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ORIGINAL ARTICLE
Year : 2014  |  Volume : 12  |  Issue : 2  |  Page : 119-123

Assessing the knowledge of dietitians regarding diet and oral health in Bengaluru city


1 Department of Public Health Dentistry, Raja Rajeswari Dental College and Hospital, Bengaluru, India
2 Department of Public Health Dentistry, Vydehi Institute of Dental Sciences, Bengaluru, India

Date of Web Publication6-Sep-2014

Correspondence Address:
Shwetha Hulikere Lingaraj
No. 281, 2nd Floor, Karumariamma Temple Road, Whitefield 560 066, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.140280

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  Abstract 

Objective: To assess the knowledge of dietitians regarding diet and oral health in Bengaluru city. Materials and Methods: A cross-sectional study was conducted among the life members of Indian Dietetic Association, Bangalore chapter. A close ended, self-administered 23 item questionnaire was distributed and collected after 10 min. The data was subjected to statistical analysis. Results: About 36% felt dietary supplements can prevent oral mucosal diseases, and only 12% were aware that high content of fluoride in water leads to abnormal tooth defects. Overall knowledge of dietitians pertaining diet and oral health was 56.48%. Conclusion: Study highlights the deficiency of knowledge of dietitians regarding oral health. The multifaceted interactions between diet and oral health in practice, education and research in both dietetics and dentistry merit detailed delineation.

Keywords: Diet, dietitian, knowledge, oral health


How to cite this article:
Bhat PK, Lingaraj SH, Aruna C N. Assessing the knowledge of dietitians regarding diet and oral health in Bengaluru city. J Indian Assoc Public Health Dent 2014;12:119-23

How to cite this URL:
Bhat PK, Lingaraj SH, Aruna C N. Assessing the knowledge of dietitians regarding diet and oral health in Bengaluru city. J Indian Assoc Public Health Dent [serial online] 2014 [cited 2019 Jul 20];12:119-23. Available from: http://www.jiaphd.org/text.asp?2014/12/2/119/140280


  Introduction Top


Unique oral cavity-a gatekeeper to diet and is often referred to as mirror of overall health. [1] The oral cavity is the pathway to the rest of the body, so any problems in the oral cavity can profoundly affect appetite and ultimately diet. Diet may affect the development and integrity of the oral cavity as well as progression of oral diseases. [2],[3] Diet affects the teeth during development and malnutrition may exacerbate oral infectious diseases. [4],[5]

Diet and oral health have a synergistic bidirectional relationship. As a body of knowledge, dietetics, and nutrition has expanded to touch all segments of health care. Scientific and epidemiological data suggest a lifelong synergy between nutrition and the integrity of the oral cavity in health and disease.

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. [6],[7],[8] Thus, partnerships among dietetics, dental, and other health professionals need to be identified, developed, strengthened, and expanded to encourage integrated, comprehensive practice.

The multifaceted interactions between nutrition and oral health in practice, education, and research in both dietetics and dentistry merit detailed delineation. Collaboration between dietetics and dental professionals is recommended for oral health promotion and disease prevention and intervention. Paralleling this cross-disciplinary trend is a change in the health care system toward a coordinated team care approach that requires a collaborative effort among health care providers. Hence, the study was undertaken.

Aim and objective

To assess the knowledge of dietitians regarding diet and oral health in Bangalore city.


  Materials and Methods Top


A cross-sectional study was conducted among dietitians of Bangalore city. All the life members (339) of Indian Dietetic Association, Bangalore chapter, were included in the study. Among them, 43 were not accessible during the study period due to various reasons. Hence, the total of 296 was included in the study. The study was undertaken for a 2-month period.

Permission to conduct the study was obtained from the Indian Dietetic Association, Bangalore chapter. The study was conducted according to the guidelines laid down in the declaration of Helsinki and all procedures involving human subjects/patients were approved by the Institutional Ethics Committee informed consent: The purpose and details of the study was explained to the dietitians and written informed consent was then obtained from them.

A pilot study was conducted among 34 dietitians. Validity of questionnaire was assessed. Face validity was checked by asking experts to scrutinize the questions, while content validity was checked by ensuring that the questions covered all the areas of knowledge mapped out by initial objective. Cronbach's alpha obtained was 0.83. Internal reliability coefficient obtained was good.

Dietitians working in different sectors like multi-specialty hospitals, private clinics, and educational institutions were personally contacted. Questionnaires were administered and were duly collected after 10 min.

A close ended self-administered 23 item questionnaire with four multiple choices consisting of knowledge about

  1. Diet and oral health like dietary sugars and its association with dental caries
  2. Dental history and oral health advice in dietary counseling
  3. Protective effect of fibrous food against dental caries,
  4. Sugar substitutes
  5. Trace elements present in the diet
  6. Fluoride
  7. Abnormal tooth defects
  8. Vitamins and micronutrients for children
  9. Oral mucosal diseases with nutritional deficiencies
  10. Gingival bleeding
  11. Tooth wear
  12. Nonmilk extrinsic sugars
  13. Dietary suggestions for infants
  14. Dietary suggestions children
  15. Dietary suggestions geriatrics
  16. Malnutrition and crowding of teeth
  17. Oral clearance of carbohydrates
  18. Dry mouth and dietary deficiencies
  19. Vitamin deficiencies and oral cancer
  20. Low birth weight and bleeding gums
  21. Teeth friendly foods
  22. Diet and oral health in diabetics


Professional relation between dentist and dietetics.

Questions were close-ended so that the categories could be analyzed efficiently and with minimum bias. Study design attempted to minimize the limitation of self-administered questionnaires by:

  • Formulating questions using lay terms
  • Spreading out questions so that they were uncluttered and broken down into different sections
  • Attaching the cover page explaining the details of the study, giving instructions on completing the questionnaire.


Statistical analysis

Descriptive statistical analysis has been carried out in the present study. The statistical software SPSS no.13 statistical package, SPSS Inc. Chicago, Illinois was used for the analysis of the data and Microsoft word and Excel have been used to generate graphs and tables. Descriptive statistics has been carried out by frequency and percentage. No inferential statistics is available.


  Results Top


The average knowledge percentage obtained was 56.48%. About 33% of dietitians opted selenium, 23% agreed for molybdenum, 13% felt fluoride and 31% thought vanadium as trace elements which has a protective effect against dental caries [Figure 1].
Figure 1: Distribution of knowledge among dietitians about trace elements which protect against dental caries

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In this study, 39% of the dietitians felt confectionaries among nonmilk extrinsic sugars are the greatest threat to dental health of children, and only 1% opted for fruit juices and 4% for honey and syrups and 55% were having correct knowledge about nonmilk extrinsic sugar and dental health [Figure 2].
Figure 2: Distribution of knowledge among dietitians about dental health of children and nonmilk extrinsic sugars

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About 52% of dietitians opted carbonated and sport drinks, only 2% opted for citrus fruit, 0% for Vitamin C chewable tablets, as the cause of tooth wear [Figure 3]. About 16% of dietitians accepted, 41% denied, 28% were not sure, and 15% were unaware that low birth weight of a child is associated with bleeding gums during pregnancy [Figure 4].
Figure 3: Distribution of knowledge among dietitians about causes of tooth wear

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Figure 4: Distribution of knowledge among dietitians about low birth weight of a child and bleeding gums during pregnancy

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Regarding dietary counseling, 67% of dietitians accepted, 3% didn't accept, 30% were not sure that dental history and oral health advice are important aspects. About 70% answered appropriately that the fluoride eliminates the sugar-caries relationship.

Regarding dietary suggestions for geriatrics regarding oral health, 65% were sure, 27% opted for calcium and vitamin supplements, 7% opted for fibrous food and 0% opted for legumes and grains. About 14% felt micronutrients, 23% thought antioxidants, 9% felt beta-carotene, and 54% had appropriate knowledge about protective effects against oral cancer.

It is important to rinse the mouth with water after the intake of sweets or sweetened drinks was the opinion of 93% of the participants. About 41% were aware that food rich in protein and fat increases oral clearance of carbohydrates. When asked about the causes for dry mouth, 32% opted Vitamin A and Vitamin B6 deficiency, 12% opted iron deficiency, 9% opted essential fatty acid deficiency [Table 1].
Table 1: Distribution of dietetic students knowledge regarding diet and oral health


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  Discussion Top


The changing social and economic realities of today's health care system have had a dramatic effect on the preparation and training of dietetics professionals. The core knowledge of principles of nutrition and diet and their clinical application in practice provides the underpinning for achievement of several of the competencies.

Dietitians knowledge about fibrous food and its protective effect against dental caries was 81%. The main reason that fibrous foods protect the teeth is because they mechanically stimulate salivary flow. [9],[10],[11] A study [12] conducted by k Shah found that only 4% of dietetic and nutrition students thought that consumption of dried fruit might lead to oral health problems, but in the present study 11% dietitians felt dry fruits causes dental caries. Dried fruit may potentially be more cariogenic since the drying process breaks down the cellular structure of the fruit, releasing free sugars, and dried fruits tend to have a longer oral clearance. [12],[13]

About 23% opted antioxidants, and 14% opted micronutrients as protective measures against oral cancer. Micronutrient intakes via diet have been found to have an inverse relationship with the incidence of oral cancer. [14],[15]

About 16% of dietitians agreed low birth weight of a child is associated with bleeding gums during pregnancy. New research suggests a link between preterm, low birth weight babies and gingivitis. Excessive bacteria, which cause gingivitis, can enter the bloodstream. If this happens, the bacteria can travel to the uterus, triggering the production of chemicals called "prostaglandins," which case uterine contractions that induce premature labor. The positive correlation between maternal gingival status and low birth weight was demonstrated by other authors. [16],[17],[18]

About 33% dietitians were aware trace element selenium present in the diet doesn't have a protective effect against dental caries. The incorporation of trace element selenium into the apatite microcrystals of enamel may alter their physical properties and hence their susceptibility to degradation. [19]

About 71% of dietitians felt vitamin deficiencies and tobacco intake leads to increases risk of precancerous lesions. An important second aspect which needs to be considered is the preconditioning of the oral mucosa by a prolonged, chronic deficiency of iron and/or Vitamin B complex. [20]

About 39% of dietitians felt malnutrition leads to crowding of teeth. In the field of oral health, the association between malnutrition and impaired growth and the development of facial bones has been reported by a number of researchers and has been linked to a reduction in the length of the skull base and jaw height. It is believed, therefore, that malnutrition may also be associated with malocclusion, particularly dental crowding, which is defined as misalignment of the teeth due to insufficient space for them to erupt in the correct place. [21]

Dietitians need to develop the skills required interpreting, translate and apply nutritional science to provide practical, impartial and safe information about diet and oral health. In this context, dietitians should be able to provide frontline consultations for individuals and groups as well as training and supporting other members of the health care team to provide informed, realistic and practical dietary (with the skills and knowledge that exemplifies this paradigm in practice, dietetics and dental educators must assume responsibility for integrating oral health/diet and nutrition topics and clinical/community experiences).


  Conclusion Top


Study highlights the deficiency of knowledge of dietitians regarding oral health. Consistent with the current climate of health care delivery, which stresses collaboration between health care providers, qualified dietetics, and dental professionals should pursue opportunities to create a health care paradigm that will mesh optimum oral and nutrition health care with improved oral, nutritional, and systemic health status.

To prepare practitioners with the skills and knowledge that exemplifies this paradigm in practice, dietetics and dental educators must assume responsibility for integrating oral health/diet and nutrition topics and clinical/community experiences in education, respectively.

As a body of knowledge, dietetics, and nutrition has expanded to touch all the segments of health care. Multi-skilling on basic levels of care, including risk identify and referral for intervention, will foster successful strategies related to oral health and diet.

 
  References Top

1.Position of the American dietetic association: Oral health and nutrition. J Am Diet Assoc 1996;96:184-9.  Back to cited text no. 1
    
2.Pew Health Professions Commission. The fourth report of the pew health professions commission. San Francisco, CA: Center for the Health Professions; 1998.  Back to cited text no. 2
    
3.US Department of Health and Human Services. Oral health in America: A report of the surgeon general. Executive summary. Rockville, MD: US Dept. of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000.  Back to cited text no. 3
    
4.König KG. Diet and oral health. Int Dent J 2000;50:162-74.  Back to cited text no. 4
    
5.Hargreaves JA. Discussion: Diet and nutrition in dental health and disease. Am J Clin Nutr 1995;61:447S-8.  Back to cited text no. 5
[PUBMED]    
6.Position of the American dietetic association: Nutrition services for children with special health needs. J Am Diet Assoc 1995;95:809-12.  Back to cited text no. 6
    
7.Touger-Decker R, Mobley CC, American dietetic association. Position of the American dietetic association: Oral health and nutrition. J Am Diet Assoc 2003;103:615-25.  Back to cited text no. 7
    
8.Touger-Decker R, Mobley CC, American dietetic association. Position of the American dietetic association: Oral health and nutrition. J Am Diet Assoc 2007;107:1418-28.  Back to cited text no. 8
    
9.Sheiham A. Dietary effects on dental diseases. Public Health Nutr 2001;4:569-91.  Back to cited text no. 9
[PUBMED]    
10.Moynihan PJ, Snow S, Jepson NJ, Butler TJ. Intake of non-starch polysaccharide (dietary fibre) in edentulous and dentate persons: An observational study. Br Dent J 1994;177:243-7.  Back to cited text no. 10
    
11.Joshipura KJ, Willett WC, Douglass CW. The impact of edentulousness on food and nutrient intake. J Am Dent Assoc 1996;127:459-67.  Back to cited text no. 11
    
12.Shah K, Hunter ML, Fairchild RM, Morgan MZ. A comparison of the nutritional knowledge of dental, dietetic and nutrition students. Br Dent J 2011;210:33-8.  Back to cited text no. 12
    
13.Moynihan PJ. Dietary advice in dental practice. Br Dent J 2002;193:563-8.  Back to cited text no. 13
[PUBMED]    
14.MacKeown JM, Cleaton-Jones PE, Edwards AW. Energy and macronutrient intake in relation to dental caries incidence in urban black South African preschool children in 1991 and 1995: The Birth-to-Ten study. Public Health Nutr 2000;3:313-9.  Back to cited text no. 14
    
15.Moynihan P, Petersen PE. Diet, nutrition and the prevention of dental diseases. Public Health Nutr 2004;7:201-26.  Back to cited text no. 15
    
16.Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, Maynor G, et al. Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol 1996;67:1103-13.  Back to cited text no. 16
    
17.Dasanayake AP, Boyd D, Madianos PN, Offenbacher S, Hills E. The association between Porphyromonas gingivalis-specific maternal serum IgG and low birth weight. J Periodontol 2001;72:1491-7.  Back to cited text no. 17
    
18.Jeffcoat MK, Geurs NC, Reddy MS, Cliver SP, Goldenberg RL, Hauth JC. Periodontal infection and preterm birth: Results of a prospective study. J Am Dent Assoc 2001;132:875-80.  Back to cited text no. 18
    
19.Davies BE, Anderson RJ. The epidemiology of dental caries in relation to environmental trace elements. Experientia 1987;43:87-92.  Back to cited text no. 19
[PUBMED]    
20.Marshall TA, Warren JJ, Hand JS, Xie XJ, Stumbo PJ. Oral health, nutrient intake and dietary quality in the very old. J Am Dent Assoc 2002;133:1369-79.  Back to cited text no. 20
    
21.Thomaz EB, Cangussu MC, da Silva AA, Assis AM. Is malnutrition associated with crowding in permanent dentition? Int J Environ Res Public Health 2010;7:3531-44.  Back to cited text no. 21
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

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