About

Riva Touger-Decker is a faculty member at Rutgers School of Dental Medicine, serving in the Department of Diagnostic Sciences. She holds the role of Professor and can be contacted via email at decker@rutgers.edu. Her professional focus is within the academic and clinical environment of dental medicine, contributing to the education and training of students in the field. The page does not provide additional details about her research, background, or key contributions.

Selected publications

• Interventions to Reduce Food and Nutrition Insecurity Among Dental Students

  Journal of Dental Education · 2025-02-09 · 1 citations

  articleOpen access1st authorCorresponding

  PURPOSE/OBJECTIVE: The prevalence of food insecurity (FI) on university campuses is increasing. This study explored the prevalence of food and nutrition insecurity (NI) among dental students and barriers and interventions to address them. METHODS: A cross-sectional web-based survey was conducted. Validated tools were used to assess FI and NI. Univariate binary logistic regressions and a multivariable logistic regression model identified factors independently associated with FI. RESULTS: The response rate was 11.9% (n = 67). The mean age was 28.4 years; 67% were D1/D2 students; 53.7% were female, 15.2% identified as Hispanic, and 50.7% as White. Forty percent experienced FI; 24.2% had low nutrition security (NS), and 26.9% reported partial or full responsibility for others' living expenses. Twenty-four percent were married, 25.8% used a food pantry; 11.1% had unsuccessfully applied for Supplemental Nutrition Assistance Program benefits. In the adjusted model, low NS, nonmarried status, and food pantry use increased the likelihood of FI (odds ratios of 16.854, 10.182, and 9.123, respectively). Common barriers and potential interventions to address FI and NI were explored. CONCLUSIONS: The prevalence of FI in this sample was greater than the national average. Those who were unmarried, had low NS, and used a food pantry were significantly more likely to have FI. Proposed interventions include student services enhancements and curriculum modifications on nutrition and wellness. Further research is necessary with a larger sample to understand factors contributing to NI and FI among dental students.

  PublisherOA PDFDOI

• Is Your Patient Hungry? Screening for Food Insecurity in Dental Education

  Journal of Dental Education · 2025-09-22

  articleOpen accessSenior author

  A healthy oral cavity enables essential functions such as eating, drinking, and speaking, allowing individuals to live without pain, discomfort, or embarrassment [1]. As such, oral health encompasses much more than the absence of disease. Achieving and maintaining oral health throughout the lifespan depends on collaboration between the oral health care provider (OHCP) and the individual. OHCPs are expected to provide anticipatory preventive oral health guidance while treating existing disease, and individuals are expected to perform routine oral hygiene and adopt healthy lifestyle practices while minimizing exposures that increase the risk of oral and systemic disease. As part of preventive guidance, OHCPs often recommend that patients increase intakes of fruits, vegetables, and dairy foods while lowering intakes of added sugars by reducing consumption of sugar-sweetened beverages, candy, and other processed foods and beverages both between and with meals. Such recommendations assume the patient has a choice; that is, the patient has the resources and access to procure healthier food items in their lived environment. Are such assumptions relative to food choice valid? How do we know? Food security is defined as having access to sufficient, safe, and nutritious foods to meet daily needs [2]. Food insecurity (FI) is a social determinant of health (SDH) defined as having limited or uncertain access to adequate food to meet daily needs. In 2023, the prevalence of any FI, low food security, and very low food security was 13.5%, 8.4%, and 5.1%, respectively, in the United States [2]. FI is higher for households with versus without children, headed by single mothers, composed of racial minorities, and/or living in poverty [2]. Individuals living with FI often have limited availability of transportation to full-service grocery stores and inadequate financial resources to access healthy foods, resulting in higher intakes of inexpensive ultra-processed foods. Although readily accessible and convenient, ultra-processed foods, including hot dogs and cold cuts, sugar-sweetened beverages, cereals, snack foods, and desserts, are typically of high energy density, low nutrient density, and high in added sugars. Higher diet quality is associated with higher food cost. As a result, individuals from lower socioeconomic status groups, including those with FI, typically have lower-quality diets than their peers from higher socioeconomic status groups. FI is associated with an increased risk of diet-related, non-infectious systemic diseases, including obesity, type 2 diabetes, cardiometabolic diseases, and cancers. Dental caries is a diet-dependent disease; without fermentable carbohydrates, caries do not occur. Although periodontal disease is not directly caused by diet- or nutrient-related factors, adequate nutrient intakes are necessary to support soft tissue health and immune function. Cardiometabolic disease, associated with a higher risk of periodontal disease, is also higher in individuals consuming ultra-processed foods with low nutrient intakes. Oropharyngeal cancers are associated with lower intakes of fruits and vegetables and higher intakes of processed meats. Thus, a healthy diet is necessary to support oral health. The relationship between oral health and a healthy diet is bidirectional, as oral health also facilitates the consumption of a healthy diet. An increased prevalence of caries, periodontal disease, and oropharyngeal cancers is associated with lower Healthy Eating Index scores, a measure of overall diet quality. Likewise, FI is associated with a greater prevalence of caries and periodontal disease. Drumond et al. conducted a meta-analysis and reported that individuals with FI were more likely to have caries than individuals with food security (OR = 1.66; 95% CI: 1.36–2.02) [3]. FI has been associated with periodontal disease using NHANES data; the predicted probability of periodontal needs increased with increasing severity of FI [4]. Thus, FI is not only a barrier to a healthy diet but also a barrier to oral and systemic health. To provide effective dietary counseling that enables a patient to reduce their risks of diet-related caries, periodontal disease, and oropharyngeal cancers and improve overall diet quality, the OHCP must individualize dietary recommendations to the patient consistent with their food security status. Food security status is readily identified through screening protocols. Ideally, early interventions addressing FI facilitate preventive care and lower the likelihood of costly interventions in the future. As educational institutions, the goal of dental schools is to prepare students to provide comprehensive care to maintain and improve the oral health status of individuals and populations. Faculty guide students to screen, diagnose, and treat patients with oral diseases as well as provide recommendations to promote oral health and prevent oral infectious diseases. As part of comprehensive care, some dental schools are also screening for chronic diseases such as hypertension, diabetes, and cardiovascular disease. In addition to preparing students to screen for and address disease, dental schools have an obligation to prepare students to identify and address SDH, which can increase disease risk and preclude patient participation in their care plan [5]. Patients who seek oral health care at dental schools are typically disadvantaged, have low socioeconomic status, and present with financial and transportation barriers. The demographic profile of many patients seeking care at dental schools is consistent with being at risk of FI. Mays et al. reported that 34% of respondents to a survey designed to identify unmet SDH needs within the University Of Minnesota School Of Dentistry experienced FI [5]. Dental schools teach students how to screen for diet-related caries and periodontal disease risks and provide appropriate dietary recommendations. Ideally, the identification of achievable dietary recommendations is a negotiation with the patient. There are multiple avenues to achieving a healthy diet based on food group adequacy and meal structure. Fundamental to compliance with the negotiated recommendations is having access to appropriate foods and beverages. If FI is a barrier to compliance with dietary guidance, then the FI precludes the patient's ability to improve their oral and systemic health. In addition to didactic SDH instruction that presents FI definitions, FI epidemiology, and associations between FI and both oral and systemic disease, dental education should prepare students to screen for and address SDH, including FI, in their patients. Faculty modeling FI awareness, FI screening, and addressing FI in the patient population and student experience will increase student comfort and encourage continued behavior in their future practice. Screening for FI improves clinician awareness of SDH, builds trust with their patients, and advances holistic patient-centered care. To facilitate patient screening for FI, dental schools are encouraged to include screening instruments in their electronic health records. The ‘Hunger Vital Sign’ is a two-item FI screen initially validated in a pediatric clinic, supported by the Children's Health Watch, and currently used in a limited number of medical and dental schools [6, 7]. Numerous health professional organizations, including the American Academy of Pediatrics, the Centers for Medicare & Medicaid Services, and the Academy of Nutrition and Dietetics, support screening for FI in healthcare settings [7, 8]. Although clinicians support FI screening, barriers to implementing screening protocols include clinician discomfort, time commitment, concerns related to alienating patients, addressing positive responses, and limited knowledge of community resources [9]. These barriers can be addressed through faculty and clinician education, collaboration with other health professionals (i.e., social workers, registered dietitian nutritionists), and experience. Inclusion of the Hunger Vital Sign screen in electronic health records as part of medical histories or other intake forms can normalize the screening process, provide experience for dental students, and support interprofessional collaboration. Within the past 12 months, we worried whether our food would run out before we got money to buy more. Within the past 12 months, the food we bought just didn't last, and we didn't have the money to get more. An often true or sometimes true response to one or both statements is consistent with FI. Prior to screening for FI in the clinic setting, administrators must identify actions to assist respondents who screen at risk for FI and communicate these actions to both faculty and students. Depending on the nature of the dental school, social workers or registered dietitian nutritionists might lead the process of identifying resources to address FI or connecting patients with community health resources. Actions to assist respondents with FI might include patient education tools providing a list of phone numbers for the Supplemental Nutrition Assistance (SNAP) and Women, Infants, and Children (WIC) programs, as well as local food banks, food pantries, and soup kitchens. The patient education tools can be made available online for students and faculty to print on demand to give to patients at risk for or with FI. Kopparapu et al. found that over 70% of FI adults surveyed at academic university or neighborhood clinics responded that the following information would be helpful: Referral for financial assistance programs for which one qualified, a list of food bank locations, a list of farmer market locations, and referral to local community organizations [10]. Consistent with principles of patient-centered care, administrators and faculty should emphasize the importance of employing empathy and compassion when engaging patients in FI screening and facilitating connections to FI resources. FI screening is part of the information-gathering process; provision of resource information is most relevant when FI is identified. Resources can also be provided during treatment planning or reintroduced during the dietary counseling phase. Knowledge of a patient's food security status enables patient-centered dietary guidance to support healthier eating. Acknowledgement of barriers is appropriate when negotiating strategies to improve diet quality to improve both oral and systemic health. Presentation of resource information to alleviate barriers, consultation with other health care providers, and referral for community resources may be necessary to support patients in achieving healthier dietary behaviors. Furthermore, OHCPs can advocate for food security in their local communities to address health disparities and promote public health. Becoming a competent OHCP requires students to acknowledge individual SDH that limit patient participation in their oral healthcare and identify strategies to address the SDH barrier. FI is prevalent in the patient population that seeks care in dental schools and is a barrier to oral and systemic health. Preparing students to screen for and address FI starts with faculty leadership. Faculty must model practices to ensure that FI screening is integrated into the dental clinic setting. Providing students with both the tools to identify FI and resources to help patients access healthy foods is a critical step toward empowering patients to make informed food choices. This, in turn, supports patients’ active participation in their oral health care and contributes to better oral and systemic health outcomes. The authors declare no conflicts of interest.

  PublisherOA PDFDOI

• The Limits of Digital Health for Primary Care Patients and Clinicians: Communication, Information Exchange, and Portal Use

  Health Communication · 2025-09-11

  article

  orientation. They perceived in-person communication with their clinicians to be especially effective and described portals as unnecessary, imagining them to only be necessary when in-person visits are ineffective. Clinicians approached portals from a hybrid orientation, adopting both complementary and substitution orientations depending on how information and communication tasks via portals were perceived to redefine their workload. Unlike patients, clinicians sometimes conflated the functions of information exchange and communication. Neither patients nor clinicians perceived portals to effectively support bidirectional communication. We reflect on the need to develop and implement technological systems that complement bidirectional patient-clinician communication, rather than replace it with the linear exchange of health information to better serve the needs of patients with diverse backgrounds.

  PublisherDOI

• Associations between periodontal disease severity and selected cardiometabolic risk factors.

  PubMed · 2025 · 2 citations

  Senior author
  • Medicine
  • Environmental health
  • Dentistry

  OBJECTIVES: The objective was to explore associations between periodontal disease severity and cardiometabolic risk factors, including body mass index, age, Type 2 diabetes mellitus risk, sex, and hypertension in patients at an urban dental school clinic. METHOD AND MATERIALS: A cross-sectional study design was used to analyze electronic health record data, including periodontal status, demographic characteristics, cardiometabolic risk factors and the American Diabetes Association Diabetes Risk Test (DRT) score. Chi-square tests and ordinal logistic regression were conducted using SAS 9.4. RESULTS: Of those with available data (n = 6,778), 44% were male, 70.2% were overweight/obese, and the mean age was 50.9 (SD = 16.6) years. Associations between PD severity and body mass index, sex, age, DRT score, and hypertension were statistically significant (all P .0001) in bivariate analyses. Using logistic regression, hypertension (P = .0006), sex (P .0001), and age (P .0001) were significant predictors of severe periodontal disease, which was most common in those with hypertension (35.9%), males (31.7%), and those > 60 years (36.6%). The odds of having severe periodontal disease for those with hypertension were 1.2 times that of those without hypertension. Males were 1.7 times more likely to have severe periodontal disease than females. Those aged 40 to 49 years, 50 to 59 years, and > 60 years were 2.9, 4.2, and 4.3 times more likely to have severe periodontal disease than those who were 18 to 39 years, respectively. CONCLUSION: All cardiometabolic risk factors were associated with periodontal disease severity in bivariate analyses. In the logistic regression model, being older, male, and having hypertension were significant predictors of periodontal disease severity. Future research is needed with a more diverse sample.

  PublisherDOI

• A Framework to Establish Diet and Nutrition Competencies for Oral Health Care Education

  Journal of Dental Education · 2025-12-17

  articleOpen accessSenior author

  OBJECTIVE: To prevent and manage oral disease, oral health care practitioners (OHCPs) must provide dietary counseling based on nutrition science. OHCPs are often ill-equipped to provide such counseling due to fragmented and inadequate dietary education, which is typically attributed to limited curricular time or appropriately qualified faculty. Perhaps a more significant barrier is the absence of agreement on diet and nutrition competencies to guide oral health curricular content. Our objective was to define a framework of diet and nutrition competencies for the graduating oral health care student. METHODS: Initially, we identified the core diet and nutrition knowledge and associated educational objectives necessary to facilitate effective dietary counseling to support oral health. Subsequently, we identified behavioral expectations with evaluation criteria for diet and nutrition oral health competencies. RESULTS: Diet and nutrition oral health domains secondary to food choices, dietary behaviors, and/or nutrient intakes included caries, erosion, periodontal disease, and oral cancer, while outcomes of oral disease impacting food choices and dietary behaviors included oral dysfunction. Fundamental diet and nutrition principles supporting oral and systemic health and counseling skillsets were identified. Behavioral expectations for OHCPs for each oral health domain were articulated. For example, the behavioral expectation for caries competency is "Identifies and addresses diet-related caries risk factors within the context of environmental and social barriers." CONCLUSIONS: A framework to identify the knowledge base for and define diet and nutrition oral health competencies is presented as a foundation to advance diet and nutrition-related oral health education.

  PublisherOA PDFDOI

• Dentition and weight status in <scp>community‐dwelling</scp> older adults

  Gerodontology · 2024-03-11 · 2 citations

  articleOpen access

  BACKGROUND/OBJECTIVE: Tooth loss is common among older adults and can affect dietary intake and weight status. This study investigated associations between dentition status and body mass index (BMI) in older adults. MATERIALS AND METHODS: This was a cross-sectional study of data from a convenience sample of older adults (65-89 years) treated at an urban U.S. dental school clinic. Clinical and demographic data were obtained from electronic health records. Dentition status was determined based on data from odontograms. Multinomial logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of having a non-normal weight status for each measure of dentition status, after adjusting for covariates. RESULTS: ; 72.5% were overweight or obese. The median (IQR) number of remaining teeth was 20.0 (13.0-24.0); the median numbers of anterior and posterior occluding pairs of teeth were 5.0 (2.0-6.0) and 2.0 (0.0-5.0), respectively; and 44.9% had a functional dentition (≥21 teeth). Having a higher number of remaining teeth and more posterior occluding pairs were associated with lower odds of obesity (OR = 0.980, 95% CI = 0.964, 0.997, p = .022 and OR = 0.931, 95% CI = 0.885, 0.980, p = .006, respectively). Lack of a functional dentition was associated with higher odds of obesity (OR = 1.400, 95% CI = 1.078, 1.818, p = .012), after controlling for covariates. CONCLUSION: Older adults with tooth loss - especially loss of posterior occlusion and lack of a functional dentition - were more likely to be obese than of normal weight.

  PublisherOA PDFDOI

• Oral health and multimorbidity: is diet the chicken or the egg?

  Proceedings of The Nutrition Society · 2024-05-14 · 3 citations

  articleSenior author

  Oral health is a critical component of overall health and well-being, not just the absence of disease. The objective of this review paper is to describe relationships among diet, nutrition and oral and systemic diseases that contribute to multimorbidity. Diet- and nutrient-related risk factors for oral diseases include high intakes of free sugars, low intakes of fruits and vegetables and nutrient-poor diets which are similar to diet- and nutrient-related risk factors for systemic diseases. Oral diseases are chronic diseases. Once the disease process is initiated, it persists throughout the lifespan. Pain and tissue loss from oral disease leads to oral dysfunction which contributes to impaired biting, chewing, oral motility and swallowing. Oral dysfunction makes it difficult to eat nutrient-dense whole grains, fruits and vegetables associated with a healthy diet. Early childhood caries (ECC) associated with frequent intake of free sugars is one of the first manifestations of oral disease. The presence of ECC is our 'canary in the coal mine' for diet-related chronic diseases. The dietary sugars causing ECC are not complementary to an Eatwell Guide compliant diet, but rather consistent with a diet high in energy-dense, nutrient-poor foods - typically ultra-processed in nature. This diet generally deteriorates throughout childhood, adolescence and adulthood increasing the risk of diet-related chronic diseases. Recognition of ECC is an opportunity to intervene and disrupt the pathway to multimorbidities. Disruption of this pathway will reduce the risk of multimorbidities and enable individuals to fully engage in society throughout the lifespan.

  PublisherDOI

• Exploring Associations Between Tooth Loss and Cardiometabolic Risk Factors in Adults

  Current Developments in Nutrition · 2024-06-29

  articleOpen access

  Objectives: To explore associations between tooth loss (number of remaining teeth (NRT), and functional dentition (FD)) and cardiometabolic risk (CMR) factors (age, gender, race, ethnicity, body mass index (BMI), physical activity (PA), smoking status, diabetes mellitus (DM), hypertension (HTN), stroke, and cardiovascular disease (CVD)). Methods: Cross-sectional secondary analysis of patients aged 18-89 years receiving routine care at an urban Northeast US school of dental medicine clinics between January 1, 2020, and June 1, 2023. Associations between tooth loss and CMR factors including age, gender, race, ethnicity, BMI, smoking, self-reported history of DM, HTN, stroke, and CVD were explored. Kruskal-Wallis, Mann-Whitney U, chi-square, and Spearman’s correlation tests were utilized. Results: The sample (N = 32,564) was 67.7% 40 years or older, 51.7% female, 69.9% overweight or obese, 51.7% White/Caucasian, 41.6% Black/African American, and 70.3% non-Hispanic/non-Latino. The median NRT was 26.0; 75.7% had FD. Fewer teeth and lack of FD were positively associated with older age, White/Caucasian or Black/African American race, non-Hispanic/non-Latino ethnicity, BMI≥25 kg/m2, smoking, and history of DM, HTN, Stroke, and CVD (all Ps < 0.001). There was a moderate negative correlation between the NRT and older age (r = - 0.585, P< 0.001), and a weak negative correlation between NRT and higher BMI (r = -0.055, P< 0.001). Tooth loss was not associated with gender. Conclusions: Tooth loss was positively associated with older age, race, ethnicity, higher BMI, smoking, and history of DM, HTN, stroke, and CVD. Further research on associations between tooth loss, BMI, and other CMR factors is necessary to enhance the generalizability of these findings. Funding Sources: None.

  PublisherOA PDFDOI

• Associations Between Food Security Status and Tooth Loss in Adults

  Current Developments in Nutrition · 2024-06-29

  articleOpen access

  Objectives: The primary aim of this study was to explore associations between food security status and dentition status (number of remaining teeth and functional dentition status) in adults seen in a dental school clinic. Associations between dentition status and other relevant sociodemographic characteristics were also explored. Methods: This was a cross-sectional secondary analysis of data obtained from the electronic health records of adults 18-89 years of age who sought dental care between July 1, 2016 and June 1, 2023 at an urban northeast US dental school’s clinic. Kruskal Wallis, Mann-Whitney U test, Fisher’s exact test, and chi-square tests were used to analyze data. Results: Patients with available data (N=10,940) were 55.7% female, 48.4% White, 43.8% African American, and 39.0% Hispanic/Latino. The median (IQR) age was 54.0 (39.0-64.0) years; 69.3% were overweight or obese. Participants had a median (IQR) of 24.0 (19.0-27.0) teeth and 70.1% had functional dentition (21 or more teeth). Neither the number of teeth nor functional dentition were associated with food security status. However, other sociodemographic factors, including being older, being overweight and obese, not being of the Hispanic/Latino ethnicity, and being of the Black race were significantly associated with having fewer teeth and lack of functional dentition when compared to those who were younger, had a normal BMI, were Hispanic/Latino, White, or Asian (all P values < 0.01). Conclusions: Older age, having a higher BMI, not being of the Hispanic/Latino ethnicity, and being of the Black race, were each significantly associated with having fewer teeth and a lack of functional dentition. Although food security status was not associated with dentition status in this study, future research can explore these associations in those with these sociodemographic characteristics who are most vulnerable to tooth loss and food insecurity. Funding Sources: No funding sources to disclose.

  PublisherOA PDFDOI

• A <scp>user‐centered</scp> approach to the development of a diet education tool for older adults with tooth loss

  Gerodontology · 2023-06-13 · 1 citations

  articleOpen accessSenior author

  BACKGROUND: Tooth loss is associated with suboptimal nutrient intake and greater risk of malnutrition. OBJECTIVE: To develop and field-test a stakeholder-informed diet education tool that addresses the unique needs of older adults with tooth loss who do not wear dentures. METHODS: An iterative user-centered approach was used. Initial content was developed based on findings from previous research. Stakeholder panels of older adults with 20 or fewer teeth, and dentists, were conducted at two time points to obtain feedback on the tool, which was revised following each panel. The tool was field-tested in a dental school clinic and evaluated using the Patient Education Materials Assessment Tool; it was further revised based on feedback. RESULTS: A diet education tool entitled "Eating Healthier With Tooth Loss" was developed. Sections for fruits and vegetables, grains, and proteins food groups, and one addressing socioemotional aspects of eating with missing teeth were included. Panel members provided constructive, positive feedback; recommendations for editing text, images, design, and content were integrated. Field-testing in the dental clinic with 27 pairs of student dentists and their patients resulted in scores of 95.7% for understandability and 96.6% for actionability, with over 85% agreement with each item. The tool was revised based on field-testing feedback. CONCLUSION: A diet education tool for older adults with tooth loss was developed using a user-centered approach, integrating the 'patient voice' and patient experiences with US dietary guidelines. Use of this tool is feasible in a dental clinic setting. Future research should explore usage in larger settings.

  PublisherOA PDFDOI