Required nutrition for our body.

1. Presented by-
Dr. Sonal Kale
PG 1st
year
NUTRITION AND
ORAL HEALTH
1

2. CONTENTS
 Introduction
 Definitions
 Nutrients
 Proteins
 Carbohydrates
 Fats
 Vitamins
2

3.  Effect of nutrition on oral tissues
 Nutrition and dental caries
 Nutrition and periodontal disease
 Conclusion
 References
3

4. Introduction
 Nutrients are organic and inorganic complexes
contained in food. Each nutrient has a specific
function in body.
 For proper function, even when no major
stresses are present, every cell of each organ,
tissue system and structure has a continuing
demand for nutrients to perform its specialized
dynamic and interrelated function.
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5. Definition
 Diet is defined as the types and amounts of food
eaten daily by an individual
FDI,1994
 Food – defined as an edible substance made up
of a variety of nutrients that nourish the body
.Essentially, there are two broad categories of
food: plant and animal.
Nizel Papas
5

6. Rugg-Gunn AJ., Nunn JH. Nutrition, Diet and Oral Health. Oxford Medical Publications.P 113-239.
Nutrition -
 Nutrition can be defined as the science of how
body utilizes food to meet the requirements for
development, growth, repair and maintenance
or as the science of food and relationship to
health.
 Nutrition is concerned with the absorption and
metabolism of nutrients from dietary sources.
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7. Classification of Nutrients
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 Macro nutrients – Carbohydrates
Fats
Proteins
 Micro nutrients- Vitamins
Minerals

8. Carbohydrates
 Carbohydrates are a major source of energy in
the diet. They are divided into-
 Monosaccharides
 Oligosaccharides
 Polysaccharides
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9. Functions of carbohydrates
• Supply energy and regulates blood glucose
• Facilitate oxidation of fats and prevents ketosis
• Spare proteins
• Contribute to the body structure
• Plays a role in gastro-intestinal function
• Provide energy to the oral and intestinal bacteria
• Biological recognition process
9

10. Carbohydrates and oral health
Fermentable dietary carbohydrates play an important role in
causation of caries:
 Glucose
 Fructose
 Sucrose
These sugars are easily and rapidly fermented by cariogenic
bacteria to produce acids at or near the tooth surface &
cause dissolution of hydroxyappetite crystals followed by
dentin.
Rate of caries attack depends on the form of carbohydrate &
the frequency of intake of such carbohydrate.
10

11.  Risk of caries increases if sugar is taken repeatedly in
between the two major meals.
 Risk of caries increases greatly if the dietary sugar is
sticky in nature which can remain adhered to the tooth
surface for a long time.
 Fermentable dietary carbohydrate due to their low
molecular weight gets rapidly diffused into the plaque &
hence are easily available for fermentation.
 Following the ingestion of these sugars the pH of plaque
falls to 4.5-5 within 1-3 minutes & it takes another 10-30
minutes to return to neutrality.
11

12. On periodontium
 The carbohydrate binding of the bacterium
acts as a first step in the bacterial invasion
process of the dental pocket epithelium,
subsequently leading to damage to
periodontal tissue and tooth loss.
(Hellstrom U, Hallberg EC, Sandros J, Rydberg L, Backer AE. Carbohydrates act as receptors for
the periodontitis-associated bacterium Porphyromonas gingivalis: a study of bacterial binding to
glycolipids. Glycobiology. 2004 Jun;14(6):511-9)
12

13. Fats/lipids
 Fats or lipids are high energy yielding
nutrients-9kcal/gram.
 They are classified as –
 Unsaturated fats
 Saturated fats
 Trans fats
 Unsaturated fats are considered “good” fats
and should be a part of a healthy diet.
 High intakes of saturated fat have been
associated with rise blood cholesterol levels.
13

14. Functions of fats
 The main function of fats in the body is to
provide energy.
 Fats prevent consumption of proteins.
 Fats help in forming structural material of cells
and tissues such as the cell membrane.
 Fats also carry the fats soluble vitamins A, D,
E and K into the body and help in the
absorption of these vitamins in the intestine.
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15. Fats and oral health
 There is an evidence that dietary fats may help
prevent caries in humans.
 Consuming cheese following a sugary snack
virtually abolishes the usual fall in pH that is
associated with sugars consumption.
 Cheese stimulates salivary secretion and
increases plaque calcium concentration.
 Cows’ milk contains lactose and also calcium,
phosphorus and casein all of which are thought
to inhibit caries by inhibiting fall in pH.
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16.  Mechanism :
 Food particle will not be so readily retained.
 Fatty protective layer over plaque would
prevent fermentable sugar substrate from
being reduced to acids.
 High conc. of fatty acids may interfere with the
growth of cariogenic bacteria.
 Increased dietary fat will decrease the amount
of dietary carbohydrates necessary for organic
acid formation.
(Dennison CJ, Randolph; Diet, nutrition and dentistry)
16

17. Proteins
Protein is of prime importance to all of life-
because it is an indispensable constituents of
the cytoplasm and nuclei of all cells and serves
as building blocks for cellular membranes and
tissue structures
They are classified as-
Simple protein
Conjugated protein
Derived protein
17

18. Functions of protein
 Building, repair &replacement of body tissue.
 Function as enzyme, hormone, regulators of fluid & acid
base balance.
 Transport molecules (hemoglobin).
 Constituent of cytoplasm &nuclei of cells, serve as
building block for cell membrane and tissue structure.
 Serve as source of energy– when carbohydrate and fats
are inadequate.
18

19. Effect of protein deficiency on jaws and
teeth
 Adequate protein diet during pregnancy – significant
bone and dental development
 71% infants whose mothers poor protein diet showed
retarded bone and teeth
19

20.  Basic consideration for growth and development of oral
cavity
 If there is less essential amino acids available during
critical period of active growth, permanent structural
damage of the tissues occurs.
 Weaning is critical period, liquid and soft diet changes to
solid diet. Inadequate diet at this time – jaw and tooth
malformations
20

21. Effect of protein deficiency on dental
caries
 Protein deficient diet to animals during pre-
eruptive tooth development increase caries
susceptibility
 Causes enamel matrix defect
21

22. Effect of protein on periodontal disease
 Protein deficiency – affect activity of fibroblasts,
osteoblasts, cementoblasts
 Atrophic and degenerative changes seen
 Mineralized tissues, bone and cementum
-evidence of breakdown
22

23.  Foreign body introduced into pocket of protein
deficient animal, causes –
 Resorption of alveolar crest,
 Downgrowth of epithealial attachment
 Inflammatory exudate increased
23

24. Vitamins
 The word vitamins comes from Latin word
VITA means Life.
 These are the substances which must be
obtained by dietary means because It can not
be synthesize by human body.
 Fat soluble - Vit. A,D,E,K
 Water soluble - Vit. B complex & C
24

25. It is widely distributed in
 Animal foods- Liver ,eggs ,butter ,cheese ,fish
 Plant foods- Green leafy vegetables like
fortified foods- Vanaspati ,fortified milk
25

26. Functions
 Contributes to production of retinal pigments
 Necessary for maintenance of integrity and
normal function of the glandular and epithelial
tissues
 Supports skeletal growth
 An anti-infective
 May protect against some cancers
26

27. Vitamin A
 Fat soluble vitamin, also called as retinol.
 Promotion of the health of the oral structures-the
teeth, periodontium, and oral mucous
membrane
 Promotion of bone remodelling
 Vitamin A has been known to have beneficial
effects on immunity against infection
27

28. Oral health
Deficiency Causes-
 Night blindness
 Conjunctival xerosis
 Hyperplasia of gingiva
 Altered taste sensation
 Gingivitis and periodontitis
(can exacerbate existing periodontitis)
( Dorsky 2001, Nizel 1989 )
28

29.  Odontogenic epithelium fails to undergo histological and
morphological differentiation
 Crowding of the teeth and stunting and thickening of the
tooth roots can also be seen in vitamin A-deficiency
 Atrophy of salivary glands -reduced salivary flow and
consequently increased caries incidence.
 Candidiasis
 Decreased formation of ameloblast and odontoblast
(produces hypoplastic and chalky white incisors)
29

30. Vitamin D
 Naturally occurring form of the vitamin in
animal tissues, is produced in the skin.
 Occurs naturally but in small amounts in
egg yolk, liver, and fish. Milk is a poor
source of vitamin D.
 Stimulates mineralization of bone and
enhances bone resorption .
 Permits normal growth.
30

31.  Rickets in children and Osteomalacia in
adults.
 Enamel hypoplasia - increased
succeptibility to dental caries- High caries
index.
 Formation of globular and hypocalcified dentin
with clefts and tubular dentin.
31

32.  Delayed eruption of deciduous as well as
permanent teeth
 Abnormal alveolar bone pattern
 Decreased mineralization
 Absence of lamina dura in some instances
32

33. Vitamin K
 The vitamin K dependent coagulation proteins
comprise of factors ii,vii,ix,and x
 It is a cofactor for the production of blood
clotting factors.
 Bone osteoblasts contain three vitamin K-
dependent
proteins- osteocalcin- leads to bone
mineralization.
33

34. Oral manifestations-
 Increased risk of bleeding
 Candidiasis
 Anemia,
 Increase in the prothrombin time and
haemorrhage
34

35. Vitamin C
 Also called as Ascorbic acid.
 Powerful reducing agent, main role is to control
the redox potential within cells.
 Hydroxylation of proline to hydroxyproline, which
is necessary for the formation of collagen.
 Preventive effect in atherosclerosis and cancer.
35

36. Scurvy-red swollen gingiva
 Gingival bleeding
 Gingival friability
 Periodontal destruction
 Sore burning mouth
 Soft tissue ulceration
 Increased risk of candidiasis
Oral health
36

37.  Malformed teeth (inadequate dentine)
 Spongy gums with bleeding and
superadded infection
 Mobility of teeth
37

38. Vitamin B1
 Thiamin diphosphate, often called thiamin
pyrophosphate (TPP), is a cofactor in
carbohydrate metabolism.
 Required for normal functioning of the
brain, nerve, muscles ,and heart.
38

39. Oral health
Tongue enlarged,flabby,red and
edematous apperance with enlargement of
fungiform papillae.
 Gingiva becomes inflamed and present with an
‘old rose’ color appearance.
 Beriberi.
39

40. Vitamin B2
 Riboflavin is a flavoprotein
 Cofactor for many oxidative reactions in
the cell.
 Maintenance of mucous membrane
40

41. Oral health
Glossitis
 Dermatitis
 Angular cheilosis
 Atrophy of filliform papillae
 Enlarged fungiform papillae
 Magenta coloured tongue and sore tongue
41

42. Vitamin B12
 Vitamin B12 is important for metabolism,
formation of red blood cells (RBCs) and
maintenance of central nervous system .
42

43. Oral health
 Angular cheilosis
 glossitis
 Diffuse erythematous mucositis
 Stomatitis
 Recurrent oral ulcer
 Oral candidiasis
 Pale oral mucosa
43

44.  Sore or burning mouth
 Haemorrhage gingiva
 Halitosis
 Detachment of periodontal fibres,
 Ulceration, ulcerative gingivitis
 Glossodynia, tongue is "beefy"red, smooth &
glossy,
 Delayed wound healing, bone loss,
 Apthous ulcers.
44

45. Vitamin B3 (niacin)
 It is also known as nicotinic acid
 It is essential for metabolism of carbohydrate,
protein & fat.
Functions
 Act as hydrogen acceptors in many oxidative
reactions, and in their reduced forms (NADH
and NADPH) act as hydrogen donors in
reductive reactions.
45

46.  It is important for proper functioning of
nervous system .
 It dilates the blood vessel & increases the flow
of blood to the peripheral capillary.
 It is essential for production of estrogen
progesterone & testosterone.
46

47. Oral manifestations
 Mucositis
 Stomatitis
 Angular cheilosis
 Glossitis
 Ulceration especially under tongue, mucosa of
lower lip and opposite of molar teeth
 Ulcerative gingivitis
 Denuded tongue
47

48. Vitamin B5(Pantothenic acid)
 It helps in metabolism & synthesis of proteins
& fats, synthesis of cholesterol & steroid
hormones.
 Protect the liver in infections.
 Accelerates wound healing.
 It is also used as anti-stress factor
48

49. Oral manifestation-
 Angular cheilosis
 Sore or burning mouth
 Glossitis
 Glossodynia
49

50. Vitamin B6 (Pyridoxine)
 It is important co enzyme in the intermedullary
metabolism of amino acids and complex
glycolipids.
 It is white crystalline substance soluble in water
and alcohol.
Oral manifestation-
 Angular cheilosis
 Sore or burning mouth
 Glossitis

50

51. Vitamin B8 (BIOTIN)
 It was known as vitamin H
 It functions as a co-enzyme.
Oral manifestation-
 It causes atrophy of the papillae of tongue.
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52. Vitamin B9(FOLIC ACID)
 It is also known as folacin or folate.
 It is water soluble vitamin .
 It is a yellow crystalline substance.
 Folic acid in combination with vitamin B12 is
essential for formation and maturation of RBCs.
Oral manifestation-
 Severe ulcerative stomatitis.
 Swelling & redness of lips.
52

53. Nutritional programmes in India
Ministry of Rural Development
 Applied nutrition programme
Ministry of Social Welfare
 Integrated child development services scheme
 Balwadi nutrition programme
 Special nutrition programme
53

54. Ministry of Health and Family Welfare
 National nutritional anemia prophylaxis programme
 National prophylaxis programme for prevention of
blindness due to vitamin A deficiency
 National iodine deficiency disorder control programme
Ministry of Education
 Mid-day meal programme
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55. Applied nutrition programme
 Started in Orissa on 1963 and later extended to
Tamilnadu and UP.
Objectives:
 Promoting production and of protective food such
Vegetables and fruits
 Ensure their consumption by pregnant & lactating
women and children.
Services
 Nutritional education
 Nutrition worth 25 paise for children and 50 paise for
pregnant and lactating women for 52 days in a year
55

56. Integrated child development
service(ICDS) scheme
 Initiated-Oct.2,1975
Objectives
 Lay the foundation for proper psychological, physical
and social development of child
 Improve nutritional & health status of children
 Reduce incidence of mortality, morbidity, malnutrition
and school drop-outs
 Enhance the capability of mother & family
 Achieve effective coordination among various
departments
56

57. Services provided were-
 Supplementary nutrition
 Non-formal pre-school education
 Immunization
 Health Check-up
 Referral services
 Nutrition and Health Education
57

58. Balwadi nutrition programme
 This was started in 1970
 Preschool children 3-5years of age are benefited.
 Services
 300kcal and 10gm protein for 270 days in a year.
 Also provide with pre school education
58

59. Special nutrition programme
 Started in 1970
 Main aim is to improve nutritional status in targeted
group.
 Children below 6 years and
Pregnant and lactating women are benefited.
Services
Preschool children : 300kcal and 10-12gm protein
Pregnant & lactating mothers :500kcal and 25 gm protein
59

60. National nutritional anemia prophylaxis
programme
 Launched during 4th
5-year plan in 1970.
Children 1-5years of age, expecting and lactating
mothers, family planning (IUD) acceptors are
benefited.
60

61. National iodine deficiency disorder
control programme
 (1956-72)
 Focuses on use of Iodised Salt – Replace of common
salt with iodised salt, Cheapest method to control IDD.
Objectives
Health education
Supply of iodised salt
61

62. First started in Tamilnadu.
 Improve the school attendance
 Reduce school drop outs
 Beneficial impact on child’s nutrition.
62
Mid-day meal
programme

63. Role of a public health dentist
 Through nutritional education about the selection of right
kind of foods and planning for nutritionally adequate diet.
 Community health workers and multipurpose workers
can impart nutritional education to families
 Supplementary feeding programs 3.Midday school
meals
 Vitamin A prophylaxis programs Real solution can only
be obtained through fundamental measures which
corrects the basic cause of malnutrition-increasing the
Quality and Quantity of available food.
 Health education campaigns and health promotion
websites should be encouraged.
63

64. Conclusion
 Nutrition is vital for human development ,
growth, and Health Maintenance.
 The Dental visits which is usually longer in
duration than the medical visits affords better
opportunities for motivational interventions to
enhance self care and health care decision.
64

65. References
 Shafer. Oral aspects of metabolic disease. Rajendran R. Textbook
of oral pathology, 6th
edition. New Delhi, Elsiever, 2009;613-61
 Ghom AG. Vitamins.Textbok of oral medicine, 2nd
edition. New
Delhi, Jaypee brothers, 2010;926-43
 Peter S. Nutrition and oral health. Essentials of preventive and
community dentistry, 4th
edition. New Delhi, Arya publishing house,
2009;476-87
 Hellstrom U, Hallberg EC, Sandros J, Rydberg L, Backer AE.
Carbohydrates act as receptors for the periodontitis-associated
bacterium Porphyromonas gingivalis: a study of bacterial binding to
glycolipids. Glycobiology. 2004 Jun;14(6):511-9
 Moynihan P, Petersen PE. Diet, nutrition and the prevention of
dental diseases. Public Health Nutr. 2004;7:201-26. Review.
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