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Part II Nutrition Assessment, Consequences, and Implications

TABLE 9.1 Functional Oral Nutrition Risk Assessment Structure Lips

Finding

Dryness; sensation; cracking or fissuring, swelling; history of blisters or ulcers

Angular cheilitis Gingiva and oral mucosa

Soreness/pain; bleeding spontaneously, change in appearance; swelling, growths, discharge; bad taste; halitosis

Red or white patches/lesions; erosion/ulceration; focal pigmentation; erythema

Teeth Tongue

Toothache/pain; looseness and mobility; dental prosthesis (removable or fixed); edentulism

Soreness/pain; burning; rough patches; dryness; cracking or fissuring; growths; changes in taste; ulcers

Temporomandibular joint muscles of mastication

Salivary glands

Difficulty or painful mouth opening; grinding sounds on joint opening, biting or chewing difficulty or pain, range of motion difficulty

Mucosal dryness; too little or too much saliva; drooling; change in color, consistency, difficulty swallowing dry food, altered taste, dry eyes; gland pain or swelling

Management Alter diet texture and consistency

Screen for etiology (diabetes, drooling, vitamin deficiency, dehydration)

Alter diet texture, temperature, and consistency

Adjust diet texture and consistency; evaluate for nutrient deficiencies; screen for oral cancer

Adjust diet, consistency; evaluate caries risk and diet adequacy— ability to bite, chew, swallow

Alter diet texture; screen for anemias, systemic disease; evaluate for nutrient deficiencies

Alter diet consistency, food “hardness,” and limit chewy foods; evaluate cranial nerve function

Increase fluids (if dry mouth); limit spices, “hard” foods; review changes in medications; evaluate for dysgeusia, dysphagia; evaluate zinc status and blood sugar, minimize dietary caries risk

For each section, ask about patient complaints, duration of symptoms, and any changes in appearance, size, acuity, frequency, and pain.

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; 2014:359.

nutrition-focused physical exam. An alternative route of training is to ask a dental professional (dentist or registered dental hygienist) to train the RDN in the performance of an oral screen. Prior to integrating the exam into practice, RDNs should seek out and docu- ment training they receive and their level of compe- tency achieved. Aside from developing the competencies to conduct the oral assessment, the RDN must also understand the purpose for the exam- ination, interpretation of findings, and nutrition

intervention and referral needs for the older adult, based on assessment results (27).

The intraoral component of the screen should include looking at the integrity of the oral tissue and teeth. Cranial nerve function is assessed during the intra- and extraoral components of the screen (1). The degree of edentulism (tooth loss) should be noted as well as occlusion. Notation of areas of tooth loss —maxillary (upper jaw bone) or mandibular (lower jaw bone) and anterior or posterior—should also be noted.