1. A.MAHESH KUMAR
MDS 1ST year
Drs SIDS
Dept of Pedodontics &
Preventive dentistry
Nutrition and diet
1

2. Contents
 References
 Introduction
 Definitions
 Recommended Daily Allowance.
 Dietary goals
 Food Group Guide
 Proteins
 Carbohydrates
 Lipids
 Diet counseling
2

3. Contents
 Principles of diet management
 Management of patients.
Communication
Interviewing
Teaching & Learning
Counseling
Motivation.
 Parent counselling
3

4. References
 Clinical Pedodontics, Sidney B. Finn.
 Dentistry for the Child and Adolescent, Ralph E.
McDonald and David R. Avery.8th edition. Mosby.
 Fundamentals of Pediatric Dentistry, Richard J.
Mathewson and Robert E. Primosch.
 Pediatric Dentistry. Infancy through adolescence.
Pinkham JR; 3rd edition, W B Saunders Co.
 Dorsky R. Nutrition and oral health. General
Dentistry 2001:49(6) 576-582
4

5. References
5
 Laura M. Romito. “Nutrition & oral health”, Dental
Clinics of North America vol 47, No.2, April 2003
 American Dietetic Association. Position of the
American Dietetic Association : Oral health and
nutrition. J Am Diet Assoc 1996 ; 96 (2) : 184-189.
 Naidoo S , Myburgh N Nutrition, oral health and the
young child Matern Child Nutr. 2007 Oct;3(4):31221
 Paula Moynihan, and Poul Erik Petersen Diet,
nutrition and the prevention of dental diseases
Public Health Nutrition: 7(1A), 201–226

6. INTRODUCTION:
 All the children have their important needs to be
fulfilled
 1) A feeling that they are loved
 2) Enough supply of healthy food and
 3) Freedom from infection
 Well nourished and loved children have a low risk
of getting serious infections. For a child to lead a
healthy and happy life they need energy from
variety of nutrients /food.
6

7. INTRODUCTION:
 The process of providing or obtaining the food
necessary for health and growth is called
Nutrition. While adequate food is necessary
throughout childhood, it is crucial during the first
five years, especially during first 3years when
rapid growth occurs and the child is entirely
dependent on the mother and the family for food
 A child needs energy for
 1) Growth
 2) Daily physical activities like crawling, walking,
and playing
 3) Catch up growth following infection.7

8. Introduction
 Energy is measured by calories. The energy
obtained from food or the energy required for the
optimum functioning of the human body is
measured as calories/kilocalories.
 It is defined as heat required raising the
temperature of 1 kg of water from 14.5 to 15.5 c
 1 gm of fat – 9 kcal
 1gm of carbohydrate &and protein – 4 kcal.
8

9. Definition
 Nutrition:
Nutrition is the sum of the process concerned in
the growth, maintenance, & repair of the living
body as a whole or of its constituents parts.
[Finn]
Nutrition is the science of the food & its
relationship to health. Its concerned primarily
with the part played by the nutrients [WHO
1971]
9

10. Definitions
 Diet:
Diet is the customary allowance of food and drink
taken by person from day to day.[Newbrun]
It’s the total intake of substance that provide
energy.[Finn]
 Food:
Food is any substance which when taken into the
body of an organism may be used either to
supply energy or to build tissue.[Finn]
10

11. Nutrients
They are biochemical substances that can be supplied
in adequate amounts from an outside source,
normally from food.
Nutrients or “food factor” is used for specific dietary
constituents such as proteins, carbohydrates,
vitamins and minerals.
Good nutrition means maintaining a nutritional status
that enables us to grow well & enjoy good health.
 Nutrients may be divided into:
1. Macronutrients:
These are proteins, fats, and carbohydrates.
Often called ‘proximate principles’ because they form
the main bulk of food.11

12. Nutrients
In the Indian dietary practices, they contribute to
the total energy intake in the following proportions
 Proteins - 7 to 15 per cent
 Fats - 10 to 30 per cent
 Carbohydrates – 65 to 80 per cent .
 Micronutrients:
These are vitamins and minerals.
They are called micronutrients because they are
required in small amounts which may vary from a
fraction of a milligram to several grams.
12

13. Classification of food:
 Based upon origin:
Foods of animal origin.
Foods of vegetable origin.
 Based upon chemical composition.
Proteins
carbohydrates
Fats
Vitamins
Minerals
13

14. Classification of food:
 Based upon predominant function
Body building food eg: milk, meat, poultry, fish ,
eggs, pulses.
Energy giving foods eg: cereals, sugars, roots
and tubers.
Protective foods, eg: vegetables, fruits, milk.
 Based upon nutritive value:
Cereals & millets
Pulses
Vegetables
14

15. Nutritional Requirement
Knowledge of nutritional requirement is necessary in
order to assess the nutritional adequacy of diets for
growth of infants, children and adolescents and for
maintenance of health in adults of both sexes &
during pregnancy and lactation in women.
Various terms have been used to define the amount of
nutrients needed by the body as:
 Optimum requirement.
 Minimal requirements.
 Recommended intakes/ allowances.
 Safe level of intake.
Of all these the term “recommended daily intake or
allowance” (RDA) has been widely accepted.
15

16.  RDA is defined as the amount of nutrients
sufficient for the maintenance of health in nearly
all the people.
 The RDA are the set values of intake of the
nutrients currently considered essential so as to
meet he physiological need of the individual.
 Dietary standards & allowances are different for
different people because people live under
different climate, cultural & social conditions.
 A reasonable small variation ( 10%) from the ideal
figure is still a realistic & acceptable allowance for
an adequate diet.
16

17. Group Age Bd
Wt
(kg)
Net
Energy
(Kcal/d
)
Protein
(g/d)
Fat
(g/d)
Ca
(mg/
d)
Fe
(mg/
d)
Vit A Vit C Vit
B12
Infant
Childre
n
0-6
month
6-12
month
5.4
8.6
108/kg
98/kg
2.05/kg
1.65/kg
-
500
-
1750 25 0.2
Childre
n
1-3
yrs
4-6
yrs
7-9
yrs
12.2
19.0
26.9
1240
1690
1950
22
30
41
25 400
12
18
26
400
2000
3000
40 0.2-
1
Boys
Girls
10-12
yrs
35.4
31.5
2190
1970
54
57
22 600 34
19
3000 40 0.2-
1
Boys
Girls
13-
15yrs
47.8
46.7
2450
2060
70
60
22 600 41
28
3000 40 0.2-
1
Boys 16- 57.1 2640 78 22 500 50 3000 40 0.2-
RDA for Indians
17 Source : Gopalan. C, Rama Sastri B.V. and Balasubramanian, S.C., 2004
Nutritive Value of Indian Foods, National Institute of Nutrition, ICMR, Hyderaba

18. Dietary goals
The dietary goals as recommended by WHO committee
are:
 Dietary fat should be limited to 20-30% of the total
daily intake.
 Saturated fat should not contribute more than 10% of
the total energy intake; unsaturated vegetable oil
should be substituted for the remaining fat
requirement;
 Excessive consumption of refined fat should be
avoided, some amount of carbohydrate rich in natural18

19. Dietary goals
 Sources rich in such as fats and alcohol should be
restricted.
 Salt intake should be restricted to an average of not
more than 5g/day (In India it averages 15g/day).
 Protein should account for apprx 15-20% of daily
intake.
 Junk food such as colas, ketchup and other food that
supply empty calories should be restricted.
19

20. Changes in food selection and
preparation suggested by the dietary
goals
 Increase consumption of fruits ,vegetables and whole
grains .
 Decrease consumption of refined sugars .
 Decrease consumption of food high in total fat &
replace saturated fat with poly saturated fats .
 Decrease consumption of butter fat ,eggs & other
sources high in cholesterol .
 Decrease consumption of salt and foods high in salt
contents .
20

21. Implementation of dietary goals
 Eat a variety of foods.
 Eat foods with adequate starch and fiber
,such as whole grain
 Bread ,cereals, raw vegetables & fruits .
 Eat minimum to moderate amount of sugar.
 Eat minimum to moderate amount of salt.
 Consume alcohol in moderation.
 Achieve and maintain ideal weight.
21

22. Food Group Guide
 The objective of the national food guide has been
to translate dietary standards into simple &
reliable devices for the nutritional education of the
person.
 The factors which were taken in the development
of the food guide include the:
Customary food pattern
Availability of food
Food economics
Nutritive value of food in the particular local.
22

23. Food group guide
 The food group guides serves as a practical and
workable plan for helping the homemaker select the
kinds and amount of food need to be included in
each day meals in order to provide a balanced diet.
 The food groups were designed and categorized on
the basis of their similarity in composition or nutritive
value or both.
23

24. The daily Food Guide
The food guide pyramid was introduced by the
USDA in 1992 as a pictorial representation for
daily food guide. It is a tool commonly used to
help plan a healthful diet.
It compromises of the commonly eaten food divided
into 5 groups according to their nutritive value:
Vegetable- fruit
 Bread- cereal
 Milk- cheese
 Meat, poultry, fish & beans.
 Fats, sweets & alcohol.
24

25. 25

26. Vegetable-Fruit group
Important as they provide Vit A,C
and fibre as well as trace amount of
other nutrients.
Color of the vegetable & fruits is a guide to its food
value. Dark green & deep yellow veg: are good
source of Vit A.
Most dark green vegetables if not overcooked are
good source of Vit C as well as riboflavin, folacin,
Fe, Mg.
Certain greens – collards, kale, mustard greens
provide calcium.
Servings: 3-4 times daily as ½ cup of veg:/ fruit, or26

27. Bread – Cereal group:
Most economical source of nutrients
in our daily diet as wide variety of
cereals available like; wheat,
rice, corn etc.
Cereals contains enriched amount of Vitamin B and
Fe.
Serving: 1-2 serving daily of breads and cereals.
27

28.  Milk- Cheese group:
Milk is an important part of the daily
diet and provides about 2/3rd of Ca.
Milk is low in Vit C & Fe.
Cheese is the curd (solids) of milk
separated from the whey (liquid) by coagulation;
contains most of the protein, Ca.
Servings: 1-2 glass of milk daily or about 1-inch
cube of cheese.
Pregnant women and those over 50yrs 1-2 cups
daily.
28

29.  Meat, poultry, fish
&beans:
These foods are valued for
protein, phosphorus, niacin
Vit B₁₂ & Fe.
Only foods of animal origin
provide Vit B₁₂.
To obtain full advantage of protein from the foods in
this group, its preferable to have an occasional egg
for breakfast.
Servings: ½ to ¾ c cooked dry beans, dry peas,
soyabeans.
2 eggs are equivalent to about 3 oz of meat.
29

30.  Fats, sweets & alcohol group:
These group of food provides the
most calories and they include butter, mayonnise,
oils other salad dressings, jams, jellies, syrup
etc.
Vegetable oils supply Vit E & essential fatty acids.
Butter provides Vit A.
30

31. 31

32. Limitation of food group guide
 The nutrients not monitored will be
automatically ingested into the diet such as
legumes which are accepted as an alternative
for fish, meat, but these animal products
contain Vit B₁₂ & legumes do not.
 The high amounts of iron required by
pregnant, lactating and premenopausal
women cannot be met by these 5 food
groups.32

33. PROTEINS
Is derived from a Greek word meaning “of first
rank.”
Its of prime importance in life as is
indispensable constituent of the cytoplasm
and nuclei of all cells and serves as building
blocks for cellular membranes and tissue
structure.
They are the precursor of antibodies and are
also essential components of enzymes and
hormones which acts as catalysts and
regulators in metabolism
33

34. PROTEINS
 They are the building blocks of the body. They
are necessary for growth, repair and maintenance
of body tissues, maintenance of osmotic
pressure, catalytic functions through enzymes,
protection through immunoglobulins and
interferon, hormonal role as with insulin, transport
through hemoglobin &albumin, provision of
energy when calorie intake is inadequate .
 A protein is said to be biologically complete if it
contains all the needed essential aminoacids.
Human milk and egg serves as a reference
34

35. Chemical nature, classification &
properties
 Large complex molecules that basically contain
C, H,N,O₂ atoms arranged in amino acids.
 They are classified as simple, conjugated and
derived based upon their solubility
 Simple proteins yields amino acids on hydrolysis.
E.g. globulins found in legumes.
 Conjugated proteins are formed by attachment of
protein molecule to non-protein molecule. E.g.
globin + heme = hemoglobin.
 Derived proteins are resulted from the hydrolysis
of proteins. E.g. protease & cooked egg albumin.
35

36. Amino acid requirement of
humans
 22 different amino acids are required by the
body for the synthesis of tissue protein
 A dietary supply of 9-10 amino acids are
essential for the humans such as:
Amino acid Infants 2yr old 10-12 yr old Adults
Histidine 28 ? ? 8-12
Isoleucine 70 31 30 10
Leucine 161 73 45 14
Lysine 103 64 60 12
Methionine
+ cystine
58 27 27 13
Phenylalanin
e + tyrosine
125 69 27 14
Tryptophan 17 12.5 4 3.536

37.  Recommended Daily allowance- 0.9/kg bd
weight.
 This RDA value increases as according to the
requirement of the body for the persons such
as pregnant female, lactating mothers.
37

38. PROTEIN V/S ORAL HEALTH
 Protein comprises to the major part of
organic component of the enamel and dentin.
 Any deficiency in protein intake during the
developing stage results in late eruption,
hypoplasia of teeth and even defective
periodontal ligament.
 Experimental studies have shown that when
animals were fed on protein deficient diet
resulted in irregular pre-dentin matrix as well
as as poorly calcified dentin matrix.
38

39.  EFFECTS ON PDL TISSUES
A dietary protein deficiency has a direct effect
on the activity of the fibroblasts, osteoblasts,
cementoblasts, resulting in the atrophic and
degenerative changes in the gingival as well
as the periodontal connective tissue.
39

40. Protein energy malnutrition:
Protein energy malnutrition (PEM) is
characterized by weight, stature or weight for
stature indices below the 5th percentile for the
age group.
It results from the inadequate energy or the
protein intake to maintain weight and support
growth.
It can even result secondarily from defective
digestion / absorption/ altered metabolism or
an increased demand.
The commonly associated illness with secondary
PEM are chronic renal failure, inflammatory
bowel disease, intestinal malabsorption,
malignancy.
40

41. PEM in young children is of 2 types:
 Marasmus
 Kwashiorkor
 Marasmus
Acc to WHO a child is stated to suffer
from marasmus when his/her body
weight is reduced 60% below than
that given by the WHO for that age.
It seen to occur in children before 1yr of
age.
41

42.  Etiology:
Early transition from breast feeding to nutrition-poor
foods in infancy,
Acute infection of the gastro intestinal tract.
Chronic infection such as HIV or Tuberculosis.
The imbalance between decreased energy intake and
increased energy demands result in a negative energy
balance.
 C/F:
Decreased activity, lethargy, behavioral changes, slowed
growth, and weight loss. loss of subcutaneous fat and
muscle, resulting in growth retardation.
Gaseous distension of the body with diarrhoea..
The majority of children who suffer from marasmus
never return to age-appropriate growth standards.
42

43.  Treatment:
Nutritional requirement of the child should be met
by atleast 150 kilocalories/kg /day.
Dehydration must be addressed with oral
rehydration therapy.
Supplementation of micronutrients.
Immunization must be reviewed.
43

44.  Kwashiorkor
Type of malnutrition disease commonly caused by
the insufficient intake of protein.
Derived from the local language of Ghana
which means “rejected one” .
Reflecting the condition of older child
weaned from the breast milk at early age
for the sibling.
The term was introduced by
Jamican Pediatrician Cicely D.Williams
in 1935.
Usually affects children b/w 1-4 yrs.
44

45.  Etiology:
Due to deficiency of one of several types of
nutrients (e.g., iron, folic acid, iodine,
selenium, vitamin C), particularly those
involved with anti-oxidant protection.
Important anti-oxidants in the body that are
reduced in children with kwashiorkor
include glutathione, albumin, vitamin E and
polyunsaturated fatty acids.
Therefore, if a child with reduced type one
nutrients or anti-oxidants is exposed to
stress (e.g. an infection or toxin) he/she is
more liable to develop kwashiorkor.
45

46.  C/F:
Generalized edema
Protuberant (swollen) abdomen
Diarrhea
Desquamation of skin
Pigmentation(red) of hair.
Decreased muscle mass.
Stunted growth
Delayed puberty.
46

47.  Treatment:
Rehydration
Subsequent increase in diet firstly with
carbohydrate followed by proteins
47

48.  Gastroenteritis & septicaemia.
 Respiratory infections especially
bronchopneumonia
 Tuberculosis.
 Streptococcal & staphylococcal skin
infections.
Infections associated with PEM
48

49. Investigations
 Measure body weight, mid arm
circumference & skin fold thickness .
 Hb, TC, ESR
 Plasma glucose : low but albumin level
is maintained
 Endocrine : Decreased insulin secretion
Increased
glucagons,cortisol
secretion.
 Serum T3 & T4 - decreased level
49

50. Management
 Good nursing, frequent feeding & prevention of infections.
 Protein intake has to be increased upto 2-3 gm/kg/day.
 Supplement of vit & minerals.
 Corrections of hypothermia, hypokalemia, dehydration,
acidosis & electrolyte imbalance.
 The National Institute of Nutrition, Hydrabad
recommends an energy-protein rich mixture to treat PEM
at home
Whole wheat 40 gm
Bengal gram 16 gm
Ground nut 10 gm
Jaggery 20 gm
50

51. Prevention of PEM
 UNICEF has given mnemonic GOBIFFF for
prevention of PEM .
G - Growth monitoring.
O - Oral rehydration .
NaCl 3.5 gm + NaHCO3 2.5
gm + KCl 1.5 gm
+glucose 20gm/ l.
B - Breast feeding.
I - Immunization against measles
diphteric,mumps,tetanus,
TB,polio.
F - Supplementary feeding .
F - Female child care .
F - Family welfare .
51

52. CARBOHYDRATE
Carbohydrates are the organic compounds of the
elements C, H & O₂.
They are classified as:
 Monosaccharide
 Disaccharide
 Polysaccharides.
Monosaccharides are the most simplest
carbohydrates , common being pentose and
hexose.
Disaccharides contains linkage of 2
monosaccharide such as sucrose, lactose.
Polysaccharide are complex carbohydrates made52

53.  The 3 hexose –glucose, fructose & galactose are of
major nutritional importance.
Functions:
 Provides energy.
 Facilitate the oxidation of fats.
 Spare proteins
 Contribute to body structure
 Affects food consumption
 Furnishes fibres for normal peristalsis
53

54. Metabolism & utilization:
The end result of metabolism of all the various
carbohydrates is to furnish energy.
Glucose is the simple carbohydrate which
provides energy to the body.
54

55. 55

56. 56

57. 57

58. 58
Lipids
 These are the most concentrated energy yielding
group of nutrients.
 Basic structure –molecules of glycerol
to which one to three
fatty acid molecules

59. 59
Lipids
 Sources –
-fruits -egg yolk
-vegetables -butter
- milk - ghee
-meat -cereals
-fish

60. 60
Lipids
 Classified as
- saturated
-unsaturated
 Physical properties –
insoluble in water.
less dense than water.
not affected by temperature.

61. 61
Lipids
 Digestion-
stomach- naturally occurring emulsified fat
small intestine-bile is secreted
-emulsification

62. 62
Lipids
 Pancreatic lipase and intestinal lipase
triglycerides
diglycerides
monoglycerides
v

63. 63
Lipids
 Absorption and storage
digested and divided molecules are taken up from
the GIT .
 30%-free fatty combine with bile salts
 70%-resynthesised immediately to form
triglycerides –lymph

64. 64
Lipids
Function –
 Source of energy -1gm-9kcal.
 Carrier of the fat soluble vitamins.
 Source of other essential fatty acids.

65. 65

66. Methods to enlist diet history
 A 24 hour diet history
 5 day history
1.24 hour diet history : can be taken by the
chairside.
Should include time at which each meal is
taken.
Include every in between snack that has been
taken.
Amount of sugar that has been added or
sweetened food that has been ingested.
Measurements should be given in tablespoons,66

67. 24 hours diet history
 Method 1
Questions can be asked like :
1.Appetite :good ,fair or poor.
2.Person responsible for food preparation
3.Eat with family or alone
4.Is there a craving for sweets?
5.Religious or ethnic practices
6.Is there a candy dish or cookie jar always at
home?
7.Fluorides water ?toothpaste?
67

68. 68

69. 5 day diet history
 Patient is asked to keep a five day food diary.
 Includes time of each meal; time of each in –
between meal snack.
 Amount ingested .
 Type of preparation.
 Amount of sugar added or sweetened foods
ingested.
 Patient s diet is then evaluated on this diet history
that the patient submits.
69

70. DIET ASSESSMENT
STEP 1
Average daily intake.
Time at which it is taken.
Amount ingested.
Preparation of food.
No. of teaspoons of sugar added.
70

71. 71

72. Step 2
Scoring the four food groups
 Circle sweetened items
 Classify encircled foods into the four food groups
 For each serving place a check mark
 Add the no. of checks and multiply by the number
shown.
 Add the points.
 Sum=the food group score(96 is the highest
score)
72

73. 73

74. 74

75. Instructions for keeping a food Diary
A five day food diary is recommended. The diary is kept for
five consecutive days including a week end day or holiday;
the providing a more representative sampling of food
intake.
 Daily Food Diary
Breakfast
Snack
Lunch
Snack
Dinner
Total Daily Intake:75

76. Patient should record meal by meal and snack by
snack, proper keeping of the diary is one of the
indications of the genuine interest of the patient in
diet change and the sincerity with which the patient is
likely to adhere to any diet prescription.
The patient is asked not to make many changes in his
usual dietary pattern during this week because the
diet he is taking may be perfectly acceptable and may
be unrelated to dental caries problem.
76

77. 3. NUTRIENT EVALUATION
CHART
 In each of the eight columns of foods ,check the
one or more eaten food on this usual weekday.
 If the food is checked, circle the no. 7 beside the
nutrient that heads this column.
 Regardless of the no. of foods that are checked in
the same column only 7 points is given per nutrient.
77

78. 78

79. Step 4
Sweets evaluation chart
 List the sweets and sugar sweetened foods
 Frequency with which they are taken
 Classify each sweet into liquid ,solid and sticky
or slowly dissolving .
 Place check mark in the frequency column for
each item as long as they are eaten 20 mins
apart.
 Add the no. of checks. If sweets are liquid
multiply by 5.
 Solid multiply by 10
 Slowly dissolving multiply by 15
 Total the products. This makes the sweets score.
79

80. 80

81. Step 5
Dental health score card
 Transfer the 4 food group score and sweet score
to the totaling scores page.
 If 4 food group score is barely adequate or not
adequate
 If sweet score is in the watch out zone ,
 Then nutrition counseling is indicated.
81

82. 82

83. Principles of diet management
 There are four rules
 1.maintain overall nutritional adequacy
 2.prescribed diet should vary from the normal
diet pattern as little as possible
 3.the diet should meet the body’s requirements
for the essential nutrients as generously as the
diseased condition can tolerate.
 4.prescribed diet should take into consideration
patients likes and dislikes.
83

84. Diet counselling
 Basic prerequisites
1. Educating the patient and the parents.
a.Mechanism of caries .
b.Relation of caries to diet.
c.Prevention of caries in relation to diet.
84

85. 1.co-operation of the patient
 Diet counselling will not succeed with every
patient .
 These patients or their parents have to give
complete co-operation to the dentist.
 They should give high priority to preventive
dentistry.
 These patients or their guardians should follow
every dietary advice given
 Should keep up recall visits and appointments
given .
85

86. 2.Effort by the patient
 The dentist has to make it clear to the patient ‘s
parents and the patient that a sincere effort has to
be made by them.
 The alterations in the diet has to be followed .
 The patient must be willing to improve current
undesirable food selections and eating habits.
86

87. 3.Responsibility of the patient
 A basic prequisite for accomplishing dietary
change is the advice that the patient not the
counsellor bears the responsibility for making
the change.
 It should be the patients responsibility to make a
demonstrable need for dietary improvement
,based on their current food intake regimen.
 The patient should take the responsibiliity of
visiting the dentist for recalls.
87

88. Minimal requirements
1.to enroll active patient involvement in planning
,implementing and evaluating the diet before
and after counselling.
 Assisting the patient to select an adequate non
cariogenic diet.
Step1
 Commend the patient .
 It is important to commence a counselling
procedure on a positive note
 Do not criticize.
 Since the food evaluation chart will show that
the recommended allowances were met in at
least one or two food groups ,a good starting
point is to commend the patient for this and urge
the patient continuance of this good practise.
88

89. 2.Allow the patient to suggest improvements and
write his or her own diet prescription.
 Refer to the evaluation chart.It can be seen
that an intake of only two or three food
groups is insufficient.
 Suggest to the patient to include a variety of
foods which would achieve a balanced diet.
 Not only should the adequacy of the total diet
be improved ,the nutrient balance of each
meal needs improvement.
 A balanced diet provides at one meal all the
nutrients necessary for the optimal
functioning of the human machine.
89

90. Allow the patient to delete from the diet plaque-
forming ,sugar sweetened foods
 Reexamine the sweets evaluation chart ,ask the
patient to note the grand total of the number of
exposures to sweets ,the types of sweets most often
consumed ,and the frequency with which they are
consumed.
 Since frequency and form of sweets taken are the
pressing factors of caries it must be emphasised to
delete these substances.
 They can be substituted with the cariostatic food
substances.
 The sweets the patients can give up should be
recorded.
90

91. Allow the patient to select non –plaque promoting
snack substitutes.
 If snacking is a habit of long standing it is unrealistic
to expect total immediate abandonment of between
meal nibbling .
 Acceptable alternatives raw vegetables,cheese or
nuts can be prescribed.
 Provision of suitable noncariogenic snack substitutes
is one of the successes of this counselling.
 However if the patient is consistently reminded that
increasing the food intake at each meal will satisfy
appetite and hunger ,it is possible that the number
between meals can be eventually reduced.
91

92. Allow the patient to select menus.
 Starting with the existing menu as a nucleus
,encourage the patient to examine each meal and
make deletions ,substitutions ,or additions with which
he or she can live with.
 Rule is to improve the quality not quantity.
 For example if the patient is used to having
doughnuts and coffee with sugar we can suggest
replacing sugar with a substitute and replace
doughnuts with toast or muffins.
 Gradual improvement is a more realistic goal than
drastic change .
 Evolution not revolution should be the aim of this
prescription.92

93. Compare the new diet with the old
 Encourage the patient and the patients parents to
evaluate the old and the new diet .
 The adequacy of the new diet,and also to note
the number ,form and frequency of concentrated
sweets and sugar rich foods having an overtly
sweet taste.
 The patient and the parents usually compares
with a sense of satisfaction the changes were
made it so much ease.
93

94. Reinforcement by follow up
reevaluation.
 Schedule a follow up visit for 2 weeks later
 Patient is asked to complete a 5 day diary as before.
 Evaluate the new food diary and compare the results
with the original plan.
 Discuss problems that arised during this time .Menu
changes are recommended if neccesary.
 Continuing reinforcement of dietary advice is just as
important as continuing review of toothbrushing and
flossing practices.
 Repetition ,clarification and encouragement are the
keys to success in long term maintenance of the new
,acceptable ,less cariogenic and more nutritious diet.
94

95. Management of patients
1.COMMUNICATION
Communication is a basic tool in preventive
dentistry.It can create motivation for
change.Communication is the giving and
taking of information;it involves the
knowledge ,thoughts and opinions of the
counsellor and patient.
95

96. Three rules for effective communication.
 1.during a face to face interview ,keeping an
eye contact with the patient is as persuasive
and powerful device for motivational
behavioural change.
 2.communications can be both verbal and
nonverbal words transmit information.the
interviewer s tone of voice, facial expression
& gestures convey sincerity ,enthusiasm &
empathy.These nonverbal actions can be
influential in helping the patient to change his
or her behaviour.
96

97. Three rules for effective communication.
 3.the message must be adapted to the patients
needs and level of understanding .
Personalisation of the message is more likely to
result in a sustained change in behaviour.
 For effective communication with a patient
:combination of 1.interviewing 2.teaching
3.counselling 4.motivation.
97

98. Interviewing
 Purpose:to obtain information and to give
help.
 Goals:1.understand the problems
2.understand the factors contributing
to it .
3.and personality of patient.
Importance of gathering information on food
&dietary intake &habits of patients.
1.dietary interview can serve as diagnostic
aid.Food selection & eating habits may affect
a person ‘s general health or dental or both
.Apprasial of an individual’s dietary status98

99.  2. Knowledge of patient ‘s daily routine is
important for adapting the caries preventive
diet to an individual ‘s lifestyle.This
adaptation may help a patient adhere to the
newly prescribed diet ,the basis for achieving
the health goals &rewards from diet
counselling.
 3.Many practical research contributions
could be made if data from nutritional
assessments could systematically be
gathered to coorelate dental ,periodontal or
oral mucosal problems with such factors as99

100. Diet interviewer and physical setting
 Good dietary interviewing requires skill ,time,and
some background knowledge of the science and
practise of nutrition ,including familarity in which food
habits are formed and factors that affect these
habits.
 Even if nutritionists can readily qualify with some
extra course in the nature of dental caries and
periodontal problems still the dentist has to be the
ultimate force who must reinforce advice given by
dental hygienist or nutrtionist.
 Privacy and a comfortable relaxed atmosphere are
important.It should take place in a separate
counselling room that contains a small table ,some
chairs,a blackboard and visual aids.100

101. Teaching and learning
 Patient education is more than simply giving
information.It requires the presentation of
information with sufficient impact to stimulate
action by the learner.
 Number of teaching aids must be used such
as booklets,pamphlets.
 Visual aids include ivorine tooth models
depicting caries or rubberlike food models to
help the patient visualise what you are
teaching.
 The more the patient is involved in the
educational process the greater is the extent
of learning.101

102. FOODS THAT HAVE CARIOSTATIC
PROPERTIES
FOOD
CARIOSTATIC
FACTORS
MECHANISMS
COW ‘MILK CALCIUM,PHOSPH
ATE,
CASEIN
PROMOTES REMINERALISATION
AND DECREASES
DEMINERALISATION.
CHEESE CALCIUM,PHOSPH
ATE,
CASEIN
INCREASES SALIVARY FLOW RATE
AND PH.CARIOSTATIC FACTORS
PROMOTES REMINERALISATION.
PEANUTS HIGH IN
MONOUNSATURAT
ES
GUSTATORY FLOW AND
MECHANICAL STIMULUS FOR
SALIVARY FLOW.
HIGH
FIBER
FOODS
MECHANICAL STIMULUS FOR
SALIVARY FLOW.
APPLES FLAVONOIDS INHIBITION OF BACTERIAL
ADHERENCE AND ANTI BACTERIAL
ACTION
GREEN & FLUORIDE,FLAVON INHIBITION OF BACTERIAL
102

103. Counseling
Two types of counseling
1. Directive
2.Non Directive
Guidelines for counseling
Gather Information
Evaluate and Interpret
Information
103

104. Develop and Implement a Plan of
Action
Seek
Active Participation of the
Patient ‘s Family
Follow up to assess the
progress made
104

105. Motivation
 Motivation stimulates or is an incentive for
action.
 According to GARN the basic factors that
motivate people are self
preservation,recognition,love and money.
 If clinicians can help people understand the
importance of a healthy mouth and a nice
looking smile it can help them achieve one or
more of these goals ,patient will be inclined to
adopt a diet that will promote better oral
health.
105

106. Four preliminary stages a person passes
in changing a diet pattern
1.awareness: recognition that a problem exists
,but without an inclination to solve it.
2.Interest : greater degree of awareness but still
with no inclination to act.
3.Involvement :is an interest and an intention to
act.
4.action: trial performance.
Fifth stage involves forming a habit
5.habit:is a commitment to perform this action
regularly over a sustained period of time.
106

107. Parent counselling
Parent counselling can be defined as educating
the parents regarding the child ‘s oral health
status,optimal health care and informing them
about the prevention of potential diseases.
Education of parents in regard to diet and its
effects from infancy to adolescence.
infant and toddler (0 to 3 years old )
the period of most rapid growth in
humans occurs during the first 6 months of
life.
107

108. Thus energy and nutrient requirements are
high during this time.
A full term infant is capable of digesting and
absorbing protein ,a moderate amount of
fat,and simple carbohydrates.
Liquid or semisolid foods are the choice until
the teeth begin to erupt .
Breastfeeding continues to be the best overall
method of infant feeding.
Parents must be educated about proper oral
hygiene measures in infants and proper
feeding habits.
108

109. Preschooler (3 to 6 yrs old )
 Physical growth occurs in spurts between 3
and 6 yrs of age.
 Thus fewer calories are required but
relatively high protein and mineral needs
remain.
 Variety of foods must be offered.
 Child of this age should be encouraged to
involve in physical activities.
 Parents must be advised to provide
wholesome nutritious snacks which can
promote adequate intake of essential
nutrients without adding excessive calories.109

110. Preschooler ( 3 to 6 yrs old )-contd
Parents must be educated about diet and their ill
effects on initiation of caries.
They must be educated about how the frequency
and rate at which sugar is cleared from the oral
cavity makes a difference.
Cariostatic food items can be recommended which
are relatively safer like cheese ,peanuts,high
fiber food,raw vegetables.
Use of fluoride toothpastes must be
recommended.
Parents must be instructed to brush for the child at
least once a day,additional brushings can be
done by the child.110

111. SCHOOL AGED CHILDREN (6 TO 12 YRS
OLD )
 This group of children is accompanied by a
reduced rate of growth which results in a
decline in food requirements per unit of body
weight.
 Emphasis must be given on high nutrient
density foods.
 In this age group regular eating must be
established at the same time consumption of
nutritious snacks must be on and the use of
sweets as rewards to be avoided.
 A focus on high nutrient diet and physical
activity must be given.111

112. School aged children (6 to 12 yrs )
 Children of this school age are developing
some autonomy in eating habits.
 They may make their own choices and may
purchase snacks at school.
 Parents should be instructed to monitor the
dietary practices ,especially for children who
experience smooth surface decay
 Regular use of fluoridated toothpastes must
be recommended.
 Parents must monitor brushing and flossing
in this age group.
112

113. Adolescent
Nutritional requirements are influenced by the
onset of puberty and the final growth spurt of
children .
The profound increase in growth rate is
accompanied by increased needs for energy
,protein ,vitamins and minerals.
In this age group girls require more nutrition but
unfortunately they consume less at this age
group for wt losing purposes.
Parents must be educated to tackle this age
group with diplomacy.
113

114. Adolescence
 In this age group in patients with high caries
rate rampant dental decay may result in an
extensive damage to the dentition .
 It is usually associated with poor dietary
habits and poor oral hygiene practices.
 Progress of lesions can be halted with an
appropriate diet control and an aggressive
fluoride therapy.
 Peer pressure may lead to the habit of
smoking which could lead to addiction and
ultimately cancer.The dentist along with
parents support should start counselling in
such cases.114

115. Special children
 In children with disabilities one should assess
type of diet by reviewing answers on a diet
survey with parents ,realizing that allowances
must be made for certain conditions for which
dietary modifications have to be made.
 For example a child with severe cerebral palsy
have difficulties in swallowing ;such patients may
have to have a pureed diet.
 Whatever the special circumstances ,any dietary
recommendations should be made individually
after proper consultation with the patient’s
physician or dietician.
115

116. Special children
 Particular emphasis must be placed on
discontinuation of the nursing bottle by 12
months of age and cessation of at- will breast
feeding after teeth begin to erupt to decrease
the likelihood of nursing caries.
 Systemic fluoride through the ingestion of
optimally fluoridated water should be
advocated to handicapped children .
 Where the level is suboptimal ,fluoride
supplementation is required(tablets,drops
,rinses)
116

117. Conclusion
1. The dietary guidance advocated here can
improve general as well as dental health.
2. Personalized dietary counseling added to other
caries preventive measures should reduce
caries recurrence significantly.
3. The daily ingestion of a balanced and varied
selection of foods from the 4 food
groups,avoidanceof sweets that are retained
next to tooth enamel and discontinuance of
between meal snacking are the basic elements
in achieving a diet that produces few caries.
117

118. My pyramid
118

119. References
 Clinical Pedodontics, Sidney B. Finn.
 Dentistry for the Child and Adolescent, Ralph E.
McDonald and David R. Avery.8th edition. Mosby.
 Fundamentals of Pediatric Dentistry, Richard J.
Mathewson and Robert E. Primosch.
 Pediatric Dentistry. Infancy through adolescence.
Pinkham JR; 3rd edition, W B Saunders Co.
 Pediatric dental medicine , Donald J . Forrester.
 Dorsky R. Nutrition and oral health. General
Dentistry 2001:49(6) 576-582
119

120. References
120
 Laura M. Romito. “Nutrition & oral health”, Dental
Clinics of North America vol 47, No.2, April 2003
 American Dietetic Association. Position of the
American Dietetic Association : Oral health and
nutrition. J Am Diet Assoc 1996 ; 96 (2) : 184-189.
 Naidoo S , Myburgh N Nutrition, oral health and the
young child Matern Child Nutr. 2007 Oct;3(4):31221
 Paula Moynihan, and Poul Erik Petersen Diet,
nutrition and the prevention of dental diseases
Public Health Nutrition: 7(1A), 201–226

121. Thank you
121