Table Of ContentNutrition and Health
Series Editor: Adrianne Bendich
Riva Touger-Decker
Connie Mobley
Joel B. Epstein E ditors
Nutrition and
Oral Medicine
Second Edition
N H
UTRITION AND EALTH
Adrianne Bendich, Morristown NJ, USA, SERIES EDITOR
For furthervolumes:
http://www.springer.com/series/7659
Riva Touger-Decker Connie Mobley
•
Joel B. Epstein
Editors
Nutrition and Oral Medicine
Second Edition
Editors
RivaTouger-Decker JoelB. Epstein
Department of NutritionalSciences CedarsSinai Medical Center,Samuel
School ofHealth Related Professions Oschin ComprehensiveCancer Institute
and Department ofDiagnostic Sciences Los Angeles
RutgersSchool ofDental Medicine Cityof HopeNational Medical Center
RutgersUniversity Biomedical Division ofOtolarynology and Head
and Health Sciences and Neck Surgery
Newark, NJ Duarte, CA
USA USA
Connie Mobley
School ofDental Medicine
Universityof Nevada Las Vegas
Las Vegas,NV
USA
ISBN 978-1-60761-489-0 ISBN 978-1-60761-490-6 (eBook)
DOI 10.1007/978-1-60761-490-6
Springer New YorkHeidelberg Dordrecht London
LibraryofCongressControlNumber:2014930746
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On April 16, 2013 Dr. Dominick P. DePaola, author of the
Foreword for the first edition of this textbook, passed away
at the age of 70 at his home in Palm Beach Gardens,
Florida.Thattheeditors ofthissecond editionof‘‘Nutrition
and Oral Medicine’’ so generously made the decision to
dedicate this book to him is both fitting and proper, as very
few people have influenced the study and the practice of the
role of nutrition on oral health and disease as much as he.
Through his advocacy, his leadership, and his research he
was one of a handful of scientists, clinicians, and educators
who propelled the evolution of the field from one based
upon poorly substantiated folk medicine to an evidence-
based discipline. In recognition of his role in this
evolutionary, perhaps even revolutionary process, he
received numerous honors during his lifetime; possibly the
one he was most proud of was his being awarded honorary
membership in the American Dietetic Association, the only
dentist so honored.
Dom’s contributions to health care and healthcare educa-
tion went way beyond nutrition. As dean of three nationally
prominent dental schools, as CEO and President of the
nation’s largest free standing dental research institute, and
as past President of both the American Association of
Dental Research and the American Dental Education
Association, his influence is at least partially responsible
for the adoption of concepts that today are considered basic
tenets of healthcare education, including the interprofes-
sional training of clinicians who are critical thinkers, who
can adapt to a continuing changing environment and who
not only care about the health of the individual patient but
about the health of the public at large.
Upon hearing of the passing of Dom Depaola, Dr. Richard
Valachovic, Executive Director of the American Dental
Education Association, commented that ‘‘this is a sad day
for dental education and research.’’ I need to add that it
was even a sadder day for those numerous individuals that
he touched in a very personal way and, by so doing,
transformed them and their careers. I feel extremely blessed
that I was one of those individuals and who during my
career knew Dom as a mentor, as a colleague and, most
cherished by me, as a friend. He will be sorely missed. If
consolation can be taken, it is from knowing that in some
small way Dom DePaola lives on in those of us whose lives
he influenced, both directly and indirectly, including many
of the contributors to this textbook.
Richard I. Vogel
Executive Vice Dean
Periodontology and Implant Dentistry
New York University College of Dentistry
New York, NY
USA
Preface
This second edition of Nutrition and Oral Medicine addresses the complex, multifaceted relation-
ships between diet/nutrition and oral health, explores proposed relationships among oral, systemic,
and nutritional well-being and provides insights into interprofessional, comprehensive care for
individuals. Chapters focus on diet, nutrition, and oral health promotion and disease prevention
acrossthelifespan,oralanddentaldiseasesanddisorders,oralmanifestationsofsystemicdiseases,
and discussions of the synergy between oral tissues and nutrients. Editors and authors include
expertsinnutritionandoralhealthfromaroundtheworld.Oralandsystemicdiseasesandorofacial
pain syndromes are addressed with a focus on associations with and impact on nutrition status, the
impact of medications and treatments on the head, neck, oral cavity and oropharynx and nutrition
status. Oropharyngeal cancers are examined in light of nutrition etiologies, impact upon oral
function,anddietinterventionstrategies.Suggestedmanagementstrategiesarepairedwithselected
topics in oral health. Cutting edge research issues regarding the relationships between individual
nutrients, other nutrient substrates, complementary and alternative medicine, and genetics and oral
health/disease are covered. The links among compromised immunity, oral infections, and systemic
disease and nutrient deficiencies in relation to oral diseases and systemic diseases are included as
well as the impact of impaired host defense on oral and nutrition health.
The book is divided into five parts, synergistic relationships among nutrition, oral, and systemic
health, between oral and systemic health, between nutrition and oral health, and between select
diseases/conditions with nutrition and oral health interfaces and nutrition and oral medicine edu-
cation and practice. Chapters examine the research and practice relative to the topic as well as
address contemporary andproposedpracticesasappropriate.Severalscreeningandeducationtools
are included in the appendices for our readers to use for educational purposes. We hope our
colleaguesinoral,allied,andprimaryhealthandeducationandpracticeandstudentsinthefieldsof
nutrition/dietetics anddentistry aswell as otherdisciplines whoseresearch, practice, andeducation
includes nutrition and oral medicine find the text a valuable resource.
Riva Touger-Decker
Connie Mobley
Joel B. Epstein
vii
Series Editor Page
ThegreatsuccessoftheNutritionandHealthSeriesistheresultoftheconsistentoverridingmission
ofprovidinghealthprofessionalswithtextsthatareessentialbecauseeachincludes:(1)asynthesis
ofthestateofthescience,(2)timely,in-depthreviewsbytheleadingresearchersintheirrespective
fields, (3) extensive, up-to-date fully annotated reference lists, (4) a detailed index, (5) relevant
tablesandfigures,(6)identificationofparadigmshiftsandtheconsequences,(7)virtuallynooverlap
of information between chapters, but targeted, inter-chapter referrals, (8) suggestions of areas for
future research, and (9) balanced, data-driven answers to patient as well as health professionals
questionswhicharebaseduponthetotalityofevidenceratherthanthefindingsofanysinglestudy.
TheSeriesvolumesarenottheoutcomeofasymposium.Rather,eacheditorhasthepotentialto
examine a chosen area with a broad perspective, both in subject matter as well as in the choice of
chapter authors. The editor(s), whose training(s) is (are) both research and practice oriented, have
the opportunity to develop a primary objective for their book, define the scope and focus, and then
invitetheleadingauthoritiestobepartoftheirinitiative.Theauthorsareencouragedtoprovidean
overviewofthefield,discusstheirownresearch,andrelatetheresearchfindingstopotentialhuman
healthconsequences.Becauseeachbookisdevelopeddenovo,thechaptersarecoordinatedsothat
the resulting volume imparts greater knowledge than the sum of the information contained in the
individual chapters.
‘‘NutritionandOralMedicine,SecondEdition,’’editedbyRivaTouger-DeckerPh.D.,RD,CDN,
FADA, Connie Mobley Ph.D., RD and Joel B. Epstein DMD, MSD, Diploma American Board of
Oral Medicine, and FRCD(C) FDS RCS (Edin) clearly exemplifies the goals of the Nutrition and
Health Series. The major objective of this comprehensive revised and updated text is to review the
body of research on associations between diet/nutrition and oral health and disease as well as the
growing importance of adequate dietary intake of the essential nutrients and sufficient calories to
maintain normal weight, and improve indices of good health including oral health.
Thisupdatedvolumeincludeschaptersthatdiscussoralhealthashavinghealthyteethaswellas
beingfreeofchronicoral-facialpainconditions,oralandpharyngeal(throat)cancers,oralsofttissue
lesions, birth defects such as cleft lip and palate, and scores of other diseases and disorders that
affecttheoral,dental,andcraniofacialtissues.Thebookincludes20up-to-dateinformativereviews
of the current thinking about associations between oral health and diseases, systemic health, and
diet/nutritionaswellastherelationshipbetweendietqualityandtheoverallhealthofindividualsas
well as the importance of oral health in assuring the overall health of the individual. Of great
importance, there are in-depth reviews by the leading researchers in the fields on the associations
among chronic and infectious diseases, oral health, and diet and nutrition. Practicing health
professionals, researchers, and academicians can rely on the chapters in this volume for objective
data-driven sources about the complex interactions among oral health, systemic health, and
nutritionalstatus.Thisnewcomprehensivevolumeincludesoralhealthandoralmedicineaswellas
uniquechaptersthatexamineapproachestoassessmentoforalhealthandexaminationoftheprocess
ix
x SeriesEditorPage
of curriculum development in the dental school. Thus, the book contains valuable chapters that are
of great importance to the nutrition and oral healthcommunities as well asfor health professionals
whohavetoanswerpatient,client,orgraduatestudentsquestionsaboutthenewestclinicalresearch
oninteractionsandrelationshipsamongdiet,nutrition,oralhealth,andoverallhealthconsequences.
‘‘Nutrition and Oral Medicine, Second Edition’’ represents a thorough review of food
consumption during the lifespan and how diet affects oral health and how the status of one’s oral
health can affect one’s nutritional status. It is to the credit of Drs. Touger-Decker, Mobley, and
Epsteinthattheyhaveorganizedthisvolumesothatitprovidesanin-depthoverviewofthecritical
issuesinvolvedinthedeterminationofthebestnutritionalstrategiesforinfants,toddlers,school-age
children,adult,andseniorpopulationsthatcanbebeneficialtotheirteeth,gums,andotherstructures
withintheoralcavity.Thevolumes’editorsprovidetheirin-depthknowledgeandexpertisetohelp
the reader to understand the value of diet quality in the development of national dietary
recommendations. Dr. Riva Touger-Decker Ph.D., RD, CDN, FADA is Professor and Chair of the
Department of Nutritional Sciences—School of Health Related Professions and serves as the
Director oftheDivisionofNutrition—RutgersSchoolofDentalMedicine,nowpartoftheRutgers
UniversityBiomedicalandHealthSciences(formerlyUniversityofMedicineandDentistryofNew
Jersey).Dr.Touger-Deckerservedascoeditorofthefirsteditionof‘‘NutritionandOralMedicine.’’
Shehasbeenrecognizedbyhercolleaguesandpeersforhersuccessfuleffortstoincludenutritionin
the dental school curriculum as well as her research findings. She has been awarded both the
American Dietetic Association Medallion Award and Excellence in Dietetic Education Award; the
American Society for Clinical Nutrition Dannon Institute Award for Excellence in Medical/Dental
Nutrition Education and in 2008, the University of Medicine and Dentistry of New Jersey
ExcellenceinResearchAward,SchoolofHealthRelatedProfessionsandin2012,shewaselecteda
Fellow, New York Academy of Medicine. Dr. Joel B. Epstein DMD, MSD, FRCD(C) FDS
RCS(Edin)isaconsultantintheDivisionofOtolaryngologyandHeadandNeckSurgeryattheCity
of Hope Hospital in Los Angeles, CA and is a Collaborative Member, Samuel Oschin
Comprehensive Cancer Institute, and medical-dental staff at Cedars-Sinai Medical Center in Los
Angeles, CA. He is a Fellow of the College of Dental Surgeons of Canada in Oral Medicine/Oral
Pathology, a Fellow of the Royal College of Surgeons of Edinburgh, and a Diplomat of the
American Board of Oral Medicine and was an examiner and President of the Board of Oral
Medicine.He hasbeen recognized forhis expertise inoral cancer andoralcomplicationsofcancer
therapy. Dr. Connie Mobley Ph.D., RD is Associate Dean of Research and Professor in the
Department of Biomedical Sciences in the School of Dental Medicine at the University of Nevada
LasVegas,LasVegas,NV.Dr.Mobleyservedascoeditorofthefirsteditionof‘‘NutritionandOral
Medicine.’’ She is internationally recognized for her leadership in interdisciplinary research in
nutrition/diet,healthpromotion,andoralhealth.AlongwithDr.Touger-Deckersheisthecoauthor
of ‘‘Oral Health and Nutrition.’’ She has held many positions of leadership in the Academy of
NutritionandDieteticsandisanactivememberoftheInternationalAssociationofDentalResearch
Nutrition Research Group.
The second edition of ‘‘Nutrition and Oral Medicine’’ contains 20 comprehensive chapters that
are organized into five parts. Part I provides an overview and perspective on the importance of
understandingnutritionalterminology,dietquality,andthenutritionalandoverallhealthbenefitsof
adopting high-quality diets for prevention of obesity before and during pregnancy and throughout
childhood,adolescence,andadulthood.Focusisplacedontheoralhealthconsequencesoftheaging
processandhowtheseaffectnutrientintakesandoverallhealth.Chapter 1presentsacomprehensive
review of the importance of diet quality and lays the foundation for understanding the basis of
nutritional guidelines and recommendations. Chapter 2 examines the interaction between prospec-
tive mothers, parents, infants, and young children and the quality offoods consumed. The authors
SeriesEditorPage xi
haveincludedover140referencesandeighttablesandtakeanevidence-basedapproachtoexamine
the underlying mechanisms contributing to the protective effects of nutritional adequacy on tooth
development.Welearnthatmaternalnutritionalstatusdirectlyimpactsthedevelopmentofboththe
enamel and dentin of the primary and permanent teeth during fetal growth. In addition, precon-
ceptionnutritionalstatusofthemotherimpacts thegeneralhealthandbirthoutcomesoftheinfant.
Topicsincludechildhoodcaries,effectsofdiabetes,cysticfibrosis,andotherchildhoodillnessesas
wellasbirthdefectsinvolvingtheoralcavity.Chapter 3reviews therelationshipbetweennutrition
andtheagingprocess.Thereisahighprevalenceoftoothlosswithaging,especiallyinseniorsatthe
poverty level, and tooth loss can directly affect diet via masticatory, sensory, salivary, and gastro-
intestinalchanges.Decliningoralhealthinagingadultsisdiscussedwithregardtomalnutrition,oral
surgery, periodontal disease, restorative oral care, temporal-mandibular joint disorders, and dys-
phagia.Chapter 4inthispartreviewstheliteratureconcernedwithobesityanditsroleinoralhealth.
Therearepotentiallinksbetweencertainoralbacteriaandtheriskofobesitythatarediscussed.The
importanceofaninterdisciplinaryteaminthetreatmentoftheobeseindividualisreviewedin-depth.
Part II looks at the interactions between oral health and systemic health and also contains a
chapterthatreviewstheimpactofcertainmedicationsonsalivaryglands,toothstructure,andother
components of the oral cavity. Oral/systemic interactions that are discussed and tabulated include
periodontal disease and diabetes and atherosclerotic cardiovascular disease; gingivitis and
alterations in sex hormone levels; autoimmune diseases and salivary gland dysfunctions resulting
in increased caries; cancer therapies and oral mucosal diseases; dysphagia resulting from
neurogenic, myogenic, or other causes. Chapter 6 explores the interactions among prescription
and over-the-counter (OTC) medications, nutrition, dietary supplements, and oral health and
includes 12 relevant tables and over 100 references. Many of the drugs used by oral health care
professionals can adversely affect nutrient absorption from foods as well as dietary supplements.
Likewise, many prescription and OTC drugs can cause adverse effects in the oral cavity including
oral lesions, stomatitis, reduced salivation, and decreased taste and smell sensations.
PartIIIofthisvolumecontainsfourchaptersthatdescribeassociationsbetweennutritionandoral
health. As indicated by the authorsofChapter 7 inthis part: ‘‘Nutritional status and oral health are
reciprocallyrelated,andeachoneaffectstheother—adown-turninnutritionimpairsoralfunction.’’
The chapter emphasizes the importance of fetal nutrition as calcification of the enamel on the
deciduous teeth occurs early in fetal development and is dependent upon sufficient calcium in the
pregnant mother’s diet. The effects of deficiencies of vitamins A, D, C, B12, protein, and energy,
calciumomega-3fattyacids,andantioxidantnutrientsontheoralcavityareexaminedindetailand
well referenced. The interactions among the immune system, inflammation, nutrition, and the oral
cavityaswellasrelatedsystemicdiseaseconsequencesareexaminedinalogicalorderinChapter 8
thatincludesover125referencesandhelpfultablesandfigures.Thechapterdescribestheeffectsof
autoimmune diseases, allergic reactions, infection, inflammation, with emphasis on periodontal
diseases and immune responses on the structures and blood supply to the oral cavity. The next
informativeChapter 9reviewsthenumerouscomplementaryandalternativemedicinepracticesthat
maybeusedbypatientseitherforreducingpainorotheroralcavitysymptomsorforsystemicuses.
Thechapterincludesoverviewsandusefultablesondietarysupplements;bothherbalandnon-herb
containing dietary supplements, homeopathy, Traditional Chinese Medicine, acupuncture, medita-
tion and hypnosis, commonly used oral health drug–herb interactions, chiropractic and osteopathic
medicine, and use of massage with reference to dental practices. Chapter 10 in this part contains a
uniqueevaluationofthecurrentstateofthesciencelinkinggeneticfactorstooralhealth.Theauthor
informs us that the exploration of gene-based mechanisms in dental medicine is in its early stages.
Geneticvariationshavebeenassociatedwithcariesdevelopment,enamelformation,gingivitis,and
periodontitis.Asanexample,thenewfieldofpharmacogenomicshelpstopredictpatientresponses
