WEEK 1 - Review Notes & Worksheet:

Read Sroda & Reinhard (2018) Ch. 1 and the following documentation:

Table of Contents:
Introduction
Nutritional Counselling Process of Care
Factors that Influence Nutrition
Introduction to Key Nutrients
Energy Needs & Calories
Nutrient Density

Objectives:
1. List the steps of the Nutritional Counselling Process of Care.
2. Identify at least 3 clients who may require nutritional counseling.
3. Name and describe at 3 factors that affect nutrition.
4. Explain what nutrition is comprised of.
5. Differentiate between essential and nonessential nutrients.
6. List the 6 key classes of nutrients.
7. Know the number of Calories (kcals) in 1 gram of a carbohydrate, protein, and fat.
8. Name 3 reasons the body needs energy.
9. Differentiate between a state of energy balance and imbalance.
10. Describe nutrient density by differentiating between a high nutrient dense, low
nutrient dense, and empty calorie food.

Introduction:

Our 1st in-class session introduced some of the common definitions to understand as you
begin the study of nutrition. We also discussed the importance of nutrition and its close
relationship to oral health and to our overall health. We reviewed the factors of decay
epidemiological ‘triangle’ (more than 3 factors!) to illustrate the impact of diet on caries
formation. By eating fermentable carbohydrates (sugar & starches) less frequently, the
bacteria will have no source of energy to produce acids, and we can inhibit dental decay. In
addition, you have learned in previous courses, that we can also make a tooth less
susceptible because of dietary factors, such as consuming appropriate minerals to
strengthen the enamel and thereby making it more resistant to bacterial acids.

But what about other oral conditions such as periodontal (gum) disease, post surgical or
traumatic wounds, orthodontic tooth movement, and a host of other oral aliments? We will
discover that diet and nutrition can play a significant role in causing, preventing or helping
to heal these problems.

Throughout the remainder of this course we will be keenly studying the effects of nutrition
on oral health and overall health. Conversely, we will also be studying the factors that
influence our diet and nutrition. So, let’s start there now…

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The dental practitioner is not only concerned with educating clients for the prevention of
caries and periodontal disease. Due to the frequent contact with clients, the dental
practitioner is in an important position to screen clients for other diet and health related
risks.

The “Nutritional Counselling Process of Care” outlines the steps to providing nutritional
care. The steps were briefly in class; however, we will eventually be looking at each step
in detail.

Nutritional Counselling Process of Care:

1. Assessment:
Document clinical observations, health, and social history
Dietary record

2. Diagnosis:
Analyze & interpret data
Review / Research / Calculate

3. Planning:
Determining recommendations / strategies for change (improvement)
Goal setting with client

4. Implementation:
Counselling process, communication
Provide resources
Client action

5. Evaluation:
Re-assess
Draw conclusions

Who Needs Counselling?

In the last class we discussed various types of clients who may benefit from dietary
counselling. Dental hygienists must keep up to date regarding their scope of practice
regarding nutrition counselling. An important message to emphasize:

Clients with multiple diet related health problems whose diet or eating pattern
appears to be inadequate, or who have a complicated health condition, should be
referred to their physicians or a diet / nutritional specialist.

First Step: “Assessment”

Objectives of Dietary Assessment:
 “To provide an opportunity for a client to study personal dietary habits objectively.
 To obtain an overall picture of the types of food in the client’s diet, food
preferences, and quantity of food eaten.
 To study the food habits and snacking patterns.
 To record frequency of use and when the cariogenic (cavity causing) food is

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 consumed.
 To determine the overall consistency (sticky, liquid, etc.) of the diet and the fibrous
foods that are regularly included.
 To identify the nutritional status of an individual with regard to overall requirements
and then collaborate with the patient to make suggestions for modification in
nutritional adequacy of the diet in health promotion
 Plan with the patient for necessary changes to improve the health of the oral
mucosa and periodontium and prevent dental caries”.

Wilkins, E. M. (2017). Clinical practice of the dental hygienist. Philadelphia: Wolters Kluwer Health/Lippincott
Williams & Wilkins. P 582

There are a number of observations to be made. Some of the most obvious “visual” data
can be gathered while the client is present for their dental visit. Other clinical data may
need to be assessed by a specialist.

Clinical observations, or signs, of good or poor nutritional status may appear in:
 Body size /Posture /Gait
 Face /Skin /Nails
 Eyes
 Oral cavity – lips, teeth, gingival (firm oral tissue), tongue, mucosa (soft oral tissue) -
(signs often first observed here - often oral problems are a manifestation of an
underlying health problem!)

It is important that the client is treated as a ‘whole’, i.e. considering all of the factors
relating to their nutrition that can be assessed.

Factors that Influence Nutrition:

Read about each factor and try to provide a specific example for any of
these from your experiences.

Oral Health:
- It is important to consider that the oral cavity is the gateway to providing nourishment
for the whole body. Disturbances in oral health can profoundly affect diet & ultimately
nutritional status.

Eg._____________________________________________________________

Activity Level:
- Activity requires energy, as we will be looking at more closely later on in this lesson.
To expend energy our bodies need to take in energy, food, to be specific. Some
people need more energy for activity than others.

Eg._____________________________________________________________

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Age/ Growth Stage/ Gender:
- From our embryonic stage through infancy, childhood, adolescence, & into our old age,
we have varying nutritional needs. Again we will be studying these needs in depth,
later in the course though. Our body’s change in growth needs according to our age &
gender, & therefore in nutrient needs.

Eg._____________________________________________________________

Overall Health / Disease / Medications:

- Just as nutrition can affect overall health, overall health can also affect nutrition. There
are many health conditions that can physically, systemically or emotionally affect
nutrient intake & /or metabolism. Often medications taken to treat these problems can
also interact and affect nutrient intake.

Eg._____________________________________________________________

Cultural / Religious:
- There are numerous cultural or traditional foods eaten by various populations. Their
‘way’ of eating can significantly affect nutrient intake patterns. Similarly, religious
traditions can dictate various types & times food is eaten.

Eg._____________________________________________________________

Geographic Location:
- Where we live can often influence the types and availability of food products we readily
have access to. This in turn can relate to our ability to find a variety of food to supply
all of the necessary nutrients.

Eg._____________________________________________________________

Lifestyle:
- Our and food selection, preparation, and dining practices are often directly related to
our lifestyle. It may be an ongoing practice or temporary according to changing life &
schedule influences.

Eg._____________________________________________________________

Marketing/ Advertising/ Peer Influence:

- We are bombarded with food, diet & nutrition messages from the media. Needless to
say they can have some level of influence on our food choices & eating habits. As
well, we can be readily influenced by our peers to eat socially acceptable, “cool” foods.

Eg._____________________________________________________________

Education / Scientific Information:

- Knowledge through education empowers us to make appropriate food choices which
can significantly affect nutrition. This education may come from school courses, health
professionals, parents, books, media reports, reading food labels…

Eg._____________________________________________________________

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Socio-economic status:
- Our monetary status and other social supports can make purchasing or achieving
nutritious foods easier or more difficult.

Eg._____________________________________________________________

Preferences/ Senses/ Past experiences:

- There are some foods we like, and some we don’t. Often this is based on the
response of our 5 senses – sight, smell, taste, sound & feel. Sometimes it may relate
to a past happy or unhappy experience with a food. Or we may have an emotional
association with food.

Eg._____________________________________________________________

Food processing/ Additives/ Enrichment:

- The processing of ‘modern’ foods can lead to a loss of nutrients or the addition of
excessive nutrients due to preparation techniques. Potentially harmful additives to
these foods may serve no nutritional purpose. On the other hand some ‘modern’
processing techniques can enrich the nutritional value of some foods, and increase our
ability to ‘take in’ necessary nutrients.

Eg._____________________________________________________________

Introduction to Key Nutrients:

NUTRITION = NUTRIENTS + ENERGY

In order to choose foods for health and performance we must assess:
- The body’s need for water, energy and nutrients
- What kinds and combinations of foods meet those requirements?
Let’s begin our investigation…

Nutrients are substances that supply the body with essential elements. These nutrients
are necessary for:
- growth, maintenance, and repair of tissues
- energy requirements
- regulating body processes
- maintaining a constant internal environment”

Essential nutrients are those necessary for healthy body function. Nutrients that could be
eliminated from the diet with no adverse effects are termed nonessential nutrients.
There are about 40-45 essential nutrients. The concepts of what is essential and the roles
of nonessential nutrients are constantly changing as new scientific research emerges (an
example is the increasingly important role of ‘phytochemicals’ being determined in today’s
research).

Nutrients are traditionally classified into six key nutrient classes. They are:

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(following the 1st class, you should now be able to “fill in the blanks”)
1.
2.
3.
4.
5.
6.

We will be focusing on each of the key nutrients in great detail over the next few weeks,
but first let’s focus on the “energy” part of the equation.

Energy Needs:

Several of these key nutrients play an important role of providing energy to our bodies. Of
the 6 key nutrient classes, the nutrients which provide energy include carbohydrates,
proteins, and fats. The relative energy from each source varies and is measured in
calories.

The calorie is also the basic unit used to measure our energy needs & energy use. One
calorie is the amount of heat required to raise the temperature of 1 gram of water by 1
degree. Take note: the term ‘Calorie’ with a capital ‘C’ is equal to 1000 calories (with a
small ‘c’) or a “kilocalorie”. However, it has been commonly accepted to speak in terms of
“Calories” - but – a small ‘c’ is used in place of the capital (confusing – I agree!).

In Canada you may find calories on food labels expressed as “kilojoules” This is the
metric (international) measurement of food energy.
4.184 kilojoules = 4,184 joules = 1 Calorie = 1 kilocalorie = 1,000 calories

It is known that:
1 gram of carbohydrate = ____ Calories
1 gram of protein = ____ Calories
1 gram of fat = ____ Calories
1 gram of alcohol = 7 Calories – (this reference given to point out the significantly high #
of calories in alcohol, even though it is not a nutrient)

The average adult male requires 2400 Calories of energy from food each day. The
average adult female requires 2000 Calories/day.

These energy requirements change according to the individual’s stage in the lifespan and
physical activity levels. For example a rapidly growing adolescent, pregnant woman, or a
professional athlete will have greater energy requirements.

Watch this video to gain a clearer explanation of how energy is measured in food:
https://www.youtube.com/watch?v=VEQaH4LruUo
- What is a "large" Calorie? Also, this video does a good job at explaining how the need
and use of calories varies for each individual.

The body needs energy for many different functions:

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 1. basal metabolism the energy required for involuntary physiological
functions to maintain life, including respiration, circulation, and
maintenance of muscle tone and body temperature (60-70% of total
energy)
2. to consume and digest the nutrients in food (10% of total energy)
3. physical activity
Energy balance in an individual is achieved by consuming an equal # of calories as the #
of calories expended on growth, physical activity, basal metabolism and
thermogenesis (digestion and absorption). When more (+) or less (-) calories are
consumed than are expended, the body is said to be in an energy imbalance. When too
few calories are consumed over a long period of time it will lead to weight loss. When
more calories are consumed than expended it will lead to weight gain. Both cases can
lead to an increased risk of illness and disease.

How do we know if a person is of a ‘healthy' weight? One way to determine this is by

calculating their Body Mass Index (BMI). BMI is a “#” given to describe the relative weight
according to a person’s height. When calculated correctly, by measuring various body
circumferences & tissue folds, BMI can be an indicator of healthy weight, or under or
overweight status and potential risk of related illness and disease.

It is helpful to be familiar with the BMI calculation table and you may wish to calculate your
own BMI using internet tools.

BMI measurement using charts alone does not take into account variations in body types.
Note that the Canadian Heart & Stroke Foundation believes measuring your waist line may
be a more effective risk assessment tool as you can read about at this site:
http://www.heartandstroke.ca/get-healthy/healthy-weight/healthy-weight-and-waist

Nutrient Density

Another concept that is important to consider when looking at the # of calories in a food, is
the nutrient density. Nutrient density is an indication of the amount of nutrients provided
by a food relative to its calories. If a food is packed with vitamins and minerals, and
contains few calories, this food is said to have a high nutrient density. If a food contains
very few nutrients in comparison to the high number of calories, that food is said to have a
low nutrient density. If a food contains little or no nutrients and high calories, that food is
referred to as an empty calorie food.

Compare the mineral nutrient calcium to the number of calories in two different foods: 1
piece of custard pie contains 110mg of calcium and 250 Calories,
½ ounce of cheddar cheese contains 102mg of calcium and 60 Calories.

1. Which food is more nutrient dense?

2. Provide an example of an empty calorie food (perhaps your ‘favourite’ one!) Why do
you eat these types of food? Is it ‘ok’ to eat these foods?

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