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NUTRITIONAL ASPECTS OF GINGIVITIS AND PERIODONTAL DISEASE CHAPTER 18 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. Introduction Nutrient deficiencies, excesses, or imbalances do not initiate periodontal disease nor do megadoses of supplements cure or prevent periodontal disease However, nutrition may alter development, resistance, and/or repair of the periodontium Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. From Bird DL, Robinson DS: Torres and Ehlrlich Modern Dental Assisting, ed 9. St. Louis: Saunders, 2009. 2 DEFINITIONS Gingivitis Periodontal Disease Present: Chronic inflammation Inflammation Swelling plaque accumulation possible calculus accumulation bleeding on probing Not present: attachment loss, connective tissue loss bone loss Communicable infection Loss of connective tissue Bone loss Gingival bleeding Pain Supppuration Leading cause of tooth loss in adults over 35 years Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 3 PERIODONTAL DISEASE AS A HEALTH RISK Causes increased risk for: 1. Cardiovascular disease 2. Stroke 3. Premature births 4. Respiratory infections 5. Diabetic problems High glucose levels with uncontrolled diabetes Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 4 Physical Effects of Food on Periodontal Health An imbalance of one or more nutrients can be a factor in disruption of tissue integrity and immune response Normal growth and development of periodontal and oral tissues need: Vitamin A (salivary glands, epithelial tissue) Vitamin C (collagen, connective tissue) Vitamin B-complex (epithelial, connective tissue) Calcification of bone and cementum requires: Amino acids, calcium, phosphorus, vitamin D, and magnesium Maintenance of oral tissues, immunity and repair responses requires: Vitamins A, C, and D Proteins Carbohydrates Calcium Iron Zinc Folic acid Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 5 Physical Effects of Food on Periodontal Health Food consistency Chewing firm, coarse, and fibrous foods, such as raw fruits and vegetables, stimulates saliva flow The increase in saliva will enhance oral clearance of food and reduce food retention Plaque biofilm is not physically removed by eating firm foods, but soft, sticky foods may increase accumulation of food. Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 6 Nutritional Considerations for Periodontal Patients Increased nutrients and energy are required by periodontal patients experiencing: Stress Tissue catabolism Infection Medical and social history can indicate whether patient at risk for nutrient deficiencies i.e.; alcoholism, anorexia Dietary counseling of all periodontal patients enhances: Tissue repair and wound healing Resistance to infection Reduction in number/severity of complications Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 7 Gingivitis Gingivitis may develop with the combination of local factors and systemic factors. Systemic factors: Immunocompromised system (AIDS) Medications Hormonal changes (pregnancy, puberty) Vitamin C deficiency A lack of nutrients does not cause gingival inflammation but may be a predisposing factor in that it disrupts the process of tissue repair Encourage vitamin C–rich foods and well-balanced, nutrientdense diet using MyPyramid as a guide Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 8 Chronic Periodontitis Initiation and progression of periodontitis do not occur unless plaque biofilm is present Excess glucose and sucrose also results in an increased rate of bacterial growth in early stages of biofilm development Certain types of food (soft, retentive, and/or a fermentable carbohydrate) can enhance food retention and severity of gingival inflammation Nutritional status determines the immunocompetence of the periodontium Intake of nutrients beyond the recommended amount does not improve or speed up healing and may be detrimental Maintain nutritional diet; avoid retentive foods Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 9 Chronic Periodontitis: Periodontal Surgery Preoperative Immunological competency is important for optimal healing Conduct preliminary assessment of patient for adequate nutrient reserves An elective surgery may need to be postponed for 1 or 2 weeks to allow nutritional status to be improved in a patient with poor nutrition Medically compromised patient should be referred to a registered dietitian Patient should be given tailored meal plan listing nutrientdense foods and beverages (e.g.;Ensure) to choose/consume during recovery Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 10 Chronic Periodontitis: Periodontal Surgery Postop Adequate nutrient intake by the patient is required, following periodontal surgery, due to: Blood loss Increased catabolism, tissue regeneration Host defense activities Dietary intake can be influenced by complications of anorexia, nausea, dysphagia, and oral discomfort Full-liquid diet If patient is unable to chew (by cup-no straw) Mechanical soft diet (p. 358, Box 18-3) If chewing is compromised For Perio dressing, no hard, sticky, or brittle foods, soft diet for 1-2 days, cool liquids for 1st 24 hrs to harden dressing Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 11 Necrotizing Periodontal Diseases Nutrient deficiencies, such as protein or Vitamin C and/or B- complex deficiency, are contributing factors to NUG because of lowered host resistance Those with NUG may lose the desire to eat because of pain or may choose soft foods that are easier to eat Tissue infection and destruction increase requirements for all nutrients When fever is present, a 12% increase in energy and nutrients is recommended for each degree above normal body temperature Severity of NUG determines initial dietary recommendations Liquid nutrition supplements may be needed until a regular diet can be resumed From Perry DA, Beemsterboer P: Periodontology for the Dental Hygienist, ed 2. St. Louis: Saunders, 2007. Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 12 Necrotizing Periodontal Diseases Dental hygiene considerations While ulcerations are present, encourage bland, soothing foods (such as gelatin, pudding) and avoidance of spicy and acidic foods (such as citrus fruits and tomatoes) A liquid diet may be needed initially with advancement to a mechanical soft diet followed by a regular diet, depending on the patient’s tolerance and comfort Cooler-temperature foods are more soothing when ulcerations are present Referral to an RD may be indicated Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 13