nutritional assessment and education for dental patients chapter 21 copyright © 2015, 2010, 2005,...

NUTRITIONAL ASSESSMENT AND NUTRITIONAL ASSESSMENT AND EDUCATION FOR DENTAL PATIENTSEDUCATION FOR DENTAL PATIENTS

CHAPTER 21CHAPTER 21

Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

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Evaluation of the Patient: Health HistoryAsk open-ended questions about

diseases/conditionsDoes this disease or condition require a

change in diet? Gastric bypass End-stage renal or liver disease

What kind of changes have been made? Are changes supervised by an MD/RD?

Frequency of alcohol or tobacco use

Changes in taste or ability to chewCopyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

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Evaluation of the Patient: Health History

Specifically ask about herbal and supplement useWhat herbal medications or supplements are you taking?What is the dose and frequency of these

herbs/supplements?Have patients bring in their herbal medications and

dietary supplements and all prescription medications1 in 5 patients unable to properly identify herbs and

supplements they are takingDuring routine preoperative assessment, 70% of patients

failed to disclose dietary supplements


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Evaluation of the Patient: Nutrition Screening

Purpose in dentistryIdentify patients at nutritional risk or suspected to

be at risk due to eating habits, disease, or medical treatment

Identify those with cariogenic eating habits that are at high caries risk

ProcedurePatient can fill out the screening form while waiting

for treatmentDental professional should evaluate whether

patient receiving nutrition care from another source


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Evaluation of the Patient: Psychosocial/Social History

Socioeconomic status of patientIs there access to adequate food?

May need to direct to social service agencies for assistance

Does the patient live alone?Often a significant risk factor for poor nutrition in

the elderly Does the patient like to cook for himself or herself? Is patient able to get to the grocery store or to congregate

meal sites?


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Evaluation of the Patient: Dental History

Does oral condition affect what patient eats?People with dentures eat less meat, fruit, vegetablesAphthous ulcers interfere with eating and drinking

Are there significant changes in oralhealth (caries rate)?

Does dry mouth or xerostomia affectwhat patient eats and drinks?

History of fluoride exposure


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Clinical Observation: Physical Appearance Assessment

WeightDoes patient appear to be under- or overweight?

May be concerns about protein and calorie intakeHas the patient’s weight changed significantly since the last visit?

Hair, fingernails, skin color and toneIron deficiency results in changes in the fingernailsPatients with anemia are often extremely paleVitamin A toxicity may result in alopecia, cheilosisBeta-carotene excess may cause yellowish palms of the hands

MobilityMay limit dexterity and ability to perform HC procedures May affect obtaining and preparing food


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Clinical Observation: Extraoral/Intraoral Examination


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Clinical Observation: Anthropometric Evaluation

Anthropometric evaluationAsk patient’s height and weightCalculate BMI

Reduction of 10% of usual weight over a 6-month period is significant

Loss of 20% of body weight or greater may indicate depletion of body stores affecting immune response and ability to heal following invasive dental treatment


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Determining Diet History: 24-Hour Recall

Retrospective data about food intake/habitsDisadvantages

Remembering accurately what was eaten the day before

May consciously or unconsciously alter intake reported to simplify recording or to impress the interviewer

May be an atypical dayAdvantage

Relatively quick and simple to do during a clinic visit


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Determining Diet History: Food Frequency Questionnaire

Purpose of FFQ is to determine how often a patient consumes specific foods

DisadvantagesNot specific and does not gather enough data to

evaluate nutrient intakeRelies on patient’s memory

AdvantageRequires limited explanation and little timeAllows for analysis of food group consumption and

carbohydrate intakeCopyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

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Determining Diet History: 3- to 7-Day Food Diary

Food is recorded as it is eatenNutrient intakes are calculated and averaged

over the 3- to 7-day period and compared to RDA or FGP guidelines

DisadvantagesComplianceFoods not written down immediately may be forgottenTime-consuming to the person assessing the diet

AdvantagesGet a better idea of the actual intake


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Clinical ExaminationSignificant increase in caries rate

XerostomiaDietary changes Changes in oral self-care routines

Decay or erosion in unusual locationsEating disordersGERD

Periodontal disease out of proportion to local factors

Difficulty chewing or swallowing

From Perry DA, Beemsterboer P: Periodontology From Perry DA, Beemsterboer P: Periodontology for the Dental Hygienist, ed 3. St. Louis: for the Dental Hygienist, ed 3. St. Louis:

Saunders, 2007.Saunders, 2007.


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Identification of Nutritional StatusComparison of intake to MyPlate and Dietary

Guidelines for Americans 2020Tally the number of servings consumed from each food

group Average intakes determined by dividing totals by the

number of days in the food diaryUse averages for comparison with MyPlateIdentify deficient or excessive nutrients

Cariogenicity of the dietCircle or highlight each carbohydrate

exposure and identify form, frequency, and time eaten


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Formation of Nutritional Treatment Plan

How do you decide what to focus on once the nutrient analysis is complete?What issues did you identify in the screening or review

of the patient history? Lactose-intolerant adolescent or postmenopausal woman Elderly man living alone who doesn’t cook and doesn’t like to

shop Middle-aged woman with poorly controlled diabetes and active

moderate periodontitis that requires SRP and possible surgery Elderly woman with a dry mouth due to polypharmacy Teenager who eats fast food and energy drinks and tells you he

has “tons” of new cavities every time he visits the dentist


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Formation of Nutritional Treatment Plan: Integration and Implementation

Purpose of nutritional counseling is to provide accurate information and motivate and encourage patient to initiate positive changes in behaviorSetting goals

Resistance to change, despite knowledge, a natural response Goal chosen should be difficult enough to be challenging but not so

difficult as to seem impossible Goal needs to be measurable or observable: Eat one vegetable

each day Successful achievement of smaller steps motivates one toward

larger changes


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Formation of Nutritional Treatment Plan: Integration and Implementation

Menu creation Dental hygienist helps patient establish a

menu that follows principles in the Menu Planning Record, including nutritionally adequate and noncariogenic situations

Follow-up Monitor progress, provide

encouragement, adjust goals as necessary

Review Summarize the pertinent points


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Formation of Nutritional Treatment Plan: Integration and ImplementationEvaluation

Ongoing process that occurs in all stages of assessment and counseling; need to continually revise goals

DocumentationTreatment record serves as tool for communication

with other members of the dental team as well as other healthcare professionals


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Facilitative Communication SkillsCreate atmosphere of sincerity, trust, and

empathyUse nonjudgmental and noncritical responses

Active listening Involves more than hearing; it includes interpreting what is

said, how it is said, and nonverbal actions observed

Nonverbal actions Facial expressions, eye contact, body movements, personal

distance, head-nodding, and vocal cues

Questioning Ask open-ended questions to encourage sharing


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Appropriate Referral

Know when the case is outside the scope of dental practice! Know when and how to refer!If complex conditions require special diet

instructions, consult with the physician to see if a referral can be made to a registered dietitian Referral by the MD is more likely to result in coverage

by insurance Find a nutrition professional online at

www.eatright.org Most medical insurance and Medicaid cover medical

nutrition therapy for specific disease conditions


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Nutrition and Oral Health BasicsLimit between-meal snacksEat cariogenic foods during mealsInclude whole grains, vegetables, fruits, low-fat dairy

as snacksLimit simple and retentive CHOs like crackers, soft drinks,

sports drinks, fruit juice between meals

Rinse with water, chew xylitol gum, or brush teeth after snacks with fermentable carbohydrates

Calcium-rich foods such as low-fat cheese, yogurt, or milk for snacks

Appropriate use of fluorides, meticulous daily

plaque removal


nutritional assessment and education for dental patients chapter 21 copyright © 2015, 2010, 2005,...

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patients unable

significant changes

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