Caries-Prone Patients: Prevention, Assessment, and Interventions, 3rd Edition __________________________
THE NUTRITIONAL COUNSELING APPOINTMENT
Some examples of these goals are: • Limiting soda drinks to mealtimes • Exchanging sugared gum or candies for sugar-free or xylitol-sweetened varieties • Replacing soda with flavored water • Including sweet foods with meals, when the sugar content will be diluted • Making a conscious effort to eat a fruit or vegetable with every meal, as fruits and vegetables act as natural oral cleansers • Brushing with a xylitol-containing toothpaste and chewing xylitol gum twice a day As patients set and achieve goals, additional changes can be recommended to further decrease caries risk. Nutritional counseling, like other behavioral modification interventions, is a dynamic process that is emphasized depending on need.
Patients with a moderate- to high-risk level of caries may ben- efit from a separate nutritional counseling appointment. The appointment length is individualized based on the patient’s dental knowledge, dietary habits, and motivation level. During this appointment, the dental professional and patient have an opportunity to evaluate the patient’s current diet, discuss preventive treatments, and set goals to improve the diet and reduce caries incidence. To gain information concerning dietary habits, the dental professional may have patients complete a diet questionnaire and food log [87]. An example of a dietary questionnaire and food log was previously shown in Table 1 . Alternatively, the dental professional may choose to interview patients concern- ing dietary habits, using questions such as: • What are your favorite snacks? • On a typical school or workday, what do you eat for lunch? • What is your favorite soft drink or fruit juice, and how often do you drink it? • How long does it take you to finish a can of soda or a glass of juice? • How often do you brush your teeth? How often do you floss? Follow-up to the nutritional counseling appointment should take place in order to encourage the patient’s goals and rein- force habit changes. This follow-up may consist of a phone call to check in with the patient, or it may be a short appoint- ment a few weeks after the counseling appointment. The patient’s progress can be reevaluated at subsequent dental appointments. Establishing and routinely reassessing a patient’s caries risk level allows the dental professional to provide proactive care and recommend preventive measures to minimize the patient’s risk of dental decay. Occasionally, a patient may benefit from a referral to a dieti- cian, nutritionist, or primary care physician. This is especially true if a condition such as acid reflux, an eating disorder, or chemical dependency is suspected or confirmed.
CASE SCENARIOS
CASE SCENARIO 1: SAVANNAH’S FIRST DENTAL APPOINTMENT
Savannah is a 4-year-old girl coming to your office for the first time. She is wearing a pretty dress and sparkly shoes, and she has a pink bow tying her long black hair up in a ponytail. She is obviously frightened. As you escort Savannah and her mother to the treatment room, the only thing Savannah says is that she does not want silver teeth. Savannah has an unremarkable medical history, takes no medications, is current with her vac- cinations, and has no allergies. When you ask Savannah if any of her teeth hurt, she quietly nods. Upon being asked whether Savannah has been to the dentist, her mother explains that Savannah lived with her aunt for several months and during that time had been taken to her aunt’s dentist. Her aunt’s dentist had recommended stainless-steel crowns for Savannah’s carious teeth #E and #F, but the aunt did not want to have the crowns placed without Savannah’s mother’s permission. Savan- nah is covered by insurance, but the insurance pays only for stainless-steel crowns, and Savannah’s mother admits to having been unable to afford the tooth-colored crowns until now. Establishing a caries risk level for this child should be easy, as her mother admits that she has active carious lesions. What is her caries risk level? One look at Savannah’s cute smile reveals severe caries on teeth #E and #F. At this point, you complete the caries risk assessment form, determining the child’s fluo- ride exposure level, oral hygiene routine, and snacking habits.
SETTING GOALS • The dental professional should be practical
when recommending changes to a patient’s diet. Asking patients to forfeit their favorite foods in exchange for increased brushing and flossing will rarely improve patient compliance. It is important to note, however, that relatively minor changes in nutrition and habits can lower a patient’s caries risk. By evaluating each patient’s individual incentives and motivation level, dental professionals can help patients set goals that are realistic and achievable.
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