Improving families' oral health by supporting healthy diets

By the CDHP team

By Christie Lumsden, PhD, MS, RDN

Dr. Lumsden is a Registered Dietitian Nutritionist and an Associate Research Scientist at Columbia University College of Dental Medicine. She focuses on diet-related behavioral research to reduce oral health disparities in young children.

There are myriad ways in which food influences our overall health and oral health. From maintaining a healthy weight to reducing the risk of various cancers, diet and nutrition both play essential roles in making and keeping us healthy. But the connection between diet and oral health remains absent in many efforts to promote health — limiting their effectiveness. In response to this notable absence, I was pleased to support Children’s Dental Health Project in their recently submitted comments to the US Department of Agriculture (USDA) on the agency’s proposed updates to the Dietary Guidelines for Americans. 

Reissued every five years, the Dietary Guidelines provide science-based recommendations for health professionals to help Americans reduce chronic disease risk by promoting healthy eating throughout the lifespan. Diet and nutrition both exert unique influences on our health. Diet is about how we eat and what we eat. Nutritionon the other hand, refers to how food is used by our body. Nutrients like Vitamin A, Vitamin C, Iron, Calcium, and Phosphorus are essential to the development and health of our teeth, gums, and bones. They also help prevent oral diseases, including dental caries — the disease that underlies tooth decay.

To effectively advance children’s oral health, we must recognize dietary risk factors for dental caries and enable families to make targeted behavior changes to reduce those risks.

Formal recognition of diet’s role in oral health dates back to scientific research and textbooks published in the early 1920s. More recently, health professional organizations, including the Academy of Nutrition and Dietetics and the American Academy of Pediatric Dentistry, have issued position papers and practice guidelines urging health providers to recognize the diet-oral health link and to assess and educate patients accordingly.

Despite such a consensus, this crucial link was missing in the UDSA’s draft Dietary Guidelines. Its inclusion is all the more critical given the focus of the document’s next version. The upcoming edition will feature a life stage approach with specific guidelines for women who are pregnant and for young children 0-24 months — two populations for whom oral health is of particular importance.

Strong evidence shows that a child’s diet is among the factors that shape their risk of tooth decay. Dental caries in children is connected to their consumption of refined carbohydrates (such as candy, pretzels, and cookies), sugar sweetened beverages, and between-meal snacks.

To effectively advance children’s oral health, we must recognize dietary risk factors for dental caries and enable families to make targeted behavior changes to reduce those risks. One way to help families is through interprofessional referrals. Dental providers can engage Registered Dietitian Nutritionists (RDNs) as partners in practice and can make patient referrals in much the same manner as they would for any other health care specialty.

For socially vulnerable children, who suffer the greatest burden of tooth decay, a lack of health insurance and financial resources may limit their ability to obtain RDN counseling services. Moreover, providing office or clinic-based counseling services to such children may pose additional challenges.

An alternative, promising approach that can overcome those barriers and support families’ adoption of healthful dietary behaviors is to elicit support of Community Health Workers (CHWs). Often working for community-based organizations, CHWs are viewed as peer counselors, sharing cultural, linguistic and racial/ethnic backgrounds with the communities they serve. They extend the reach of dental providers by meeting families where they are, in homes and community settings. CHWs provide health education in an accessible way, while also serving as an essential link to social services (housing, food, legal, insurance, etc.) and helping families navigate complex health systems. Although CHWs do not possess the extensive knowledge and training of nutrition and dental professionals, they can effectively deliver targeted oral health counseling when equipped with new health technologies.

The rise of mobile health technologies has made it possible to deliver science-based health interventions outside of traditional healthcare settings. One such example is the MySmileBuddy Program. It pairs technology-assisted CHWs with families of children at risk, or already affected by, dental caries. The MySmileBuddy Program equips CHWs with a tablet-based counseling platform founded on principles of chronic disease management, as dental caries is a preventable chronic condition. With the program, CHWs use apps, videos, and risk assessments to address a family’s underlying behaviors that impact their children’s risk of dental caries. By giving CHWs the tools they need to deliver targeted behavioral counseling, the MySmileBuddy program addresses barriers to oral health from the individual- to the systems-level.

Families need ongoing, consistent support to make lasting changes in children’s dietary behaviors. Technology-equipped CHWs are a unique example of how such support could be provided, particularly for hard-to-reach families. Although dietary behavior change may be difficult to achieve, it is essential to putting children on a path to better oral health. Ensuring the link between diet and oral health is included in benchmark documents like the USDA’s Dietary Guidelines is one key step on this journey. Investing in solutions to effectively help families is another.  Innovative ways of incorporating diet and nutrition in children’s oral health promotion efforts should be a priority for dental providers, policymakers, and oral health advocates alike.

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children ages 6-12 suffered a toothache in the previous six months.
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