Carole A. Palmer

Position of the American Dietetic Association: The impact of fluoride on dental health

The American Dietetic Association reaffirms that fluoride is an important element for all mineralized tissues in the body. Appropriate fluoride exposure and usage is beneficial to bone and tooth integrity and, as such, has an important, positive impact on oral health as well as general health throughout life. Fluoride is an important element in the mineralization of bone and teeth. The proper use of topical and systemic fluoride has resulted in major reductions in dental caries (tooth decay) and its associated disability. The Centers for Disease Control and Prevention have named fluoridation of water as one of the 10 most important public health measures of the 20th century. Nearly 100 national and international organizations recognize the public health benefits of community water fluoridation for preventing dental caries. However, by the year 2000, over one third of the US population (over 100 million people) were still without this critical public health measure. Fluoride also plays a role in bone health. However, the use of high doses of fluoride for prevention of osteoporosis is considered experimental at this point. Dietetics professionals should routinely monitor and promote the use of systemic and topical fluorides, especially in children and adolescents. The American Dietetic Association strongly reaffirms its endorsement of the appropriate use of systemic and topical fluorides, including water fluoridation, at appropriate levels as an important public health measure throughout the life span.

The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness

Nutrition is a recognized determinant in 3 (ie, diseases of the heart, malignant neoplasms, cerebrovascular diseases) of the top 4 leading causes of death in the United States. However, many health care providers are not adequately trained to address lifestyle recommendations that include nutrition and physical activity behaviors in a manner that could mitigate disease development or progression. This contributes to a compelling need to markedly improve nutrition education for health care professionals and to establish curricular standards and requisite nutrition and physical activity competencies in the education, training, and continuing education for health care professionals. This article reports the present status of nutrition and physical activity education for health care professionals, evaluates the current pedagogic models, and underscores the urgent need to realign and synergize these models to reflect evidence-based and outcomes-focused education.

Nutrition and Oral Health Guidelines for Pregnant Women, Infants, and Children

Good oral health care and nutrition during pregnancy, infancy, and childhood are essential but often overlooked factors in the growth and development of the teeth and oral cavity. Pregnant women and parents and caregivers of infants and children often receive little guidance about proper preventive dental and oral health care, including fluoride and dietary measures. Pregnant women can maintain their health through proper diet, good oral hygiene, and appropriate use of fluoride. An adequate diet during gestation is important for optimal oral development of the fetus. To promote good oral health in infancy, caregivers need to provide the infant with appropriate amounts of fluoride in addition to a healthful diet. As the teeth erupt into the mouth, the caregiver needs to clean the teeth thoroughly on a daily basis. When solid foods are introduced in later infancy, it is also important to limit the frequency of caries-promoting fermentable carbohydrates between meals. Good oral hygiene habits and dietary practices that emphasize minimum exposure to retentive, fermentable carbohydrates; use of fluoridated water; and a varied, balanced diet should continue throughout childhood to set the stage for optimal oral health for a lifetime.

Dietary Intake and Severe Early Childhood Caries in Low-Income, Young Children

Evidence suggests that risk for early childhood caries (ECCs), the most common chronic infectious disease in childhood, is increased by specific eating behaviors. To identify whether consumption of added sugars, sugar-sweetened beverages (SSBs), and 100% fruit juice, as well as eating frequency, are associated with severe ECCs, cross-sectional data collected from a sample of low-income, racially diverse children aged 2 to 6 years were used. Four hundred fifty-four children with severe ECCs and 429 caries-free children were recruited in 2004-2008 from three pediatric dental clinics in Columbus, OH; Cincinnati, OH; and Washington, DC. Dietary data were obtained from one parent-completed 24-hour recall and an interviewer-administered food frequency questionnaire (FFQ). Multivariate logistic regression analyses were conducted to assess associations between severe ECCs and dietary variables. On average, children with severe ECCs consumed 3.2-4.8 fl oz more SSBs (24-hour recall=1.80 vs 1.17; P< 0.001; FFQ=0.82 vs 0.39; P<0.001) and reported significantly more daily eating occasions (5.26 vs 4.72; P<0.0001) than caries-free children. After controlling for age, sex, race/ethnicity, maternal education, recruitment site, and family size, children with the highest SSB intake were 2.0 to 4.6 times more likely to have severe ECCs compared with those with the lowest intake, depending on dietary assessment method (24-hour recall odds ratio 2.02, 95% CI 1.33 to 3.06; FFQ odds ratio 4.63, 95% CI 2.86 to 7.49). The relationship between eating frequency and severe ECC status was no longer significant in multivariate analyses. Specific dietary guidance for parents of young children, particularly regarding SSB consumption, could help reduce severe ECC prevalence.

Capacity building in nutrition science: Revisiting the curricula for medical professionals

The current nutrition education curricula for students in U.S. medical schools, and schools of other health professions, such as nursing and oral health, do not provide enough opportunity to gain knowledge of the interactions among micro‐ and macronutrients, their role in maintaining optimal body functions, factors that interfere with these interactions, or, importantly, how to integrate this knowledge into medical practice. There is a need to better prepare healthcare professionals for identifying nutrition risk and managing hospitalized patients, especially those with chronic conditions, using an interprofessional, team‐based approach. A major goal of this report is to revisit current nutrition training programs for physicians and other healthcare professionals in order to explore opportunities for providing healthcare providers with the essential tools of preventative and therapeutic nutrition intervention strategies. The issues addressed include whether a consensus exists on how to integrate basic and applied nutrition into the general healthcare professional curriculum, and if so, at which stages of training and at what depth should these integrations occur; how nutrition education is dealt with and achieved throughout all the health professions; and whether current nutrition education models are sufficient. To help address these issues, the report will review current nutrition education practices—their strengths and weaknesses—as well as evaluate promising new initiatives, and offer proposals for new directions for nutrition education training of future generation of medical practitioners.

Gerodontic nutrition and dietary counseling for prosthodontic patients

The older dental patient can be at risk of poor nutrition for a variety of reasons including physiologic, oral, psychosocial, functional, and medical factors. Any decline in the ability to eat increases the risk of malnutrition. Oral impairments can affect diet and nutrition because of chances in the ability and desire to taste, bite, chew, and swallow foods. The dental team must be aware of these potential detrimental effects of dental treatment and provide counteractive dietary guidance. Problems vary with the patient and the dental condition, so suggestions must be tailored to meet the patients specific needs. Caregivers should: Screen patients to determine whether there are risk factors that could compromise nutrition. Provide diet guidance to prepare patients for any changes in eating ability. Promote diet adequacy by suggesting appropriate choices from each food group in the Food Guide Pyramid. Consult with and refer clients to a registered dietitian whenever possible.

Position of the Academy of Nutrition and Dietetics: The Impact of Fluoride on Health

It is the position of the Academy of Nutrition and Dietetics to support optimal systemic and topical fluoride as an important public health measure to promote oral health and overall health throughout life. Fluoride is an important element in the mineralization of bone and teeth. The proper use of topical and systemic fluoride has resulted in major reductions in dental caries and its associated disability. Dental caries remains the most prevalent chronic disease in children and affects all age groups of the population. The Centers for Disease Control and Prevention has named fluoridation of water as one of the 10 most important public health measures of the 21st century. Currently, >72% of the US population that is served by community water systems benefits from water fluoridation. However, only 27 states provide fluoridated water to more than three quarters of the states residents on public water systems. Fluoride also plays a role in bone health. However, at this time, use of high doses of fluoride for osteoporosis prevention is considered experimental only. Dietetics practitioners should routinely monitor and promote the use of fluorides for all age groups.

Effect of omega-3 and vitamin E supplementation on dry mouth in patients with Sjögren's syndrome

To determine whether omega-3 (n-3) increases saliva production in patients with Sjögrens syndrome, 61 patients with Sjögrens received either wheat germ oil (n = 23) or n-3 supplement (TheraTears Nutrition®) (n = 38) in a prospective, randomized, double-masked trial. The outcomes assessed were salivary secretion and markers for oral inflammation. The differences between the n-3 group and wheat germ oil group were not statistically significant for either unstimulated (US) or stimulated (SS) salivary secretion (p= 0.38 and p= 0.346, respectively) nor for the number of sites with probing depth (PD) ≥ 4 mm (p= 0.834). In this pilot study, supplementation with n-3 was not found to be significantly better than wheat germ oil in stimulating saliva production in patients with Sjögrens syndrome.

Development of a pediatric cariogenicity index

OBJECTIVES This study was designed to develop food and liquid cariogenicity indices and to preliminarily test their utility using dietary data from a study of children with and without severe early childhood caries (S-ECC), defined as 3 + smooth surface carious lesions, including at least one pulpally involved tooth. METHODS Data were collected in a diverse cohort of low-income preschool-aged children made up of 454 children with S-ECC and 429 caries-free children who presented for care at pediatric dental clinics in Washington, DC, Columbus, OH, and Cincinnati, OH. The cariogenicity indices were used to score dietary data from a Food Frequency Questionnaire (FFQ) and a 24-hour recall (24HR). RESULTS There were no statistically significant differences in mean food cariogenicity scores between groups. The liquid cariogenicity score was higher in the S-ECC group as compared with caries-free children (24HR: 5.28 versus 4.66, respectively, P < 0.001; FFQ: 5.03 versus 4.38, P < 0.001). The food cariogenicity score did not discriminate between those with and without S-ECC, while the liquid cariogenicity score did differentiate between the two groups (24HR: OR: 1.2; 95 percent CI: 1.1, 1.3; FFQ: 1.7; 95 percent CI 1.4, 2.0). The liquid cariogenicity score was also associated with number of carious lesions. CONCLUSIONS The liquid cariogenicity index has potential in research and clinical settings to provide a liquid cariogenicity score and help quickly identify modifiable risk factors within a childs diet. Further research is needed to test its utility in clinical and public health settings.

Oral and Dental Health Considerations in Feeding Toddlers

The oral condition is often overlooked and underappreciated as a crucial health risk factor, despite the fact that oral problems can have far-reaching effects on overall health and well-being. Dental caries (tooth decay) is the number 1 chronic condition among US children and is 5 times more prevalent than childhood asthma. However, oral healthcare is still the most common unmet healthcare need among children. Diet is the primary etiologic factor in the caries process. Unfortunately, the usual exhortation to “avoid sugar” or “avoid sweets” is meaningless because the dietary factors involved in the caries process are more complex than simply encompassing the general category of sweets. Thus, dietary guidelines must be provided to pediatric populations if dental caries is to be prevented. This article reviews the factors involved in dental caries—especially the dietary factors—in young children and provides strategies for preventing this serious disease.