September 26, 2013
by Patti J. Frith, Wendy E. Ward, B. Arts & Sci. (Hons), MSc, PhD;Peter C. Fritz, BSc, DDS, FRCD(C), Ph
The success of a delicate periodontal procedure is dependent on both the skill of the clinician as well as several patient-associated factors. These include the past and present smoking status, systemic health conditions and compliance to post-operative protocols. Any one of the factors or in combination can delay or impair the healing process. However, common to all patients is the need to eat after the procedure. The post-operative meal planning instructions given to patients is critical in ensuring they do not disrupt the intra-oral surgical wound. It is surprising that so little evidence-based information exists to assist clinicians in guiding patients during the post-operative period. This article synthesizes the evidence available in the literature today and provides some practical guidance.
We can also use Canada’s Food Guide to ensure that the proper number of servings from each of the 4 food groups — vegetables and fruits; grains; milk and alternatives; or meat and alternatives — is attained.1 For many, it has been a while since they were taught or reviewed the daily number of servings from each food group that we are to consume for general health (Table 1). Moreover, the number of servings varies slightly depending on gender or age. For example, the number of servings for milk and alternatives is higher after age 50 to support bone health.
While Canada’s Food Guide provides general guidance on food group servings, there may be benefits gained by use of dietary supplements but this area of understanding is in its early stages. Only a few studies have investigated the role of post-operative diet or supplement use for healing after periodontal and dental implant surgery and we recently wrote an evidence-based review on this topic.2 Of the nutrients studied, the role for supplemental vitamin D in healing is supported by some data. Most studies, however, have focused on a specific nutrient or supplement, such as vitamin D, and its relationship to better periodontal health.2 Perhaps not surprisingly, healthier dietary patterns – including higher intakes of vitamin D and omega-3 fatty acids from fish and lower intakes of saturated fat–are associated with better overall periodontal health.2
What advice can we provide a patient regarding food choices after a delicate periodontal procedure?
Because the first step in this process, mastication, can cause significant damage to the healing site, it is imperative that a patient understand that temperature and texture of foods must be considered. To protect the healing site from direct trauma, and ensure best possible chances for healing, patients need guidelines to ensure the surgical site is not damaged by diet. Below, is the content of our brochure entitled “Post Surgery Meal Planning: Suggested Food Choices Following Periodontal Surgery” that we developed for our patients, to assist them in making the best diet choices that will protect the healing site and ensure that proper nutrition is attained during the first two weeks after periodontal surgery. It has been well received by our patients and is the subject of an ongoing research project. We are reproducing it below for the benefit of practitioners:
This brochure contains important instructions to guide you through your recovery. Proper care after your periodontal surgery will help your mouth heal quickly and cleanly. Listed are some food suggestions to help you prepare in advance for your upcoming periodontal surgery.
Your temporary soft food diet may seem challenging at first, but with a little planning it doesn’t have to be boring. Luckily, it can be much more than just soup and ice cream! Variety will help insure your diet has all the nutrients you need to heal quickly.
Drink approximately 8 cups of fluid per day. Start drinking nutritious fluids such as juices, milk and milkshakes as soon as you are able to. Drink water too. Avoid using a straw, drink normally out of a glass. Avoid hot liquids like coffee and tea–let them cool first before drinking. Hot fluids increase the flow of blood and your wound can start to bleed again.
A general rule of thumb for the first two weeks post-surgery is to avoid any foods that take “more than three chews” to swallow.
Try to base your daily meals for the first two weeks around the food groups outlined in Canada’s Food Guide.1
Fruits and Vegetables: Seven (males 51 years and older; females 31 years or older) or eight (males 31-50 years) servings of soft fruit and well-cooked vegetables (to make them soft and less likely to damage the healing site) each day. Consume more dark green and orange vegetables, and more servings of vegetables than fruits. Suggested foods include applesauce stewed or canned fruit or smoothies. Try soups, containing lower levels of sodium, made with lots of veggies. This should be well cooked or pureed, but not served very hot. Sweet potatoes, mashed vegetables such as carrots, turnip or other root vegetables are both filling and nutritious. Broccoli cooked until soft and served with melted cheese adds variety and allows you to incorporate a serving from the milk and alternatives group.
Grain Products: Six (women) or seven (men over age 51 years) or eight (men 31-50 years) servings of bread, cereal, rice, pasta or couscous each day. Half of your servings of grains should be whole wheat each day. Chose grain products low in fat, sugar and/or salt. This could be achieved with porridge, oatmeal or cream of wheat (cooled), or other cereals without nuts or fruit. Pasta dishes made with small shapes or noodles and plenty of sauce (cooled, and prepared with soft vegetables to help you consume enough vegetables for the day). Soft bread without crusts are another choice.
Milk and Alternatives: Two (men and women under age 51 years) or three (men and women over age 51 years) servings of milk and alternatives each day. Choose skim, 1 percent or 2 percent milk. Select lower fat milk alternatives whenever possible. Calcium fortified soy or rice milk can be included here if you prefer. Puddings, yogurt or cheeses such as cottage cheese are all choices you might include. Pay attention to serving size; a serving of dairy is 250 mL (1 cup) for milk or 50 g (1.5 ounces) for cheese.
Meats and Alternatives: Two (females) or three (males) servings of tender meat, poultry or fish, eggs, peas, beans or lentils each day. Chose meat alternatives such as beans, lentils and tofu often as they are rich in vitamins and minerals and healthier fats (less unhealthy saturated fat and more of the healthier polyunsaturated fats). Consume at least two servings of fish each week and chose lean meat and alternatives prepared with little or no added fat or salt. Suggestions include tuna, salmon or other flakey fish served without crunchy coating. Poultry should be well-cooked and cut into small bite sized pieces. Baked beans are an option. Omelets or scrambled eggs can add diversity served with or without cheese and provide a strategy for incorporating a serving of vegetables.
Avoid alcohol and tobacco as much as possible during the healing period of two weeks as both are known to delay the healing process. You may wish to take a multivitamin supplement as it may promote healing.
We also encourage you to visit Canada’s Food Guide online at http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php before your procedure to help you plan your diet options after surgery. You can develop a diet plan that is individualized by selecting food options that most appeal to you. Also, there are useful planning tips and information about serving size for each food group.OH
Patti J. Frith — Reconstructive Periodontics and Implant Surgery, Fonthill, Ontario, Canada. L0S 1E5.
Wendy E. Ward — Center fo
r Bone and Muscle Health, Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada. L2S 3A1. Phone: 905 688 5550 X3024, Fax: 905 688 8364
Peter C. Fritz – Staff Periodontist, Niagara Health System Phone: 905 892 0800, Fax: 905 892 0005
Oral Health welcomes this original article.
1. Eating Well with Canada’s Food Guide, Health Canada (accessed August 18, 2013) http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php
2. Lau BY, Johnston BD, Fritz PC, Ward WE. Dietary Strategies to Optimize Wound Healing after Periodontal and Dental Implant Surgery: An Evidence-Based Review. Open Dentistry Journal. 2013, 7, 36-46 http://benthamscience.com/open/todentj/articles/V007/36TODENTJ.pdf (accessed August 18, 2013)