Download CDHO Advisory Nutritional Disorders

CDHO Advisory | Nutritional Disorders
COLLEGE OF DENTAL HYGIENISTS OF ONTARIO ADVISORY
ADVISORY TITLE
Use of the dental hygiene interventions of scaling of teeth and root planing including
curetting surrounding tissue, orthodontic and restorative practices, and other invasive
interventions for persons 1 with nutritional disorders.
ADVISORY STATUS
Cite as
College of Dental Hygienists of Ontario, CDHO Advisory Nutritional Disorders, 2010-01-23
INTERVENTIONS AND PRACTICES CONSIDERED
Scaling of teeth and root planing including curetting surrounding tissue, orthodontic and
restorative practices, and other invasive interventions (“the Procedures”).
SCOPE
DISEASE/CONDITION(S)/PROCEDURE(S)
Nutritional disorders
INTENDED USERS
Advanced practice nurses
Dental assistants
Dental hygienists
Dentists
Denturists
Dieticians
Health professional students
Nurses
Patients/clients
Pharmacists
Physicians
Public health departments
Regulatory bodies
ADVISORY OBJECTIVE(S)
To guide dental hygienists at the point of care relative to the use of the Procedures for
persons who have nutritional disorders, chiefly as follows.
1.
2.
3.
4.
1
Understanding the medical condition.
Sourcing medications information.
Taking the medical and medications history.
Identifying and contacting the most appropriate healthcare provider(s) for medical
advice.
Persons includes young persons and children
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5. Understanding and taking appropriate precautions prior to and during the Procedures
proposed.
6. Deciding when and when not to proceed with the Procedures proposed.
7. Dealing with adverse events arising during the Procedures.
8. Record keeping.
9. Advising the patient/client.
TARGET POPULATION
Child (2 to 12 years)
Adolescent (13 to 18 years)
Adult (19 to 44 years)
Middle Age (45 to 64 years)
Aged (65 to 79 years)
Aged 80 and over
Male
Female
Parents or guardians of children and young persons with nutritional disorders.
MAJOR OUTCOMES CONSIDERED
For persons who have nutritional disorders: to maximize health benefits and minimize
adverse effects by promoting the performance of the Procedures at the right time with the
appropriate precautions, and by discouraging the performance of the Procedures at the
wrong time or in the absence of appropriate precautions.
RECOMMENDATIONS
UNDERSTANDING THE MEDICAL CONDITION
Nomenclature of nutritional disorders
Adapted from
 Disorders of Nutrition and Metabolism, Undernutrition
 Nutritional Disorders, Undernutrition
 HealthInsite Food and Nutrition
 World Health Organization
 UNICEF, Undernutrition
Among centres and authorities, terminology varies as does the meaning ascribed to key
terms. The following represents broad but not necessarily universal usage.
1. Acidic oral fluids, as defined for this Advisory, includes those that
a. usually are ingested, such as
i. acidic beverages
ii. citrus fruits
b. result from fermentation to lactic and other acids of sucrose and other non-milk
sugars in food items, other than fresh fruits and vegetables, by plaquebacterium Streptococcus mutans
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2.
3.
4.
5.
6.
7.
8.
9.
c. occasionally originate as gastric contents, with
i. gastroesophageal reflux disease
ii. vomiting of a recurrent nature, as in
1. bulimia
2. vomiting associated with repeated, excessive consumption of
alcohol.
Anorexia, a type of eating disorder that may
a. arise from
i. dental problems that restrict the ability to chew and therefore digest
food
ii. swallowing problems associated with
1. dry mouth
2. neurological disorders, such as stroke
3. esophageal candidiasis
ii. poverty in extreme conditions, such as famine or war
iii. association with various medical conditions
iv. functional impairment of activities of daily living
b. may also involve psychological disorders, such as
i. anorexia nervosa in girls and young women
ii. anorexia associated with
1. loneliness, especially in the elderly
2. depression.
Body mass index, BMI, measure of body fat based on height and weight for adult men
and women.
Bulimia, also called bulimia nervosa, an eating disorder of psychological origin,
characterized by episodes of secretive excessive eating (bingeing) followed by
inappropriate methods of weight control such as
a. self-induced vomiting
b. abuse of laxatives and diuretics
c. excessive exercise.
Catabolism, with various meanings, including
a. breakdown of complex substances, such as proteins in the body or food, into
simpler ones together with release of energy
b. a destructive type of metabolism.
Cachexia, wasting that results from chronic disease; signals include
a. weight loss
b. loss of muscle mass
c. loss of appetite.
Cancrum oris, noma, orofacial gangrene, gangrenous stomatitis, which causes
progressive and devastating destruction of the infected tissues
a. occurs almost exclusively in children, chiefly in those under 10 years
b. seen almost only in developing countries.
Cytokines, regulatory proteins, such as the interleukins and lymphokines, released by
immune-system cells; act as intercellular mediators in the generation of an immune
response.
Dental erosion, tooth erosion, irreversible loss of tooth enamel due to chemical
processes that do not involve bacterial action.
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10. Enamel hypoplasia, characterized by hypoplastic grooves, with or without pits in the
enamel, often horizontal or linear in appearance, and enamel opacities.
11. Gluten enteropathy, a chronic disease of the digestive tract that interferes with the
digestion and absorption of gluten, a protein commonly found in wheat, rye, and barley.
12. Hyperphagia, abnormally increased appetite for and consumption of food.
13. Lean body mass, the weight of the body minus the fat.
14. Malnourishment, occurs when the
a. diet fails to provide adequate calories and protein for growth and maintenance
b. body is unable to fully utilize the food consumed
c. person consumes too many calories.
15. Metabolic syndrome, a combination of risk factors for cardiovascular disease and type 2
diabetes, especially
a. excess intra-abdominal fat
b. insulin resistance
c. some combination of
i. elevated plasma triglyceride levels
ii. decreased high density lipoprotein (HDL)
iii. hypertension.
16. Malnutrition, malnourishment, commonly used to mean undernutrition, but technically
also refers to overnutrition; occurs when
a. the diet does not provide adequate calories and protein for growth and
maintenance
b. illness impairs the full utilization of food consumed
c. excess of calories are consumed.
17. Obesity, excess body fat, the effects of which depend not only on the absolute amount
but also on the distribution of the fat.
18. Overnutrition, an increasing problem in North America which
a. is caused by
i. dietary imbalances and excesses
ii. insufficient exercise
b. increases as a risk when the body weight is 20 percent greater than the
appropriate norms for age and height
19. Nutritional disorder, nutrition disorder, caused by
a. insufficient or excessive intake of food or certain nutrients
b. inability of the body to absorb and use nutrients
c. overconsumption of certain nutrients.
20. Nutritional Support
a. required for undernourished person to increase lean body mass
b. may involve
i. oral feeding
ii. behavioural approaches
iii. tube feeding
iv. enteral tube feeding
v. parenteral nutrition
21. Protein-energy undernutrition, occurs in
a. the institutionalized elderly
b. persons with disorders that decrease appetite or impair nutrient digestion,
absorption, or metabolism
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c. in young children at the time of weaning in developing countries, resulting from
inadequate intake of protein and calories, characterized by emaciation; is
related to starvation evidenced as
i. marasmus
ii. kwashiorkor.
22. Stoss therapy, a regimen of vitamin D supplementation.
23. Type 2 diabetes, begins with insulin resistance, a condition in which fat, muscle, and
liver cells do not use insulin properly; is related to obesity; eventually the pancreas loses
the ability to produce sufficient insulin for meals.
24. Undernutrition, a form of malnutrition
a. variously defined
i. as a consequence of consuming too few essential nutrients
ii. as a consequence of the body’s using or excreting essential nutrients
more rapidly than they can be replaced
iii. as the outcome of insufficient food intake and repeated infectious
diseases
iv. in comparison to the norms for the person’s age and height
1. as underweight
2. too short
3. dangerously underweight
v. deficient in vitamins and minerals.
b. results from
i. inadequate ingestion of nutrients
ii. malabsorption
iii. impaired metabolism
iv. loss of nutrients through
1. diarrhea
2. excessive sweating
3. hemorrhage
4. kidney failure
v. restriction of nutrient intake because of
1. age-related illnesses and conditions
2. excessive dieting
3. severe injury
4. serious illness
5. lengthy hospitalization
6. substance abuse
vi. increased nutritional requirements resulting from
1. infection
2. trauma
3. hyperthyroidism
4. extensive burns
5. prolonged fever
vii. any condition that increases cytokines, which may be accompanied by
muscle loss, lipolysis, low albumin levels, and anorexia
c. progresses in stages; each stage usually takes time to develop
i. early stage: nutrient levels in blood and tissues change
ii. mid-stage: intracellular changes in biochemical functions and structure
iii. advanced stage: symptoms and signs
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CDHO Advisory | Nutritional Disorders
Overview of nutritional disorders
Adapted from
 Nutritional Disorders
 Disorders of Nutrition and Metabolism, Undernutrition
 Nutritional Disorders, Undernutrition
 HealthInsite Food and Nutrition
 World Health Organization
 UNICEF, Undernutrition
 Nutrition: General Considerations
 Mineral Deficiency and Toxicity
Disorders caused by nutritional imbalance, either overnutrition or undernutrition, include
1. Obesity, which
a. occurs
i. in childhood
1. in which it is a greater concern than in adults
2. results in complications that include
a. poor self-esteem
b. social difficulties
c. depression
d. musculoskeletal complications
e. obesity-related conditions when obese children become
adults
ii. in the elderly
1. in whom it is increasing in incidence
2. favours complications, the risk of which is increased by
a. abdominal obesity
b. duration and severity of the obesity
c. loss of skeletal muscle mass and its replacement by fat
b. is caused by
i. genetic predisposition
ii. persistent imbalance of
1. energy intake
2. energy utilization for basic metabolic processes
3. energy expenditure from physical activity
iii. pregnancy factors, including
1. maternal obesity
2. a permanent gain of 9 kg or more with each pregnancy in some
15 percent of women
iv. obesity that persists beyond early childhood, which acts to constrain
weight loss in later life
v. eating disorders
1. binge eating disorder
a. is consumption of large amounts of food quickly coupled
with a sense of loss of control during the binge and distress
after
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b. does not include compensatory behaviours such as
vomiting (as in bulimia)
c. occurs in
i. 1 to 3 percent of both sexes
ii. 10 to 20 percent of persons entering weightreduction programs
d. is characterized by
i. severe obesity
ii. loss or gain of large amounts of weight
iii. psychological disturbances
2. night-eating syndrome, which
a. comprises
i. morning anorexia
ii. evening hyperphagia
iii. insomnia
b. occurs in some 10 percent of persons seeking treatment for
severe obesity
c. is characterized by consumption of half or more of the daily
food intake after the evening meal
d. is more extreme that nocturnal eating, which also
contributes to excess weight gain.
3. medications
c. is diagnosed and assessed by
i. body mass index
ii. family history of
1. type 2 diabetes
2. premature cardiovascular disease
iii. growth charts for children
iv. weight charts for adults
v. waist circumference
vi. blood pressure, fasting plasma glucose, and lipid levels
d. is associated with complications, including
 cardiovascular disorders
 osteoarthritis
 deep venous thrombosis
 premature death
 diabetes
 pulmonary embolism
 fatty liver and cirrhosis
 reproductive disorders, both sexes
 gallstones, gallbladder disease
 skin disorders
 gastroesophageal reflux disease  sleep insufficiency
 mental health problems
 social and mental health problems
 obstructive sleep apnea
 various cancers
e. is treated by
i. physical activity
ii. dietary and nutrition management
iii. behavioural modification
iv. drugs
v. surgery
f. is prevented by
i. regular physical activity and healthy eating to
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1. improve general fitness
2. control weight
3. help control diabetes
4. decrease risk of cardiovascular disorders
ii. sufficient good-quality sleep
iii. management of stress
iv. moderation of alcohol intake.
2. Metabolic syndrome
a. is a serious and increasing problem, which affects children and adults
b. resembles obesity in causes, complications, diagnosis, and treatment.
3. Undernutrition
a. occurs in association with
i. social deprivation
ii. cachexia
iii. certain phases of life
1. infancy, childhood and adolescence, because of high demand for
energy and essential nutrients
2. pregnancy and breastfeeding
3. institutionalization of the elderly, as
a. protein-energy undernutrition, which is common
b. replacement of lost muscle mass by fat, which accounts for
many of the complications of undernutrition
c. anorexia
iv. various diseases and medical procedures, such as
1. diabetes
2. some chronic disorders that affect the gastrointestinal tract
3. intestinal resection, and certain other gastrointestinal surgical
procedures that may impair absorption of vitamins
4. gluten enteropathy
5. pancreatic insufficiency
6. liver disorders
7. kidney disorders
b. particular diets, including
i. vegetarian diets, which may lead to nutritional deficiencies, such as
1. ovo-lacto vegetarian
2. vegan
3. fruit-only
ii. fad diets, which may lead to nutritional deficiencies
c. alcohol or substance abuse because of
i. neglect of nutritional needs
ii. impairment of absorption and metabolism of nutrients
d. medications
e. may result in complications such as
i. iron deficiency
ii. osteoporosis
iii. impaired storage of vitamins
iv. interference with metabolism of protein and energy sources
v. protein, iron, and vitamin deficiencies
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CDHO Advisory | Nutritional Disorders
f.
is identified and assessed by
i. questionnaire
ii. reference to norms for weight for age and height
1. growth charts for children
2. weight charts for adults
iii. clinical status
g. treated with nutritional support.
Comorbidity
Comorbid conditions are those which co-exist with nutritional disorders but which are not
believed to be caused by it; associated conditions and complications are those that may
have some link with of nutritional disorders.
Oral health considerations
Adapted from
 Malnutrition and Dental Caries: A Review of the Literature
 Point of Care, Question 1
 Dental damage, sequelae, and prevention
 Prevalence of Caries among Preschool-Aged Children in a Northern Manitoba
Community
 Dental Erosion in Gastroesophageal Reflux Disease
 Diagnosis, Risk Factors and Management of Dental Erosion: An Evidence Based Report
 Oral manifestations associated with malnutrition
 A Longitudinal Study of Dental Caries in the Primary Teeth of Children who Suffered
from Infant Malnutrition
 Association between Growth Stunting with Dental Development and Skeletal
Maturation Stage
 Noma: Life Cycle of a Devastating Sore
 Is There an Association Between Edentulism and Nutritional State?
 Dental Nutrition
1. Oral healthcare
a.
as an important healthcare strategy is a recurrent theme in the literature on
nutritional disorders
b.
is important in nutritional disorders because of interactions
i. between nutritional disorders and the state of oral health
ii. that involve some combination of nutritional disorders, the state of oral
health, medical conditions and medications
c.
is provided to populations in which social and demographic factors influence
nutrition and its disorders and therefore forms part of the integrated approach
to prevention, detection of and care for nutritional disorders, especially for
i. children
ii. seniors.
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2. Effects of diet on oral health include
a.
Early eruption of the first primary tooth may be linked with Stoss therapy.
b.
Cancrum oris, which occurs mainly in children with malnutrition, poor oral
hygiene and debilitating concurrent illness.
c.
Decalcification of teeth and the ensuing caries associated with acidic oral fluids.
d.
Delayed eruption resulting from early childhood malnutrition
i. is established for the primary teeth
ii. is not established for the permanent teeth
e.
Dental caries
i. in primary dentition appear to be associated with early childhood
malnutrition
ii. in permanent dentition are not firmly linked with early childhood
malnutrition
iii. result from in-mouth fermentation of food-related acidic oral fluids,
which causes decalcification, in combination with the associated breaking
up of proteins
iv. in early childhood (early childhood caries) may be associated with
1. poor oral hygiene
2. the practice of adding sugar to the content used for bottle-feeding.
f.
Dental erosion results from chemical attack on the mineralized, hard-enamel
protection of the tooth by acidic oral fluids the effects of which
i. are normally neutralized by saliva, but this protection may fail if the acid
attack occurs too frequently
ii. in gastroesophageal reflux disease may be reduced by
1. plaque control
2. reduction of intake of refined carbohydrates and carbonated
beverages to maximize the potential for
a. remineralization
b. optimization of the neutralizing effects of saliva
iii. eventually erode the enamel if the erosion is allowed to progress,
exposing small areas of dentine
iv. require consideration of
1. what foods and beverages are consumed because natural foods and
beverages, such as apples and fruit juice, may through acidity cause
erosion if consumed in excessive quantities
2. how foods and beverages are consumed because frequent
consumption repeated over short periods is most harmful because
it limits the time available for the saliva to neutralize the acidity
v. may be the result of past rather than current dietary habits
vi. may require review of tooth-brushing habits because
1. tooth-brushing shortly after consumption of acids may cause
damage to teeth to a greater extent than after, say, 30 minutes
because it removes from the teeth the saliva that would have
neutralized the acidity
2. brushing teeth before meals may be more protective than after
them, when acidic food and drink are consumed.
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g.
Enamel hypoplasia in
i. primary dentition is associated with malnutrition in early childhood
ii. permanent dentition is not firmly linked with malnutrition in early
childhood.
h.
Salivary insufficiency may
i. be associated with early childhood malnutrition through a possible
linkage involving
1. salivary flow rates
2. buffering capacity and the protein composition/content of saliva
ii. increase caries risk.
i.
Tooth pain may result from thermal stimulation or from sweet or sour food or
drink when caries reach the dentine.
j.
Tooth wear, attrition of the occlusal surfaces, may arise from a combination of
acid erosion, abrasion and attrition, but the interaction among them is unclear.
3. Effects of oral health on nutrition
a. Oral health problems may
i. impair the
1. ability to eat
2. appetite or desire to eat
ii. create undernutrition which then
1. causes additional symptoms
2. may exacerbate existing or create new further oral health problems.
b. Edentulism
i. carries the risk of compromised nutrition
1. because of
a. difficulty chewing
b. dietary modification in response to chewing difficulties
2. in persons who
a. are elderly
b. have chronic medical conditions
c. have serious mental health disorders
ii. may be treated with oral rehabilitation with simple mandibular-implant
overdentures for persons wearing conventional dentures.
MEDICATIONS SUMMARY
Sourcing medications information
1. Adverse effect database
 Health Canada’s Marketed Health Products Directorate
toll-free 1-866-234-2345
 Health Canada’s Drug Product Database
2. Specialized organizations
 US National Library of Medicine and the National Institutes of Health Medline Plus
Drug Information
 WebMD
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3. Medications considerations
All medications have potential side effects whether taken alone or in combination with
other prescription medications, or as over-the-counter (OTC) or herbal medications.
4. Information on herbals and supplements
 US National Library of Medicine and the National Institutes of Health Medline Plus
Drug Information All Herbs and Supplements
Types of medications
Warnings
Individual medications may be subject to important warnings, which
1. change from time to time
2. may affect the appropriateness, efficacy or safety of the Procedures
3. are accessible via the links to the particular medications listed below or through the
specialized organizations listed above
4. through the links, should be viewed by dental hygienists in the course of their
familiarizing themselves about a medication or combination of medications identified in
the patient/client’s medical and medications history.
Medications
1. Medications with effects such as
a. appetite suppression as the therapeutic purpose
i. such as
phentermine (Adipex-P®, Ionamin®)
diethylpropion (Tenuate®, Tenuate Dospan)
ii. should be used with a reduced-calorie diet and appropriate exercise,
which must be continued after the weight has been lost
b. appetite suppression as a side effect
c. impairment of absorption of nutrients
d. appetite stimulation as the therapeutic purpose, such as
megestrol (Megace®)
dronabinol (Marinol®)
e. appetite stimulation as a side effect
f. increasing catabolic action
g. interactions with food, which may
i. affect appetite, taste, and food intake
ii. affect excretion
iii. alter the ways medications are absorbed, utilized or detoxified in the
body
iv. cause nausea and vomiting
v. change with aging, when
1. medications are not metabolized as well as in earlier years, and
vulnerability to side effects increases
2. multiple medications compounds the risk for nutritional
deficiencies.
h. medications that impair absorption or metabolism of nutrients
2. Vitamins and mineral supplements
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a. are used as medication for the treatment of
i. specific, well-documented risk of deficiencies
ii. diagnosed diseases arising from deficiencies
b. have limited usefulness in the prevention and treatment of systemic diseases
c. are misused on the assumption that they prevent various diseases or even cure
them.
Side effects of medications
The following resource supports exploration of oral and nutritional side effects of particular
medications.
US National Library of Medicine and the National Institutes of Health Medline Plus Drug
Information
THE MEDICAL AND MEDICATIONS HISTORY
The medical and medications history-taking should
1. Focus on screening the patient/client prior to treatment decision relative to
a. key symptoms
b. medications considerations
c. contraindications
d. complications
e. comorbidities
f. associated conditions.
2. Explore the need for advice from the appropriate primary care provider(s).
3. Inquire about
a. the patient/client’s understanding and acceptance of the need for oral
healthcare
b. symptoms indicative of nutritional disorders
c. medications considerations, including over-the-counter medications, herbals
and supplements
d. problems with previous dental/dental hygiene care
e. problems with infections generally and those specifically associated with
dental/dental hygiene care
f. how the patient/client’s state of health is at this moment
g. how the patient/client’s current symptoms relate to
i. oral health
ii. health generally
iii. recent changes in the patient/client’s condition.
IDENTIFYING AND CONTACTING THE MOST APPROPRIATE HEALTHCARE PROVIDER(S) FOR ADVICE
Identifying and contacting the most appropriate healthcare provider(s) from whom to obtain
medical or other advice pertinent to a particular patient/client
1. Record the name of the physician/primary care provider most closely associated with
the patient/client’s healthcare, and the telephone number.
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2. Obtain from the patient/client or parent/guardian written, informed consent to contact
the identified physician/primary healthcare provider.
3. Use a consent/medical consultation form, and be prepared to fax the form to the
provider.
4. Include on the form a standardized statement of the Procedures proposed, with a
request for advice on proceeding or not at the particular time, and any precautions to
be observed.
UNDERSTANDING AND TAKING APPROPRIATE PRECAUTIONS
Infection Control
Dental hygienists are required to keep their practices current with infection control policies
and procedures, especially in relation to
1. The Recommendations published by the Centers for Disease Control and Prevention
(a frequently updated resource).
2. Relevant occupational health and safety legislative requirements.
3. Relevant public health legislative requirements.
4. Best practices or other protocols specific to the medical condition of the patient/client.
DECIDING WHEN AND WHEN NOT TO INITIATE THE PROCEDURES PROPOSED
In an otherwise healthy patient/client without severe nutritional disorder there is no
contraindication to the Procedures. But the Procedures may be postponed pending medical
advice if the patient/client has
1. One or more comorbidities of nutritional disorder.
2. One or more complications of nutritional disorders.
3. Recently changed medications, under medical advice or otherwise.
4. Recently experienced changes in his/her medical condition.
DEALING WITH ANY ADVERSE EVENTS ARISING DURING THE PROCEDURES
Dental hygienists are required to initiate emergency protocols as required by the College of
Dental Hygienists of Ontario’s Standards of Practice, and as appropriate for the condition of
the patient/client.
First-aid provisions and responses as required for current certification in first aid.
RECORD KEEPING
Subject to Ontario Regulation 9/08 Part III.1, Records, in particular S 12.1 (1) and (2)
For a patient/client with a history of nutritional disorder, the dental hygienist should
specifically record
1. A summary of the medical and medications history.
2. Any advice received from the physician/primary care provider relative to the
patient/client’s condition.
3. The decision made by the dental hygienist, with reasons.
4. Compliance with the precautions required.
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5. All Procedure(s) used.
6. Any advice given to the patient/client.
ADVISING THE PATIENT/CLIENT
The patient/client is urged to alert any healthcare professional who proposes any
intervention or test that he or she has a history of nutritional disorders.
As appropriate, discuss
1. The importance of a good diet in the maintenance of oral health, with particular
reference to
a. reducing consumption and, especially, frequency of intake of food and drink
containing sugar
b. limiting to meals and avoiding as snacks food and drink containing sugar
c. consuming snacks food and drinks that are free from sugar
d. avoiding frequent consumption of acidic drinks.
2. The need for regular oral health examinations and preventive oral healthcare.
3. Home oral hygiene including information about choice of toothpaste, tooth-brushing
devices, dental flossing, mouth rinses and saliva control, with particular reference to the
timing of tooth-brushing relative to meals.
4. Medication side effects such as dry mouth, and recommend treatment.
5. Scheduling and duration of appointments for patients/clients who are debilitated.
6. Comfort level while reclining, and stress and anxiety related to the Procedures.
7. Mouth ulcers and other conditions of the mouth relating to nutritional disorders,
comorbidities, medications or diet.
8. Pain management.
BENEFITS/HARMS OF IMPLEMENTING THE RECOMMENDATIONS
POTENTIAL BENEFITS
1. Promotion of health through oral hygiene for persons who have nutritional disorders.
2. Reduction of the adverse effects, such as undernutrition in the institutionalised elderly, by
a. monitoring for indications of nutritional disorders in persons undergoing oral
healthcare
b. generally increasing the comfort level of persons in the course of dental hygiene
interventions
c. using appropriate techniques of communication
d. providing advice on scheduling and duration of appointments .
3. Reduction of risk of oral health needs being unmet.
POTENTIAL HARMS
1. Failing to identify and seek advice for dental erosion.
2. Performing the Procedures at an inappropriate time, such as
a. when the patient/client is weakened by nutritional disorder which requires
medical attention
b. in the presence of complications or comorbidities for which prior medical advice
is required
c. in the presence of acute oral infection without prior medical advice.
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3. Disturbing the normal dietary and medications routine of a person with nutritional
disorder.
4. Inappropriate management of pain or medication.
CONTRAINDICATIONS
CONTRAINDICATIONS IN REGULATIONS
Identified in the Dental Hygiene Act, 1991 – O. Reg. 218/94 Part III
ORIGINALLY DEVELOPED
2010-01-23
DATE RELEASED
2010-01-23
ADVISORY DEVELOPER(S)
College of Dental Hygienists of Ontario, regulatory body
Greyhead Associates, medical information service specialists
SOURCE(S) OF FUNDING
College of Dental Hygienists of Ontario
ADVISORY COMMITTEE
College of Dental Hygienists of Ontario, Practice Advisors
COMPOSITION OF GROUP THAT AUTHORED THE ADVISORY
Dr Gordon Atherley
O StJ , MB ChB, DIH, MD, MFCM (Royal College of Physicians, UK), FFOM (Royal College of
Physicians, UK), FACOM (American College of Occupational Medicine), LLD (hc), FRSA
Lisa Taylor
RDH, BA, MEd
ACKNOWLEDGEMENTS
The College of Dental Hygienists of Ontario gratefully acknowledges the Template of
Guideline Attributes, on which this advisory is modelled, of The National Guideline
Clearinghouse™ (NGC), sponsored by the Agency for Healthcare Research and Quality
(AHRQ), U.S. Department of Health and Human Services.
Denise Lalande
Final layout and proofreading
COPYRIGHT STATEMENT
© 2008–2010 College of Dental Hygienists of Ontario
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