Academy Position Paper

Position of the Academy of Nutrition and Dietetics: Oral Health and Nutrition

Written by Riva Touger-Decker, PhD, RD, FADA and Connie Mobley, PhD, RD. Presented in the
Journal of the Academy of Nutrition and Dietetics in May 2013.

Dave Camilleri
NFS 4950
February 9, 2015

It is the position of the Academy of Nutrition and Dietetics that nutrition is an integral
component of oral health. The academy supports the integration of oral health with nutrition services,
education, and research. Collaboration between dietetics practitioners and oral healthcare
professionals is recommended for oral health promotion and disease prevention and intervention.
This position is in effect until December 31, 2016. The authors of this position are Riva Touger-Decker,
PhD, RD, FADA and Connie Mobley, PhD, RD.
In order to better understand the coaction between oral health and nutrition, it is important to
understand that the body works as systems that constantly interact with each other. For example, the
oral cavity, part of the digestive system, works in conjunction with the immune system to eliminate
pathogens from the body. These systems work in unity to promote overall oral health and nutrition
status. Similarly, having a medical issue in one system can have a cascade effect on other systems in
the body. It is important to recognize this whole-body approach to better understand the connection
between oral health and nutrition, as well as using it to provide improved medical, nutritional, and
periodontal care. Unfortunately, many clinical issues manifest themselves in the oral cavity or
adversely affect oral health. Among these issues, cancer treatments, eating disorders, and nutritional
deficiencies and excesses are highlighted by the Academy of Nutrition and Dietetics.
Cancer treatments, especially those for the treatment of oropharyngeal cancers, can have a
negative affect on oral health and nutrition status. Common cancer therapies include surgery, radiation
treatment, and chemotherapy. One or more of these treatment methods may be implemented based on
the severity and type of cancer. Unfortunately, all of these treatments can have adverse effects. Loss of
appetite is seen in patients being treated for cancers. Likewise, the inability to taste may occur. The
combination of both symptoms are likely to effect a patient's desire to keep their body properly
nourished. Another issue with both radiation and surgery treatments is that depending on the duration
and severity, dental caries, tooth loss, and the muscles used to chew food can be affected. Even if the
patient has the desire to eat, surgery and radiation may make conventional chewing and swallowing

difficult, resulting in undernourishment. This is especially detrimental during the healing process, as
the body expends more energy, requiring greater nutrient consumption. Cancer treatments as a whole
can have a significant effect on the desire and ability to eat.
Eating disorders such as bulimia and anorexia can have a significant affect on the tissues of the
oral cavity, such as the enamel. This is due to the heightened exposure to acid in the oral cavity caused
by frequent vomiting, exposure to foods that cause the formation of acid, as well as other
gastrointestinal fluids. This weakening of the enamel can leave the teeth susceptible to further damage,
and in prolonged cases, tooth loss and periodontal disease. Another possible cause of premature
periodontal issues is seen in individuals with anorexia. Some medications used to treat anorexia-related
depression can cause xerostomia (dry mouth). This can affect the secretion of saliva, which functions as
a defensive mechanism against decay, as well as an aid in the digestion of carbohydrates. Eating
disorders are among one of many possible culprits behind the development of poor oral health.
Nutritional deficiencies and excesses are also commonly seen among those with poor oral
health and nutrition. The tissues of the mouth act as a good marker of nutritional concerns because of
their quick replacement rate. Using the oral tissues as a diagnostic device, medical practitioners are
able to diagnose nutritional deficiencies and excesses more effectively. The Journal of the Academy of
Nutrition and Dietetics provides an example of nutrient excess and its consequences. Vitamin A toxicity
can slow or reduce the proper development of oral mucosal epithelium.
The roll of a Registered Dietitian Nutritionist (RDN) is crucial in any Nutrition Care Process
(NCP). Through the process of assessment, diagnosis, intervention, monitoring, and evaluation, the
RDN can create individualized plans for patients. It is important for the RDN to properly assess the
patient using as much information that is available. With that being said, an adequate oral assessment
would be beneficial to better understand the patient's nutrition status and to create the best possible
NCP. In addition, a collaborative effort between the RDN and any of the patient's healthcare
professionals can help create the best oral health and nutrition outcomes for that patient.

In my opinion, I feel that the Academy of Nutrition and Dietetics did an excellent job covering
the topics related to oral health and nutrition. One aspect that I think needs special attention is the
curriculum of both Dietetic programs as well as Dentistry curriculum. The Journal article states:
neither oral health screening or nutrition-focused physical examination are cited as specific
competencies or criteria in the Accreditation Commission for Education in Nutrition and Dietetics
education standards for entry-level practice. In addition, RDs in the United States have reported a lack
of education and training on oral health screening(1). I believe that this is a serious issue that needs to
be addressed. I believe that a multi-faceted approach to both Dietetic care and Dental care needs to be
implemented. An adequate oral screening and diet history are excellent tools that can be used to
properly assess, diagnose, and treat patients. If data is missing or inadequate, the RDN or Dental
professional should order them before a proper diagnosis and NCP can be implemented. This approach
will result in overall better outcomes for patients and will help to improve their nutrition status.

References
1. Touger-decker R, Mobley C. Position of the Academy of Nutrition and Dietetics: oral health and
nutrition. J Acad Nutr Diet. 2013;113(5):693-701.