Recommendations for Poor Oral Hygiene and Diet
What would you recommend for an adult patient with extensive decay due to poor oral hygiene and diet? I have provided extensive patient education, but nothing seems to motivate her.
1 Answers
The first step is to thoroughly assess the medical, dental, and social history to determine the risk factors associated with the extensive decay. As indicated by the question, the dental hygienist has uncovered poor oral hygiene and diet as the risk factors. To tackle the concern with the patient’s food choices, a complete assessment of nutritional intake will reveal the components of the patient’s dietary intake and behaviors that may be causing the problem. The patient should fill out a food record for 1 day to 7 days. There are many food records available online, as well as apps designed to record food intake. The more days requested, the stronger the assessment will be. As all carbohydrates have the potential to be cariogenic, identify all carbohydrates consumed on one day and review with the patient. Involve the patient in the process and have her identify all carbohydrates on the remaining days. Including the patient as much as possible gives her more ownership of the problem and enhances compliance.
Continue with a discussion on the process of decay related to carbohydrate intake, the reduction of pH to 5.5 or below in the oral cavity, and the subsequent demineralization of enamel. The discussion can lead back to the patient’s food diary to show examples of meals, snacks, or eating behaviors that lend to an acidic environment in the oral cavity. Consider the form of the food (eg, sticky carbohydrates are more cariogenic than liquid carbohydrates), frequency of intake (eg, the carbohydrate is consumed at once or over a period of time), or sequence in a meal (eg, the carbohydrate consumed at the end of a meal may be more cariogenic than one consumed with a meal). It is also important to discern meals or snacks that contain carbohydrates, but do not cause a reduction of pH below 5.5 due to anti-cariogenic, cariostatic, or noncariogenic properties of food.
For example, a meal consisting of:
- Unsweetened tea
- Cottage cheese with peaches
- Baked chicken breast
- Green beans
- Sweetened applesauce
- Roll with butter
- Stegeman CA, Davis JR. The Dental Hygienist’s Guide to Nutritional Care. 5th ed. New York: Elsevier; 2019:351–364.
- Arnett M, Gwozdek A. Motivational interviewing for dental hygienists. Dimensions of Dental Hygiene. 2017;15(5):54-57.
- Dörfer CE. Abrasivity of dentifrices from a clinical perspective. J Clin Dent. 2010;21(Suppl):S4.
- Yaacob M, Worthington HV, Deacon SA, et.al. Powered versus manual toothbrushing for oral health. Cochrane Database Syst Rev. 2014;(6):CD002281.
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