Recommending Vitamin Supplements

 This is not an easy question to answer, as scope of practice regulations vary by state and many don't address nutritional counseling at all. Some direction is provided by state medical, diete - tic, and dental boards; the American Dental Hygienists' Association (ADHA); and the Academy of Nutrition and Dietetics. The ADHA states, "The dental hygienist employs critical decisionmaking skills to reach conclusions about the patient's needs related to oral health and disease that fall within the dental hygiene scope of practice."¹ In order to achieve this outcome, ADHA specifies that dental hygienists are to collaborate with dentists and other health care professionals to provide optimal oral health for patients. Observing a need for a single supplement, such as calcium or a multivitamin, may require referral to the patient's health care provider, registered dietitian (RD), or registered dietitian nutritionist (RDN). According to the Academy of Nutrition and Dietetics, "The best nutrition-based strategy for promoting optimal health and reducing the risk of chronic disease is to wisely choose a wide variety of foods. Additional nutrients from supplements can help some people meet their nutrition needs as specified by science-based nutrition standards, such as the Dietary Reference Intakes."² Recommending supplements or advice to support medical nutrition therapy is the purview of RDs and RDNs. As a dietitian, when I suspect a patient may require a single supplement, I evaluate the entire situation. I read documentation from the patient's health care providers; review medical and social histories; interpret laboratory tests (eg, hematocrit, hemoglobin); assess the patient's nutritional status via analysis obtained from a 3-day to 7-day food record; observe clinical issues, such as gingival inflammation; and review the anthropometric information (eg, height, weight, change in weight). Armed with this information, I am able to provide an effective recommendation. It is easy to exceed the tolerable upper level (UL) of some nutrients, especially when a patient consumes fortified foods and beverages or a multivitamin. High levels of nutrients can have a drug-nutrient or nutrient-nutrient interaction. For example, iron levels above the UL can decrease zinc absorption and high doses of vitamin E can cause bleeding in individuals taking anticoagulant medications. A general rule of thumb is that providing nutritional information— based on 2010 Dietary Guidelines for Americans (health.gov/dietaryguidelines) and United States Department of Agriculture's Choose MyPlate (choosemyplate.gov)—that pertains to the oral health of patients is acceptable. When counseling involves a complicated health issue—such as diabetes, unfamiliar nutritional intakes, or goes beyond these nutritional education tools—referring the patient to a health care provider or RD/RDN is the most prudent choice.

References

1. American Dental Hygienists' Association. Position of the Association: Dental Hygiene Diagnosis and the Dental Hygiene Process of Care. Available at: adha.org/resources-docs/7111_Dental_Hygiene_Diagnosis_Position_Paper.pdf. Accessed September 2, 2014.
2. Academy of Nutrition and Dietetics. Nutrient Supplementation. Available at: eatright.org/About/Content.aspx?id=8409. Accessed September 2, 2014.