Advantages of the dental environment
Dental offices have fewer barriers to initiating nutrition conversations with patients. For example, they do not weigh adult patients, and patients can often get to dental offices more easily. Some signs and symptoms of malnutrition can only be observed by a dentist because they go unnoticed during most medical office visits.‘It does not include a comprehensive examination of the mouth.
The ADA recognizes this advantage and already has a dental code (D1310) that provides nutritional counseling for the control and prevention of oral disease. Frequency of dentist visits is also an advantage. According to the Centers for Disease Control and Prevention, 65.5% of American adults and 86.9% of children visit dental offices one to four times a year.6
Hygienists also typically spend 45 to 90 minutes with each patient. Building personal relationships and trust through repeat visits is a great way to guide patients to healthy choices. We already do this by providing patients with recommendations to improve their oral health; It’s time to add nutrition to our education services.
Keep in mind that dental professionals have equal or greater nutritional requirements in their schedules compared to medical doctors. Most medical schools do not have a formal nutrition course; instead, they embed food-based content into classes such as biochemistry, pathology, and physiology.7 In contrast, the Commission on Dental Accreditation (CODA) requires all dental hygiene programs to have at least a three-hour nutrition course in addition to courses in biomedical science, anatomy, physiology, and pathology.8
Observations in the dental setting
Dentists observe many things about nutrition that can lead to controversy. The first thing we do at every appointment is review medical history, medications, and supplements. In most states, dental hygienists are required to measure blood pressure. Many health conditions can benefit from proper nutrition or the addition of supplements.
When radiographs are taken and patients are diagnosed with multiple cavities, it is easy to discuss reduced sugars and acids in the diet. Calcified atherosclerotic plaques are sometimes seen on panoramic radiographs. An office policy should be in place to refer a patient to their PCP and initiate a conversation about diet by explaining the disease process and providing basic nutritional recommendations such as limiting high-cholesterol foods or triglycerides. This helps the patient prepare to hear lifestyle recommendations from a second healthcare provider.
Bleeding, ginflammation, and worsening of periodontal disease can sometimes be attributed to a lack of appropriate vitamins and minerals. Periodontal patients should know the role of nutrition in periodontitis and how to obtain necessary nutrients through diet.
Develop a strategy
Starting a conversation about nutrition can be difficult. You need to know your patients and their motivations. Change can be overwhelming, and making too many suggestions may not result in any change. When recommending the first step, the patient may be more likely to add a serving of vegetables or a multivitamin rather than eliminating something.
Have the patient sit upright so that he or she can see your findings and be an equal part of the discussion. Discuss the disease process and how to manage or reverse it with nutrition and supplementation. Resources such as brochures or websites are available through the American Heart Association, American Diabetes Association, and USDA. Document your discussion and note it on their chart to follow up on your next visit.
put together
Dentists have a unique advantage in discussing nutritional needs with patients. Our patients see us more often, for longer periods of time, and often enjoy seeing the same provider at every appointment.
Patients trust us with their mouth, but now it’s time for us to connect the mouth to the rest of the body. Our knowledge of the human body benefits patients by explaining how nutrition plays a vital role in the prevention and treatment of disease. We have the expertise and valuable insight to make recommendations that will increase patients’ current nutritional intake.
Editor’s note: This article was published in the October 2024 print edition. RDH magazine. Dental hygienists in North America are eligible for a free print subscription. Sign up here.
References
1. The USA and Europe are once again ahead in daily calorie intake. News United Nations. 12 December 2022. Access date: 20 May 2024. https://news.un.org/en/story/2022/12/1131637
2. Dietary Guidelines for Americans, 2020-2025. U.S. Department of Agriculture and U.S. Department of Health and Human Services. December 2020. https://www.dietaryguidelines.gov/
3. Standard American diet. Nutrition facts. Access date: May 20, 2024. https://nutritionfacts.org/topics/standard-american-diet/
4. Amy NK, Aalborg A, Lyons P, Keranen L. Barriers to routine gynecologic cancer screening for Caucasian and African American obese women. International J Obes (London). 2006;30(1):147-155. doi:10.1038/sj.ijo.0803105
5. Denniss E, Lindberg R, McNaughton SA. Quality and accuracy of online nutrition information: a systematic review of content analysis studies. Nutrition in Public Health. 2023;26(7):1345-1357. doi:10.1017/S1368980023000873
6. Oral and dental health. Centers for Disease Control and Prevention. May 22, 2024. Access date: June 3, 2024. https://www.cdc.gov/nchs/fastats/dental.htm
7. Millard E. How is nutrition education for physicians evolving? Time. May 24, 2023. Access date: June 3, 2024. https://time.com/6282404/nutrition-education-doctors/
8. Accreditation standards for dental hygiene education programs. Commission on Dental Accreditation. 2023. Access date: August 5, 2024. https://coda.ada.org/standards