Ch. 15

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Kymberli
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82933
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Ch. 15
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2011-05-01 18:35:47
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Nutritional Concerns Dentally Compromised Pt
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Nutrition Exam 3
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  1. T/F: Oral problems can be an important predictor of weight loss.
    TRUE
  2. TMJ Disorders or other facial structure dysfunctions:
    may alter food choices drastically
  3. 2 things Dysphagia can lead to:
    • REDUCTION in caloric intake
    • DECREASED consumption of fiber
  4. Oral surgery & maxillomandibular fixation
    can temporarily alter food intake & contribute to weight loss
  5. Orthodontic treatment may result in:
    dietary changes that can be detrimental to oral health
  6. Poor oral function may impact a person's:
    • self-esteem
    • quality of life
  7. ORTHODONTICS
  8. Role of Systemic Nutrition:
    • HEALTHY bones & tissues are required for POSITIVE PDL & bone response to Orthodontic tooth movement
    • Well-nourished individuals are best equipped to respond to the stresses on tissues
    • Nutritional imbalances may INTERFERE with tissue synthesis
  9. Ascorbic Acid deficiencies:
    SLOWS collagen breakdown & collagen synthesis (formation) during tooth movement
  10. Calcium & Vitamin D deficiencies:
    UNDERMINE bone mineralization & remodeling
  11. 3 Local Food Factors related to Orthodontics:
    • 1.) Orthodontic bands & brackets lead to food retention & gingival irritation
    • 2.) Orthodontic appliances provide a nidus (nest) for plaque growth, which leads to caries risk
    • 3.) Frequent exposure to sugars, sugar-starch combinations, & retentive carbohydrates leads to caries risk
  12. ADOLESCENTS WITH ORTHO
  13. 6 Things to Look for in Adolescents with Ortho:
    • 1.) Inflammation
    • 2.) Caries
    • 3.) Decalcification
    • 4.) Lesions from sharp appliances
    • 5.) Root resorption
    • 6.) Food debris around brackets
  14. 3 Things to Ask Adolescents with Ortho about Fermentable CHO's:
    • 1.) Frequency of Fermentable CHO's
    • 2.) Time consumption of Fermentable CHO's
    • 3.) Form of food of Fermentable CHO's
  15. 6 Oral Hygiene Recommendations for Adolescents with Ortho:
    • Daily OHI: floss threaders, Platypus, water rinses
    • Daily Fluoride
    • Antimicrobial rinses
    • Salt water rinses
    • Calcium Phosphate: MI paste
    • Xylitol gum/mints
  16. ORAL SURGERY
  17. 6 Types of Oral & Maxillofacial Surgery:
    • 1.) Extractions
    • 2.) Orthognathic surgery (corrective jaw surgery to reposition the teeth)
    • 3.) Implants
    • 4.) Fracture repair
    • 5.) Periodontal surgery
    • 6.) Maxillomandibular fixation (for fractures)
  18. When & Why is a person's Nutritional Status Important for Oral Surgery:
    nutritional status is IMPORTANT before & after oral surgery to facilitate healing & recuperation
  19. 5 Stresses Oral Surgery Puts On The Body:
    • 1.) Blood Loss
    • 2.) Catabolism
    • 3.) Infection
    • 4.) Immunosuppression (suppressed immune system)
    • 5.) Complications
  20. RDH Role in Oral Surgery:
    • Nutritional assessment: adequate nutrition & fluid intake
    • Know WHEN to refer to Dietician
  21. BEFORE surgery an ADEQUATE supply of 6 Nutrients are NEEDED to PROMOTE healing :
    • 1.) CHO
    • 2.) Protein
    • 3.) Vitamin A
    • 4.) Vitamin C
    • 5.) Vitamin D
    • 6.) Vitamin K
  22. MAINTAINING good nutrition DURING Recovery from Oral Surgery does 3 things:
    • Enhances the host immune response
    • Facilitates wound healing (makes it easier)
    • Lowers the risk of infection
  23. 5 Guidelines for the FIRST 12-24 hours AFTER Oral Surgery:
    • 1.) Eat HIGH calorie liquid diet
    • 2.) HIGH Carbohydrate (CHO) intake
    • 3.) Powdered skim milk to fortify fluid milk, soups, cereals, & puddings
    • 4.) Eat soothing cool/cold foods
    • 5.) 8 glasses of fluids/liquids EVERY day (24 hrs)
  24. 4 Guidelines for the 2nd or 3rd Day AFTER Oral Surgery:
    • 1.) Soft diet
    • 2.) HIGH nutrient dense foods
    • 3.) Do NOT skip meals
    • 4.) SMALLER high calorie & high protein meals
  25. INTERMAXILLARY FIXATION
  26. Intermaxillary Fixation -
    wiring the maxilla & mandible together:

    • 1.) major reconstructive jaw surgery
    • 2.) immobilization of a fractured jaw (inability to move it)
  27. 5 Diet Recommendations During Intermaxillary Fixation:
    • 1.) Smooth liquid diet
    • 2.) 6-8 SMALL meals/day to get adequate calories
    • 3.) Foods that can pass through a straw, blenderized foods are preferred
    • 4.) Broth, milk, & juices can be used to THIN out foods
    • 5.) HIGH protein liquid supplement for meals/snacks
  28. 4 Effects of Intermaxillary Fixation & Diet:
    • 1.) Limited jaw opening can cause eating to be tedious
    • 2.) Monitor weight loss
    • 3.) Liquid meals can cause a feeling of fullness & can become monotonous (dull, tedious, and repetitious; lacking in variety and interest)
    • 4.) High sugar content of supplements leads to increased caries risk: have pt. rinse w/water AFTER consuming liquid drink & brush frequently with fluoride toothpaste
  29. CHEWING/MASTICATORY ABILITY
  30. 4 Things About Chewing/Masticatory Ability:
    • 1.) it is a function of dentition status
    • 2.) aging has LITTLE EFFECT on chewing ability & efficiency
    • 3.) REDUCTION in muscle mass may ADVERSELY affect oral motor function (chewing/mastication)
    • 4.) OLDER adults masticate/chew MORE & LONGER to PREPARE food for swallowing
  31. Swallowing Threshold Test Index:
    • measures chewing ability
    • assesses the # of chewing strokes that are REQUIRED to REDUCE a hard food to a small enough size for swallowing
  32. % of Adults who have Lost ALL their Natural Teeth in the U.S.:
    • 25 or >: 11%
    • 65 or >: 30%

    HIGHER % for those in POVERTY
  33. T/F: The LOSS of teeth IS a normal result of the AGING PROCESS.
    FALSE.

    The loss of teeth is NOT a normal result of the aging process.
  34. * WHAT are the 2 MAJOR CAUSES of TOOTH LOSS?
    • 1.) Extractions from Dental Caries
    • 2.) Extractions from Periodontal Disease
  35. DENTURES
  36. People that are Edentulous or have Dentures:
    • 0-20% masticatory efficiency
    • LIMITED chewing ability
    • POOR food choices
  37. Chewing Ability of Complete Dentures:
    = 1/5th that of person with natural teeth
  38. Food Selection of People with Dentures:
    • they often AVOID detersive/fibrous foods & foods that contain seeds or pits
    • chewing/masticatory performance & food selection are IMPACTED
  39. Dentures & Alveolar Bone Resorption:
    • Resorption of the Alveolar Ridge occurs with COMPLETE denture wearers
    • It is DIFFICULT to obtain GOOD retention & stability in the presence of severe mandibular bone loss resorption
  40. 5 Nutritional Implications of Dentures:
    • 1.) Diet quality tends to DECREASE as the # of missing teeth INCREASES
    • 2.) Dentures do NOT necessarily IMPROVE diet quality
    • 3.) Dentures may be associated with health risks such as: high cholesterol, increased weight, non-insulin dependent diabetes mellitus, high sugar & carbohydrate (CHO) diet
    • 4.) Upper denture can impair taste & swallowing function & INCREASE risk of choking
    • 5.) Denture wearer may have ACCELERATED Alveolar Bone resorption & LOWER Calcium intake
  41. 6 Interventions for Denture Wearers:
    • 1.) NEW denture wearers: liquid diet to learn new swallowing patterns & get the feel of appliance before chewing food
    • 2.) Advance to mechanical soft diet
    • 3.) Dairy intake to PREVENT bone loss (Calcium)
    • 4.) Will be a DECLINE in taste
    • 5.) Eat SMALL pieces & chew WELL & LONG
    • 6.) AVOID sticky foods & seeds
  42. 3 Diet Suggestions for Denture Wearers:
    • 1.) Rx/Prescribe nutritional supplements during the "breaking in" period
    • 2.) Instruct to chew longer, eat more slowly, & cut up fibrous foods bite size
    • 3.) Stress adequate Fiber, Calcium, & Vitamin D intakes
  43. 3 Effects of Dentures on Taste & Swallowing:
    • 1.) Hard Palate contains taste buds & a person's taste sensitivity is REDUCED when the Soft Palate is COVERED by dentures
    • 2.) Swallowing may be poorly coordinated, which can lead to an INCREASED risk of choking
    • 3.) POORLY fitting dentures may cause weight loss due to LOW calorie intake or LIMITED variety of foods
  44. SWALLOWING
  45. Swallowing:
    • Adults swallow about 2,400 times/day
    • Occurs during meals & throughout the day & night
    • Involves a complex series of movements
    • 5-6 Major CNS Nerves
    • 23 Muscles
  46. DYSPHAGIA
  47. Dysphagia -
    condition in which swallowing is difficult
  48. 10 Conditions that can Cause Dysphagia:
    • 1.) Stroke (CVA)
    • 2.) Head & Neck Radiation
    • 3.) Oral Surgery
    • 4.) Severe Oral or Facial trauma
    • 5.) Multiple Sclerosis
    • 6.) Muscular Dystrophy
    • 7.) Pharynx or Esophagus Inflammation
    • 8.) Older Patients
    • 9.) Xerostomia
    • 10.) Neurological disorders(3): Cerebal Palsy, Parkinson's disease, Alzheimer's disease
  49. What stage of swallowing can Dysphagia occur?
    Dysphagia can occur during ANY STAGE of SWALLOWING.
  50. 3 Things People with Dysphagia are at a HIGH RISK for:
    • 1.) Malnutrition
    • 2.) Respiratory infections
    • 3.) Death

    *Food can be aspirated into the lungs when swallowing &/or when choking reflex is impaired
  51. Dysphagia from Xerostomia:
    can be relieved by eating a soft diet &/or drinking plenty of fluids with meals
  52. Dysphagia from Neurological Disorders: (Stroke/CVA, Cerebral Palsy, Alzheimer's, Parkinson's)
    leads to a HIGH RISK of aspiration (to inhale)
  53. Dysphagia can affect Esophageal structures:
    by Head & Neck Radiation
  54. 3 Stages of Swallowing:
    • 1.) Oral Preparation Stage
    • 2.) Pharyngeal Stage
    • 3.) Esophageal Stage
  55. 1.) Oral Preparation Stage (4)
    • 1.) Food enters the mouth, it's chewed, & formed into a bolus
    • 2.) Bolus is gathered into the center of the tongue by using a sucking movement of the tongue, lips, & cheeks
    • 3.) Tongue forms a cupped shape around the Bolus & holds it ready for swallowing
    • 4.) The Bolus is pushed to the back of the mouth
  56. 2.) Pharyngeal Stage (4)
    • 1.) Tongue squeezes the Bolus to the back of the mouth & swallow reflex is triggered
    • 2.) Larynx RISES, Vocal Cords CLOSE, & Soft Palate RISES to CLOSE OFF the Nasal Passage
    • 3.) Bolus is moved by Muscles through the Pharynx, past the closed Larynx, & into Esophagus
    • 4.) Throat wall Muscles facilitate a downward movement of the Bolus through Peristalsis
  57. 3.) Esophageal Stage (3)
    • 1.) Food moves from the LOWER part of the Throat
    • 2.) Food moves through the Esophagus
    • 3.) Food moves into the Stomach assisted by Peristaltic Wave
  58. 8 Swallowing Tips for People with Dysphagia:
    • 1.) Sit UPRIGHT when eating or drinking
    • 2.) Maintain the head in a slightly chin-tucked position when eating or drinking to avoid opening the airway inadvertently
    • 3.) Concentrate on maintaining a slow, steady rate of feeding, & minimize distractions
    • 4.) Clear any excessive saliva from the mouth before eating or drinking
    • 5.) Take SMALL bites & SMALL sips, drink SLOWLY, place ONLY 1 bite in the mouth before swallowing
    • 6.) Swallow 2-3 times to make sure ALL food has cleared the throat
    • 7.) MOISTEN food with sauces & gravy
    • 8.) Use a STRAW to drink liquids to keep the chin DOWN
  59. TMJ DYSFUNCTION (TMD)
  60. TMJ Dysfunction (TMD) -
    dysfunction of the area where the Mandible joins the Temporal Bone
  61. 5 Effects of TMJ Dysfunction:
    • 1.) Orofacial pain
    • 2.) Frequent headaches
    • 3.) Restricted Mandibular mobility
    • 4.) Tinnitus
    • 5.) Joint popping/clicking
  62. TMJ Dysfunction can lead to:
    • Pain, discomfort & impaired Mandibular mobility/movement
    • INABILITY to open the mouth WIDE can LIMIT biting & chewing ability
    • May INTERFERE with food intake & ALTER the TYPES of foods chosen
  63. 6 Causes of TMJ Dysfunction:
    • 1.) Clenching
    • 2.) Grinding
    • 3.) Stress
    • 4.) Malocclusion
    • 5.) Injury
    • 6.) Bone Abnormalities
  64. More about the Common Causes of TMJ Dysfunction:
    • Injury to the joints or muscles of the jaw
    • Occlusal disharmonies: Malocclusion, Jaw misalignment
    • Parafunctional Habits: Clenching, Bruxing/Grinding, EXCESSIVE gum chewing
  65. HOW to Prevent TMJ Dysfunction:
    • NO gum chewing
    • AVOID hard to chew foods: caramels, bagels, taffy
    • Mechanical SOFT diet
  66. DYSGEUSIA
  67. Dysgeusia -
    • distortion of taste
    • abnormal taste
    • impaired taste acuity
  68. Causes of Dysgeusia:
    • 1.) POOR oral hygiene
    • 2.) Tobacco use
    • 3.) Xerostomia (dry mouth)
    • 4.) Medications (can interefere with taste mechanism)
  69. Can nutritional intake be COMPROMISED from unpleasant tasting foods due to Dysgeusia?
    YES!

    Nutritional intake CAN be COMPROMISED from UNPLEASANT tasting foods due to Dysgeusia.
  70. 2 WAYS to MANAGE Dysgeusia:
    • ADDRESS contributing factors
    • ADD flavoring agents or spices to food
  71. ALVEOLAR OSTEOPOROSIS
  72. Alveolar Osteoporosis is caused from:
    • a NEGATIVE Calcium balance created over a LIFETIME
    • Calcium DEPLETION from the Bones
  73. 8 Risk Factors for Alveolar Osteoporosis:
    • 1.) Age
    • 2.) Heredity
    • 3.) Calcium deficiency
    • 4.) Smoking
    • 5.) Menopause
    • 6.) Excessive Caffeine
    • 7.) Alcohol
    • 8.) Inactive lifestyle
  74. 6 Effects of Alveolar Osteoporosis:
    • 1.) Spongy, Trabecular Alveolar Bone
    • 2.) Bone Absorption & Resorption
    • 3.) Tooth Loss
    • 4.) ACCELERATED bone loss AFTER extractions
    • 5.) DECREASED masticatory/chewing efficiency
    • 6.) DECREASED nutritional status
  75. GLOSSITIS
  76. Glossitis -
    a condition in which the Tongue becomes swollen & changes color (fire red or pale pink) ; it can become painful/sore/tender
  77. Nutrition & Glossitis:
    • because it is a painful condition it can lead to DECREASED food intake
    • which then leads to POOR nutritional status
  78. 5 Types of Glossitis:
    • 1.) Infectious: Bacterial, Fungal, Viral
    • 2.) Drug-induced
    • 3.) Psychogenic: stress
    • 4.) Nutrient Deficiency: B Vitamins
    • 5.) Allergic Reactions: foods or drugs
  79. Symptoms of Glossitis:
    • 1.) Slight or total atrophy of Filiform & Fungiform Papillae (smooth tongue)
    • 2.) Shiny, smooth, red or pale tongue
    • 3.) Localized or Generalized
    • 4.) Micro or Macroglossia (abnormally small or large tongue) from dehydration (micro) or edema (macro)
  80. T/F: Impaired oral function can affect the diet & nutritional status of a patient by altering their ability & desire to bite, chew, & swallow foods.
    TRUE!
  81. T/F: ANY DECREASE in a person's eating ability INCREASES the risk of malnutrition
    TRUE!

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