Chapter 9 Consequences of Poor Oral Health

BOX 9.2 Medical and Physical Risk Factors for Compromised Nutritional and Oral Health Status ●

Alterations in taste

● Autoimmune disorders ● Cardiovascular disease ● Craniofacial anomalies ● Cranial nerve dysfunction ● Crohn’s disease

● ●

Deficiencies of vitamins, minerals, trace elements

Dental procedures altering ability to eat a usual diet

● Developmental disorders ● Diabetes

● Disorders of taste and smell ● Eating disorders

● Early childhood caries ● End-stage renal disease ● Erosion

● Extensive dental caries

● Fad dieting/nutrition quackery ● Gastroesophageal reflux disease ● Hypertension

● ●

Infectious diseases ● Multiple sclerosis

● Musculoskeletal disorders ● Neoplastic disease

● Physical/mental handicaps ● Polypharmacy

● Poor dentition/edentulism ● Poverty

● Protein-energy malnutrition/wasting ● Spinal cord injury ● Radiation therapy ● Salivary dysfunction

● Substance abuse (alcohol and/or drugs) ● Transplant surgery ● Ulcerations/lesions

● Unhealthy body weight ● Unintentional weight loss ● Vesiculobullous disease ● Xerostomia

Source: Touger-Decker R, Mobley C, Epstein JB. Approaches to oral nutrition health risk screening and assessment. In: Nutrition and Oral Medicine. 2nd ed. New York, NY: Humana Press; 2014:354.

difficulty (NC-1.2) can be used, as appropriate, to docu- ment oral problems (25).

NUTRITION-FOCUSED PHYSICAL

ASSESSMENT OF THE ORAL CAVITY The Surgeon General’s report Oral Health in America states that nondental health care providers can con- tribute to improving oral health status by identifying oral health needs and initiating referrals to dental-care professionals (2). Box 9.3 lists recommended approaches to oral nutrition management for RDNs to integrate the oral exam and a consultation into MNT and the Nutrition Care Process (39). First and fore- most, RDNs should perform an oral exam on all older adult clients. This can help detect factors that impact functional and systemic diet and nutrition needs (Table 9.1, see page 138 [33]). It is important to note that an exam by an RDN is not a replacement for a dental exam but a component of the nutrition- focused physical assessment by the RDN (40). Any non- normal findings should be documented and reported to a dentist; a referral should also be made and the findings reported to the primary care physician if war- ranted. Training for RDNs on how to conduct an oral

exam is available (41,42). The components of an oral, head, and neck screen by the RDN are listed in Box 9.4 (see page 143 [43]), and Figure 9.1 (see pages 144–145 [44]) reviews a stepwise approach for oral screening for use by the RDN during the

BOX 9.3 Approaches to Oral Nutrition Management for Dietetics Practitioners

●

Include oral health screening exams as part of nutrition assessment protocols (ie, cranial nerve function, integrity of the soft tissue, occlusion, edentulism, masticatory ability, swallowing, salivary adequacy).

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Recognize oral manifestations of systemic diseases, and provide patients with guidelines to maximize oral intake.

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Confer with and refer patients (via consults) to dental practitioners for management of oral diseases and/or risk factors for oral diseases.

●

Consult with dental professionals in interpre- tation of oral-nutrition assessment findings and planning in the long-term care setting.

137

Immunocompromising conditions (eg, cancer, HIV infection, AIDS)