Dental Tribune India Issue

Dentaltribune|July-September, 2010 Feature 17 Dietary analysis consists of two elements. *Enquiry into lifestyle. *Enquiry into dietary components themselves. Information about the diet it- self is of little value unless it is taken in context with the patient’s lifestyle. Only dietary recomme- ndations tailored to the patient’s life are likely to be adopted. The diet record should include all the food and drinks consumed the amount and the time of eating or drinking. Every morsel eaten & every drop that has been drunk. The diet record should include all the foods & drinks consumed, the amount in readily estimated units and the time of eating or drinking. Analysis of the diet itself may be performed in a variety of way. The patient can be asked to rec- all all foods consumed over the previous 24 hrs. This is not very effective,relyingonagoodmem- ory and honesty, and is unlikely to give a representative account. Relying on memory for more than24hrs.istooinaccurate.The most effective method is to keep a written record of their diet for four-five consecutive days, inclu- ding two working days and two leisure days. The need for the patient to comply fully & assess their diet honestly must be stre- ssed &, of course, the diet should not be changed because of it be- ing recorded. Ideally the analysis should be performed before any dietary advice is given. Even the patient who does not keep an honest account has been made more aware of their diet. If they know what foods to omit from the sheet to make their dentist/ oral health educator/dental nurse happy, at least the first step in an educativeprocesshasbeenmade. How to analyse a diet sheet Highlightsugarrichfoods&drinks Note whether they are confined to meal times or whether they are eaten frequently and spaced through out the day as snacks. The number of sugar attacks should be counted and discussed with the patient. Also the consis- tency of the food because dry & sticky foods take longer to be cleared from the mouth. Sugared drinks taken immediately before bed are highly significant beca- use salivary flow is reduced dur- ing sleep and clearance time is greater. Identify foods with a high hidden sugar content because patients often do not realise that such foods are in significant, eg., baked beans, breakfast cereals, tomato ketchup, & plain biscuits. If the diet sheet shows the main problem for the patient is too many sugar contains drinks and frequent drinks & carbona- teddrinks&frequentsnackingof biscuitsandcakes.Mostmealsor snackscontain high sugar item & some more than one. The patient needstobeeducatedinsaferdiet. The patient should be educated in the relationship between car- ies & high frequency in consum- ption of sugar. The dental profes- sion has been aware for over half a century that the frequency of sugar intake is far more signifi- cant in the development of caries than the amount consumed at any given time. Advice based on Diet Diary • Particularly those containing sugar. It is important to give the same advice as other health pro- fessionals such as dieticians and health visitors, who are concer- ned with other aspects of health, such as obesity. But it is rare that patient opt to have a healthy diet having concerns about their teeth rather than size. • Dental profession has sugges- ted that plain crisps, peanuts & cheese are tooth-friendly alterna tives to sweet, biscuits & confec- tionary. When reading labels, it can be seen that some nut snacks contain hidden sugars, and this should be pointed out to the patients. • Should always check and liase with the patients medical condi- tion. Some must have been a told by their health professionals to avoid such foods for other health reasons. Advice always must be balanced and accurate. • Particularly school children & adolescent require frequent in- takes of carbohydrates to sustain energy. In such cases it is essen- tial to mention frequent snacks such as pasta, bread & toast, bread sticks fruit and raw vegetables. • Public has raised awareness of hidden sugar & salt with the cur- rent trend towards healthy eat- ing. It is important to be able ide- ntify hidden sugars (eg. Glucose, fructose, dextrose, maltose, lac- tose & molasses) to look for these on food labels. • Also the relationship with such food can contribute to obesity & heart disease as well as caries and behavioural disorders. • The use of artificial sweeteners is increasing as the public beco- mes more diet conscious, since their low calorific value means that they are virtually non-cario- genic & non fattening. Sweeten- ers can be of synthetic or natural origin.(eg.xylitol,aplantextract). Facts-The advice below can elaborate on it more *Reduce the amount of sugar Checkmanufactures’slabelsand avoid foods with sugar such as sucrose, glucose & fructose lis- ted. Natural sugars (eg honey, brown sugar) are as cariogenic as purified/added sugars. When sweet foods are required, choose those containing sweetening ag- ents such as saccharin, acesul- fame- K & aspartame. Diet for- mulations contain less sugar than their standard counter- parts. Reduce the sweetness of drinks & foods. Become accusto- med to a less sweet diet overall. Restrict frequency of sugar intakes tomealtimesasfaraspossible Try to reduce snacking. When snacks are required select safe snacks such as cheese, crisps, fruit or sugar free sweets, such as mints or chewing gum (which not only no sugar but also stimu- lates salivary flow and increases pH). Use artificial sweeteners in drinks taken between meals. Speed clearance of sugar from the mouth Never finish meals with a sugary food/drink. Follow sugary foods with a sugar free drink, chewing gum or a protective food such as cheese. The dietary advice is almost always provided using the health belief model of health education. How ever it is well known that education about the risks and consequences of life style, habits & diet is often inef- fective. It is important to judge the patients likely compliance & provide dietary advice which can be used to make small but significant changes rather than attempting to eradicate all the sugar from diet. As the diet im- proves, the advice can be adop- ted & extended, Advice must be acceptable, practical and afford- able. In this case the patient has already suffered consequences from his poor diet & this may help change behaviour. The patient must be made aware that dam- age to teeth continues up to 20 mins to 2 hrs of sugar intake. The statement should compre- hendedwithStephancurvewith- out difficulty. The Stephan Curve describes the change in dental plaque pH in response to a challenge. The type of challenge does not matter but it is usually some element of the diet. Characteristically the Stephan Curve reveals a rapid drop in plaque pH, followed by a slower rise until the resting pH is attained. The time course varies between individuals and the nature of the challenge. The initial drop is usually rapid with the lowest pH being attained within a very few minutes. How- ever, pH recovery can take any- thing between 15 & 40 minutes depending to a large extent on the acid-neutralising properties of the individual’s saliva. The patient should be advi- sed to use fluoride containing toothpaste. During the period of dietary change it would also be beneficial to use a weekly fluoride rinse as well. This could be continued for as long as the diet is felt to be unsafe. Oral hygi- ene instruction is also important in view with elaborating impor- tance of diet. The Committee on Medical Aspects of food Nutrition Policy established in 1986 in the UK. It is the panel on Dietary sugars to look at the role of the sugars in the diet. Make sure all the patients are very welcome to do their own research. Amongst the panel recommendations: • The frequency of sugary snacks and drink consumption should be minimised. •Foodanddrinksthatpredispose caries should be limited to main meal times. This is specially im- portant for older dentate people, children and adolescents. Conclusion According to the UK Department of Health ‘Eating a healthy, balanced diet which contains plenty of fruit and vegetables and is low in fat, salt and sugar and based on whole grain prod- ucts, is important for promoting good health.’ Food is the fuel which pro- vides energy for the cells of living organism to grow, repro- duce and eliminate waste: and if the cells of the body are to fun- ction efficiently, all the nutritio- nal substances must be consu- medinthecorrectproportions. DT ImportanceofaDietDiary A diet diary is an essential piece of evidence in to a patients teeth and for the health, says Dilhani Silva Dilhani Silva is a qualified and reg- istered Dental Nu- rse who has done theOHEexamand is getting ready to sit for the Dental Radiography exam in December 2010. SheworksasaDentalNurse/Recep- tionist/Oral Health Educator & as AdministratorforApexDentalCare, London. About the author