The Dental Hygienist’s Guide to Nutritional Care

Cynthia A. Stegeman, RDH, EdD, RDN, LD, CDE Ohio Delegate to the Academy of Nutrition and Dietetics National Board Dental Hygiene Examination Test Construction Committee Commission on Dental Competency Assessments Consultant Professor and Chairperson, Dental Hygiene Program University of Cincinnati, Blue Ash Cincinnati, Ohio

Judi Ratliff Davis, MS, RDN Former Quality Assurance Nutrition Consultant Women, Infants and Children (WIC) Program Texas Department of State Health Services Austin, Texas

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4

Table of Contents

Cover image

Title Page

Reference Tables

Copyright

Dedication

Preface

New to This Edition

Organization

About Evolve

Note From the Authors

Acknowledgments

About the Authors Part I Orientation to Basic Nutrition

1 Overview of Healthy Eating Habits

Basic Nutrition

Physiologic Functions of Nutrients

Basic Concepts of Nutrition

Government Nutrition Concerns

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Nutrient Recommendations: Dietary Reference Intakes

Food Guidance System for Americans

Support Healthy Eating Patterns for All

MyPlate System

Other Food Guides

Nutrition Labeling

Student Readiness

References

2 Concepts in Biochemistry

What is Biochemistry?

Fundamentals of Biochemistry

Principle Biomolecules in Nutrition

Summary of Metabolism

Student Readiness

References

3 The Alimentary Canal

Physiology of the Gastrointestinal Tract

Oral Cavity

Esophagus

Gastric Digestion

Small Intestine

Large Intestine

Student Readiness

References

4 Carbohydrate

6

Classification

Physiologic Roles

Requirements

Sources

Hyperstates and Hypostates

Nonnutritive Sweeteners/Sugar Substitutes

Student Readiness

References

5 Protein

Amino Acids

Classification

Physiologic Roles

Requirements

Sources

Underconsumption and Health-Related Problems

Overconsumption and Health-Related Problems

Student Readiness

References

6 Lipids

Classification

Chemical Structure

Characteristics of Fatty Acids

Compound Lipids

Cholesterol

Physiologic Roles

7

Dietary Fats and Dental Health

Dietary Requirements

Sources

Overconsumption and Health-Related Problems

Underconsumption and Health-Related Problems

Fat Replacers

Student Readiness

References

7 Use of the Energy Nutrients

Metabolism

Role of the Liver

Role of the Kidneys

Carbohydrate Metabolism

Protein Metabolism

Lipid Metabolism

Alcohol Metabolism

Metabolic Interrelationships

Metabolic Energy

Basal Metabolic Rate

Total Energy Requirements

Energy Balance

Inadequate Energy Intake

Student Readiness

References

8 Vitamins Required for Calcified Structures

8

Overview of Vitamins

Vitamin A (Retinol, Carotene)

Vitamin D (Calciferol)

Vitamin E (Tocopherol)

Vitamin K (Quinone)

Vitamin C (Ascorbic Acid)

Student Readiness

References

9 Minerals Essential for Calcified Structures

Bone Mineralization and Growth

Formation of Teeth

Introduction to Minerals

Calcium

Phosphorus

Magnesium

Fluoride

Student Readiness

References

10 Nutrients Present in Calcified Structures

Copper

Selenium

Chromium

Manganese

Molybdenum

Ultratrace Elements

9

Student Readiness

References

11 Vitamins Required for Oral Soft Tissues and Salivary Glands

Physiology of Soft Tissues

Thiamin (Vitamin B1)

Riboflavin (Vitamin B2)

Niacin (Vitamin B3)

Pantothenic Acid (Vitamin B5)

Vitamin B6 (Pyridoxine)

Folate/Folic Acid (Vitamin B9)

Vitamin B12 (Cobalamin)

Biotin (Vitamin B7)

Other Vitamins

Student Readiness

References

12 Fluids and Minerals Required for Oral Soft Tissues and Salivary Glands

Fluids

References

Electrolytes

Sodium

Chloride

Potassium

Iron

Zinc

10

Iodine

Student Readiness

References

Part II Application of Nutrition Principles

13 Nutritional Requirements Affecting Oral Health in Women

Healthy Pregnancy

Lactation

Oral Contraceptive Agents

Menopause

Student Readiness

References

14 Nutritional Requirements During Growth and Development and Eating Habits Affecting Oral Health

Infants

Children Older Than 2 Years of Age: Dietary Guidelines 2015–2020 and Healthy People 2020

Utilizing the ChooseMyPlate Website

Toddler and Preschool Children

Attention-Deficit/Hyperactivity Disorder

Children With Special Needs

School-Age Children (7–12 Years Old)

Adolescents

Student Readiness

References

15 Nutritional Requirements for Older Adults and Eating Habits Affecting Oral Health

11

General Health Status

Physiologic Factors Influencing Nutritional Needs and Status

Socioeconomic and Psychological Factors

Nutrient Requirements

Eating Patterns

Dietary Guidelines and MyPlate for Older Adults

Student Readiness

References

16 Food Factors Affecting Health

Health Care Disparities

Food Patterns

Working With Patients With Different Food Patterns

Food Budgets

Maintaining Optimal Nutrition During Food Preparation

Food Fads and Misinformation

Referrals for Nutritional Resources

Role of Dental Hygienists

Student Readiness

References

17 Effects of Systemic Disease on Nutritional Status and Oral Health

Effects of Chronic Disease on Intake

Anemias

Other Hematologic Disorders

Gastrointestinal Problems

Cardiovascular Conditions

12

Skeletal System

Metabolic Problems

Neuromuscular Problems

Neoplasia

Acquired Immunodeficiency Syndrome (AIDS)

Mental Health Problems

Student Readiness

References

Part III Nutritional Aspects of Oral Health

18 Nutritional Aspects of Dental Caries

Major Factors in the Dental Caries Process

Other Factors Influencing Cariogenicity

Dental Hygiene Care Plan

Student Readiness

References

19 Nutritional Aspects of Gingivitis and Periodontal Disease

Physical Effects of Food on Periodontal Health

Nutritional Considerations for Periodontal Patients

Gingivitis

Chronic Periodontitis

Necrotizing Periodontal Diseases

Student Readiness

References

20 Nutritional Aspects of Alterations in the Oral Cavity

13

Orthodontics

Xerostomia

Root Caries and Dentin Hypersensitivity

Dentition Status

Oral and Maxillofacial Surgery

Loss of Alveolar Bone

Glossitis

Temporomandibular Disorder

Student Readiness

References

21 Nutritional Assessment and Education for Dental Patients

Evaluation of the Patient

Assessment of Nutritional Status

Identification of Nutritional Status

Formation of Nutrition Treatment Plan

Facilitative Communication Skills

Student Readiness

References

Glossary

Answers to Nutritional Quotient Questions

Index

IBC

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15

Reference Tables

Criteria and Dietary Reference Intake Values: For Energy by Active Individuals by Life Stage Groupa

Life Stage Group

Criterion ACTIVE PAL EERb (kcal/d) Male Female

0 through 6 mo

Energy expenditure plus energy deposition 570 520 (3 mo)

7 through 12 mo

Energy expenditure plus energy deposition 743 676 (9 mo)

1 through 2 y

Energy expenditure plus energy deposition 1,046 992 (24 mo)

3 through 8 y

Energy expenditure plus energy deposition 1,742 1,642 (6 y)

9 through 13 y

Energy expenditure plus energy deposition 2,279 2,071 (11 y)

14 through 18 y

Energy expenditure plus energy deposition 3,152 2,368 (16 y)

>18 y Energy expenditure 3,067c 2,403c (19 y) Pregnancy 14 through 18 y

Adolescent female EER plus change in Total Energy Expenditure (TEE) plus pregnancy energy deposition

1st trimester

2,368 (16 y)

2nd trimester

2,708 (16 y)

3rd trimester

2,820 (16 y)

19 through 50 y

Adult female EER plus change in TEE plus pregnancy energy deposition

1st trimester

2,403c (19 y)

2nd trimester

2,743c (19 y)

3rd trimester

2,855c (19 y)

Lactation 14 through 18 y

Adolescent female EER plus milk energy output minus w eight loss

1st 6 mo 2,698 (16 y) 2nd 6 mo 2,768 (16 y) 19 through 50 y

Adult female EER plus milk energy output minus w eight loss

1st 6 mo 2,733c (19 y) 2nd 6 mo 2,803c (19 y)

aFor healthy active Americans and Canadians. Based on the cited age, an active physical activity level, and the reference heights and weights cited in Table 1.1. Individualized EERs can be determined by using the equations in Chapter 5. bPAL = Physical Activity Level, EER = Estimated Energy Requirement. The intake that meets the average energy expenditure of individuals at the reference height, weight, and

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age (see Table 1.1). cSubtract 10 kcal/d for males and 7 kcal/d for females for each year of age above 19 years.

Reproduced with permission from Energy Calculations for Active Individuals by Life Stage Group. In Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate, National Academy of Sciences. Washington, DC: National Academies Press, 2005.

Dietary Reference Intakes (DRIs): Dietary Allowances and Adequate Intakes, Total Water, and Macronutrients (Food and Nutrition Board, National Academy of Medicine)

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