Nutrition and Oral Medicine (Nutrition and Health)

Chapter 7 / Compromised Nutrition 121value if the stimuli from dental plaque are not removed. There is still little knowledgeabout the interaction between the presence or absence of plaque and coexisitance ofnutritional deficiencies. Further studies are needed to clarify the role of nutrition inperiodontal disease and to determine the extent to which adequate dietary intake willaffect the initiation, progression, or treatment of periodontal disease.7. SUMMARY OF THE RELEVANCE TO CURRENT-DAY DENTISTRYAlthough severe nutritional deficiencies are rare in the Western world, they are commonlyfound in developing countries. In the latter, oral diseases are not the main targetfor health authorities where general health aspects take priority. However, it is generallybelieved that malnutrition impairs innate and adaptive defenses of the host and that theseverity of oral infections can be intensified, leading to their development into lifethreateningdiseases such as noma (50). As one tool in the combat against the differentoral diseases discussed in this chapter, an optimal dietary intake of nutrients should betaken care of. Generally optimal oral health, including reduced levels of dental caries andperiodontitis, is considered essential in order to retain a high number of teeth into olderage and thereby have the ability to consume a healthy, varied diet. There is evidence thatloss of teeth may be associated with suboptimal intake of nutrients (119–121).The primary oral infectious diseases, dental caries and periodontitis, can today bekept at a low level by different preventive tools such as adequate exposure to fluoride,restricted free sugars consumption (with respect to dental caries), and oral hygiene anddifferent antimicrobial agents (with respect to periodontal disease). One may speculatewhether the nutritional status is of lesser importance during high preventive measures.Unfortunately, there is still a lack of knowledge to which extent different nutrientsinterfere with the initiation and progression of certain oral diseases. Little is also knownabout how this differs among individuals and in relation to variation in a general healthperspective. This is of particular interest for the increased number of older persons seenworldwide.Today, many nutritional aspects are well understood but seldom considered in formulatingand executing a treatment plan. Patients may not be aware of the effects of diet and/or nutritional status on the development and maintenance of a healthy mouth, includingteeth free from caries and signs of periodontal disease. It is important that all dental careproviders look for potential signs of nutritional deficiencies or nutrition-related problemsin all patients, but particularly for those with chronic diseases. The link between nutritionand oral health may vary from subtle to overt.8. CONCLUSIONS AND RECOMMENDATIONSAn important consideration is that many of the oral consequences of compromisednutritional status discussed in this chapter may themselves directly or indirectly result inan aggravation of the malnutrition. This applies not only to developing low-incomecountries, because a clear example is the housebound older adult living in industrializednations. One example is that a poor diet in earlier life results in tooth loss in later life.Tooth loss then limits the diet and compromises nutritional status, which may thenpredispose to other oral conditions and impaired general health. A second example is areduced salivary secretion (which is common in older age) that results in sore gingiva and