_____________________________________ Caries-Prone Patients: Prevention, Assessment, and Intervention
Habit Eating habits start early and may be difficult to change, espe- cially as time solidifies these behaviors [39; 42]. Habits such as eating at the table, having a healthy breakfast, and eating fruits and vegetables can and should start in childhood; however, it is never too late to start these beneficial habits [40; 43]. Through discussing habits with patients, dental professionals can encourage behaviors that will promote oral health and identify caries-promoting practices that need to be altered. Cost The cost of food is a factor that influences dietary choices for many people. Foods with low nutritional value are often more affordable and more easily accessible than foods with high nutritional value. Fresh fruits, vegetables, and lean proteins are more costly per serving than alternatives that are higher in sugar and fermentable carbohydrates [44]. In addition, there is an inverse relationship between calories and cost per serving: Nutritionally deficient foods such as those with high sugar, fermentable carbohydrate, and fat content are among the most affordable dietary choices [45]. When recommending diet modifications to patients, dental professionals need to consider food costs for many reasons. Studies show that persons of low socioeconomic status tend to live in neighborhoods known as food deserts , where good quality, nutritional foods are scarce and transportation and the time needed to get to nutritional food sources factor into the cost of food [46]. Due to the higher costs associated with healthier foods, people with low incomes incur the highest risks of diet-related conditions [47]. Media Media have an impact on diet in two ways. Children ages 8 to 18 spend approximately 7.5 hours every day with media, includ- ing television, the Internet, music, magazines, cell phones, and tablets. Marketing of foods and snacks to children tends to be geared toward low-nutrition foods and beverages [48]. Media influence diet choices, especially those of children, by the sheer number of food-related advertisements found on television, in print, and on cell phones and tablets—which can evade parental monitoring [48]. By realizing the factors that affect patients’ diets, dental profes- sionals are more likely to recommend diet changes to which patients will be willing to adhere. Also, dental professionals can educate patients about these factors to facilitate self-assessment of dietary influences. POPULATIONS AT RISK Certain populations are at increased risk for caries formation due to diet, habits, lack of adequate oral hygiene, and other fac- tors. These populations can especially benefit from nutritional counseling and caries prevention applications and procedures.
established limits on the amount of fat, sugar, sodium, and calories in foods that are sold in vending machines within school settings [35]. The Smart Snacks school nutrition stan- dards have specific nutritional requirements for food items sold in vending machines, student stores, and snack bars [36]. However, simply not having these options available is not the complete answer. Hungry teens need to understand the ben- efits of high-nutrient snack options and learn to seek them out. Within the United States, vending machines are present in 43% of elementary schools, 74% of middle schools, and 98% of high schools [37]. Though Congress has mandated a reduc- tion of foods and snacks in schools that are correlated with obesity and dental caries, schools continue to struggle with replacing these items with more nutritional, low-fat options as do hospitals and workplaces [38]. Many schools gain some rev- enue from vending machine sales, which adds to the complexity of changing food items. Schools, food vendors, and families continue to struggle with balancing nutrition, funding, and adolescents’ food preferences. Vending machines are found in many places besides schools, and the low nutritional quality of vending machine foods is generally consistent throughout the different locations [38]. Increasing the nutritional value of foods available through vending machines would have a positive impact on various groups. Dental professionals should educate patients about the healthiest and least caries-promot- ing vended items, such as sunflower seeds, nuts, crackers with cheese, and sugar-free gum. Many fast food chains have added more nutritious options to their menus in an effort to appeal to health-conscious consum- ers. Dental professionals can promote patients’ oral health by educating them about the impact of common convenience foods on the caries process and guiding them toward more healthful choices. Parental Influence Parental influence also plays a role in diet choices, especially those of children and adolescents [39]. Because parents gener- ally purchase the foods available for snacking and family meals, they have a high level of control over what foods are eaten by their children. Children tend to emulate their parents’ food choices [39; 40]. Parents’ food choices and nutritional guidance can be driven by habits, myths, misinformation, weight control efforts or problems, availability, and their own nutritional knowledge [17; 41]. Other factors that influence dietary choices include cultural preferences, parenting styles, and family dynamics [17]. Dental professionals should guide parents to not buy sodas and low-nutrient foods in an effort to discourage the formation of habits such as snacking and soda consumption that can contribute to caries. Parents may need to be guided to make healthy, affordable choices for themselves and their families. Also, parents can limit snacking by not allowing children to eat while watching television or playing video games. Educating parents about their influence and guiding them toward healthy food choices can benefit the entire family.
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