Episode 3 – Series 2 – Smile Revolution Podcast – Dr Vee – Thinking more about Nutrition and Oral Health
Following on from Dr. Vee’s Smile Revolution Podcast recording, Dr Vee shares even more about further considerations around Nutrition and Oral Health.
To listen to the full episode visit the www.smile-revolution.net/call-to-action/
You talk about ulcers in the mouth and gut health. What should we as clinicians be asking to understand if the ulcers could be contributed to by diet?
As part of our oral medicine training, we are taught to recognise the parallels between gut and oral health and how certain GI conditions can manifest in the oral cavity.
As part of thorough patient assessment we are taught to delve into a patients medical history, often more times than not, ulcers are recurrent and linked to either stress or a recognised GI condition but in rarer cases, patients will have not had any formal diagnosis nor have they gone to see their GP for further investigation surrounding this.
I always encourage patients to request a blood test to check for a full blood count, iron levels etc to rule out anaemia. It is then I try to further understand their diet, is it balanced, is it high in vitamins and minerals/ is the patient malnourished? Understanding if the pattern is consistent with habits they may have such as drinking a lot of alcohol or frequently eating/ drinking acidic foods
It’s important to recognise foods that can exacerbate ulcers which may or may not be stress/ GI related and treat each patient uniquely
On the same note, sadly oral cancers can sometimes appear as ulcers in the mouth and thus reviewing the patient in 2 weeks to check if it’s healed or not is paramount to patient safety
You speak about bespoke treatment for every patient. Do you have a systematic approach to understand more about a patients diet?
Yes, I use my examinations as a chance to understand more about the patient
In the same way we ask about oral hygiene and and their routine at present, I try to understand more about lifestyle and dietary choices to better connect with my patient
If so what is it?
In many circumstances I request diet diary’s from patients in order to educate them by highlighting trends and picking up habits which can work together to improve
Do you have a systematic approach in delivering diet advise?
I always try to approach diet from an education standpoint rather than telling patients what they’re doing incorrectly as I feel this is far more effective
The first step is to understand their dietary choices and learn more about their lifestyle
I then try to notice and compile information about their diet which I subconsciously think about ways of improving
I may take an aspect of a patients diet and rather than criticising this I’ll politely suggest an alternative which I think they may enjoy and benefit from more- I find Patients are always far more interested in listening this way.
You speak about not wanting to have a negative impact on childrens diet related to sugar, how do you approach diet advice for children?
I am very cautious when educating and talking to children about diet, I always ensure parents are both in the room and the listening in order to carry forth the positive connotations with food I portray
I believe that (and studies have also shown) we shouldn’t restrict children or create negative rules around food as this can lead to an unhealthy relationship with food into adulthood
We know that restrictions lead to binges which may actually be far more detrimental to their oral, physical and mental health long term
I do not believe that teaching children anything is forbidden or taboo but rather educate about balance and making the best choices to feel the best and perform our best.
So again, I like to approach from an education standpoint
I do not preach sugar is out of bounds but rather tastes better after dinner and for pudding and that there are a multitude of ways to naturally and better flavour foods and drinks which give us health bodies, teeth etc
You also talk about slow releasing carbohydrates that will release energy slowly. What foods would you recommend for diabetic patients?
With regards to diabetic patients there is no one size fits all. You need to firstly understand if they are type 1 or type 2, if their diabetes is well controlled etc
You need to appreciate what stage they are in with their diabetes, some patients will have suffered with it for years, will already know how to best manage it and will already be aware of the oral implications namely periodontitis associated with the condition. Some patients however will require a lot more education, patients diagnosed with type 2 diabetes later on in life will need to be helped with a lifestyle change and thus these patients require support and guidance. In general, the best education for these patients highlights the benefits of slow release starchy carbohydrates for them in their diet, the important of proteins, healthy fats and and a diet rich in vitamins and minerals. Generally early stages can be controlled and reversed with diet and lifestyle changes alone, working along side our patients as well as teaching them about the oral side effects of diabetes, we can help reverse the effects together and increase insulin resistance by sparking a desire for a lifestyle change.
Dr Vee (BDS BSc UKDilP)