Part II Application of Nutrition Principles
13 Nutritional Requirements Affecting Oral Health in Women
Healthy Pregnancy
Lactation
OralContraceptive Agents
Menopause
StudentReadiness
References
14 Nutritional Requirements During Growth and Development and Eating Habits Affecting Oral Health
Infants
Children Older Than 2 Yearsof Age: Dietary Guidelines 2015–2020 and Healthy People 2020
Utilizing the ChooseMyPlate Website
Toddler and PreschoolChildren
Attention-Deficit/Hyperactivity Disorder
Children With SpecialNeeds
School-Age Children (7–12 YearsOld)
Adolescents
StudentReadiness
References
15 Nutritional Requirements for Older Adults and Eating Habits Affecting Oral Health
GeneralHealth Status
Physiologic FactorsInfluencing NutritionalNeedsand Status
Socioeconomic and PsychologicalFactors
NutrientRequirements
Eating Patterns
Dietary Guidelines and MyPlate for Older Adults
StudentReadiness
References
16 Food Factors Affecting Health
Health Care Disparities
Food Patterns
Working With PatientsWith DifferentFood Patterns
Food Budgets
Maintaining OptimalNutrition During Food Preparation
Food Fadsand Misinformation
Referralsfor NutritionalResources
Role of DentalHygienists
StudentReadiness
References
17 Effects of Systemic Disease on Nutritional Status and Oral Health
Effectsof Chronic Disease on Intake
Anemias
Other Hematologic Disorders
GastrointestinalProblems
Cardiovascular Conditions
SkeletalSystem
Metabolic Problems
Neuromuscular Problems
Neoplasia
Acquired Immunodeficiency Syndrome (AIDS)
MentalHealth Problems
StudentReadiness
References
Part III Nutritional Aspects of Oral Health
18 Nutritional Aspects of Dental Caries
Major Factorsin the DentalCariesProcess
Other FactorsInfluencing Cariogenicity
DentalHygiene Care Plan
StudentReadiness
References
19 Nutritional Aspects of Gingivitis and Periodontal Disease
PhysicalEffectsof Food on PeriodontalHealth
NutritionalConsiderationsfor PeriodontalPatients
Gingivitis
Chronic Periodontitis
Necrotizing PeriodontalDiseases
StudentReadiness
References
20 Nutritional Aspects of Alterations in the Oral Cavity
Orthodontics
Xerostomia
RootCariesand Dentin Hypersensitivity
Dentition Status
Oraland MaxillofacialSurgery
Lossof Alveolar Bone
Glossitis
Temporomandibular Disorder
StudentReadiness
References
21 Nutritional Assessment and Education for Dental Patients
Evaluation of the Patient
Assessmentof NutritionalStatus
Identification of NutritionalStatus
Formation of Nutrition TreatmentPlan
Facilitative Communication Skills
StudentReadiness
References
Glossary
Answers to Nutritional Quotient Questions
Index
Reference Tables
14 through 18 y Adolescent female EER plus change in Total Energy Expenditure (TEE) plus pregnancy energy deposition
14 through 18 y Adolescent female EER plus milk energy output minus weight loss 1st 6 mo
19 through 50 y Adult female EER plus milk energy output minus weight loss 1st 6
aFor healthy active Americansand Canadians. Based on the cited age, an active physical activity level, and the reference heightsand weightscited in Table 1.1. Individualized EERs can be determined by using the equationsin Chapter 5.
bPAL= PhysicalActivity Level, EER= Estimated Energy Requirement The intake that meetsthe average energy expenditure of individualsatthe reference height, weight, and
age (see Table 1.1).
cSubtract10 kcal/d for malesand 7 kcal/d for femalesfor each year of age above 19 years.
Reproduced with permission fromEnergy Calculationsfor Active Individualsby Life Stage Group. In Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate, NationalAcademy of Sciences Washington, DC: NationalAcademiesPress, 2005.
Dietary Reference Intakes (DRIs): Dietary Allowances and Adequate Intakes, Total Water, and Macronutrients (Food and Nutrition Board, National Academy of Medicine)
aBased on 1 5 g/kg/day for infants, 1 1 g/kg/day for 1–3 y; 0 95 g/kg/day for 4–13 y, 0 85 g/kg/day for 14–18 y, 0 8 g/kg/day for adults, and 1 1 g/kg/day for pregnant(using prepregnancy weight) and lactating women.
bAcceptable MacronutrientDistribution Range (AMDR) isthe range of intake for a particular energy source thatisassociated with reduced riskof chronic disease while providing intakesof essentialnutrients If an individualhasconsumed in excessof the AMDR, there isa potentialof increasing the riskof chronic diseasesand insufficient intakesof essentialnutrients.
cND 5 Notdeterminable due to lackof data of adverse effectsin thisage group and concern with regard to lackof ability to handle excessamounts Source of intake should be fromfood only to preventhigh levelsof intake.
dApproximately 10% of the totalcan come fromlonger-chain, n-3 fatty acids.
Dietary cholesterol, trans fatty acids, saturated fatty acids: Aslowaspossible while consuming a nutritionally adequate diet
Added sugars: Limitto no more than 25% of totalenergy.e
Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids Washington, DC: The NationalAcademiesPress, 2002
Note: Thistable representsRecommended Dietary Allowances(RDAs) in bold type and *Adequate Intakes(AIs) in ordinary type. RDAsand AIsmay both be used asgoalsfor individualintake. RDAsare setto meetthe needsof almostall(97%–98%) individualsin a group For healthy breastfed infants, the AI isthe mean intake The AI for other life-stage and gender groupsisbelieved to cover the needsof allindividualsin the group, butlackof data preventsbeing able to specify with confidence the percentage of individualscovered by thisintake.
Dietary Reference Intakes (DRIs): Recommended Dietary Allowances and Adequate Intakes, Vitamins (Food and Nutrition Board, National Academy of Medicine)
aAsretinolactivity equivalents(RAEs). 1 RAE = 1 µg retinol, 12 µg β-carotene, 24 µg βcarotene, or 24 µg β-cryptoxanthin. The RAE for dietary provitamin Acarotenoidsis twofold greater than retinolequivalents(RE), whereasthe RAE for preformed vitamin Ais the same asRE
bAscholecalciferol. 1 µg cholecalciferol= 40 IUvitamin D.
cUnder the assumption of minimalsunlight.
dAsα-tocopherol α-Tocopherolincludes RRR-α-tocopherol, the only formof α-tocopherol thatoccursnaturally in foods, and the 2R-stereoisomeric formsof α-tocopherol(RRR, RSR, RRS, and RSS-α-tocopherol) thatoccur in fortified foodsand supplements. Itdoes notinclude the 2S-stereoisomeric formsof α-tocopherol(SRR, SSR, SRS, and SSS-αtocopherol), also found in fortified foodsand supplements.
eAsniacin equivalents(NE). 1 mg of niacin = 60 mg of tryptophan; 0–6 months= preformed niacin (notNE)
fAsdietary folate equivalents(DFE) 1 DFE = 1 µg food folate = 0 6 µg of folic acid from fortified food or asa supplementconsumed with food = 0.5 µg of a supplementtaken on an empty stomach.
gAlthough AIshave been setfor choline, there are fewdata to assesswhether a dietary supply of choline isneeded atallstagesof the life cycle, and itmay be thatthe choline requirementcan be metby endogenoussynthesisatsome of these stages.
hBecause 10% to 30% of older people may malabsorb food-bound B12, itisadvisable for those older than 50 yearsto meettheir RDAmainly by consuming foodsfortified with B12 or a supplementcontaining B12
iIn viewof evidence linking folate intake with neuraltube defectsin the fetus, itis recommended thatallwomen capable of becoming pregnantconsume 400 µg from supplementsor fortified foodsin addition to intake of food folate froma varied diet
jItisassumed thatwomen willcontinue consuming 400 µg fromsupplementsor fortified food untiltheir pregnancy isconfirmed and they enter prenatalcare, which ordinarily occursafter the end of the periconceptionalperiod the criticaltime for formation of the neuraltube
NOTE: Thistable (taken fromthe DRI reports; see wwwnap edu) presentsRecommended Dietary Allowances(RDAs) in bold type and Adequate Intakes(AIs) in ordinary type followed by an asterisk(*). An RDAisthe average daily dietary intake level; sufficientto meetthe nutrientrequirementsof nearly all(97%–98%) healthy individualsin a group. Itis calculated froman Estimated Average Requirement(EAR) If sufficientscientific evidence isnotavailable to establish an EARfor calculating an RDA, an AI isusually developed For healthy breastfed infants, an AI isthe mean intake The AI for other life-stage and gender groupsisbelieved to cover the needsof allhealthy individualsin the groups, butlackof data or uncertainty in the data preventbeing able to specify with confidence the percentage of individualscovered by thisintake
SOURCES: Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride (1997); Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (1998); Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000); Dietary Reference Intakesfor Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001); Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2005); and Dietary Reference Intakes for Calcium and Vitamin D (2011). These reportsmay be accessed via www.nap.edu.
Dietary Reference Intakes (DRIs): Recommended Dietary Allowances and Adequate Intakes, Elements (Food and Nutrition Board, National Academy of Medicine)
Infants
Children
Males
Females
Pregnancy
Copyright2001 by the NationalAcademy of Sciences Allrightsreserved
SOURCES: Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride (1997); Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (1998); Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000); Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001); Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2005); and Dietary Reference Intakes for Calcium and Vitamin D (2011). These reportsmay be accessed via www.nap.edu.
Dietary Reference Intakes (DRIs): Estimated Average Requirements (Food and Nutrition Board, National Academy of Medicine)
0–6
aAsretinolactivity equivalents(RAEs) 1 RAE = 1 µg retinol, 12 µg β-carotene, 24 µg αcarotene, or 24 µg β-cryptoxanthin. The RAE for dietary provitamin Acarotenoidsistwofold greater than retinolequivalents(RE), whereasthe RAE for preformed vitamin Aisthe same asRE.
bAsα-tocopherol α-Tocopherolincludes RRR-α-tocopherol, the only formof α-tocopherol thatoccursnaturally in foods, and the 2R-stereoisomeric formsof α-tocopherol (RRR-, RSR-, RRS-, and RSS-α-tocopherol) thatoccur in fortified foodsand supplements. Itdoes notinclude the 2S-stereoisomeric formsof α-tocopherol(SRR-, SSR-, SRS-, and SSS-αtocopherol), also found in fortified foodsand supplements
cAsniacin equivalents(NE). 1 mg of niacin = 60 mg of tryptophan.
dAsdietary folate equivalents(DFE) 1 DFE = 1 µg food folate = 0 6 µg of folic acid from fortified food or asa supplementconsumed with food = 0 5 µg of a supplementtaken on an empty stomach.
Note: An Estimated Average Requirement(EAR) isthe average daily nutrientintake level estimated to meetthe requirementsof the healthvindividualsin a group EARshave not been established for vitamin K, pantothenic acid, biotin, choline, chromium, fluoride, manganese, or other nutrientsnotyetevaluated via the DRI process.
SOURCES: Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride (1997); Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (1998); Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000); Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001); Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (2002/2005); and Dietary Reference Intakes for Calcium and Vitamin D (2011) These reportsmay be accessed via wwwnap edu
Dietary Reference Intakes (DRIs): Tolerable Upper Intake Levels, Vitamins (Food and Nutrition Board, National Academy
y Lactation
y
y
aAspreformed vitamin Aonly
bAsα–tocopherol; appliesto any formof supplementalα–tocopherol.
cThe ULsfor vitamin E, niacin, and folate apply to synthetic formsobtained from supplements, fortified foods, or a combination of the two
dβ-Carotene supplementsare advised only to serve asa provitamin Asource for individualsatriskof vitamin Adeficiency.
eND = Notdeterminable due to lackof data of adverse effectsin thisage group and concern with regard to lackof ability to handle excessamounts Source of intake should be fromfood only to preventhigh levelsof intake.
Note: ATolerable Upper Intake Level(UL) isthe highestlevelof daily nutrientintake thatis likely to pose no riskof adverse health effectsto almostallindividualsin the general population Unlessotherwise specified, the ULrepresentstotalintake fromfood, water, and supplements Due to a lackof suitable data, ULscould notbe established for vitamin K, thiamin, riboflavin, vitamin B12, pantothenic acid, biotin, and carotenoids. In the absence of a UL, extra caution may be warranted in consuming levelsabove recommended intakes. Membersof the generalpopulation should be advised notto routinely exceed the UL The ULisnotmeantto apply to individualswho are treated with the nutrientunder medical supervision or to individualswith predisposing conditionsthatmodify their sensitivity to the nutrient.
SOURCES: Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride (1997); Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (1998); Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000); Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001); and Dietary Reference Intakes for Calcium and Vitamin D (2011). These reportsmay be accessed via wwwnap edu
Dietary Reference Intakes (DRIs): Tolerable Upper Intake Levels, Elements (Food and Nutrition Board, National Academy of Medicine)
aAlthough the ULwasnotdetermined for arsenic, there isno justification for adding arsenic to food or supplements.
bThe ULsfor magnesiumrepresentintake froma pharmacologic agentonly and do not include intake fromfood and water
cAlthough silicon hasnotbeen shown to cause adverse effectsin humans, there isno justification for adding silicon to supplements.
dAlthough vanadiumin food hasnotbeen shown to cause adverse effectsin humans, there isno justification for adding vanadiumto food and vanadiumsupplementsshould be used with caution. The ULisbased on adverse effectsin laboratory animals; thisdata could be used to seta ULfor adultsbutnotchildren and adolescents.
eND = Notdeterminable due to lackof data of adverse effectsin thisage group and concern with regard to lackof ability to handle excessamounts Source of intake should be fromfood only to preventhigh levelsof intake.
Note: ATolerable Upper Intake Level(UL) isthe highestlevelof daily nutrientintake thatis likely to pose no riskof adverse health effectsto almostallindividualsin the general population Unlessotherwise specified, the ULrepresentstotalintake fromfood, water, and
supplements. Due to a lackof suitable data, ULscould notbe established for vitamin K, thiamin, riboflavin, vitamin B12, pantothenic acid, biotin, and carotenoids. In the absence of a UL, extra caution may be warranted in consuming levelsabove recommended intakes. Membersof the generalpopulation should be advised notto routinely exceed the UL. The ULisnotmeantto apply to individualswho are treated with the nutrientunder medical supervision or to individualswith predisposing conditionsthatmodify their sensitivity to the nutrient
SOURCES: Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride (1997); Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (1998); Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000); Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001); Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2005); and Dietary Reference Intakes for Calcium and Vitamin D (2011) These reportsmay be accessed via www.nap.edu.
Body Mass Index Table
SOURCE: Adapted fromClinicalGuidelineson the Identification, Evaluation, and Treatment of Overweightand Obesity in Adults: The Evidence Report Bethesda, MD: NationalHeart, Lung, and Blood Institute, 1998.
