Nutrition 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 (cid:2)SpringerScience+BusinessMediaNewYork2014 This work is subject to copyright. 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Theuseofgeneraldescriptivenames,registerednames,trademarks,servicemarks,etc.inthispublicationdoesnotimply, evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfromtherelevantprotectivelawsandregulationsand thereforefreeforgeneraluse. Whiletheadviceandinformationinthisbookarebelievedto betrueandaccurate atthedateofpublication,neitherthe authorsnortheeditorsnorthepublishercanacceptanylegalresponsibilityforanyerrorsoromissionsthatmaybemade.The publishermakesnowarranty,expressorimplied,withrespecttothematerialcontainedherein. Printedonacid-freepaper HumanaPressisabrandofSpringer SpringerispartofSpringerScience+BusinessMedia(www.springer.com) 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