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Nutrition Test 1 Basics

STUDY
PLAY
What are the primary source of energy in metabolism?
Carbohydrates
What vitamines are water soluble?
B and C
What vitamins are fat soluble?
A, D, E and K
What two things are considered micronutrients?
vitamins and minerals
How much vitamin C should men and women have per day?
90mg/day for men
75 mg/day for women
What is the recommended vitamin D intake per day?
5 micrograms/day for people 50 and below

10-15 micrograms/day for old people
What is the tolerable upper level intake of Vitamin C and Vitamin D?
Vitamin C - 2000mg/day
Vitamin D - 50 micrograms/day
A lack of iron can lead to which disease?
Mucosal Candidosis
What condition is a reliable predictor of protein malnutrition?
Hypoalbuminemia
- checking for serum albumin
What levels of serum albumin would be considered a problem?
Less than 3.0 g/dL predicts mortality
Less than 3.5 g/dl suggests chronic PEM (protein energy malnutrition)
What are the two serum proteins tested for when doing a protein assessment?
Serum Albumin
Serum Transferrin - More Sensitive
What test do you use to test the function of the immune system?
Antigen-recall skin testing
What is the Nutritional Status?
A measurement of the extent to which physiological need for nutrients are being met
A Nutritional Assessment includes what tests?
A clinical observationPhysical Assessment
Medical/Social History
Dietary Assessment
Biochemical/Lab Assessment
What test is considered to be one of the most sensitive markers of adequate nutritional status?
Whether or not the cells of the oral mucosa turn over every 3-7 days
What is a 'dietary assessment'?
A screening process and a tool
A characterization of current intake
Appropriate use of a Biochemiical/Lab assessment requires what?
○ Understanding of purpose
○ Awareness of normal values
○ Knowledge of conditions contributing to abnormal results
What things are tested in a biochemical test?
- Blood glucose
- Electrolytes
- Hemoglobin
- Serum Folate
- Plasma pyridoxal 5-phosphate
What perameters are assessed when doing a Body Composition test?
Creatinine-height ratio
Hydroxyproline
What is Serum Transferrin effected by?
Tissue iron stores
What is Serum albumin effected by?
Liver, renal or GI disease
Also by level of hydration
What are the two other Protein assessment proteins?
Thyroxine-binding prealbumin
Retinol-binding protein
What affect do you see on the immune system with malnutrition?
A decline in T cells and a decline in Thymic function
What is the role of the dentist in regards to nutrition?
- Screening with dietary assessment
- Is more in-depth assessment needed?
- Determining what available information is pertinent to dental patient treatment planning and care
What vitamins/minerals can delay eruption patterns of teeth?
Vitamin D, calcium, and phosphorus
Low levels of which mineral can delay tooth eruption?
Iodine
How many grams of protein should you have per day while pregnant?
60-80 grams/day
What are two important pre-natal vitamins?
Folic Acid
Heme iron
Lack of this vitamin/mineral can lead to cleft lips/palates?
Folic Acid
Hypomineralized primary teeth can be caused by what?
Malnutrition during ANY part of pregnancy or even postnatally
What things ARE and ARE NOT associated with ECC?
ARE:
-Carrying the bottle all day long

ARE NOT:
- Infant holding the bottle
- Napping and going to bed with the bottle
When is the best time to start introducing foods to your baby?
Between 4 and 6 months
-before or after this range results in a higher incidence of ECC
What is the best thing a 4-10 year old can be drinking?
Water
When does primary tooth development begin in the fetus?
10 weeks
When does mineralization begin in the fetus?
4 months
How much protein should a mother have per day?
60-80 grams
How much weight should a baby gain per week in its last 30 weeks in the womb?
14 ounces
What is birth weight dependent on?
Maternal nutrition
When should you ween your baby off of the bottle?
Before 19 months
How often should a toddler eat?
How often should a preschooler eat?
3-4
4-5
How much milk should a toddler and a preschooler eat?
Toddler = greater than 32 oz
Preschooler = 17-32 oz
Are ECC rates higher or the same as poor families?
higher in poor families
What would be classified as Simple ECC?
1 or more DMF tooth surfaces in any primary tooth
What would be classified as Severe ECC?
○ any sign of smooth surface caries in children under 3 years of age
○ 1 or more cavitated, missing, or filled smooth surfaces in primary maxillary anterior teeth in children ages 3 and 5
If a child is continuously coughing during sleep, what condition could they possibly have?
GERD
As dentist, what do we want to educate the public about?
The association between the frequent consumption of carbohydrates and caries
What does the AAPD recommend?
○ That dentists provide dietary and nutritional counseling
○ People who make the food labels make the nutritional content on the label more prominent and consumer friendly
○ Health education programs in schools
○ Research, education and appropriate legislation to promote diverse and balanced diets
What is the 54321 rule for kids?
○ 5 servings of fruits and vegetables everyday
○ 4 servings of water
○ 3 servings of low-fat dairy
○ 2 hours or less of TV/Video games per day

1 hour or more of physical activity
What percentage of health problems are attributed to nutritional status?
Half
How do you change a loss in muscle mass?
Increase protein intake
Decrease Calorie intake
How do you change a decrease in bone density?
Increase calcium intake
Increase Vitamin D intake
How do you change xerostomia?
Increase water intake
Eat more fruits and Vegetables and Grains
How do you change an increase in gastric pH?
Increase intake of:
-Vitamin B-12
-Folic Acid
-Calcium
-Zinc
How do you change a decrease hepatic uptake of retinol?
Decrease vitamin A intake
How do you change an increased level of homocysteine?
Increase:
-Folic acid
-Vitamin B-6
-Vitamin B-12
How do you change a decrease in immune function?
Increase:
-Protein
-Vitamin B-6
-Vitamin E
-Zinc
How do you change an increase in Oxidative stress?
Increase:
-Phytochemicals (beta-carotene)
-Vitamin C
-Vitamin E
What percentage of adults over 25 are edentulous?
11%
What percent of people over 65 are edentulous?
30%
What group of people has the most periodontitis?
Poor people between the ages of 65 and 74
Which two vitamins will be the most influential in not getting periodontitis and losing teeth?
Vitamin D and especially Calcium
These types of conditions are frequently associated with prosthetic dental appliances?
Digestion and GI conditions
What are the recommended amounts of the essential nutrients for people over 50?
○ Protein - 46-56 grams - 10-35%
○ CHO - greater than130 grams - 45-65%
○ FAT - - 20-35%
○ Fiber - 20-31 grams
What are the groups highest at risk for caries?
- Children with socioeconomic risk factors
- Older adults 55yrs or greater
- People that have Enamel Hypoplasia
What are the peak ages for dental caries?
2-5 years for primary teeth
Early adolescence
Elderly
Deficiencies in which vitamins during fetal development are associated with enamel hypoplasia?
Vitamins D and A
Also, Protein Energy Malnutrition (PEM)
What are some protective factors to caries?
○ Salivary proteins
○ Fluoride, calcium and phosphate
○ Dietary components
Which type of carbohydrates are bad for your teeth?
Fermentable Carbohydrates - leads to a steep drop in pH and an increase in the solubility of calcium hydroxyapatite (mineral disolves)
What is the critical pH when it starts to become bad for the teeth?
5.5
The next slide however says that a pH of less than 5.2 causes demineralization
What minerals in saliva help it to remineralize teeth?
It is super saturated with calcium and phosphate at a pH of 7
What mainly controls the rate of demineralization?
The concentration of hydrogen and fluoride ions at the tooth surface
What elements are lost from the teeth during demineralization?
Calcium
Phosphate
Carbonate
What elements are put back into the tooth during remineralization?
Calcium
Phosphate
Fluoride
- So fluoride replaces the Carbonate
Name two bacteria that are key to forming biofilms on tooth surfaces
Strep Mutans
Strep Sorbrinus
Generally what kinds of foods are 'Cariogenic'?
Anything that contains fermentable carbohydrates (CHO) - leads to a drop in plaque pH
What would be an example of Complex carbohydrates?
Veggies
Fruits
Grains/nuts
What would be an example of Refined Carbohydrates?
White bread
Candy
Cake
Honey
Sugar
etc
How much sugar per day is associated with an increase risk of caries?
55 grams/day
-Not that much
Does cooked starch or uncooked starch lower the pH in your mouth more?
Cooked Starch
-Maltose
-Fructose
-Glucose
-Sucrose
What bread made the dental plaque the most acidic?
Syrup Sweetened Wheat Rye Bread
What bread made the dental plaque the most basic?
Barley Kernel Bread
What are the best combinations of food to eat in order to maintain a neutral oral pH?
-Combine cooked starches with fresh fruits and vegetables
-Eat high quality proteins
-Eat dairy foods when eating fermentable carbohydrates
What is a caloric sweetner?
Cane and beet sugar
Corn sweetners
What is an 'Added Sugar'?
Brown sugar
Raw sugar
Honey
Name a couple 'High intensity Non-Nutrative sweetners'
Saccharine
Aspartame
- aka Sweet'n low, Nutrasweet, Splenda, etc
What does Xylitol claim to do?
Inhibit bacterial glycolytic enzymes
- Impairs the ability of bacteria to stick to the tooth and form colonies
The three biggest things in caries prevention..
Fluoride
Plaque control
Diet
Name three acids that cause erosion to the teeth
Citric
Malic
Phosphoric
How many acid intakes per day are most highly associated with caries?
Four
What types of diseases affect the gingiva?
Autoimmune diseases
Immunosuppression
Medication side effects
What percentage of people over the age of 13 show evidence of periodontal problems
90%
What are some major health problems that are associated with periodontal infections?
Pre-term birth
Cardiovascular disease
Stroke
What can be a serious contributor to gingivitis?
"Behavioral Exposures"
-Exercise
-Diet
-Nutrition
Name two things that are pro-inflammatory to the gingiva
-Refined Carbohydrates
-Saturated Fats (Dairy Products)
What things are Anti-inflammatory to the gingiva?
Antioxidants (Veggies)
How do diets rich in refined carbohydrates and saturated fats stimulate inflammation?
Through the generation of excess ROS (whatever that is) and Oxidative Stress
What three Vitamins/minerals are the gingiva dependent on in order to stay healthy?
Protein
Vitamin A
Zinc
Regeneration of the oral epithelium requires which vitamins?
B-complex vitamins
Vitamin C
Which vitamins/minerals are essential to collagen formation? (important in making dentin, cementum, alveolar bone, and periodontal ligaments)
Protein and adequate Calories
Vitamin C
Vitamin A
How many grams of protein should you have per day?
46-71
What does Vitamin D help you do?
Absorb calcium
What does Vitamin E help you do?
Helps with keeping the immune system health and antibody production
What does Vitamin K help?
Bone density and strength
-Lack of Vit K will be associated with gingival bleeding
What does Vitamin A help?
Collagen synthesis
What are the Fat Soluble Vitamins?
Vitamins A, D, E, K
What are the water soluble vitamins?
B-complex, and Vitamin C
Define 'Diet'
The pattern of individual food intake, eating habits, and kinds and amounts of foods eaten
Define 'Food'
Chemical compounds configured by Nature or formulated by manmade processes to mimic nature
Define Nutrition
- The science and sum of dietary quality and physiological and biological activity necessary to maintain life and meet requirements for growth, development, repair and maintenance of cellular activity
Define Dietary Quality
- Agricultural or industrial sources of food, nutrient content, organoleptic appeal, variety and adequacy
Define Optimal Nutrition
- A physiological state whereby an individual is both receiving (consuming and assimilating) and using (metabolically processing) essential nutrients to maintain health and well-being at the highest level possible
Define Nutrient
- A chemical substance that is present in food and is needed by the body in adequate ratio and proportion for growth, maintenance, and repair of damaged tissues
Define Non-Nutrient
- Chemical substances present in food that enhance, mediate or sustain optimum health status in concert with nutrients
Define Nutritional Status
- A measurement of the extent to which physiological need for nutrients are being met