Clinical examination and Nutrition considerations

The dentist must also be prepared to anticipate how a medical problem might alter a patient’s response to planned anesthetic agents and surgery. If obtaining the history is done well, the physical examination and laboratory evaluation of a patient usually play minor roles in the presurgical evaluation. The standard format used for recording the results of medical histories and physical examinations is illustrated. This general format tends to be followed even in electronic medical records. The medical history interview and the physical examination should be tailored to each patient, taking into consideration the patient’s medical problems, age, intelligence, and social circumstances; the complexity of the planned procedure; and the anticipated anesthetic methods.

The extent of the medical history, physical examination, and laboratory evaluation of patients requiring outpatient dent alveolar surgery, under local anesthesia, nitrous oxide sedation, or both, differs substantially from that necessary for a patient requiring hospital admission and general anesthesia for surgical procedures. A patient’s primary care physician typically performs periodic comprehensive history taking and physical examination of patients; so, it is impractical and of little value for the dentist to duplicate this process.

When the leading causes of death are tabulated, heart disease and cancer top the list. When an attempt is made to identify the root causes of death, three major culprits are involved: cigarette smoking, inappropriate dietary choices, and a sedentary lifestyle The basis for most of our dietary choices and our nutritional status is established relatively early in life. Thus it is clear that food choices and patterns of eating initiated in childhood can affect our health and well-being for the remainder of our lives. There are many ways in health professionals can enhance the health of their patients. This chapter is considered that the nutritional factor is the most important that have the greatest potential to influence the systemic and oral health of the pediatric dental patient.

The recommendations for improving health through better dietary choices are as follows:

1. Eat a variety of foods. Consuming a broad base of different foods reduces the risks of having insufficient intakes of essential nutrients.

2. Balance the amount of food eaten with physical activity levels to maintain or improve body weight.

3. Choose a diet with plenty of fruits, vegetables, and grains. These types of foods tend to be high in antioxidant vitamins and fiber, and low in fat and calories.

4. Choose a diet low in fat, saturated fat, and cholesterol. Following this guideline will reduce the risk of consuming too many calories and of promoting elevated serum cholesterol levels.

5. Choose a diet moderate in sugar content. Although there is no direct relationship between the amount of sugar in the diet and the amount of dental decay, a diet containing excessive 1evels of sugar is considered to be detrimental to dental health.

6. Use salt and sodium only in moderation. High intakes of sodium may be associated with hypertension in those with a family history of this disease.

7. Drink alcoholic beverages in moderation. Alcohol is high in calories and contains few, if any, nutrients.

The Healthy People 2020 document, which is intended to build on the objectives and goals set in Healthy People 2010, is currently being developed. The Healthy People 2020 objectives will be released in January 2010 along with guidance for achieving new 10-year targets that reflect assessments of major health risks, public health priorities, and emerging technologies affecting disease prevention and health preparedness in the United States.

The Dietary Guidelines for Americans (the ABCs) promulgated by the U.S. Department of Agriculture (USDA) support the objectives in Healthy People 2010 and include the following recommendations:

Aim for fitness, Aim for a healthy weight, Be physically active each day, Build a healthy base, Let the Food Guide Pyramid guide your food choices, Choose a variety of grains daily, especially whole grains, Choose a variety of fruits and vegetables daily, Keep food safe to eat, Choose sensibly, Choose a diet low in saturated fat and cholesterol and moderate in fat, Choose beverages and foods so as to moderate your intake of sugars.

Nowadays, dietary recommendations for children and teenagers have changed substantially. Thus, in 2015, the World Health Organization recommended restricting sugar intake. The Food and Drug Administration in United States and the most recent US Dietary Guidelines specifically recommended a restriction of not only added sugars, but also of refined grains. In 2014, the latest, updated Nordic Nutrition Recommendations proposed limiting the intake of added sugars from sugar sweetened beverages and sugar-rich foods, to reduce the risk of some diseases such as diabetes, weight gain and dental caries. These dietary recommendations provide a starting point to an optimum diet for preventing dental caries and for improving periodontal health in children and teenagers.

Nutrition may act both systematically and locally in relation to dental caries. An optimal intake in energy and nutrients to achieve optimal tooth formation is important. This period starts during fetal stage and is, to a large extent, completed around six years of age. Nutritional deficiencies disturb the mineralization process, resulting in a tooth with defects in its structure, more easily liable to developing caries

The MyPyramid Food Guidance System is a pictorial representation of the USDA’s Daily Food and Physical Activity recommendations. Released in 2005, MyPyramid replaced the nation’s previously well-known nutrition education tool, the Food Guide Pyramid (1992). In MyPyramid, daily physical activity is represented by the stairs on the left side of the pyramid. Food groups are represented by the vertical bands, which comprise the body of the pyramid. Bandwidth indicates portion size; the wider the band, the more foods from that group should be consumed. Examples of portions, or serving sizes, are further delineated for each food group. However, in most cases, the serving sizes used in MyPyramid are considerably smaller than the exaggerated portion sizes that many Americans have become accustomed to. In MyPyramid, foods are organized into five major groups and one miscellaneous category. The latter category includes fats, oils, and sweets, all of which should be consumed sparingly. An individualized nutrition plan based on personal factors such as age, gender, and physical activity, can be developed using the online tools, such as the MyPyramid Menu Planner and the MyPyramid Tracker .

So what is MyPyramid, MyPyramid, released by the United States Department of Agriculture (USDA) on April 19, 2005, was an update on the earlier American food guide pyramid. It was used until June 2, 2011, when the USDA's My Plate replaced it. The icon stresses activity and moderation along with a proper mix of food groups in one's diet. As part of the MyPyramid food guidance system, consumers were asked to visit the MyPyramid website for personalized nutrition information. Significant changes from the previous food pyramid include:

Inclusion of a new symbol—a person on the stairs—representing physical activity. Measuring quantities in cups and ounces instead of servings. MyPyramid was designed to educate consumers about a lifestyle consistent with the January 2005 Dietary Guidelines for Americans, an 80-page document. The guidelines, produced jointly by the USDA and Department of Health and Human Services (HHS), represented the official position of the U.S. government and served as the foundation of Federal nutrition policy.

Malnutrition

Malnutrition consist of either under nutrition (inadequate intake of nutrients) or over nutrition (excessive dietary intake patterns established in childhood that predispose individuals to chronic diseases during adulthood).

PROBLEMS OF UNDERCONSUMPTION

1. Iron Deficiency

Anemia is a major problem world- wide. It has frequently been observed among infants and young children between the ages 6 months and 3 years. Typically the high iron needs for growth, when combined with a low dietary intake, produce a low or marginal iron status in children, which leads to behavioral problems.

Clinical signs of iron-deficiency anemia include weakness, fatigue, pallor and numbness. Common oral manifestations are glossitis and fissures at the corners of the mouth, a condition called angular cheilitis. The papillae of the tongue may be atrophied, giving the tongue a smooth, shiny, red appearance.

2. Calcium Inadequacies

Childhood and adolescence are crucial times for development of the skeletal system. Low calcium intakes, particularly in combination with low levels of physical activity, may compromise the attainment of peak bone mass, which is thought to be a major protection against age-related bone loss (Osteoporosis).

3. Zinc Inadequacies

Zinc plays numerous essential physiologic roles, including one involved with normal growth and development. Severe deficiencies may result in dwarfism, hypogonadism, and delayed sexual maturation. This trace element is also required for proper wound healing.

PROBLEMS OF OVERCONSUMPTION

High-fat and high-calorie food items contributes to numerous diseases, including diabetes, hypertension, coronary heart disease, and some types of cancer. Diseases that become evident during adulthood, but have their origins in child hood.

1. Cholesterol Concerns in Children

Atherosclerotic heart disease begins with deposits of lipid (primarily cholesterol and its esters) in the large muscular and elastic arteries of the body. As it progresses, loss of elasticity and narrowing of the lumens occur in these vessels. Atherosclerosis of the coronary arteries can produce myocardial infarction and coronary heart disease.

In general, atherosclerotic lesions in both coronary vessels and the aorta are positively associated with elevated total serum cholesterol and elevated low-density lipoprotein (LDL) cholesterol, and negatively associated with serum high-density lipoprotein (HDL) cholesterol concentrations .Overall health goal is to reduce elevated levels of total and LDL cholesterol, while increasing HDL cholesterol.

2. Obesity

It is obvious that technologic advances have produced a marked decline in the average daily expenditure of energy. Thus, low energy expenditure appears to be the key determinant of the current epidemic.

There is considerable data to suggest that reducing obesity among the population would significantly reduce the risk for numerous chronic diseases, including heart disease and cancer. Moreover, evidence indicates that obese children are more likely than children of normal weight to become obese adults.

It is evident that reducing childhood obesity requires the implementation of both a healthful diet without excessive energy intake and increased levels of physical activity.

The following basic principles are important to keep in mind when dealing with the overweight child:

1. It is often better to help the child grow into his or her current body weight rather than encourage weight loss. It is not healthy to encourage weight loss.

2. Limiting fat in the diet will help to minimize body fat and keep caloric intake at acceptable levels.

3. Moderate exercise should be regular.

4. Skipping breakfast should not be encouraged