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Chapter 17: Effects of Systemic Disease on Nutritional Status and Oral…
Chapter 17: Effects of Systemic Disease on Nutritional Status and Oral Health
Oral problems may develop as a result of disease processes or therapies or by nutritional deficiencies
subsequent oral issues can cause inadequate intake
Ramification of a patients systemic health are important to the dental hygienist because they provide cues to possible oral problems.
More than 1/3 of the patients seen in a dental office do not frequently interact with general health care providers
Effects of Chronic Disease on Intake
Anorexia and Appetite
Anorexia nervosa refer to a condition in which a patient has a poor appetite and/or decreased food intake for a variety of reason
Malnutrition and other stresses, like infection, surgery, and injuries result in anorexia, deplete body stores of calories, macronutrients, and micronutrients needed to regenerate and repair cells
Appetite is associated with enjoyment of food . Most healthy individuals have a good appetite with no problems eating adequate amounts
During illness, appetite may decrease because of pain, apathy, anorexia, drugs, inactivity, or many other reasons
Taste and Smell Disorders
Foods that people choose to eat are modulated by taste, smell, and oral textural perception. Taste and smell dramatically affect appetite and food intake
Various disease conditions, medications, smoking, and treatment for the conditions may result in chemosensory disorders
Xerostomia
saliva protects hard and soft oral tissues from mechanical, thermal, and chemical irritants in addition to its roles in buffering acids, antimicrobial activity, and remineralization.
can affect nutritional status in several ways:
chewing is difficutl because a bolus cannot be formed without additional moisture
chewing is painful because the mouth is sore
swallowing is difficult because of loss of lubrication from saliva
food intake may decrease because of changes in taste perception
Anemias
Typical symptoms of all the anemias are pallor of the skin, oral mucosa, and conjunctival tissues, along with overall weakness as a result of inadequate oxygen-carrying power of the blood
occurrence and severityt of clinical symptoms depend on the degree of anemia and speed of onset
Iron Deficiency Anemia
can be caused by a deficiency of dietary iron or by excessive bleeding
likely to occur in periods where iron requirements are high, such as during infancy or pregnancy
Megaloblastic (pernicious) Anemia
Vitamin b12 deficiency can result in a megaloblastic anemia
condition occurs when vitamin B12 is deficient in the diet, absorption is inadequate or requirements are increased
Another type of megaloblastic anemia is caused by folic acid deficiency, which is frequently associated with poor diets or medications that interfere with folate absorption or metabolism
Neutropenia
a diminished number of neutrophils, the most abundant type of WBC
may predispose an immunocompromised patient to life-threatening infections
Gastroesophageal Reflux, Hiatal Hernia, and Esophagitis
The most common symptom of gastroesophageal reflux disease is heartburn 30 minutes to an hour after eating
this condition is commonly associated with hiatal hernia- a partial protrusion of the stomach through the diaphragm
also associated with pregnancy and obesity
Esophagitis is an inflammation of the lower esophagus and may cause discomfort when swallowing
Patients are frequently advised to decrease their intake of foods that may precipitate reflux, such as fatty foods, peppermint, caffeinated foods, alcohol, and onions
Malabsorptive Conditions
Many chronic diseases are associated with poor nutrient absorption, including Crohn disease, ulcerative colitis, cystic fibrosis, glutensensitive enteropathy, and AIDS.
Gluten is a protein found in mainly wheat and to a lesser degree in rye, oat, and barley
Different parts of GI tract are affected in these disorders, and manifestations differ from one individual to another with the same condition
Oral problems associated with Crohn disease and ulcerative colitis include swollen, bleeding, erythematous gingiva; diffuse pustular eruptions on the buccal gingiva; oral ulcerations
Cardiovascular Conditions
CVD encompasses numerous prevalent chronic heart problems, including hypertension, congestive heart failure, myocardial infarction, cerebrovascular accident, and arteriosclerosis
there may be a risk of CVD resulting from systemic exposure to periodontal pathogens
Cerebrovascular Accident (Stroke)
results if occlusion or ischemia occurs in an artery supplying the brain or if hemorrhaging in the brain occurs
Ischemia is inadequate blood flow and lack of oxygen because of constriction or obstruction of arteries
Thrombus is the proper term for a blood clot
Atherosclerosis is caused by an accumulation of fatty materials on smooth inner walls of arteries
Hypertension
Blood pressure that is consistently 140/90 mm Hg or higher is known as stage 1 hypertension
Hyperlipidemia
patients with other types of heart disease involving elevated cholesterol levels or increased risk of atherosclerosis normally have a saturated, trans and total fat restriction as well as a calorically restriction
Skeletal System
systemic bone disturbances initially may be detected by the following changes in the maxilla or mandibular during an oral examination
Metabolic Problems
Diabetes Mellitus
current evidence supports an interrelationship between diabetes and oral health problems
pateints with uncontrolled or undiagnosed diabetes may have a characteriestic fruity-smelling breath, increased thirtst, unexplained weight loss, or frequent urinations