Patient Education - Eating

Smart Eating

A nutritious diet and good oral hygiene routine are important parts of maintaining a healthy life. They become especially important if you lose your health. Eating nutritious food and staying on top of your oral health in the face of illness can make all the difference. Consider these common concerns about the impact of nutrition and oral health when dealing with disease and its symptoms:

• Cancer and Dental Health
• Mouth Sores
• Dry Mouth and Difficulty Swallowing
• Oral Care Tips

Cancer and Dental Health

Good oral care is always important but it can be especially critical when someone is being treated for cancer. According to the National Institute of Dental and Craniofacial Research, one-third of cancer patients develop complications that affect the mouth. Chemotherapy and radiation therapies can cause issues with eating and affect your mouth in other ways, too. For example, chemotherapy treatment sometimes causes painful mouth and throat sores. More critically, since chemotherapy lowers your immunity defenses, the natural bacteria that live in your mouth can easily infect these sores. Once infected, the sores can be difficult to heal, so it's important to do everything you can to prevent them from happening in the first place.

If you get mouth sores, try these tips to make eating easier and speed healing:

• Eat soft or pureed foods, like mashed potatoes, pureed or cream soup, scrambled eggs, yogurt, cooked cereal, pudding and custard, cottage cheese, macaroni and cheese, and milk shakes.
• Avoid tart, salty, spicy and acidic foods and drinks.
• Choose cool or room temperature foods.
• Blend and moisten dry or solid foods.
• Drink through a straw to bypass mouth sores.
• Eat high protein, high calorie foods to speed up healing time. For example, add protein powder to milk shakes or powdered dry milk to fortify mashed potatoes and soups.

During cancer treatment, your mouth or throat may also become dry and irritated, or your saliva may thicken, making it difficult to swallow. To help ease the pain:

• Drink lots of liquids to help loosen mucous.
• Chew sugarless gum or suck on sugar-free candy to stimulate saliva production. Don't chew ice; it can damage your teeth.
• Eat soft, bland foods that are either room temperature or are cold. Puree fruits and veggies, try frozen ice pops or slushies, or soft cooked chicken, beef or fish.
• Moisten dry foods with soup, broth, gravy, butter or margarine, or sauce. Dip or soak your food in what you're drinking.

Oral Care Tips

• Two weeks prior to beginning chemotherapy, have your teeth cleaned and have any procedures completed, such as filling cavities, treating gum disease or fixing dentures.
• Brush your teeth and gums.
• Ask your dentist about using a daily fluoride rinse to help prevent dental caries. Avoid using most mouthwashes, since they typically contain irritants like alcohol that can make mouth sores even more painful. Ask your dentist or dental hygienist for suggestions on mild mouthwash options.
• If you develop mouth sores, tell your doctor, since you need to treat them. This is particularly important if they are keeping you from eating.
• Visit MedlinePlus, the National Institutes of Health's website, for more information.

Eating Food

You know that what you eat directly impacts your health, and that includes the health of your teeth and gums. But it can work the other way around too. If you have an orthodontic appliance, such as braces, or have had certain dental problems or procedures, the health and comfort of your teeth and gums can directly impact what you eat. Here are some tips for what to eat and how to avoid these common dental issues.

• Braces
• Problems Chewing
• Problems Swallowing
• Dry Mouth
• Canker Sores
• Oral Surgery and Implants

Braces

Braces and orthodontic treatment are used to correct "bad bites," or malocclusion (teeth that are crowded or crooked). In some cases your teeth may be straight, but your upper and lower jaws may not meet properly. These jaw or tooth alignment problems may be inherited or could result from injury, early or late tooth loss, or thumbsucking.

If you have an abnormal bite your dentist may recommend braces or another orthodontic treatment to straighten out your smile. Correcting the problem can create a nice-looking smile, but more importantly, orthodontic treatment results in a healthier mouth. Not correcting an abnormal bite could result in further oral health problems, including:

• tooth decay
• gum disease
• tooth loss
• affected speech and/or chewing
• abnormal wear to tooth enamel
• jaw problems

Straightening your teeth can be accomplished in different ways. The kind of orthodontic treatment you have will depend on your preference and the options provided by your dentist or orthodontist. Traditional braces realign teeth by applying pressure. They usually consist of small brackets cemented to your teeth, connected by a wire, which is periodically tightened by your dentist or orthodontist to gradually shift your teeth and jaw. The brackets may be metal or tooth colored. Sometimes they are placed behind your teeth. Removable aligners are another option for treating orthodontic problems.

Orthodontic treatment may be provided by your dentist or an orthodontist, a dentist who specializes in the diagnosis, prevention and treatment of dental and facial irregularities. It will depend on the orthodontic experience of your dentist and the severity of your case.

Since abnormal bites usually become noticeable between the ages of 6 and 12, orthodontic treatment often begins between ages 8 and 14. Treatment that begins while a child is growing helps produce optimal results. That doesn't mean that adults can't have braces; healthy teeth can be orthodontically treated at any age.

Treatment plans will vary based on your situation, but most people are in treatment from one to three years. This is followed by a period of wearing a retainer that holds teeth in their new positions. Today's braces are more comfortable than ever before. Newer materials apply a constant, gentle force to move teeth and usually require fewer adjustments.

While you have braces it's important to maintain a balanced diet for the health of your teeth. Of course, a healthy diet is always important, but eating too many sugary foods with braces can lead to plaque build-up around your brackets that could permanently stain or damage your teeth. Avoiding foods like popcorn, corn on the cob, chewing gum, whole apples, and other sticky foods is also a good idea. Ask your dentist about foods to avoid while you are in treatment.Not all of us are born with beautiful smiles, but with a good oral hygiene routine, and a little help from orthodontics, you can have a beautiful and healthy smile.

Braces are delicate, and any foods that are sticky, chewy or hard can easily cause them to break, including:

• ice
• nuts
• popcorn
• hard candy
• gum
• chewy candy like caramel or gummi bears
• whole hard fruit like apples and pears and hard, raw veggies like carrots
• corn on the cob
• hard pretzels
• peanut brittle
• pizza crust
• hard rolls or bagels
• ribs

Any food that you need to bite into to eat is prime for breaking braces. You can get around this by cutting the food, such as corn off the cob or rib meat off the bone, or slicing apples and chopping carrots into small, bite-size pieces. You may also experience problems eating after your braces are tightened teeth may feel sore. The first few days are the worst, so try eating softer foods like those listed below until the soreness passes:

• scrambled eggs
• oatmeal
• soup with soft vegetables or pureed or cream soups
• soft cheeses, including cottage cheese
• smoothies and milkshakes
• pudding and custard
• meatloaf
• mashed potatoes
• sorbet and frozen yogurt
• tortillas (soften by microwaving or steaming)
• yogurt
• soft-cooked, shredded chicken and meat
• protein shakes
• tofu
• ripe fruits, such as peaches and nectarines, cut into bite-size pieces
• couscous, quinoa, bulgur, soft-cooked rice
• pasta and noodles
• polenta
• baked apples
• peanut butter
• chicken or tuna salad
• refried beans
• avocado
• applesauce
• macaroni and cheese
• pancakes
• soft bread
• saltines and matzoh
• mashed bananas
• cooked veggies
• hummus
• canned or cooked fruit

Problems Chewing

Chewing problems may be caused by tooth loss, gum disease, cavities and ill-fitting dentures, so your first step should be a visit to your dentist to help determine the cause of your problem. Meanwhile, eating soft foods (see tips for braces) can you help maintain your nutrients until you can see your dentist.

Gum disease is an infection of the tissues that surround and support your teeth. It is a major cause of tooth loss in adults. Because gum disease is usually painless, you may not know you have it. Also referred to as periodontal disease, gum disease is caused by plaque, the sticky film of bacteria that is constantly forming on our teeth.

Here are some warning signs that can signal a problem:

• gums that bleed easily
• red, swollen, tender gums
• gums that have pulled away from the teeth
• persistent bad breath or bad taste
• permanent teeth that are loose or separating
• any change in the way your teeth fit together when you bite
• any change in the fit of partial dentures

Some factors increase the risk of developing gum disease. They are:

• poor oral hygiene
• smoking or chewing tobacco
• genetics
• crooked teeth that are hard to keep clean
• pregnancy
• diabetes
• medications, including steroids, certain types of anti-epilepsy drugs, cancer therapy drugs, some calcium channel blockers and oral contraceptives

See your dentist if you suspect you have gum disease because the sooner you treat it the better. The early stage of gum disease is called gingivitis. If you have gingivitis, your gums may become red, swollen and bleed easily. At this stage, the disease is still reversible and can usually be eliminated by a professional cleaning at your dental office, followed by daily brushing and flossing.

Advanced gum disease is called periodontitis. Chronic periodontitis can lead to the loss of tissue and bone that support the teeth and it may become more severe over time. If it does, your teeth will feel loose and start moving around in your mouth. This is the most common form of periodontitis in adults but can occur at any age. It usually gets worse slowly, but there can be periods of rapid progression.

Aggressive periodontitis is a highly destructive form of periodontal disease that occurs in patients who are otherwise healthy. Common features include rapid loss of tissue and bone and may occur in some areas of the mouth, or in the entire mouth. Research between systemic diseases and periodontal diseases is ongoing. While a link is not conclusive, some studies indicate that severe gum disease may be associated with several other health conditions such as diabetes or stroke.

It is possible to have gum disease and have no warning signs. That is one reason why regular dental checkups and periodontal examinations are very important. Treatment methods depend upon the type of disease and how far the condition has progressed. Good dental care at home is essential to help keep periodontal disease from becoming more serious or recurring.

Remember: You don't have to lose teeth to gum disease. Brush your teeth twice a day, clean between your teeth daily, eat a balanced diet, and schedule regular dental visits for a lifetime of healthy smiles.

Tooth decay is the destruction of your tooth enamel, the hard, outer layer of your teeth. It can be a problem for children, teens and adults. Plaque, a sticky film of bacteria, constantly forms on your teeth. When you eat or drink foods containing sugars, the bacteria in plaque produce acids that attack tooth enamel. The stickiness of the plaque keeps these acids in contact with your teeth and over time the enamel can break down. This is when cavities can form. A cavity is a little hole in your tooth.

Cavities are more common among children, but changes that occur with aging make cavities an adult problem, too. Recession of the gums away from the teeth, combined with an increased incidence of gum disease, can expose tooth roots to plaque. Tooth roots are covered with cementum, a softer tissue than enamel. They are susceptible to decay and are more sensitive to touch and to hot and cold. It's common for people over age 50 to have tooth-root decay.

Decay around the edges, or a margin, of fillings is also common for older adults. Because many older adults lacked benefits of fluoride and modern preventive dental care when they were growing up, they often have a number of dental fillings. Over the years, these fillings may weaken and tend to fracture and leak around the edges. Bacteria accumulate in these tiny crevices causing acid to build up which leads to decay.

You can help prevent tooth decay by following these tips:

• Brush twice a day with a fluoride toothpaste.
• Clean between your teeth daily with floss or interdental cleaner.
• Eat nutritious and balanced meals and limit snacking.
• Check with your dentist about the use of supplemental fluoride, which strengthens your teeth, and about use of dental sealants (a plastic protective coating) applied to the chewing surfaces of the back teeth (where decay often starts) to protect them from decay.
• Visit your dentist regularly for professional cleanings and oral examination.

Dentures are removable appliances that can replace missing teeth and help restore your smile. If you've lost all of your natural teeth, whether from gum disease, tooth decay or injury, replacing missing teeth will benefit your appearance and your health. That's because dentures make it easier to eat and speak better than you could without teeth things that people often take for granted.

When you lose all of your teeth, facial muscles can sag, making you look older. Dentures can help fill out the appearance of your face and profile. They can be made to closely resemble your natural teeth so that your appearance does not change much. Dentures may even improve the look of your smile.

Types of dentures:

• Conventional - This full removable denture is made and placed in your mouth after the remaining teeth are removed and tissues have healed, which may take several months.
• Immediate - This removable denture is inserted on the same day that the remaining teeth are removed. Your dentist will take measurements and make models of your jaw during a preliminary visit. You don't have to be without teeth during the healing period, but may need to have the denture relined or remade after your jaw has healed.
• Overdenture - Sometimes some of your teeth can be saved to preserve your jawbone and provide stability and support for the denture. An overdenture fits over a small number of remaining natural teeth after they have been prepared by your dentist. Implants can serve the same function, too.

New dentures may feel awkward for a few weeks until you become accustomed to them. The dentures may feel loose while the muscles of your cheek and tongue learn to keep them in place. It is not unusual to experience minor irritation or soreness. You may find that saliva flow temporarily increases. As your mouth becomes accustomed to the dentures, these problems should go away. Follow-up appointments with the dentist are generally needed after a denture is inserted so the fit can be checked and adjusted. If any problem persists, particularly irritation or soreness, be sure to consult your dentist.

Even if you wear full dentures, you still have to practice good dental hygiene. Brush your gums, tongue and roof of your mouth every morning with a soft-bristled brush before you insert your dentures to stimulate circulation in your tissues and help remove plaque.

Like your teeth, your dentures should be brushed daily to remove food particles and plaque. Brushing also can help keep the teeth from staining.

• Rinse your dentures before brushing to remove any loose food or debris.
• Use a soft bristle toothbrush and a non-abrasive cleanser to gently brush all the surfaces of the dentures so they don't get scratched.
• When brushing, clean your mouth thoroughly including your gums, cheeks, roof of your mouth and tongue to remove any plaque. This can help reduce the risk of oral irritation and bad breath.
• When you're not wearing your dentures, put them in a safe place covered in water to keep them from warping.
• Occasionally, denture wearers may use adhesives. Adhesives come in many forms: creams, powders, pads/wafers, strips or liquids. If you use one of these products, read the instructions, and use them exactly as directed. Your dentist can recommend appropriate cleansers and adhesives; look for products with the ADA Seal of Acceptance. Products with the ADA Seal have been evaluated for safety and effectiveness.

If you have any questions about your dentures, or if they stop fitting well or become damaged, contact your dentist. Be sure to schedule regular dental checkups, too. The dentist will examine your mouth to see if your dentures continue to fit properly.

Problems Swallowing

Swallowing problems can occasionally happen, but if it persists, talk to your doctor since it could be related to something serious. Causes of swallowing issues vary and treatment depends on what is causing the problem.

If you are having trouble swallowing, to prevent choking and aspiration avoid these foods:

• alcoholic beverages
• extremely hot foods and beverages
• caffeine
• spicy foods
• popcorn
• bran cereal
• nuts
• cottage cheese (unless pureed)
• skins of fruits
• celery
• dry, crumbly, or sticky foods (such as bread, cake, peanut butter, banana)

Depending on level of swallowing difficulty, the following foods may be included in the diet. These foods are grouped into four different categories:

• Thin liquids that dissolve quickly in the mouth such as frozen yogurt, ice cream, gelatin and broth.
• Nectar-like liquids where liquid coats and drips off a spoon such as nectars, milkshakes, cream soup and vegetable juices.
• Honey-like liquids that flow off a spoon in a ribbon like in yogurt, tomato sauce and honey.
• Spoon-thick liquids that are thickened to pudding consistency such as pudding, custard or hot cereal.

Dry Mouth

Dry mouth is not a normal part of aging. If you have dry mouth, talk to your dentist or doctor. Dry mouth can be a sign of certain diseases or can be caused by certain medications or the result of medical treatments. If you have dry mouth:

Dry mouth also called xerostomia results from an inadequate flow of saliva. It is not a disease, but a symptom of a medical disorder or a side effect of certain medications, such as antihistamines, decongestants, pain killers, diuretics and many others.

Saliva is the mouth's primary defense against tooth decay and maintains the health of the soft and hard tissues in the mouth. Saliva washes away food and other debris, neutralizes acids produced by bacteria in the mouth and provides disease-fighting substances throughout the mouth, offering first-line protection against microbial invasion or overgrowth that might lead to disease.

Some of the common problems associated with dry mouth include a constant sore throat, burning sensation, trouble speaking, difficulty swallowing, hoarseness or dry nasal passages. In some cases, dry mouth can be anindicator of Sjögren's (pronounced SHOW-grins) syndrome. Sjögren's syndrome is a chronic autoimmune disorder in which the body's immune system mistakenly attacks its own moisture-producing glands, the tear-secreting and salivary glands as well as other organs.

Without saliva, extensive tooth decay can also occur. Your dentist can recommend various methods to restore moisture. Sugar-free candy or gum stimulates saliva flow, and moisture can be replaced by using artificial saliva and oral rinses.

For more information, visit the Sjögren's Syndrome Foundation.

• don't use tobacco or drink alcohol
• drink water regularly with and between meals
• avoid drinks that contain caffeine such as colas, coffee and tea since it can dry out your mouth
• chew sugarless gum or suck on sugarless candy to stimulate saliva flow
• avoid spicy or salty foods if they cause pain in your mouth

You know smoking is bad for your health, so it should be no surprise that cigarettes and chewing tobacco are also harmful to your oral health. For one, tobacco products can cause bad breath, but that's only the beginning.

Other possible oral health impacts of smoking and all tobacco products include:

• stained teeth and tongue
• dulled sense of taste and smell
• slow healing after a tooth extraction or other surgery
• difficulties in correcting cosmetic dental problems
• gum disease
• oral cancer

Quitting is the only way to decrease your risk of these and other tobacco-related health problems. The addictive quality of nicotine, which is found in cigarettes, cigars and chewing tobacco, can make this especially difficult. That's why it's important to have a plan and a support network, people to help you stick to your plan. Write down your reasons for quitting. Exercising, chewing gum and keeping yourself occupied can help you quit. Talk to your dentist or doctor to see if the medications available would help you to stop using tobacco.

Bottom line: A smoke-free environment is healthier for you and for those around you. Make a plan to quit, stick to it and start living a healthier life.

For more information and free resources on how to quit, visit Smokefree.gov.