Nutritional Case Study Presented By: Darcie Vlangas Jessica Blanchette Megan McWilliams Talayna Duval Amy Brine

Andrew Barker 18 Year old male College Student Preparing for finals Stays up late to study and gets up early for class

Subjective Information

Medical History Dental care and x-rays 3 months ago The following were indicated as positive on med hx form Bad breath Bleeding Gums Sensitivity to sweets Sores/Growths in mouth Flossing occasionally- only when food gets stuck Brushes once a day at night Participates in sports (doesn’t use a mouthguard) He is in good health Physical was just over 1 year ago Allergy to latex No medications

Chief Complaint Dietary History “I keep getting sores on my tongue and the inside of my cheeks” Dietary History 9am - coffee w/sugar and cream 11am- coffee w/sugar and cream 2pm- Burger, French fries, soda 6pm- pizza and soda 9pm- cereal with milk 11pm- Doritos and soda

Patient Images

Objective Information

Soft Tissue Exam Extraoral examination unremarkable. Intraoral examination 5mm red, flat, oval lesion on left side buccal mucosa three red, enlarged foliate papilla left side of tongue

Hard Tissue Exam

Periodontal Charting

Plaque Index

Radiographs

Assessment

Nutritional Deficiencies Possible Causes stress poor diet inadequate nutrient intake bruxism Irritation- biofilm, chemical, mechanical GERD/vomiting lack of sleep poor oral hygiene Nutritional Deficiencies whole grains fruits vegetables protein dairy vitamins (B12/B complex)

Impact on clinical practice and patient management: He is in pain because of the lesions on the buccal mucosa and tongue, he may be non-compliant with oral hygiene If he’s non- compliant with the nutritional counseling he will still be deficient in vitamins and may not improve May have need for topical/oraqix/LA to control pain GOAL: Nutritional counseling Stress reduction Improve OH Healthy mouth healthy body

Additional Questions Do you know the correlation between a good diet and good health? Is this dietary history typical to your day to day regimen? Do you consume your beverages slowly throughout the day sipping, or do you drink your coffee and soda quickly? Do you ever experience G.E.R.D (acid reflex) or do you regularly vomit? Do you ever clench your teeth? Do you understand the importance of wearing a mouthguard while participating in sports?

PLAN

Recommendations Dietary Suggestions: Decrease/Replace soda/coffee consumption with water Whole wheat pastas Include fruit & vegetables Increase Protein & Dairy consumption Home Care Recommendations: Sonicare Fluoride mouth rinse Flossers Orajel Salt rinses Community Services Available: Nutritional counseling Learning center MyPlate.gov DH clinic

How to prevent the problem Limit soda substitute with H2O With coffee substitute sugar with sugar substitute Don't sip on cariogenic beverages all day Eat a well balanced meal, utilizing choosemyplate.gov Perform adequate homecare Visit dentist to restore carious lesions and remove decay Continue visiting hygienist regularly for prophy Relieve stress

Reassessment Follow up: Outcome Assessed by: 3-4 weeks to evaluate tissues and healing Outcome Assessed by: Subjective information How has the patient been feeling lately Periodontal reevaluation Soft tissue exam Intra oral camera Plaque score Current dietary intake Utilized from my plate journal