Diet Counselling

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Diet CounselLing :

Diet CounselLing It provides individualizing nutritional care for encouraging modification of eating habits. It may also assist in prevention or treatment of nutrition-related illnesses such as cardiovascular disease, cancer , obesity, diabetes , and hyperlipidemia . The clinician must teach the patient about diet, health and cause and prevention of the disease. Successful diet counselling depends on the ability of the clinician to make the patient see the problem clearly and thereby work upon its solution. Source : Textbook of Pedodontics 2


Definitions Nutrition : Science of food and its relationship to health. It is concerned primarily with the part played by the nutrients in body growth, development and maintenance (WHO 1971). Food : Anything that is eaten, drunk or absorbed for maintenance of life, growth and repair of tissues (Nizel 1989). Source : Textbook of Pedodontics 3

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Diet : Total oral intake of a substance that provides nourishment and energy (Nizel, 1989). Balanced Diet : it is one which contains varieties of foods in such quantities and proportion that the need for energy, amino acids, vitamins, fats, carbohydrates and other nutrients is adequately met for maintaining health, vitality and general well being and also makes provision for a short duration of leanness (Chauliac, 1984). Source : Textbook of Pedodontics 4

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HOW OUR FOOD AFFECTS HEALTH? The food that we eat affects our body in two ways : Systemic effect : depends on their content of nutrients and includes the influence of such nutrients on general health, growth and development, cell renewal, ability of the tissues to repair and resistance to disease. Local effect : consists of what food can do to the tissues or the environment because of their mere presence in such an environment. In dentistry, most local effects result from the interaction between food residues and oral bacteria, which leads to plaque formation. Source : Textbook of Pedodontics 6


CLASSES OF NUTRIENTS Energy providing carbohydrates and lipids . Tissue building proteins . Regulator vitamins and minerals . Water comprising 55 to 65% of the total body weight. Source : Textbook of Pedodontics 7



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PRINCIPLES OF DIET MANAGEMENT Maintain overall nutritional adequacy. The prescribed diet should vary from the normal diet pattern as little as possible. The diet should meet the body’s requirements for the essential nutrients. The prescribed diet should take into consideration and accommodate the patient’s likes and dislikes, food habits, and other environmental factors as long a they do not interfere with the objectives. Source : Textbook of Pediatric Dentistry 14


DIET AND DENTAL CARIES The patient’s diet and dental caries activity are related. Dental caries is caused by the ingestion of fermentable carbohydrates, particularly sucrose. Solid and retentive sucrose containing food are more cariogenic than liquid and non retentive. The frequency and time of ingestion of foods are also important. Source : Textbook of Pedodontics 15

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In decreasing order of cariogenicity, the food are grouped as: Adherent, sucrose containing foods eaten frequently between meals. Adherent, sucrose containing foods eaten during meals. Non retentive (liquid) sucrose containing beverages consumed frequently between meals. Non-retentive (liquid) sucrose-containing foods consumed during meals. Source : Textbook of Pedodontics 16

The Proposed Diet Counselling Program is Based on a Step by Step Progression Through:

The Proposed Diet Counselling Program is Based on a Step by Step Progression Through Interview, where diet diary forms are introduced with a brief discussion of the purpose of diet counseling. A 24-hour diet record is prepared by the patient. A six day diet diary is advised to be prepared by the patient Complete records of six days diet diary are analyzed regarding the balanced and unbalanced diet. Source : Textbook of Pedodontics 17

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Isolating the sugar factors. Educating the patients in the role of sugar in the decay process. The consumption of acceptable substitutes instead of more cariogenic foods. The recognition of practical limitations to immediate success. Provision of continuous positive reinforcement. Source : Textbook of Pedodontics 18

Communication Technique:

Communication Technique Rules to achieve effective communication : Face to face interview keeping eye contact with the patient. Communications can be both verbal and non verbal. The message must be adapted to the patient’s needs and level of understanding. A combination of interviewing, teaching, counseling, and motivation is used. Source : Textbook of Pediatric Dentistry 19


Interviewing The basic purpose in interviewing is to understand the problem, the factors that contribute to it and the personality of the patient. It can serve as a valuable diagnostic aid to provide knowledge of a person’s daily routine for adapting a caries preventive diet. Privacy, comfortable and relaxed atmosphere are important requisite for an interview. It should take place in separate counseling room. The interviewer should encouraging and sympathetic and should not assume an adversary position. Source : Textbook of Pediatric Dentistry 20

Teaching and Learning:

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. A number of teaching aids can be used, including booklets on nutrition and dental health. Source : Textbook of Pediatric Dentistry 21


Counselling 2 types of approaches : Directive – decisions made by counsellor. Nondirective – patient can make his own decisions The nondirective counseling approach is recommended for diet counselling. Guidelines : Gather information. Evaluate and interpret information. Develop and implement a plan of action. Family participation. Follow up. Source : Textbook of Pediatric Dentistry 22

Pre-requirements of Counselling:

Pre-requirements of Counselling Elicit a true response. Phrase the questions correctly. Listen and wait for an answer Source : Textbook of Pediatric Dentistry 23


WHO SHOULD RECEIVE COUNSELLING? Ideally all children brought under dental care need to be counseled. The child under the age of 6 yrs is almost completely dependent upon the parent, usually the mother, for his or her food supply and subsequent food habit development. Therefore the dentist must counsel the mother in an effort to prepare her for an important role as an educator and model. To adolescents group, direct communication and diet counseling should be performed. Several sessions of 20 minutes may be preferable. Source : Textbook of Pedodontics 24


DIET DIARY Diet diary is a record of all food and beverages consumed during a specific period. The patient (or mother) usually completes the food diary at home, writing in foods after they are eaten. Source : Textbook of Pediatric Dentistry 25

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Please record every food item consumed-solid, liquid-during 6 consecutive days. Record food consumed at mealtime, between meals, or while watching television. Also record candies, chewing gum, cough drops or syrups. The approximate amount in household measures such as 1 cup, 1table spoon(T), tea spoon(t). The kind of food and how it was prepared, such as baked chicken, raw apple, cooked cereal, etc. Additions to food in cooking or at the table: butter, sugar, cream, etc. Source : Textbook of Pedodontics 26


NUTRITIONAL CONSIDERATIONS INFANT AND TODDLER (0 TO 3 YEARS OLD ) Rapid growth occurs during the first 6 months of life. Liquid or semi liquid foods are the choice until the teeth begin to erupt. Breast feeding continues to be the best overall method of infant feeding, and breast milk could well be the infant’s only food source for the first 4 to 6 months. Milk can be supplemented with various pureed food. When the infant becomes a toddler and the rapid growth rate of the first year declines, there is a noticeable reduction in appetite. A variety of foods should be offered in smaller amounts several times a day to provide the key nutrients. New foods should be introduced singly to permit detection of allergies. Source : Dentistry for the Child and Adolescent 27

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PRESCHOOLER (3 TO 6 YEARS OLD) Physical growth occurs in spurts between 3 and 6 years of age. The child is not growing as rapidly as in the first years of life. Thus, fewer calories are required but relatively high protein and mineral needs remain. The child of this age should be helped to grow out of fatness by increasing physical activity rather than by severely restricting calories. Providing wholesome, nutritious snacks can promote adequate intake of essential nutrients without adding excessive calories. Source : Dentistry for the Child and Adolescent 28

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SCHOOL-AGED CHILD(6 TO 12 YEARS OLD) The 6 to 12 year stage is generally accompanied by a reduced rate of growth, which results in a decline in food requirements per unit of body weight. Vegetables are generally among the least favoured foods in this age group, but fruits are usually liked and provide many of the same nutrients. Regular eating patterns should be established; at the same time, consumption of nutritious snacks should be stressed and the use of foods, particularly sweets, as rewards should be minimized. Children should be encouraged to eat breakfast. A focus on eating foods with high nutrient value and maintaining sufficient physical activity levels is important throughout this age range, because obesity problems often begin in this period. Source : Dentistry for the Child and Adolescent 29

Recommended Food Servings for Children:

Recommended Food Servings for Children FOOD GROUP PRESCHOOL 6-12 YEARS TEEN GIRLS TEEN BOYS Milk 3 3-4 4 4 Meat 2 2-3 2-3 2-3 Vegetables 3 3-4 3-4 4-5 Fruit 2 2-3 2-3 3-4 Grain 4 6-9 6-9 9-11 Source : Dentistry for the Child and Adolescent 30

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ADOLESCENT (12 TO 18 YEARS OLD) The nutritional requirements of adolescents are influenced primarily by the onset of puberty and the final growth spurt of childhood. This profound increase in growth rate is accompanied by increase needs for energy, protein, vitamins, and minerals. In general, girls consume far less food than do boys and must meet their needs for individual nutrients within a smaller range of calorie intake. Source : Dentistry for the Child and Adolescent 31

Gender Differences in Adolescent Nutritional Issues:

Gender Differences in Adolescent Nutritional Issues FEMALES MALES Lower energy needs Higher energy needs Thinness considered important Strength considered important Concern about peak bone mass Less concern about peak bone mass Higher risk for eating disorders Lower risk for eating disorders Higher risk for nutritional deficiencies Lower risk for nutritional deficiencies Source : Dentistry for the Child and Adolescent 32

For adults and teens:

For adults and teens 1600 calories is about right for many sedentary women and some older adults. 2200 calories is about right for most children, teenage girls, active women, and many sedentary men. Women who are pregnant or breastfeeding may need somewhat more. 2800 calories is about right for teenage boys, many active men, and some very active women. Source : Dentistry for the Child and Adolescent 33


PROBLEMS OF UNDERCONSUMPTION IRON DEFICIENCY To prevent it, vulnerable populations should be encouraged to eat iron-rich foods and breast feed or use iron-fortified formula for infants. Iron is found in meat, poultry, fish, beans, lentils, cereals. Clinical signs of iron deficiency anemia are weakness, fatigue, pallor, numbness and tingling of the extremities. Oral manifestations are glossitis and fissures at the corners of the mouth (angular cheilitis). The papillae of the tongue may be atrophied, which gives the tongue a smooth, shiny, red appearance. Source : Dentistry for the Child and Adolescent 34

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CALCIUM DEFICIENCY Childhood and adolescence are crucial times for development of the skeletal system, and the dietary requirement for calcium peaks during the teenage years. The Food and Nutrition Board of the Institute of Medicine recommends an intake of 1300 mg per day of calcium during adolescence. Educate youth to select more calcium rich foods ( dairy products, cereals). Osteoporosis is a bone disease of older individuals and is primarily seen in postmenopausal women. Achieving a high peak bone mass is the first line of defense against osteoporosis. Source : Dentistry for the Child and Adolescent 35

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VITAMIN D DEFICIENCY Exposure to sunlight is a main source of vitamin D, because ultraviolet rays from the sun trigger vitamin D synthesis in the skin. Vitamin D is an essential nutrient for proper bone growth, and children who receive too little can develop the bone disease rickets VITAMIN B 12 DEFICIENCY It is the only vitamin that contains a mineral. It is essential for the synthesis of red blood cells and for myelin synthesis in the nervous system. People following vegetarian diets should ensure an adequate intake of vitamin B 12 . Sources are animal products like meat, dairy products, and eggs. Source : Dentistry for the Child and Adolescent 36


PROBLEMS OF OVERCONSUMPTION OBESITY Obesity is defined as the excessive accumulation of fat in the body Obesity results from a chronic imbalance between energy intake and energy intake and energy expenditure. It is diagnosed based on weight and weight for height measures. Type 2 diabetes in children and adolescents is associated with obesity and a persistently elevated body mass index (BMI). A BMI of 30 or higher generally is considered to indicate obesity. There are also significant psychologic and quality of life to be considered. Source : Dentistry for the child and adolescent 37

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The following are some general findings concerning physical activity and health that have emerged over the past decade or two: People who tend to be inactive can improve their health and well being by becoming even moderately active on a regular basis. Physical activity need not be strenuous to provide some health benefits. Greater health benefits can be achieved by increasing the intensity, frequency, or duration of the physical activity. Source : Dentistry for the child and adolescent 38

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Anyone can eat for good health . Just follow these 2 simple steps: Eat food from all Five Food Groups everyday. Each food group provides you with different nutrients. Eat different foods from each food group everyday. Some foods in a food group are better sources of a nutrient than others. By eating several foods from each food groups, you increase your chance of getting all the nutrients you need. Guide to Good Eating 39


ISOLATE THE SUGAR FACTORS The patient should be aided in identification of those foods which are likely to cause oral diseases, the time when they are most harmful and also those which are most nutritious and least cariogenic. The cariogenic potential of a patient’s diet is evaluated by determining the total number of exposures to sucrose-containing foods during 6 consecutive days. Exposure is defined as eating the food at one time. source : Textbook of Pedodontics 40

Educating the Patient in the Role of Sugar in Decay Process:

Educating the Patient in the Role of Sugar in Decay Process The plaque that forms in the teeth every day contains bacteria. These bacteria change the sugar present in food into acids. SUGAR(in food) + PLAQUE / BACTERIA (germs) = TOOTH + ACID = DECAY source : Textbook of Pedodontics 41

Determine the Adequacy of Diet:

Determine the Adequacy of Diet Determine the number of servings of food in each of the basic five food groups and compare this with the recommended number of servings. source : Textbook of Pedodontics 42

Calculation of Dental Health Diet Score:

Calculation of Dental Health Diet Score Dental Health Diet Score = FOOD SCORE + NUTRIENT SCORE – SWEET SCORE Food Group Score Table (highest score possible is 96) Food RDA No. of servings Points Milk 3 X8 Meat 2 X12 Fruits and Vegetables 1 X6 Vitamin C 1 X6 Others 2 X6 Breads and Cereals 4 X6 Source : Textbook of Pediatric Dentistry 43

Nutrient Score Table:

Nutrient Score Table Protein and Niacin – cheese, dried peas, dried beans, eggs, fish, meat, milk, vitamin A – apricot, butter, carrot, eggs, liver, milk, and spinach. Iron – beef, eggs, liver, green leafy vegetables Folic Acid – cereals, spinach, yeasts Riboflavin – broccoli, chicken breasts, eggs, milk, mushrooms Vitamin C – grapefruit, green peppers, oranges, strawberries, tomatoes . Calcium and Phosphorus – cheese, eggs, green leafy vegetables, milk. Source : Textbook of Pediatric Dentistry 44

Sweet Score Table:

Sweet Score Table (Classify the sweet by its nature and multiply according to severity) Liquid : (X5) Soft drinks, fruit drinks, cocoa, sugar and honey in beverages, ice cream, flavored yogurt, pudding, custard. Solid and Sticky : (X10) Cake, doughnuts, sweet rolls, pastry, bananas, chocolate, caramel, chewing gum, jelly, jam. Slowly Dissolving : (X15) Hard candies, breath mints, antacid tablets, cough syrups. Source : Textbook of Pediatric Dentistry 45

Assessment of Dental Health Diet Score:

Assessment of Dental Health Diet Score Score Result Interpretation 72-96 Excellent Counseling not required 64-72 Adequate Educate the patient 56-64 Barely adequate Counseling required 56 or less Not adequate Counseling with diet modifications Source : Textbook of Pediatric Dentistry 46

Recall Visits:

Recall Visits During the next months at regular intervals, the dentist should evaluate the patient’s progress and psychological reinforcement. Evaluations are made by means of: - The patient’s comments - New diet diaries - Susceptibility tests such as Synder test - Clinical judgement Reinforcement is provided by praising the patient’s efforts. Point out the improvements made. Emphasis should be placed on making the patient fully aware of the benefits derived from the program and that the benefits are the product of the patient’s own efforts. Source : Textbook of Pedodontics 47


BIBLIOGRAPHY Textbook of Pedodontics – Shobha Tandon Textbook of Pediatric Dentistry – Nikhil Marwah Dentistry for the Child and Adolescent – R.E. McDonald, D.R. Avery 48



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