As children return to school this week, parents wonder what they will put in their lunchboxes. Obesity is a big concern, so there’s a lot of pressure to avoid junk food—particularly sugar-sweetened beverages (SSBs). Oral health professionals (OHPs) can play a vital role in guiding families who need help in making these dietary decisions.
Texas A&M University College of Dentistry recently explored how OHPs can use behavior modification tools such as motivational interviewing to help families address SSB consumption and promote positive dietary habits for improved weight management and oral health outcomes. One of the authors of the study, Lisa F. Mallonee, MPH, RDH, shared her insights with Dentistry Today.
Q: Why do physicians need to address SSBs with parents and pediatric patients?
A: SSBs are loaded with empty calories. Essential nutrients are replaced in the diet by these sugar-laden beverages that kids consume. It is crucial that physicians educate parents about excess sugar intake and the added potential for weight gain. Kids who are inactive, overweight, and/or genetically predisposed to heart disease, diabetes, and elevated blood cholesterol need to be educated about the negative impact of frequent consumption of SSBs and how they contribute to increased risk of weight gain.
Q: Specifically, what makes OHPs especially ideal for having these conversations?
A: OHPs are ideally suited to discuss SSB consumption with parents and pediatric patients due in part to the fact that we see patients more frequently than physicians. We often see patients twice, if not 3 or 4 times, a year. SSBs have a direct impact on the oral cavity based solely on the fact that regular consumption contributes to demineralization and increased risk of dental caries. Discussions on the need to curtail consumption of SSBs on a frequent basis also has the potential to reduce childhood obesity and the long-term co-morbidities associated with excess weight.
Q: Where should OHPs go to learn more about good nutritional practices?
A: OHPs are well qualified to discuss diet as it pertains to oral disease risk. Indirectly, discussion on a healthy diet for the body—fresh fruits, vegetables, lean meat/plant based protein, dairy and whole grains—is beneficial for the mouth as well. Continuing education courses led by credentialed experts in the area of nutrition, evidenced-based literature, and textbooks or modules specific to oral health and nutrition are essential tools to encourage continued growth of knowledge in this area and to understand more fully how it can be applied to patient care.
Q: Are there specific techniques providers should use in introducing these topics into discussion?
A: Evidenced-based literature supports the use of motivational interviewing techniques to incorporate these topics into patient education. According to the American Academy of Pediatrics:
“Motivational interviewing is a set of patient-centered communication techniques—focused on being empathetic, nonjudgmental, and supportive—which helps individuals express their own reasons for change and take responsibility for their own behavior. Some tools in your motivational interviewing toolkit include asking open-ended questions, reflective listening, sharing the agenda setting, eliciting pros and cons of change, providing information using the elicit-provide-elicit technique, inquiring about the importance and confidence of making a change, and summarizing the conversation.”
Q: Some families may resist dietary advice from their dentist. How should dentists respond?
A: I think it’s important that OHPs focus on the dietary advice they are most confident about. Diet should be discussed in relation to the etiology of caries. The caries process is multifactorial. Discussions with patients should address host factors, bacteria (biofilm present in the mouth), salivary function, and, finally, diet. Caries cannot be discussed without linking it to diet. Forms of foods consumed (sticky, slow dissolving, acidic beverages, both regular and diet) should be included in the dietary advice provided to the patient. Healthy eating patterns for general health can be reinforced. However, this isn’t the primary role of the dietary advice in the dental setting. Families will be more open to dietary advice from OHPs if discussions are not geared toward weight loss per se but rather how diet affects the mouth—and inadvertently how this can have an impact on the body as whole.
Q: Once the topic has been broached, what are some of the strategies OHPs and families can use to address SSBs and diet?
A: First and foremost, we should be realistic when establishing strategies for decreased consumption of SSBs. Patient education about SSB consumption, diet, and how it not only impacts oral health but also overall health is a crucial element of patient education. The use of food diaries may be beneficial to encourage patient awareness of SSBs and cariogenic foods consumed. I think it is also important to appeal to visual learners. Filling 20-oz bottles of a variety of different SSBs with the amount of sugar that these beverages contain so that patients can fully grasp an understanding of sugar content is a suggested educational tool. Multipacks of small boxes of sugary cereals is another great way to review sugar content on nutrition labels. Goal setting to limit consumption may also be a useful strategy.
Q: Should dentists collaborate with the family’s primary care physician in establishing and maintaining these strategies?
A: Absolutely! I feel interprofessional collaboration and mutual reinforcement is a key element to ensure successful adoption of healthful habits for oral health and total body health.