diet and nutritional effect on periodontium

1. Effect of N utritionandDiet on
teethandPeriodontium
Presented To: Dr. AhmadTarabaih
PresentedBy: StéphanieChahrouk
I D: 201501713
By: Stephanie Chahrouk

2. outline
 Introduction
 Definitions
 Role of nutrition on PDL and Teeth
 Diet History analysis
 Diet History recommendation
 Conclusion

3. Introduction
“Many studies have observed that a balanced diet has an essential role in
maintaining Teeth and periodontal health.
Additionally, the influences of nutritional supplements and dietary components
have been known to affect healing after periodontal surgery.
Studies have attempted to find a correlation between tooth loss, periodontal
health, and nutrition.
Moreover, bone formation and periodontal regeneration are also affected by
numerous vitamins, minerals, and trace elements"

5. Definition

6. Diet and nutrition play a key role
in: Tooth development
 Gingival and oral tissue
integrity
 Bone strength
 Prevention and management
of diseases of the oral cavity

7. Factors affect the caries process
 form of food or fluid
 the duration of exposure
 nutrient composition
 sequence of eating
 salivary flow
 presence of buffers
 oral hygiene

8. EARLY CHILDHOOD CARIES
(ECC)
 Defined as “ the presence
of one or more decayed
(noncavitated or cavitated
lesions), missing (due to
caries), or filled tooth
surfaces in any primary
tooth in children from birth
through 71 months of age”

9. Increased risk for ECC:
 Delayed or abnormal progression through transition
stage of infant nutrition: by increasing the quantity
or frequency of carbohydrate exposure.
 Excessive reliance on beverages for nutrition.
 Delayed acceptance of solid food .
 Delivery of beverages by bottle or closed cup
system.
 Continued nocturnal bottles combined with
decreased saliva during sleep.
 Prolonged breast feeding 12

10. Prevention of ECC:
 Early evaluation of dietary habits
 Anticipatory guidance
 Appropriate transition to table food
 Limited intake of sugared

11. Types of food
Cariogenic Cariostatic anticariogenic

12. Cariogenic Food
 containing fermentable
carbohydrates that can cause a
decrease in salivary pH to <5.5 and
demineralization when in contact
with microorganisms in the mouth;
promoting caries development
 Promote formation of caries
 Fermentable carbohydrates, those
that can be broken down by salivary
amylase
 Result in lower mouth pH

13. Cariostatic food
 Not metabolized by
microorganisms in plaque
to cause a drop in salivary
pH to <5.5
 Foods that do not
contribute to decay
 Do not cause a drop in
salivary pH
 Includes protein foods,
eggs, fish, meat and
poultry; most vegetables,
fats, sugarless gums

14. Anticariogenic foods
 Prevent plaque from recognizing an acidogenic
food when it is eaten first
 May increase salivation or have antimicrobial
activity
 Includes xylitol (sweetener in sugarless gum)
and cheeses

15. A variety of nutrients have a major
impact on periodontal health?!

16. Nutrients are of two types:
1. Micronutrients:
i. Are those components of food that are required in small or trace amounts.
ii. The human diet contains a number of antioxidants in the form of micronutrients
iii. Antioxidant micronutrients include:
1. Vitamins and Minerals
2. Macronutrients:
i. are nutrients required in large quantities,
ii. for example minerals, proteins, carbohydrates, and fats in addition to oxygen and
water
3. trace nutrients

18. According to the American Dietetic Association
 Nutrition is an integral component of oral health.
 Diet and nutrition are major multifactorial environmental factors in the
etiology and pathogenesis of craniofacial diseases.”
Relation between diet and caries (Miller’s chemoparasitic theory)
 Caries is caused by the dissolution of the teeth by acid produced by the metabolism of
dietary carbohydrates by oral bacteria.
 The primary bacteria involved in caries formation are mutans streptococci and
lactobacilli.
 In the 1960s the caries theory was depicted as circles for dental caries:
o the tooth, the diet, and dental plaque”

19. PROTEINS
 Word protein means “of prime importance”, because it mediates most of the actions of
life.
 Essential for all body tissues: skin, tendons, bone matrix, cartilage, and connective
tissue.
 forms hormones, enzymes, antibodies and acts as a chemical messenger within the
body.
 Requirements for protein vary between 40-65 g/day depending on physical activity,
stress, and growth cycles.
 Excess is stored as fat.
 The specific dynamic action (SDA) or the thermic effect of food (TEF) for protein (29%) is
much higher than that of carbohydrate and fat (5%).
 Deficiency state: Protein energy malnutrition
 (PEM) : Kwashiorkar, Marasmus and Marasmic Kwashiorkar

20. Quality of protein:
That provides amino acid pattern close to that of tissue protein
Breast milk and egg protein satisfy this criteria
Egg: called reference protein: provides all essential amino acids.”

21. “
 Bright reddening of tongue
 Loss of papillae: erythematous and smooth dorsum of tongue
 Kwashiorkar:
o Edema of tongue with scalloping around the lateral
margins due to indentation of the teeth.  Bilateral
angular cheilosis
 Fissuring of lip
 Loss of circumoral pigmentation
 Dry mouth
 Reduced caries activity due to lack of substrate
carbohydrate.
 Decreased overall growth of jaws
 Delayed eruption
Deciduous teeth may show linear hypoplasia”.

22. LIPIDS
 Fats insulate against the cold, cushion organs, slow digestion, carry fat-soluble vitamins
A, D, E, K, and make foods taste good.
 Types :
o Saturated fats
•mainly from animal foods, such as meat, poultry, butter, and whole milk.
•They increase the risk of cardiovascular disease, cancer, and obesity.
o Unsaturated fats:
 Mono and polyunsaturated fats are heart healthy fats.
 EFA: “essential fatty acids” are Polyunsaturated fatty acids, used to be called
“queen of vitamins” and then it was designated as vitamin F.”

24. Vitamin A
 Vitamin A is a fat-soluble vitamin that plays a role in maintaining the
integrity of epithelial cells
 Dietary sources of vitamin A include:
o eggs, cod liver oil, carrots, capsicum, liver, sweet potato, broccoli, and
leafy vegetables.
 A healthy individual needs approximately 900 µg/day.
 Deficiency results in:
o retinal disorders (such as night blindness and hyperkerotosis).
 Considering the antioxidant potential, vitamin A has been used to
supplement periodontal treatment

26. “ORAL MANIFESTATIONS
TEETH:
 Defective formation of enamel
 Odontogenic epithelium fails to undergo normal histodifferentiation and
morphodifferentiation, leading to increased rate of cell proliferation.
 Epithelial invasion of pulpal tissue is characteristic of vitamin A def.
 Distortion of shapes of incisors and molars
 Enamel hypoplasia: enamel matrix is poorly defined.
 Calcification is disturbed.
 Atypical dentin: lacking normal tubular arrangement, and containing vascular and
cellular inclusions.
 Increased caries susceptibility.
 Delayed eruption.

27. GINGIVA
 Hyperplastic gingival epithelium
In prolonged defi: shows keratinization

28. Vitamin B Complex
 The vitamin B complex family consists of vitamins:
o B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid),
B6 (pyridoxine, pyridoxal, pyridoxamine) B7(biotin), B9 (folic acid),
and B12 (cobalamins).
 B vitamins play a vital role in:
o cell metabolism
o repair
o proliferation
 Deficiency of B vitamins results in a number of diseases and symptoms
 Signs and symptoms of B-vitamins deficiency range from dermatitis and
paresthesia to oral manifestation such as:
o angular chilitis and glossitis.

29.  In addition to anemia, a deficiency of vitamin B12 may lead to:
o gingival bleeding.
 possible link between low serum vitamin B12levels and periodontitis
 reduced serum vitamin B9 levels have been observed in smokers, which may
lead to periodontitis
 B-vitamin complex supplementation:
o accelerates the healing of wounds after periodontal flap surgery”

30. Vitamin C
 Vitamin C (ascorbic acid) is primarily required for:
o the synthesis of collagen
o Prevents oxidative damage by acting as a ROS scavenger
 Scurvy is the name given to the disease caused by the deficiency of vitamin C
 hallmarks of scurvy:
o malaise, lethargy, and
o spots on the skin,
o periodontal bleeding,
o inflamed PDL
o Painful gums.

31.  Treatment: Vitamin C supplementation cures and prevents scurvy
 Dentifrice containing vitamin C-containing magnesium salt has successfully been used to
reduce gingival
 The vitamin C-containing dentifrice exhibited a significantly higher anti-ROS activity
compared to conventional dentifrice.
 vitamin C may also be used in coatings and/or gel forms to:
o enhance the osseointegration of dental implants
o Improve post-surgical periodontal healing.”

33. Vitamin D
 Enhances the absorption of minerals including calcium, magnesium, iron, phosphate,
and zinc in the intestine.
 deficiency of dietary vitamin D leads to:
o periodontal inflammation
o delay in post-surgical periodontal healing
 vitamin D3 coated on dental implants may enhance osseointegration with alveolar bone
 intraperitoneal injections of vitamin D3 accelerates orthodontic tooth movement,
making it possible to induce orthodontic tooth movement in patients undergoing
bisphosphonate therapy”

34. “ORAL MANIFESTATIONS of Vit D deficiency:
 Developmental abnormalities of dentin and enamel
 Delayed eruption
 Malalignment of teeth
 Higher caries index
 Enamel: may be hypoplastic, mottled, yellow gray in colour
 Large pulp chambers
 High pulp horns
 Delayed closure of root apices
Osteoid is so soft that the teeth are displaced, leading to malocclusion of the teeth.”

36. Vitamin E
 Vitamin E (tocopherol) is a fat-soluble vitamin that is considered one of the key
extracellular antioxidants.
 Diets rich in vitamin E include poultry, meat, fish, nuts, seeds, and cereals
 reduction of vitamin E was observed in patients with periodontal diseases compared to
healthy individuals
 The level of vitamin E in the alveolar fluid of smokers is reduced, corresponding to
increased production of oxidants during smoking [95].
 The mechanism of action of vitamin E for periodontal health is not very well understood
and needs further research.”
“ORAL MANIFESTATIONS OF VITAMIN E DEFICIENCY
 Loss of pigmentation
Atrophic degenerative changes in enamel

38. Nutrient Dietary Source(s) Importance in Periodontal Heath
Calcium Milk products, eggs,
canned bony fish,
leafy vegetables, nuts,
seeds
Required for formation of teeth and bones.
Supplementation improves outcomes of non-
surgical periodontal therapy. Local
application enhances osseointegration.
Magnesium Cocoa, soybeans,
nuts, spinach, marine
vegetables, tomatoes
Required for cell metabolism and bone
formation. Supplementation may improve
outcomes of non-surgical periodontal
therapy.
Iron Red meat, tuna, dry
beans, spinach
Possible anti-oxidant effect on periodontium.
Zinc Protein-rich foods,
spinach, grains
Possible anti-oxidant effect on periodontium.
Reduces severity of diabetes-induced
periodontitis
Fluoride Grape fruits, cocoa,
tea, dried fruits and
nuts, fluoridated
water
Supplementation and topical application
prevents dental caries.”

39. Preventive Mesures ???

40. Reducing Sugar intake

42. Trace Elements and Caries:

51. Recommendation
Get your oral hygiene on.
Seriously. Are you flossing
yet? Are you brushing at
least twice per day? If not,
start.

52.  Brush your teeth, not only with fluoride-based toothpaste,
but also baking soda-based toothpaste. The baking soda
will raise the pH in your mouth, making it more alkaline and
therefore decreasing risk of cavities.
 Avoid smoking. Smoking can wreak havoc on gum and
tooth health.
 Drink green tea. Drinking green tea improves the health
of your teeth and gums, as it decreases inflammation,
makes your mouth more alkaline, inhibits the growth of
cavity-causing bacteria, prevents tooth loss, may slow
progression of oral cancer, and freshens breath by killing
odor-causing bacteria. Wow! All this, and it can help you to
lose fat, too.
 Chew xylitol gum after meals. Xylitol increases saliva
production and prevents the bacteria in your mouth from
producing the acids that cause cavities. But don’t go
overboard, because even if sugar alcohols won’t harm
your teeth, they can cause gas and bloating.

53.  Eat mostly whole, nutrient-dense foods that
provide plenty of calcium, phosphorus,
magnesium, vitamin K (especially K2) and
vitamin D. Foods like leafy green vegetables,
nuts, seeds, hard aged cheeses, plain yogurt,
meats, natto, beans, mushrooms, fish, eggs, and
organ meats all work here. Oh, and make sure
you get some sunlight.
 Eat some raw, crunchy fruits and vegetables
every day. Raw veggies clean your teeth to a
degree (apples, carrots, bell peppers, etc). Eating
an apple as dessert after lunch will help to
remove material that has adhered to the surface
of your teeth. Plus, apples contain naturally
occurring xylitol.

54.  Limit added sugars from both foods and beverages. This
includes soda, fruit juice, energy drinks, candies, etc.
Energy drinks are particularly damaging as they combine a
high sugar load with an incredibly acidic pH. If your diet is
built around energy bars and energy drinks, you probably
won’t have any teeth remaining on your 45th birthday.
 Maintain a lean/healthy body composition. Excess body
fat can promote poor systemic health, including poor oral
health.
 Increase the amount of arginine in your diet. Eat more
spinach, lentils, nuts, eggs, whole grains, meat, seafood,
and soy.
 Get regular exercise. Exercise seems to protect against
periodontal disease.

55. References
 G. A. Scardina. P. Messina, Good Oral Health and Diet,
Journal of Biomedicine and Biotechnology. 2012; 2012
 Paula Moynihan1. Poul Erik Petersen, Diet, nutrition
and the prevention of dental diseases, Public Health
Nutrition: 7(1A), 201–226
 Moursi AM, Fernandez JB, Daronch M, Zee L, Jones
CL. Nutrition and oral health considerations in children
with special health care needs: implications for oral
health care providers. Pediatr Dent. 2010 Jul-Aug;
32(4):333-42