Is Nutritional Counseling Really Within A Dentist's Scope of Practice?

Kelly has a family whose members are pictures of health. The mother is a nutritionist. The kids are homeschooled, so they don't have access to soda and candy from the cafeteria vending machines. The family follows a vegan diet and has a sparkling oral health history with no caries or decalcification, but a strange thing happened. During a recent preventative exam, Kelly discovered that her previously caries-free children all had tooth decay. The family practiced good oral health hygiene and had a nutritious diet, so Kelly wondered what had changed. She discovered that it wasn't what the family ate but rather how they ate, is what created problems. "We juice our fruits and vegetables," Kelly said. Even though the food is healthy, the form they ate produced a potent combination of fruit acids and sugars. Dr. Aver could have just treated the symptoms, but by digging a little deeper, she identified the real issue and educated her patients on how to fix and prevent it.

"The old concept of dentistry is to restore and repair teeth/gums." Dr. Aver said. "But now we need to focus on education, prevention, and maintenance more than just drilling and filling teeth. The first step toward any treatment should be finding the underlying root cause: nutrition and habits". Discussing nutrition with patients may feel like you are blurring the lines between dentistry and dietetics, but it could provide a clear pathway toward integrating dentistry as a crucial component of whole-body healthcare. For Dr. Aver, nutrition is essential to oral and systemic health. She doesn't shy away from dietary conversations, as they help her achieve her practice's goal of addressing "the complete foundation of health" for her patients. "We have always educated and advised our patients regarding the effect of acid on teeth, including fruit acids, and not brushing after snacking," she said. "Overall health begins with oral health. Thus, proper nutrition and habits are equally important for oral health". So how does a general dentist with nutrition in the background have these conversations with patients? A comprehensive refresher in key oral health and nutrition concepts is an excellent place to start.



The Oral Healthcare Effects of Vitamins and Minerals

Vitamins A, B, and D and calcium and phosphorus have significant oral health implications. Vitamin B (B2, B3, B6, and B12) deficiencies are most common in older adults, alcohol users, people with restricted diets (e.g., vegan or vegetarian), and people with gastrointestinal issues or recent surgeries. Vitamin B deficiency manifests as a burning feeling in the mouth, angular cheilitis/cracks at the corner of the mouth, recurrent ulcers, glossitis - pain, swelling, and or redness of the tongue, and loss of taste. Healthy foods that contain the highest levels of the B complex are: salmon (low mercury fish with high Omega 3 fats and selenium), leafy greens (spinach, collared greens, turnip greens), liver of pasture-raised animals, organic eggs, organic beef, legumes (black beans, chickpeas, lentils), organic chicken, brewer's yeast, lake trout, and sunflower seeds.

Enamel hypoplasia - softening of the enamel, the cause of tooth decay and sensitivity, is an oral health condition linked to a vitamin D and K deficiency. Vitamin D supports the functions of calcium and phosphorus in re-mineralizing and strengthening teeth. In addition, vitamin D and vitamin K stimulate calcium and phosphorus absorption in the intestines and kidneys. Hormones, such as parathyroid, mobilize calcium, leading to an increased risk for osteoporosis (in adults) or rickets (in kids). Vitamin D deficiency typically results in low-to-normal calcium and phosphorus in the blood. Still, deficiencies aren't the only problem with vitamin D. Dr. Aver says that "the main source of vitamins is the sunshine, but since we live in the Midwest, we don't get an abundance of sun, and I always recommend vitamin D levels be checked before taking a supplement, so you know how much to supplement."



It's Not What You Eat; It's How

The misconception is that it's all those cookies or jellybeans causing cavities, but it's the frequency of exposure to any carbohydrates. The bacteria in your mouth that causes cavities doesn't care if the carb comes from candy or grapes. Dr. Aver feels that constantly snacking throughout the day, even on healthful foods like dairy, whole grains, and fruit, a steady diet is provided for oral bacteria. The message should be limiting carb-centric snacking. How you eat plays a big, if not bigger, role in oral health than what you eat. Kelly's family of vegans is an example of how eating a nutrient-rich diet the wrong way can create dental problems.

Changing dietary behaviors can decrease caries and erosion risk. These changes include having structured and brief mealtimes throughout the day (limited snacking and grazing) and eliminating sweetened or acidic beverages. After meals, rinse with water, chew sugar-free and aspartame-free gum, and brush/floss. Wait for twenty minutes before brushing if the food or beverage was acidic.



Dietary Associations With Oral and Systemic Disease

How diet leads to caries is well known, but nutrition also plays several roles in the management and prevention of periodontal disease. Diet-dominated conditions increase periodontal disease risks, such as obesity, heart disease, and uncontrolled diabetes. In addition, poor nutrition prevents the immune system from functioning correctly, affecting wound healing. Nutrient deficiencies, namely vitamin C, D, and calcium, are also linked to periodontal risk.

Dehydration is another nutritional aspect that can significantly impact a patient's oral health. Research shows that dehydration may lead to caries and even difficulty achieving adequate dental anesthesia in your dental practice.

Please read the labels. Know precisely what you are consuming. Be well and stay healthy!

Kelly has a family whose members are pictures of health. The mother is a nutritionist. The kids are homeschooled, so they don't have access to soda and candy from the cafeteria vending machines. The family follows a vegan diet and has a sparkling oral health history with no caries or decalcification, but a strange thing happened. During a recent preventative exam, Kelly discovered that her previously caries-free children all had tooth decay. The family practiced good oral health hygiene and had a nutritious diet, so Kelly wondered what had changed. She discovered that it wasn't what the family ate but rather how they ate that created problems. "We juice our fruits and vegetables," Kelly said. Even though the food is healthy, the form they ate produced a potent combination of fruit acids and sugars. Dr. Aver could have treated the symptoms, but by digging a little deeper, she identified the real issue and educated her patients on how to fix and prevent it.

"The old concept of dentistry is to restore and repair teeth/gums." Dr. Aver said. "But now we need to focus on education, prevention, and maintenance more than just drilling and filling teeth. The first step toward any treatment should be finding the underlying root cause: nutrition and habits". Discussing nutrition with patients may feel like you are blurring the lines between dentistry and dietetics, but it could provide a clear pathway toward integrating dentistry as a crucial component of whole-body healthcare. For Dr. Aver, nutrition is essential to oral and systemic health. She doesn't shy away from dietary conversations, as they help her achieve her practice goal of addressing "the complete foundation of health" for her patients. "We have always educated and advised our patients regarding the effect of acid on teeth, including fruit acids, and not brushing after snacking," she said. "Overall health begins with oral health. Thus, proper nutrition and habits are equally important for oral health". So how does a general dentist with nutrition in the background have these conversations with patients? A comprehensive refresher in key oral health and nutrition concepts is an excellent place to start.



The Oral Healthcare Effects of Vitamins and Minerals

Vitamins A, B, and D and calcium and phosphorus have significant oral health implications. Vitamin B (B2, B3, B6, and B12) deficiencies are most common in older adults, alcohol users, people with restricted diets (e.g., vegan or vegetarian), and people with gastrointestinal issues or recent surgeries. Vitamin B deficiency manifests as a burning feeling in the mouth, angular cheilitis/cracks at the corner of the mouth, recurrent ulcers, glossitis - pain, swelling, and or redness of the tongue, and loss of taste. Healthy foods that contain the highest levels of the B complex are: salmon (low mercury fish with high Omega 3 fats and selenium), leafy greens (spinach, collared greens, turnip greens), liver of pasture-raised animals, organic eggs, organic beef, legumes (black beans, chickpeas, lentils), organic chicken, brewer's yeast, lake trout, and sunflower seeds.

Enamel hypoplasia - softening of the enamel, the cause of tooth decay and sensitivity, is an oral health condition linked to a vitamin D and K deficiency. Vitamin D supports the functions of calcium and phosphorus in re-mineralizing and strengthening teeth. In addition, vitamin D and vitamin K stimulate calcium and phosphorus absorption in the intestines and kidneys. Hormones, such as parathyroid, mobilize calcium, leading to an increased risk for osteoporosis (in adults) or rickets (in kids). Vitamin D deficiency typically results in low-to-normal calcium and phosphorus in the blood. Still, deficiencies aren't the only problem with vitamin D. Dr. Aver says that "the main source of vitamins is the sunshine, but since we live in the Midwest, we don't get an abundance of sun, and I always recommend vitamin D levels be checked before taking a supplement, so you know how much to supplement."

It's Not What You Eat; It's How

The misconception is that it's all those cookies or jellybeans causing cavities, but it's the frequency of exposure to any carbohydrates. The bacteria in your mouth that causes cavities doesn't care if the carb comes from candy or grapes. Dr. Aver feels that constantly snacking throughout the day, even on healthful foods like dairy, whole grains, and fruit, a steady diet is provided for oral bacteria. The message should be limiting carb-centric snacking. How you eat plays a big, if not bigger, role in oral health than what you eat. Kelly's family of vegans is an example of how eating a nutrient-rich diet the wrong way can create dental problems.

Changing dietary behaviors can decrease caries and erosion risk. These changes include having structured and brief mealtimes throughout the day (limited snacking and grazing) and eliminating sweetened or acidic beverages. After meals, rinse with water, chew sugar-free and aspartame-free gum, and brush/floss. Wait for twenty minutes before brushing if the food or beverage was acidic.



Dietary Associations With Oral and Systemic Disease

How diet leads to caries is well known, but nutrition also plays several roles in the management and prevention of periodontal disease. Diet-dominated conditions increase periodontal disease risks, such as obesity, heart disease, and uncontrolled diabetes. In addition, poor nutrition prevents the immune system from functioning correctly, affecting wound healing. Nutrient deficiencies, namely vitamin C, D, and calcium, are also linked to periodontal risk.

Dehydration is another nutritional aspect that can significantly impact a patient's oral health. Research shows that dehydration may lead to caries and even difficulty achieving adequate dental anesthesia in your dental practice.

Please read the labels. Know precisely what you are consuming. Be well and stay healthy!

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