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The role of sugar consumption and oral health refocused largely due to associations between systemic diseases and conditions (type 2 diabetes, obesity) and oral health. This review examines the evidence supporting the impact of sugars on oral diseases and the role of sugars in oral-systemic complications. The increased consumption of dietary sugars, including sugar-sweetened beverages, and the increasing percentage of sugars as a component of the US diet affect oral health in the population. It is important for dental professionals to know public health implications and strategies to effectively communicate this risk to patients’ oral health. Local and state governments experienced success with the regulation of sodas and sugar-sweetened beverages and studies demonstrated that these regulations are largely successful in decreasing consumption among adolescents. It is the role of the dental professional to support these activities to promote healthy dietary choices for patients.

The American Dental Education Association’s Leadership Institute (ADEA LI) is the association’s flagship development program for those aspiring to leadership in dental and higher education. As with previous studies of the ADEA LI, ADEA will use information from the survey described in this report to improve the ADEA LI curriculum and to guide other leadership development efforts. In 2014-15, ADEA distributed a 50-item online survey via email to all ADEA LI alumni from the classes of 2000 through 2014. The survey included selected-response questions, closed-ended questions, and open-response questions. The survey had an overall response rate of 47% (133/285); response rates to individual items varied. The mean age of the respondents when they participated in the Institute was 48.5 years. Men and women were almost equally represented among the respondents. Nearly half reported their ultimate career goal as department chair, associate dean, or assistant dean, while 20 (15.8%) indicated a goal of becoming dean and 15 (11.8%) aspired to administrative roles higher than dean. Areas the respondents recommended for improvement included more programming in budgeting and financial management, fundraising, and personnel management. Almost 100% of the respondents indicated they would recommend the ADEA LI to others. Overall, the survey respondents confirmed the value of the ADEA LI in their assessment of their fellowship and its subsequent application to their careers. Comparison of elements from this study to previous studies of ADEA LI alumni demonstrates the effectiveness of past changes made to the Institute and the creation of additional ADEA leadership initiatives.

To develop a profile of current U.S. dental school deans and report their perceptions, challenges, and opportunities that should be addressed in the leadership development programs of the American Dental Education Association (ADEA), data were gathered using a web-based survey organized into seven content areas. In 2014, the deans of all accredited dental schools in the U.S. including Puerto Rico were invited to participate in the survey. The response rate was 86% (56/65). A majority of the deans were male (N=44; 79%) and white/non-Hispanic (N=49; 88%); all reporting degrees held a DDS/DMD (N=54; 100%). Just over half were between the ages of 46 and 55 (N=31; 55%) when they first became a dean. The mean age of these deans was 61.4 years, with a range of 48-72. The respondents reported that school administration/management, fundraising, students, the academic environment, leadership development, and faculty had a high level of influence on their job satisfaction. Communication, conflict resolution, and finance were reported as the most important knowledge areas. A majority reported being better prepared for clinical education and student relations than fundraising and research when they took their positions. They responded that finances and faculty recruitment and retention were their greatest challenges as a dean. Among these respondents, 98% (N=55) reported being satisfied to very satisfied with their job overall. The survey results will inform ADEA’s leadership development programs for the next five to seven years.

The purpose of this project was to evaluate a Research, Professional Development, and Critical Thinking Integrative Model developed for use in a dental curriculum. This article outlines strategies used in developing a competency-based pedagogical model designed to provide a tailored student learning environment with objective, measurable, and calibrated assessment outcomes. The theoretical model integrated elements of critical thinking, professionalism, and evidence-based dentistry across dental school disciplines; implementation was based on consensus of dental faculty and student representatives about course content, faculty allocation, and curriculum alignment. Changes introduced included the following: 1) conversion and integration of previously siloed course content taught in Years 1 and 2 to sequential two-year combined courses; 2) reduction of course and content redundancies; 3) delivery of courses by teams of faculty members in biomedical, behavioral, and clinical sciences; and 4) reduction of total curriculum credit/contact hours from 13.5 (201 contact hours) to 5.0 (60 contact hours), allowing the Curriculum Committee to accommodate additional courses. These changes resulted in improvement in student satisfaction.

Georgia Dounis,1 Marcia Ditmyer,2 Susan VanBeuge,3 Sue Schuerman,4 Mildred McClain,1 Kiki Dounis,1,5 Connie Mobley21Department of Clinical Sciences, 2Department of Biomedical Sciences, 3Department of Physiological Nursing, 4Department of Physical Therapy, University of Nevada Las Vegas School of Dental Medicine, Las Vegas, NV, USA; 5Department of Family Medicine, University of Nevada School of Medicine, Reno, NV, USABackground: Health care workforce shortages and an increase demand for health care services by an older demographic challenged by oral–systemic conditions are being recognized across health care systems. Demands are placed on health care professionals to render coordinated delivery of services. Management of oral–systemic conditions requires a trained health care workforce to render interprofessional patient-centered and coordinated delivery of health care services. The purpose of this investigation was to evaluate the effectiveness of an interprofessional health care faculty training program.Methods: A statewide comprehensive type 2 diabetes training program was developed and offered to multidisciplinary health care faculty using innovative educational methods. Video-recorded clinically simulated patient encounters concentrated on the oral–systemic interactions between type 2 diabetes and comorbidities. Post-encounter instructors facilitated debriefing focused on preconceptions, self-assessment, and peer discussions, to develop a joint interprofessional care plan. Furthermore, the health care faculty explored nonhierarchical opportunities to bridge common health care themes and concepts, as well as opportunities to translate information into classroom instruction and patient care.Results: Thirty-six health care faculty from six disciplines completed the pre-research and post-research assessment survey to evaluate attitudes, knowledge, and perceptions following the interprofessional health care faculty training program. Post-training interprofessional team building knowledge improved significantly. The health care faculty post-training attitude scores improved significantly, with heightened awareness of the unique oral–systemic care needs of older adults with type 2 diabetes, supporting an interprofessional team approach to care management. In addition, the health care faculty viewed communication across disciplines as being essential and interprofessional training as being vital to the core curriculum of each discipline. Significant improvement occurred in the perception survey items for team accountability and use of uniform terminology to bridge communication gaps.Conclusion: Attitude, knowledge, and perceptions of health care faculty regarding interprofessional team building and the team approach to management of the oral–systemic manifestations of chronic disease in older adults was improved. Uniform language to promote communication across health professionals, care settings, and caregivers/patients, was noted. Interprofessional team building/care planning should be integrated in core curricula.Keywords: team building, patient-centered care, oral–systemic, older adults

It is the position of the Academy of Nutrition and Dietetics that nutrition is an integral component of oral health. The Academy supports integration of oral health with nutrition services, education, and research. Collaboration between dietetics practitioners and oral health care professionals is recommended for oral health promotion and disease prevention and intervention. Scientific and epidemiological data suggest a lifelong synergy between diet, nutrition, and integrity of the oral cavity in health and disease. Oral health and nutrition have a multifaceted relationship. Oral infectious diseases, as well as acute, chronic, and systemic diseases with oral manifestations, impact an individual's functional ability to eat and their nutrition status. Likewise, nutrition and diet can affect the development and integrity of the oral cavity and progression of oral diseases. As knowledge of the link between oral and nutrition health increases, dietetics practitioners and oral health care professionals must learn to provide screening, education, and referrals as part of comprehensive client/patient care. The provision of medical nutrition therapy, including oral and overall health, is incorporated into the Standards of Practice for registered dietitians and dietetic technicians, registered. Inclusion of didactic and clinical practice concepts that illustrate the role of nutrition in oral health is essential in education programs for both professional groups. Collaborative endeavors between dietetics, dentistry, medicine, and allied health professionals in research, education, and delineation of practice roles are needed to ensure comprehensive health care. The multifaceted interactions between diet, nutrition, and oral health in practice, education, and research in both dietetics and dentistry merit continued, detailed delineation.

Objective: This study examined the correlation between parenting style and oral health status. Methods: Eighty-seven children aged 2 - 14 years old were examined and their oral health status was measured by the decayed, missing, filled teeth (DMFT/dmft) index, untreated caries and caries experience. Caries experience was defined as untreated and treated teeth, either restored or filled. The parenting style of parents was measured by the Parenting Style Dimension Questionnaire (PSDQ). Demographic information recorded included race/ethnicity, level of education and child’s type of dental insurance. Results: The majority of the parents identified with the authoritative parenting style. There was no correlation between parenting styles and oral health status. Hispanic children and those whose parents had less education and low socioeconomic status (Medicaid) tended to show poorer oral health status. Conclusion: The expected relationship between parenting style and oral health status was not confirmed. Race/ethnicity, level of parents’ education and socioeconomic status may have a greater impact on oral health than parenting approaches.

The American Dental Education Association’s Leadership Institute (ADEA LI) is the association’s flagship development program for those aspiring to leadership in dental and higher education. As with previous studies of the ADEA LI, ADEA will use information from the survey described in this report to improve the ADEA LI curriculum and to guide other leadership development efforts. In 2014-15, ADEA distributed a 50-item online survey via email to all ADEA LI alumni from the classes of 2000 through 2014. The survey included selected-response questions, closed-ended questions, and open-response questions. The survey had an overall response rate of 47% (133/285); response rates to individual items varied. The mean age of the respondents when they participated in the Institute was 48.5 years. Men and women were almost equally represented among the respondents. Nearly half reported their ultimate career goal as department chair, associate dean, or assistant dean, while 20 (15.8%) indicated a goal of becoming dean and 15 (11.8%) aspired to administrative roles higher than dean. Areas the respondents recommended for improvement included more programming in budgeting and financial management, fundraising, and personnel management. Almost 100% of the respondents indicated they would recommend the ADEA LI to others. Overall, the survey respondents confirmed the value of the ADEA LI in their assessment of their fellowship and its subsequent application to their careers. Comparison of elements from this study to previous studies of ADEA LI alumni demonstrates the effectiveness of past changes made to the Institute and the creation of additional ADEA leadership initiatives.

Food service directors have a concern that federal reimbursement is not meeting the demands of increasing costs of healthier meals. The purpose of this article is to report the food option changes and the annual revenues and expenses of the school food service environment.The HEALTHY study was a 3-year (2006 to 2009) randomized, cluster-designed trial conducted in 42 middle schools at 7 field centers. The schools selected had at least 50% of students who were eligible for free or reduced-price lunch or who belonged to a minority group. A randomly assigned half of the HEALTHY schools received a school health intervention program consisting of 4 integrated components: nutrition, physical activity, behavioral knowledge and skills, and social marketing. The nutrition component consisted of changing the meal plans to meet 5 nutrition goals. Revenue and expense data were collected from income statements, federal meal records, à la carte sale sheets, school store sale sheets, donated money/food records, and vending machines.Although more intervention schools reached the nutritional goals than control schools, revenues and expenses were not significantly different between groups.The HEALTHY study showed no adverse effect of school food policies on food service finances.

This descriptive study assessed dental students’ attitudes about computer use as it relates to study habits and use of e-textbook technology. Academic deans and student leaders at all accredited dental education programs in the United States, Puerto Rico, and Canada were asked to forward an e-mail to students explaining the purpose of the study and asking them to participate. The e-mail included an embedded URL link to the survey. A total of 703 complete responses from twenty-four dental schools were received and used in the final analysis. Because the number of students contacted could not be determined, the overall response rate cannot be calculated. Over 65 percent of the respondents reported spending >11 hours per week studying although over 75 percent said they spent little time studying from their textbooks. Over 55 percent were from schools that use e-textbooks exclusively, with 25 percent from schools that exclusively use print textbooks. One-fourth indicated they purchased a traditional printed textbook even when an e-textbook was provided; more than one-third printed information from the e-textbooks rather than reading on the computer. A majority (59 percent) preferred traditional textbook resources over e-textbooks, with over 50 percent reporting not using the required e-textbooks at all. E-textbooks were used by students in this study less frequently than materials/notes provided by dental school faculty. The majority preferred to use traditional resources as references and for augmenting lecture material.

Background In three separate scenarios, the authors illustrate dietary assessment evaluations completed in dental settings by oral health care professionals (OHCPs) using time-efficient guidelines and targeted realistic patient education messages. Conclusions Patients' responses to key questions can provide OHCPs with a road map for conducting dietary assessments and evaluations, selecting specific assessment approaches, and developing targeted patient nutrition and oral health education messages. Clinical Implications To individualize and enhance comprehensive patient care, OHCPs can conduct dietary assessments, evaluate results, refer patients when indicated, and provide patient nutrition and oral health education.

The growing proportion of older adults in the U.S. population, as well as escalating dental expenditures, is leading to major changes in the demands on oral health care delivery. Researchers over the years have clearly demonstrated the shortcomings of traditional restorative treatment and the cycle of repeat interventional care. Oral health care professionals are constantly seeking advances in technology, protocols, methodologies, and materials to meet the needs of the growing, diverse older population. Early stages of oral diseases such as caries and periodontal disease are vigorous, preventable, and reversible. Assessment of social, systemic, and oral risk factors that emphasize patient counseling to facilitate risk reduction, along with individualized evidence-based disease prevention planning, is more cost-effective than traditional restorative treatment and will improve overall outcome. The purposes of this article are to briefly describe current issues and challenges related to oral health promotion for older adults and to examine strategies for disease prevention and health promotion in health and dental care settings.

Frequent consumption of simple carbohydrates, primarily in the form of dietary sugars, is significantly associated with increased dental caries risk. Malnutrition (undernutrition or overnutrition) in children is often a consequence of inappropriate infant and childhood feeding practices and dietary behaviors associated with limited access to fresh, nutrient dense foods, substituting instead high-energy, low-cost, nutrient-poor sugary and fatty foods. Lack of availability of quality food stores in rural and poor neighborhoods, food insecurity, and changing dietary beliefs resulting from acculturation, including changes in traditional ethnic eating behaviors, can further deter healthful eating and increase risk for early childhood caries and obesity. America is witnessing substantial increases in children and ethnic minorities living in poverty, widening the gap in oral health disparities noted in Oral Health in America: A Report of the Surgeon General . Dental and other care providers can educate and counsel pregnant women, parents, and families to promote healthy eating behaviors and should advocate for governmental policies and programs that decrease parental financial and educational barriers to achieving healthy diets. For families living in poverty, however, greater efforts are needed to facilitate access to affordable healthy foods, particularly in urban and rural neighborhoods, to effect positive changes in children's diets and advance the oral components of general health.

Objectives One objective of this study was to determine the prevalence and severity of caries among Nevada youth, subsequently comparing these data with national statistics. A second objective was to identify the risk factors associated with caries prevalence and severity in order to develop and tailor a theoretical screening tool for this cohort for future validation. Methods Researchers computed the prevalence rates of dental caries (D-score) and severity rates of decayed, missing, and filled teeth indices in a cohort of 9202 students, 13 to 18 years of age, attending public/private schools in the 2005/2006 academic year. Multiple regression established which of the 13 variables significantly contributed to caries risk, subsequently using logistic regression to ascertain the weight of contribution and odds ratios of significant variables. Results Living in counties with no municipal water fluoridation, increased exposure to environmental smoke, minority race, living in rural communities, and increasing age were the largest significant contributors (respectively). Exposure to tobacco, being female, lack of dental insurance, increased body mass index risk, and lack of dental sealants were also significant, but to a lesser extent. Nonsignificant factors included socioeconomic status, ethnicity, and family history of diabetes. Conclusions This study confirmed high caries prevalence and severity and identified significant risk factors for inclusion in a theoretical risk screening tool for future validation and translation for use in the early detection of caries risk in Nevada youth.

Abstract Many protocols have been used in clinical and research settings for collecting systolic blood pressure (SBP) measurements to calculate the ankle–brachial index (ABI); however, it is not known how useful it is to replicate measurements and which measures best reflect cardiovascular risk. Standardized measurements of ankle and arm SBP from 5140 overweight or obese individuals with type 2 diabetes were used to estimate sources of variation. Measurement characteristics of leg-specific ABI, as calculated using a standard algorithm based on the highest SBP of the dorsalis pedis or posterior tibial arteries, were projected using simulations. Coefficients of variability ranged from 2% to 3% when single SBP measurements were used and ABI was overestimated by 2–3%. Taking two SBP measurements at each site reduced standard errors and bias each by 30–40%. The sensitivity of detecting low ABI ranges exceeded 90% for ABI within 0.05 of the 0.90 clinical cut-point. The average and the minimum of the two (i.e. right and left) leg-specific ABI values had similar U-shaped relationships with Framingham risk scores; however, the average leg ABI had slightly greater precision. Replicating SBP measurements reduces the error and bias of ABI. Averaging leg-specific values may increase power for characterizing cardiovascular disease risk.

To develop a profile of current U.S. dental school deans and report their perceptions, challenges, and opportunities that should be addressed in the leadership development programs of the American Dental Education Association (ADEA), data were gathered using a web-based survey organized into seven content areas. In 2014, the deans of all accredited dental schools in the U.S. including Puerto Rico were invited to participate in the survey. The response rate was 86% (56/65). A majority of the deans were male (N=44; 79%) and white/non-Hispanic (N=49; 88%); all reporting degrees held a DDS/DMD (N=54; 100%). Just over half were between the ages of 46 and 55 (N=31; 55%) when they first became a dean. The mean age of these deans was 61.4 years, with a range of 48-72. The respondents reported that school administration/management, fundraising, students, the academic environment, leadership development, and faculty had a high level of influence on their job satisfaction. Communication, conflict resolution, and finance were reported as the most important knowledge areas. A majority reported being better prepared for clinical education and student relations than fundraising and research when they took their positions. They responded that finances and faculty recruitment and retention were their greatest challenges as a dean. Among these respondents, 98% (N=55) reported being satisfied to very satisfied with their job overall. The survey results will inform ADEA’s leadership development programs for the next five to seven years.

It is the position of the American Dietetic Association that nutrition is an integral component of oral health. The American Dietetic Association supports the integration of oral health with nutrition services, education, and research. Collaboration between dietetics and dental professionals is recommended for oral health promotion and disease prevention and intervention. Scientific and epidemiological data suggest a lifelong synergy between nutrition and the integrity of the oral cavity in health and disease. Oral health and nutrition have a synergistic bidirectional relationship. Oral infectious diseases, as well as acute, chronic, and terminal systemic diseases with oral manifestations, impact the functional ability to eat as well as diet and nutrition status. Likewise, nutrition and diet may affect the development and integrity of the oral cavity as well as the progression of oral diseases. As we advance in our discoveries of the links between oral and nutrition health, practitioners of both disciplines must learn to provide screening, baseline education, and referral to each other as part of comprehensive client/patient care. Dietetics practice requires registered dietitians to provide medical nutrition therapy that incorporates a person's total health needs, including oral health. Inclusion of both didactic and clinical practice concepts that illustrate the role of nutrition in oral health is essential in both dental and dietetic education programs. Collaborative endeavors between dietetics and dentistry in research, education, and delineation of health provider practice roles are needed to ensure comprehensive health care. The multifaceted interactions between diet, nutrition, and oral health in practice, education, and research in both dietetics and dentistry merit continued, detailed delineation.

To determine if there was an association between the type of dental procedure being performed on children and parental desire to be present in the operatory.Parents (N=339) whose children had dental appointments at a university pediatric dental clinic or affiliated practices in Southern Nevada completed a survey. Parents identified attitudes/preferences associated with five commonly conducted pediatric dental procedural scenarios. Data were analyzed using chi-square tests (P=.05).Most respondents (N=339) were female (N=248) and/or Hispanic (N=204), had a household income of less than $50,000 annually (N=251), and a high school education. The primary reason (78 percent) parents wanted to be present during their child's dental treatment was comfort. Most parents wanted to observe exams/X-rays (70 percent), sedation procedures (69 percent), fillings and crowns (66 percent), extractions (64 percent), and physical restraint (61 percent). Only 38 percent of parents would be content with the dentist unilaterally deciding about their presence in the operatory.Parents in this study expressed a preference to remain with their child during any dental treatment. Practitioners are encouraged to consider their presence customary and establish office policies and protocols that beneficially involve parents in the pediatric patient's care.

Background Little is known about diet quality with a reduced-energy, low-fat, partial meal replacement plan, especially in individuals with type 2 diabetes. The Action for Health in Diabetes (Look AHEAD) trial implemented a partial meal replacement plan in the Intensive Lifestyle Intervention. Objective To compare dietary intake and percent meeting fat-related and food group dietary recommendations in Intensive Lifestyle Intervention and Diabetes Support and Education groups at 12 months. Design A randomized controlled trial comparing Intensive Lifestyle Intervention with Diabetes Support and Education at 0 and 12 months. Participants/setting From 16 US sites, the first 50% of participants (aged 45 to 76 years, overweight or obese, with type 2 diabetes) were invited to complete dietary assessments. Complete 0- and 12-month dietary assessments (collected between 2001 and 2004) were available for 2,397 participants (46.6% of total participants), with 1,186 randomized to Diabetes Support and Education group and 1,211 randomized to Intensive Lifestyle Intervention group. Main outcome measures A food frequency questionnaire assessed intake: energy; percent energy from protein, fat, carbohydrate, polyunsaturated fatty acids, and saturated fats; trans -fatty acids; cholesterol; fiber; weekly meal replacements; and daily servings from food groups from the Food Guide Pyramid. Statistical analyses performed Mixed-factor analyses of covariance, using Proc MIXED with a repeated statement, with age, sex, race/ethnicity, education, and income controlled. Unadjusted χ 2 tests compared percent meeting fat-related and food group recommendations at 12 months. Results At 12 months, Intensive Lifestyle Intervention participants had a significantly lower fat and cholesterol intake and greater fiber intake than Diabetes Support and Education participants. Intensive Lifestyle Intervention participants consumed more servings per day of fruits; vegetables; and milk, yogurt, and cheese; and fewer servings per day of fats, oils, and sweets than Diabetes Support and Education participants. A greater percentage of Intensive Lifestyle Intervention participants than Diabetes Support and Education participants met fat-related and most food group recommendations. Within Intensive Lifestyle Intervention, a greater percentage of participants consuming two or more meal replacements per day than participants consuming less than one meal replacement per day met most fat-related and food group recommendations. Conclusions The partial meal replacement plan consumed by Intensive Lifestyle Intervention participants was related to superior diet quality.

Background The author examined fad diet practices associated with oral health status and the role of the dental practitioner in addressing relevant issues. Conclusions The author reviewed the literature regarding overweight and obesity in the United States to interpret issues that might arise in reviewing fad diet practices among dental patients. The author provides suggestions for assisting patients in choosing dietary and lifestyle behaviors that are based on current public health evidence in support of achieving and maintaining a healthy body weight. Clinical Implications Dental professionals are well-positioned to guide patients toward dietary choices that support dental health and the attainment of a healthy weight associated with a decreased risk of developing chronic diseases.

Dental structures are influenced by nutritional status only during the period of tooth formation. Thereafter, deficient nutrition may influence the supporting structures of the teeth and the oral mucosa Adequate early feeding programs in developing countries are important to avoid enamel defects and compromised salivary secretion, both of which may increase susceptibility to dental caries, the latter having more widespread oral consequences The early signs of nutritional deficiencies are seen in the oral soft tissues and include thinning, inflammation, and ulceration. Malnutrition also impairs immune responses and may predispose to life-threatening diseases of the oral soft tissues such as noma An optimal nutritional status is important in reducing the origin and severity of periodontal disease but is likely to be of limited value if the stimuli from dental plaque are not removed. Further research is needed in order to identify to what extent dietary modification will modulate periodontal disease and subsequent tooth loss Nutritional status and oral health are reciprocally related, and each one affects the other— a downturn in nutrition impairs oral function

Oral health care professionals’ roles in health promotion and disease risk reduction includes addressing overweight/obesity in oral health even though the magnitude of association is unclear Environmental factors influencing risk of overweight/obesity and oral health status are comparable and can be addressed in the dental setting Approaches to screening strategies for overweight and obesity in both children and adults for oral health care professionals include as outcomes patient referral to registered dietitians and provision of health education resources to address findings Oral health care professionals should confer and consult with all health professionals, including registered dietitians, to educate, refer, and counsel those seeking to achieve a healthy body weight

Adequate nutritional status prior to and during pregnancy supports the development of oral health in infants and children Recommended infant feeding practices, introduction of foods, and healthful dietary choices promote optimum growth and development and decreased risk of early childhood caries Caries in children is associated with multiple dietary factors including frequent fermentable carbohydrate consumption Poor oral health in children with childhood disorders and diseases is associated with possible increased risk for malnutrition and growth impairment

Dietary excesses and inadequate physical activity increase risk of obesity and chronic diseases including cardiovascular disease, diabetes, and some cancers Protein energy malnutrition, nutritional anemia, nonalcoholic liver disease, and osteoporosis are associated with nutrient deficiencies that increase risk of oral diseases and conditions Government, health agencies, and health foundations define dietary guidelines and patterns supported by evidence-based research and presented in formats to increase health promotion and disease prevention Oral health care professionals and nutrition professionals can participate in healthcare teams to provide nutrition education and counseling to promote optimum oral health

Diet, nutrition, and oral health have a dynamic relationship and are determinants of active aging A plant-based diet rich in vegetables, fruits, fish, and whole grains supports cardiovascular health, oral health, and the unique demands of healthy aging The prevalence of tooth loss with aging can affect diet and nutrition if dietary adaptations are not identified relative to masticatory, sensory, salivary, and gastrointestinal changes Declining oral health in aging adults associated with malnutrition, oral surgery, restorative oral care, temporomandibular joint disorders, and dyspahgia can be addressed with special dietary guidance

Nutrition education as a component of interprofessional pre- and postdoctoral dental education and continuing dental education is important in order to translate theory into practice Nutrition education and training in dental schools in the twenty-first century includes diet and nutrition in relation to health promotion, chronic disease risk screening, control, and referral Competencies for nutrition and dietetics as part of dental education, considering the interprofessional approach should address: measurement of height and weight and calculation of body mass index, communication of the findings of such measurements to the patient/care giver, diet assessment and education as appropriate for health promotion, dental caries and dental procedures such as dentures (partial or full), oral surgery, trauma, head/neck cancer therapies, and referral approaches

Objective. The objective of this study was to determine if there were any differences in the parotid saliva output and composition related to caries activity. Study design. Stimulated parotid saliva samples were collected from 85 healthy young adults, caries-active or caries-free. Flow rates were determined, and samples were analyzed for pH and buffer capacity, total protein, electrolytes, proteins with a high performance liquid chromatography method, and histatins. Results. There were no differences in flow rates or pH, but buffer capacity was higher in women than in men, and K+ and Cl− were both slightly higher in the caries-active group. The women had a significantly higher total protein concentration, as well as higher concentrations of each of the individual protein components assayed. There were no differences attributable to caries activity. Conclusions. Significant sex differences in salivary protein concentrations exist. Caries activity may be related to some salivary electrolyte alterations, but not to protein composition.

Oral health is not independent of total health, and systemic health is impacted by oral health. Women’s oral health is greatly affected by their stage of life due to the effects of changing hormone levels on oral tissues during transitions from puberty to menstruation, and in pregnancy, perimenopause, menopause and post menopause. The impact of hormone levels on dental health is significant and long term, with hormone levels altering the relationships between oral disease and the initiation, progression and severity of several chronic diseases. Because of these hormonal fluctuations, women are particularly vulnerable to the impact of tooth loss, alveolar bone loss, periodontal disease, salivary changes, caries, changes in taste sensation and oral discomfort. Each of these oral health problems impact women’s total health. Thus, women need to undertake preventive strategies to maintain dental health throughout their lives in order to lessen the impact of poor dental health on systemic health.

Purpose Tobacco use is the leading cause of preventable death worldwide. If current trends persist, tobacco will kill more than 8 million people worldwide by 2030 and 1 billion by the end of the century. The purpose of this study was to determine trends in tobacco/marijuana use in Nevada adolescents and their effect on dental health status. Relative comparative data were compared with nationally reported data. Methods Retrospective data in this cohort study was from an ongoing statewide, school-based, dental health screening initiative that was conducted across 8 years (2002–2010) in public/private middle/high schools in Nevada. A total of 66,941 dental health screenings of adolescents between ages 13–18 were conducted. Self-reported data were collected on tobacco/marijuana use. Descriptive statistics and trends were reported. Means (SE) were computed for caries prevalence and severity. Effect size was reported on dental caries and use of tobacco/marijuana. Results Overall, percentage prevalence of tobacco use was approximately the same as the national average; however, there were significantly higher rates of marijuana use (12.0% vs. 3.3%). Prevalence and severity of dental caries was significantly higher in those who used tobacco/marijuana than those who did not across all variables and across all 8 years controlling for gender, race/ethnicity, where they lived, and exposure to secondhand smoke. Conclusions Tobacco use negatively affected dental health status with marijuana having the largest negative effect. The findings from this study identified the need for tobacco/marijuana prevention services targeting adolescents residing in the geographic areas most at risk.

BACKGOUNDThe HEALTHY primary prevention trial developed an integrated multi-component intervention program to moderate risk factors for type 2 diabetes in middle schools. The nutrition component aimed to improve the quality of foods and beverages served to students. Changes in the School Breakfast Program (SBP), National School Lunch Program (NSLP), and a la carte venues are compared to the experience of control schools.METHODSThe intervention was implemented in 21 middle schools from winter 2007 through spring 2009 (following a cohort of students from sixth through eighth grades); 21 schools acted as observed controls. The nutrition component targeted school food service environmental change. Data identifying foods and nutrients served (selected by students for consumption) were collected over a 20-day period at baseline and end of study. Analysis compared end of study values for intervention versus control schools.RESULTSIntervention schools more successfully limited dessert and snack food portion size in NSLP and a la carte and lowered fat content of foods served. Servings of high fiber grain-based foods and/or legumes were improved in SBP but not NSLP. Intervention and control schools eliminated >1% fat milk and sugar added beverages in SBP, but intervention schools were more successful in NSLP and a la carte.CONCLUSIONThe HEALTHY program demonstrated significant changes in the nutritional quality of foods and beverages served in the SBP, NSLP, and a la carte venues, as part of an effort to decrease childhood obesity and support beneficial effects in some secondary HEALTHY study outcomes.

Background The objective of this study was to measure the validity and reliability of a multifactorial Risk Factor Model developed for use in predicting future caries risk in Nevada adolescents in a public health setting. Methods This study examined retrospective data from an oral health surveillance initiative that screened over 51,000 students 13-18 years of age, attending public/private schools in Nevada across six academic years (2002/2003-2007/2008). The Risk Factor Model included ten demographic variables: exposure to fluoridation in the municipal water supply, environmental smoke exposure, race, age, locale (metropolitan vs. rural), tobacco use, Body Mass Index, insurance status, sex, and sealant application. Multiple regression was used in a previous study to establish which significantly contributed to caries risk. Follow-up logistic regression ascertained the weight of contribution and odds ratios of the ten variables. Researchers in this study computed sensitivity, specificity, positive predictive value (PVP), negative predictive value (PVN), and prevalence across all six years of screening to assess the validity of the Risk Factor Model. Results Subjects' overall mean caries prevalence across all six years was 66%. Average sensitivity across all six years was 79%; average specificity was 81%; average PVP was 89% and average PVN was 67%. Conclusions Overall, the Risk Factor Model provided a relatively constant, valid measure of caries that could be used in conjunction with a comprehensive risk assessment in population-based screenings by school nurses/nurse practitioners, health educators, and physicians to guide them in assessing potential future caries risk for use in prevention and referral practices.

The authors evaluated the validity and reliability of the Block Kids Food Frequency Questionnaire (BKFFQ) and the Block Kid Screener (BKScreener) in Mexican American children living along the Texas–Mexico border who participated in the National Institutes of Health–funded Proyecto Bienestar Laredo. The Bienestar/NEEMA health program is a school-based diabetes and obesity control program, and the Proyecto Bienestar Laredo is the translation of the Bienestar/NEEMA health program to 38 elementary schools in Laredo, Texas. Par ticipants included 2,376 eight-year-old boys (48%) and girls (52%) from two school districts in Laredo. Two Food Frequency Questionnaire (BKFFQ and BKScreener) dietary intakes were collected, and an expert panel of nutritionist assigned a classification response quality of “Good,” “Questionable,” and “Poor,” based on playfulness (systematic or nonrandom) patterns and completion rates. In addition, both instruments were assessed for reliability (test–retest) in 138 students from a San Antonio School District. Children’s height, weight, percentage body fat, reported family history of diabetes, and Texas Assessments of Knowledge and Skills in reading and mathematics scores were collected. This study showed that for Mexican American children living along the Texas–Mexico border, within the time constraints of the classroom, BKScreener yielded better data than the BKFFQ.

Background The HEALTHY study was designed to respond to the alarming trends in increasing rates of overweight, obesity, and type 2 diabetes mellitus in youth. The objective of this analysis was to examine the effects of the HEALTHY study on student self-reported dietary intakes (energy, macronutrients and grams consumed of selected food groups). Methods HEALTHY was a cluster-randomized study in 42 public middle schools. Students, n = 3908, self-reported dietary intake using the Block Kids Questionnaire. General linear mixed models were used to analyze differences in dietary intake at the end of the study between intervention and control schools. Results The reported average daily fruit consumption was 10% higher at the end of the study in the intervention schools than in the control schools (138 g or approximately 2 servings versus 122 g, respectively, p = 0.0016). The reported water intake was approximately 2 fluid ounces higher in the intervention schools than in the control (483 g versus 429 g respectively; p = 0.008). There were no significant differences between intervention and control for mean intakes of energy, macronutrients, fiber, grains, vegetables, legumes, sweets, sweetened beverages, and higher- or lower-fat milk consumption. Conclusion The HEALTHY study, a five-semester middle school-based intervention program that integrated multiple components in nutrition, physical education, behavior change, and social marketing-based communications, resulted in significant changes to student's reported fruit and water intake. Subsequent interventions need to go beyond the school environment to change diet behaviors that may affect weight status of children. Clinical Trials Registration NCT00458029

Oral health is an integral component of general health, and quality of life. The purpose of this study was to determine the perceptions of oral health status and acces\s to dental care by Southern Nevada Assisted Living Facilities Residents.A cross-sectional questionnaire study design was used to survey residents between 34 and 99 years old residing in Assisted Living Facilities. Seventy respondents (42 males and 28 females) completed a survey that included personal oral hygiene, access to care, and demographic information. Data analyses included descriptive statistics and chi-square.Mean age was 75.78 years, and the majority had a college education (n = 41). Four currently smoked cigarettes. Twenty-nine (males = 14; females = 15) reported having dental insurance. Eleven respondents had seen a dentist twice a year, while 33 reported a visit less than 6 months. Forty-one reported the facility did not provide oral health care with majority (n = 64) indicating that accessing oral health care was difficult. Self-rated response to oral hygiene, a majority (n = 64) reported their oral hygiene as fair and five reported their oral hygiene as poor.Assisted living residents in Southern Nevada reported difficulty accessing dental services within and outside of the facility. Oral care models to address this unique population should be explored.

Background Little has been reported regarding food and nutrient intake in individuals diagnosed with type 2 diabetes, and most reports have been based on findings in select groups or individuals who self-reported having diabetes. Objective To describe the baseline food and nutrient intake of the Look AHEAD (Action for Health in Diabetes) trial participants, compare participant intake to national guidelines, and describe demographic and health characteristics associated with food group consumption. Methods The Look AHEAD trial is evaluating the effects of a lifestyle intervention (calorie control and increased physical activity for weight loss) compared with diabetes support and education on long-term cardiovascular and other health outcomes. Participants are 45 to 75 years old, overweight or obese (body mass index [BMI]≥25), and have type 2 diabetes. In this cross-sectional analysis, baseline food consumption was assessed by food frequency questionnaire from 2,757 participants between September 2000 and December 2003. Statistical analysis Descriptive statistics were used to summarize intake by demographic characteristics. Kruskal-Wallis tests assessed univariate effects of characteristics on consumption. Multiple linear regression models assessed factors predictive of intake. Least square estimates were based on final models, and logistic regression determined factors predictive of recommended intake. Results Ninety-three percent of the participants exceeded the recommended percentage of calories from fat, 85% exceeded the saturated fat recommendation, and 92% consumed too much sodium. Also, fewer than half met the minimum recommended servings of fruit, vegetables, dairy, and grains. Conclusions These participants with pre-existing diabetes did not meet recommended food and nutrition guidelines. These overweight adults diagnosed with diabetes are exceeding recommended intake of fat, saturated fats, and sodium, which may contribute to increasing their risk of cardiovascular disease and other chronic diseases.

The author examined fad diet practices associated with oral health status and the role of the dental practitioner in addressing relevant issues.The author reviewed the literature regarding overweight and obesity in the United States to interpret issues that might arise in reviewing fad diet practices among dental patients. The author provides suggestions for assisting patients in choosing dietary and lifestyle behaviors that are based on current public health evidence in support of achieving and maintaining a healthy body weight.Dental professionals are well-positioned to guide patients toward dietary choices that support dental health and the attainment of a healthy weight associated with a decreased risk of developing chronic diseases.

Background Increasingly, genetic specimens are collected to expand the value of clinical trials through study of genetic effects on disease incidence, progression or response to interventions. Purpose and methods We describe the experience obtaining IRB-approved DNA consent forms across the 19 institutions in the Action for Health in Diabetes (Look AHEAD), a clinical trial examining the effect of a lifestyle intervention for weight loss on the risk of serious cardiovascular events among individuals with type 2 diabetes. We document the rates participants provided consent for DNA research, identify participant characteristics associated with consent, and discuss implications for genetics research. Results IRB approval to participate was obtained from 17 of 19 institutions. The overall rate of consent was 89.6% among the 15 institutions that had completed consenting at the time of our analysis, which was higher than reported for other types of cohort studies. Consent rates were associated with factors expected to be associated with weight loss and cardiovascular disease and to affect the distribution of candidate genes. Non-consent occurred more frequently among participants grouped as African-American, Hispanic, female, more highly educated or not dyslipidemic. Limitations The generalizabilty of results is limited by the inclusion/exclusion criteria of the trial. Conclusions Barriers to obtaining consent to participate in genetic studies may differ from other recruitment settings. Because of the potentially complex associations between personal characteristics related to adherence, outcomes and gene distributions, differential rates of consent may introduce biases in estimates of genetic relationships.

I. Synergistic Relationships Between Nutrition and Health Impact of Dietary Quality and Nutrition on General Health Status Connie C. Mobley and Teresa Marshall Pregnancy, Child Nutrition, and Oral Health Connie C. Mobley and Elizabeth Reifsnider Age-Related Changes in Oral Health Status: Effects on Diet and Nutrition Carole A. Palmer Impact of the Environment, Ethnicity, and Culture on Nutrition and Health Joanne Kouba II. Synergistic Relationships Between Oral and General Health Bidirectional Impact of Oral Health and General Health Angela R. Kamer, David A. Sirois, and Maureen Huhmann Impacts and Interrelationships Between Medications, Nutrition, Diet, and Oral Health Miriam R. Robbins III. Relationship Between Nutrition and Oral Health Oral Consequences of Compromised Nutritional Well-Being Paula J. Moynihan and Peter Lingstrom Nutritional Consequences of Oral Conditions and Diseases A. Ross Kerr and Riva Touger-Decker Complementary and Alternative Medical Practices and Their Impact on Oral and Nutritional Health Ruth M. DeBusk and Diane Rigassio Radler Emerging Research and Practices Regarding Nutrition, Diet, and Oral Medicine Shelby Kashket and Dominick P. DePaola IV. Select Diseases and Conditions With Known Nutrition and Oral Health Relationships Diabetes Mellitus: Nutrition and Oral Health Relationships Riva Touger-Decker, David A. Sirois, and Anthony T. Vernillo Oral and Pharyngeal Cancer Douglas E. Morse Human Immunodeficiency Virus Anita Patel and Michael Glick Autoimmune Diseases David A. Sirois and Riva Touger-Decker Osteoporosis Elizabeth A. Krall Wound Healing Marion F. Winkler and Suzanne Makowski V. Education and Practice Approaches to Oral Nutrition Health Risk Assessment Riva Touger-Decker and David A. Sirois Oral Medicine and Nutrition Education Riva Touger-Decker and David A. Sirois Appendices Index

Promotion of sound dietary practices is an essential component of caries management, along with fluoride exposure and oral hygiene practices. Scientific discoveries have lead to better understanding of the caries process, the ever-expanding food supply, and the interaction between the two. Fermentable carbohydrates interact dynamically with oral bacteria and saliva, and these foods will continue to be a major part of a healthful diet. Dental health professionals can serve their patients and the public by providing comprehensive oral health care and by promoting lifestyle behaviors to improve oral and general health within the time constraints of their practice. Dietary advice given should not contradict general health principles when providing practical guidance to reduce caries risk. The following principles should guide messages: * Encourage balanced diets based on moderation and variety as depicted by the Food Guide Pyramid and the Dietary Guidelines for Americans to provide a sound approach. Avoid references to "bad" foods and focus on "good" diets that include a variety of foods. * Give examples of how combining and sequencing foods can enhance mastication, saliva production, and oral clearance at each eating occasion. Combining dairy foods with sugary foods, raw foods with cooked, and protein-rich foods with acidogenic foods are all good examples. Suggest that eating and drinking be followed by cariostatic foods such as xylitol chewing gum. * Drink water to satisfy thirst and hydration needs as often as possible. Restrict consumption of sweetened beverages to meal and snack times when they can be combined with other cariostatic foods. * When a patient reports excessive dietary intake of a fermentable carbohydrate to the point of displacing other important foods in the diet, identify alternatives that will help the patient maintain or achieve a healthy body weight, oral health status, and a nutrient-dense intake.

Statement of Problem. Previous studies in complete denture wearers evaluated the relationship between diet and measures of chewing, yet only isolated nutrient intake was considered. This limited information makes the assessment of overall diet quality and the planning of interventions difficult. Purpose. This study investigated the relationship of complete denture quality to masticatory performance, perceived ability to chew, and diet quality as measured by the Healthy Eating Index (HEI), an overall diet quality index. Material and Methods. The study population comprised 54 complete denture wearers. Data were obtained from clinical examinations, masticatory performance measurements, and 2 non-consecutive 24-hour dietary recalls. (Masticatory performance data were not collected for 9 subjects because of time constraints, patient fatigue, or patient refusal. Statistical analysis showed no significant effect of their absence on the reported findings.) Based on a composite rating scale, subjects were divided into 3 denture quality groups described as good, medium, and poor. The outcome variables were the HEI and its components, plus selected nutrient and non-nutrient intake. Explanatory variables were quality of complete dentures, masticatory performance, and reported chewing ability. Data were analyzed with Kruskal-Wallis tests, Mann-Whitney U-tests, and Fisher exact tests. Because a large number of dietary components were examined, results were considered significant at α=.01. Results. Masticatory performance and perceived ability to chew were unrelated to diet quality. The good quality denture group had significantly better masticatory performance than the medium and poor quality groups, but the median HEI scores and dietary intakes were not significantly different among these 3 groups. Milk, vegetable, fruit, and grain intake scores were mainly responsible for the low overall HEI scores. Conclusion. In the population evaluated, complete denture quality, food comminution capacity, and perceived chewing ability were not related to diet quality. The majority of subjects had deficient diets regardless of the technical quality of their dentures. (J Prosthet Dent 2002;87:490-8.)

Clues identified in oral health screening can be associated with medical conditions, medical treatments, and overall health status. Thorough oral health screening involves not only talking with the patient, but touching and exploring the mouth. Oral health screening expands the role of dietitians in improving the nutritional and dietary practices of clients.