The clinical power of a diet diary for dental patients

Nina Farmer details how a deeper understanding of patient nutrition can elevate clinical outcomes through the use of a simple diet diary.

It is well known that diet plays a central role in oral health. We know that sugar is a substrate for the bacteria that cause dental caries, acidic foods and drinks contribute to dental erosion; and it is becoming well known that the Western diet increases inflammation in the body, leading to problems with the host response and patient healing, which in turn impacts patient outcomes.

The diet can also be protective. Certain foods can help to support the oral cavity – for example, calcium and phosphate in dairy products support remineralisation. Fibrous foods help to stimulate saliva flow, which supports the buffering capacity of saliva, and foods high in nutrients support the immune system and inflammatory pathways, helping the host response.

It isn’t just about looking at foods that cause disease, but also what supports health.

Tracking and frequency

Then there is the timing and frequency. This will highlight patterns such as frequent snacking, sugary drinks, and acidic foods. These patterns will highlight risks and allow for personalised, evidence-based advice to minimise them, whilst showing patients how their own habits are impacting their oral health and creating a powerful moment of awareness.

A diet diary is more than just a record; it is a conversation starter. As helpful as a diet diary can be, it is important to note that it does need to be handled carefully by a dental professional, as the advice given is tailored to the patient but mostly generic due to scope and time restrictions. A nutritional therapist, nutritionist, or dietitian would spend an hour getting to know the client and their relationship with food, and it is important that advice is safe and doesn’t contribute to any disordered eating habits.

My advice as a nutritional therapist is never to take any foods away, but to look at what can be added to make it better or how it can be improved to decrease risk. For example, keeping sugary foods to mealtimes is a great example of this.

Here are some tips for getting a patient started with a diet diary:

Gain informed consent from the patient

Explain the purpose to them and let them know that it is about understanding, and not about judgement. Educate on the relevance and give examples. Give the patient a choice. If the patient is unsure, alternatives that could be offered are – a verbal 24-hour recall, discussing a typical day, or just focusing on specific areas such as sugary drinks and building on this at future appointments.

Timeframe

Ask the patient to complete the diet diary over three days and ensure one of these days is at the weekend, so you can see what they do when they are out of routine.

Record

All food and drinks should be recorded, ensuring details such as anything added to foods or drinks (such as sugar in tea/coffee) are included, as well as how long it took to drink a fizzy drink – small sips over an hour or drunk quickly. Ask them to record the timings also.

Review together

• Look at the frequency of sugar/acid
• Highlight high-risk times such as late-night snacking, grazing, and sipping
• Look for protective habits, ie, healthy snacks, meals versus grazing, hydration, and nutrition
• Avoid terms like ‘good’ and ‘bad’ foods, and do not restrict items, to avoid risking food anxiety
• Focus on patterns, not perfection.

Give personalised advice

Keep the conversation supportive and stay within scope. Keep it positive and champion the patient where possible. Watch for red flags and be alert for any anxiety, distress, mention of restrictive behaviours, bingeing, or feelings of guilt around food. If this happens, stop the process and consider a different approach and signposting.

Reinforce and follow up

This can help to track progress and support behaviour change. This can be at routine appointments, or consider getting the patients back in earlier if they need more support.

Signposting

Always signpost to the patient’s doctor if you have any concerns regarding disordered eating or eating disorders. You can signpost to a nutritional therapist, nutritionist, or dietitian in your area to support your patients. Find someone local that you can refer to, and who could also refer to you; or you can go onto directories such as the ‘find a practitioner’ search on the British Association for Nutrition and Lifestyle Medicine (BANT).

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