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Progress Notes

Lisa Mallonee

Lisa Mallonee (top center), with dental hygiene graduate Haley Hays and BUMC dietetic intern Ryan Whitcomb. Mallonee,
associate professor in dental hygiene, is also a licensed dietitian and instructs several dietetic interns each year.

Media Resources/Steven Doll

If the adage “You are what you eat” holds true, what does that mean for your teeth?

In these Q-and-A sessions, we take a closer look at some pressing topics within the dental profession and just what they mean to Texas A&M Health Science Center Baylor College of Dentistry. From TAMHSC-BCD initiatives to hot-button questions, we consult the college’s own subject matter experts to get their input.

This issue includes the perspectives of Lisa Mallonee, associate professor in the Caruth School of Dental Hygiene. She’s been a faculty member since 2001, and for most of that time, Mallonee — also a licensed dietitian with a master’s degree in public health and coordinated degree in nutrition — has maintained another distinctive job responsibility. It’s one that she created herself.

From August through May, Mallonee instructs dietetic interns fulfilling the required 1,200 hours for licensure through the Dietetic Internship Program at Baylor University Medical Center at Dallas. For a few afternoons each semester since fall 2004, she has brought each of the eight dietetic interns to the dental hygiene clinic one-by-one, where they get face time with her, a dental hygiene student and patient during a three-hour session.

The clinical rotation carries multiple benefits: The dietetic interns have the opportunity to learn about the comprehensive preventive care provided during the dental hygiene visit and get a taste for just how much diet and oral health are connected. In turn, Mallonee’s dental hygiene students gain a few pointers on how to ask their patients detailed diet-related questions and integrate this information into the oral disease risk assessment.

Mallonee’s clinical rotation with the dietetic interns continues to grow, with an expansion to the Children’s Medical Center dental clinic on the horizon. As she prepares for her largest clinical rotation class yet, boasting 12 dietetic interns, Mallonee shares some eye-opening facts about the interplay between nutrition and oral health and how dentists and dietitians can benefit from a little collaboration.

BDRO: It’s incredible the number of health conditions that manifest themselves in the mouth. What are the top three nutritional issues affecting oral health today?

Mallonee:

1. Obesity – I would say the number one issue is obesity. Obesity affects dentistry because the same foods that create a cariogenic environment in the mouth contribute to Americans’ expanding waist lines. A calorie-dense diet results in decreased nutrient intake, which lends itself to reduced immune function. There’s evidence-based research that individuals with a higher body mass index have a higher incidence of inflammation in the mouth and an increased risk for periodontal disease. It has also been demonstrated that inflammatory biomarkers produced by fat cells contribute to insulin resistance and increased risk of Type 2 Diabetes. Diabetes, in turn, is known to increase the risk for periodontal disease. 

2. Diet – Diet also plays a big role in oral health. Liquid sugar is the biggest thing as a profession that we can take a stand on. It’s a small thing we can talk to our patients about. Even healthy foods can cause risk. Foods such as baked chips, pretzels and whole wheat bread are retentive and don’t clear from the mouth as readily. Anything with carbonation or acid is going to contribute.

Juicing is a very big trend right now. Although a power-packed source of vitamins, when you’re not eating the whole vegetable or fruit, it means reduced cleansing action from lack of mastication and greater erosive potential. “Grazing” or eating five- to-six small meals is a healthy habit, but it can wreak dental havoc. Since frequency of consumption can be a concern, patients should be educated on how often and how long teeth are exposed. There is no need to discourage these healthy choices; instead reinforce good oral hygiene in conjunction with eating habits. 

3. Dentition – Another issue is dentition. If clients have altered dentition like partial or full dentures or missing teeth, that’s going to affect their dietary choices. Typically, these individuals are not going to be eating fresh vegetables and fruits, and oftentimes meat is excluded. They’re going to be eating a softer diet which can lead to increased risk of caries, and reduced immune function and healing properties in the mouth.

BDRO: Your work teaching the BUMC dietetic interns while they’re on clinical rotation is one example of how to fuse dental and nutrition-based knowledge. Can you elaborate on some of the possibilities for interdisciplinary collaboration between the two professions?

Mallonee: I think there are tons of opportunities. Oral surgery, periodontal practices and even general practices would benefit from collaboration with a registered dietitian. In dentistry, we provide our patients with restorative, prosthodontic and surgical care but fail to arm them with dietary information important for proper healing and transition. I feel there is a need to be more proactive with providing necessary guidance for patients.

Pediatric dentistry is an area with opportunities between dietitians and dental practices, since educating the patient and the parents about good habits can carry over for a lifetime.

From a community perspective, I think there also are opportunities to work jointly with dietitians at WIC clinics and pregnancy centers for low-income mothers. Our general pregnant patient population would benefit as well! We can educate expectant mothers on good dietary choices for their oral health and how it can affect the developing fetus. Mothers need to be educated that good oral health starts before that first tooth cuts. We can stress the importance of wiping out the mouth after each feeding and of finding a first dental home by no later than twelve months of age. There are opportunities for us in the dental profession to educate these and many other patient populations.