Role of vitamins in orthodontics final /certified fixed orthodontic courses by Indian dental academy


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Role of vitamins in orthodontics final /certified fixed orthodontic courses by Indian dental academy

  1. 1. ROLE OF VITAMINS IN ORTHODONTICS INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2. Nutrition       Nutrition is the science of food and its relationship to health. The nutritional sciences deal with the nature and distribution of nutrients in food, their metabolic effects, and the consequences of inadequate food intake. Nutrients are chemical compounds in foods that are absorbed and used to promote health. Some nutrients are essential because they cannot be synthesized by the body and thus must be derived from the diet. Essential nutrients include vitamins, minerals, amino acids, fatty acids, and some carbohydrates as a source of energy. Nonessential nutrients are those that the body can synthesize from other compounds, although they may also be derived from the diet. Nutrients are generally divided into macronutrients and micronutrients.
  3. 3. Macronutrients :They constitute the bulk of the diet and supply energy as well as essential nutrients needed for growth, maintenance, and activity. Carbohydrates, fats (including essential fatty acids), proteins, and water are macronutrients. Vitamins, which are classified as water-or fat-soluble, and trace minerals are micronutrients Essential trace minerals include iron, iodine, fluorine, zinc, chromium, selenium, manganese, molybdenum, and copper. Except for fluorine and chromium, each of these minerals is incorporated into enzymes or hormones required in metabolism. Nutritional Requirements The objective of a proper diet is to achieve and maintain a desirable body composition and a high potential for physical and mental work. The daily dietary requirements for essential nutrients, including energy sources, depend on age, sex, height, weight, and metabolic and physical activity.
  4. 4. VITAMINS Vitamins are organic nutrients that are required in small quantities for a variety of biochemical functions and which generally cannot be synthesized by the body and therefore be supplied by the diet. Vitamins are not related chemically, but are considered as a group because of the similarity in their functions. Vitamins being accessory food factors, are essential for metabolic reactions and form coenzymes to many enzyme systems.
  5. 5. The vitamins are named one after another as they were discovered as A,B,C,D and so on, and each one of them has a different chemical nature. The nature of solubility was made use of, in classifying them into two groups. They are as follows vitamins Fat soluble Vitamin A Vitamin D Vitamin E Vitamin K B12) water soluble non B-complex Vitamin C vitamin B-complex energy releasing Thiamin B1 Riboflavin B2 Niacin B3 Pyridoxine B6 Biotin B7 Pantothenic acid  hematopoitic Folic acid Cyanocobalamin (vitamin
  6. 6. Vitamin A          The fat soluble vitamin A is present only in foods of animal origin, however its provitamins carotenes are found in plants. Dietary sources: animal sources contain preformed vitamin A, like liver, kidney, egg yolk, milk, cheese, butter, fish (cod or shark) liver oils. Vegetable sources contain provitamin A-carotenes. Yellow and dark green vegetables and fruits are good sources e.g. carrots, spinach, amaranthus, pumpkins, papaya, mango etc Biochemical functions: Vitamin A is necessary for a variety of functions like vision, proper growth and differentiation, reproduction and maintenance of epithelial cells. Carotenoids function as antioxidants and reduce the risk of cancers initiated by the free radicals and strong oxidants.
  7. 7. Recommended dietary requirement Adults-750ug,  Infants and young children- 300ug,  Women during pregnancy and lactation- 1200ug Deficiency manifestations: they are mainly related to the eyes, skin and growth  Effect on eyes: night blindness (nyctalopia), xeropthalmia, keratomalacia  On growth: retardation due to impairment in skeletal formation  On reproduction: degeneration of germinal epithelium leads to : sterility in males, termination of pregnancy due to fetal death  On skin and epithelial cells: keratinization of epithelial cells. Hypervitaminosis A: Excessive consumption of vitamin A leads to toxicity. Symptoms include dermatitis, hepatomegaly, skeletal decalcification, tenderness of long bones and joints, loss of weight etc. ingestion of high quantities of vitamin A by pregnant women induces risk of congenital malformations in the developing fetus 
  8. 8. Vitamin D Vitamin D is a fat soluble vitamin resembling sterols in structure and functions like a hormone Sources : include fatty fish, fish liver oils, egg yolk etc, by irradiating foods (yeast) that contains precursors of vitamin D, and natural sunlight.  Recommended daily requirement:  Vitamin D is required for proper growth of the skeleton, recommended doses are  Infants: 400 to 800 IU daily  Children and adolescents: 400 IU daily  During pregnancy and lactation: 400 to 800 IU daily Biochemical functions: ergocalciferol and cholecalciferol are the sources of vitamin D activity and are referred to as provitamins. The biologically active form is calcitriol. Calcitriol regulates the plasma calcium levels of calcium and phosphate. It acts on intestine, bone and kidney to maintain calcium levels. 
  9. 9. Deficiency manifestations:   Results in demineralization of bone . The result is rickets in children and osteomalacia in adults. Rickets in children is characterized by bone deformities due to incomplete mineralization resulting in soft and pliable bones and delay in teeth formation. In osteomalacia demineralization of bone occurs making them susceptible to fracture. Hypervitaminosis D: toxic effects of hypervitaminosis include demineralization of bone (resorption) and increased calcium absorption from the intestine, leading to hypercalcemia. Prolonged hypercalcemia leads to deposition of calcium in the soft tissues such as kidneys, blood vessels, forming renal calculi (stones). High consumption of vitamin D is associated with loss of appetite, nausea, increased thirst, loss of weight etc.
  10. 10.         Vitamin E (Tocopherols) This is a naturally occurring antioxidant essential for normal reproduction and hence known s ‘anti sterility vitamin’. Sources : occur abundantly in plants. All green plants, especially lettuce and Alfa alfa are rich sources. vegetable oils like wheat germ oil and seed germ oil, milk, eggs and meat are also good sources. Biochemical functions: vitamin E prevents the non enzymatic oxidation of various cell components by molecular oxygen and free radicals such as super oxide (O2-) and hydrogen peroxide (H2O2). Recommended requirement: 20-25mg . Deficiency manifestations: associated with sterility, degenerative changes in the muscle, megaloblastic anemia and changes in the central nervous system.
  11. 11. Vitamin K This is the only fat soluble vitamin with a specific coenzyme function. It is required for the production of blood clotting factors, hence essential in coagulation. Sources: cabbage, cauliflower, tomatoes, Alfa alfa, spinach and other green vegetables are good sources. It is also present in egg yolk, meat, liver, cheese and dairy products. Biochemical functions: concerned with the blood clotting process. It brings about post-translational modification of certain blood clotting factors. Deficiency manifestations: leads to the lack of active prothrombin in the circulation, adversely affecting the blood coagulation. The blood clotting time is increased. Hypervitaminosis K: administration of large doses produces hemolytic anemia and jaundice particularly in infants. The toxic effect is due to increased breakdown of RBC. 
  12. 12. Vitamin C (Ascorbic acid) This is a water soluble vitamin playing an important role in human health and disease. Sources: in plants abundantly seen in citrus fruits, berries, melons, sprouting seeds, leafy vegetables, spinach, cauliflower, cabbage, tomatoes, drumstick and guava. In animals present in liver, kidneys and adrenal cortex. Recommended requirement: 75-100 mg per day. Biochemical functions: most important function of vitamin C is its property to undergo reversible oxidation.  Vitamin C plays an important role in collagen formation, acting as a coenzyme, thereby facilitating cross linkage of collagen fibers and increases its strength.  Helps in bone formation, plays a role in iron and hemoglobin metabolism, takes part in the metabolic reactions of tryptophan, tyrosine, folic acid and cholesterol, enhances the synthesis of 
  13. 13. Immunoglobulins and increases their phagocytic action and also acts as a strong biological antioxidant. Deficiency manifestations.: leads to scurvy, characterized by spongy and sore gums, loose teeth, swollen joints, anemia, fragile blood vessels, delayed wound healing, hemorrhage, osteoporosis etc. Hypervitaminosis C : mega doses of vitamin C are used in common cold, wound healing trauma etc. as an antioxidant, ascorbic acid certainly provides health benefits. However, the potential toxic effects of mega doses of vitamin C cannot be ignored. Ascorbic acid, as such, is not toxic. But, dehydroascorbic acid (oxidized form of ascorbic acid) is toxic. Further, oxalate is a major metabolite of vitamin C. oxalates have been implicated in the formation of kidney stones.
  14. 14. Vitamin B-complex B-complex group of vitamins comprise a large number of water soluble vitamins which are nutritional essentials for all forms of life, from the lowest form of yeast and bacteria to the highest form, the man. Apart from being important nutritionally, they form essential co enzymes to certain important intracellular enzyme systems. There are about individual components, most of them are synthesized by the microbial flora. Components of vitamin B complex are:1.Thiamine 2.Riboflavin 3. Niacin 4.Pyridoxine 5.Pantothenic acid 6.Biotin 7.Folic acid group 8.cyanocobalamin
  15. 15. Vitamin B1- Thiamin (anti beriberi, antineuritic vitamin) Free thiamin is basic and is heat stable. It has a specific coenzyme, thiamine pyrophosphate (TPP), which is mostly associated with carbohydrate metabolism. Dietary sources: cereals, pulses, oil seeds, nut and yeast are good sources. Thiamine is mostly concentrated in the outer layer (bran) of cereals. Also present in animal foods like pork, liver heart, kidney, milk, etc Biochemical functions: The enzyme thiamine pyrophosphate or cocarboxylase is intimately connected with the energy releasing reactions in the carbohydrate metabolism. TPP also plays an important role in the transmission of nerve impulse. This is because TPP is required for acetylcholine synthesis and the ion translocation of neural tissue. Recommended requirements: for an average man who takes 3000 calories of food 1.5mg of thiamine is recommended.
  16. 16. Deficiency manifestations : The deficiency of vitamin B1 results in a condition called beriberi. The early symptoms of thiamine deficiency are loss of appetite (anorexia), weakness, constipation, nausea, mental depression, peripheral neuropathy, irritability etc. In adults, two types of beriberi, namely wet and dry beriberi occur. Infantile type of beriberi is also seen. Wet beriberi is characterized by cardiovascular manifestations including edema of legs, face, trunk and serous cavities, with breathlessness and palpitations, along with increase in systolic and decrease in diastolic blood pressure. Dry beriberi is associated with neurological manifestations resulting in peripheral neuritis, with progressive weakening in muscles resulting in difficulty to walk. Infantile beriberi: seen in infants born to mothers suffering from thiamine deficiency, characterized by sleeplessness, restlessness, vomiting, convulsions and bouts of screaming, these are due to cardiac dilatation.
  17. 17. Riboflavin (vitamin B2) Riboflavin through its coenzymes Flavin mononucleotide (FMN) and Flavin adenine dinucleotide (FAD) takes part in a variety of cellular oxidation-reduction reactions. Enzymes that use flavin coenzymes are called flavoproteins, many flavoproteins contain metal atoms and hence known as metalloflavoproteins. Recommended requirement: for adults- 1.5-1.8 mg. Pregnant and lactating women and children require 2.0-2.5 mg daily. Dietary sources: milk and milk products, meat, eggs, liver, kidney are rich sources. Cereals, fruits, vegetables and fish are moderate sources. Deficiency symptoms: includes cheilosis, glossitis, and dermatitis. Riboflavin deficiency as such is uncommon, it is seen along with other vitamin deficiencies. Chronic alcoholics are more susceptible to this vitamin deficiency.
  18. 18. Niacin ( nicotinic acid) Also known as the pellagra preventive factor of Goldberg. The coenzymes of niacin are synthesized by the essential amino acid, tryptophan. These coenzymes NAD+ and NADP+ are involved in a variety of oxidation-reduction reactions. Recommended daily requirement: for adults it is 17 to 21 mg. Increased amounts are required during adolescence, pregnancy and lactation. Dietary sources: the rich natural sources of niacin include liver, yeast, whole grains, pulses like beans and peanuts. Milk, fish, eggs and vegetables are moderate sources. The essential amino acid tryptophan can serve as a precursor for the synthesis of nicotinamide coenzymes.
  19. 19. Deficiency manifestations: niacin deficiency results in a condition called as pellagra. The disease pellagra involves skin, gastrointestinal tract and central nervous system. Symptoms are commonly referred to as three D’s. the disease also progresses in the order dermatitis, diarrhea, dementia, and if not treated may rarely lead to death (4th D). The symptoms of dementia include anxiety, irritability, poor memory, insomnia etc. Therapeutic uses: administration of niacin in pharmacological doses results in a number of biochemical effects in the body. These are believed to be due to the influence of niacin on cyclic AMP levels.
  20. 20. Pyridoxine (vitamin B6) Vitamin B6 is sued to collectively represent the three compounds namely pyridoxine, pyridoxal and pyridoxamine. The active form of vitamin B6 is the coenzyme pyridoxal phosphate (PLP). PLP is closely associated with the metabolism of amino acids. The synthesis of certain specialized products like serotonin, histamine, niacin coenzymes from amino acids are dependent on pyridoxine. PLP participates in reactions like transamination, decarboxylation, deamination, transsulfuration, condensation etc. Recommended daily requirement: for an adult 2-2.2 mg/day. During pregnancy, lactation and old age an intake of 2.5mg/day is recommended. Dietary sources: animal sources such as egg yolk, fish, milk, meat are rich in B6. wheat, corn, cabbage, roots and tubers are good vegetable sources.
  21. 21. Deficiency symptoms: pyridoxine deficiency is associated with neurological symptoms such as depression, irritability, nervousness and mental confusion. Convulsions and peripheral neuropathy are observed in severe deficiency. These symptoms are related to the decrease in the synthesis of biogenic amines like serotonin, nor epinephrine and epinephrine. Demyelination of neurons is also observed. Decrease in hemoglobin levels, associated with hypochromic microcytic anemia, is seen in B6 deficiency, this is due to the decrease in heme production.
  22. 22. Biotin Biotin, also called as anti-egg white injury factor, vitamin B7 or vitamin H, is a sulfur containing B-complex vitamin. Biotin acts as a carrier of CO2 in carboxylation reactions. Dietary sources: biotin is widely distributed in both animal and plant foods. The rich sources are liver, kidney, egg yolk, milk, tomatoes, grains, etc. Recommended daily requirement: 100-300 mg for adults, but this vitamin is abundantly synthesized by the intestinal bacteria. Deficiency symptoms: symptoms include anemia, loss of appetite, nausea, dermatitis, glossitis etc. biotin deficiency is not common since it is well distributed in foods and also supplied by the intestinal bacteria.
  23. 23. Pantothenic acid Pantothenic acid, also known as chick anti-dermatitis factor or filtrate factor, is widely distributed in nature. The functions of pantothenic acid are exerted through coenzyme A or CoA. CoA is the central molecule involved in all the metabolisms (carbohydrate, lipid and protein), acting as the carrier of activated acetyl or acyl groups. Recommended dietary requirement: 5-10 mg for adults. Dietary sources: widely distributed in plants and animals, rich sources are egg, liver, meat, yeast, milk etc. Deficiency symptoms: no deficiency manifestations in man
  24. 24. Folic acid Folic acid or folacin is abundantly found in green leafy vegetables. It is important for one carbon metabolism and is required for the synthesis of certain amino acids, purines and the pyrimidine-thymine. Tetrahydrofolate (THF or FH4), the coenzyme of folic acid is actively involved in the one carbon metabolism. THF serves as an acceptor or donor of carbon units in a variety of reactions involving amino acid and nucleotide metabolism. Recommended daily requirement: around 100ug. In the women, higher intakes are recommended during pregnancy (300ug/day) and lactation (150ug/day). Dietary sources: the rich sources are green leafy vegetables, whole grains, cereals, liver, kidney, yeast and eggs.
  25. 25. Deficiency symptoms :decreased production of purines and dTMP is observed which impairs DNA synthesis. Due to block in DNA synthesis, the maturation of erythrocytes is slowed down leading to macrocytic RBC leading to macrocytic anemia
  26. 26. Vitamin B12 Vitamin B12 is also known as anti-pernicious anemia vitamin and extrinsic factor of Castle. It has derived the names of cobalamine and cyanocobalamine due to the presence of cobalt and cyanide groups. B12 helps in the formation of labile methyl groups, for the synthesis of thymine and therefore for synthesis of nucleic acids, and along with folic acid for the normal hemopoisis. Dietary sources: not seen in plant foods. Animal sources are liver, kidney, eggs, milk, and meat. Deficiency symptoms: most important is pernicious anemia characterized by low hemoglobin levels, decreased number of erythrocytes and neurological manifestations.
  27. 27. Vitamin like compounds These are components present in food and act as accessory factors. They are Choline : it is trimethylhydroxy ethylammonium hydroxide. It is a component of phospholipids, acts as a lipotropic factor, takes part in one carbon metabolism and in transmission of nerve impulse. Inositol: is hexahydroxy-cyclohexane. Acts as a second messenger for the release of Ca2+ ions, as a lipotropic factor and in synthesis of phosphotidylinositol- a constituent of cell membrane
  28. 28. Bone metabolism  Orthodontists and dentofacial orthopedists manipulate bone. The biomechanical response to altered function and applied loads depends on the metabolic status of the patient.  The skeletal system is composed of highly specialized mineralized tissues that have both structural and metabolic functions. Bone modeling and remodeling are distinct physiologic responses to integrated metabolic and mechanical demands. Biomechanical manipulation of bone is the physiologic basis of orthodontics and dentofacial orthopedics.  Bone is the primary reservoir of calcium in the body. Approximately 99% of the calcium in the body is stored on the skeleton. The continual flux of bone mineral responds to a complex interaction of endocrine, biomechanical and cell-level control factors that maintain the serum calcium level at about 10 mg/dl.
  29. 29.
  30. 30. Maintaining zero calcium balance requires optimal function of the gut, parathyroid glands, bone, liver and kidney. PTH and the active metabolite of vitamin D, 1,25 dihydroxycholecalciferol (DHCC), are the major hormones involved
  31. 31. Calcium homeostasis Calcium homeostasis is the process by which mineral equilibrium is maintained. Maintenance of serum calcium levels at about 10 mg/dl is an essential life support function. When substantial calcium is needed to maintain the critical serum calcium level, bone structure is sacrifice. The alveolar processes and basilar bone of the jaws also are subject to metabolic bone loss. Calcium homeostasis is supported by three temporally related mechanisms: 1. Rapid flux of calcium from the bone fluid (occurs in seconds) 2. Short-term response by osteoclasts and osteoblasts (extends from minutes to days) and 3. Long term control of bone turnover (over weeks to months).
  32. 32. Instantaneous regulation of calcium homeostasis is accomplished in seconds by selective transfer of calcium ions into and out of bone fluid. Bone fluid is separated from extracellular fluid by osteoblasts or relatively thin bone-lining cells. A decrease in the serum calcium level stimulates secretion of PTH, which enhances transport of calcium ions from bone fluid into osteocytes and bone-lining cells. The active metabolite of vitamin D (1,25-DHCC) enhances pumping of calcium ions from bone-lining calls into the extracellular fluid. Within physiologic limits it is possible to support calcium homeostasis without resorbing bone. However, a sustained negative balance can be compensated for only by removing calcium from bone surfaces.
  33. 33.        Short term control of serum calcium levels affects rate of bone resorption and formation within minutes through the action of three calcific hormones, PTH, 1,25-DHCC and calcitonin. Calcitonin, a hormone produced by the interstitial cells of the thyroid gland, is believed to help control hypercalcemia by transiently suppressing bone resorption. PTH, acting in concert with 1,25-DHCC, accomplishes three important tasks: 1. it enhances osteoclast recruitment from promonocyte precursors, 2. it enhances the resorption rate of existing osteoclasts, and 3. it may suppress the rate at which osteoblasts form bone. Long term regulation has profound effects on the skeleton. Biomechanical factors, noncalcific hormones, and the metabolite mechanisms dictate mass, geometric distribution and the mean age of the bone.
  34. 34. Flowchart of calcium homeostasis showing the roles of PTH, vitamin D, the kidneys, gut and bone.
  35. 35. Dietary calcium recommendations Group Age mg/day Infants 0-6 months 400 6-12 months 600 1-5 years 800 6-10 years 800-1200 Adolescents and young adults 11-24 years 1200-1500 Men 25-65 years 1000 Women 25-50 years 1000 Children pregnant or lactating 1200-1500 Post menopausal Receiving estrogen replacement therapy 1000 Not receiving 1500 Men and women >65 years 1500
  36. 36. ROLE OF VITAMINS Vitamin A has a hormonal effect in the regulation of epithelial differentiation. One of the basic changes is a keratinizing metaplasia of the epithelial cells, occurring throughout the body including the oral mucous membrane and salivary glands. The teeth of animals on a vitamin A deficient diet contains less ash than the teeth of normal animals. Absence of this vitamin during the period when dental structures are formed results in disturbance in the calcification of enamel and dentin, retards tooth eruption. The alveolar bone is retarded in its rate of formation.
  37. 37.   A nutrient seldom discussed in terms of bone health is vitamin K. There is, however, an association between vitamin K insufficiency and reductions in bone density and possibly bone strength. This may be of particular concern among people taking vitamin K antagonists such as oral anticoagulants as a significant decrease in bone mineral density has been observed. The most common oral manifestation of vitamin K deficiency is gingival bleeding. Prothrombin levels below 35% will result in bleeding following tooth brushing, however, when prothrombin level fall below 20%, spontaneous gingival hemorrhages will occur.
  38. 38. The very structure of the body - the skin, bones, teeth, blood vessels, cartilage, tendons and ligaments - depends on collagen. And the integrity of collagen, in turn, depends on vitamin C. In a report on ascorbic acid in Vitamin Intake and Health, S.K. Gaby and V.N. Singh explain that collagen protein requires vitamin C for "hydroxylation," a process that allows the molecule to achieve the best configuration and prevents collagen from becoming weak and susceptible to damage. Beyond that, they say, recent evidence indicates that vitamin C increases the level of procollagen messenger RNA. "Collagen subunits are formed within fibroblasts as procollagen, which is excreted into extra cellular spaces. Vitamin C is required to export the procollagen molecules out of the cell. The final...structure of the collagen is formed after pieces of the procollagen are enzymatically cleaved," state Gaby and Singh.
  39. 39.   Type 1 - Connective tissue of skin, bone, teeth, tendons, ligaments, fascia, organ capsules Type 2 - Cartilage Without vitamin C, collagen formation is disrupted, causing a wide variety of problems throughout the body. The oral manifestations of vitamin C deficiency occur chiefly in the gingival and periodontal tissues. The interdental and marginal gingiva is swollen, bright red, with a smooth and shiny surface. In fully developed scurvy, the gingiva becomes boggy, ulcerates and bleeds. The color changes to a violaceous red.
  40. 40.     In severe chronic cases, hemorrhages and swelling of the periodontal membranes occur, followed by the loss of bone and loosening of teeth, which eventually exfoliate. Formation of intercellular cement substances in connective tissues, bones, and dentin is defective, resulting in weakened capillaries with subsequent hemorrhage and defects in bone and related structures. Hemorrhagic areas are organized avascularly, so that wounds heal poorly and break open easily. Endochondral growth ceases because osteoblasts fail to form osteoid tissue, resulting in bone lesions. Instead, a fibrous union forms between the diaphysis and the epiphysis, and costochondral junctions enlarge. Densely calcified fragments of cartilage are embedded in this fibrous tissue. Small ecchymotic hemorrhages within or along the bone or large subperiosteal hemorrhages due to small fractures just shaftward of the white line complicate these lesions.
  41. 41. Oper Dent. 2003 Nov-Dec;28 Kaya.AD, Turkun.M Reversal of dentin bonding to bleached teeth. Many studies have shown a considerable reduction in enamel bond strength of resin composite restorations when the bonding procedure is carried out immediately after bleaching. These studies claim that a certain waiting period is needed prior to restoration to reach the original bond strength values prior to bleaching. This study determined the effect of anti-oxidant applications on the bond strength values of resin composites to bleached dentin. Ninety human teeth extracted for orthodontic purposes were used in this study. The labial surface of each tooth was ground and flattened until dentin appeared. The polished surfaces were subjected to nine different treatments: 1) bleaching with gel (35% Rembrandt Virtuoso); 2) bleaching with gel + 10% sodium ascorbate (SA); 3) bleaching with gel + 10% butylhydroxyanisole (BHA); 4) bleaching with sol (35% hydrogen peroxide); 5) bleaching with sol + 10% sodium ascorbate; 6) bleaching with sol + 10% BHA; 7) bleaching with gel + immersed in artificial saliva for seven days; 8) bleaching with sol + immersed in artificial saliva for seven days; 9) no treatment.
  42. 42. After bonding application, the resin composite in standard dimensions was applied to all specimens. The teeth were stored in distilled water at 37 degrees C for 24 hours and a universal testing machine determined their resistance to shear bond strength. The data was evaluated using ANOVA and Duncan tests. Bond strength in the bleached dentin group significantly decreased compared to the control group. On the other hand, the antioxidant treatment had a reversal effect on the bond strength to dentin. After the bleaching treatment, the 10% sodium ascorbate application was effective in reversing bond strength. In the samples where antioxidant was applied after the bleaching process, bonding strength in dentin tissue was at the same level as those teeth kept in artificial saliva for seven days
  43. 43. •The B-complex vitamins, such as niacin, thiamin, riboflavin, folic acid, and B12, are co-factors in energy metabolism and needed in DNA and RNA synthesis. This makes them indispensable for tissue maintenance and the production of new cells during development and healing. Descriptions of vitamin B deficiencies appear as early as 2600 BC, but a majority of the reports of B vitamin deficiencies originate in the early 1900's when these conditions reached nearly epidemic proportions. Epidemiologic and experimental studies conducted in the early 1900's identified the most common symptom of B vitamin deficiencies to be the loss of the integrity of the oral mucosa. The oral manifestations of the loss of integrity include stomatitis, angular cheilitis, and glossitis.
  44. 44.  Bone growth and the quality of osseous structures are very much dependent vitamin D. In deficiency states enamel and dentin are poorly formed an eruption of teeth is delayed leading to misalignment of teeth in the jaws. In human rachitic teeth there is an abnormally wide predentin zone with much interglobular dentin. Jaw growth is retarded and the alveolar processes are bulky and poorly calcified. In addition to abnormal cementum, the lamina dura around the teeth is frequently absent or poorly defined.
  45. 45. Journal of Bone and Mineral Metabolism, 2004 Masayoshi Kawakami and Teruko Takano-Yamamoto Local injection of 1,25-dihydroxyvitamin D3 enhanced bone formation for tooth stabilization after experimental tooth movement in rats The present investigation evaluated the effect of 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) on alveolar bone formation during tooth movement in rats. Orthodontic elastics were inserted between the maxillary first and second molars on bilateral sides in male rats. 1,25(OH)2D3 was injected locally, at the concentration of 10–10 M, once every 3 days in the sub mucosal palatal area of the root bifurcation of the molar on the right side. Histomorphometric analysis revealed that tooth movement without application of 1,25(OH)2D3 decreased the mineral appositional rate (MAR) on the compression area at 7 days. Repeated injections of 1,25(OH)2D3 in the orthodontically treated animals distinctly stimulated alveolar bone formation on the mesial side at 14 days. There was a significant increase in MAR associated with elevated osteoblast surface value on the tension surface. These findings suggest that local application of 1,25(OH)2D3 enhances the reestablishment of supporting tissue, especially alveolar bone of teeth, after orthodontic treatment.
  46. 46. Department of Orthodontics, Gazi University Faculty of Dentistry, Ankara, Turkey. Kale S, Kocadereli I, Atilla P, Asan E. Comparison of the effects of 1,25, DHCC and prostaglandin E2 on orthodontic tooth movement. This study compared the effects of local administrations of prostaglandin E2 (PGE2) and 1,25-dihydroxycholecalciferol (1,25-DHCC) on orthodontic tooth movement in rats. Thirty-seven 6-week-old male Sprague-Dawley rats, weighing 160 +/- 10 g were used. Five rats served as the baseline control group. A fixed appliance system exerting 20 g of distally directed force was applied on the maxillary incisors of 32 animals for 9 days. Eight rats served as the appliance control group; 8 received a 20microL injection of dimethyl sulfoxide (solvent for 1,25-DHCC) on days 0, 3, and 6; 8 received 20 microL of 10(-10) mol/L 1,25DHCC on days 0, 3, and 6; 8 received a single injection of 0.1 mL of 0.1 microgm PGE2 only on day 0.
  47. 47. There was no significant difference in tooth movement between the PGE2 and the 1,25-DHCC groups. Both PGE2 and 1,25DHCC enhanced the amount of tooth movement significantly when compared with the control group. The numbers of Howship's lacunae and capillaries on the pressure side were significantly greater in the PGE2 group than in the 1,25-DHCC group. On the other hand, the number of osteoblasts on the external surface of the alveolar bone on the pressure side was significantly greater in the 1,25-DHCC group than in the PGE2 group. Thus, 1,25-DHCC was found to be more effective in modulating bone turnover during orthodontic tooth movement, because its effects on bone formation and bone resorption were well balanced.
  48. 48. Quintessence Int. 2001 May;32 Tyrovola JB, Spyropoulos MN Effects of drugs and systemic factors on orthodontic treatment. Orthodontic tooth movement and bone remodeling activity are dependent on systemic factors such as nutritional factors, metabolic bone diseases, age, and use of drugs. Therefore, a comprehensive review of the effects of these factors on orthodontic tooth movement is attempted in this article. Systemic hormones such as estrogen, androgen, and calcitonin are associated with an increase in bone mineral content, bone mass, and a decrease in the rate of bone resorption. Consequently, they could delay orthodontic tooth movement. On the contrary, thyroid hormones and corticosteroids might be involved in a more rapid orthodontic tooth movement during orthodontic therapy and have a less stable orthodontic result.
  49. 49. Drugs such as bisphosphonates, vitamin D metabolites, and fluorides can probably cause a reduction of tooth movement after the orthodontic force is applied. Nonsteroidal antiinflammatory drugs have also been shown to reduce bone resorption. Long-term administration of these drugs may therefore delay the necessary bone response to respective toothborne pressure and should not be administered for long periods of time to patients undergoing orthodontic tooth movement. Attention has also been focused on the effects of prostaglandins and leukotrienes in orthodontic tooth movement. It seems that they might have future clinical applications that could result in enhanced tooth movement. The use of the above drugs should be considered by every dentist in evaluating the treatment time and in planning treatment when tooth movement is attempted.
  50. 50. ASDC J Dent Child. 1997 Orthodontic treatment of a patient with hypophosphatemic vitamin D-resistant rickets. Kawakami M, Takano-Yamamoto T. Hypophosphatemic vitamin D-resistant rickets, when developed later in life, is less severe and may not be characterized by rickets or other osseous deformities. A Japanese girl, age nine years and one month, was first seen in the Dental Hospital of Osaka University, complaining of the crowding of the maxillary teeth. At one year of age, the patient was admitted to Osaka University Hospital for her leg deformities. Although the patient has been administered 4 micrograms 1 alpha/-hydroxyvitamin D3 and 1.0 g phosphorous daily, the serum phosphate has been low and never reached normal level. This case was a Class II division 2 malocclusion with severe anterior crowding and retarded mandibular growth. We treated her with a functional appliance (elastic open activator), followed by the extraction of four premolars and the use of an edgewise appliance. No unfavorable root resorption or bone defect occurred. Good occlusion was achieved and the facial features were pleasing.
  51. 51. Conclusion  Although vitamins are required in minute quantities, they are indispensable for maintaining the integrity and proper functioning of various body systems. Though the clinical applications of vitamins, as far as the branch of orthodontics is concerned, is limited in the present day situation, there may be a time when injection or application of vitamin solutions may itself help in faster tooth movement, helps faster bone formation after the desired movement is achieved. Research is yet to take place in this area.
  52. 52. References 1.Essentials of biochemistry – Harper. 2.R.W.Strang – Text book of Orthodontics 3.Graber and vanarsdall – Orthodontic principles and practice, 4. Quintessence Int. 2001 5. Journal of Bone and Mineral Metabolism, 2004 6. Oper Dent. 2003 7.Textbook of medical physiology by Guyton and Hall. 8.J.A.Salzmann – orthodontic practice and techniques
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