Nutritional Requirements Affecting Oral Health in Women

MULTIPLE CHOICE

1. Current recommendations for nutrition during pregnancy focus on avoidance of undernutrition because the placenta does not perform well if the mother’s nutritional status is poor.

a.
Both the statement and the reason are correct and related.
b.
Both the statement and the reason are correct but are not related.
c.
The statement is correct, but the reason is not correct.
d.
The statement is not correct, but the reason is correct.
e.
Neither the statement nor the reason is correct.

ANS: D

Previous recommendations focused on avoidance of undernutrition and inadequate weight gain. However, current primary concern has shifted to obesity and excess weight gain. New guidelines are based on body mass index categories. Addressed are factors that affect pregnancy before conception and continue through the first year postpartum.

REF: p. 244

2. The factor that is least predictive of a healthy pregnancy is:

a.
the mother’s nutritional status before conception.
b.
appropriate weight gain.
c.
gestation of 39 to 41 weeks.
d.
birth weight less than 5 pounds.

ANS: D

An infant weighing more than 6 pounds is considered mature. Low birth weight, considered less than 5 pounds, is not predictive of a healthy pregnancy.

REF: p. 244

3. An infant is considered premature if the gestational period is less than 39 weeks. Mortality rates are highest for infants born at 32 to 36 weeks’ gestation.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: B

A full-term pregnancy is 39 to 41 weeks. An infant is considered premature if gestational age is less than 37 weeks. Mortality rates are highest for infants born at 22 to 23 weeks and decline sharply with increasing gestational age at 32 to 36 weeks.

REF: p. 244

4. A pregnancy that occurs less than 1 year after a previous pregnancy can contribute to each of the following except one. Which one is the exception?

a.
Increase incidence of preterm birth
b.
Decrease of fetal calcium and iron
c.
Fetal growth retardation
d.
Risk of maternal mortality and morbidity

ANS: B

Although pregnancies occurring within a year can decrease maternal nutritional reserves and result in an infant with low birth weight (LBW), it is commonly believed that the fetus is protected at the mother’s expense. With calcium and iron, maternal absorption becomes more efficient to supply fetal needs. With other nutrients, inadequate maternal intake can deplete the mother’s stores, and the infant’s stores may be suboptimal at birth. The remaining selections accurately state risks of not allowing adequate time between pregnancies for replenishment of maternal nutritional reserves.

REF: p. 244

5. Women practicing pica behaviors are usually from lower socioeconomic groups or have less than a high school education. Pica, affecting 10% of American women, is more frequently practiced by women living in densely populated urban areas.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: C

Pica, the abnormal consumption of specific food and nonfood substances such as dirt, clay, and paint chips, is more frequently practiced by women living in rural areas—more specifically, African American women living in rural areas with a childhood and family history practice pica. This unusual dietary pattern affects 20% to 75% of American women. Other unusual substances consumed include baking soda, stones, cloth, baby powder, starch (laundry and corn), large quantities of ice/frost, and other inedible items. Micronutrient deficiencies, especially iron and zinc, can result from these abnormal behaviors. Depending on the snacks consumed, the substance can cause teeth to wear down rapidly.

REF: p. 244

6. When talking with a young woman trying to become pregnant, the dental hygienist recalls that weight adjustment ideally should be achieved:

a.
before conception.
b.
after conception.
c.
before labor.
d.
during lactation.

ANS: A

One of the most important times for prenatal care is before a pregnancy begins. Ideally, weight adjustments of overweight or underweight women should be achieved before conception. The Academy of Nutrition and Dietetics and the American Society for Nutrition recommend that all overweight and obese women of reproductive age receive counseling by a registered dietitian before a pregnancy.

REF: p. 244

7. Each of the following is true of health issues concerning maternal weight before and during pregnancy except one. Which one is the exception?

a.
The goal for women who are overweight before pregnancy is to avoid excessive weight gain during pregnancy.
b.
Women who gain more than 22 pounds during pregnancy are more likely to retain the weight.
c.
The risk of spontaneous preterm birth decreases in underweight women.
d.
Infants born to mothers who gain more than 50 pounds during pregnancy are at risk for higher body mass in later life.

ANS: C

Underweight women are at increased risk for spontaneous preterm birth. Note that an additional challenge for women who are overweight prior to pregnancy is that they must consume adequate kilocalories to allow optimal fetal growth. Infants born to mothers who gain more than 50 pounds during pregnancy are more than twice as likely to be heavier at birth. Excluding genetic components, this is a predictor for a higher body mass index later in life.

REF: p. 246

8. The best time period for a pregnant woman to receive routine dental care is during the:

a.
first 6 to 8 weeks.
b.
first trimester.
c.
second trimester.
d.
third trimester.
e.
last month.

ANS: C

Routine dental care received during the second trimester (gestational weeks 13 to 21) is not associated with an increased risk of serious medical events, preterm deliveries, spontaneous abortions, or fetal deaths or anomalies. Dentistry during the first trimester is not recommended because major organs are developing.

REF: p. 246

9. The ideal time to begin taking folate to prevent neural tube defects is:

a.
before conception.
b.
once pregnancy begins.
c.
at 6 weeks.
d.
upon completion of the first trimester.

ANS: A

Maternal health and fetal growth and development are affected by nutrient intake during pregnancy and before conception. Low levels of folic acid (folate) before pregnancy have been linked to neural tube defects. Also pertinent, low levels of iron and folate before pregnancy have been linked to premature births and stunted growth. The concept of preventive care before pregnancy extends to all aspects of health.

REF: p. 252

10. Most gravidas younger than 18 years old have adequate intake of calcium and iron, but lack stores of vitamins A, D, and niacin. Most girls this age are still growing and storing nutrients in their own bodies.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: D

Gravidas (pregnant women) younger than 18 can have unique problems because most adolescent girls do not complete linear growth and achieve gynecologic maturity until age 17. Most have inadequate intake of calcium, iron, vitamins A and D, niacin, and kilocalories. About one in every three teenage mothers shows signs of significant bone loss after giving birth, but greater calcium and vitamin D consumption during pregnancy can protect against bone loss.

REF: p. 245

11. Low-dose iron supplementation during pregnancy, even if the gravida is not anemic, improves the woman’s iron status and protects the infant from iron-deficiency anemia. Maternal and fetal goiter, cretinism, and intellectual impairments are linked to infant iron deficiency.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: C

Fetal and infant iron deficiency is linked to cognitive and neurobehavioral outcomes. Maternal iron deficiency requires increased cardiac output to maintain adequate oxygen for maternal and fetal cells. If iron is deficient and hemorrhage occurs at delivery, prognosis is poor. Regarding the second statement, iodine deficiency is linked to maternal and fetal goiter, cretinism, intellectual impairments, neonatal hypothyroidism, and infant mortality. Dietary iodine requirements are increased during pregnancy because of increased maternal thyroid hormone production and fetal iodine requirements.

REF: p. 252

12. A multivitamin supplement containing folic acid is recommended for all young women because of the number of unintentional pregnancies in women 15 to 24 years old.

ANS: A

Folate (folic acid) supplementation is considered prudent if adequacy of intake is questionable. Because a deficiency of this nutrient, as well as others, has the potential to harm the embryo from the moment of conception, and the high percentage of unplanned pregnancies in this age group, it is prudent to recommend a multivitamin multimineral supplement. In support of this recommendation, most women do not know they are pregnant for at least several weeks.

REF: p. 253

13. A goal for Healthy People 2020 is to reduce iron-deficiency anemia among pregnant females because the Institute of Medicine (IOM) has concluded that iron is the only known nutrient to warrant global supplementation during pregnancy.

ANS: A

Although considerable controversy exists among health practitioners and health-related researchers, a subcommittee of the IOM concluded that iron is the only prenatal nutrient that warrants global supplementation. Consequently, Healthy People 2020 has adopted a goal of reducing iron-deficiency anemia among pregnant females and recommends 30 mg of ferrous iron during the second and third trimesters of pregnancy. Note also that because serious consequences of folate deficiency early in pregnancy, a multivitamin supplement containing folic acid is recommended for all young women.

REF: p. 253

14. Omega-3 fatty acids, also known as docosahexaenoic acid, should not be consumed during pregnancy because they interfere with central nervous system and visual development in infants.

ANS: E

Polyunsaturated fatty acids have benefits of reducing serum lipids. It is thought that omega-3 fatty acids, (docosahexaenoic acid) can lessen some obstetrical complications. Together with omega-6 fatty acids (arachidonic acid), docosahexaenoic acid is important for central nervous system growth and visual development of infants. Although requirements for omega-3 fatty acids have not been established, they are thought to exceed that of a nonpregnant woman.

REF: p. 250

15. Maternal iron-deficiency anemia is associated with each of the flowing except one. Which one is the exception?

a.
Excessive caloric intake
b.
Low iron intake
c.
Increased risk of preterm delivery
d.
Impaired intellectual development
e.
Low birth weight

ANS: A

Maternal iron-deficiency anemia is associated with low caloric intake and inadequate gestational gain. The remaining selections correctly correlate with maternal iron deficiency.

REF: p. 252

16. Increased levels of vitamins B6 and B12 have been noted in women taking oral contraceptive agents (OCAs) due to increased levels of estrogen. Progestins within OCAs can cause weight gain related to increased appetite and related carbohydrate metabolism.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: C

Low levels of vitamins B6 and B12 have been noted in women using OCAs. Note that low levels of B6 are associated with risk for chronic inflammation. Although progestins can cause weight gain related to increased appetite and altered carbohydrate metabolism, estrogens can lead to an increase in subcutaneous fat and fluid retention.

REF: p. 257

17. Each of the following is a prudent recommendation for a dental hygienist to make for a menopausal patient except one. Which one is the exception?

a.
Supplement calcium and vitamin D slightly beyond upper intake (UI) level because of increased metabolic needs.
b.
Encourage lean protein and regular exercise to maintain muscle mass.
c.
Avoid alcohol and alcohol-containing oral hygiene products if xerostomia is present.
d.
Consumption of 90 mg daily of isoflavones in soy products helps to increase bone mass.

ANS: A

Calcium and vitamin D supplementation beyond the tolerable upper intake level should be discouraged unless taken under the supervision of a healthcare provider. The dental hygienist can help menopausal patients by explaining the links between declining hormone levels and diminishing bone mass/increased risk of fractures. Many medications and products cause dry mouth, xerostomia, and dental hygienists can provide valuable preventive and therapeutic advice to minimize oral conditions related to diminished salivary flow.

REF: p. 260 | Nutritional Directions

18. Each of the following is true of fetal alcohol syndrome (FAS) and fetal alcohol syndrome disorder except one. Which one is the exception?

a.
FAS is a cluster of birth defects resulting from prenatal alcohol exposure.
b.
The brain is one of the first organs affected by alcohol.
c.
At birth, an infant with FAS has a head circumference that is larger than normal.
d.
The first trimester is the most vulnerable time for the fetus.
e.
Four to five drinks per day can produce the full FAS syndrome.

ANS: C

At birth, the circumference of the head is small (microcephaly), indicating abnormal brain capacity. This corresponds with fewer brain cells, damaged brain function, and disorganized thought processes that result in permanently disturbed thinking ability. Note that Fetal Alcohol Spectrum Disorder (FASD) is a combination of irreversible birth defects and behavioral challenges in infants and children whose mothers consumed alcohol during pregnancy.

REF: pp. 260-261

19. Synthesis of keratin in tooth enamel depends on:

a.
zinc.
b.
vitamin A.
c.
vitamin C.
d.
vitamin D.

ANS: B

Keratin in enamel is dependent on vitamin A for its synthesis. Zinc is essential early in pregnancy during the formation of fetal organs. Vitamin C is important to formation of both enamel and dentin because it is essential to the collagen matrix. Vitamin D, calcium, magnesium, and phosphorus are essential for mineralization of enamel.

REF: p. 249

20. Tooth development begins early in the second trimester. Calcification of deciduous teeth begins around the fourth month.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: D

Tooth development begins by the sixth week of gestation. Calcification of deciduous teeth begins about the fourth month, but it should be noted that at this time the mandible is calcified. Also pertinent, development of more than 60% of the 52 deciduous and permanent teeth is initiated during gestation.

REF: p. 247

MULTIPLE RESPONSE

1. Which of the following are weight-related pregnancy complications? (Select all that apply.)

a.
Listeriosis
b.
Cesarean delivery
c.
Large-for-gestational-age infants
d.
Preeclampsia

ANS: B, C, D

Listeriosis is a serious infection usually caused by food contaminated with the bacterium Listeria monocytogenes, which principally affects infants and adults with weakened immune systems. Preeclampsia is a potentially serious complication of pregnancy involving high blood pressure that often leads to premature delivery. Preconceptual obesity or being underweight can set the stage for metabolic problems during pregnancy. Results often necessitate cesarean delivery and cause large-for-gestational-age infants. Infant death is much more likely when the mother is obese. Other weight-related complications include gestational diabetes, miscarriage or stillbirth, and postpartum hemorrhage.

REF: p. 244

2. Infant birth weights are most affected by nutrient intake during which gestational time period? (Select all that apply.)

a.
The first 6 to 8 weeks
b.
The first trimester
c.
The second trimester
d.
The third trimester

ANS: C, D

Infant birth weights are most affected by nutrient intake during the second and third trimesters. Note that the first trimester involves rapid development of body parts and organs.

REF: p. 244

3. Which of the following are true regarding prenatal physiologic roles of zinc? (Select all that apply.)

a.
Zinc is crucial early in pregnancy for formation of fetal organs.
b.
An increase in high-protein food improves zinc intake.
c.
Zinc is critical to erythropoiesis.
d.
Severe zinc deficiency is associated with congenital rickets.
e.
Requirements are highest in late pregnancy for fetal growth and development.

ANS: A, B, D

Zinc is crucial in early pregnancy during formation of fetal organs, but requirements are highest in later pregnancy for fetal growth and development. An increase in high-protein food, especially meats, improves zinc intake. Folate and iron are critical to erythropoiesis (the formation of red blood cells). Congenital rickets is associated with severe vitamin D deficiency during pregnancy and has been associated with fractures in the newborn.

REF: p. 252

4. Which of the following are appropriate nutritional recommendations for a dental hygienist to provide to lactating mothers? (Select all that apply.)

a.
Breastfeeding is positively related with child mental development.
b.
Vegan mothers may be deficient in vitamin B12.
c.
Prescription drugs should be avoided, but herbal supplements are safe because they do not pass into breast milk.
d.
Fortified milk and cereals should be avoided because of processing concerns.
e.
Breastfeeding helps with weight loss.

ANS: A, B, E

Neurologic impairments have occurred in children of breastfeeding vegan mothers who eat very little or no foods of animal origin are usually deficient in vitamin B12. Fortified milk and cereals are especially important to assure adequate vitamin D synthesis. This is true for all expectant mothers, but it should be emphasized in those with limited exposure to ultraviolet light. To support women during lactation, dental hygienists can use and refer patients to ChooseMyPlate.com to provide state of the art nutrition education.

REF: pp. 255-257

5. Only 22% to 34% if women receive dental care during pregnancy. Which of the following accurately describe prenatal oral health concerns? (Select all that apply.)

a.
Pregnancy gingivitis usually becomes evident in the second trimester.
b.
Even when oral problems exist, most women do not see a dentist.
c.
Pregnancy tumors are large lumps originating from gingivitis.
d.
Periodontal disease is a significant risk factor for preeclampsia.
e.
Dental erosion can result from nausea during pregnancy.

ANS: B, C, D, E

Pregnancy gingivitis usually becomes evident during the second month of pregnancy. Hormonal changes (estrogen and progesterone) contribute to an increased susceptibility to gingivitis and periodontitis. Pregnancy tumors are large lumps that can form from gingivitis induced by plaque biofilm. Numerous studies indicate that periodontal disease during pregnancy is a significant risk factor for preeclampsia—a dangerous maternal condition characterized by high blood pressure—or delivering a premature or low-birth-weight (LBW) infant, or both. Increased oral acidity (low pH) causes nausea, vomiting, and gastroesophageal reflux disease, all of which contribute to dental erosion.

REF: p. 246

MATCHING

Nutritional counseling is an integral component to the practice of dental hygiene, but perhaps of even greater value with pregnant patients. Match the condition or term with the appropriate description or result.

a.
Nutritional insult
b.
Preeclampsia
c.
Gravida
d.
Erythropoiesis
e.
Anencephaly
f.
Lactation
g.
Alcohol
h.
Dysesthesia
i.
Menopause
j.
Hormone replacement therapy
k.
Toxoplasmosis