Diet and nutrition "bridge" the bidirectional relationship between oral and systemic health.1 Local oral diseases, oral manifestations of systemic disease, and pain syndromes can all impact the functional ability to consume an adequate diet and subsequently nutrition status. Similarly, oral manifestations of nutrient deficiency or chronic diseases such as diabetes2 and osteoporosis3 can affect the integrity of the oral cavity. Early detection of oral problems, which can alter the functional ability to eat, is important to prevent further deterioration in oral function and maintain nutritional well-being.4

Although the comprehensive oral examination and diagnosis of oral diseases is reserved for the dentist, the dietetics professional can play an integral role in detection of oral sequelae or diseases that affect the oral cavity and management of diet and nutrition as a result of oral problems. This issue of Topics in Clinical Nutrition has several articles that address the depth and breadth of nutrition and oral health and will prove to be valuable resources to the dietetics practitioner.

Rigassio Radler and Touger-Decker address how dietetics professionals can integrate the oral screening examination in their assessment and monitoring protocols. An oral screening examination that incorporates the extraoral and intraoral components, lymph nodes, and cranial nerves provides an assessment of normalcy or "abnormal" findings relative to infection, function, soft tissue disorders, and factors affecting the ability of patients to consume an adequate diet.

Two articles, by Marshall and by Mobley, address the critical problem of dental caries in the pediatric population. While the incidence of caries in the United States is declining, it remains one of the most common infectious diseases of childhood.5 Eighty percent cases of the disease are found in 20% of the population.5 Unfortunately, although water fluoridation is more widespread in the United States,6 sugar intake of children and adults continues to rise and sugared beverages often displace water and milk in diets, adding to the problem. Marshall addresses the issue of fluoridation and screening strategies for dietetics professionals while Mobley covers management through diet.

Oral health and nutrition issues facing older adults are addressed in the article by Touger-Decker. In this segment of the population, the link between systemic and oral health is quite evident in terms of chronic diseases and prescription and over-the-counter medications. Although there is an increase in the percentage of individuals who keep their natural teeth longer, there is still a substantive segment of the population who have full or partial dentures or, in contrast, are missing some or all of their natural teeth.

Eliav and Benoliel address the topic of oral facial pain (OFP). Various OFP syndromes and their sequelae can have a significant impact on oral function and subsequently appetite and intake. While the research in this area is limited, some studies have demonstrated7 an inverse relationship between dietary fiber intake and OFP; as pain increases, diet quality is negatively affected. Dietetics professionals should be aware of the range and types of OFP syndromes, their impact on oral function, management, and how diet can be modified to meet patient needs during acute and chronic conditions.

Czerniniski and Kaplan provide an overview of oral and pharyngeal cancer and the relationship of this group of cancers to diet and nutrition. The impact of the cancer and cancer therapies on appetite and the functional ability to eat are addressed as well as the epidemiological relationships between diet and cancer risk. Oral and pharyngeal cancers (Morse etc) have been demonstrated to be inversely related to fruit and vegetable intake in several studies in the United States and Europe.8 The registered dietitian has a unique role to play not only in management of oral sequelae of the cancer therapy but also in health promotion and cancer prevention by stressing the importance of fruit and vegetable intake relative to cancer risk reduction.

Patel and Hansen review the integral role of nutrition and oral health in HIV-infected and immunocompromised patients. She emphasizes the nutritional implications in the treatment of oral lesions and the need for early intervention and referral to the dietitian.

Krall addresses osteoporosis, or the "silent-killer" disease of the 21st century. The prevalence and incidence of osteoporosis are rising steadily in women and men. Although the primary causes of the disease are related to diet and physical activity, secondary causes such as other systemic diseases and medications are also prevalent. Oral manifestations of osteoporosis include tooth loss and periodontal disease. Dietetics and dental professionals can play important roles in early detection and prompt referral for diagnosis and treatment of this disease. Diet is a cornerstone of disease prevention and management in osteoporosis, and dietetics professionals should stress calcium-rich foods and appropriate supplementation when needed as part of medical nutrition therapy.3

More, Sasson, Godfrey, and Sehl describe a model for training dietetic interns in the dental school setting. Such models are unique and exist in schools such as the New York University College of Dentistry, Tufts Dental School, the New Jersey Dental School, and select others. Their role is important in providing early education and training on the relationship between diet, nutrition, and oral health to the dental-dietetic team. Collaborative learning programs such as this one provide a model for teamwork in practice between dietetics and dental professionals.

This issue of Topics in Clinical Nutrition provides readers with an excellent overview of nutrition and oral health considerations for practice across the life span, in health and disease by international experts in the fields of nutrition and oral medicine. Diet and nutrition are an integral part of oral health, and oral health is an integral component of diet and nutritional well-being. Collaboration across disciplines in educating future health professionals, patient care, consumer education, and research will help to strengthen the "bridge" across the two disciplines.1

In addition to the articles on oral health and nutrition, Vangsness and colleagues focus on preparing dietetic interns to increase their knowledge and understanding of herbs and dietary supplements as part of complementary and alternative medicine. Only half of the 168 participants reported sufficient education to answer client questions in an online questionnaire; thus, increased educational efforts seem to be necessary in dietetics education programs. The article also includes helpful complementary and alternative medicine resources/Web sites and case examples, which may help educators and practitioners.

A review of Nutrition and Oral Medicine edited by Touger-Decker et al is also included and is an excellent resource.

Special thanks to our guest editor, who did an outstanding job with this issue.

Riva Touger-Decker, PhD, RD, FADA, Guest Editor, Associate Professor

School of Health-Related Professions, University of Medicine and Dentistry of New Jersey, Newark

Judith A. Gilbride, PhD, RD, FADA, CDN, Editor

REFERENCES