Hi, I am Dr Komal Ghiya, a pediatric dentist by profession, I am here to share some of my own presentations for educational purposes. I hope a presentation on NUTRITIONAL DEFICIENCIES IN CHILDHOOD will be useful for all the dental and medical students. Comments are welcome if you like the presentations and if not please suggest some ways I could make them better for you. All the best

1. GOOD MORNING

2. NUTRITIONAL DEFICIENCIES
DURING CHILDHOOD
KOMAL GHIYA
MDS-Pedodontics and Prevevntive Dentistry

3. INDEX
 DEFINITION:NUTRION AND DIET
 FOOD PYRAMID
 MYPYRAMID
 GENDER DIFFERENCE IN ADOLESCENCE AND NUTRITIONAL ISSUE
 ESSENTIAL NUTRIENT COMPONENTS
 DEFICIENCIES RELATED TO:
 CARBOHYDRATE
 LIPIDS
 PROTEIN

4.  VITAMINS
 MINERALS
 WATER
 RECOMMENDED DIETARY ALLOWANCE
 EATING DISORDERS:
 ANOREXIA NERVOSA
 BINGE EATING
 BULIMIA
 PICA
 CONCLUSION
 REFERENCES

5. DEFINITIONS
 WHO:NUTRITION IS THE INTAKE OF FOOD,CONSIDERED IN RELATION TO BODY’S
DIETARY NEEDS.
 NIZEL:THE SCIENCE WHICH DEALS WITH THE STUDY OF NUTRIENTS AND FOODS
AND THEIR EFFECT ON THE NATURE AND FUNCTION OF THE ORGANISM UNDER
DIFFERENT CONDITIONS OF AGE ,HEALTH AND DISEASE
 DCNA 2003:THE SCIENCE ,HOW THE BODY UTILIZES FOOD TO MEET
REQUIREMENT FOR DEVELOMENT,GROWTH AND REPAIR AND MAINTENANCE
REF:NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

6. DIET
 NIZEL(1989):TOTAL ORAL INTAKE OF A SUBSTANCE THAT PROVIDES
NOURISHMENT AND SUPPLY
 BALANCED DIET:IS THE ONE WHICH CONTAINS VARITIEIS OF FOODS IN SUCH
QUANTITIES AND PROPORTION THAT ARE NEEDED FOR ENERGY
 FOOD: AS AN EDIBLE SUBSTANCE MADE UP OF A VARIETY OF NUTRIENTS THAT
NOURISH THE BODY.
REF:NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

7. FOOD PYRAMID
REF:DEAN J,AVERY D,MCDONALD R, MC DONALDS AND AVERY ‘S DENTISTRY FOR THE CHILD
AND ADOLESCENT,9 TH EDITION

8. MY PYRAMID
REF:DEAN J,AVERY D,MCDONALD R, MC DONALDS AND AVERY ‘S DENTISTRY FOR THE
CHILD AND ADOLESCENT,9 TH EDITION

9. DENTAL CARIES
MICROBIAL SUBSTRATES
TOOTH DEVELOPMENT
SALIVA
IMMUNOCOMPETENCE
ENAMEL MATURATION
PERIODONTAL DISEASE
PLAQUE METABOLISM
CALCIUM PHOSPHATE RATIOS
SULCULAR PERMEABILITY
IMMUNE FUNCTION
GINGIVAL FLUID
REPAIR
DEVELOPMENTAL
PROBLEMS
CARIES
MALOCCLUSION
CONGENITAL
DEFECTS
MUCOSAL LESIONS
ANGULAR CHEILOSIS
TONGUE LESIONS
TASTE ABBERATIONS
ORAL CANCER
WOUND HEALING
NUTRITION CORRELATES OF ORAL
PROBLEMS
: ALFANO
REF:STEWART R,BARBER T,TROUTMAN K,WEI S,PEDIATRIC DENTISTRY,SCIENTIFIC
FOUNDATIONS AND CLINICAL PRACTICE,1982

10. GENDER DIFFERENCE IN ADOLESCENT
NUTRITIONAL ISSUES
FEMALES MALES
LOWER ENERGY NEEDS HIGHER ENERGY NEEDS
THINNESS CONSIDERED IMPORTANT STRENGTH CONSIDERED IMPORTANT
CONCERN ABOUT PEAK BONE MASS LESS CONCERN ABOUT BONE MASS
HIGHER RISK FOR EATING DISORDERS LOWER RISK FOR EATING DISORDERS
HIGHER RISK FOR NUTRITIONAL
DEFICIENCIES
LOWER RISK FOR DEFICIENCIES
REF:DEAN J,AVERY D,MCDONALD R, MC DONALDS AND AVERY ‘S DENTISTRY FOR THE CHILD
AND ADOLESCENT,9 TH EDITION

11. ESSENTIAL PARTS OF NUTRITIONS
 CARBOHYDRATES
 LIPIDS
 PROTEINS
 VITAMINS
 MINERALS
 WATER
ADAPTED FROM BELL,G.H TEXTBOOK OF PHYSIOLOGY AND BIOCHEMISTRY,6 TH
EDITION,P166 IN NIZEL AND PAPAS,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

12. CARBOHYDRATES
 FRUCTOSE INTOLERANCE:
 REDUCED OR NO CARIES
 NEWBRUN ET AL:1978:15 OF 27 INDIVIDUALS WERE CARIES FREE AND OTHERS
FOR WHOM A DMFT SCORE COULD BE ASCERTAINED HAD A LOW CARIES RATE
 MARTHALER& FROESCH:1967:LOWER INCIDENCE OF DENTAL CARIES AND
PERIODONTAL DISEASE AS A RESULT OF SELF IMPOSED DIETARY RESTRICTIONS
 SAXEN ET AL:1989:FRUCTOSE RESTRICTION MAY ITSELF CONTRIBUTE TO
PERIODONTAL DISEASES AS ORAL MICROBIOME CHANGES
REF:NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION
BAKER P,AYRES L,GAUGHAN S,WEISFELD A,HERIDITARY FRUCTOSE INTOLERANCE,GENE
REVIEWS,DEC,17,2015

13. LIPIDS
 INDIRECT EVIDENCE THAT DIETARY FATS MAY HELP TO PREVENT CARIES
 E.G:ESKIMOS:WHOSE DIETS ARE SOLELY OF ANIMAL ORIGIN AND FURNISH ABOUT
70-80% OF THEIR TOTAL CALORIE AS FAT EXPERIENCE,HAVE VERY LITTLE DECAY
 MECHANISM :
 COATING OF TOOTH SURFACES WITH AN OILY SUBSTANCE WOULD MEAN THAT
FOOD PARTICLES WILL NOT BE SO READILY RETAINED
 A FATTY PROTECTIVE LAYER OVER PLAQUE WOULD PREVENT FERMENTABLE SUGAR
SUBSTRATE FROM BEING REDUCED TO ACIDS
 HIGH CONCENTRATIONS OF FATTY ACIDS MAY INTERFERE WITH GROWTH OF
CARIOGENICITY
 INCREASED DIETARY FAT WILL DECREASE THE AMOUNT OF DIETARY FERMENTABLE
CARBOHYDRATE NECESSARY FOR ORGANIC ACID FORMATION
REF:NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

14. PROTEINS

15. PROTIEN ENERGY MALNUTRITION
 KWASHIORKAR
 ADEQUATE IN CALORIES BUT DEFICIENT IN PROTIEN
 INFANT ,PRESCHOOL CHILDREN1-4 YEARS
 SIGNS:
 GROWTH RETARDATION
 EDEMA
 MENTAL APATHY
 WASTING OF MUSCLES BUT PRESERVED ADIPOSE TISSUES
 FLANKY PAINT SKIN RASH
 DISTENDED ABDOMEN AND ENLARGED LIVER
 HAIR SPARSE AND DEPIGMENTED
 DIARRHOEA,HYPOTHERMIA,BRADYCARDIA AND HYPOTENSION
REF:NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

16. ORAL MANIFESTATIONS
 TONGUE IS BRIGHT AND RED WITH LOSS OF PAPILLAE
 BILATERAL ANGUALAR CHEILOSIS
 FISSURING OF LIPS
 LOSS OF CIRCUMORAL PIGMENTATION
 DECREASED GROWTH OF JAWS

17. STUDIES
 IN NIGERIAN CHILDREN WITH KWASHIOKAR,PROTEIN DEFICIENCY MAY BE ONE
REASON FOR THE DELAYED ERUPTION AND HYPOPLASIA OF THEIR DEIDUOUS
TEETH
 PROTIEN DEFICEINT DIETS TO RATS:AMINOACIDS:LYSINE OR TRYPTOPHAN
PRODUCE AN IRREGULAR PREDENTIN LAYER AND A NUMBER OF
INTERGLOBULAR SPACES IN POORLY CALCIFIED DENTINAL MATRIX
REF:NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

18. MARASMUS
 BOTH PROTEIN AND CALORIE DEFICIENCY
 OCCURS IN CHILDREN LESS THAN YEAR
 GROSS MUSCLE AND SUBCUTANEOUS FAT WASTING
 ABSENCE OF EDEMA
 WITHDRAWN AND APATHETIC
 SKINFOLD THICKNESS AND MIDARM CIRCUMFERENCE MARKEDLY REDUCED
 MANAGEMENT
 BEST MANAGED IN HOMES
 EDUCATE PARENTS
 100 kcal/kg OF EXPECTED WT.
 FEED IN SMALL AMOUNTS
 FREQUENT INTERVALS

19. EFFECT OF PROTIEN DEFICIENCY ON JAW AND
TEETH
 ROTATED TEEETH,CROWDED,RETARDED GROWTH OF JAW BONES
 MENAKER AND NAVIA:BOTH MATERANAL AND NEONATAL PROTEIN
DEFICIENCY AFFECTS BIOCHEMICAL COMPOSITION AND FUNCTION OF SALIVARY
GLANDS AND IMPAIRS THEM
 SEVERE LINEAR ENAMEL HYPOPLASIA HAS BEEN POSITIVELY CORRELTED WITH
MATERNAL AND NEONATAL MALNUTRITION
 LINEAR ENAMEL HYPOPLASIA CAUSED BY MALNUTRITION IS A PREDISPOSING
FACTOR THAT WHEN COMBINED WITH LOCAL CARIOGENIC FACTORS RESULTS IN
RAMPANT CARIES OF PRIMARY ANTERIOR TEETH
REF:STEWART R,BARBER T,TROUTMAN K,WEI S,PEDIATRIC DENTISTRY,SCIENTIFIC
FOUNDATIONS AND CLINICAL PRACTICE,1982

20. VITAMINS

21. VITAMIN D
 SKELETAL AND DENTAL DEVELOPMENT
 INCERASES CALCIUM ABSORPTION FROM GIT
 DEFICIENCY :
 RICKETS :BONE DEFORMITY,POOR MUSCLE DEVELOPMENT,
 SPINAL CURVATURE
 BOWED LEGS,ENLARGED JOINTS,
 DELAYED CLOSING OF SKULL BONES MAY BE PRESENT
 HYPOPARATHYROIDISM,CELIAC DISEASE,CHRONIC RENAL DISEASE,INTESTINAL
MALABSORPTION SYNDROMES
REF:DEAN J,AVERY D,MCDONALD R, MC DONALDS AND AVERY ‘S DENTISTRY FOR THE CHILD
AND ADOLESCENT,9 TH EDITION

22. STUDIES:
 WENG:YOUTH AGES 6-21 YEARS IN NORTHEASTERN UNITED STATES,MORE
THAN HALF THE CHILDREN HAD LOW SERUM VIT D
CONCENTRATIONS,PREVALENCE WAS INCREASED WITH OLDER AGE AND IN
WINTER MONTHS,ESPECIALLY IN AFRICAN –AMERICAN CHILDREN.
 400 HEALTHY MASSACHUETTS INFANTS AND TODDLERS ,12.1% HAD
SUBOPTIMAL SERUM LEVELS OF VITAMIN D AND 1/3 OF THESE CHILDREN
EXHIBITED RADIOGRAPHIC EVIDENCE OF BONE DEMINERALIZATION
 CUSHMAN:EVALUATED THE EFFECTS OF SUBCLINICAL VITAMIN D DEFICIENCY
OR BONE MINERAL DENSITY AND BONE TURNOVER IN HEALTHY ADOLESCENT
BOYS AND GIRLS
 12-15 YEAR OLD GIRLS WITH HIGH VITAMIN D STATUS HAD SIGNIFICANTLY
GREATER BONE DENSITY ,LOWER SERUM PARATHYROID AND LOWER BONE
TURNOVER MARKERS THAN GIRLS WITH LOW VITAMIN D STATUS
REF:DEAN J,AVERY D,MCDONALD R, MC DONALDS AND AVERY ‘S DENTISTRY
FOR THE CHILD AND ADOLESCENT,9 TH EDITION

23.  ORAL MANIFESTATIONS:
 PRESENCE OF RICKETS DURING TOOTH DEVELOPMENT:ENAMEL AND DENTIN
HYPOPLASIA,INCOMPLETE OR DELAYED TOOTH ERUPTION
 INCISORS,CANINES,FIRST PERMANENT MOLARS,HOWEVER THE AFFECTED
WERE NOT MORE SUSCEPTIBLE TO DENTAL CARIES
 SAME CONDITION MAY OCCUR IN HYPOCALCEMIA OF NEWBORN,HOWEVER
HYPOPLASTIC LESION HAVE BEEN MOSTLY LIMITED TO PRIMARY TEETH
REF:STEWART R,BARBER T,TROUTMAN K,WEI S,PEDIATRIC DENTISTRY,SCIENTIFIC
FOUNDATIONS AND CLINICAL PRACTICE,1982

24. VITAMIN C
 SEVERE DEFICIENCY CAUSES PETECHIAL HAEMORRHAGE,TENDERNESS OF LOWER
EXTREMITIES AND SWELLING OF JOINTS
 CALCIFICATON OF ALL MINERALIZED TISSUE IS SEVERELY AFFECTED,BONE IS THIN
AND TRABECULATION IS DIMINISHED
 FAILURE OF THE ONTOBLAST TO FORM OSTEOID AT EPIPHYSEAL PLATE
 THE TEETH ARE QUALITATIVELY AND QUANTITATIVELY DEFICIENT N DENTIN
FROMATION WITH ATOPIC CALCIFICATION OR PULPAL STONE FORMATION
 SCURVY:SWOLLEN AND BLEEDING GUMS
REF:STEWART R,BARBER T,TROUTMAN K,WEI S,PEDIATRIC DENTISTRY,SCIENTIFIC
FOUNDATIONS AND CLINICAL PRACTICE,1982

25. VITAMIN A
 NIGHT BLINDNESS
 XEROPHTHALMIA
 KERATOMALACIA
 FOLLICULAR HYPERKERATOSIS
 CESSATION OF ENDOCHONDRAL BONE FORMATION
 ORAL MANIFESTATIONS
 EPITHELIAL METAPLASIA
 HYPERKERATINIZATION
 TOOTH DEVELOPMENT:PRE ERUPTIVE ROLE
 SALIVARY GLANDS:ATROPHY REDUCTION IN SALIVARY FLOW
REF:NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

26. VITAMIN K
 FUNCTION:
 CATALYSES SYNTHESIS OF PROTHROMBIN BY LIVER
 ESSENTIAL FOR PRODUCTION OF CLOTTING FACTOR 8,9 AND 10
 DEFICIENCY:
 GINGIVAL BLEEDING
REF:NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

27. VITAMIN B COMPLEX
NAME OF VITAMIN SIGNS AND SYMPOMS ORAL MANIFESTATIONS
THIAMINE BERI BERI
PERIPHERAL NEURITIS
ATAXIC GAIT
ANOREXIA
WEIGHT LOSS
WEAKNESS
DIARRHEOA
HYPERESTHESIA OF ORAL
MUCOSA
BURNING TONGUE
LOSS OF TASTE
RIBOFLAVIN DYSPHAGIA
CHEILOSIS
ANGULAR STOMATITIS
TONGUE APPEARS
PURPLISH RED OR
MAGENTA
ATROPHY OF FILLIFORM
PAPILLAE
PEBBLED APPEARANCE OF
TONGUE
REF:NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION
SHAFER,HINE,LEVY SHAFER’S TEXTBOOK OF ORAL PATHOLOGY,6 TH EDITION

28. PYRIDOXINE MICROCYTIC
HYPOCHROMIC ANEMIA
GROWTH RETARDATION
PERIPHERAL
NEUROPATHY
CHELIOSIS
GLOSSITIS
STOMATITIS
SEBORRHAIC DERMATITIS
IN NASOLABIAL FOLDS
NIACIN DERMATITIS
DIARRHEA
DEMENTIA
UNTREATED:DEATH
TONGUE BECOMES
SWOLLEN
ENTIRE ORAL MUCOSA
BECOMES FIERY RED
EPITHELIUM
DESQUAMATION
TENDERNESS,PAIN,
REDNESS AND
ULCERATION BEGIN AT
INTERDENTAL GINGIVAL
PAPLLAE AND SPREADS
VINCENTS INFECTION IS
COMMON SEQUEL
REF:NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

29. BIOTIN DERMATITIS
LOSS OF APETITE,SLEEP
NAUSEA
MUSCULAR PAINS
HYPERESTHESIA
PARESTHESIA
GLOSSITIS
FOLIC ACID WEAKNESS,FAINTING
SEVERE PALENESS OF
CONGESTIVE HEART
FAILURE
CIRRHOSIS OF LIVER
BURNING SENSATION OF
TONGUE AND ORAL
MUCOSA
TONGUE:RED,SORE,SWOL
EN
ANGULAR CHEILOSIS
GINGIVITIS
REF:NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

30. RIBOFLAVIN DEFICIENCY NIACIN DEFICIENCY
FOLIC ACID DEFICIENCY

31. MINERALS

32. IRON
 CLINICAL SIGNS:
 WEAKNESS, FATIGUE, PALLOR, NUMBNESS, TINGLING OF EXTREMITIES
 ORAL MANIFESTATIONS:
 GLOSSITIS AND FISSURES AT CORNERS OF THE MOUTH(ANGULAR CHELITIS)
 PAPILLAE OF TONGUE:ATROPHIED,SMOOTH SHINY,RED APPEARANCE
 PALLOR OF ORAL MUCOSA OR LIPS MAY BE OBSERVED
 AFFECTED INDIVIDUAL INCREASED RISK FOR FUNGAL INFECTIONS,SUCH AS
CANDIDIASIS
 PLUMMER VINSON SYNDROME:
REF:DEAN J,AVERY D,MCDONALD R, MC DONALDS AND AVERY ‘S DENTISTRY FOR THE
CHILD AND ADOLESCENT,9 TH EDITION

33. ZINC
 STUNTED GROW
 SIGNS AND SYMPTOMS:
 ABNORMAL IMMUNE RESPONSE
 DECREASED REPRODUCTIVE DEVELOPMENT AND FUNCTION
 SKELETAL ABNORMALITIES
 ORAL MANIFESTATIONS:
 IMPAIRED WOUND HEALING
 ALTERATIONS OF ORAL EPITHELIUM
 XEROSTOMIA
 REDUCED OR ALTERED SENSE OF TASTE OR SMELL AND REDUCED APPETITE
 DURING TOOTH FORMATION,INCREASED RISK FOR DENTAL CARIES
 IMPACT ON IMMUNE FUNCTION,INCREASE THE RISK OF ORAL INFECTIONS SUCH AS
PERIODONTAL DISEASE AND CANDIDIASIS
REF:DEAN J,AVERY D,MCDONALD R, MC DONALDS AND AVERY ‘S DENTISTRY FOR THE
CHILD AND ADOLESCENT,9 TH EDITION

34. CALCIUM
 ESSENTIAL FOR PROPER NERVE AND MUSCLE ACTIVITY,BLOOD CLOTTING,TRANSPORT
OF IONS ACROSS CELL MEMBRANES AND MNERALIZATION OF SKELETON AND
DENTITION
 CHILDHOOD AND ADOLESCENCE ARE CRUCIAL TIMES FOR DEVELOMENT OF SKELETAL
SYSTEM ,DIETARY REQUIREMENT PEAKS DURING TEENAGE YEARS
 ACHIEVING A HIGH PEAK BONE MASS IS THE FIRST LINEOF DEFENSE AGAINST
OSTEOPOROSIS
REF:DEAN J,AVERY D,MCDONALD R, MC DONALDS AND AVERY ‘S DENTISTRY FOR THE
CHILD AND ADOLESCENT,9 TH EDITION

35. FLUORIDE
 ESSENTIAL ELEMENT IN THE MINERALIZATION OF TEETH AND BONES
 LOW LEVEL OF FLUORIDE IN BREAST MILK (<0.1 PPM), A DAILY FLUORIDE
SUPPLEMENTATION OF 0.25mg FROM BIRTH UNTILL WEANING IS
RECOMMENDED FOR THE FULLY BREAST FED INFANTS
 ORAL MANIFESTATIONS
 FLUOROSIS OF TEETH
REF:STEWART R,BARBER T,TROUTMAN K,WEI S,PEDIATRIC DENTISTRY,SCIENTIFIC
FOUNDATIONS AND CLINICAL PRACTICE,1982

36. WATER
AGE (YEARS) WATER(ml per kg Body
weight)
INFANTS BIRTH-1 120-100
CHILDREN 0-10 60-80
ADOLESCENTS 11-18 41-55
ADULTS 19-51 20-30
WATER REQUIREMENT
ADAPTED FROM BELL,G.H TEXTBOOK OF PHYSIOLOGY AND BIOCHEMISTRY,6 TH
EDITION,P166 IN NIZEL AND PAPAS,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

37.  FUNCTIONS
 ELECTROLYTIC BALANCE
 METABOLIC REACTIONS
 SOLVENT
 VEHICLE TO TRANSPORT
 TEMPERATURE REGULATION
 LUBRICANT IN DIGESTION
 FLUSHING ACTION OF SALIVA IS MAINLY DUE TO WATER,SO A DECREASE IN
WATER CONTENT WILL CAUSE DRY MOUTH AND INCREASE IN CARIES
REF:NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION

38. RECOMMENDED DIETARY
ALLOWANCES

39. RECOMMENDARY DIETARY ALLOWANCES(INDIAN)
GROUP BODY
WEIGHT
(Kg)
ENERGY
(Kcal
/day)
PROTEIN
S(g/day)
FAT
(g/day)
CALCIUM
(mg/day)
IRON
(mg/
day)
ZINC
(mg/
ay)
MAGNESIUM
(mg/day)
INFANTS 0-6
MNTHS
5.4 92/kg 1.16/kg 19 500 46MIC
ROGR
AM/K
G
30
6-12 8.4 80/kg 1.69/kg 27 5 45
1-3 12.9 1060 16.7 25 9 5 50
CHILDREN 4-6YRS 18.0 1350 20.1 30 600 13 7 70
7-9 25.1 1690 29.5 35 16 8 100
BOYS 10-12 34.3 2190 39.9 35 21 9 120
GIRLS 10-12 35.0 2010 40.4 35 800 27 9 160
BOYS 13-15 47.6 2750 54.3 45 32 11 165
GIRLS 13-15 46.6 2330 51.9 40 800 27 11 210
BOYS 16-17 55.4 3020 61.5 50 28 12 195
GIRLS 16-17 52.1 2440 55.5 35 800 26 12 235

40. VIT
C(mg/day
)
FOLATE
(microgra
m/day)
VIT B12
(microgra
m/day)
RIBOFLAV
IN
(mg/day)
NIACIN
(mg/day)
VIT B6
(mg/day)
RETIN
OL
B CAROTENE
(microgram/
day)
THIAMINE
(mg/day)
INFANTS 0-6
MNT
S
25 25 0.2 0.3 710
micrgra
m/kg
0.1 350 0.2
6-12 0.4 650
microgr
am/kg
0.4 2800 0.3
1-3 80 0.6 8 400 3200 0.5
CHILDRE
N
4-
6YRS
40 100 0.2-1.0 0.8 11 0.9 0.7
7-9 120 1.0 13 600 4800 0.8
BOYS 10-12 40 140 0.2-1.0 1.3 15 1.6 1.1
GIRLS 10-12 1.2 13 1.0
BOYS 13-15 40 150 0.2-1.0 1.6 16 1.6 1.4
GIRLS 13-15 1.4 14 600 4800 1.2
BOYS 16-17 40 200 0.2-1.0 1.8 17 1.6 1.5
GIRLS 16-17 1.2 14 1.0

41. EATING DISORDERS

42. ANOREXIA NERVOSA
 FOOD INTAKE IS SEVERELY LIMITED OR THE BINGE EATING/PURGING TYPE IN
WHICH INDIVIDUALS WHO ENGAGE IN SELF INDUCED VOMTING OR MISUSE OF
LAXATIVES,DIURETICS OR ENEMAS
 FOUR DIAGNOSTIC CRITERIA FOR ANOREXIA NERVOSA:
 REFUSAL TO MAINTAIN A BODY WEIGHT EQUAL TO OR GRETAER THAN 85%OF
THAT EXPECTED FOR THE PATIENT’S AGE AND HEIGHT
 AN INTENSE FEAR OF GAINING WEIGHT OR BECOMING FAT,EVEN THOUGH THE
INDIVIDUAL IS UNDERWEIGHT
 A DISTORTED VIEW OF ONE’S BODY WEIGHT ,SIZE OR SHAPE THE EMACIATED
ANOREXIC INDIVIDUAL ACTUALLY FEELS FAT.
 IN POSTMENARCHAL WOMEN AND GIRLS ,THE ABSENCE OF AT LEAST THREE
CONSECUTIVE MENARCHAL CYCLES
REF:DEAN J,AVERY D,MCDONALD R, MC DONALDS AND AVERY ‘S DENTISTRY FOR THE CHILD
AND ADOLESCENT,9 TH EDITION

43.  QUALITATIVE DEFICIENCIES IN THE DIET MAY LEAD TO:
ANEMIA,HYPOPROTIENEMIA,VITAMIN DEFICIENCIES.
 ELECTROLYTE IMBALANCE ,HYPOKALEMIA,CAN OCCUR WHEN VOMITING OR
LAXATIVE OR DIURETIC ABUSE IS PRACTICED
 SIGNS AND SYMPTOMS:
 ENLARGEMENT OF PAROTID GLANDS
 EDEMA TO LEGS
 INCREASED FACIAL HAIRS
 REDUCTIONS IN BLOOD PRESSURE AND PULSE RATE
REF:DEAN J,AVERY D,MCDONALD R, MC DONALDS AND AVERY ‘S DENTISTRY FOR THE CHILD
AND ADOLESCENT,9 TH EDITION

44.  ORAL MANIFESTATIONS:
 GLOSSITIS,GINGIVITIS,REDUCTION IN THE AMOUNT AND pH of the saliva
 INCREASE IN DENTAL CARIES SUSCEPTIBILITY
 DENTAL EROSION MAY BE EVIDENT ON PALATAL ASPECT OF ANTERIOR AND
POSTERIOR TEETH
 SELF INDUCED VOMITING CAUSES EPITHELIAL EROSION,GINGIVITIS AND DENTAL
EROSION ON PALATAL SURFACE OF MAXILLARY ANTERIOR TEETH
 TREATMENT:
 FLUOXETIN HYDROCHLORIDE:HELPS CONTROL THE OBSSESIVE COMPULSIVE
BEHAVIOUR
 DRUG RAISES THE BRAIN LEVELS OF SEROTONIN AND AS A CONSEQUENCE THE
URGE TO BINGE AND PREOCCUPATION WITH FOOD APPEARS TO LESSEN
REF:DEAN J,AVERY D,MCDONALD R, MC DONALDS AND AVERY ‘S DENTISTRY FOR THE CHILD
AND ADOLESCENT,9 TH EDITION

45. BULIMIA
 BINGE EATING+SELF INDUCED VOMITING
 USUALLY BEGINS DURING LATE ADOLESCENCE OR EARLY ADULT LIFE
 DIAGNOSTIC CRITERIA:
 CONSUMPTION OF AN UNUSUALLY LARGE AMOUN OF FOOD IN A DISCRETE
TIEM PERIOD(WITHIN 2 HOURS)
 PERCIEVED LACK OF CONTROL OVER EATING DURING AN EPISODE
 COMPENSATORY BEHAVIOUR TO RID THE BODY OF EXCESS CALORIES AND
PREVENT WEIGHT GAIN
 THE OCCURRENCE OF BINGE EATING AND COMPENSATORY BEHAVIOURS AT
LEAST TWICE A WEEK FOR MONTHS
 A PERSISTENT CONCERN WITH BODY SHAPE AND SIZE
REF:DEAN J,AVERY D,MCDONALD R, MC DONALDS AND AVERY ‘S DENTISTRY FOR THE CHILD
AND ADOLESCENT,9 TH EDITION

46.  SIGNS AND SYMPTOMS
 FLUID AND ELECTROLYTE ABNORMALITIES
 HYPOKALEMIA
 ORAL MANIFESTATIONS
 ENAMEL EROSION
 TOOTH BRUSHING AFTER VOMITING PROMOTES ENAMEL LOSS :PATIENT SHOULD
BE INSTRUCTED TO RINSE WITH AN ALKALNE SOLUTION SUCH AS SODIUM
BICARBONATE DISSOLVED IN WATER
 USE OF LIQUID SUGAR FREE ANTACIDS,WATER OR MILK
 FLUORIDE TREATMENT
 DAILY RINSES:0.5% SODIUM FLUORIDE AND 1.1% NEUTRAL FLUORIDE GEL IN
CUSTOM TRAYS
 ANTIDEPRESSANT MEDICATIONS MAY BE HELPFUL
REF:DEAN J,AVERY D,MCDONALD R, MC DONALDS AND AVERY ‘S DENTISTRY FOR
THE CHILD AND ADOLESCENT,9 TH EDITION

47. BINGE EATING
 DEFINITION: CONSUMPTION OF EXCESSIVE AMOUNTS OF FOOD ALONG WTH
THE SENSATION OF LOSS OF CONTROL
 ASSOCIATED WITH THREE OR MORE
 EATING MUCH MORE RAPIDLY THAN NORMAL
 EATING UNTIL FEELING UNCOMFORTABLY FULL
 EATING LARGE AMOUNTS OF FOOD WHEN NOT FEELING HUNGRY
 EATING ALONE FROM EMBARRASMENT OF THE AMOUNT CONSUMED
 FEELING DISGUSTED ,DEPRESSED,OR GUILTY AFTER OVEREATING
REF:DEAN J,AVERY D,MCDONALD R, MC DONALDS AND AVERY ‘S DENTISTRY FOR THE
CHILD AND ADOLESCENT,9 TH EDITION

48.  FEELING MARKED DISTRESS REGARDING BINGE EATING
 BINGE EATING AT LEAST 2 DAYS PER WEEK FOR 6 MONTHS,ON AVERAGE
 TREATMENT
 PHARMACOTHERAPY :ANTIDEPRESSANT,SELECTIVE SEROTONIN REUPTAKE
INHIBITORS
 PSYCHOTHERAPY
REF:DEAN J,AVERY D,MCDONALD R, MC DONALDS AND AVERY ‘S DENTISTRY FOR THE
CHILD AND ADOLESCENT,9 TH EDITION

49. PICA
 A CONDITION IN WHICH APETITE IS PERVETED
 MANY UNUSUAL OBJECTS AND SUBSTANCES MAY BE INGESTED
 OBJECTS SUCH AS BUTTONS,SCREWS,PINS,NAILS ETC MAY CAUSE
GASTROINTESTINAL OBSTRUCTIONS OR PERFORATIONS
 CHILDREN SOMETIMES CHEW PAINTED OBJECTS AND SUCCUMBED IN LEAD
POISONING
SCULLY C,CAWSON R,MEDICAL PROBLEMS IN DENTISTRY,5 TH EDITION

50. CONCLUSION
 THUS A BALANCED DIET IS NECESSARY FOR THE GROWTH AND DEVELOPMENT
OF BODY IN CHILDHOOD AS WELL AS FOR PROPER FUNCTIONING OF BODY.

51. REFERENCES
 STEWART R,BARBER T,TROUTMAN K,WEI S,PEDIATRIC DENTISTRY,SCIENTIFIC
FOUNDATIONS AND CLINICAL PRACTICE,1982
 DEAN J,AVERY D,MCDONALD R, MC DONALDS AND AVERY ‘S DENTISTRY FOR
THE CHILD AND ADOLESCENT,9 TH EDITION
 NIZEL R,PAPAS T,NUTRITION IN CLINICAL DENTISTRY,THIRD EDITION
 ADAPTED FROM BELL,G.H TEXTBOOK OF PHYSIOLOGY AND BIOCHEMISTRY,6 TH
EDITION,P166 IN NIZEL AND PAPAS,NUTRITION IN CLINICAL DENTISTRY,THIRD
EDITION
 BAKER P,AYRES L,GAUGHAN S,WEISFELD A,HERIDITARY FRUCTOSE
INTOLERANCE,GENE REVIEWS,DEC,17,2015

52. REFERENCES
 SCULLY C,CAWSON R,MEDICAL PROBLEMS IN DENTISTRY,5 TH EDITION
 SHAFER,HINE,LEVY SHAFER’S TEXTBOOK OF ORAL PATHOLOGY,6 TH EDITION
 DAVIDSON ‘S PRINCIPLES AND PRACTICE OF MEDICINE,21 ST EDITION

53. THANKYOU