Nutrition

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Nutrition

  1. 1. USC/RKH AEGD PROGRAM Oral Health & Nutrition Prepared & Presented By Dr. Mohammed Al-Shehri Class 2004
  2. 2. Rationale <ul><li>Oral infectious diseases, as well as acute, chronic, and terminal systemic disease with oral manifestations, affect diet and nutritional status. </li></ul><ul><li>Nutrition and diet may affect the development and progression of diseases of the oral cavity. </li></ul>
  3. 3. Nutrition as a component of dental practice <ul><li>Dental practitioners like other health providers, should provide nutrition as a component of comprehensive care; examining nutrition risk and providing diet education relative to oral health fits within that comprehensive provider role. </li></ul>
  4. 4. Conditions associated with compromised nutritional and oral health status <ul><li>Polypharmacy </li></ul><ul><li>Menopause </li></ul><ul><li>Major surgery </li></ul><ul><li>Poor dentition/edentulism </li></ul><ul><li>Craniofacial anomalies </li></ul><ul><li>Disorders of taste and smell </li></ul><ul><li>Salivary dysfunction </li></ul><ul><li>Physical/mental handicaps </li></ul>
  5. 5. Conditions associated with compromised nutritional and oral health status <ul><li>Immunocompromising conditions (e.g., cancer, HIV infection, AIDS) </li></ul><ul><li>Cancer therapy </li></ul><ul><li>Specific disease status: </li></ul><ul><ul><li>Autoimmune diseases </li></ul></ul><ul><ul><li>Protein-energy malnutrition/wasting </li></ul></ul><ul><ul><li>Infectious diseases </li></ul></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><li>End-stage renal disease </li></ul></ul><ul><ul><li>Cardiovascular disease </li></ul></ul>
  6. 6. Conditions associated with compromised nutritional and oral health status <ul><li>Specific disease status cont.: </li></ul><ul><ul><li>Substance abuse (alcohol and/or drugs) </li></ul></ul><ul><ul><li>Anemia </li></ul></ul><ul><ul><li>Developmental disorders </li></ul></ul><ul><ul><li>Gastrointestinal disorders </li></ul></ul><ul><ul><li>Osteoporosis </li></ul></ul><ul><ul><li>Hypertension </li></ul></ul><ul><ul><li>Eating disorders </li></ul></ul><ul><ul><li>Musculoskeletal </li></ul></ul>
  7. 7. Dental caries & nutrition <ul><li>For many years, the primary focus of oral health was the prevention of dental caries with an emphasis on dietary influences on caries formation. </li></ul><ul><li>Today prevention focuses on fluoride, the use of sealants, frequency of eating and good oral hygiene. </li></ul>
  8. 8. Periodontal health & nutrition <ul><li>The Periodontal health relies on equal balance between the host, environmental, and bacterial factors.* </li></ul><ul><li>The primary etiology of periodontal disease is bacterial (plaque biofilm), but a susceptible host response is also necessary for disease initiation.** </li></ul><ul><li>Nutrition is one of the modifiable factors that impact the host's immune response and the integrity of hard and soft tissues of the oral cavity.* </li></ul>
  9. 9. Integrity of the Oral Mucosa <ul><li>The soft tissues of the oral cavity are made up of epithelial cells that have rapid rates of replication, metabolism, and maturation which require a steady supply of essential nutrients. </li></ul><ul><li>Typically these cells turnover every three to seven days, which makes the tissues of the oral cavity a sensitive indicator of adequate nutritional status. </li></ul>
  10. 10. Overview of nutrient effects on the periodontium <ul><li>Protein : </li></ul><ul><ul><li>Important in DNA and RNA replication, transcription of RNA and the translation of proteins necessary for new cell growth. </li></ul></ul><ul><ul><li>Protein deficiency : </li></ul></ul><ul><ul><ul><li>may be associated with changes in the connective tissue that result in altered growth and wound healing, but studies of these effects are difficult due to the &quot;long half-life of connective tissue proteins and the extracellular nature of events”. </li></ul></ul></ul>
  11. 11. Overview of nutrient effects on the periodontium <ul><ul><li>Protein deficiency cont. : </li></ul></ul><ul><ul><ul><li>Mild protein malnutrition has been shown to reduce the effectiveness of the inflammatory response to invading pathogens. </li></ul></ul></ul><ul><ul><ul><li>Kwashiorkor “a form of Protein-energy malnutrition symptoms include edema, immune deficiency …“ </li></ul></ul></ul><ul><ul><ul><li>Protein-energy malnutrition present in wasting-type conditions such as cancer, AIDS, and rheumatoid arthritis; so patients with these conditions may have an impaired immune response. </li></ul></ul></ul><ul><ul><ul><li>Compromised antibacterial properties of saliva. </li></ul></ul></ul>
  12. 12. Overview of nutrient effects on the periodontium <ul><ul><li>Groups at risk of inadequate intake : </li></ul></ul><ul><ul><ul><li>Poorly controlled diabetics. </li></ul></ul></ul><ul><ul><ul><li>Advanced cancer. </li></ul></ul></ul><ul><ul><ul><li>Advanced AIDS. </li></ul></ul></ul><ul><ul><ul><li>Patient fasting > 4 days. </li></ul></ul></ul><ul><ul><ul><li>Chronic poor nutrient intake. </li></ul></ul></ul><ul><ul><ul><li>Elderly. </li></ul></ul></ul>
  13. 13. Overview of nutrient effects on the periodontium <ul><li>Vitamin A : </li></ul><ul><ul><li>Important in DNA and RNA replication, transcription of RNA and the translation of proteins necessary for new cell growth. </li></ul></ul><ul><ul><li>Antioxidant that impact the immune response. </li></ul></ul><ul><ul><li>Involved in collagen metabolism by affecting cell differentiation. </li></ul></ul><ul><ul><li>Production of gamma interferon. </li></ul></ul>
  14. 14. Overview of nutrient effects on the periodontium <ul><ul><li>Vitamin A deficiency : </li></ul></ul><ul><ul><ul><li>Decrease in the rate of proliferation of epithelial cells. </li></ul></ul></ul><ul><ul><ul><li>Affect bone formation. </li></ul></ul></ul><ul><ul><li>Groups at risk of inadequate intake : </li></ul></ul><ul><ul><ul><li>Cystic fibrosis. </li></ul></ul></ul><ul><ul><ul><li>Advanced AIDS. </li></ul></ul></ul>
  15. 15. Overview of nutrient effects on the periodontium <ul><li>Vitamin B : </li></ul><ul><ul><li>Important in tissue maintenance and the production of new cells during development and healing. </li></ul></ul><ul><ul><li>Vitamin B deficiency : </li></ul></ul><ul><ul><ul><li>Breakdown of the mucosal barrier to pathogens. </li></ul></ul></ul><ul><ul><ul><li>Loss of integrity of the oral mucosa “ stomatitis, angular cheilitis and glossitis ”. </li></ul></ul></ul><ul><ul><ul><li>Inability to produce adequate energy. </li></ul></ul></ul><ul><ul><ul><li>Affect protein synthesis including DNA and RNA. </li></ul></ul></ul>
  16. 16. Overview of nutrient effects on the periodontium <ul><ul><li>Groups at risk of inadequate intake : </li></ul></ul><ul><ul><ul><li>HIV. </li></ul></ul></ul><ul><ul><ul><li>Elderly. </li></ul></ul></ul><ul><ul><ul><li>Vegans “Vitamin B 12 ”. </li></ul></ul></ul><ul><ul><ul><li>Gastrectomy. </li></ul></ul></ul><ul><ul><ul><li>Patient on medications : H 2 blockers, phenytoin and methotrexate. </li></ul></ul></ul><ul><ul><ul><li>Alcoholics. </li></ul></ul></ul>
  17. 17. Overview of nutrient effects on the periodontium <ul><li>Vitamin C : </li></ul><ul><ul><li>Antioxidant that impact the immune response. </li></ul></ul><ul><ul><li>Maintaining integrity of oral mucosa. </li></ul></ul><ul><ul><li>Affect bone formation. </li></ul></ul><ul><ul><li>Vitamin C deficiency : </li></ul></ul><ul><ul><ul><li>Scurvy “ swollen & inflamed gingiva, loosening of the teeth, hemorrhage, weakness, malaise, sore joints, bruising and weight loss ”. </li></ul></ul></ul><ul><ul><ul><li>Conditioning factor in the development of gingivitis. </li></ul></ul></ul><ul><ul><ul><li>Breakdown of the mucosal barrier to pathogens. </li></ul></ul></ul><ul><ul><ul><li>Affect neutrophill function. </li></ul></ul></ul>
  18. 18. Overview of nutrient effects on the periodontium <ul><ul><li>Groups at risk of inadequate intake : </li></ul></ul><ul><ul><ul><li>Smokers. </li></ul></ul></ul><ul><ul><ul><li>Elderly. </li></ul></ul></ul><ul><ul><ul><li>Chronic disease. </li></ul></ul></ul>
  19. 19. Overview of nutrient effects on the periodontium <ul><li>Vitamin D : </li></ul><ul><ul><li>Regulate absorption of calcium. </li></ul></ul><ul><ul><li>Collagen synthesis and accumulation of mineralized bone are dependent on adequate levels of vit. D and calcium. </li></ul></ul><ul><ul><li>Vitamin D deficiency : </li></ul></ul><ul><ul><ul><li>Stimulates osteoclasts to help mobilize the calcium stored in bone. </li></ul></ul></ul>
  20. 20. Overview of nutrient effects on the periodontium <ul><ul><li>Groups at risk of inadequate intake : </li></ul></ul><ul><ul><ul><li>Elderly. </li></ul></ul></ul><ul><ul><ul><li>Those with little sun exposure. </li></ul></ul></ul>
  21. 21. Overview of nutrient effects on the periodontium <ul><li>Vitamin E : </li></ul><ul><ul><li>Antioxidant that impact the immune response. </li></ul></ul><ul><ul><li>Improve cellular immune function. </li></ul></ul><ul><ul><li>Vitamin E deficiency : </li></ul></ul><ul><ul><ul><li>Affect overall immune response. </li></ul></ul></ul><ul><ul><ul><li>Affect antibody production. </li></ul></ul></ul><ul><ul><li>Groups at risk of inadequate intake : </li></ul></ul><ul><ul><ul><li>GI conditions with malabsorption. </li></ul></ul></ul><ul><ul><ul><li>Advanced AIDS. </li></ul></ul></ul>
  22. 22. Overview of nutrient effects on the periodontium <ul><li>Vitamin K : </li></ul><ul><ul><li>Affect bone formation and bone health. </li></ul></ul><ul><ul><li>Vitamin K deficiency : </li></ul></ul><ul><ul><ul><li>Reduce bone density and possibly bone strength. </li></ul></ul></ul><ul><ul><li>Groups at risk of inadequate intake : </li></ul></ul><ul><ul><ul><li>Anticoagulant therapy. </li></ul></ul></ul>
  23. 23. Overview of nutrient effects on the periodontium <ul><li>Calcium : </li></ul><ul><ul><li>Affect bone formation. </li></ul></ul><ul><ul><li>Involved in calcified tissue. </li></ul></ul><ul><ul><li>Calcium deficiency : </li></ul></ul><ul><ul><ul><li>Inadequate formation of peak bone mass. </li></ul></ul></ul><ul><ul><ul><li>Accelerated bone loss postmenopausally. </li></ul></ul></ul><ul><ul><ul><li>Osteoporosis. </li></ul></ul></ul><ul><ul><li>Groups at risk of inadequate intake : </li></ul></ul><ul><ul><ul><li>Postmenopausal. </li></ul></ul></ul>
  24. 24. Overview of nutrient effects on the periodontium <ul><li>Copper : </li></ul><ul><ul><li>Important participant in collagen metabolism and wound healing. </li></ul></ul><ul><ul><li>Essential for the cross-linking of both collagen and elastin. </li></ul></ul><ul><ul><li>Involved in calcified tissue. </li></ul></ul><ul><ul><li>Antioxidant that impact the immune response </li></ul></ul><ul><ul><li>Copper deficiency : </li></ul></ul><ul><ul><ul><li>Reduce tensile strength of collagen. </li></ul></ul></ul><ul><ul><ul><li>Bone fragility. </li></ul></ul></ul>
  25. 25. Overview of nutrient effects on the periodontium <ul><ul><li>Copper deficiency : </li></ul></ul><ul><ul><ul><li>Osteoporotic-like bone lesions. </li></ul></ul></ul><ul><ul><ul><li>Affect proliferation of neutrophils. </li></ul></ul></ul><ul><ul><li>Groups at risk of inadequate intake : </li></ul></ul><ul><ul><ul><li>Intake of antacids. </li></ul></ul></ul><ul><ul><ul><li>Alcohol abuse. </li></ul></ul></ul><ul><ul><ul><li>Cystic fibrosis. </li></ul></ul></ul>
  26. 26. Overview of nutrient effects on the periodontium <ul><ul><li>Groups at risk of inadequate intake : </li></ul></ul><ul><ul><ul><li>Postmenopausal. </li></ul></ul></ul><ul><ul><ul><li>Patient on medications : Dexamethasone and penicillamine. </li></ul></ul></ul>
  27. 27. Overview of nutrient effects on the periodontium <ul><li>Iron : </li></ul><ul><ul><li>Important for optimum wound healing. </li></ul></ul><ul><ul><li>Antioxidant that impact the immune response </li></ul></ul><ul><ul><li>Iron deficiency : </li></ul></ul><ul><ul><ul><li>Affect neutrophil phagocytic activity. </li></ul></ul></ul><ul><ul><ul><li>Affect proliferation of lymphocytes. </li></ul></ul></ul><ul><ul><li>Groups at risk of inadequate intake : </li></ul></ul><ul><ul><ul><li>Young children. </li></ul></ul></ul>
  28. 28. Overview of nutrient effects on the periodontium <ul><li>Magnesium : </li></ul><ul><ul><li>Important participant in collagen metabolism and wound healing. </li></ul></ul><ul><ul><li>Involved in calcified tissue. </li></ul></ul><ul><ul><li>Affect bone formation. </li></ul></ul><ul><ul><li>Magnesium deficiency : </li></ul></ul><ul><ul><ul><li>More rapid development of osteopenia. </li></ul></ul></ul><ul><ul><li>Groups at risk of inadequate intake : </li></ul></ul><ul><ul><ul><li>Chronic alcoholics. </li></ul></ul></ul>
  29. 29. Overview of nutrient effects on the periodontium <ul><ul><li>Groups at risk of inadequate intake : </li></ul></ul><ul><ul><ul><li>Patients on medication : Diuretics. </li></ul></ul></ul><ul><ul><ul><li>Elderly. </li></ul></ul></ul><ul><ul><ul><li>Postmenopausal women. </li></ul></ul></ul>
  30. 30. Overview of nutrient effects on the periodontium <ul><li>Selenium : </li></ul><ul><ul><li>Essential component of antioxidant enzymes. </li></ul></ul><ul><ul><li>Antioxidant that impact the immune response. </li></ul></ul><ul><ul><li>Enhance proliferation of activated T cells. </li></ul></ul><ul><ul><li>Selenium deficiency : </li></ul></ul><ul><ul><ul><li>Associated with impaired immune response. </li></ul></ul></ul><ul><ul><li>Groups at risk of inadequate intake : </li></ul></ul><ul><ul><ul><li>Viral infection. </li></ul></ul></ul>
  31. 31. Overview of nutrient effects on the periodontium <ul><li>Zinc : </li></ul><ul><ul><li>Important in DNA and RNA replication, transcription of RNA and the translation of proteins necessary for new cell growth. </li></ul></ul><ul><ul><li>Important participant in collagen metabolism and wound healing. </li></ul></ul><ul><ul><li>Affect bone formation. </li></ul></ul><ul><ul><li>Antioxidant that impact the immune response. </li></ul></ul><ul><ul><li>Important role in cell division and growth. </li></ul></ul><ul><ul><li>Needed for proper immune function. </li></ul></ul>
  32. 32. Overview of nutrient effects on the periodontium <ul><ul><li>Zinc deficiency : </li></ul></ul><ul><ul><ul><li>Thymic atrophy. </li></ul></ul></ul><ul><ul><ul><li>Reduction in lymphocytes “lymphopoiesis”. </li></ul></ul></ul><ul><ul><ul><li>Reduction in neutrophils. </li></ul></ul></ul><ul><ul><ul><li>Impaired defense. </li></ul></ul></ul><ul><ul><li>Groups at risk of inadequate intake : </li></ul></ul><ul><ul><ul><li>Elderly. </li></ul></ul></ul><ul><ul><ul><li>Alcoholics. </li></ul></ul></ul><ul><ul><ul><li>HIV. </li></ul></ul></ul><ul><ul><ul><li>Burns. </li></ul></ul></ul><ul><ul><ul><li>Severe wasting disease. </li></ul></ul></ul>
  33. 33. Recommendation <ul><li>The previous nutritional status of the patient, the nature and duration of the infection and dietary intake during recovery are all important aspects of nutrition that must be considered to improve the outcomes of periodontal treatment as well as other invasive dental procedures. </li></ul><ul><li>A nutritional assessment will help identify individuals with marginal nutritional status or poor dietary habits who will benefit from nutritional rehabilitation prior to extensive dental treatment. </li></ul>
  34. 34. Recommendation <ul><li>The Nutrition Screening Initiative is a screening tool that can be used to assist the dental practitioner in identifying those patients at nutritional risk. </li></ul><ul><li>If the patient is at high nutrition risk, referral to a registered dietitian is recommended. </li></ul>
  35. 35. Conclusion <ul><li>Dental practitioners have to expand their role not just to treat oral disease but to share with the other health professionals the responsibility for maintaining a patient total health, they must also be able to function as a partners in providing baseline comprehensive health services. </li></ul>
  36. 36. THANK YOU From time immemorial, the family unit has been a basic building block of human communities and societies.

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