By Dr. Kyla Romard
NSDA Clinical Affairs Manager

As the hustle and bustle of back-to-school season approaches, families find themselves immersed in shopping for supplies, adjusting to new schedules, and preparing meals amidst the chaos. In this flurry of activity, one aspect that often gets overlooked is maintaining good nutrition, especially when it comes to oral health.

Dentists have a unique role as healthcare providers, as much of our daily interaction with patients occurs through routine examinations and preventative therapy. These annual or semi-annual check-ups are (usually) painless and stress-free for patients, creating an atmosphere that easily lends itself to patient education about a variety of topics, including oral hygiene, restorative treatment options, care of oral appliances, and nutrition.

Many dentists may consider nutritional counselling to be an intrusive and awkward conversation to have with patients. Others may find it to be beyond the scope of practice, believing their knowledge to be limited on such an expansive topic. However, nutrition is an integral component in both oral and overall health, and dentists should be able to provide some basic nutritional education to their patients. Poor nutrition can lead to oral maladies, including caries, gingivitis, and mucosal pathologies. It may also lead to the progression of periodontitis and the reduction of tissue repair capacity needed to combat recurrent oral diseases or induce proper healing after surgical procedures.

When it comes to establishing life-long nutritional habits conducive to a healthy oral cavity, dietary counselling can begin as early as three months in utero. Indeed, the systemic effects of diet are most important when teeth are forming, which occurs between the third and sixth month of pregnancy. As such, it is essential your patients who are pregnant or are trying to become pregnant consume enough protein, vitamins (especially A, C, and D), calcium, and phosphorus needed for the development of healthy tooth buds. To reduce the risk of birth defects, you should recommend these patients take a dietary supplement of folic acid and eat foods high in folate and rich in folic acids (e.g. asparagus, broccoli, spinach, legumes, oranges, strawberries, bananas, and grain products fortified with folic acid). Once the baby arrives, dentists can encourage breastfeeding, if possible, but should advise parents that at-will nocturnal breastfeeding after eruption of the first tooth can cause early tooth decay. Should parents choose to bottle feed, it is important to discuss with them the frequency of feedings.

Parents should also be advised of the following:

• Avoid putting children to bed with a bottle, as prolonged night-time feedings past the age of six months can increase the risk of caries 
• Avoid filling bottles with sugar water, juice, or soft drinks

Most dentists encourage parents to bring their child in for a complete oral exam by age one. During this exam, it is customary to begin a dialogue with parents regarding the child’s dietary habits. Dentists should recommend children be encouraged to drink from a cup by their first birthday. Milk or juice should only be offered with meals (never in a sippy cup), as the increase in saliva during mealtime and decrease in frequency that the teeth are in contact with sugars lowers the risk of tooth decay. Children should be given healthy and nutritious snacks throughout the day, including vegetables, fruits, and cheese, cut in sizes easy for little hands. Foods that are overly sticky or chewy, such as dried fruit, should be avoided, as these are not easy to remove from teeth and create an environment that contributes to cavity formation. Snacks that are high in starches, such as loose cereal, crackers, or teething biscuits, should be avoided for the same reasons. 

Adolescents and young adults can pose challenging obstacles when it comes to nutritional counselling, as they may be more independent when making food choices. Opting for sugary, high-fat, high-carb foods, while tempting, can cause serious long-term damage to the oral cavity. Teenage boys are found to be the highest rising consumers of sugar-sweetened beverages, such as soft drinks, sports drinks, and energy drinks. In combination with oral appliances (i.e. braces, retainers), which are commonly worn in this demographic, poor nutrition can result in loss of tooth structure and the beginning stages of more serious chronic oral conditions. Nutritional counselling in combination with oral hygiene instruction is imperative in teenage years.

It is also important to note that eating disorders, such as bulimia, can be first diagnosed by dental professionals due to the pattern of acidic wear on the teeth — most notably the lingual of the maxillary anteriors. Though dentists and other dental professionals are not expected to provide treatment for eating disorders, early diagnosis is important and referral to the patient’s family physician can help aid in successful recovery. 

Acknowledging the hectic schedules of back-to-school season, dentists can provide practical tips for families to integrate healthy eating habits seamlessly into their routines:

• Meal prep: Spending some time on weekends to prepare nutritious meals and snacks for the week ahead can save time and promote healthier choices.
• Smart snacking: Keeping convenient, tooth-friendly snacks, like cut-up vegetables, fruit slices, or cheese sticks, readily available can prevent reliance on less healthy options.
• Hydration: Encouraging children to drink water throughout the day not only keeps them hydrated, but also helps wash away food particles that can contribute to tooth decay.

Approaching the subject of nutrition doesn’t have to be overly formal or rigorous. It can be as simple as asking a patient to fill out a questionnaire about their dietary habits, including the frequency of sugar consumption and nutritional supplements they may be taking. Recommendations can be made based on patient’s responses in conjunction with age, gender, and any medical morbidities/comorbidities.

Dentists can also provide a variety of resources to patients, such as Canada’s Food Guide, which can be easily accessed online. Resources for consumers include healthy eating recommendations, food guide snapshots, and education on understanding food labels. There are also resources for professionals, including dietary guidelines and toolkits.

In cases where full nutritional counselling is complex, dentists should advise their patients as best they can and refer them to an appropriate healthcare professional (e.g. family physician, a registered dietitian) for further guidance. The more support patients feel from their healthcare providers as a team, the more likely they are to take positive action in regards to their diet and maintain a healthy lifestyle.

As families gear up for another school year, the guidance provided by dentists serves as a reminder that prioritizing good nutrition can be both manageable and rewarding, laying the foundation for healthier smiles and happier lives.