Nutrition Instruction in Community Dentistry

for Health Promotion of Children

MASAFUMI MOTOHASHIAssociate Professor, Department of Oral Health,Nihon University, School of Dentistry

1. An Introduction to Nutrition Instruction

OCTOBER 30, 2008

1. Basic concept of nutritional instruction

2. Nutrients needs for normal development of

teeth and periodontal tissue.

Topics

Human being and food –stuffs are constructed from

nutrients. Human being must continue to take nutrients

to maintain its life.

Lack of nourishment and excess of nourishment

may cause certain diseases.

Nutrition instruction for expecting mother,

mother and children is very important to promote

systemic health and oral health.

Purpose of nutrition instruction

Composition of

human body

60 Kg Adults water

62.6 %

proteins

16.4 %

fats

15.3 %

minerals,5 .7 %

carbohydrates

1.0 %

Nutritional and energy balance is basic principlein nutritional instruction

Carbohydrates

Proteins Energy

Lipid Source

Vitamins

Minerals

waters

Maintenance

Work

Child Growth

Fetus growth

Appropriate intakeof all the nutrients

Nutrients, Nutrition and health

Nutrition

Foodstuffs ⇒Health

Disease

Disorder

Digestion

Absorption

metabolism

Nutrients

WHO’s statementNutrition is an input to and foundation for health and

development. Better nutrition means stronger immunesystems, less illness and better health.

Nutrients Deficiency and Oral Manifestation

in Children

Protein deficiency in children

Systemic manifestationPoor growthPoor wound healingIncreased susceptibility to infectionAnemiaOthers

Oral manifestationDelay of eruptionHypoplasia and hypocalcification

Periodontal tissueAtrophic and degenerative changes in the periodontaltissue.

Vitamin A deficiency

Systemic manifestation

Dryness in the skin (hyperkeratinization) and eye

Night-blindness

Oral manifestation

Enamel Hypoplasia

Periodontal tissue

Gingival hyperplasia and hyperkeratosis

Vitamin D Deficiency

Systemic manifestation

Rickets in children

Osteomalacia in adults

Oral manifestation

Delay of eruption

Enamel hypoplasia

Dentine hypoplasia

Vitamin C Deficiency

Systemic manifestation

Scurvy

Greater Susceptibility to infection

Oral manifestation

Gingivitis: Swollen and bleeding gingiva

Dentine hypoplasia

A Case of Enamel Decalcification 1

Deficiency of Vitamin A, Vitamin D or Proteincan be suspected

A Case of Enamel Decalcification 2

A white spot of enamel 10 years old boy

A Case of Enamel Hypoplasia

Nursing Bottle Syndrome

Photo library

A case of Nursing Bottle Syndrome

Rampant caries caused by the use of nursingbottle to feed sweet beverage

中国新聞医療サイト

Sex Age Height Weight DMFT dft

F 12 129 26 9 0

A Case seems to have some problem in eating habitin addition to some problems in brushing habit.

A case with severe dental caries

Steps of Nutrition Instruction in Community Medicine

Estimation of problem in target community↓

Analysis of the problem related to malnutrition↓

Planning of the of nutrition instruction↓

Evaluation of potential effect of the instruction↓

Practice of nutrition guidance↓

Evaluation of the intervention

1. Children with many carious teeth have a

tendency of unbalanced diet.

2. Too much sugar or carbohydrates leads to

unbalanced nutrients intake

Oral health and nutrition instruction

Dental caries incidence in one of the good indicatorsof appropriateness of food eating habit

A

A Case seems to have some problem in eating habitin addition to some problems in brushing habit.

Sex Age Height Weight DMFT dft

F 12 129 26 9 0

A case with severe dental caries

STANDARD TABLES OF FOOD COMPOSITION IN JAPANFifth Revised and Enlarged Edition - 2005 –

Food Composition Databaseby Japan Science and Technology Agency

01031 French bread (in Japan)(per 100 g edible portion)

Energy：279 kcal

Protein：9.4 g Vitamin B1：0.08 mgLipids：1.3 g Vitamin B2：0.05 mgCarbohydrate：57.5 g Vitamin C：0 mg

Vitamin D：0 mg

Calcium：16 mgIron：0.9 mg

STANDARD TABLES OF FOOD COMPOSITION IN JAPANFifth Revised and Enlarged Edition - 2005 –

01215 Chicken Thigh Without skin, raw(per 100 g edible portion)

Energy：138 kcal

Water:72.3

Protein：22.0 g Vitamin B1：0.10 mgLipids：4.8 g Vitamin B2：0.31 mgCarbohydrate：0 g Vitamin C：1 mg

Vitamin D：0 mg

Calcium：9 mgFe：2.1 mg

STANDARD TABLES OF FOOD COMPOSITION IN JAPANFifth Revised and Enlarged Edition - 2005 –

07107 Banana Raw(per 100 g edible portion)

Energy：86 kcal

Water:75.4

Protein：1.1 g Vitamin B1：0.05 mgLipids：0.2 g Vitamin B2：0.04 mgCarbohydrate：22.5 g Vitamin C：16 mg

Vitamin D：0 mg

Calcium：6 mgIron：0.3mg

STANDARD TABLES OF FOOD COMPOSITION IN JAPANFifth Revised and Enlarged Edition - 2005 –

Dietary Reference Intakes in Japan

Japanese “Dietary Reference Intakes” shows the standard ofcaloric intake and amount of nutrients. The aim is to promotehealth of people and to prevent diseases caused by malnutrition

Indicators for each nutrient

Estimated Energy Requirement: EER

Estimated Average Requirement: EAR

Recommended Dietary Allowance: RDA

Adequate Intake: AI

Dietary Goal for preventing life-style related diseases: DG

tolerable Upper intake Level: UL

Example of Dietary Reference Intakes 1

Dietary Reference Intakes of Energy：Estimated energy requirement （kcal/day）

Sex

Activity level Low Ordinary High Low Ordinary High

0～5(months)Breast feeding - 600 - - 550 -

0～5(months)Bottle feeding - 650 - - 600 -

6～11(ｍonths) - 700 - - 650 -

1～2(years) - 1,050 - - 950 -

3～5years) - 1,400 - - 1,250 -

6～7(years) - 1,650 - - 1,450 -

8～9(years) - 1,950 2,200 - 1,800 2,000

10～11(years) - 2,300 2,550 - 2,150 2,400

12～14(ｙears) 2,350 2,650 2,950 2,050 2,300 2,600

15～17(years) 2,350 2,750 3,150 1,900 2,200 2,550

18～29(years) 2,300 2,650 3,050 1,750 2,050 2,350

male female

Dietary Reference Intakes of Energy

sex

EAR RDA AI DG EAR RDA AI DG(g/day

)

(g/day

)

(g/day

)(% Energy)1 (g/day

)

(g/day

)

(g/day

)(% Energy)1

6～11 （months）

Breast feeding)- - 15 - - - 15 -

6～11 （months）

Bottle feeding- - 20 - - - 20 -

1～2 (years) 15 20 - - 15 20 - -

3～5 (years) 20 25 - - 20 25 - -

6～7 (years) 30 35 - - 25 30 - -

8～9 (years) 30 40 - - 30 40 - -

10～11 (years) 40 50 - - 40 50 - -

12～14 (Aears) 50 60 - - 45 55 - -

15～17 (years) 50 65 - - 40 50 - -

18～29 (years) 50 60 - Lower than 20 40 50 - Lower than 201 Protein energy rate

Age

Male Female

Example of Dietary Reference Intakes 2

Japanese– Food Guide Spinning Top

Do you have a well-balanced diet?

Two essential component in nutritional guidance

for health promotion for children and mother

1. Appropriate amount of nutrients taken in everyday life

・ Eating habit considering dietary reference Intakes

・ Balanced nutrients intake

2. Regular eating habit and care for characteristics of foodstuffs

・ Well-regulated dinner and between meal taking

・ Care for development of oral function

・ Care for prevention of oral diseases