What we eat and how we eat it are critical to our health, well-being, and risk of developing a myriad of diseases. The importance of a healthy diet and disease control has long been recognized as an essential component of oral health care. Poor diet is not only a key contributor to oral health and disease, but it is now considered the leading cause of death in the United States, having overtaken the decades-long reign of tobacco as leader.1
Jean Anthelme Brillat-Savarin,2 a French lawyer and politician, is credited with the common idiom, ?you are what you eat,? derived from his 1825 text, Physiologie du Go?t, in which he stated, ?Tell me what you eat, and I will tell you what you are.? He also was a proponent of a low-carbohydrate diet and considered sugar and white flour as being causative of obesity, which is a serious issue plaguing populations around the globe.
Humans have evolved from consuming raw meat and plants to cooking, domesticating animals for food, raising crops, and processing foods. Cooked and processed foods are easier to digest and thus offer a more rapid caloric source than raw meats and vegetables. Dietary changes have occurred over extended periods and have changed how we eat and what we are. Diet-driven evolution has genetically modified whole populations of people, exemplified in certain indigenous populations that are particularly susceptible to lactose intolerance and gain weight when eating carbohydrate-rich processed foods.3
The US Department of Agriculture publication Dietary Guidelines for Americans, 2020-2025, for the first time, makes recommendations on dietary modifications related to stages of life.4
Although the guidelines do address customizing dietary patterns for life-stage groups and pregnant women, they do not address requirements for the specific nutrients contained in foods and beverages or treatments for people who have a chronic disease. Can the dental office serve as a meaningful contact point to help reinforce the importance of a healthy diet and provide counseling to help customize dietary issues related to chronic oral disease and overall systemic health?
Obesity in the United States and globally has risen for decades, along with associated diseases such as type 2 diabetes, and has risen as a cause of death. In September 2023, the Centers for Disease Control and Prevention released new data showing dramatic increases in people with obesity in many states. US adult obesity is now at or above 35% in 22 of the 50 states.5
The importance of diet as a critical health determinant is undeniable, and the challenges for improving the diet of a population are diverse and complex. How can oral health care providers influence the dietary habits and patterns of their patients to help manage chronic disease and improve their health?
The goals of available nutrition programs vary to include the provision of food, such as school lunch programs and the Special Supplemental Nutrition Program for Women, Infants, and Children, and the education of people about the relationship between diet and health, and how to find and choose healthy foods. Many of these programs have existed for decades, and chronic health conditions, such as obesity, type 2 diabetes, caries, and periodontal disease, continue to be pervasive. So, how can health care providers promote improved nutrition patterns for their patients? The United States spends about 18% of its gross domestic product ($3.6 trillion) on health care with about $10,000 per person going to treatment costs and less than $300 going to prevention.1
Does the dental office provide a useful setting for dietary education?
The evidence is clear that diet is important in the development of chronic oral health conditions, including caries, periodontal disease, and oral cancer. Dental offices can include risk assessments and screening for cardiovascular disease, obesity, and type 2 diabetes.6
Approaches such as motivational interviewing can help patients modify their dietary patterns and reduce diseases such as caries.7
This holds true for patients at different life stages. Clinical studies have indicated that periodontal disease is associated with the inflammatory load of the diet and that there are micronutrients that help reduce gingival bleeding and gingivitis.7,8
The evidence is clear that diet is important in the development of chronic oral health conditions, including caries, periodontal disease, and oral cancer.
Given there can be positive outcomes to dietary education and support, what are some of the barriers and opportunities to advance nutritional support in the dental office setting?
Barriers to implementing diet and chronic disease programs include challenges around cultural diversity, the stigmatization of obesity, how to address social determinants of disease that relate to diet and lifestyle, training of health care professionals to provide effective education, and motivational interviewing. Opportunities abound to improve the dietary influence of the oral health care team members. Recommendations for the dental team members include using disease risk assessments that include questions about dietary behavior and patterns in all patients with disease activity.7
Include objective measures such as height, weight, and blood pressure to help identify people who are at risk of disease. Consider referral to a general medical practitioner or dietitian for additional dietary intervention and support, and engage in weight loss and glycemic control discussions when appropriate.
New technologies, including artificial intelligence, could be valuable in the development of meaningful precision nutrition by helping gather and analyze data related to the social context, health information, and genetics of a patient.9 Wearable devices that can monitor food exposures, the settings and time in which they occur, and in what social context are another possibility. Some of this information can be extracted from passively collected smartphone data.9 There is a need for research that evaluates different intervention approaches in well-controlled studies in diverse populations with distinct levels of disease and health.
Improving the health of patients through diet modification is certainly not a new concept in the oral health care environment. I routinely ask about dietary issues associated with caries and have discussions with patients and parents directed at adopting alternative and more healthful dietary patterns. Our understanding of diet and health continues to advance, and there are new and exciting approaches that will strengthen our ability to support precision nutrition that will positively influence the health trajectory of patients. If we are what we eat, then oral health care providers have a responsibility and opportunity to help patients customize their diets so that what they eat helps them achieve what we all want to be?healthy.
Article info
Publication history
Published online: February 17, 2024
Footnotes
Editorials represent the opinions of the authors and not necessarily those of the American Dental Association.
Identification
DOI: https://doi.org/10.1016/j.adaj.2024.01.003
Copyright
? 2024 American Dental Association. All rights reserved.
