nutrition and its role in periodontitis

1. PRESENTED BY
R ANIL KUMAR PG-I
NUTRITION AND IT’S ROLE IN
PERIODONTAL HEALTH

2. CONTENTS
 INTRODUCTION
 DEFINITION
 CLASSIFICATION
 LOCAL EFFECT OF DIET ON PERIODONTAL HEALTH
 INTERACTION OF IMMUNITY, INFECTION & NUTRITIONAL
STATUS
 NUTRITION AND PERIODONTAL HEALTH
INTERRELATIONSHIP
 NUTRITION AND EPITHELIAL BARRIER
 EFFECT OF NUTRITION UPON ORAL MICROORGANISMS.
 HOST NUTRITION AND PLAQUE BIOFILM
 WOUND HEALING AND NUTRITION
 NUTRITION AND HEALING
 CONCLUSION
 REFERENCES

3. INTRODUCTION
 Nutrition defined as the science of how the body utilizes food
to meet requirements for development, growth, repair and
maintenance.
 Nutrition includes digestion, absorption, assimilation and
the actual use of nutrients by the cells of the body

4.  Lavoisier often referred to as the Father of Science of
Nutrition.
 Nutrition plays primarily a modifying role in the
progression of periodontal disease.
 However, nutrition may alter development, resistance,
and/or repair of the periodontium.

5. DEFINITIONS
 DIET: is total oral intake of substance that provides
nourishment and energy.(Nizel,1989)
 NUTRITION: is science of food and its relationship to
health. It is concerned primarily with part played by
nutrients in body growth, development and
maintenance.( WHO 1971)
 MALNUTRITION: impaired health related to nutrient or
caloric deficiency, absorption, utilization or excretion

6. CLASSIFICATION
 Nutrients: These are organic and inorganic complexes
contained in food.
 Each nutrient has specific functions in the body

7. PROTEINS
 Made up off smaller units called aminoacids.
DAILYREQUIREMENT:60-65 gms/day for adults
FUNCTIONS:
 Necessary for growth and repair of the body.
 Build up new tissues during the period of
growth or pregnancy & lactation.

8.  Required for the formation of digestive enzymes,
hormones, plasma proteins, hemoglobin and vitamins.
PROTEIN DEFICIENCY & PERIODONTAL DISEASE
 Degeneration of the connective tissue of the gingival and
periodontal ligament.
 Osteoporosis of alveolar bone.
 Retardation in the deposition of cementum.
 Delayed wound healing.

9. CARBOHYDATES
DAILY REQUIREMENT: 300-500 gm/day
FUNCTIONS
 Primary function is to provide a source of energy to
facilitate body metabolism (1200 kcal).
 Brain and nervous tissue utilize only glucose as energy
source (5 grams per hour).

10. FATS AND OILS
 Fats are solid at 20 deg c.
 Called oils if they are liquid at that temperature.

11. DAILY REQUIREMENTS: 10-20 gms/day
FUNCTIONS
 Serve as vehicle for fat soluble vitamins.
 Essential fatty acids are required for the body growth and
structural integrity
FAT AND ITS ROLE IN DISEASE
 OBESITY
 CORONARY HEART DISEASE
 CANCER
 ATHEROSCLEROSIS
 CHRONIC SWELLING OF PAROTID GLANDS due to
disturbances in lipid metabolism.

12. VITAMINS
 Vitamins may be defined as organic compounds
occurring in small quantities in natural foods which are
necessary for growth and maintenance of good health
in human beings.
 Funk et al (1912) coined the term vitamin from the
words Vital + Amine.
 1915-Mc Collum and Davis classified vitamins into fat
soluble and water soluble vitamins.

13. FUNCTIONS:
 Acts as co- enzyme.
 Regulate metabolism by releasing energy from fats,
carbohydrates.
 Involved in AA metabolism.
 Acts as catalysts.

14. FAT SOLUBLE VITAMINS

17. metabolism
Deficiency

18.  Charles F. Hildebolt 2005 - demonstrate that calcium
and vitamin D are important adjuncts to standard
treatments for preventing and treating periodontal
disease.
 Stein et al 2013 – The ability of vitamin D to stimulate
the innate response through the production of
antimicrobial peptides, such as beta defisins and
cathelicidin, would strengthen physical barriers and
make it more difficult for pathogens to breach the
epithelium.

19.  Dr. Bonnet et al 2019 - provide modest evidence
supporting a relation between low 25(OH)D
concentrations and periodontal disease as measured by
GI and LOA.
 Nithya Anand et al 2020 - The 1, 25(OH) 2D3-VDR
system plays a significant role in oral homeostasis and its
dysfunction leads to periodontal disease. Through its
effect on bone and mineral metabolism, innate immunity,
and several vitamin D receptor gene polymorphisms,
vitamin D has been reported to be associated with the
periodontal disease.

23.  Deficiency of vitamin K leads
to the lack of active
prothrombin in the
circulation.
 The result is that blood
coagulation is adversely affected.
Hypervitaminosis K
 Administration of large doses of vitamin K produces
hemolytic anemia and jaundice, particularly in infants.
 The toxic effect is due to increased breakdown of RBC.

24. Non B- complex
Vitamin C
WATER SOLUBLE VITAMINS
B-complex
Energy releasing
 Thiamine (B1)
 Riboflavin (B2)
 Niacin (B3)
 Pantothenic acid (B5)
 Pyridoxine (B6)
 Biotin (B7)
 Folic acid (B9)
 Cynacobalamine (B12)
Hemotopoietic

25. Deficiency

27. CHEILOSIS
SEBORRHEA

29. PELLAGRA (Italian: rough skin)
Skin, GIT & CNS
3D’s – Dermatitis, Diarrhoea, Dementia
Not treated 4th D – Death
Dermatitis :Inflammation of skin exposed to sunlight
Diarrhoea : Loose stools, often with blood and mucus
Dementia (Degeneration of nervous tissue) : Anxiety,
irritability, poor memory, insomnia etc
DEFICIENCY

30.  The functions of pantothenic acid are exerted
through coenzyme A or CoA
 RDA-Adults 5-10 mg/day

33.  Formerly known as anti-egg white injury factor,
vitamin B7 or vitamin H
 It directly participates as a coenzyme in the
carboxylation reactions

34.  High consumption of raw eggs. The raw egg white
contains a glycoprotein avidin, which tightly binds with
biotin and blocks its absorption from the intestine

36.  Folatedeficiency causes gingival enlargement.
 Lack and Thomson, studied the effects of supplementation
with folic acid on pregnancy gingivitis concluded that
topical folate application produces significant improvement
in gingival health compared to systemic administration and
placebo.

38. Megaloblastic anemia Babinski sign
mouth ulcers beefy red tounge
Weakness and fatigue
Pale or jaundiced skin

41.  The Importance Of Vitamin C Or Ascorbic Acid In
Periodontal Health Has Been Known Since Long.
 Vitamin C Is A Potent Antioxidant Radical Scavenger
And Is Found To Be In The Aqueous Phase Severe
Vitamin C Deficiency Leads To A Severe Periodontal
Condition Called “Scorbutic Gingivitis” Or “Scurvy,”
Which Is Characterized By Ulcerative Gingivitis And
Rapid Periodontal Pocket Formation And Attachment
Loss.
 Ascorbic Acid Is A Significant Nutrient, Showing Rapid
Intestinal Absorption.

42.  Melnick Et Al Reported That There Is An Interrelationship
Between Ascorbic Acid Deficiency And Necrotizing
Ulcerative Gingivitis
 Blignaut And Grobler Reported That Deeper Pockets
(CPITN Codes 3 And 4) Were Seen Less Frequently In
People Who Consumed Vitamin C-rich Foods.

43.  Amarasena Et Al , In An Elderly Group Of Japanese
Volunteers, Showed A Definite Negative Correlation Between
Serum Vitamin C Levels And Attachment Loss Regardless Of
Habits, Systemic Status (E.G., Diabetes), Sex, And The
Number Of Teeth Present.
 Shimabukuro et al 2015 – The regular application of
dentrifrice containing L-ascorbic acid 2 phospahte magnesium
salt, a long acting ascorbic acid derivative significantly
reduces gingival redness, gingival bleeding in gingivitis
individuals.

44. Minerals
The mineral (inorganic) elements constitute only a small
proportion of the body weight

45. Classification of Minerals

46. major characteristics of principal elements (macroelements)

47. major characteristics of trace elements (microelements)

48. Importance in periodontal health.

49. LOCAL EFFECT OF DIET ON PERIODONTAL
HEALTH
 Local effects of physical consistency of food on periodontal
health shows that firm fibrous food are beneficial to
periodontal health and soft, sticky food have adverse
effect.

50.  Vigorous masticatory function is associated with a
widening of the PDL.
(Collidge1937)
 Aukeset al(1987) suggest that chewing pattern depends
on the texture of the masticated food, hard and tough food
requiring more vertical movements and soft food requiring
less vertical movement.

51.  Nutrients interact with immune cells in the blood streams,
lymph nodes and specialized immune system of the
gastrointestinal tract.
 Majority of nutrient deficiencies will impair the immune
response and predispose the individual to infection.
INTERACTION OF IMMUNITY, INFECTION &
NUTRITIONAL STATUS

52.  Individuals who are undernourished have impaired immune
response including abnormality in adaptive immunity ,
phagocytosis and antibody function.
 Epidemiological and clinical data also suggests that
nutritional deficiencies alter immune responses and increase
the risk of infection.

53. Vitamin A
- Cellular differentiation-immune cell and proliferation
response to antigens
- Antibody production
Vitamin E
- Antioxidant
- Antibody synthesis
- Lymphocytes
Vitamin C
- Neutrophils and macrophages
- Antibody response
- T cell activity

54. NUTRITION AND PERIODONTAL HEALTH
INTERRELATIONSHIP
Periodontal destruction is a consequence of infection and a
nutritional deficiency alone is no longer believed to initiate
periodontal disease, it is more likely, that a state of malnutrition
will predispose a subject to onset of a periodontal infection, or
will modify the rate of progression of established disease.
(Glickman 1964, Ferguson 1969)

55. Food and nutrition affect periodontal health at 3 levels:
 Contributing to microbial growth in gingival crevice
 Affecting the immunological response to bacterial antigen
 Assisting in the repair of connective tissue at the local site
after injury from plaque calculus and so forth

56. NUTRITION AND EPITHELIAL BARRIER
 Rapid rate of turn over of epithelial cells of gingival sulcus
indicates the need of continuous synthesis of DNA, RNA and
tissue protein.
 This indicates that sulcularepithelium has high requirement
of such nutrients as folic acid and protein which are involved
in cell formation.
 At the base of the sulcularepithelium is a narrow basement
membrane made up of collagen.

57.  Since collagen is the major component of basement
membrane and ascorbic acid and zinc are important for
collagen synthesis.
 This membrane act as a barrier for entrance of toxic
material.

58. EFFECT OF NUTRITION UPON ORAL
MICROORGANISMS.
 Although dietary intake is generally thought of in terms of
sustaining the individual it also source of bacterial nutrients.
Composition of the diet may influence the relative distribution
of types of microorganism their metabolic activity, their
pathogenic potential which in turn affects the occurrence and
severity of oral disease. (Morhant & Fitzgerald 1976)

59. HOST NUTRITION AND PLAQUE BIOFILM
Nutrition has both direct and indirect effects on development and composition of plaque biofilm
The biofilmis made up primarily of microorganisms that include bacteria. Fungi, yeasts. and viruses
In addition, 20 to 3O% of the plaque mass is made up of intracellular matrix consisting of organic and inorganic
components
The organic components include polysaccharides, proteins, glycoproteinsand lipids.
Inorganic components are primarily calcium and phosphorus with trace amounts of sodium, potassium and fluoride

60. The early bacteria colonizing the dental pellicle are aerobic, gram-positive and primarily use sugars as an energy
source
The secondary colonizers of the more mature plaque biofilm are anaerobic, gram negative bacteria and use amino
acids and small peptides as energy sources
The primary mechanism by which nutrition impacts the biofilm is through a direct supply or specific nutrients (such
as sucrose) as substrates for energy, nitrogen, or carbon for the bacteria.
An example of this is the introduction of excess glucose to a plaque biofilm which has been shown to result in an
increased rate of bacterial growth in the early stages of biofilm development

61. WOUND HEALING AND NUTRITION
 The nutrition status of the patient affects wound healing
 Wound healing requires energy.
 Protein serves as energy source, its primary purpose is
cellular proliferation.
 Einhorn TA (1990) demonstrated that proteins were
important in bone repair.
 Patients who are severely malnourished demonstrate
delayed wound healing (there was delayed angiogensis and
impaired wound contraction).

62. Vitamins and minerals are also important in wound
healing
Vitamin A
- Essential for epithelialization
- Collagen synthesis
- Fibroblast differentiation
Vitamin C
- Cofactor in the hydroxylation of lysine and proline in
collagen synthesis
- Reports suggest that preoperative administration
promotes healing

63. Vitamin D and Calcium- essential for healing of hard
tissue
A deficiency can contribute to poor healing of hard tissue
or poor fracture repair
Vitamin E -Is a lipid soluble antioxidant
Antioxidants are thought to reduce damage from free
oxygen radicals that are reduced during wound healing.
Vitamin K
Is important in the activation of several clotting factors

64. Nutrition and aging
 Reduction in mastication efficiency in aged individual is
likely to be the result of unreplaced missing teeth, loose
teeth, poorly fitting dentures.
 Reduced masticatory efficiency leads to poor chewing
habits and the possibility of associated digestive
disturbances.
 Avitaminosis is relatively common in aged persons.

65.  Most nutrient requirements of older persons are similar to
those of younger people.
 An adequate intake of vitamins, calcium, iron, may be
advisable.
 A diet high in fiber and vitamins and comparatively low in
fat may also be beneficial.

66. CONCLUSION
 A well balanced diet is required for the normal growth and
development of an individual. Any increase or decrease of
the nutrients in the long run may lead to devastating
situations.
 There are nutritional deficiencies that produce changes in
the oral cavity. But, there are no nutritional deficiencies
that by themselves will cause these changes.
 They can only affect the condition of the periodontium and
thereby aggravate the injurious effects of local factors and
excessive occlusal forces.

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2005;100:688-692
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