Nutrition for Oral and

Dental Health
Nutrition for Oral and Dental Health

• Nutrition influences the integrity of

the oral mucosa

• The mouth is an indicator of

nutritional information reflecting past
and present nutritional insults more
than almost any other body site
 Nutrition for Oral and Dental Health
Diet influences:
•the health of the oral cavity
•the onset of caries
•the development of the enamel
•the onset of dental erosion
•the state of periodontal health, and of the oral mucous in
general.

Early nutritional imbalance influences malformations most

•Nutritional imbalance in a very active period of growth will
produce greater damage
Oral and Dental Health
 Nutrition for Oral and Dental Health
Teeth are made from protein
matrix that is mineralized with
collagen (requiring vitamin C),
calcium, and phosphorus
(requiring vitamins D and A)
Nutrition for Oral and Dental Health

• Caries is a gradual demineralization of

the inorganic part of the tooth with the
dissolution of the organic substance

• The demineralization of the enamel and

of the dentine is caused by organic
acids that form in the dental plaque
because of bacterial activity, through
the anaerobic metabolism of sugars
found in the diet
Nutrition for Oral and Dental Health
• Demineralization occurs when the organic acids
produced increase the solubility of the calcium
hydroxyapatite that is present in the hard tissue of teeth
Nutrition for Oral and Dental Health
• The development of caries requires the presence of
sugars and bacteria but it is influenced by :
• the susceptibility of the teeth
• the type of bacteria
• the quantity and quality of the salivary secretion.
Nutrition for Oral and Dental Health
• frequency of sugar eaten is the primary factor involved
in the caries process
• sugary foods or liquids consumed 20 minutes apart
allows for separate opportunities for bacteria to feed
and produce acid.
• When the pH of the dental plaque falls below 5.5, the
caries process begins.
• Form and composition of a fermentable carbohydrate
plays a secondary role depending on how long it takes
for a food or drink to clear the oral cavity.
• Liquids clear faster than soft, sticky foods. 
The Decay Process
• Saliva is supersaturated with calcium and phosphate with a pH
equal to 7, a level that favours remineralization

• Sticky mix of microorganisms, protein, polysaccharides leads to

plaque formation

• Bacteria metabolizing fermentable carbohydrate produce acid

• Acid production: oral pH<5.5 allows tooth demineralization

• When acid stimulation is too strong demineralization prevails

until the formation of a carious lesion
• treptococcus
• Smutans—most common
bacteria involved
• Fermentable
Carbohydrate
• Time
• Drop in salivary pH to
below 5.5
 Nutrition for Oral and Dental Health
• Diet in the prevention of caries

• Increase in the consumption of fibres: diminution of the absorption of

sugars contained in other food.
• Diets composed of little sugar produces very low levels of caries.
• Cheese has cariostatic properties.
• Calcium, phosphorus and casein contained in cow milk inhibit caries.
• Wholemeal foods have protective properties: they require more
mastication, thus stimulating salivary secretion.
• Peanuts, hard cheeses, and chewing gum are good gustative/mechanical
stimulators of salivary secretion.
• Black tea extract increases the concentration of fluorine in the plaque
and reduces the cariogenicity of a diet rich in sugars.
• Fluorine.
 Nutrition for Oral and Dental Health

Fluoride
•Primary anticaries agent
•Water fluoridation
•Fluoridated toothpastes
•Oral rinses
•Dentrifices
•Beverages made with fluoridated
water
Major Nutrients for Oral Health and their Specific Roles.

•Vitamin D •Vitamin A
Calcium and phosphorus absorption Forms oral epithelium
•Builds skeletal bones and teeth •Enhances immune system
•Alveolar process support •Wound healing

•Protein
•B-Complex Vitamins
Supports growth of cells
Formation of new cells
•Resist infection
•Cofactor for nutrients
•Makes antibodies

•Vitamin C •Iron, Zinc, Copper

Aids in collagen formation Aids in collagen formation
•Promotes capillary integrity •Wound healing
•Enhances immune response •Regulates inflammation
Cariogenic: Foods that Cariostatic: Anticariogenic
promote caries Foods that do not FoodsPrevent plaque
development contribute to decay from recognizing an
contain fermentable not metabolized by acidogenic food when it
carbohydrates that can microorganisms in is eaten first
cause a decrease in plaque to cause a drop May increase salivation
salivary pH to <5.5 and in salivary pH or have antimicrobial
demineralization when activity
in contact with
microorganisms in the
mouth
Include crackers, chips, Includes protein foods, Includes xylitol (sweetener
pretzels, cereals, breads, eggs, fish, meat and in sugarless gum) and
fruits, sugars, sweets, poultry; most vegetables, cheeses
desserts fats, sugarless gums
Nutrition for Oral and Dental Health
The nutritional state of the client can influence
the health of teeth even before they erupt

•. A lack of vitamins D and A and protein-energy

malnutrition have been associated to hypoplasia
of the enamel and atrophy of the salivary glands,
conditions that determine a greater susceptibility
to caries.

•Some hypoplasia and pits on the surface of the

enamel correlate to a lack of vitamin A

•Hypoplasia on the surface of the enamel

suggests alack of vitamin D.
 Nutrition for Oral and Dental Health

• Periodontal Disease
• Malnutrition and Bad oral hygiene
• Inflammation of the gingiva with
destruction of the tooth
attachment apparatus

• Gingivitis—early form

• Nutritional care involves

increasing vitamin C, folate, and
zinc
Nutrition for Oral and Dental Health

Stomatitis: general term for

inflammation of the oral mucosa

• it includes Candidiasis and herpes

simplex: fungal and viral infections
which can affect mouth and
esophagus causing pain and
dysphagia

•The correlation between candidiasis

and the lack of folic acid, vitamins A,
B1, B2, vitamins C, K, zinc, and a diet
rich in carbohydrates is significant
Nutrition for Oral and Dental Health

Xerostomia dry mouth:

• Hundreds of medications, including many
over-the-counter drugs, produce dry mouth
as a side effect. Among the more likely types
to cause problems are some of the drugs
used to treat depression, high blood pressure
and anxiety, as well as some antihistamines,
decongestants, muscle relaxants and pain
medications

•For xerostomia, try artificial salivas, citrus

beverages, sugar free candies or gums
Nutrition for Oral and Dental Health
Oral Health Affects Nutrition
•just as inadequate nutrition can affect oral health, poor
oral health status affects food choices and, thus,
nutritional status.
Nutrition for Oral and Dental Health
• Dysphagia is the inability to chew or swallow normally or
to transfer liquid or solid foods from the oral cavity to the
stomach.
• Dysphagia is not a disease, but rather a symptom or
condition.

• It occurs in association with changes in the physiological

process, or from neuromuscular/degenerative diseases,
resulting in weakness, paralysis and sensory loss in the
muscles associated with swallowing.
 Nutrition for Oral and Dental Health
Dysphagia
Mechanical causes Neuromuscular causes

Trauma to esophagus with CVA, brain tumors

scar tissue Head injury
Inelasticity due to Parkinson’s disease, MS,
repeated ALS
inflammation Achalasia (cardiospasm)
Tumor of esophagus Spinal cord injury
Aneurism of aorta
Nutrition for Oral and Dental Health
Consequences of dysphagia
•Dehydration, malnutrition, weight loss, anorexia,
aspiration pneumonia and depression are documented
outcomes of undiagnosed or untreated dysphagia.
• The latter may also pre-dispose the patient to
secondary complications including constipation, poor
wound healing, increased susceptibility to infection and
impaired muscle function
Nutrition for Oral and Dental Health
Symptoms of Dysphagia
•Drooling, choking, coughing during or after meals
•Inability to suck from a straw
•Holding pockets of food in cheeks (pt may be unaware)
•Absent gag reflex
•Chronic upper respiratory infections
•Gargly voice quality or moist cough after eating
 Nutrition for Oral and Dental Health
MNT for Dysphagia Intervention
depends on severity of deficit
• Mealtime supervision, cueing
Thickened liquids:
• thin » nectarlike » honeylike »
spoon thick

• Altered consistency:
• Level 1: pureed
• Level 2: mechanically altered
• Level 3: advanced
Nutrition for Oral and Dental
Health
• MNT for Dysphagia
• In severe cases, patient may be
made NPO and enteral feedings
initiated
 Nutrition for Oral and Dental Health
Strategies for Improving Acceptance
Thickened liquids:
• commercial products can improve quality and consistency
of thickened liquids
•Seasoning:
• persons with dysphagia often have dulled sense of taste.
Add seasonings to foods
•Pureed foods can be thickened and molded for more
attractive appearance
Nutrition for Oral and Dental
Health
Complications of Dysphagia Diet
•Patients on altered consistencies tend
to eat less and often lose weight
•Patients on thickened liquids are at risk
for dehydration

Re-evaluate patients and advance diet

as quickly as possible