurt Milk

Iodine sources

Poorly absorbed, needs certain conditions: ◦ Addition of vitamin C ◦ Acidic gastric juices Absorption inhibited by: ◦ Presence of Zn, Cu, Ph, Ca+ or Mn ◦ High fiber diet ◦ Tannins (tea) ◦ Too much iron already present ◦ Malabsorption conditions ◦ Alkaline pH

Iron absorption/secretion

◦ Microcytic anemia ◦ Angular cheilosis ◦ Pallor of lips and gingiva ◦ Sore, burning tongue; glossitis ◦ Atrophy of filiform papillae ◦ Risk of candidiasis ◦ Possible increased caries susceptibility

Iron deficiency

Component of hemoglobin: ◦ Carries oxygen from the lungs to all cells ◦ Returns carbon dioxide to the lungs As a cofactor for enzymes: ◦ Release of energy from macronutrients ◦ Conversion of beta-carotene to preformed vitamin A ◦ Formation of collagen Other Roles: ◦ Removal of lipids from the blood ◦ Detoxification of drugs in the liver ◦ Production of antibodies

Iron functions

Ferric iron: iron binds to the serum protein transferrin and is continuously transported through the body

Iron in food is mostly :

Recommended levels of dietary iron assume a 10% rate of absorption Designed to replace daily losses, maintain stores, and avoid iron overload RDA ◦ Men 19+ and women 51+: 8mg/day ◦ Women 19-50: 18mg/day ◦ Pregnancy: 27mg/day ◦ Lactation: 9-10mg/day UL 45mg/day for adults Hidden iron-red wine

Iron requirements

-Iron is essential for proper hemoglobin function and subsequent oxygen transport -Iron deficiency anemia is of particular concern in women -Iron requirements are higher for women due to the need to replace monthly blood losses -Patients should be encouraged to consume a variety of iron-rich foods

Iron summary

◦ Hemochromatosis ◦ Organ damage ◦ Coronary heart disease ◦ Skin pigmentation ◦ Cirrhosis of the liver

Iron toxicity

200

Jaws crush food with a force of almost ___ pounds of pressure

-Water-soluble vitamins (C, thiamine, riboflavin, B6, folic acid) -Mono- and disaccharides

Jejunum absorbs:

Ketosis

Ketone bodies build up in the blood

Ketosis: fruity breath odor Cause: Low carbohydrate diet Not eating Uncontrolled diabetes The body metabolizes fats faster than the body can oxidize them and the resulting product of the fast rate of metabolism and slow rate of oxidation is an accumulation of ketones.

Ketosis

Zinc, calcium, vitamins D and B, and long chain n-3 fatty acids.

Key nutrients that may fall short of the DRIs in the vegan diet and less often in the vegetarian diet include:

-Adequate caloric intake, inadequate high quality protein intake. -Occurs in young children ***acute -Have some subcutaneous fat tissue -Edema of belly

Kwashiorkor

-Facial and abdominal edema (ascites) -Hair color and texture changes -Scaly, patchy skin and sores -High serum levels of iron leading to bacterial growth -Weakness and anemia -Infection, fever, electrolyte imbalances -May lead to heart failure and death

Kwashiorkor symptoms

-FDA authorized the terms "does not promote," "useful in not promoting," or "expressly for not promoting" dental caries on the packaging of foods containing sugar alcohols, hydrogenated starch hydrosylates, and hydrogenated glucose syrups -Foods must be labeled sugar (sucrose) free and must not lower plaque pH below 5.7

Labeling Initiatives for Cariogenic Potential

cause

Lack of vitamin C can lead to development of gingivitis - NOT the ____

Ideally: ◦ Exclusively breastfeeding for first 4-6 months Breast milk is all the infant needs ◦ Add some foods at 6 months until 12 months Incidence of thumb sucking/tongue thrusting ↓ Develops oral motor function = ↓ need for orthodontics ↓ risk of food allergies, ↓ risk of overweight and developing diabetes Develops a stronger immune system

Lactation

-Approximately 85 kcal are needed for every 100 mL of milk produced, (an increase of ҇500 kcal daily) Protein- an additional 25 g/day (total of 70 g/day) Other nutrients needed in larger quantities: ◦ Vitamins A, E, C, B6, B12, and riboflavin ◦ Minerals: copper, zinc, iodine, and selenium Additional 1000 mL/day (4 cups) of fluid

Lactation : nutrition requirements

-"finishes the job" -Picks up where S. mutans left off and extends the lesion into the dentin

Lactobacillus role in caries

-Reabsorbs water and electrolytes -Holds feces until defecation -Lining is smooth - ___________________________ -Secretes mucus -Has a neutral pH -Houses about 400 different species of microflora -Break down undigestible substances - Synthesize vit K, B12, biotin, thiamin, and riboflavin -Boost the immune systems -Inhibit pathogenic bacteria

Large intestine functions

Protein

Large molecular structure containing carbon, hydrogen, oxygen and *nitrogen*

plasma proteins

Leukocytes and ____ invade the site of attack or injury, causing swelling and edema

membranes

Lipids are important because they enter in the formation of the ____ of all cells.

Dorsal surface of the tongue Soft palate Posterior wall of the pharynx Larynx Epiglottis Uvula First third of the esophagus

Location of taste buds

deficiences

Long term antibiotic use can result in vit K, B12 and biotin ______

Several factors, including poor calcium intake over a lifetime, create a physiological negative calcium balance Post-extraction: accelerated atrophy of alveolar bone (mandible greater than maxilla) Reduction in masticatory efficiency increases resorption, loss of bone mass, or alveolar osteoporosis Teach pt to massage alveolar ridge Encourage crunchy foods to stimulate osteoclasts and osteoblasts

Loss of alveolar bone

Low levels of vitamins B6 and B12 have been noted in women using OCAs

Low levels of these vitamins have been noted in women using oral contraceptive agents (OCAs). What vitamins have been noted in this population?

1) kills or inhibits growth of bacteria 2) denatures proteins making them ready for hydrolysis into amino acids 3) activates gastric enzymes 4) hydrolyzes some sugars 5) increases solubility and absorption of Ca+ and Fe+

Low pH of stomach benefits:

-May play an important role in regulating blood pressure -The DASH study (Dietary Approaches to Stop Hypertension) suggests HBP can be lowered by diet high in magnesium, potassium, and calcium, and low in sodium and fat - Whole grains, fruits, vegetables and low-fat dairy

Magnesium

240-420mg/day UL : 350 mg/day from nonfood sources

Magnesium requirements

-Dark green, leafy vegetables -Whole grains and nuts -Chocolate

Magnesium sources

-Insulin from pancreas removes excess glucose from the blood stream -Stores excess glucose in the liver and muscle -When stores are full, glucose is routed to fat depots -When the body needs energy, glucagon releases stored glucose from the liver -Glucose is returned to the blood stream -The body uses glucose for fuel

Maintaining blood glucose levels

Physical form of food -Liquids include fruit juice, soda, sports drinks, energy drinks, liquid medications -Liquids pass quickly- constantly bathing detrimental -An acidic medium further demineralizes the tooth -Diet soft drinks contain added citric and phosphoric acids -Retentive CHOs- hang around longer bakery items, crackers, potato chips, pretzels -Slowly dissolving CHOs- bathing the teeth antacids, cough drops, breath mints Frequency of intake -Linear relationship between caries rate and number of meals and/or snacks consumed -Solids: Fermentable carbohydrates drop the salivary pH below the critical level for approx. 40 minutes -Liquids: anything other than water drops salivary pH below critical level for approx. 20 minutes Enamel demineralization occurs Eventually demineralization progresses to the point at which decay may be detected clinically -Acid exposure is additive throughout the day -Ca+ and P in saliva need time to remineralize the tooth between meals/snacks -Timing and sequence in a meal -Amount of acid is reduced if a fermentable carbohydrate food is eaten before or between other noncariogenic foods -Dairy products, such as cheese, reduce demineralization and help buffer acids produced by the bacteria -Sialagogues, like sugar-free chewing gum, stimulate the saliva and promote buffering of acids produced by bacteria and aid in oral clearance of the food

Major Factors in the Dental Caries Process

Poor functioning liver can cause irregular glucose levels Elevated or depressed glucose levels can cause poor wound healing, increased risk of infection Inability to reabsorb nutrients in the kidneys affected by: Medications Kidney disorder Fluid balance Malfunctioning kidneys can cause retention or loss of drugs and nutrients In heart faillure, the kidneys resorb more water from the blood, diuretics are used to remove that excess water. Loop diuretics remove too much potassium, while potassium sparing diuretics increase the amount of potassium in the body. Potassium is important for heart function and blood pressure regulation. A loss or retention of drugs and nutrients either way is not desireable.

Malfunctions of the Liver and Kidneys

edentulous status, tooth mobility, uncomfortable appliance

Malnutrition may be a result of declining dentition status. Compromised nutritional intake may be a result of which of the following?

Diabetes, hypertension, and cardiovascular problems are all maternal pregnancy risks after age 35

Many women are choosing to become pregnant at an older age. Maternal risks of pregnancy after age 35 include the following:

-Inadequate caloric and protein intake -Occurs in infants -***May also be caused by an inability to use protein because of a defect in metabolism - *Chronic*

Marasmus

hydrogenated fats

Margarine and shortening are examples of ____

BCP may lower B6 levels, during pregnancy & in breast milk Drugs that affect B6 metabolism: ◦ Isoniazid & cycloserine (for TB) ◦ Penicillamine (for Wilson's disease, lead poisoning, kidney stones & arthritis) ◦ Theophylline (for asthma) Excessive B6 can reduce clinical benefits of L DOPA therapy for Parkinson's disease or other neurological problems

Medications that can alter B6

-Decreased production of estrogen and progesterone by the ovaries resulting in termination of menses ◦ Reduced estrogen affects bone turnover resulting in decreased bone mass density ◦ Rate of bone loss is rapid in early menopause with gradual declines -Alveolar bone is labile source of calcium, and losses may indicate early osteoporosis Perimenopause: symptoms prior to menopause: loss of bone density, hot flashes, sweats, etc. -Reduced salivary flow -Gingival effects ◦ Atrophic gingivitis ◦ Menopausal gingivostomatitis ◦ Exaggerated response to plaque biofilm -Increases in body fat and declines in lean body mass -Hormone replacement therapy (HRT) is controversial but reduces risk for osteoporosis

Menopause

Phytoestrogens (soy) and soluble fiber may help: ◦ Regulate cholesterol levels ◦ Decrease menopausal symptoms Maintain meticulous daily oral self-care and regular preventive dental care Encourage calcium and vitamin D-rich food choices to maintain bone mass Encourage lean protein sources to minimize loss of lean body mass

Menopause: dental hygiene considerations

Food sources are almost completely absorbed Body can transform tryptophan (essential amino acid) into niacin ◦ Transformation requires vitamins B1, B2, B3 and B6 ◦ 1mg of niacin can be produced from 60mg of tryptophan Can also be synthesized from intestinal microorganisms ◦ Niacin status is assessed by measuring the amount of niacin metabolic by-products excreted in the urine

Metabolism of Niacin/B3

Includes milk, soy milk, yogurt, cheese Number of servings depend on stage of life 3 cups for all ages 2-3 yrs=2 cups 4-8 yrs = 2.5 cups

Milk and Milk Products

-Required in larger amounts (major minerals) -Required in smaller amounts (micronutrients or trace elements)

Minerals subdivided into two categories:

Low quality/Incomplete protein

Missing one of more essential amino acid Will support life but will not support growth, maintenance and repair

One simple sugar: 2-6 carbon atoms -Glucose - blood sugar, aka dextrose or corn sugar-naturally found in grapes, oranges, dates, corn -Fructose - fruit sugar; honey and fruits -Galactose - milk sugar -Sugar alcohols: formed from or converted to sugar - sorbitol, xylitol, mannitol

Monosaccharides

Calcium

Most abundant mineral in the body

Electrolytes

Most plentiful in the body: ◦ Sodium (Na+) ◦ Potassium (K+) ◦ Chloride (Cl) -In health - balanced -In illness - imbalanced ◦ Death may occur from electrolyte imbalance ◦ Example: Bulimia nervosa , frequent vomiting of gastric contents, low potassium, cardiac arrythmia

intrinsic factor

Mucus, hydrochloric acid (HCl), the enzymes pepsin and lipase, and ____ are released to aid in the break down of the bolus.

-Provide information to patients about MyPlate as it relates to positive changes in dietary lifestyle changes -Use MyPlate system to evaluate adequacy of a patient's diet -Eliminating food groups may lead to inadequate intake of nutrients -If only nutrient-dense foods are selected discretionary kcal can be used on other foods -MyPlate is an easy to read logo and to visualize

MyPlate Dental Hygiene Considerations

-Deficiencies of protein, vitamin C and/or B complex vitamins are contributing factors due to lowered host resistance -NUG-clients may alter diet due to pain (may not eat, may eat only soft foods) -A 3-7 day diet diary may be needed to identify eating patterns and counsel accordingly -Client may need to be on a liquid diet for 1-3 weeks following scaling - May also need liquid diet due to oral ulcers or painful gingiva -Avoid seeds, nuts, spicy foods -Eat bland foods: gelatin, cream of wheat, white rice, white bread -More frequent meals

NUG/NUP

-Arginine ** -Alanine -Asparagine -Aspartic acid -Cysteine -Glycine -Glutamine -Glutamic acid -Proline -Serine -Tyrosine

Nonessential amino acids

-Assess nutrient intake of groups at high risk for developing nutritional deficiencies (low income, medically compromised) -Encourage consumption of dairy and vitamin D-fortified foods -Supplement in excess of RDA should not be recommended -Encourage daily intake of foods high in vitamin C -Vitamin E is important for *immune function and as an antioxidant* -Antibiotic therapy may deplete of interfere with vitamin K absorption

Nutritional Considerations

-Can be due to genetic, environmental, behavioral, cultural, and socioeconomic factors -Different diets for everyone's needs -Ideal weight loss is ½-2 pounds per week -Slow and steady wins the race! -Too many calories consumed, not enough physical activity to burn them off and some more -Large around the middle (android obesity) more dangerous than large on the bottom (gynecoid obesity)

Obesity

vapor

Odors can be detected by olfactory nerves only if the flavor molecules are in ___ form. Cold foods cannot be smelled until they are warmed up.

9

One gram of fat can provide ___ kcals.

3500

One pound of fat releases ___kcal for energy

synthetic

Only ___ sweeteners are noncaloric

-Incomplete calcification of teeth -Tooth and bone malformations -*Increased tooth mobility **compare x-rays -*Premature tooth loss -Increased risk of hemorrhage

Oral Implications of Inadequate Calcium Intake

Increased susceptibility to periodontal disease - *During tooth formation:* *Incomplete dentin formation* **wider tubules allows bacteria to enter more easily and cause decay *Incomplete calcification of teeth* *Increased caries susceptibility*

Oral Implications of Phosphorus Deficiency

Assess nutritional needs for patients prior to surgical procedure to better cope with postsurgical demands and minimize complications May need to refer to registered dietitian for medical nutrition therapy prior to the procedure Malnourished patients due to variety of chronic disease and conditions, are at increased risk for delayed healing and infection (likely to be immunosuppressed) following surgery Emphasize meeting recommendations of MyPlate Optimal healing during recovery needs adequate intake of: Kilocalories Carbohydrates Protein Fat Vitamins, minerals, and fluids Liquid nutritional supplement or multivitamin with minerals may be necessary Frequent small meals with nutrient-dense foods help meet nutrient needs

Oral and Maxillofacial surgery

Nutrient absorption negatively affected by OCAs ◦ Vitamins B6 and B12 ◦ Folate Folate, B12= megalobalstic anemia Progestins may cause: ◦ Weight gain related to increased appetite and altered CHO metabolism ◦ Changes in lipids increasing risk for heart disease Undesirable decrease in HDL cholesterol levels and elevation of LDL and total cholesterol levels Some drugs & herbals may ↑ or ↓ OCA effectiveness

Oral contraceptives

-Burning oral mucosa Tongue: ◦ Burning ◦ Swelling and pallor of tip ◦ Reddening of the tip ◦ Atrophy of filiform papillae on the tip and laterally ◦ Bright red fungiform papillae -Angular cheilosis -Ulceration of buccal mucosa, palatal and gingival epithelium -Gingivitis, periodontal disease -Folate may reduce gingival hyperplasia in those taking Dilantin

Oral effects - too little folate

Angular cheilitis Angular stomatitis Tongue: ◦ Sore, swollen, scarlet red color ◦ Loss of filiform & fungiform papillae creating smooth, shiny tongue Secondary infection with fungi or bacteria Inflammation of oral mucosa leading to painful eating and swallowing Lesions in GI tract resulting in diarrhea creating less vitamin absorption

Oral effects of niacin deficiency

-Stomatitis of oral mucous membranes -Angular cheilitis -Glossitis

Oral implications of B6 deficiency

Pallor of the tongue Patchy atrophy of lingual papillae ◦ Lateral borders OR ◦ Entire dorsum

Oral signs of biotin deficiency

Biotin (B7)

Oral signs of this vitamin deficiency include: pallor of the tongue and patchy atrophy of the lingual papillae. Although the pattern resembles geographic tongue, it is confined to the lateral margins or is generalized to the entire dorsum. What vitamin deficiency do these oral signs describe?

3-7

Oral soft tissues have a more rapid turnover time (____ days) than other tissues in the body

Increased risk for: Decalcification Gingival inflammation Soft tissue trauma from orthodontic appliances Root resorption Accumulation of food debris in brackets/wires Chaotic meal patterns and snack habits After initial placement, adjustments, or repair of orthodontics may require a liquid or mechanical soft diet for 1 to 2 days Emphasize importance of oral self-care, daily fluoride use, and possibly an alcohol-free antimicrobial rinse Soft drinks, energy drinks, and sports drinks with fermentable carbohydrate or with citric acid should be avoided to minimize enamel decalcification Adequate nutritional intake is necessary for maintenance and repair of hard and soft tissue to withstand stresses of tooth movement

Orthodontics

"Disease of adolescence" -90% of peak bone mass is attained by age 16.9 + 1.3 yr and 99% by age 26.2 + 3.7 yr -BMD associated with fractures in elder years, but also may predict fractures in children -Inadequate calcium intake in early life accounts for as much as 50% of difference in hip fracture rates in postmenopausal years -Reduction in total skeletal mass directly related to reduction in mandibular bone density in women with osteoporosis -Postmenopausal women who lost teeth also lost bone mineral of the whole body and femoral neck at greater rates than those who retained their teeth -Systemic bone loss appears to be a predictor of tooth loss in dentate postmenopausal women

Osteoporosis

1. Start with exercise 2. Focus on food, not grams 3. Eat a plant-based diet 4. Cut way back on American staples, e.g., red meat and refined sugars and grains 5. Take a multivitamin and maybe have a drink

Other Food Guides: Healthy Eating Pyramid

caries

Over the past 2 decades sugar (carbohydrate) consumption has increased steadily, but the incidence of ___ has decreased

food choices

Overall health, medications, and ____ influence the properties of plaque & saliva

-Delayed exfoliation and eruption of primary and permanent teeth -Increased risk of decay -Secretory IgA levels are depressed - 1st line of defense in the oral cavity

PEM effects on child

-Smaller molars -Delayed eruption -Deformed mandible -Smaller salivary glands -Different protein composition -Amylase & aminopeptidase activity is different -Poor development of: epithelium, connective tissue and bone -Enamel is more affected by acid attacks

PEM effects on dental health during prenatal development

-Negative nitrogen imbalance- tissues depleted of reserves, blood protein levels are lowered, resistance to infection is lowered -Increase in Noma and NUG

PEM general effects

-Minor surgery on a healthy client should not need diet modifications -Medically compromised clients may need referral to a RD to analyze or modify nutrient intake prior to surgery Postoperative: -Full liquid diet usually recommended for 1-3 days depending on type and extent of surgery -High protein, high kilocalories -Any specific diet modifications due to disease must be taken into consideration -Mechanical soft diet is the next step-from day 3-7 of recovery. -Moist food that is soft, ripened, chopped, ground, mashed or pureed

Periodontal Surgery

Vitamins B12 and D, possibly zinc and Iodine.

Persons following a vegan diet must pay closer attention to food choices and will need supplementation of fortification of :

hormones

Pancreatic juices released by _____ in response to acidic chyme entering the intestine

Four key elements of MI

Partnership > between pt. and clinician Deep Acceptance > of the pt. and their behavioral choices Compassion > welfare of patients Evocation > clinician encourages the pt. to disclose their perspective and internal motivation

Diffusion

Passive transport

masticatory efficiency, number of teeth/location, fit of appliance

Patients with removable prosthetic appliances have a number of variables impacting nutritional intake. What are some of the considerations a dental hygienist should assess for assuring adequate nutrition for these patients?

700 mg/day

Phosphorus RDA

-Formation of bones and teeth -Muscle contraction and nerve activity -Component of phospholipids in cell membranes, DNA, and RNA -Energy metabolism (ADP) -Buffer for the body

Phosphorus functions

-Abundant in foods—deficiency rare -Best sources are milk products and meats -Food additive in baked goods, cheese, processed meats, and soft drinks

Phosphorus sources

Bones contain almost 2/3 of body's magnesium -Role in bone and mineral physiology -Cofactor for more than 300 enzymes -Necessary for DNA and RNA synthesis -Regulates transmission of nerve impulses and muscle contraction -*Associated with vitamin D conversion in the liver* -Facilitates blood clotting -Facilitates PTH secretion

Physiological Roles: Magnesium

-consume at the beginning of a meal, and follow with either a crunchy food or cheese. -if consumed before bedtime, follow with brushing

Placement of fermentable carbs

acid

Plaque bacteria feed on carbohydrates and produce ___ that demineralizes enamel

Complex carbohydrates -Very good low fat food source -More than 10 monosaccharides -Starch -Glucose Polymers -Glycogen -Dietary Fiber -Contain vitamins, minerals, fiber and water -Brown rice, whole grain bread, cereal, whole wheat pasta, legumes, fruits, vegetables

Polysaccharides

worse

Poor nutrition does not cause periodontal disease, but it can make an existing conditions ____

-Major electrolyte in the intracellular fluids -98% of total body potassium is intracellular -Highest potassium concentrations are in the skeletal muscle -Total amount of body potassium is closely correlated with lean body mass

Potassium

Small intestine

Principal site for nutrient absorption

Proteins

Principle source of nitrogen for the body

Dentition status Dental hygiene considerations

Prior to placement of new denture, counsel about the initial days of adaptation so appropriate foods can be available Cut foods into small pieces Cooked fruits & vegetables easier to chew Chew food longer Evenly distribute food bilaterally Avoid sticky, chewy foods, nuts, and seeds Swallowing foods may be challenge to new denture wearers Encourage intake of dairy products fortified with vitamin D to slow rate of bone loss Liquid nutritional supplement may be needed to meet caloric and nutrient needs to promote healing from extractions and/or sore spots

-products containing live bacteria -Aid in restoring and maintaining an intestinal balance of healthful bacteria -Decrease the incidence or duration of diarrhea -Aid tolerance to antibiotics -Aid with lactose intolerance

Probiotics

nutritional status

Problems in the oral cavity & the body can profoundly affect appetite, diet, and ultimately, _____

Anabolism

Process requires energy to build substances that make up the body itself and other substances necessary for body functions

-Amino acids (AAs) are transported through portal vein to liver -Liver is an "aminostat" monitoring intake and breakdown of AAs -Constant dynamic state between anabolism and catabolism -Anabolism Utilizes an "amino acid metabolic pool" (70 g of AA) to maintain equilibrium -Catabolism Occurs in liver, muscle, and kidney, creating urea as a waste product -Liver releases a.a. into the blood to maintain certain levels -The body maintains a storage of a.a. to be used for anabolism and to maintain an equilibrium state of a.a. -Amount stored is very small -Still need to eat a daily diet that includes essential amino acids -When a.a. are not needed for protein anabolism and energy is not needed they are converted to fat and stored in the body -Catabolism of protein removes the nitrogen group from the aa -Carbon skelton and ammonia -Carbon skeleton is used to Make nonessential aa Produce energy via the Krebs cycle Converted to fats and stored as fatty tissue Urea is the most abundant waste product Liver converts ammonia to urea and passes it on to the kidneys to be excreted

Protein Metabolism

10-35%

Protein should provide ____% of caloric intake daily

-Enzymes that control the rates of metabolic reactions -Clotting factors -The keratin of skin and hair -Elastin and collagen of connective tissue -Plasma proteins that regulate water balance -The muscle components actin and myosin -Certain hormones -The antibodies that protect against infection

Proteins are...

the bloodstream

Proteins, starches, fats, vitamins, minerals, water and alcohol have all been reduced to the smallest unit possible so they can permeate the intestinal wall and find their way into ______

1. Reduce the frequency of consumption of foods and drinks containing fermentable carbohydrates, especially between meals 2. Finish any eating or drinking with a non-cariogenic and cariostatic food Non-cariogenic snacks: raw fruits and vegetables; low-fat cheese, milk, and yogurt; nuts; popcorn; seeds; pizza and tacos 3. Combine and sequence foods to enhance mastication, saliva production, and oral clearance 4. Drink water to satisfy thirst and hydration needs 5. Consume sweetened and acidic beverages with meals and snacks that contain other foods that can buffer their cariogenic and acidogenic effects 6. Don't eat so close to bedtime, brush and floss before bed.

Recommendations to Reduce the Cariogenic Risk of the Diet:

What Happens in the Kidneys

Removes waste from the blood Removes toxins from the blood Metabolic end products from cells Unnecessary substances absorbed from the GI tract Drugs Filters and reabsorbs: Glucose Amino acids Vitamins Water Minerals

AI - 1000mg *Only 1 in 4 Americans meets AI for calcium* Current levels of intake Males ages 9+ : Average intake ~925 mg/day Females ages 9+: Average intake ~657 mg/day AI for those with self-diagnosed lactose intolerance~320 mg/day (25% of AI) -At high risk of inadequate intakes to build peak bone mass and prevent osteoporosis

Requirements: Calcium

AI - 3-4mg UL - 10mg

Requirements: Fluoride

19-50 years : 5 mcg (200 IU)/day 51-70 years : 10 mcg (400 IU)/day > 70 years : 15 mcg (600 IU)/day Median intake : 90-114 mcg/day UL: 50 mcg (2000 IU)/day

Requirements: Vitamin D

-RDA15 mg/day α-tocopherol (α-TE) -UL : 1000 mg/day

Requirements: Vitamin E

Women - 90 mcg/day Men - 120 mcg/day no UL established

Requirements: Vitamin K

Anabolism

Requires energy to synthesize the end products

-goes hand-and-hand with composition -If you remove the retentive factor, starch is the least cariogenic of carbohydrates (large molecule that must be broken down before it can diffuse through plaque) -Still cariogenic because it is retentive

Retentive factor

Men: 1.3 mg/day Women: 1.1 mg/day

Riboflavin requirements

Beef liver Lowfat milk Lowfat yogurt Oysters Cereal Avocado Collard greens Chicken meat Canned salmon Asparagus Broccoli Brussel sprouts Spinach Whole wheat bread

Riboflavin sources

Age Gender Fluoride exposure Systemic illness Medications Oral hygiene Salivary function Diet

Risk Factors for Root Caries

-Lower socioeconomic groups -Less than a high school education -Poor nutritional health -Behavioral/environmental factors, such as substance abuse -Nutrient deficiencies, especially iron, may occur -Cravings -May be cultural and regional and may result in poor nutrition

Risk factors for Pica

-Periods of rapid growth -Medically compromised patients -Patients with substance abuse issues (alcohol, tobacco, methamphetamine) -Psychological and physical stress -Vegans -Following vitamin-deficient diets for prolonged periods -Alcoholism; due to poor diet and liver failure -Older people; due to lack of appetite, poor-fitting dentures, medications -Anyone with physiological disorders that interfere with vitamin ingestion, digestion, absorption, or utilization

Risks & Reasons for vitamin deficiency

Recommend 3-month recall Meticulous oral self-care, topical fluoride application at home, fluoridated water Brush before consuming acidic foods to neutralize the pH of saliva Yogurt Pickled foods Citrus Wait 40 minutes to brush after consuming acid foods/vomiting Rinse with water or chew a xylitol gum Reduce consumption of or use a straw for acidic drinks Coffee/tea/wine Carbonated drinks/sport & energy drinks Avoid foods that cause sensitivity Choose room temperature drinks/eat foods at room temperature Decrease frequency of intake of fermentable carbohydrates or follow with a chewing gum containing xylitol or a noncariogenic food (cheese or milk)

Root caries - hygiene considerations

Root caries -Particularly susceptible to decay due to anatomically thin layer of enamel and cementum Dentin hypersensitivity -Erosion is major cause -Bulimia -Commonly result of exposure to acids from food, beverages, and GERD -Recession -Abfraction/abrasion -Poor oral hygiene (heavy plaque build-up)

Root caries and hypersensitivity

Second trimester

Routine dental care during which trimester is not associated with increased risk of serious medical events, preterm delivery, spontaneous abortion, or fetal death or anomalies?

steroids

Sex hormones like testosterone, estrogen, and progesterone belong to the group of lipids called ____

Setting goals

Should be difficult enough to be challenging, but not so difficult as to seem impossible.

Iron

Signs and symptoms of a deficiency of this nutrient include: microcytic anemia, fatigue, faulty digestion, blue sclerae, pale conjunctivae, and tachycardia. What nutrient is missing?

◦ Rapid weight gain ◦ Puffy eyelids ◦ Distended neck veins ◦ Elevated blood pressure ◦ Peripheral edema Symptom: ◦ Denture is too tight

Signs: Fluid volume excess

-Milk and dairy products -Preferred sources = high calcium, lactose, and other nutrient content that enhances Ca absorption -Fortified soy and rice milk -Fortified foods (orange juice) Supplements -Limited *bioavailability* -Better absorbed when taken with food -Calcium citrate malate, calcium lactate, calcium citrate, and calcium sulfate have high absorption rates

Sources: Calcium

Retinoids (preformed): -Found in animal products -Liver -Fortified dairy -Fish -Fortified foods Carotenoids (precursor) -Deep-colored fruits and vegetables -Carrots -Cantaloupe -Squash

Sources: Vitamin A

Sunlight Fish liver oils Fatty fish Fortified foods Milk Cereals Orange juice

Sources: Vitamin D

Vegetable oils, especially soybean oil Unprocessed cereal grains or fortified cereals Nuts and seeds Wheat germ Green leafy vegetables Some fruits such as apples, apricots, and peaches

Sources: Vitamin E

-Human gut contains bacteria that produce a form of vitamin K, but unclear how this contributes to maintenance of vitamin K status -Green leafy vegetables -Absorption enhanced with presence of dietary fat -Fats and oils

Sources: Vitamin K

-Is a polysaccharide -Many glucose units in long chains or branched -Amount of starch in a vegetable increases with aging -Cell wall makes starch insoluble in cold water -Most complex carbohydrates are in the form of starch: cereal grains, roots, vegetables and legumes

Starch

1.5

Stomach stores the masticated food for about ___ hours and continues to break it down into smaller particles

-gram-positive -anaerobic -spherical

Streptococcus mutans characteristics

-"starts the job" -Initiates pit & fissure, smooth surface & root surface decay. -Invades to the enamodentinjunction.

Streptococcus mutans role in caries

pathogenic

Strong immune system can fight off initial ____ invasion

Electrolytes

Substances that dissociate into charged particles (ions) when dissolved in water or other solvents, and conduct electrical currents

Sorbitol Xylitol Maltitol Mannitol Lactitol Isomalt Erythritol Sugar alcohols or polyols sweeten with less energy per gram than sucrose (averaging 2.4 kcal/g) Provide calories but are used in smaller amounts Potential to cause gastric upset Sorbitol and mannitol Essentially noncariogenic Maximum recommended amount <20 g/day

Sugar alcohols

-May decrease calories (good for weight control) and decrease caries but added ingredients to make them more like the texture of sugar may make them cariogenic 500mg/day = saccharin (Sweet & Low) 50mg/kg body weight = aspartame (Equal) 15mg/kg body weight = Acesulfame-K Saccharin should not be used by pregnant women - crosses the placenta

Sugar substitutes

-Encourage water as beverage of choice to fulfill daily water needs rather than caloric beverages -Assess patients for electrolyte imbalances and nutrient deficiencies/excesses and refer to medical providers as needed -Consume less than 2300 mg (approximately 1 tsp salt) of sodium per day by choosing and preparing foods with little added salt -Deficiencies manifest in the oral cavity-monitor nutritional status.

Summary - Water

-Deficiencies of thiamin, riboflavin, and niacin are rare in developed countries due to enrichment of grains -Deficiency of only one of these vitamins and not the others is rare -Supplements are not usually needed for those having a healthy diet -Supplementation of niacin for cholesterol control needs to be under the careful supervision of a physician

Summary of B1, B2, B3

-Older patients are at greatest risk for deficiency -Deficiency of folic acid in pregnant women can cause irreversible birth defects -Oral signs of deficiency are seen, particularly burning tongue and glossitis -Daily multivitamin supplement containing folate is recommended for young women of childbearing age -Daily multivitamin containing folate and B12 is recommended for older patients -Supplements of B6 are usually NOT indicated, and excesses can cause harmful side effects

Summary of Hematopoietic Vitamins

Nervous system/saliva

Sympathetic - controls composition Parasympathetic- controls amount secreted

Aspartame (phenylalanine and aspartic acid—two AAs) NutraSweet and Equal Saccharin (derivative of petroleum) Sweet'n Low Acesulfame-K Sweet One Sucralose Splenda Erythritol- from grapes & pears Truvia

Synthetic Sweeteners with intense sweetening power that have FDA approval

noncariogenic

Synthetic sweeteners and sugar alcohols are _____

◦ Color ◦ Shape ◦ Functional Integrity ◦ Size ◦ Texture

Systemic conditions may be seen in oral cavity (sign) before a patient notices (symptoms)

True

T/F: -A food that is 80% sucrose may not be any more harmful than one that is 40% sucrose

TRUE. Potato chips are retentive (stick/stay on teeth) while hard candies melt. The potato chip instantly breaks down into starch on the tongue. (Only FALSE if the person were to be sucking on hard candy for a long period of time)

T/F: A potato chip worse than a hard candy.

False:

T/F: A relationship exists between nutritional status of a patient and tooth mobility, missing teeth, and denture performance.

True

T/F: A smooth purplish red or magenta tongue may be observed in patients with B6 deficient.

False: Although she is "eating for two" normal energy requirements are not doubled. Depending on the pre pregnancy weight, approximately 300 k calories more than her usual caloric requirement are needed during the second and third trimester

T/F: A woman should eat twice as much food when she is pregnant because she is eating for two

True

T/F: ALL carbohydrates can demineralize enamel.

False: If the diet is deficient in calcium, the fetal calcium requirements would be met first, but some of the calcium may come from her bones, not from her teeth

T/F: After pregnancy, most mothers have at least one carious lesion because calcium was pulled from teeth for use by the developing fetus

False: These cravings of not reflect natural instincts for required nutrients

T/F: All efforts should be made to satisfy a pregnant women's food cravings because cravings reflect an innate need for certain nutrients.

False: Beriberi is caused by a thiamin deficiency; niacin deficiency causes pellagra

T/F: Beriberi is caused by niacin deficiency

False: Breast milk is normally thin and nutritionally adequate

T/F: Breast milk is too thin and must be nutritionally inadequate

False: Liver, leafy vegetables, legumes, grapefruit and oranges are rich sources of folate

T/F: Carrots are a good source of folate

False: Flushing and intentional disturbances are symptoms of niacin toxicity. No toxicity symptoms have been observed for thiamin.

T/F: Complaints of flushing and intestinal disturbances are symptoms of thiamin toxicity

True

T/F: Enriched breads and cereals are good sources of thiamin

True

T/F: Glossitis can be a symptom of a nutrient deficiency.

TRUE. They are slow dissolving.

T/F: Hard candies and breath mints are cariogenic.

False: It is important to have nutrient-dense available, but in different consistencies. A full liquid diet, progressing to a mechanically altered diet and then to a regular diet would allow the patient to adjust to swallowing, chewing, and biting with the new appliance.

T/F: Hard, fibrous, nutrient-dense food are recommend for the first few days after insertion of new dentures to promote healing and prevent loss of alveolar bone.

True

T/F: Heme iron is provided by meat sources and is more readily absorbed than iron from vegetable or grain products

False: more often an infant nurses the more milk produced. Milk production is most active during infant sucking.

T/F: If breast milk supply is inadequate, a feeding should be omitted to have more milk available later

TRUE. (Honey can sometimes be more cariogenic b/c of its thick and sticky properties)

T/F: Natural sugars such as honey, molasses, and raw sugar are *just as cariogenic* as refined sugar.

False: Spongy cancellous bone is the major component of alveolar bone

T/F: The primary component of alveolar bone in compact cortical bone

True

T/F: Virtually all women can produce enough milk to support nutritional needs of the infant

False: Iron and folate are usually the nutrients needing supplementation

T/F: Vitamin A is the only nutrient warranting global supplementation during preganancy

False: Vitamin D is called the sunshine vitamin because sun facilitates the body's production of vitamin D; vitamin B6 is also called pyridoxine, pyridoxal and pyridoxamine

T/F: Vitamin B6 is the sunshine vitamin

T

T/F: Vitamins cannot be used if macronutrients and some minerals are not present

True

T/F: WIC is a governmental program that provides supplemental foods for women, infants and children

True

T/F: Water is the most abundant component in the body

False: other causes are possible, such a frequent intake of hard candy. No single factor is adequate to diagnose the presence, extent, or cause of root caries. An inaccurate evaluation can lead to inappropriate recommendations

T/F: While charing for dental caries, the dental hygienist notes several root caries and documents xerostomia as the cause. This is a correct assessment.

True

T/F: Xerostomia can be a contributing factor to malnutrition in an older patient.

False: although xerostomia is a common complaint in older adults, the changes in saliva in a healthy older individual is minimal. Xerostomia can be associated with medications, systemic disease, radiation

T/F: Xerostomia is a consequence of the aging process

mitochondria

Take in protein, carbohydrates and fats → broken down into amino acids, glucose and fatty acids → these are used by the _____ → the Krebs cycle uses enzymes to convert them into carbon dioxide, water and energy

16-24 hours

Takes _______________from the time you eat something until the time you excrete it

faster

Taste & smell decline significantly with age; smell declines ____ than taste. Medications, health conditions and radiation therapy can decrease as well.

nose

Taste and smell are driving force of eating choices. If the ____ doesn't know then the taste buds don't know either

appetite

Taste and smell contribute significantly to ____ and the ability to enjoy food

30-100

Taste buds provide sense of taste. Each taste bud consists of ___ cells

Rapid Cellular Turnover, Constant attack by microorganisms, Trauma Tense environment

The oral cavity is the site of a wide variety of systemic disease manifestations. Clinicians and patients can see signs and symptoms several ways. Which ways demonstrate this?

dehydration synthesis (condensation synthesis)

The process by which fatty acids attach to glycerol to form triglycerides is called ____

Folate

The recommended dietary allowance (RDA) of which vitamin is significantly more than RDA for a woman who isn't pregnant?

Prebiotics

_____ are food for probiotics

-Usually mono and dissaccharides are sweet to the taste -Candy, cookies, cake, soda, ripe fruits -The exceptions are milk and glucose-not sweet but are simple sugars

The simple sugars

cholesterol

The steroid component of cell membranes is called _____

an ester linkage

The type of linkage (bond) between each fatty acid and glycerol is called ____.

Retentive

_____ foods allow bacteria to feed and produce acid longer

Vegetarian diets

This diet generally results in lower dietary intake of Saturated fat and cholesterol, iron, zinc, and calcium, and high levels of dietary fiber, magnesium, potassium, vitamins C and E, and folate

-Those with infections -Pneumonia, rheumatic fever, and tuberculosis -Those with higher demands for collagen synthesis -Severe burns or fractures or undergoing surgical procedures -Alcohol users, cigarette smokers, those taking oral contraceptives, daily ASA users

Those Who Should Consume Vitamin C Above DRI:

-The body is unable to excrete excess sodium -Too much sodium in the body, not enough water ◦ Cells shrink -Water held in the extracellular fluid can lead to: ◦ Edema or ascites ◦ Characteristic of congestive heart failure, renal failure, adrenal tumors, liver disease -Can also result from dehydration or steroid medications -Can produce a dry, sticky tongue -High sodium intake exacerbates high blood pressure in salt-sensitive individuals Occurs as a result of: ◦ Water deprivation ◦ Excessive sweating, hyper ventilation ◦ Diarrhea

Too much sodium

-Megalobastic anemia (large pale RBC) ◦ Caused by RBC that did not develop normally -Birth defects ◦ Spina bifida and other neural tube defects ◦ Cleft palate and lip ◦ Low birth-weight ◦ Premature baby

Too little folate

Hypothyroidism ◦ Decreased metabolic rate Goiter ◦ Enlargement (hypertrophy and/or hyperplasia) of the thyroid gland due to inadequate intake ◦ Can be caused by an excessive intake of goitrogens: cabbage, cauliflower, Brussel sprouts, broccoli, kale, raw turnips and rutabagas Stillbirths, abortion, congenital anomalies Fetal iodine deficiency Cretinism- stunted growth and mental retardation

Too little iodine

-Excessive loss or inadequate intake of potassium -Deficiency may occur with very low calorie diets, anorexia nervosa, alcoholism, excessive vomiting, diarrhea, tissue wasting, diabetic ketoacidosis or the use of certain medications (diuretics, antibiotics) -Side effects of low potassium: ◦ Cardiac arrest and respiratory failure ◦ Muscle cramping

Too little potassium (hypokalemia)

-More sodium is lost from the body than water OR, another way to say it: More water exists in the body than sodium ◦ Hyponatremia: water intoxication -Deficiency can result from extremely heavy sweating in athletes, people doing heavy work in hot environments (heat exhaustion) -Others at risk for sodium deficiency: ◦ Those experiencing severe vomiting or diarrhea ◦ Those with adrenal gland disease or cystic fibrosis ◦ Drinking excessive amounts of water ◦ Use of diuretics

Too little sodium

neurological disorders

Too much B6 can cause ____

Thyroiditis Hypothyroidism Hyperthyroidism Goiter Can occur from food intake, supplements, topical medications and iodinated contrast media Overconsumption of seaweed may cause iodine toxicity Sea salt contains less iodine than table salt

Too much iodine

Hemosiderosis (hereditary iron storage disorder) happens when excessive iron is stored called hemosiderin ◦ May develop with: Excessive iron intake Multiple blood transfusions Failure to regulate absorption Iron supplements should only be taken under a doctor's orders

Too much iron

Toxicity can result from ◦ Sudden increase in dietary intake in those unable to excrete excesses, i.e., renal failure ◦ Improper use of salt substitutes or potassium tablets ◦ Renal failure causing impaired excretion ◦ Dehydration, adrenal insufficiency ◦ Major infection, hemorrhaging into the GI tract ◦ Increased and rapid protein catabolism -May lead to cardiac arrest -Symptoms of toxicity include ◦ Numbness of the face, tongue, and extremities ◦ Muscle weakness ◦ Cardiac arrhythmia ◦ Cardiac failure

Too much potassium (hyperkalemia)

-Can contribute to obesity -Stresses the kidneys and liver -For every 100 kcal of protein, the body needs 350g (12oz) of water to metabolize it

Too much protein

-pre-eruption -pits & fissures -rotations vs. straight alignment -crowding vs. straight teeth -mineralized vs. demineralized -diastemas

Tooth Structure Considerations

rate

Under normal circumstances in an adult, anabolism and catabolism both occur at the same ____

It can cause an overzealous attempt to eliminate pathogens Body sends an overabundance of immune cells to the area Immune cells produce cytokines and other enzymes Cytokines and enzymes destroy periodontal fibers and stimulate osteoclastic activity

Unhealthy Immune System

Use of tobacco, alcohol, caffeine, some medications, megadoses of nutrients, and illegal drugs may detrimentally affect the fetus.

Use of these products may detrimentally affect the fetus:

*Retinoids* (preformed): in animal products 70%-90% absorption *Carotenoids* (precursors): fruits and vegetables 9%-22% absorption -Vision in dim light -Growth: cell differentiation (DNA/RNA synthesis), bone, tooth development -Integrity of skin, mucous membranes -Maintenance of immune function

Vitamin A

Women- 700ug Men-900 ug Almost doubles for lactating women UL : 3000 mcg/day

Vitamin A RDA

Mineral oil

_____ interferes with absorption of Vitamin K and should not be consumed close to a meal

B12

Vegan diet not recommended for infants, children, or lactating women. Breastfed infants of two vegan mothers in the US developed brain abnormalities as a result of vitamin ____ deficiency

Should make up ½ of the plate Fruit = 1.5-2 cups/day Minimal fruit juice Vegs = 2-3 cups/day Weekly: 1.5 to 2 cups dark green 4-6 cups red and orange 1.5 to 2 cups dry beans and peas 4-6 cups starchy 4-5 cups other Both are primary source of Vit A & C, folic acid and K+ Vitamin C occurs naturally only in fruits and vegetables

Vegetables and fruits

-Iron, zinc, and calcium should be monitored for adequacy -Vegans can obtain calcium from tofu, green vegetables and some nuts, but may need supplementation -Vegans may need vitamin D and vitamin B12 supplementation

Vegetarian dietary considerations

-Consume diets primarily derived from plant sources -Diet tends to be fibrous and more abrasive than nonvegetarian diets -Diet tends to be higher in carbohydrates -However, prevalence of caries is relatively low compared to non-vegetarians

Vegetarians caries risk

Better weight control Improved gastrointestinal function Fewer breast and colon cancers Better glucose control A lower incidence of gallstones Lower blood pressure A decreased rate of CHD Greater longetivity

Vegetarians exhibit:

-*frequency* of consumption is the *prime factor* in caries activity -*form* and *composition* of sweets is important -*when* you consume fermentable carbohydrates plays a big role in caries -quantity of sugar eaten is NOT important

Vipeholm Study Findings

-Decreases the transit rate -Also called Soluble fiber -Includes pectins, gums, psyllium, mucilages, algal polysaccharides -Bind bile acids and decrease serum cholesterol levels -Improve glucose tolerance

Viscous fiber

-First of 8 B-complex vitamins to be discovered Deficiency recognized in 2600 BC ◦ Eat polished rice -> polyneuritis (Primary dietary deficiency in developing countries) ◦ Eat whole grain rice -> no disease -Morale vitamin ◦ Short-term deficiency causes depression, irritability, anorexia, fatigue and lack of concentration

Vitamin B1

◦ Metabolism of CHO, proteins, fats ◦ Energy transformation ◦ Membrane and nerve conduction ◦ Works as a coenzyme with riboflavin to synthesize niacin

Vitamin B1/Thiamin functions

RDA ◦ Men: 1.2 mg/day ◦ Women: 1.1 mg/day No UL set at this time ◦ Exercise, pregnancy, lactation, hemodialysis, fever, hyperthyroidism, cardiac conditions & alcoholism increase the requirement

Vitamin B1/Thiamin requirements

-Most complex chemical structure of any of the vitamins -Contains the mineral cobalt, which gives it a dark red color -Synthetic source is known as cyanocobalamin -Only present in animal foods -Destroyed by heavy metals and strong oxidizing and reducing agents

Vitamin B12 - cobalamin

Pregnant women, adolescents, older adults, and those who have adhered to a vegetarian diet since birth.

Vitamin B12 deficiency rates are especially high for:

A unique yellowgreen fluorescent pigment -Color pigments in foods are known as "flavins" -Stable in heat -Destroyed by alkali, ultraviolet rays, and light -Coenzyme in the metabolism of carbohydrates, proteins, and fats to release energy -Essential for healthy eyes and maintenance of mucous membranes -Works with thiamin to synthesize niacin

Vitamin B2/Riboflavin

Involved in energy metabolism Conversion of tryptophan to niacin

Vitamin B2/Riboflavin physiological role

Two active forms of the vitamin: ◦ Nicotinamide ◦ Nicotinic acid Stable in heat, acids, light, and oxygen May be lost in food if cooking water is discarded Works with riboflavin in glucose production & metabolism, lipid & protein metabolism Functions in enzymes that degrade sucrose to produce organic acid ◦ Needed for the growth of cariogenic bacteria (increases rate of caries when present)

Vitamin B3/Niacin

-Name comes from the Greek word for "everywhere" because it is found widely in foods -Component of coenzyme A ◦ Metabolizes carbohydrates, proteins, and fats -Synthesis of vitamin D -Synthesis and degradation of triglycerides, phospholipids, and sterols -Found in all body tissues, particularly in the liver -Deficiencies are rare-seen in combination with other B vitamin deficiencies -Toxicities have not been seen -Supplements generally not needed

Vitamin B5 Pantothenic Acid

A group of related compounds: ◦ Pyridoxine (plant products) ◦ Pyridoxal and pyridoxamine (animal products) Pyridoxine is the most stable form All forms can be destroyed by light, especially in neutral and alkali mediums Reduces incidence of caries in animals

Vitamin B6 Pyroxidine

-Name derived from the fact that it was found to be one of the "bios" factors which yeast needed for growth -Functions as a coenzyme in metabolism of carbohydrates, proteins & fats

Vitamin B7 biotin

-Coenzyme in hydroxylation of proline for hydroxyproline in collagen synthesis -Promotes capillary integrity -Enhances iron absorption -Aids in utilization of folic acid and vitamin B12 -Coenzyme function in metabolism of amino acids and biosynthesis of bile acids, thyroxine, epinephrine, and steroid hormones -Antioxidant

Vitamin C (Ascorbic Acid)

-Citrus fruits -Tomatoes -Raw, leafy vegetables -Strawberries -Potatoes and sweet potatoes

Vitamin C sources

-Called a vitamin, but more appropriately classified as a *hormone* -Skin cells able to make vitamin D precursor 7-dehydrocholesterol with further processing by liver and kidneys -Enhances intestinal calcium and phosphorus absorption -May be involved in cells in *hematopoiesis* (the formation of RBC), the skin, cardiovascular function and immune response

Vitamin D (Calciferol)

Antioxidant -Protects polyunsaturated fats in phospholipid cell membranes -Prevents oxidation of fatty acids and vitamins A and C Enhances release of a *prostaglandin that inhibits the aggregation of platelets, enhances vasodilation and immune response* Anticoagulant

Vitamin E

-Coenzyme for proteins involved in bone crystalline formation -Catalyst for synthesis of blood-clotting factors -Naturally occurring vitamins are K1 (phylloquinone), in green plants and K2 (menaquinone) formed by E coli bacteria in large intestine

Vitamin K

- Polar bear liver contains toxic amounts of Vitamin A - Some vitamins have a very small range of safety (vitamins A and D) due to body storage - **The body stores large amounts of fat soluble

Vitamin Overdoses and Toxicity

-To ensure adequacy, all should be obtained from the diet -Necessary at points along metabolic pathways -Consumed in active vitamin form or as precursors = converted in the body to the active vitamin

Vitamins

A, E, D, K, C

Vitamins Required for Calcified Structures

macronutrients

Vitamins act as catalysts to release energy from ____

Active transport Passive diffusion Osmosis

Vitamins, minerals and nutrients are absorbed in the small intestine via:

-Humans can only survive for about 14 days without water -Considered a macronutrient -Most abundant component of the body ◦ At birth 75%-80% of body weight ◦ In an adult 50%-60% of body weight -Body water is higher in men than in women -Water is absorbed directly from the small intestine by osmosis into the circulating blood (as much as 1liter in 1 hour) -Produced during the catabolism of macronutrients -Stored primarily in the extracellular spaces -Water is excreted by all excretory organs, particularly the kidneys

Water

20%

Water content of adipose tissue

90%

Water content of blood plasma

20%

Water content of bone

75-80%

Water content of muscle tissue

Facilitates digestion and absorption by serving as ◦ Basis of saliva and digestive juices ◦ Solution in which nutrients are absorbed ◦ Transport vehicle for nutrients and other dissolved substances via blood and lymph ◦ Transport medium for nutrients crossing cell membranes -The body's universal solvent -A required component of and produced by some chemical reactions -Dissolves and facilitates excretion of body waste -Lubricant between cells and for body parts such as joints -Maintains body lubricants (saliva, tears, mucus) -Regulates body temperature

Water functions

-Fluid Volume Excess (FVE) -Equal gain and loss of water and sodium -The more sodium, the more water -Occurs mainly in extracellular fluid (joints, pleura, GI tract), causes edema -Sodium retention in conditions such as CHF, chronic renal failure, chronic liver disease or high levels of steroids -Malnutrition & renal diseases contribute due to loss of osmotic forces

Water hyperstate

Fluid volume deficit (FVD) ◦ Associated with excessive loss of fluids from: -Gastrointestinal tract (vomiting, diarrhea, drainage tubes) -Urinary tract (diuretics, polyuria, or excessive urination) Skin (sweating) Diaphoresis (excessive sweating) ◦ Classic signs are: -Dry tongue with longitudinal fissures (slits or wrinkles that extend lengthwise on the tongue) -Xerostomia -Shrinkage of oral mucous membranes -Decreased skin turgor -Dry skin -Decreased urinary output

Water hypostates

-No Dietary Reference Intake (DRI) for water Adequate Intake ◦ Men: 15-16 cups/day (125 oz) ◦ Women: 11-12 cups/day (91oz) ◦ Infants and children: 1.5 mL/kcal Requirements change due to activity level Approximately ½ oz for every pound of body weight

Water requirements

B-complex vitamins and vitamin C Dissolve in water Transported via active or passive transport in the portal system The "body pool" must be replenished regularly from the diet Readily oxidized by heat or light,may leech out into cooking water

Water soluble vitamins

C

Water soluble vitamins

Plain tap water is the most natural source of fluids ◦ EPA regulates the levels of contaminants allowed in drinking water in public water systems ◦ Use of bottled water has increased -Soft drinks, sports & energy drinks, vitamin water, & other drinks ◦ Energy drinks containing high kilocalorie and caffeine levels are the fastest growing beverage category ◦ Beverages containing acidic flavorings may result in erosion ◦ Americans consume 21% of their daily kilocalories (approx 500 calories) from caloric beverages -Most water is obtained via food and liquids -Solid foods (fruits and vegetables) contribute about 1 liter or 4.5 cups/day -Small amount is generated through cellular metabolism (1 cup/day)

Water sources

Subjects placed in one of 3 groups: 1. Given 300mg of additional sugar in solution w/ meals (sugary drink) 2. Given an additional 50g of sugar in bread w/ meals 3. Given in-between-meal snacks of toffee & candy

What 3 groups were the residents of the Vipeholm study divided into?

Decalcification Soft tissue lesions Gingival inflammation

What are some of the dental risks associated with orthodontic treatment?

Overall, the goals for a patient with xerostomia are to protect the oral cavity from the destructive effects of xerostomia, treat existing conditions, and to provide relief of the dryness to improve the quality of the diet and the quality of life. It is the responsibility of the dental professional to recognize and manage the patient experiencing xerostomia.

What are the treatment goals for a patient exhibiting signs of xerostomia?Nothing Protect oral cavity from destructive effects of xerostomia Treat existing conditions Provide relief of dryness Improve quality of life

eating crunchy or chewy foods chewing gum, raw fruits and vegetables

What can increase salivation?

-extracellular polysaccharides (makes plaque sticky) -intracellular polysaccharides (food to bacteria, produce acid)

What do S. mutans and Lactobacillus make?

-Controls the type and amount of nutrients in the blood -The only place where monosaccharides are converted to glucose -Glycogen stores are converted to glucose and sent into the bloodstream (the liver monitors blood glucose levels) -Synthesizes lipoproteins -Converts excess carbohydrates and proteins into fatty acids and triglycerides -Synthesizes cholesterol and phospholipids -Removal of ammonia from the body by synthesis of urea

What does the liver do?

deficiences

____ result when adequate amounts of a nutrient are not available to sustain biochemical functions

-A hydrated carbon -Made of carbon, hydrogen, oxygen -Lowfat source of fiber and nutrients -Some have a sweeter flavor than others -All products of plants during photosynthesis except lactose -Expressed as Cn(H2O)n -The main building block of a carboyhydrate is C6H12O6

What is a carbohydrate?

Producing peptides, proteins, polysaccharides, lipids, nucleic acids These molecules are used to: -Build new muscle tissue -Build bone -Secrete hormones -Enzymes, antibodies

What is anabolism doing?

triglycerides

What is another name for neutral fats?

calcium, phosphate, sodium bicarbonate and proteins

What is saliva saturated with?

-The term sugar encompasses all mono-, di-and polysaccharides -Fermentable carbohydrates include all sugars or cooked starches metabolized by oral bacteria to produce acids.

What is the difference between sugar and sucrose?

acid production

What is the end product after CHOs are eating and metabolized by plaque bacteria?

starch

What is the least cariogenic carbohydrate?

sucrose

What is the most cariogenic carbohydrate?

dental caries

What is the most chronic childhood disease?

-Identify health-related considerations -Identify medications that may place a patient at nutritional risk -Identify medications that may place a patient at health risk -Provide a foundation for developing a treatment/dietary education plan

What is the primary purpose of reviewing and gathering health history data?

Virus Nutritional deficiencies Fungus Idiopathic Bacteria

What may cause glossitis?

-people are drinking more water and less soda -fluoridated water -patient education -sealant programs -increased amount of dental offices -more offices are switching to digital radiographs (catching caries incipiences earlier before becoming carious lesions)

What might be contributing to the *increased sugar consumption* and *decreased incidence* of caries?

Avoid sweet or acidic food/beverages Use topical fluorides Consider a 3-month recare schedule Eat cheese Avoid temperature extremes with food

What nutritional recommendations might a dental hygienist make to a patient with gingival recession or dentinal hypersensitivity?

After initial placement, adjustments or repair in orthodontic care may require a liquid or mechanical soft diet for 1 to 2 days; remind the patient that appliances can be damaged with sticky, hard, or firm foods or chewing on ice. Soft tissue trauma caused by sharp appliances can lead to discomfort and avoidance of certain foods. Warm saltwater rinses (8 oz water with 1 tsp of salt) and use of utility wax to cover the offending surface of the appliance provide comfort for the patient until the situation can be resolved.

What oral care interventions/recommendations might be made to patients with orthodontic appliances?

Avoid chewing gum Mechanical diet Limit jaw opening

What recommendations should be made to patients diagnosed with temporomandibular disorders?

Preeclampsia

What term is used to describe a potentially serious complication of pregnancy involving high blood pressure and that may lead to premature labor?

Osmosis

What term is used to describe the movement of water from an area of lower solute concentration to one of a higher solute concentration, across semipermeable membranes?

Mucins

What traps bacteria and removes it with normal swallowing patterns?

Water

Which is the most natural source of fluids for quenching thirst?

-Assess adequacy of overall diet particularly: -Vitamins A, B6, C, K+, Fe+, Ca+, Zn -Fluid, fiber, and protein Avoid: Dry (saltines) Crumbly (whole wheat muffins) Sticky (peanut butter) Spicy (chili) food Alcohol Commercial mouthwashes containing alcohol Tobacco -Counsel the patient about techniques/products to relieve symptoms of xerostomia -Use gravies and sauces to moisten dry foods -Choose nutrient-dense, soft, moist foods (macaroni and cheese, cottage cheese, applesauce)

Xerostomia - hygiene considerations

Systemic diseases like diabetes, Sjogren's syndrome, Obesity Dehydration

Xerostomia is characterized by diminished or absent salivary flow or a change in salivary viscosity. What are some common factors contributing to xerostomia?

The only CHO that is anticariogenic Mechanisms of action against caries: Inhibits growth of cariogenic bacteria (S. mutans) Inhibits plaque growth Decreases transmission of cariogenic bacteria Promotes remineralization Complements fluoride toothpaste use

Xylitol

-Zinc is an important nutrient for wound healing and new tissue formation -Zinc deficiency can impair healing and resistance to infection and can also affect the sense of taste -Deficiency is rare but can occur in older persons

Zinc summary

niacin

___ in corn is bound and un available

Energy

___ nutrients need vitamins and minerals to facilitate digestion, absorption and metabolism

Cholecystokinin

____ is a hormone released in response to fat in chyme -stimulates gallbladder to release bile

Bile

____ is made by the liver but stored in the gallbladder

Adult PEM

____ is often associated with long-term drug and/or alcohol abuse

Oral cavity

____ is pathway to the rest of the body

Starch -Starch must be broken down before it can diffuse through plaque -But starch IS cariogenic -More retentive than sugar

____ is the least cariogenic carbohydrate

Peristalsis

____ moves the food rapidly to the stomach

Calcium

____ requirements are increased when dietary phosphate is high as in the typical American diet

Lipolysis

breaks down fat

Pepsin

breaks down protein molecules into smaller parts

Lipase

breaks down short & medium triglycerides

heavy salivary flow

causes oral cavity to be cleared faster

Basal Energy Expenditure: (BEE)

combined total of kcal necessary to maintain BMR, kcal needed for thermic effect, voluntary movement, and any increased needs for catabolic or anabolic processes in a 24 hr period

Raw egg whites

contain a compound that can bind biotin and prevent absorption

Liver does...WHAT?

controls the kinds and quantities of nutrients in the blood, turns monosaccharides into glucose

-normal pH = 7 -critical pH = 5.5 -critical pH of exposed cementum or dentin = 6.7

enamel demineralization

Macronutrients

energy-providing nutrients needed in larger amounts than micronutrients

phosphorus & calcium

give saliva buffering effect

sucrose

glucose plus fructose=

lactose

glucose plus galactose=

function group

group of atoms that gives family of molecules its characteristics chemical and physical properties

sodium bicarbonate

has a high pH and can neutralize acids in the mouth

Reflective listening

healthcare provider listens to the pt. remarks and then paraphrases what the clinician heard the patient say effect of validating the patient, expressing understand, and typically encourages the pt. to elaborate

Metabolism

the continuous process of living organisms and cells converting nutrients into energy, body structure and waste

UL: Tolerable Upper Intake Level

the maximum daily level of nutrient intake that probably will not cause adverse health affects or toxicity

Kilocalorie

the measure of the amount of heat it takes to raise the temperature of 1 kg of water 1°C

Glucose

the most common circulating sugar in the blood, it is the major energy supply for cells

Glycogenesis

the process in which sugars are broken down and stored as glycogen

Gluconeogenesis

the process of synthesizing glucose from non-carbohydrate sources (proteins, fats)

Glycemic effect

the rate at which glucose rises in the bloodstream after a particular food is eaten

Nutrition

the use of food to obtain nutrients for energy, growth, development & maintenance

food frequency questionnaire

to determine how often a patient consumes foods from grouping containing similar nutrient content requires little time and explanations can be completed in the waiting room relevant in determining caries risk

140mg/dL

typical blood glucose 30-60 min after eating

inadequate salivary flow

will effect how long foods and drinks stay on the teeth or in the mouth.