This document provides information on minerals and their importance for nutrition and oral health. It discusses several key minerals (calcium, phosphorus, magnesium, sodium, zinc, selenium, molybdenum, chromium, copper, cobalt, iron, iodine), their functions, dietary sources, deficiency disorders, and recommended daily allowances at different life stages. It also covers nutritional considerations and guidelines for dietary counseling from infancy through adolescence.

1. DIET AND NUTRITION 3

2. CONTENTS
 Minerals
 Principles of dietary management
 Objectives of counselling
 Guidelines of counselling
 Steps in counselling
 Diet diary
 Diet score
 Nutritional considerations
 Diet assessment
 Feeding pattern
 Eating disorders
 Conclusion
 References

3. The important aim of pediatric dentistry is recreation of the childs smile via
complete oral health care, that also includes appropriate consumption of
diet and adequate nutrition.
Diet also includes various minerals essential for the body, as follows.:
Minerals are again of two types, i.e:
Macrominerals and microminerals

4. CALCIUM
 Major element of the body
 98%-bones
 10mg/dl-blood
 Dynamic equilibrium between calcium in blood and skeletonis
maintained by the interaction between VIT D,PARATHORMONE
AND CALCITONIN
Sources:

5. Life Stage Age
Males
(mg/day)
Females
(mg/day)
Infants 0-6 months 210 210
Infants
7-12
months 270 270
Children 1-3 years 500 500
Children 4-8 years 800 800
Children 9-13 years 1,300 1,300
Adolescents 14-18 years 1,300 1,300
Adults 19-50 years 1,000 1,000
Adults
51 years
and older 1,200 1,200
Pregnancy
18 years
and
younger - 1,300
Pregnancy
19 years
and older - 1,000
Breastfeeding
18 years
and
younger - 1,300
Breastfeeding
19 years
and older - 1,000

6. FUNCTIONS
 Provide rigidity and strength to bones and teeth.
 Helps in contraction and relaxation of heart muscle.
 Helps in blood coagulation.
 Activates enzymes like pancreatic lipase and alkaline phosphatase.
 Release of neurotransmitters.
 Regulation of ion transportation.
DEFICIENCY DISORDERS
PHORPHOROUS
 Second mostabundant mineral in the body
 Found- bones, small amounts found in RBC’s and plasma
 Helps in formation of bone and tooth mineral
 High energy phosphates.
 Metabolism of carbohydrates,proteins and fats
 Cell protein synthesis, acidbase balance

7.  Nucleic acids,, vitamins.
RDA AND SOURCES
 800-1200mg
 SOURCES-meat,fish,milk,eggs,nuts,legumes,cereals
Oral manifestations
Magnesium
 Essential constituent of bone and soft tissues
 Fundamental ion
 Human body-20-35mg
Remaining-soft tissues,body fluids
Cellular respiration and energy production
Acid base balance.

8. RDA AND SOURCES
MALES-350mg
FEMALES-300mg
DEFICIENCY DISORDERS
Hyperexcitability
Behavioural disturbances
Weakness
Depression
Tremors
Convulsions
Hypoplastic teeth.

9. TRACE ELEMENTS
‘Micro-minerals’
Inorganic nutrients that are required by individuals in
small quantities ie. 0.001mg-few mgs
Essential as it has a vital function and is required to
avoid a deficiency disease
CLASSIFICATION
• 1) ESSENTIAL- Fe,Zn,Cr,Cu,Fl,I,Mn,Mo,Se
• 2) PROBABLY ESSENTIAL- Ni,Ti,Vn,Si,Bo
• 3) NON-ESSENTIAL- Al,Ba,Br,Pb, Hg,Sr,Vn,Zr
MODE OF ACTION
Act as catalysts either as metallo-enzymes or as
metal enzymes
• 1) Metallo-enzymes :
• Iron
• Zinc
• Copper
• molybdenum

10. 2) Metal-enzyme :
• Arginase
DIETARY SOURCES AND CLASSIFICATION
Meat, fish, grains, fruits and vegetables
CLASSIFIED AS :-
Those with well-defined requirements- iron, zinc,
copper, iodine and fluorine
Those that are integral constituents/
enzyme activators- manganese,molybdenum,
selenium, chromium and cobalt
IRON
• The adult human body contains 3-4 g of iron
• 60-70 % is present in blood as circulating
hemoglobin
• Each gram of Hemoglobin contains 3.35 mg of
iron.
FUNCTIONS

11. Formation of haemoglobin
Brain development and function
Regulates body temperature and muscle activity
Improves immune system.
Production of antibodies
 Oxygen transport and cell respiration
AGE REQUIREMENT
2YRS 10-15MG/DAY
111-18yrs 18mg/day

12. 19 & older 10mg/day
Women(child
bearing age)
18mg/day
DEFICIENCY DISORDERS
Iron deficiency anaemia - a major nutrition
problem.
Detrimental Effects :
• Infants & children
• Pregnancy
• Postmenopausal women.
CLINICAL MANIFESTATIONS
Weakness, fatigue, pallor
 Tingling of extremities, brittle nails
Spoon shaped nails (koilonychias), altered hair
growth

13. ORAL MANIFESTATIONS
• Inflammation and atrophy of tongue
• Smooth shiny red appearance of tongue
• Dysphagia
• Greyish mucous membrane
• Angular stomatitis
• Combination of above all features is termed as
PLUMMER VINSON SYNDROME
Therapy
200mg of ferrous sulphate tablets 3 times a day
to be continued for 2 months
Increased vitamin c rich foods.
IODINE
• Adult body normally contains about 15 – 30 mg of
iodine
• 8mg is concentrated in thyroid gland and rest
occurs in the circulating blood.
• Daily adult requirement of iodine is 0.15 mg.

14. • An integral part of the thyroid hormones
SOURCES
DEFICIENCY DISORDERS
Excess
Hyper thyroidism:Excessive activity of gland
ORAL MANIFESTATIONS-
Hypothyroidism:Retarded jaw growth

15. Delayed tooth eruption
Root resorption
Hyperthyroidism: Caries
SODIUM
An essential nutrient to maintain the extracellular
fluid volume and cellular osmotic pressure
Aids in transmission of nerve impulses
Permeability of cell membrane
Muscle contractions
RDA
DEFICIENCY DISORDERS
Weakness
Fatigue
Headache

16. Muscle cramps
Confusion
Irritability
HYPERTENSION is associated with damage to the
heart( coronary heart disease) , brain (stroke)and
kidney (renal failure).
ZINC
Human body-2-3gm
Greater concentration
Present more in-eyes,liver,bones,hair
RBC’s - 85%
WBC’s – 25x
FUNCTIONS
Active component of the enzyme carbonic
anhydrase-transport of CO2 to lungs
Activates enzymes for the digestion of proteins
Bone metabolism
Added to insulin to prolong its hypoglycemic
effect

17. Synthesis of RNA,DNA
Essential for wound healing,growth of tissues and
prevention of dwarfism
Hormone activity
RDA AND SOURCES
Infants- 3mg/day
6months to 1yr-5mg/day
1-10yrs-10mg/day
Adults-15mg/day
Pregnancy and lactation-20-25mg/day
SOURCES-meat,fish,milk,oysters

18. SELENIUM
Antioxidant
Catalyzes the oxidation of glutathione
Effective in reducing the prevalence of ‘KESHAN
DISEASE’
RDA-0.05-0.2mg
SOURCES- Animal protein
MOLYBDENUM
Essential nutrient
Part of molecular structure of enzymes,xanthine
oxidase and aldehyde oxidase
TOXICITY-weight loss, growth retardation and
connective tissue changes
RDA-0.15-0.5mg
SOURCES-beef,kidney,cereals,legumes
CHROMIUM
Trivalent chromium
Cofactor in insulin
 synthesis of fatty acids and cholesterol in liver

19. Human body:6mg
RDA-0.05-0.2mg
SOURCES-corn oil,meat,whole grains
COPPER
Amount of copper in human body-100-150mg
FUNCTIONS:-
Synthesis of Hb in bone marrow
Forms & maintain compounds having enzymatic
action
Aids in the formation of pigments
Can also stimulate Fe utilization
AA synthesis & myelin sheath.
RDA AND SOURCES
2-3mg
Excess

20. COBALT
Essential trace element as it is a part of vit B12
molecule
Metabolism of sulfur containing amino-acids
DEFICIENCY-anaemia
EXCESS-polycythemia
No danger of dietary shortage as it is found in
small quantities in food .
FOOD GUIDE

22. Diet counseling:
Objectives:
1. Identification
2. Correction
2. Modification
GUIDELINES FOR COUNSELLING
GUIDELINES:-
A) Gather information
B) Evaluate and interpret
C) Develop and implement a plan of action
D) Seek active participation of patient’s family
E) Follow-up to assess the progress made
PRINCIPLES OF DIET MANAGEMENT
DIRECT
NON-DIRECT

23. 6 QUESTIONS TO BE ASKED
Questions are to be made before making decision about
which patients will benefit from diet counseling
WHO, WHAT, WHY,WHEN, WHERE AND HOW.
1. WHO may be benefited?
2. WHAT are the objectives of diet and nutrition
counseling?
3. WHY is counseling beneficial?
4. WHEN is counseling conducted?
5. WHERE should the counseling occur?
6. HOW to counsel?
STEP-BY-STEP PROCEDURE
• Interviewing, where the diet diary is introduced
with a brief discussion of the purpose of diet.
• 24 hr diet record prepared to get an idea of food,
the child is consuming.
• Six-day diet diary advised to be prepared by
patients.
• Complete record of 6 day diet diary is analyzed
regarding the balanced and unbalanced diet.
INTERVIEWING

24. PURPOSE- obtain information
help the individual
BASIC GOALS- understanding
A)Problem
B)Factors contributing
C)Patient personality
D)Daily routine and lifestyle
E)Correlation of oral problems with food habits
DIET INTERVIEWER

25. PHYSICAL SETTING
COMMUNICATION TECHNIQUES
Giving and receiving of information
Motivation
HOW TO INTERVIEW
Interviewer should be relaxed
Brief introduction about the purpose of interview
FACE-TO- FACE
INTERVIEW
UNDERSTANDING THE
PATIENT’S NEEDS
VERBAL AND NON-
VERBAL

26. Encourage the patient’s expression of feelings-dental
health,maintainence of natural dentition
Interviewer should be allowed to speak first
Cross-examination
Obtain confidence and establish rapport
Allow the patient to make his own choices
Recapitulation
Reinforcement
DIET DIARY
It is the record of all the foods and beverages
consumed during 5 or 7 day period
It can be 24 hrs recall or 3,5,7 days record of food
intake
It helps to determine-
Type, frequency, consistency of food intake.
Proper diet planning for oral health
24-HR RECALL
This is used to determine the amount: of food and
beverages consumed during a previous 24 hrs.
It’s a valuable tool for obtaining a skeletal picture
of patients food intake.

27. It is done to determine whether the 5 day or the 7
day food diary is necessary for the diet
modification (diet counseling).
No comments or opinion should be given at this
time, allow the patient to talk freely
This is the most rapid method (15-20min)for
recording current food intake
Disadvantages:- it can be over or under
estimation of food taken in a single day and may
not represent the usual diet
5 DAY FOOD DIARY
5-7 DAY FOOD DIARY

28. The patient or mother completes the food diary at
home..
 Be accurate as possible in determining quantities
and to include a weekend day.
Include medications.
Order of eating.
Mood
ANALYZE, ISOLATE & CHECK
DIET SCORE
It is a screening device which is a simple scoring
procedure that can disclose a potential problem that is
likely to adversely affect the patient oral health.
Dental Health Score=
Total Food Score+ Nutrition Score- Sweet
Score

29. Step I - Food Score
To find out the average daily intake
First, list everything you eat and drink on an
ordinary weekday including snacks
Record time, amount, preparation method and
no.of teaspoons of sugar added
Step II
1.Circle the foods in diary that have been
sweetened with added sugar or natural sweets
(honey..)
2.Classify uncircled foods or mixed food dishes
into one or more food group.
For each serving of food listed in food diary place
a check mark in appropriate food group block.
Add the no:of checks and multiply by number
shown. The max: number of points credits for
each group is ( 24x4=96 )
Add the points- The highest score-96

30. Step-3 (Nutrient score)
To find out the amount of nutrition present.
Add the circled no.
Perfect score : 56

31. Step IV Sweet Score)
1. List the sweet, sugared foods, and the frequency
with which they are consumed .
2. Classify each sweet into liquid, solid and sticky or
slowly dissolving.
3. Place check mark in the frequency column of
each item as long as they are eaten 20min apart.
4. Add the checks- if sweets are liquid-x5, solid-
x10,slowly dissolving-x15.
(Highest Score-35).

32. StepV
1. All the food group scores and sweet scores
summed to the totaling score.
If the food scores is barely adequate or inadequate or
sweet score is “watch out” zone.-
NUTRITION-COUNSELING is required
4 food group scores
72-96 -----Excellent
64-72 -----Adequate
56-64 -----Barely adequate
56 or less -----Not adequate.

33. Score 60-100 is acceptable, and diet counseling is
given only at pt request.
if 56 or less ,then dietary counseling is both
recommended and indicated as a part of preventive
program.
NUTRITIONAL CONSIDERATIONS FROM INFANCY
TO ADOLESCENCE
INFANT AND TODDLER (0-3yrs)
1st
6 months of life-period of most rapid growth,apart
from prenatal existence

34. American academy of pediatrics recommends human
milk as the sole source of nutrition for 1st
6months,with continued intake for 1st
yr, and as long
as desired thereafter
BREAST FEEDING-4-6 MONTHS
MILK SUBSTITUTES-
Regular unmodified cow’s milk is not suitable
Insufficient source of vit C and Fe
Gastrointestinal bleeding
Solute load is too heavy for infant’s renal system to
handle
Low-fat milk should not be used
Insufficient energy provision
Lack of essential fatty acids.
WEANING-
No nutritional need for introducing before 6months of
age
Earlier use-allergies,obesity
Egg yolk may be safely introduced into the weaning
diet

35. Immature kidneys of infants cannot concentrate waste
efficiently
As a result,infant must excrete more water than adult
One must be on guard against dehydration,which has
serious consequences
SUPPLEMENTS-
Vit D,Fe-after pediatrician consultation
Low Fe levels- brain,intellectual development
2ND
YEAR OF LIFE
Reduction in appetite-NORMAL
Dietary needs for proteins and minerals-HIGH
Bright coloured foods-APPEALING
40-50% energy-fats
OLDER THAN 2YRS
Consumption of 3 regular meals with healthy snacks
(2-3/day)
Variety of foods abundant in fruits and vegetables
CARBOHYDRATES-55-60%
Whole grain high fiber foods
Simple sugars-less than 10%

36. FATS-30%
Saturated and polyunsaturated-less than 10%
CALORIES
Encourage the intake of lean meat, low fat dairy
products and vegtable oils.
PRE-SCHOOLER(3-6YRS)
Physical growth occurs in spurts
Fewer calories are required,but relatively high protein
and mineral needs
Children should be helped to lose ‘baby fat’ by
increasing physical activity rather than by severely
restricting calories
DENTAL IMPLICATIONS-
 wholesome,nutritious,low sugar snacks can promote
adequate intake of essential nutrients without adding
calories or promoting dental caries
SCHOOL AGED CHILD(6-12YRS)
Decline in food requirements per unit body weight-
reduction in growth rate
Thus,emphasis on high nutrient density:high ratio of
nutrients to calories
DIET COUNSELLING-

37. Children should be encouraged to have breakfast
Adolescent(12-18yrs)
Nutritional requirements are influenced primarily by
onset of puberty and final growth spurt of childhood
Increased need for energy,proteins,vitamins and
minerals
Adolescent females-
Consume less food than boys
Encounter significant social and peer pressure
‘Female athlete triad’-American college of Sports
Medicine (1992)
Seen among adolescent female athletes
Disordered eating behaviours
Amenorrhoea
TEACHING AND LEARNING
BOOKLETS
IVORINE TOOTH
MODELS
ANALOGIES
DRAWING
SKETCHES
PLASTIC/RUBBER
FOOD MODELS

38. Motivation: Stimulates or is an incentive for action
ARRIVING AT A DIAGNOSIS
Chief complaint
 Present illness
Personal and social history
Family history
Medical history
Diet history
Diet evaluation
Clinical observations
Laboratory tests
REINFORCEMENT
Follow-up visits 2 weeks later
Evaluation and comparison with old food plan
Discuss misinterpretations and problems encountered
Continuing toothbrushing and flossing practices
Self-help preventive measures

39. ASSESSMENT OF NUTRITIONAL STATUS
1. Clinical examination.
2. Anthropometry.
3. Biochemical evaluation
4. Functional assessment.
5. Assessment of dietary intake.
6. Ecological studies.
CLINICAL EXAMINATION
• Objective is to assess levels of health of individuals or
of population groups in relation to the food they
consume
• Simplest and the most practical method
• There are a number of physical signs- specific and
non specific-associated with states of malnutrition
• When two or more clinical signs characteristic of a
deficiency disease are present simultaneously there
diagnostic significance is greatly enhanced
ANTHROPOMETRY

40. Anthropometric measurements ie.height,weight, skin
fold thickness and arm circumference-valuable
indicators of nutritional status.
In young children, measurements such
as head and chest circumference are made.
Reflect the patterns of growth and
development,deviate from the average at various ages
in body size, built and nutritional status
BIOCHEMICAL ASSESSMENT
NUTRIENT METHOD OF TEST NORMAL
VALUE
VITAMIN A SERUM RETINOL
TEST
20 mcg/dl
THIAMINE TPP STIMULATION OF
RBC ACTIVITY
1.00-1.23
RIBOFLAVIN RBC GLUTATHIONE
ACTIVITY
1.0-1.2
NIACIN URINE N-METHYL
NICOTINAMIDE
Not
reliable
FOLATE SERUM FOLATE 6.0
mcg/ml
VITAMIN
B12
SERUM VITAMIN B12
CONCENTRATION
160
mcg/ml

41. VITAMIN C LEUCOCYTE
ASCORBIC ACID
160 mg/l
VITAMIN K PROTHROMBIN TIME 11-16
secs
PROTEIN SERUM ALBUMIN
CONCENTRATION
35g/l
FEEDING PATTERN
 Preschool should eat half of their mother’s food.
 A balance should be maintained between hard and soft foods
 Strong and mildly flavored, Colorful foods add variety and stimulate interest.
 They prefer simple unmixed dishes which are neither too hot nor too cold.
Familiar foods are better liked and small portions of new foods should be
introduced only with already well accepted foods.
 Foods should be such that can be easily manipulated and handled as
preschoolers.
DIET IN CHILDHOOD
 Children particularly preschoolers, are more easily prone to deficiencies like
protein energy malnutrition, anemia and vitamin A deficiency
 The influences of childhood get further pronounced during adolescence
 A proper well balanced diet, good eating habits, a good school lunch program
combined with some amount of nutrition awareness goes a long way in improving
their nutritional status
Dental Considerations:
By 2 ½ yrs - Almost all primary teeth have erupted and permanent teeth is in
developing stage.
By 6-12 yrs- Permanent teeth begin to erupt.

42. Time of growth spurts
DIET IN ADOLESCENCE
 Breakfast is frequently neglected and omitted more often by teenagers. For
teenage girls, skipping lunch is generally taken to be a way of controlling weight.
 Diets are likely to be bizarre and unbalanced. The concern about size and shape
of the body, sexual development, vitality, skin condition and attractiveness
 a sense of freedom .
 Snacking in between meals is therefore common. The choice of foods is
important. Snacks should be wholesome and not only a source of energy but
also of proteins and other essential nutrients.
Dental consideration
II permanent molar, premolars and canine begin to erupt.
Pre-pubertal growth spurts.
NUTRITION RELATED PEDIATRIC DISORDERS
Anorexia nervosa
 Preoccupation with appearance and body weight during adolescence- condition
of self-induced starvation
 Lack the ability to recognize that their emaciated bodies are thin,believe they are
over-weight
 Less common in males
•Severely limited food intake
RESTRICTIVE
•Self-induced vomiting
•misuse of laxatives,diuretics
BINGE EATING/
PURGINGTYPE

43.  Begins before puberty
 Self-imposed weight loss,amenorrhea.
DIAGNOSTIC CRITERIA:-
 Refusal to mainatin normal body weight
 Intense fear of gaining weight
 Distorted view of one’s own size,shape and body weight
Complications
 ORAL- glossitis
 gingivitis
 reduced salivary Ph, increased susceptibility to caries, epithelial erosion
 Perimolysis
BULIMIA
 Eating disorder characterized by binge eating and invariably by self-
induced vomiting
 More prevalent in young women
 More common than anorexia nervosa
 Begins during late adolescence/early adult life
 APA DIAGNOSTIC CRITERIA:-
 Consumption of unusually large amount of food in a discrete time period
 Perceived lack of control over eating

44.  Compensatory behaviour to rid the body of excess calories/prevent weight
gain
 Occurrence-twice a week-3 months
 Persistent concern with body size and shape
COMPLICATIONS
MANAGEMENT
Rinse with Na2Co3 dissolved in H2o
Sugar-free antacids/milk
Daily rinse with 0.5% NaF
Administration of 1.1% neutral Fl gel
Antidepressant medication
BINGE EATING DISORDER
 Consumption of excessive amounts of food along with the sensation of
loss of control

45. MANAGEMENT
 Psychotherapy- cognitive behavioural therapy
 Pharmacotherapy- antidepressants serotonin reuptake inhibitors.
EARLY CHILDHOOD CARIES
Presence of one or more decayed,missing or filled tooth surfaces in any primary
tooth in children from birth through 71 months of age’
 ASSOCIATED WITH:-
 Low self-esteem issues
 Missed school days
 Behavioural problems
 Oral pain
 Impaired eating
 Oral abscess
 Poor growth
 Delayed/ abnormal progression through transition stage of infant nutrition
Eating more rapidly
than normal
From
embarassment of
amount consumed
2days/week for 6
months
Depressed/
disgusted/
guilty
Till uncomfortably
full

46.  Excessive reliance on beverages
 Delayed acceptance of solid foods
 Delivery of beverages by bottles
 Continued nocturnal bottles with decreased saliva during sleep
 Prolonged breast feeding
Management:-
 Early evaluation of dietary habits
 Anticipatory guidance
 Transition of food
 Limited intake of sugary beverages
FAILURE TO THRIVE
 A condition when the physical growth of a child is less than expected,usually
below the 3rd or 5th centile,or when the child has significant loss of weight in a
short time.
 3 categories:-
 Organic-30%
 Non-organic/psychosocial-70%
 Mixed
 Features:-
 Developmental delay
 Growth retardation
 Psychological / behavioural problems
 Neurological signs
RUMINATION
 Voluntary regurgitation,chewing and reswallowing of stomach contents

47.  Self-stimulatory behaviour
 Associated with psycho-social issues/mental retardation
 Age of onset-3-12 months
 Enamel erosion
PICA
 Pathalogical craving of food item / substance not commonly regarded as
food
eg:-
Starch,ice or paint chips,dirt,paper
 Risk of direct toxicity from the desired substance
 Lead poisoning from incidental exposure
REFERENCES
1. Nutrition in clinical dentistry.Nizel.3rd edition.
2. Text book of oral pathology.Shafer.
3. Essentials of biochemistry-U.Satyanarayana
4. Dentistry for the child and adolescent. McDonald.9th edition.
5. Diet and nutrition in pediatric dentistry .DCNA- 2003.