Nutritional deficiencies and dentofacial
growth.
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indianden...
Contents
-Introduction
-classes of nutrients
-disturbances in carbohydrates
-disturbances in lipids
-protein deficiencies
...
-nutrition and skeletal maturation
-nutrition and dental tissues
-nutrition and the oral mucosal tissues
-nutrition and cr...
Introduction
- Nutrition is defined as the science of how the body utilizes
the food to meet requirements for development ...
-These nutrients can be further divided into 2 types
essential –they are that which the body cannot manufacture in
suffici...
Energy producing nutrients –they provide calories and enable the
body to generate energy for carrying on it many functions...
www.indiandentalacademy.com
Carbohydrates
-major source of energy within the human diet
-provide 4 kcal/gm
-also called ‘spare protein’as adequate amo...
Proteins
-They hold a central position in the architecture and functioning
of all living matter.Are the major components o...
Lipids
-They are the energy store house of the human body providing
9 kcal/gm of energy
-They serve as adipose tissues in ...
Polyunsaturated fats divided into Omega 3-fats
Omega 6-fats
-Omega 3 fats –they have their 1st double bond at the 3rd carb...
 The polyunsturated fatty acids cannot be synthesized

in the body and are therefore considered essential
fatty acids . T...
Vitamins
-They are a group of essential nutrients required in very minute
amounts to participate and regulate chemical rea...
Minerals
-They provide structural components for the body.(bones ,teeth )
-They allow for nerve muscle function ,blood clo...
Protein deficiencies
Protein calorie malnutrition among children is the most
important and widespread nutritional problem ...
Many factors contribute to its rapid development ,the rapid
growth of the child and its high protein requirement
Clinical ...
Marasmus ,is a type of malnutrition caused primarily by a
deficiency of proteins and calories.It occurs in infants under 1...
Kwashiorkar

www.indiandentalacademy.com
Flag sign in kwashiorkar

www.indiandentalacademy.com
Vitamin B -1 (Beri beri)
-Beriberi, which means weakness is a disease produced by the
deficiency of thiamine.
- Symptoms i...








There are two kinds of beriberi: dry and wet.
Dry beriberi is associated with energy deprivation and
inactivi...
Vitamin B 2 (riboflavin)
-Riboflavin deficiency is particularly common in children.
-The diagnostic lesions are usually li...
-Riboflavin deficiency also effects the nasolabial folds and alae
nasi ,which exhibit a scaly ,dermatitis.
-Ocular changes...
www.indiandentalacademy.com
Niacin
-The deficiency of niacin leads to a condition called pellagra
which means rough skin.
-This syndrome is identified...
- Epithelium of the tongue desquamates
-Tongue is beefy red in chronic states and scarlet red in acute
conditions.
-Tender...
www.indiandentalacademy.com
Casals necklace in pellagra

www.indiandentalacademy.com
Bilaterally symmetrical lesions

www.indiandentalacademy.com
Vitamin B- 6(pyridoxine)
-Pyridoxine is involved in a variety of metabolic processes, major
role in amino acid metabolism....
Vitamin B-12 and Folic acid

-Deficiency leads to megaloblastic anemia symptoms of which include
pallor ,weight loss ,glos...
www.indiandentalacademy.com
Biotin deficiency

-scaly changes in the skin ,muscle pains ,glossitis and
mental depression
www.indiandentalacademy.com
Vitamin A




Vitamin A, made from carotene exists as retinol, retinal,
retinoic acid, ( formerly called "prealbumin" or...
-Deficiency of this can lead to night blindness (nyctalopia)
-Due to keratinization of the epithelial tissues ,there is in...
www.indiandentalacademy.com
Vitamin C
-it is involved in the formation of collagenous intercellular
substance,found in cartilage ,bone ,dentine ,vascu...
-tenderness associated with the joints.
-the hair of the body assume a corkscrew form and pinpoint
bleeding around the hai...
Corkscrew hair in scurvy

www.indiandentalacademy.com
Peringual hemorrhages

www.indiandentalacademy.com
Oral manifestations of scurvy

www.indiandentalacademy.com
Scorbutic rosary

www.indiandentalacademy.com
Vitamin D
- It occurs in two forms , vit D2-ergocalciferol and vit D3cholecalciferol.
-It is not a dietary essential when ...
Rickets

www.indiandentalacademy.com
www.indiandentalacademy.com
-Dental manifestations include
disturbed calcifications of enamel and dentine.
delayed erruption of deciduous and permanen...
Osteomalacia
-it is also called as Adult rickets.
-characterized by poor calcification of bones and resulting
deformities....
Vitamin E
-It has also been given the name –tocopherol which means ,the
alcohol which brings forth offspring.
- its mainly...
Vitamin K
-it exists in three forms K1 –phylloquinone
K2 - menaquinone
K3 – menadione
-it is necessary for synthesis of pr...
Minerals
-They provide structural components for the body.(bones ,teeth )
-They allow for nerve muscle function ,blood clo...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
Menke`s kinky hair syndrome

-Depigmentation of the skin and hair ,hypotheria ,seizures ,cerebral
degeneration ( impaired ...
Wilson`s disease
-This disease is characterized by markedly reduced serum copper
and cerucoplasmin levels,not due to a def...
Wilson`s disease

www.indiandentalacademy.com
Iron deficiency anemia

www.indiandentalacademy.com
Fluorine deficiency

www.indiandentalacademy.com
Disturbances in carbohydrates
-Since carbohydrates form a large part of our diet , nothing is
known of the effects of carb...
-short neck , spinal abnormalities , flexion contractures result in
claw hand
-oral manifestations include
- short broad m...
In the skull, changes of Hurler syndrome consist of premature
closure of the sagittal and metopic sutures, resulting in
sc...
Disturbances in lipids
-disturbances of lipid metabolism though rare do occur and result
in a particular group of diseases...
Hand Schuller Christian disease

Skin lesions

Osteolytic lesions of frontal, parietal
Bone.

www.indiandentalacademy.com
www.indiandentalacademy.com
Nutrition and dentofacial growth
-Growth is defined as an increase in size resulting from the
multiplication and enlargeme...
- The points at which a nutrient deficit occurs during the growth
can have just as important an impact as the type of nutr...
-The critical period concept reveals the importance of nutrition in
allowing the body to attain its full growth and develo...
- The law of minimum is applicable to proteins but not to
minerals since the body may grow to adult size although poor
in ...
Nutrition and craniofacial malformations
-Animal experiments show that maternal dietary deficiency even
when experienced f...
-The administration of riboflavin or pyridoxine to mice reduced
the incidence of cortisone induced cleft palate.
-Zinc pro...
- Cleft lip and palate is one craniofacial anomaly of particular
interest.This condition can be induced in animals by
nutr...
Nutrition and the teeth
-As tooth development begins in utero and extends into adult life
nutrition exerts a pre erruptive...
- Protein deficiency – poor bone calcifications ,retarded centres
of calcifications ,delayed tooth erruption ,retarded jaw...
-Vit A is indispensable for the proper growth and development
of the periodontium ,teeth ,salivary glands and oral epithel...
Nutritional effect on tooth movement and tissue
response to appliances
-Tooth movement relies on the biologic response of ...
Ascorbic acid is a classical example of a nutrient that may
influence the biologic response to forces.It has been reported...
-Nutritional status may also play a role in the gingival response
to orthodontic bands and brackets. Since bands and brack...
Nutrition and skeletal maturation
-

-

-

Prolonged nutritive failure in growing children shows a
retarding influence on ...
Nutrition and the oral mucosal tissues
-The nutritional state of a person is often manifested in oral
tissues due to the r...
-Patients with iron deficiency may present with pallor ,spoon
shaped nails ,pale ,atrophic tongue ,pale conjuctivae and
se...
Conclusion
-In the past ,the extent of a dentist `s nutritional counselling
involved advising patients to reduce consumpti...
-Patients should be assessed for signs of nutrient imbalances and
if they are suspected then appropriate referrals should ...
While orthodontists will rarely see the frank manifestations of
nutritional deficiencies ,it should be recognized that
sub...
References
- Nutrition and oral health.Laura M Romite . Dent Clin N Am
47,2003, 187-207.
- Nutritional considerations in o...
- Osteolytic lesions in the calvarium- an important manifestation
of Hand schuller christian disease. V K Sharma .
Ind J R...
Thank you
For more details please visit
www.indiandentalacademy.com

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Nutritional deficiencies and dentofacial growth /certified fixed orthodontic courses by Indian dental academy

  1. 1. Nutritional deficiencies and dentofacial growth. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Contents -Introduction -classes of nutrients -disturbances in carbohydrates -disturbances in lipids -protein deficiencies -mineral deficiencies -vitamin deficiencies -nutrition and growth and development www.indiandentalacademy.com
  3. 3. -nutrition and skeletal maturation -nutrition and dental tissues -nutrition and the oral mucosal tissues -nutrition and craniofacial malformations -nutritional status on tooth movement and tissue response -conclusion www.indiandentalacademy.com
  4. 4. Introduction - Nutrition is defined as the science of how the body utilizes the food to meet requirements for development ,growth, repair and maintenance. -There are six classes of nutrients found in foods Carbohydrates Proteins Fats Vitamins Minerals Water www.indiandentalacademy.com
  5. 5. -These nutrients can be further divided into 2 types essential –they are that which the body cannot manufacture in sufficient amounts. proteins ,fats,water soluble and fat soluble vitamins and minerals. non essential- they can be manufactured in the body from the raw materials supplied by the food. glucose,fructose,lecithin,cholesterol. www.indiandentalacademy.com
  6. 6. Energy producing nutrients –they provide calories and enable the body to generate energy for carrying on it many functions. carbohydrates,proteins, fats come under this category. Vitamins ,minerals and water on the other hand do not provide energy but facilitate a variety of activities in the body. RECOMMENDED DIETARY ALLOWANCES have been used as a standard for energy and nutrient intakes.RDA’S are established for energy, proteins and many vitamins and minerals.They are nutrient amounts in excess of what 98 pc of the population requires to maintain health.They are not minimum requirements or optimal intakes for all people. www.indiandentalacademy.com
  7. 7. www.indiandentalacademy.com
  8. 8. Carbohydrates -major source of energy within the human diet -provide 4 kcal/gm -also called ‘spare protein’as adequate amounts of carbohydrate allows proteins to be used for tissue anabolism and not as an energy source. Simple sugars -monosaacharides (glucose,fructose,galactose) - disaacharides (sucrose, lactose, maltose) Complex sugars – polysaacharides (starch, glycogen, cellulose) www.indiandentalacademy.com
  9. 9. Proteins -They hold a central position in the architecture and functioning of all living matter.Are the major components of bone , skin hair ,muscle and also play a vital role in living processes. -Used as an energy source in need ( 4kcal/ gm). Essential amino acids- methionine,threonine,valine,trypthophan, isoleucine,lysine,phenylalanine,histidine,leucine. Non essential amino acids – glycine ,alanine ,serine ,aspartic acid glutamic acid ,proline ,citrulline, tyrosine ,cystine,proline. www.indiandentalacademy.com
  10. 10. Lipids -They are the energy store house of the human body providing 9 kcal/gm of energy -They serve as adipose tissues in the body, serve to protect internal organs, regulate temperature , carry fat soluble vitamins . -Lipids are divided into fats and oils. -also classified as triglycerides, phospholipids and sterols. -also into saturated and unsaturated fats -unsaturated are further divided into mono and polyunsaturates www.indiandentalacademy.com
  11. 11. Polyunsaturated fats divided into Omega 3-fats Omega 6-fats -Omega 3 fats –they have their 1st double bond at the 3rd carbon from the methyl end of the molecule.These fats include Linolenic acid, may decrease cholesterol and reduce cardiac disease risk by lowering BP and preventing blood clots.Hence they are beneficial. -Omega 6 fats – they are named so as their 1st double bond is at the 6th carbon from the methyl end.They include essential fatty acid Linoleic acid and are found mainly in vegetables and meats. www.indiandentalacademy.com
  12. 12.  The polyunsturated fatty acids cannot be synthesized in the body and are therefore considered essential fatty acids . They include the linoleic acid ,linolenic acid and arachidonic acid.  Fats are important to oral health from the standpoint that phospholipids are a structural component of cell membranes , tooth enamel,dentine .They are involved in the calcification and mineralization of teeth and bones .In addition research indicates that high fat foods tend to be inhibitory towards dental caries . www.indiandentalacademy.com
  13. 13. Vitamins -They are a group of essential nutrients required in very minute amounts to participate and regulate chemical reactions within the body. -not energy producing nutrients -are available from foods and can be in an active or an inactive state -They are of two types FAT SOLUBLE - A ,D calciferol , E tocopherol , K menadione WATER SOLUBLE – C , B (thiamine ,riboflavin , niacin , folate , pyridoxine ,vit B 12 , biotin , choline, inositol , pantothenic acid ) www.indiandentalacademy.com
  14. 14. Minerals -They provide structural components for the body.(bones ,teeth ) -They allow for nerve muscle function ,blood clotting ,tissue growth ,repair,acid base balance of fluids . -classified as major and trace minerals - Major minerals –needed in amounts greater than 100mgs/ day Ca ,Mg ,P ,K ,Na ,Cl ,S. -Trace minerals -needed in lesser amounts –F ,Zn ,Se ,Cu ,I ,Mo Mn. www.indiandentalacademy.com
  15. 15. Protein deficiencies Protein calorie malnutrition among children is the most important and widespread nutritional problem .It occurs in children as two distinct clinical diseases.( PEM ) Kwashiorkar and Marasmus. Kwashiorkar , a disease caused caused by protein deficiency when the weaned child is given starchy and low protein food, though the calorie intake may be sufficient. Mostly affects children between 1 – 3 yrs whose diet are grossly deficient in protein. www.indiandentalacademy.com
  16. 16. Many factors contribute to its rapid development ,the rapid growth of the child and its high protein requirement Clinical findings - growth failure,height ,weight affected. - wasting of muscles masked by edema. - characteristic changes in skin –areas of depigmentation and other areas of deeper pigmentation (flaky paint dermatosis) - hair changes also characteristic.black hair loses its color and becomes streaked with grey,red or blond color.(flag sign) - liver is enlarged,lesions of mouth,tongue also seen. www.indiandentalacademy.com
  17. 17. Marasmus ,is a type of malnutrition caused primarily by a deficiency of proteins and calories.It occurs in infants under 1 year of age.(overall lack of calories.) Clinical findings - growth failure - extreme wasting of muscles,limbs are thin ,belly may be protuberant , edema is absent. - skin is dry ,atrophic, loose ,wrinkled. - anemia ,hair changes ,vitamin deficiencies may be present. - the mental status is unaffected in contrast to kwashiorkar where the child is irritable or disinterested. www.indiandentalacademy.com
  18. 18. Kwashiorkar www.indiandentalacademy.com
  19. 19. Flag sign in kwashiorkar www.indiandentalacademy.com
  20. 20. Vitamin B -1 (Beri beri) -Beriberi, which means weakness is a disease produced by the deficiency of thiamine. - Symptoms include fatigue, irritability, restlessness, loss of appetite, and vague abdominal discomfort. - Patients develop burning sensations, tingling in the extremities, and changes in sensation such as numbness. Patients may develop mental confusion and psychosis. Heart manifestations include heart failure with shortness of breath (dyspnea) and cyanosis (bluish tinged skin). Neurologic symptoms are caused by degeneration of the nerve fiber and its insulation (myelin). www.indiandentalacademy.com
  21. 21.      There are two kinds of beriberi: dry and wet. Dry beriberi is associated with energy deprivation and inactivity characterized by mental confusion, peripheral neuropathy, muscular wasting with loss of function or paralysis of the lower extremities. (neuromuscular symptoms) Wet beriberi is resultant of high carbohydrate intake along with strenuous exercise characterized by edema, tachycardia, pulmonary congestion, and enlarged heart.(edema) Cardiac beri beri – cardiac decompensation Wernicke kosakoff syndrome in alcoholics. www.indiandentalacademy.com
  22. 22. Vitamin B 2 (riboflavin) -Riboflavin deficiency is particularly common in children. -The diagnostic lesions are usually limited to the mouth and perioral regions. -Mild form begins with glossitis .Filiform papillae become atrophic while the fungiform papillae are normal.In severe cases the tongue becomes glazed and smooth owing to the loss of all papillae, assumes a purplish red colouration (magenta coloured) -maceration and fissuring of the angles of the mouth ( angular cheilosis) -lips are red and shiny due to desquamation. -white moist maceration can be seen (perleche). www.indiandentalacademy.com
  23. 23. -Riboflavin deficiency also effects the nasolabial folds and alae nasi ,which exhibit a scaly ,dermatitis. -Ocular changes consisiting of corneal vascularization photophobia are also seen. -Prenatal riboflavin deficiency can cause the following postnatal effects. -shortness of the maxilla and mandible -cleft palate and anomalies of incisor teeth. -angle `s class II maloclusion www.indiandentalacademy.com
  24. 24. www.indiandentalacademy.com
  25. 25. Niacin -The deficiency of niacin leads to a condition called pellagra which means rough skin. -This syndrome is identified by the three D `s. Dermatitis –bilaterally symmetrical scaly , red , thickened keratotic areas of the skin. Diaorrhea Dementia - Oral manifestations include- entire oral mucosa is fiery red and painful. edema of the tongue. salivation is profuse. www.indiandentalacademy.com
  26. 26. - Epithelium of the tongue desquamates -Tongue is beefy red in chronic states and scarlet red in acute conditions. -Tenderness ,pain ,redness and ulcerations begin at the interdental gingiva and spread rapidly. - Superimposed ANUG infection can be present. www.indiandentalacademy.com
  27. 27. www.indiandentalacademy.com
  28. 28. Casals necklace in pellagra www.indiandentalacademy.com
  29. 29. Bilaterally symmetrical lesions www.indiandentalacademy.com
  30. 30. Vitamin B- 6(pyridoxine) -Pyridoxine is involved in a variety of metabolic processes, major role in amino acid metabolism. -The features of its deficiency include dermatitis , glossitis angular stomatitis , peripheral neuropathy. -The oral lesions bear a striking resemblance to pellagrous stomatitis. www.indiandentalacademy.com
  31. 31. Vitamin B-12 and Folic acid -Deficiency leads to megaloblastic anemia symptoms of which include pallor ,weight loss ,glossitis ,degeneration of spinal cord. www.indiandentalacademy.com
  32. 32. www.indiandentalacademy.com
  33. 33. Biotin deficiency -scaly changes in the skin ,muscle pains ,glossitis and mental depression www.indiandentalacademy.com
  34. 34. Vitamin A   Vitamin A, made from carotene exists as retinol, retinal, retinoic acid, ( formerly called "prealbumin" or "transthyretin"). It is responsible for maintaining the differentiation of certain special kinds of epithelium and in deficiency states, epithelial surfaces of all kinds tend to undergo squamous metaplasia and hyper-keratinize. The best known symptoms of deficiency are xerophthalmia (from loss of differentiation of the mucus cells of the cornea), Bitot's spots (masses of desquamated keratin on the cornea or conjunctiva), keratomalacia (excess keratin on the cornea, which gets macerated and infected ) resulting in blindness. www.indiandentalacademy.com
  35. 35. -Deficiency of this can lead to night blindness (nyctalopia) -Due to keratinization of the epithelial tissues ,there is increased susceptibility to infections of all membranes protected by mucus. -Follicular keratosis –skin change ( goose flesh ) -Dental changes include -retarded erruption rate -hyperplastic giniva -retarded alveolar bone formation -pdl disease and microabscesses -disturbed enamel and dentine formation - enamel hypoplasia www.indiandentalacademy.com
  36. 36. www.indiandentalacademy.com
  37. 37. Vitamin C -it is involved in the formation of collagenous intercellular substance,found in cartilage ,bone ,dentine ,vascular epithelium,it helps maintain body structure. -other functions include synthesis of steroid hormones ,release of iron, formation of folinic acid, antioxidant property. -deficiency results in the condition called SCURVY -joint pains ,poor growth , poor wound healing and susceptibility to infections. -easy bruising – ecchymoses -petechial hemorhhages ,bleeding gums , loose teeth www.indiandentalacademy.com
  38. 38. -tenderness associated with the joints. -the hair of the body assume a corkscrew form and pinpoint bleeding around the hair follicles can confirm the diagnosis. -the osteoblasts fail to form osteoid and the calcified matrix material is not destroyed with a wide zone of nonossified matrix called the scorbutic lattice. -there is fracturing of the calcified matrix material leading to the characteristic Trummerfeld zone. -the area between this zone is free of hematopoietic cells and is made of connective tissue cells –so called Gerustmark. www.indiandentalacademy.com
  39. 39. Corkscrew hair in scurvy www.indiandentalacademy.com
  40. 40. Peringual hemorrhages www.indiandentalacademy.com
  41. 41. Oral manifestations of scurvy www.indiandentalacademy.com
  42. 42. Scorbutic rosary www.indiandentalacademy.com
  43. 43. Vitamin D - It occurs in two forms , vit D2-ergocalciferol and vit D3cholecalciferol. -It is not a dietary essential when there is adequate exposure to sunlight and it is the only vitamin known to be converted to a hormonal form. -Plays a key role in regulation of calcium and phosphorus effecting bone mineralization. -Deficiency results in faulty mineralization , resulting in RICKETS in children and OSTEOMALACIA in adults. www.indiandentalacademy.com
  44. 44. Rickets www.indiandentalacademy.com
  45. 45. www.indiandentalacademy.com
  46. 46. -Dental manifestations include disturbed calcifications of enamel and dentine. delayed erruption of deciduous and permanent teeth jaw bones are thickened maxilla is narrow and palate is high,mandible is short misalignment of teeth in the jaws. higher caries index enamel hypoplasia www.indiandentalacademy.com
  47. 47. Osteomalacia -it is also called as Adult rickets. -characterized by poor calcification of bones and resulting deformities. -it differs in etiology as it is a degenerative change –a decalcification of bone already formed rather than faulty growth. -its common in women during pregnancy. -softening and distortion of the skeleton with increased tendency towards fracture. (brittle bones) -pelvic deformities are common. www.indiandentalacademy.com
  48. 48. Vitamin E -It has also been given the name –tocopherol which means ,the alcohol which brings forth offspring. - its mainly known for its antioxidant properties. - also prevents the peroxidation of polyunsaturated fatty acids. - its deficiency can have the following effects - increased fragility of the red blood cells ( hemolysis ,anemia) fat malabsorption , cystic fibrosis . - vit E has gained a great deal of public and scientific attention due to its anti aging effect ( antioxidant property prevents the accumulation of free radicals causing cell damage in aging ) www.indiandentalacademy.com
  49. 49. Vitamin K -it exists in three forms K1 –phylloquinone K2 - menaquinone K3 – menadione -it is necessary for synthesis of prothrombin and other blood clotting factors by the liver. -also helps in growth. -deficiency rare in adults but can be seen in new born infants resulting in hypoprothrombinemia. -most common oral mainfestation is gingival bleeding. www.indiandentalacademy.com
  50. 50. Minerals -They provide structural components for the body.(bones ,teeth ) -They allow for nerve muscle function ,blood clotting ,tissue growth ,repair,acid base balance of fluids . -classified as major and trace minerals - Major minerals –needed in amounts greater than 100mgs/ day Ca ,Mg ,P ,K ,Na ,Cl ,S. -Trace minerals -needed in lesser amounts –F ,Zn ,Se ,Cu ,I ,Mo Mn. www.indiandentalacademy.com
  51. 51. www.indiandentalacademy.com
  52. 52. www.indiandentalacademy.com
  53. 53. www.indiandentalacademy.com
  54. 54. Menke`s kinky hair syndrome -Depigmentation of the skin and hair ,hypotheria ,seizures ,cerebral degeneration ( impaired activity of cu containing enzyme ) www.indiandentalacademy.com
  55. 55. Wilson`s disease -This disease is characterized by markedly reduced serum copper and cerucoplasmin levels,not due to a deficiency but rather due to abnormal hepatic copper storage. -most of the copper remains loosely bound to albumin and can be transferred more readily to the tissues. -the liver and the lenticular nucleus of the brain contain abnormally large amounts of copper. -Kayser-Fleischer rings - eye signs. www.indiandentalacademy.com
  56. 56. Wilson`s disease www.indiandentalacademy.com
  57. 57. Iron deficiency anemia www.indiandentalacademy.com
  58. 58. Fluorine deficiency www.indiandentalacademy.com
  59. 59. Disturbances in carbohydrates -Since carbohydrates form a large part of our diet , nothing is known of the effects of carbohydrate deficient diets.There is an important group of diseases representing disturbances of mucopolysaacharide metabolism. -The Hurler syndrome is their prototype and is the most common with the following manifestations. -begins in first two years of life and terminates in death before puberty. -Prominent forehead ,broad saddle nose ,hypertelorism,thick lips coarse tongue ,open mouth , nasal congestion. www.indiandentalacademy.com
  60. 60. -short neck , spinal abnormalities , flexion contractures result in claw hand -oral manifestations include - short broad mandible,wide intergonial distance - spacing of teeth - localized areas of bone destruction with represent hyperplastic dental follicles with large pools of mucopolysaccharides. - gingival enlargements, enlarged tongue. www.indiandentalacademy.com
  61. 61. In the skull, changes of Hurler syndrome consist of premature closure of the sagittal and metopic sutures, resulting in scaphocephaly. The sphenoid bone is hypoplastic, resulting in a shoe" shaped sella. The skull itself is typically thick with frontal bossing and small facial bones. www.indiandentalacademy.com
  62. 62. Disturbances in lipids -disturbances of lipid metabolism though rare do occur and result in a particular group of diseases –the lipid storage diseases. -these include the following Hand Schuller Christian disease Eosinophilic Granuloma Letterer –Siwe disease -Oral manifestations Ulcerative lesions,gingival hyperplasia,diffuse destruction of the maxilla and mandible causing loosening of teeth and premature loss. www.indiandentalacademy.com
  63. 63. Hand Schuller Christian disease Skin lesions Osteolytic lesions of frontal, parietal Bone. www.indiandentalacademy.com
  64. 64. www.indiandentalacademy.com
  65. 65. Nutrition and dentofacial growth -Growth is defined as an increase in size resulting from the multiplication and enlargement of cells and comprises of three phases. first phase – hyperplasia second phase --- hyperplasia and hypertrophy third phase ---hypertrophy -Growth and development are affected by nutritional environment -The diet can affect the process of cell replication and enlargement thus influencing tissue and organ growth - Many nutrients affect the enzymatic processes of the body and thus enzymatic regulation is also influenced by diet. www.indiandentalacademy.com
  66. 66. - The points at which a nutrient deficit occurs during the growth can have just as important an impact as the type of nutrition deficit involved .These are often referred to as the ‘critical period of growth . -For ex- permanent damage from decreased cell numbers of a particular tissue or organ may be the result of inadequate nutrition during the hyperplastic phase of growth.If the same deficit occurred during a hypertrophic phase , however, then it may be compensated for later, in the way of catch up growth when nutrition is adequate. www.indiandentalacademy.com
  67. 67. -The critical period concept reveals the importance of nutrition in allowing the body to attain its full growth and development potential.Oral tissues are no less susceptible to nutritional stresses that may affect a person`s oral health and wellness througout life. LAW OF MINIMUM (formulated by Justus von Liebig 1843) …. Among the nutrients essential for growth , the one which is furnished in minimum amount (relative to the need for growth at normal rate ) will thereby determine the rate of growth ,the organism growing only to extent that it can increase in size . www.indiandentalacademy.com
  68. 68. - The law of minimum is applicable to proteins but not to minerals since the body may grow to adult size although poor in calcium and other minerals. Children with poor bone structure may still grow to average or normal size. www.indiandentalacademy.com
  69. 69. Nutrition and craniofacial malformations -Animal experiments show that maternal dietary deficiency even when experienced for a brief time during a critical period results in some biochemical alterations followed by morphologic changes.This is true when vitamins are disturbed and nucleic acid synthesis suffers.Maternal diet affects the later part of antenatal life rather than during the early weeks of organogenesis. -Suboptimal levels of these nutrients may potentiate other terratogenic factors .The possibility of vitamins and trace minerals being suboptimal during pregnancy is great.The use of alcohol and other drugs may increase the requirement for certain nutrients. www.indiandentalacademy.com
  70. 70. -The administration of riboflavin or pyridoxine to mice reduced the incidence of cortisone induced cleft palate. -Zinc provides an example of a nutrient for which even a short term dietary deficiency could be terratogenic.No mobilizable store exists for zinc necessitating that it regularly be present in diet. -A large variety of malformations have been found in the new born of mothers with severe vit A deficiency -Deficiency of riboflavin - results in shortening of mandible cleft palate and other skeletal malformations. www.indiandentalacademy.com
  71. 71. - Cleft lip and palate is one craniofacial anomaly of particular interest.This condition can be induced in animals by nutritional deficiencies such as those of folic acid , riboflavin and zinc . - Retrospective studies of the histories of pregnancies resulting in clefts suggest that vitamin and trace metal levels have an influence. www.indiandentalacademy.com
  72. 72. Nutrition and the teeth -As tooth development begins in utero and extends into adult life nutrition exerts a pre erruptive and a post erruptive effect. -Hence teeth are affected in 2 distinct ways Local effect –depends on the intra oral chemical or physical action on the external surfaces of the teeth and oral tissues due to the products of masticatory and bacterial action on various food stuffs. Systemic effect –is important during the period of tooth development. Nutritional deficiencies during tooth development affect the tooth size ,formation ,erruption time and caries attack www.indiandentalacademy.com
  73. 73. - Protein deficiency – poor bone calcifications ,retarded centres of calcifications ,delayed tooth erruption ,retarded jaw growth crowded dentitions. - Calcium ,Vit D,P deficiency –result in retarded jaw ,tooth and condyle development ,defective enamel and dentine,loss of Pdl and bone resorptions. - Vit C deficiency – loss of connective tissue ,gingival bleeding tooth mobility ,incresed pdl disease .As it is vital to collagen production for formation of teeth and bones .Also important in healing of oral tissues due to its anti oxidant property. www.indiandentalacademy.com
  74. 74. -Vit A is indispensable for the proper growth and development of the periodontium ,teeth ,salivary glands and oral epithelium. Deficiency can lead to the following -changes in the ameloblasts –loss of physiologic ability and anatomical changes resulting in defective and decreased matrix formation. Enamel hypoplasia. -endochondral or replacement bone growth is retarded. -arrest in compact bone formation -eventually all skeletal growth development dependent upon replacement of endochondral bone formation ceases. www.indiandentalacademy.com
  75. 75. Nutritional effect on tooth movement and tissue response to appliances -Tooth movement relies on the biologic response of the pdl and alveolar bone to applied forces and this tissue response is analogus to healing -And as the orthodontic patient is selectively treated during the adolescent growth spurt which provides an additional challenge to his nutritional status. -During this healing some nutrients which are nonessential become essential or are required in higher levels. Aspargine which although is categorized as a non essential amino acid has been shown when deficient to inhibit growth and healing in demineralized bone matrix implants in rats. www.indiandentalacademy.com
  76. 76. Ascorbic acid is a classical example of a nutrient that may influence the biologic response to forces.It has been reported that 17 to 72 pc of orthodontic patients may have suboptimal levels of ascorbic acid. The rationale for its effect is based in part on the fact that a lack of it interferes with collagen synthesis by preventing hydroxylation of proline to hydroxyproline, affecting the pdl and formation of osteoid. Ascorbic acid may also influence Retention. In a study using separation of guinea pig incisors the group that was deficient showed a more rapid relapse. www.indiandentalacademy.com
  77. 77. -Nutritional status may also play a role in the gingival response to orthodontic bands and brackets. Since bands and brackets present a stress to the periodontium, especially in regard to increased exposure to retained debris, tissue tolerance needs to be maximized. -Dusterwinkle et al. (J .Periodontology 1966) studied the tissue tolerance to orthodontic banding.He concluded that oral health and disease is a function of the product of the degree of host resistance and the magnitude of the environmental challenge.A nutritional status adequate to support a healthy pdl in a non banded situation may provide suboptimal host resistance in a banded situation. www.indiandentalacademy.com
  78. 78. Nutrition and skeletal maturation - - - Prolonged nutritive failure in growing children shows a retarding influence on each of the 28 bone centres in the hand and the wrist which are used as indicators of skeletal maturation. Correction of dietary deficiencies brings an acceleration in the overall rate of skeletal maturation but does not equally affect all the bone centres. The fastest growing centres generally show the greatest relative response to dietary correction,whereas the slowest growing centres do not demonstrate a preferential utilization of nutrients. www.indiandentalacademy.com
  79. 79. Nutrition and the oral mucosal tissues -The nutritional state of a person is often manifested in oral tissues due to the rapid turnover of cells in this area and the bacterial onslaught the area receives .The soft oral tissues are sensitive to nutritional and dietary deficiencies. -Healthy oral epithelium experiences a 3 day to 7 day cell turnover and acts as an effective barrier to toxins.Inadequate nutrition may cause the tissues to breakdown ,become infected and develop lesions. Vit B complex deficiency – magenta , raw, fissures ,smooth or swollen tongue.Angular chelitis ,itchy eyes and scaly dermatitis may also occur. www.indiandentalacademy.com
  80. 80. -Patients with iron deficiency may present with pallor ,spoon shaped nails ,pale ,atrophic tongue ,pale conjuctivae and sensitivity to cold. -Routine periodical examination of the mucosa ,the tongue ,lips and the saliva is helpful in determining the nutritional status. www.indiandentalacademy.com
  81. 81. Conclusion -In the past ,the extent of a dentist `s nutritional counselling involved advising patients to reduce consumption of sweets and frequency of snacks.However much more is required today. -Dentists must be aware of how nutrition impacts general and oral health and how dental treatment affects the nutritional status .Compared with other other health care workers the dentists reach a large number of people per year and as the dental visit is of longer duration than the medical visit ,better opportunities for motivational interventions are present. www.indiandentalacademy.com
  82. 82. -Patients should be assessed for signs of nutrient imbalances and if they are suspected then appropriate referrals should be made. -Incremental increases in height and weight as compared with standards are one of the best measures of satisfied nutritional needs ,although they are not diagnostic for borderline states.Thus the orthodontist who usually uses these data for growth prediction is able to estimate past nutritional status .Additionally the presence of bands and brackets should alert the orthodontist to the cariogenecity of the diet.Perhaps the best method for patient education is the diet history. www.indiandentalacademy.com
  83. 83. While orthodontists will rarely see the frank manifestations of nutritional deficiencies ,it should be recognized that suboptimal levels of certain nutrients are common and have an effect on the biologic responses of the tissues influenced by orthodontic treatment. Additionally the age group typically involved in orthodontic treatment has particularly high nutritional demands and particularly poor dietary behaviour. www.indiandentalacademy.com
  84. 84. References - Nutrition and oral health.Laura M Romite . Dent Clin N Am 47,2003, 187-207. - Nutritional considerations in orthodontics.Wayne Hickory , Ravindra Nanda .Dent Clin N Am 25 ,1981 ,195-201. - Principles of nutrition and diet therapy .Barbara Luke. - Nutrition in health and disease .Lenna Copper. - Textbook of oral pathology .Shafer. - Severe oral manifestation in a case of Hand schuller christian disease. F.Kokelj ,C.Plozzer.Acta dermatovenerologica,2001 vol no 3. www.indiandentalacademy.com
  85. 85. - Osteolytic lesions in the calvarium- an important manifestation of Hand schuller christian disease. V K Sharma . Ind J Radiol Imaging 2002 ,12:3:391 -392. - Effect of aspargine on demineralized bone matrix implants. Hickory .J.D.R 58,139,1979;187. - Tissue tolerance to orthodontic banding. Dusterwinkle , J.Periodontology 37;132;1966 - Orthodontic tooth movement during an ascorbic acid deficiency. Litton ,A J O 65.290;1974. www.indiandentalacademy.com
  86. 86. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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