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ROLE OF CALCIUM & VITAMIN IN
GROWTH & DEVELOPMENT OF TEETH,
BONE, JAWS, ORAL MUCOSA AND IN
PERIODONTAL HEALTH
DR SHWETA DEOLEKAR
1ST YEAR PG
DEPT. OF PEDODONTICS AND PREVENTIVE DENTISTRY
2
INTRODUCTION
 Nutrition is critical to the oral health of the individual. From gestation through the
end of life, nutrition influences the integrity and function of the dentition and
supporting oral structures and has a direct effect on health in general.
 A well-balanced diet is key to ensuring that individuals receive the nutrients they
need. If the diet does not supply enough of the vitamins, minerals, and other
nutrients needed to support healthy tissues, malnutrition develops.
 Dentists who are knowledgeable about nutrition are equipped to ask patients
relevant questions about dietary habits that may affect oral and systemic health
and to provide guidance that promotes healthy lifestyles.
3
 The mineral (inorganic) elements constitute only a small proportion of the body weight.
There is a wide variation in their body content.
 Minerals perform several vital functions which are absolutely essential for the very
existence of the organism.
 These include calcification of bone, blood coagulation, neuromuscular irritability, acid-base
equilibrium, fluid balance and osmotic regulation.
 Certain minerals are integral components of biologically important compounds such as
hemoglobin (Fe), thyroxine (I), insulin (Zn) and vitamin B12 (Co).
4
CLASSIFICATION
 PRINCIPAL ELEMENTS ( MACRO-MINERALS ):
1. Calcium
2. Phosphorous
3. Magnesium
4. Sodium
5. Potassium
6. Sulfer
7. Chloride
5
 TRACE ELEMENTS ( MICRO-MINERALS)
 Essential trace elements :
• Iron, copper, iodine, manganese, zinc, molybdenum, cobalt, fluorine, selenium
and chromium.
 Possibly essential trace elements :
• Nickel, vanadium, cadmium and barium.
 Non-essential trace elements :
• Aluminium, lead, mercury, boron, silver, bismuth etc.
6
CALCIUM HISTORY
 Latin- calx or calcis meaning ”lime”
 Known as early as first century when ancient Romans prepared lime as calcium
oxide.
 Isolated in 1808 by Englishman Sir Humphrey Davy through the electrolysis of a
mixture of lime (CaO) and mercuric oxide (HgO).
 In 1883 Sir Sydney Ringer demonstrated the biological significance of calcium.
7
Cline J. Calcium and vitamin d metabolism, deficiency, and excess. Topics in companion animal medicine.
2012 Nov 30;27(4):159-64.
CALCIUM
 Calcium is the most abundant among the minerals in the body.
 The total content of calcium in an adult man is about 1 to 1.5 kg. As much as 99%
of it is present in the bones and teeth.
 A small fraction (1%) of the calcium, found outside the skeletal tissue, performs a
wide variety of functions.
 Calcium is essential for bone growth as it is required for impregnation of the bone
matrix with minerals. In addition, calcium plays a regulatory role in a number of
specialised functions in the body.
 Calcium plays an important role in muscle contraction, blood coagulation,
neurotransmitter secretion and digestion.
8
NORMAL VALUE
 In a normal young healthy adult, there is about 1,100 g of calcium in the body.
 It forms about 1.5% of total body weight.
 99% of calcium is present in the bones and teeth and the rest is present in the
plasma.
 Normal blood calcium level ranges between 9 and 11 mg/dL.
9
SOURCE OF CALCIUM
 DIETARY SOURCE :
Whole milk = 10%
Low fat milk = 18%
Cheese = 27%
Other dairy products = 17%
Vegetables = 7%
Other substances such as meat, egg, grains, sugar, coffee, tea, chocolate, etc. = 21%
 FROM BONES :
Besides dietary calcium, blood also gets calcium from bone by resorption.
10
DAILY REQUIRMENTS OF CALCIUM
 1 to 3 years = 500 mg
 4 to 8 years = 800 mg
 9 to 18 years = 1,300 mg
 19 to 50 years = 1,000 mg
 51 years and above = 1,200 mg
 Pregnant ladies and lactating mothers = 1,300 mg
11
Bueno, A. L., & Czepielewski, M. A. (2008). The importance for
growth of dietary intake of calcium and vitamin D. Jornal de
Pediatria, 84(5), 386–394
TYPES OF CALCIUM
 CALCIUM IN PLASMA
12
Ionized or diffusible
calcium :
 Found freely in plasma
and forms about 50%
of plasma calcium
Non-ionized
or non-
diffusible
calcium :
 It is about
8% to 10%
of plasma
calcium
Calcium bound
to albumin :
 Forms about
40% to 42%
of plasma
calcium.
 CALCIUM IN BONES :
Calcium is constantly removed from bone and deposited in bone. Bone
is present in two forms:
1. Rapidly exchangeable calcium or exchangeable calcium: Available in small
quantity in bone and helps to maintain the plasma calcium level.
2. Slowly exchangeable calcium or stable calcium: Available in large quantity in
bones and helps in bone remodeling.
13
14
Reid IR, Bristow SM, Bolland MJ. Calcium supplements: benefits and risks. Journal of internal
medicine. 2015 Oct 1;278(4):354-68.
ABSORPTION OF CALCIUM
 Calcium is taken through dietary sources as calcium phosphate,
carbonate, tartrate and oxalate.
 It is absorbed from the gastrointestinal tract in to blood and distributed
to various parts of the body.
 Two mechanisms have been proposed for the absorption of calcium by
gut mucosa:
1. Simple Diffusion.
2. An active transport process, involving energy and calcium pump.
15
EXCRECTION OF CALCIUM
 While passing through the kidney, large quantity of calcium is filtered in the
glomerulus.
 From the filtrate, 98 to 99% of calcium is reabsorbed in the renal tubules in to
blood and only small quantity is excreted through urine.
 Only a small quantity is excreted through urine.
 Most of the filtered calcium is reabsorbed in the distal convoluted tubules and
proximal part of collecting duct.
 Calcium leaves the body mainly in urine and feces, but also in other body tissues
and fluids, such as sweat.
16
REGULATION OF BLOOD CALCIUM
LEVEL
 Blood calcium level is regulated mainly by three hormones :
1. Parathormone
2. 1,25-dihydroxycholecalciferol (calcitriol)
3. Calcitonin.
 Parathormone
Parathormone is a protein hormone secreted by parathyroid gland and its
main function is to increase the blood calcium level by mobilizing calcium from
bone (resorption).
17
 1,25-dihydroxycholecalciferol – Calcitriol
Calcitriol is a steroid hormone synthesized in kidney. It is the activated
form of vitamin D. Its main action is to increase the blood calcium level by
increasing the calcium absorption from the small intestine.
 Calcitonin
Calcitonin secreted by parafollicular cells of thyroid gland. Thyroid gland
is a calcium-lowering hormone. It reduces the blood calcium level mainly by
decreasing bone resorption.
18
19
20
DISEASE STATES
The blood Ca level is maintained within a narrow range by the homeostatic control,
most predominantly by PTH. Hence abnormalities in Ca metabolism are mainly
associated with alterations in PTH.
21
HYPERCALCEMIA
 Elevated serum calcium level up to 12- 15 mg/dl.
 Hypercalcemia is associated with hyperparathyroidism caused by increased
activity of parathyroid glands.
 Elevation in the urinary excretion of Ca and P
, often resulting in the formation of
urinary calculi, is also observed in these patients.
 The symptoms of hypercalcemia include lethargy, muscle weakness, loss of
appetite, constipation, nausea, increased myocardial contractility and
susceptibility to fractures.
22
HYPOCALCEMIA
 Hypocalcemia is a more serious and life threatening condition. It is characterized
by a fall in the serum Ca to below 8.5 mg/dl.
 Hypocalcemia is mostly due to hypoparathyroidism. This may happen after an
accidental surgical removal of parathyroid glands or due to an autoimmune
disease.
 Clinical features include short stature, Short metacarpal or metatarsal bones.
23
ORAL MANIFESTATIONS
 Enamel hypoplasia
 Dryness of the mucous membranes
 Angular cheilitis
 Disturbances in tooth eruption
 Root defects
 Hypodontia and impacted teeth
 Large pulp chambers were observed in the deciduous teeth and the permanent
teeth
24
TREATMENT
 Supplementation of oral calcium with vitamin D is commonly employed.
 In severe cases of hypocalcemia, calcium gluconate is intravenously
administered.
25
RICKETS
 Rickets is a disorder of defective calcification of bones. This may be due to a low
levels of vitamin D in the body or due to a dietary deficiency of Ca and P — or
both.
 An increase in the activity of alkaline phosphatase is a characteristic feature of
rickets.
 Occurs in children between 6 months to 2 years of age.
 Affects long bones.
 Lack of calcium causes failure of mineralization resulting into formation of
cartilagenous form of bone.
 Most critical area that gets affected is the center endochondral ossification at
the epiphyseal plates.
26
CLINICAL FEATURES
27
ORAL MANIFESTATIONS
 Developmental abnormalities of dentin and enamel
 Delayed eruption
 High caries index
 Enamel hypoplasia
28
TREATMENT
 Oral therapy:
 Vitamin D- 0.5-1g/24 hr for children 2-4 yrs
 1-4g/24 hr for children > 4 yrs.
 For patients requiring parenteral administration of phosphate, an initial
phosphate dose of 0.08 mol per kg body weight may be given over six hours.
The dose may be increased to 0.16 mmol per kg if a patient has serious clinical
manifestations.
 With early diagnosis and compliance limb deformity Can be minimized.
 Corrective osteotomy for deformed limbs should be delayed till serum alkaline
phosphatase levels are normal.
29
Emkey RD, Emkey GR. Calcium metabolism and correcting calcium deficiencies. Endocrinology
and metabolism clinics of North America. 2012 Sep 30;41(3):527-56
CALCIUM AND ORAL HEALTH
30
MINERALISED TOOTH STRUCTURE
 Calcium helps to maintain the mineral composition of teeth, which are subject to
both demineralisation and remineralisation dependent on a number of dietary
factors and the pH of the oral environment.
 Enamel demineralisation takes place below a pH of about 5.5 (the critical pH).
 The critical pH is inversely related to both the calcium and phosphate
concentration of plaque and saliva, which are influenced.
 The concentration of calcium in plaque influences demineralisation of tooth
enamel and thus, risk of caries.
 The greater the concentration of calcium, the lower is the rate of
demineralization and risk of dental decay.
31
Role of Calcium deficiency in the
progress of periodontal diseases
 A reduction of bone mineralization aggravates pathological periodontal changes
resulting in less support for the teeth.
 Decline in dietary intake of calcium and calcium phosphorus ratio may enhance the
appearance of these conditions by increasing bone resorption.
 This type of bone loss affects the bones in descending order- jaw bones (mainly
alveolar bones), cranial bones, ribs, vertebrae and long bones.
 Alveolar bone has the highest rate of renewal and is affected first and consequently
is the most severely affected in the long term.
 Studies have shown that increased calcium intake improves the suffering of
inflammatory processes and tooth mobility in patients having gingivitis. Insufficient
dietary intake of calcium results in more severe gingival and periodontal diseases.
32
EFFECT OF CALCIUM DEFICIENCY ON
BONE AND TEETH
 The mineralization of the protein matrix is completed with the deposition of
hydroxyapatite, giving bones and teeth their compressive strength. Composed
of calcium and phosphorus minerals, hydroxyapatite is also a critical component
of both enamel and dentin.
 Inadequate intake of calcium during pregnancy may result in bone deformities,
incomplete tooth calcification, tooth malformation, and increased susceptibility
to caries after tooth eruption, especially since enamel will not regenerate once
the maturation process has ended.
33
 Bone growth continues through childhood and into adolescence. Inadequate
intake of calcium will lead to osteopenia, or decreased bone density and mass.
 If this deficiency remains unaddressed, it will lead to osteoporosis, a disorder
wherein the bones become porous, brittle, and subject to fracture.
 Tooth mobility and premature tooth loss may result. Although not the most
common site of fractures, the jaw and oral alveoli will exhibit reduced strength
due to the paucity of these minerals.
34
CONCLUSION
 Pediatricians should actively support the goal of achieving calcium intakes in children and
adolescents comparable to those in recently recommended guidelines.
 To emphasize the importance of calcium nutriture, pediatricians should consider including
the following questions about dietary calcium intake.
• What do you drink, either white or chocolate milk, with your meals?
• Do you drink milk with meals, snacks, or cereal or any other time during the day?
• Do you eat cheese, yogurt, or other dairy products such as cottage cheese?
• Do you drink calcium-fortified juices or eat any calcium-fortified foods?
• Do you eat any of the following: broccoli, tofu, oranges, or legumes (dried beans and
peas)?
• Do you take any mineral or vitamin supplements?
35
 For children and adolescents whose calcium intake seems deficient, specific
information about the sources of dietary calcium should be provided.
 Adolescents may need to be reminded that low-fat dairy products, including skim
milk and low-fat yogurts, are good sources of calcium that are not high in fat.
36
37

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calcium and oral health

  • 1. 1
  • 2. ROLE OF CALCIUM & VITAMIN IN GROWTH & DEVELOPMENT OF TEETH, BONE, JAWS, ORAL MUCOSA AND IN PERIODONTAL HEALTH DR SHWETA DEOLEKAR 1ST YEAR PG DEPT. OF PEDODONTICS AND PREVENTIVE DENTISTRY 2
  • 3. INTRODUCTION  Nutrition is critical to the oral health of the individual. From gestation through the end of life, nutrition influences the integrity and function of the dentition and supporting oral structures and has a direct effect on health in general.  A well-balanced diet is key to ensuring that individuals receive the nutrients they need. If the diet does not supply enough of the vitamins, minerals, and other nutrients needed to support healthy tissues, malnutrition develops.  Dentists who are knowledgeable about nutrition are equipped to ask patients relevant questions about dietary habits that may affect oral and systemic health and to provide guidance that promotes healthy lifestyles. 3
  • 4.  The mineral (inorganic) elements constitute only a small proportion of the body weight. There is a wide variation in their body content.  Minerals perform several vital functions which are absolutely essential for the very existence of the organism.  These include calcification of bone, blood coagulation, neuromuscular irritability, acid-base equilibrium, fluid balance and osmotic regulation.  Certain minerals are integral components of biologically important compounds such as hemoglobin (Fe), thyroxine (I), insulin (Zn) and vitamin B12 (Co). 4
  • 5. CLASSIFICATION  PRINCIPAL ELEMENTS ( MACRO-MINERALS ): 1. Calcium 2. Phosphorous 3. Magnesium 4. Sodium 5. Potassium 6. Sulfer 7. Chloride 5
  • 6.  TRACE ELEMENTS ( MICRO-MINERALS)  Essential trace elements : • Iron, copper, iodine, manganese, zinc, molybdenum, cobalt, fluorine, selenium and chromium.  Possibly essential trace elements : • Nickel, vanadium, cadmium and barium.  Non-essential trace elements : • Aluminium, lead, mercury, boron, silver, bismuth etc. 6
  • 7. CALCIUM HISTORY  Latin- calx or calcis meaning ”lime”  Known as early as first century when ancient Romans prepared lime as calcium oxide.  Isolated in 1808 by Englishman Sir Humphrey Davy through the electrolysis of a mixture of lime (CaO) and mercuric oxide (HgO).  In 1883 Sir Sydney Ringer demonstrated the biological significance of calcium. 7 Cline J. Calcium and vitamin d metabolism, deficiency, and excess. Topics in companion animal medicine. 2012 Nov 30;27(4):159-64.
  • 8. CALCIUM  Calcium is the most abundant among the minerals in the body.  The total content of calcium in an adult man is about 1 to 1.5 kg. As much as 99% of it is present in the bones and teeth.  A small fraction (1%) of the calcium, found outside the skeletal tissue, performs a wide variety of functions.  Calcium is essential for bone growth as it is required for impregnation of the bone matrix with minerals. In addition, calcium plays a regulatory role in a number of specialised functions in the body.  Calcium plays an important role in muscle contraction, blood coagulation, neurotransmitter secretion and digestion. 8
  • 9. NORMAL VALUE  In a normal young healthy adult, there is about 1,100 g of calcium in the body.  It forms about 1.5% of total body weight.  99% of calcium is present in the bones and teeth and the rest is present in the plasma.  Normal blood calcium level ranges between 9 and 11 mg/dL. 9
  • 10. SOURCE OF CALCIUM  DIETARY SOURCE : Whole milk = 10% Low fat milk = 18% Cheese = 27% Other dairy products = 17% Vegetables = 7% Other substances such as meat, egg, grains, sugar, coffee, tea, chocolate, etc. = 21%  FROM BONES : Besides dietary calcium, blood also gets calcium from bone by resorption. 10
  • 11. DAILY REQUIRMENTS OF CALCIUM  1 to 3 years = 500 mg  4 to 8 years = 800 mg  9 to 18 years = 1,300 mg  19 to 50 years = 1,000 mg  51 years and above = 1,200 mg  Pregnant ladies and lactating mothers = 1,300 mg 11 Bueno, A. L., & Czepielewski, M. A. (2008). The importance for growth of dietary intake of calcium and vitamin D. Jornal de Pediatria, 84(5), 386–394
  • 12. TYPES OF CALCIUM  CALCIUM IN PLASMA 12 Ionized or diffusible calcium :  Found freely in plasma and forms about 50% of plasma calcium Non-ionized or non- diffusible calcium :  It is about 8% to 10% of plasma calcium Calcium bound to albumin :  Forms about 40% to 42% of plasma calcium.
  • 13.  CALCIUM IN BONES : Calcium is constantly removed from bone and deposited in bone. Bone is present in two forms: 1. Rapidly exchangeable calcium or exchangeable calcium: Available in small quantity in bone and helps to maintain the plasma calcium level. 2. Slowly exchangeable calcium or stable calcium: Available in large quantity in bones and helps in bone remodeling. 13
  • 14. 14 Reid IR, Bristow SM, Bolland MJ. Calcium supplements: benefits and risks. Journal of internal medicine. 2015 Oct 1;278(4):354-68.
  • 15. ABSORPTION OF CALCIUM  Calcium is taken through dietary sources as calcium phosphate, carbonate, tartrate and oxalate.  It is absorbed from the gastrointestinal tract in to blood and distributed to various parts of the body.  Two mechanisms have been proposed for the absorption of calcium by gut mucosa: 1. Simple Diffusion. 2. An active transport process, involving energy and calcium pump. 15
  • 16. EXCRECTION OF CALCIUM  While passing through the kidney, large quantity of calcium is filtered in the glomerulus.  From the filtrate, 98 to 99% of calcium is reabsorbed in the renal tubules in to blood and only small quantity is excreted through urine.  Only a small quantity is excreted through urine.  Most of the filtered calcium is reabsorbed in the distal convoluted tubules and proximal part of collecting duct.  Calcium leaves the body mainly in urine and feces, but also in other body tissues and fluids, such as sweat. 16
  • 17. REGULATION OF BLOOD CALCIUM LEVEL  Blood calcium level is regulated mainly by three hormones : 1. Parathormone 2. 1,25-dihydroxycholecalciferol (calcitriol) 3. Calcitonin.  Parathormone Parathormone is a protein hormone secreted by parathyroid gland and its main function is to increase the blood calcium level by mobilizing calcium from bone (resorption). 17
  • 18.  1,25-dihydroxycholecalciferol – Calcitriol Calcitriol is a steroid hormone synthesized in kidney. It is the activated form of vitamin D. Its main action is to increase the blood calcium level by increasing the calcium absorption from the small intestine.  Calcitonin Calcitonin secreted by parafollicular cells of thyroid gland. Thyroid gland is a calcium-lowering hormone. It reduces the blood calcium level mainly by decreasing bone resorption. 18
  • 19. 19
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  • 21. DISEASE STATES The blood Ca level is maintained within a narrow range by the homeostatic control, most predominantly by PTH. Hence abnormalities in Ca metabolism are mainly associated with alterations in PTH. 21
  • 22. HYPERCALCEMIA  Elevated serum calcium level up to 12- 15 mg/dl.  Hypercalcemia is associated with hyperparathyroidism caused by increased activity of parathyroid glands.  Elevation in the urinary excretion of Ca and P , often resulting in the formation of urinary calculi, is also observed in these patients.  The symptoms of hypercalcemia include lethargy, muscle weakness, loss of appetite, constipation, nausea, increased myocardial contractility and susceptibility to fractures. 22
  • 23. HYPOCALCEMIA  Hypocalcemia is a more serious and life threatening condition. It is characterized by a fall in the serum Ca to below 8.5 mg/dl.  Hypocalcemia is mostly due to hypoparathyroidism. This may happen after an accidental surgical removal of parathyroid glands or due to an autoimmune disease.  Clinical features include short stature, Short metacarpal or metatarsal bones. 23
  • 24. ORAL MANIFESTATIONS  Enamel hypoplasia  Dryness of the mucous membranes  Angular cheilitis  Disturbances in tooth eruption  Root defects  Hypodontia and impacted teeth  Large pulp chambers were observed in the deciduous teeth and the permanent teeth 24
  • 25. TREATMENT  Supplementation of oral calcium with vitamin D is commonly employed.  In severe cases of hypocalcemia, calcium gluconate is intravenously administered. 25
  • 26. RICKETS  Rickets is a disorder of defective calcification of bones. This may be due to a low levels of vitamin D in the body or due to a dietary deficiency of Ca and P — or both.  An increase in the activity of alkaline phosphatase is a characteristic feature of rickets.  Occurs in children between 6 months to 2 years of age.  Affects long bones.  Lack of calcium causes failure of mineralization resulting into formation of cartilagenous form of bone.  Most critical area that gets affected is the center endochondral ossification at the epiphyseal plates. 26
  • 28. ORAL MANIFESTATIONS  Developmental abnormalities of dentin and enamel  Delayed eruption  High caries index  Enamel hypoplasia 28
  • 29. TREATMENT  Oral therapy:  Vitamin D- 0.5-1g/24 hr for children 2-4 yrs  1-4g/24 hr for children > 4 yrs.  For patients requiring parenteral administration of phosphate, an initial phosphate dose of 0.08 mol per kg body weight may be given over six hours. The dose may be increased to 0.16 mmol per kg if a patient has serious clinical manifestations.  With early diagnosis and compliance limb deformity Can be minimized.  Corrective osteotomy for deformed limbs should be delayed till serum alkaline phosphatase levels are normal. 29 Emkey RD, Emkey GR. Calcium metabolism and correcting calcium deficiencies. Endocrinology and metabolism clinics of North America. 2012 Sep 30;41(3):527-56
  • 30. CALCIUM AND ORAL HEALTH 30
  • 31. MINERALISED TOOTH STRUCTURE  Calcium helps to maintain the mineral composition of teeth, which are subject to both demineralisation and remineralisation dependent on a number of dietary factors and the pH of the oral environment.  Enamel demineralisation takes place below a pH of about 5.5 (the critical pH).  The critical pH is inversely related to both the calcium and phosphate concentration of plaque and saliva, which are influenced.  The concentration of calcium in plaque influences demineralisation of tooth enamel and thus, risk of caries.  The greater the concentration of calcium, the lower is the rate of demineralization and risk of dental decay. 31
  • 32. Role of Calcium deficiency in the progress of periodontal diseases  A reduction of bone mineralization aggravates pathological periodontal changes resulting in less support for the teeth.  Decline in dietary intake of calcium and calcium phosphorus ratio may enhance the appearance of these conditions by increasing bone resorption.  This type of bone loss affects the bones in descending order- jaw bones (mainly alveolar bones), cranial bones, ribs, vertebrae and long bones.  Alveolar bone has the highest rate of renewal and is affected first and consequently is the most severely affected in the long term.  Studies have shown that increased calcium intake improves the suffering of inflammatory processes and tooth mobility in patients having gingivitis. Insufficient dietary intake of calcium results in more severe gingival and periodontal diseases. 32
  • 33. EFFECT OF CALCIUM DEFICIENCY ON BONE AND TEETH  The mineralization of the protein matrix is completed with the deposition of hydroxyapatite, giving bones and teeth their compressive strength. Composed of calcium and phosphorus minerals, hydroxyapatite is also a critical component of both enamel and dentin.  Inadequate intake of calcium during pregnancy may result in bone deformities, incomplete tooth calcification, tooth malformation, and increased susceptibility to caries after tooth eruption, especially since enamel will not regenerate once the maturation process has ended. 33
  • 34.  Bone growth continues through childhood and into adolescence. Inadequate intake of calcium will lead to osteopenia, or decreased bone density and mass.  If this deficiency remains unaddressed, it will lead to osteoporosis, a disorder wherein the bones become porous, brittle, and subject to fracture.  Tooth mobility and premature tooth loss may result. Although not the most common site of fractures, the jaw and oral alveoli will exhibit reduced strength due to the paucity of these minerals. 34
  • 35. CONCLUSION  Pediatricians should actively support the goal of achieving calcium intakes in children and adolescents comparable to those in recently recommended guidelines.  To emphasize the importance of calcium nutriture, pediatricians should consider including the following questions about dietary calcium intake. • What do you drink, either white or chocolate milk, with your meals? • Do you drink milk with meals, snacks, or cereal or any other time during the day? • Do you eat cheese, yogurt, or other dairy products such as cottage cheese? • Do you drink calcium-fortified juices or eat any calcium-fortified foods? • Do you eat any of the following: broccoli, tofu, oranges, or legumes (dried beans and peas)? • Do you take any mineral or vitamin supplements? 35
  • 36.  For children and adolescents whose calcium intake seems deficient, specific information about the sources of dietary calcium should be provided.  Adolescents may need to be reminded that low-fat dairy products, including skim milk and low-fat yogurts, are good sources of calcium that are not high in fat. 36
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Editor's Notes

  1. Ionized or diffusible calcium: It is essential for vital functions such as neuronal activity, muscle contraction, cardiac activity, secretions in the glands, blood coagulation, etc. Non-ionized or non-diffusible calcium: Present in non-ionic form such as calcium bicarbonate.