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Nutrition Ex 2
| Question | Answer |
|---|---|
| Define and explain dental caries. | Infectious, transmissible disease process where a complex cariogenic biofilm, in the presence of an oral environmental status that is more pathological than protective, leads to the demineralization of hard tissue |
| Explain and identify clinical evidence of caries at each stage. | White spot lesions:1st sign o Can be remineralized, incipient caries Brown spot lesions: more porous o Exogenous stain entered lesion o may become smooth and shiny after remineralization Cavitated lesions Radiographic carious lesions |
| When does tooth enamel begin to demineralize? At what pH? | Teeth demineralize during acid attack w/bacteria, acid, carbohydrates -pH drops in 3 min,remains low ~40min. critical pH 5.5 (5.0) for demin to occur -acid moves through enamel tubules, creates increased solubility of tooth |
| Which Bacteria is responsible for caries? Which one is responsible for initiation of the caries and which for the cavitation? | S. Mutans – lactic acid production - Initiator of dental caries Lactobacilli – not required to initiate dental caries - Metabolic byproducts are more acidic than S. mutans - Exacerbates lesion |
| At what pH are each most destructive? | Enamel demineralizes at pH 5.5 & Dentin pH 6.5 |
| What pH does dentin demineralize at? | - Dentin demineralizes at pH 6.5 |
| Factors that reduce the risk of caries | - Saliva and sealants - Antibacterials - Fluoride/Ca/P - Effective lifestyle habits - Risk-based reassessment - Cariostatic foods, neutralize with Ca-rich foods |
| Factors the increase the risk of caries | - Bad bacteria - Absence of saliva - Destructive lifestyle habits - High carb diet, poor saliva, poor OH, unavailable fluoride - Frequeny snacking between meals - Deep pits and fissues - Recreational drug use - Visible heavy plaque biofilm |
| How long does take for cavitation to happen in a high-risk person? | 19-22 months for cavitation to progress through enamel |
| How do we know demineralization has started on a tooth? What do we see initially? | White Spot Lesion |
| Explain dental biofilm. | Bacteria Aggregate Dynamic: complex&continuous Positive Presence (Acquired Pellicle)-Protective protein barrier for erosion. Physical barrier against acids - Antibacterial prop: proteins, mucins, glycoproteins - Ca, Fl, P |
| What is the pH of the oral cavity? What is considered the critical pH, explain what happens when pH drops, for how long, and what is important for clinical care in regard to pH? | Normal pH of oral cavity: ~7 Critical pH: 5.5 - Constant low pH promotes cariogenic bacteria - Neutral pH keeps cariogenic bacteria in check - Decreases after eating |
| Explain the minerals involved in demineralization and remineralization | Oral pH return to basic pH 6.8-7 • Minerals in saliva travel through tubules to replace that which was lost—calcium and phosphorus • Fluoride in the oral cavity will incorporate into crystalline surfaces that have been partially dissolved |
| What is hydroxyapatite and fluorapatite, how are they related to enamel? Which is stronger and why? | • Hydroxyapatite converts into fluorapatite which fortifies tooth structure into crystal lattice against future acid attack. • Fluorapatite is stronger, more resistant to acid dissolution/decay compared to hydroxyapatite. |
| What are pathologic and protective factors that relate to dental caries. | Patho Pathogenic Bacteria, Dietary Sugars, Poor Oral Hyg, Xerostomia, Genetics, Medication, Medical Conditions, Socioeconmonic status Proctective FL, Balanced Diet/Cariostatic, Good Hyg Practice, Good Salivary Flow, Sealants, Xylitol |
| What are risk factors of xerostomia? | •Medications: -Drug-induced OTC and Rx •Diseases: -autoimmune (Sjogrens, SLE-lupus, rheumatoid arthritis), chronic diseases (diabetes), psychogenic (depression, anxiety, stress, fear) •Head & neck radiation •Age |
| What are treatment options for xerostomia? | -Counsel pt about techniques/products to relieve symptoms of xerostomia -Choose nutrient-dense, soft, moist foods; foods that promote salivary flow -Avoid/minimize: dry foods, crumbly, sticky, spicy, alcohol and alcohol mouthwashes, tobacco |
| How much saliva do we produce daily? How much of that is stimulated salivary flow? | 1 – 2 L stimulated saliva accounts for 80-90% of daily salivary production |
| Which salivary gland (s) produces the most stimulated saliva? | Parotid gland produces the most stimulated saliva |
| Explain the difference between Abrasion, Attrition and Abfraction. | -Abrasion: wearing away by mechanical processes involving foreign objects or substances, Most common: premolars/canines -Attrition: physical wearing away of hard tissue due to tooth-to-tooth -Abfraction: occurs as a result of stress or tooth flexure |
| What are NCCL’s? How do we treat NCCL’s? | NCCL: Non-carious cervical lesions - Can be covered with composite but will likely pop off again |
| Know the difference between Chemical and Physical Erosion including patient recommendations. | Erosion: tooth structure loss not due to cares - Chemical dissolution by acids o Intrinsic acids: gastric acid o Extrinsic acids: acidic foods and beverages - Not of bacterial origin - Result of physical mechanisms |
| Explain root caries and dentin hypersensitivity. What is the optimal patient education and tx options? | Root caries -Dentin susceptible to decay around CEJ Dentin Hypersensitivity - Erosion major cause, hydrodynamic theory Recommendations - Use a straw - Avoid foods cause sensitivity (hot coffee/iced water) - Decrease freq of fermentable carbs |
| Explain the etiology of erosion and identify who is most at risk? | 1.Regurgitation: Erosive stomach acid in oral cavity (bulimia, pregnancy, GERD, eating disorders) 2.Excessive consumption of acidic foods: sweets or citric fruits 3.Excessive consumption of carbonated beverages 4.Environmental fact 5.Meds |
| What is the etiology and considerations of glossitis? | Etio: - Bacterial, fungal, viral infection - Drugs - Psychological stress - Allergic rxn - Nutrient deficiencies (B vitamins/iron) Consid: - Choose soft, nutrient-dense foods - Liquid nutritional supplements - Instant breakfast (Boost) |
| What is the etiology and considerations of TMD? | Etiology: - Grinding, clenching - Stress - Malocclusion - Injury and/or bone abnormalities Considerations - Limit opening (chew smaller bites) - Choose foods that are not too difficult to chew - Discourage use of gum |
| Give examples of anticariogenic foods | - Ex: meat, milk, cheese, nuts, sugar free gum, candy and gum with xylitol |
| Name and explain the different types of sugar substitutes available. | Replace table sugars • Synthetic Sweeteners (not a true carb (diabetes)) • Noncaloric • Non cariogenic • Sugar Alcohols (xylitol) **Not metabolized by microorganisms to form acid |
| What is the goal of caries management? | - Apply intensive antimicrobial therapy? - To restore and maintain a balance between protective factors and pathologic factors |
| Explain adjunct therapies useful in caries management | - Fluoride paste/gel - Chlorhexidine gluconate 0.12% - Enhancing salivary flow - Calcium and phosphate past products - Sealants |
| Explain the most common chronic infectious disease in children | Dental Decay/Caries |
| Which nutrients necessary for calcified structures and soft tissues and relate this to oral health outcomes. | -Vitamin A, Vitamin D, Calcium, Phosphorus, Magnesium, MUFAs, and PUFAs. |
| Collagen formation requires which nutrients, vitamins, and minerals? | Protein, Vit C, iron, copper, zinc |
| Why is collagen formation important to the body and oral cavity? | Defective collagen synthesis will affect formation of bones and teeth |
| Explain cariogenic and cariostatic. | Cariogenic Foods: rich in fermentable carbohydrates -All forms of these sugars are used by bacteria to create acid Cariostatic Foods: do not contribute to enamel demineralization -Protein, fats, phosphorus and calcium moderate pH |
| Describe the nutrients: Vitamin A | -Vitamin A: Development of soft tissues/calcified structures |
| Describe the nutrients: Vitamin D | -Vitamin D: mineralization of bones/teeth, aids w/blood Ca levels, cell growth, helps fight disease |
| Describe the nutrients: Calcium | -Calcium: enamel’s major mineral components forming hydroxyapatite |
| Describe the nutrients: Phosphorus | -Phosphorus:2 nd most abundant mineral in body, component of energy metabolism, during reduction of ATP to release energy |
| Describe the nutrients: Magnesium | Magnesium: 3rd most prevalent mineral in teeth - Dentin 2x amount present in enamel - Enzyme for ATP prod - Deficiency cause: ename/ dentin hypoplasia - Ex: coconut oil, cheese, marbling in beef and pork, lard |
| Describe the nutrients: Monounsaturated Fatty Acids (MUFAs) | Monounsaturated Fatty Acids (MUFAs): one double bond - Not been associated with health problems - May help lower LDL cholesterol – reducing risk of CVD - Liquid at room temperature |
| Describe the nutrients: Polyunsaturated Fatty Acids (PUFAs) | Polyunsaturated Fatty Acids (PUFAs): >1 double bond - 2+ double C bonds - studies linking relationship with certain reproductive organ cancers - Liquid at room temperature - C that hold less than the max # of H atoms will double bond themselves |
| Explain absorption of fluoride | - Fluoride from water is absorbed in the stomach and small intestines - Absorbs better on an empty stomach - Ca, Al, and Mg decrease fluoride’s absorption - Fluoride is excreted through kidneys, colon |
| Describe distribution of fluoride within the tooth structure. | - Distributed by the plasma, most concentrated on the enamel - Deposited in mineralizing tissue: bone and developing teeth |
| What is fluorosis? | hypermineralization of enamel - Increases porosity of enamel - Chalky white appearance - More severe fluorosis appears as brown stains; enamel can be fragile - Necessary to have the exact balance of Fl for adequate mineralization |
| What is the recommended application for fluoride for children, adults? | High risk patients: Children – ¼ of package 5% NaF, 2-4x per year Adults – recession, root exposure, sensitivity, xerostomia, mild abfractions, preventative adjunct therapy |
| What are the clinical indications for use of fluoride, including silver diamine fluoride. | - Recession, root exposure, sensitivity, xerostomia, mild abfractions, preventative adjunct therapy SDF: children, adolescents, individuals with special needs |
| Identify and explain the various fatty acids and differences between them. SFA, MUFAs, and PUFAs | Saturated Fatty Acids : no double bonds (db), source animals/coconut/palm, Solid Monounsaturated Fatty Acids : one db, Not assoc w/health probs, lower LDL cholesterol – reducing CVD, Liquid Polyunsaturated Fatty Acids : >1 double bond, liquid |
| What is an amino acid? How do amino acids become a usable structure? | Organic compounds, building blocks of proteins. They are essential to various biological processes, including the synthesis of proteins, enzyme function, and the regulation of metabolic pathways. SHAPE of AA that determines how the body uses the AA |
| What makes an amino acid essential? | Essential AAs: Can’t be synthesized by body, obtained by food Nonessential AAs: Manufactured by body, Formed from N&C chain or similar AAs Semi-essential AAs: 4 amino acids used in childhood o cys(contains sulfur), tyr, his, arg |
| What is cholesterol and how does it affect the body? | - Lipids whose carbons form rings instead of chains - Contain NO fatty acids - high in cholesterol: bacon, sausage, fast food, red meat; high in trans and saturated fats (associated with increased risk for CVD) |
| What fats might help contribute to the lowering of LDL. | Monounsaturated (Oleic Acid) – may help lower LDL cholesterol; reducing risk of CVD |
| What is the function of a lipid? | - Insulation, cushion, energy source, satiety/slow digestion - Phospholipid bilayer - Carry fat-soluble vitamins ADEK - Required to adsorb phytonutrient B carotene/lycopene - Provides essen nutrients – linoleic (omega 6), linolenic (omega 3) FAs |
| Explain the different lipids Triglyceride | - Largest category of lipids, 95% of all fats - largest fuel reserve – vital insulation - CHO, glycerol + 3 FA chains - single bonds straight flexible chain – hard fat, BUTTER - double bonds bend at double bonds will not pack neatly – fluid, OILS |
| Explain the different lipids Phospholipid | - Function as emulsifiers that keep molecules of fat and water in solution - Make up cell membranes, control movement in/out of cells - keep ingredients from separating – emulsify - lecithin – found naturally (soy beans, egg yolks) |
| Explain the different lipids Sterols **- cholesterol most well-known sterol in food and body | - Lipids form rings - NO FATTY ACIDS - precursor to Vit D and hormones - dietary cholesterol does not significantly affect blood levels - high in cholesterol: high in trans and saturated fats (associated w/increased risk CVD) |
| Explain the process of hydrogenation and trans-fats. | Hydrogenation: process infuses hydrogen into fatty acid chain Trans Fats: oils partially hydrogenated - food pdt infused w/H, no longer saturated/unsat fat - More damage to arteries than sat fats; elicits inflammatory; alters blood cholesterol |
| Explain how fetal development plays an important role in development of oral structures. | Wk 25 – Calcification for prim dent Critical period – wks 1-8 - Environment greatest impact - Nourishment determine hlth vs disease - CNS formed – Folic acid - Tongue formed, move in 2 wks Prim teeth mineralization early 2nd tri/3rd month |
| Explain the connection of pregnancy and the oral cavity | - Encourage mom to use prenatal vitamins - Explain the lack of nutrients will impact child’s teeth and periodontal structures - Need adequate Ca, Mg, P, Vit D to build strong enamel - Vit A to build healthy periodontal tissues and salivary glands |
| What is important for your pregnant patients to understand concerning nutrition and supplementation in regard to pregnancy and the oral cavity? | Encouraging pregnant pts to maintain a balanced diet, practice good oral hyg contribute to their overall health and the well-being of the developing baby. Inadequate results in enamel hypoplasia, salivary gland atrophy and crowded dentition. |
| How does erosion play a role in pregnancy? | - Mothers may experience GERD or morning sickness - Advise mom not to brush immediately after, wait 30-40 min - Odd cravings, increased low pH foods consumption |
| What pH is the pure form of water? | pH 7 |
| What percent of water makes up our body? What is this dependent on? | Body is about 45-70% water. Brain is 90% water Depends on the amount of fat a person has – more adipose, less water you have |
| Explain what water does for the body including the major role it plays. | - Maintains homeostasis - Removes and dilutes toxic waste - Serves as a major transport system - Regulates body temperature - Protects delicate body tissue |
| What role does water play in removing toxic waste? | - Necessary to prevent poison - Dissolves flavoring compounds - Dilutes noxious substances - Total body loss comes from: o 2/3 urine o 1/3 evaporation through lungs and skin o 2.5 cups lost through normal perspiration and sweat |
| Define and explain hypohydration | When more water is lost through sweat than replaced |
| Explain how and why we must meet the need for water daily, including the recommended daily intake. | ½ your body weight in oz. - Body requires at least 1 qt. each day, more if physically active - Marathon runner = 3 Gallons |
| What constitutes water intake? | - Lost water must be replaced or you become dehydrated: normal perspiration, breathing, urination, feces elimination - 2/3 comes from drinking water and beverages - 1/3 comes from food - 1 cup is created during metabolic process |
| What are the symptoms of dehydration and who is more at risk? | Thirst, dark-yellow urine, difficulty concentrating, cognitive deterioration, slight headache - elderly are at risk – sense of thirst diminishes with age |
| Define and explain hyperthermia | Body temp rises, caused by hypohydration |
| Define and explain euhydration | When you bring body back to normal water levels through necessary hydration |
| Define and explain hyponatremia | Water intoxication, uncommon, can occur when kidneys malfunction—excess water dilutes Na in blood, causing swelling of cells - Symptoms: headache, nausea, bloating, low body temp, seizures |
Created by:
RDHSeattle