NUTRITIONAL COUNSELING 1

Nutritional Counseling of a Clinical Patient

Lillie C. Jones

Department of Allied Health, Missouri Southern State University

DH 295: Seminar in Dental Hygiene

Mrs. Merritt

November 11, 2023

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Nutritional Counseling of a Clinical Patient

The human body is a complex system that can easily be disturbed by our diets.

Inadequate nutrient intake increases the risk of developing certain diseases/conditions such as

diabetes, high cholesterol, fatty liver, etc. To prevent such things from occurring, one could

participate in nutritional counseling. This can be performed by any medical professional

educated in matters regarding nutrition. Even dental hygienists can perform said counseling with

their patients if they feel the need to intervene to promote oral and overall health. Throughout my

clinical days, I remained watchful for any patients who may benefit from nutritional counseling.

My time looking was short for I found a patient that could benefit from nutritional counseling to

improve their oral and overall health.

Patient Identification and Demographics

The patient I decided to have nutritional counseling with is a white/Caucasian, 58-year-

old female who obtained the patient ID of 13940 when she was added to our database. She was

more than eager to participate in nutritional counseling when I discussed it with her. In fact, she

had been working to improve her diet and lose weight since the start of this year. Considering her

current attitude and motivation for the opportunity, it made my decision to choose her for

nutritional counseling easy since I knew I found someone who was willing to heed my words of

advice. Once I obtained consent from Patient 13940 to follow through with nutritional

counseling our initial session began.

Dates of Counseling

The first of two sessions began on October 31st, 2023. This session consisted of my

patient and I filling out a nutritional and oral health questionnaire together, discussing the
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components of the food pyramid, educating my patient on healthy dietary habits, and assigning

her a five-day food diary to fill out before her second session. The second session done on

November 9th, 2023, was more of an evaluation to see how Patient 13940 faired in her dietary

habits. I imported each meal/snack she had into a website called MyFitnessPal. This website

created a dietary analysis report that showed what each meal consisted of, such as grams of

certain nutrients, that I could use to show her what made up her diet. We also filled out a caries

risk based on exposure form, a food diary evaluation summary form, and a diet prescription and

modification form. Based on the results, I educated Patient 13940 on dental caries, what food

groups she was excessive or lacking in, discussed what methods she could use to improve her

diet, and what goals she wished to establish to make said dietary changes.

Patients Health Status (ASA)

Apart from my patient’s need to improve her diet, she wasn’t in concerning health. She

was classified as an ASA II since she has anemia, arthritis, a history of cold sores/fever blisters, a

history of seizures, high blood pressure, high cholesterol, fatty liver disease, gastritis, and

suffered a broken back from a car accident in 2002. She does keep these conditions well-

controlled through prescribed medications and natural remedies. She takes prescribed diazepam

and hydrocodone with acetaminophen to treat her seizures and joint/back pain, respectively.

Patient 13940 also takes over-the-counter ferrous sulfate and odorless garlic to treat her anemia

and high blood pressure, respectively. As for her other conditions, she began a smoothie diet in

June of this year to help her lose weight to better manage her health. So far, she has lost 32

pounds with her new diet.

Indications for Nutritional Counseling

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As one may infer from what was previously mentioned, Patient 13940 is working to

improve her diet, but does have current signs have poor health (as suggested by her systemic

conditions). During my assessment of her oral health, I found that she has a high risk of caries

and showed signs of moderate to severe periodontal disease. I also discovered that her special

diet doesn’t provide her with an adequate number of calories for an individual seeking to lose

weight. These reasons are what led me to perform nutritional counseling on her.

Summary of Nutritional and Oral Health Questionnaire

As previously mentioned, my patient and I filled out a nutritional and oral health

questionnaire together. This form is a point-based questionnaire that helps determine what

nutritional risk level a patient is at and what form of intervention may be required to help them.

From the questions I asked her, she answered yes to having an illness that has made her change

the kinds and amount of food she eats, follows a special diet, snacks often, takes more than 3

medications daily, and having current moderate to severe periodontitis. The total points from her

answers were a seven, which put her at a high nutritional risk level and the need for dietary

education.

Goals and Objectives

On another note, my goals for counseling Patient 13940 were to help her continue her

weight loss journey safely, reduce her caries risk, decrease the effects of her periodontitis, and

improve her overall health. I just wanted to see her benefit from a healthy diet and feel better

about her oral health. To see her implement the dietary changes we discussed and continue them

after our counseling’s conclusion would be a dream come true for me. The goals my patient had

were to reduce her added sugar and sodium intake, improve her oral and overall health, and
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reverse as many side effects of her periodontitis as she could. Most of all, she wanted someone to

encourage her to keep up with her weight loss journey.

Oral Health Risks

Additionally, Patient 13940’s current diet often leaves her under the healthy goal of 1,000

calories a day for someone trying to lose weight. This not only puts her overall health at risk, but

it also deprives her body of enough nutrients to fight against bacterial infections or support oral

healing. Her food diary showed me that she rarely eats protein and consumes a lot of added sugar

and sodium. Protein is a major component in strengthening teeth enamel and preventing the

adhesion of bacteria-produced acid on the teeth. These put her at a higher risk of developing

caries, decreasing her healing factor, and increasing her diseases’ side effects. Luckily, Patient

13940 eats plenty of the other food groups and drinks enough water to help counteract some of

the risks. That means the development process of these risks is slowed down, but not prevented.

Modifications

Continually, I allowed Patient 13940 to create her own diet modifications and offered

advice when necessary. Her main dietary change was to reduce the amount of sodium in her diet

since it was rather high. She also wanted to decrease her added sugars even further, since that

was her initial goal when starting the diet. I offered her options on how to achieve these goals,

such as using low-sodium milk products, switching to unsweetened yogurt for her smoothie, and

eating snacks not processed in sugar or sodium. My patient agreed with my advice and even

discussed what alternative options she was already thinking of. I helped her choose the best

products suited to her goals based on their nutrition labels. Out of the food groups, protein and

grain were the only ones she was lacking in. Her deficiency wasn’t drastic by any means, but we
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discussed incorporating more meat and grain products into her diet to compensate. She was over

the serving amount in the other food groups, so if she were to cut back on those a little she could

surely add in the two groups she was lacking in. Adding more calorie-dense foods, like protein,

to her diet will also help her increase her caloric intake to a healthier level and promote her oral

health.

Patient Attitude

On another note, my patient’s attitude toward the modification goal was very optimistic.

She was never downhearted by our discoveries, but saw them as signs of improvement from

when she first started her diet. She was also happy to have someone helping her come up with

goals since she often came to an impasse when thinking about them. Honestly, she was very open

to trying any method I offered since she was determined to meet the goal. Patient 13940 even

told me that she planned on buying the alternative products we discussed right after our

appointment. Based on our talk, I am sure she will meet her goal in no time.

Summary

In the end, my patient didn’t meet her goal of reducing her sodium intake by our last

session. She was still working on adding the new foods, but didn’t want to waste her current

products. She assured me that she would switch to the alternative products once she finished the

others. Based on her motivation to improve herself, I used self-actualization methods to

encourage her to continue her new dietary changes. I talked about how losing weight healthily

will reduce the effects of her systemic conditions and how incorporating the new foods we

discussed will improve her oral health and promote periodontal healing. My patient was happy to
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hear this news and told me how thankful she was that I was willing to help her better herself. She

really appreciated my efforts to help her achieve goals and that is all that I can ask for.
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References

ADA. (2023). Nutrition and Oral Health. Nutrition and Oral Health | American Dental

Association. https://www.ada.org/en/resources/research/science-and-research-institute/

oral-health-topics/nutrition-and-oral-health#:~:text=Foods%20such%20as%20milk

%20and,more%20careful%20examination%20is%20needed.

Cherry, K., & Susman, D. (2022, August 14). Maslow’s Hierarchy of Needs. Verywell Mind.

https://www.verywellmind.com/what-is-maslows-hierarchy-of-needs-4136760

Delta Dental. (2022, January 18). 7 vitamins and minerals your mouth needs.

https://www1.deltadentalins.com/wellness/nutrition/articles/vitamins-and-minerals.html

MyFitnessPal. (2023). Calorie Tracker & BMR Calculator to reach your goals.

https://www.myfitnesspal.com/

Rehan, K. (2022, May 16). Whole-Body Dentistry: How Nutrition Affects Oral Health. Ontario

Academy of General Dentistry. https://www.agd.org/constituent/news/2022/05/16/whole-

body-dentistry-how-nutrition-affects-oral-health

USDA. (2023). Graphics. USDA MyPlate. https://www.myplate.gov/resources/graphics