Benefits of the dental setting
Dental practices have fewer barriers to starting the nutritional conversation with patients. For example, they do not weigh adult patients and patients can usually visit their dental office more easily. Some signs and symptoms of poor nutrition can only be observed by a dentist, as is the case with most medical office visits'A thorough examination of the mouth is not included.
The ADA recognizes this benefit and a dental code (D1310) already exists to provide nutritional guidance for the control and prevention of oral diseases. The frequency of dental 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 their dental office one to four times a year. 6
Hygienists also typically spend 45 to 90 minutes with each patient. Building personal relationships and trust over repeat visits is a great way to help patients make healthy choices. We already do this with patients by making recommendations to improve their oral health; it's time we started adding nutrition to our educational services.
Keep in mind that dentists have equal or greater nutritional needs than physicians in their programs. Most medical schools do not have a formal nutrition course; instead, they nest nutrient-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 include at least a three-hour nutrition course, in addition to biomedical sciences, anatomy, physiology and pathology classes. 8
Observations in the dental setting
Dentists see many things that can lead to a discussion about nutrition. 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 good nutrition or the addition of supplements.
When x-rays are taken and patients are diagnosed with multiple caries, it is easy to discuss reducing sugars and acids in the diet. Sometimes calcified atherosclerotic plaques appear on panoramic radiographs. There should be an office policy to refer a patient to his or her PCP and initiate a conversation about diet by explaining the disease process and providing basic nutritional advice, such as limiting foods high in cholesterol or triglycerides. This helps prepare the patient for lifestyle recommendations from a second healthcare provider.
Bleeding, gingivitis, and worsening of periodontal disease can sometimes be attributed to a lack of good vitamins and minerals. Periodontal patients need to understand the role of nutrition in periodontal disease and how to obtain essential nutrients through their diet.
Developing 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 recommendations can lead to no change at all. When a patient suggests a first step, they are more likely to add a serving of vegetables or a multivitamin than to omit something.
Sit the patient upright so that he or she can see your findings and participate in the discussion on an equal footing. Discuss their disease process and how you can manage or reverse it with nutrition and supplementation. Resources such as brochures or websites are available through the American Heart Association, the American Diabetes Association and the USDA. Document your conversation and write it down on their schedule so you can follow up on it the next visit.
Putting it together
Dental professionals have a unique advantage when it comes to discussing nutritional needs with patients. Our patients see us more often, for longer periods of time, and generally enjoy seeing the same providers at each appointment.
Patients trust us with their mouths, but it's time we connect the mouth to the rest of the body. Our knowledge of the human body allows patients to benefit by explaining how nutrition plays a crucial role in preventing and treating disease. We have the expertise and valuable insights to make suggestions to improve patients' current nutritional intake.
Editor's note: This article appeared in the October 2024 print edition of RDH magazine. Dental hygienists in North America are eligible for a free print subscription. Sign up here.
References1. Once again the US and Europe have a big lead in daily calorie intake. News United Nations. December 12, 2022. Accessed May 20, 2024. https://news.un.org/en/story/2022/12/1131637
2. Dietary Guidelines for Americans, 2020-2025. The U.S. Department of Agriculture and the U.S. Department of Health and Human Services. December 2020. https://www.dietaryguidelines.gov/
3. Standard American Diet. Nutrition facts. Accessed 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. Int 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-related information: a systematic review of content analysis studies. Public Health Nutrition. 2023;26(7):1345-1357. doi:10.1017/S1368980023000873
6. Oral and dental health. Centers for Disease Control and Prevention. May 22, 2024. Accessed June 3, 2024. https://www.cdc.gov/nchs/fastats/dental.htm
7. Millard E. How nutrition education for physicians is evolving. Time. May 24, 2023. Accessed June 3, 2024. https://time.com/6282404/nutrition-education-doctors/
8. Accreditation Standards for Dental Hygiene Education Programs. Dental Accreditation Commission. 2023. Accessed August 5, 2024. https://coda.ada.org/standards
