Nutrition and oral health are intricately linked, with dietary choices playing a significant role in maintaining the health of teeth, gums, and overall oral cavity. The foods and beverages we consume not only impact our physical health but also influence the condition of our mouths, affecting everything from tooth decay and gum disease to oral cancer risk. Understanding the connection between nutrition and oral health is essential for promoting healthy habits and preventing dental problems. the key aspects of this relationship, including the role of nutrients in supporting oral health, the impact of dietary factors on common dental issues, and the importance of maintaining a balanced diet for overall well-being. By gaining insight into how nutrition affects oral health, individuals can make informed choices to preserve their smiles and promote lifelong oral wellness. Let's delve deeper into this vital connection between nutrition and oral health.

1. Nutrition and
Oral Health

2. Contents
Introduction.
Classification of foods.
Nutrition.
Balanced diet.
Effect of nutrition on oral tissues.
Nutrition in elderly.
Preventive & social measures.

3. Introduction
Diet :- it is defined as the types & amounts of food eaten daily by an
individual (FDI, 1994).
Nutrition :- it is defined as the sum of the processes by which an
individual takes in & utilizes food (FDI, 1994).
Malnutrition :- a pathophysiological state resulting from a relative or
absolute deficiency or excess of one or more essential nutrients.

4. Classification of Foods
1.By origin :
(a) Foods of animal origin.
(b) Foods of vegetable origin.
2. By Chemical composition :
(a)Proteins.
(b) Fats
(c) Carbohydrates.
(d)Vitamins.
(e)Minerals

5. .
 3. By predominant function:-
 (a) Body- building food : milk, meat, poultry.
 (b) Energy – giving foods : cereals, sugars, roots.
 ( c) Protective foods – vegetables, fruits & milk.
 4. By Nutritive Value :- cereals & millets, pulses, vegetables, nuts,
fruits, fats & oils sugar & jaggery.

6. Nutrients
Nutrients are organic & inorganic complexes contained in food.
They are divided into two:-
1. Macronutrients :- these forms the main bulk of the food.
These include – proteins, fats and carbohydrates.
2. Micronutrients :-they are required in small amounts.
 These include vitamins and minerals.

7. Proteins
They are complex inorganic nitrogenous compounds composed of
carbon, hydrogen, oxygen, nitrogen and sulphur.
Their major functions are:-
1. Body building.
2. Repair & maintenance of tissues.
3. Syntheseis of antibodies, plasma proteins, hemoglobin, enzymes and
hormones.
4. They supply energy (4kcal/gm).

8. Sources of proteins
1. Animal sources :- milk, meat, egg.
2. Plant sources:- pulses, cereals, nuts.
The Indian Council of Medical
Research (ICMR) has recommend 1
gm protein/kg body weight for an
Indian adult.

9. Fats/ Lipids
They are concentrared sources of energy. Almost 99%
of body fats are in the form of triglycerides.
Classified as:-
1.Simple lipids – triglycerides.
2.Compound lipids – phospholipids.
3.Derived lipids- cholesterol

10. Functions of Fats
They supply energy (9 kcal / 1 gm).
They carry flavour of food.
They add satiety & variety to a meal.
They are an integral part of cells & cell membranes.
They carry fat soluble vitamins A, D, E & K.
They may act to reduce dental caries by coating the plaque, therby
preventing fermentable carbohydrates from entering it.

11. Sources of fats
Animal sources :- Ghee, butter,
cheese, egg, fat of meat & fish.
Vegetable sources :- Groundnut,
coconut, mustard.
Other sources :- rice, wheat and
jowar.

12. Carbohydrates
3rd major component of food.
It is found in cereals, fruits & vegetables & is essential
in the diet as a source of both glucose and cellulose,
the major source of energy..
Carbohydrate reserve of a human adult is about 500
gms, which is rapidly exhausted when a person is
fasting.

13. Functions of carbohydrates
They supply energy( 4 kcal /1 gm).
They are essential for the oxidation of
fats.
They are required for the synthesis of
certain non- essential amino acids.
3 main sources of carbohydrates are :-
starches, sugars and cellulose

14. Vitamins
It is a substance which must be obtained by dietary
means because of a lack of capacity in the human body
to synthesize it.
Classification of vitamins :
1.Fat soluble :- A, D, E & K.
2.Water soluble :- B & C.

15. Vitamin A
It is widely distributed in :-
Animal foods :- liver, eggs, butter, cheese, fish & meat).
Plant foods :- green leafy vegetables like spinach, papaya,
mango, carrots.
Fortified foods :- vanaspati, fortified milk.
The recommended daily intake is 600 micrograms for adults.

16. Functions
1.It contributes to the production of retinal pigments. It is
indispensable for normal vision.
2.It is necessary for maintaining the integrity & normal function
of the glandular & epithelial tissues.
3.It supports skeletal growth.
4.It is anti – infective.
5.It may protect against some cancers.

17. Deficiency Manifestations

18. Vitamin D
Can be produced in the body in adequate amounts by
simple exposure to sunlight.
It is synthesized by the action of ultraviolet rays on 7-
dehydrocholesterol.
Vitamin D is also found in foods of animal origin like liver,
egg yolk, butter and cheese.
The daily requirement is 2.5 micrograms (100 IU) for adults.

19. Functions of Vitamin D
1.It promotes intestinal absorption & renal tabular
reabsorption of calcium and phosphorus.
2.Stimulates mineralization of bone & enhances bone
resorption.
3.Permits normal growth.
Deficiency of vit. D causes – Rickets & Osteomalacia.

20. Vitamin E: (Tocopherol)
Richest sources are :
vegetable oils, egg yolk,
butter, corn, nuts, olives,
green leafy vegetables etc.
Daily requirement of vit. E is
0.8 mgms/ gm of essential
fatty acids.

21. Vitamin k :
Vit. K occurs in two forms :
 (a)Vit. K1 : it is present in fresh green leafy vegetables & cow‘s
milk.
 (b) Vit. K2 : it is synthesised by the intestinal bacteria. Stored in
liver.
Vit K is necessary for the synthesis of coagulation factor || & |X.
Daily requirement :- 0.03 mg per kg for adults.

22. Deficiency of Vitamin K
1.Significant bleeding
2.Poor bone development.
3.Osteoporosis.
4.Increased risk of
cardiovascular diseases.

23. The B- Complex Vitamins :
Thiamine (Vitamin B1) :
Sources :- whole grain cereals, wheat, gram, pulses, fish, milk,
meat, egg, groundnuts.
Daily requirement :- 0.5 mg/ 1000kcals of energy intake.
Deficiency :- (a) Beri Beri
 (b) Wernicke‘s encephalopathy.

24. Riboflavin (Vitamin B2)
Sources :- milk, eggs, liver, kidney, nuts & green leafy vegetables.
Daily requirement :- 0.6 mg/1000 kcal of energy.
Deficiency is associated with :-
1. Angular stomatitis.
2. Cheilosis.
3. Glossitis.
4. Magenta coloured tongue.

25. Niacin (Nicotinic acid)
Required for the metabolism of carbohydrates, fats & proteins.
For the normal functioning of the skin, intestinal & nervous
system.
Sources :- liver, kidney, meat, fish, legumes & groundnut.
Recommended daily allowance :- 6.6mg/1000kcal of energy.

26. Deficiency
Deficiency results in Pellagra,
characterised by the 3 D’s :
1.Diarrhoea.
2.Dermatitis.
3.Dementia.
Other features are glossitis &
stomatitis.

27. Pyridoxine (Vitamin B6)
Sources :- yeast, cereals,
pulses, oil seeds, egg, milk,
meat, fish & green leafy
vegetables.
Requirement :- 1-2 mg/ day.

28. Pantothenic acid
It plays a role in the
biosynthesis of
corticosteroids.
Sources :- yeast , liver &
egg.
Daily requirement :- 10
mg/day.

29. Folate ( Folacin Or Folic acid)
Sources :- liver, meat, dairy products, egg, milk, fruits & cereals.
Daily requirement :- 100 micrograms for adult.
Deficiency causes :-
1. Megaloblastic anemia.
2. Glossitis.
3. Cheilosis.
4. Diarrhoea.

30. Vitamin B 12
Sources :- liver, curd, meat, fish, egg, milk & cheese.
Requirements :- 1-2 micrograms / day.
Deficiency:-
1. Megaloblastic anemia.
2. Glossitis of tongue & pale skin.
3. Memory loss, confusion, dementia & depression
4. Fatigue, weakness & palpitations.

32. Vitamin C (Ascorbic acid)
Sources :- fresh fruits, green leafy vegetables & germinating
pulses.
Requirement :- 60mg / day.
Deficiency:- results in Scurvy which is characterised by :-
1. Swollen & bleeding gums.
2.Subcutaneous bleeding & bruising.
3.Delayed wound healing.
4.Anemia.

33. Minerals
Classification of minerals :-
1.Major minerals :- Calcium, phosphorous, sodium,
potassium & magnesium.
2.Trace elements :- iron, iodine, zinc, copper, cobalt,
nickel.
3.Trace contaminants with no known function :- lead,
mercury, barium, boron, aluminium.

34. Calcium
Sources :- milk & milk products, eggs & fish.
Requirement :- 400-500 mg / day for adults.
Deficiency :-
1.Tetany & muscle spasm.
2.Hypertension.
3.Formation of kidney stones.
4.Osteoporosis & fragile bones.

35. Calcium
Functions:-
1.Formation of bone & teeth.
2.Coagulation of blood.
3.Contraction of muscles.
4.Milk production.
5.Keeping the cell membrane intact.
6.Metabolism of enzymes & hormones.

36. Phosphorous
Function :- formation of bone & teeth.
Requirement :- 500 mg / day.
Deficiency :-
1.Spontaneous fractures.
2.Decreased fertility.
3.Dull hair coat.
4.Decreased growth.

37. Iron
Required for :-
1.Formation of haemoglobin.
2.Brain development & function.
3.Regulation of body temperature.
4.Muscle activity.
Sources :- meat, liver, fish, cereals, green leafy vegetables &
nuts.

38. Iron
Deficiency :-
1.Iron deficiency anemia.
2.Impaired cell mediated immunity.
3.Reduced resistance to infection.
4.Increased mortality & morbidity.

39. Balanced diet
 A balanced diet is one which contains a variety of foods in such quantities
& proportions that the need for energy, amino acids, vitamins, minerals,
fats, carbohydrates & other nutrients is adequately met for maintaining
health, vitality & general well-being & also makes a small provision for
extra nutrients to withstand short duration of leanness.
 A balanced diet contains :- (a) Proteins :- 10-15%
 (b) Fats :- 15-30%
 (c) Carbohydrates :- Remaining part

40. Food Guide Pyramid
Helps to choose
a variety of
food to help
achieve a
balanced diet.

41. Eat the right food
According to the Healthy Eating Food Pyramid, we have to eat a
variety of foods among all food groups as well as within each
group in order to get different nutients.
Eat the right amount :- everyday we need a specific amount of
nutrients to maintain optimal health. If we don’t eat enough,
under nutrituon & symptoms of deficiency are likely to develop,
while over-nutrition & obesity can be resulted when we consume
an excessive amount of any type of food.

42. Healthy Eating Food Pyramid
Eat most – Grains.
Eat more – vegetables & fruits.
Eat moderately – meat, fish, egg & alternatives (including
dry beans) & milk alternatives.
Eat less – Fat/oil, salt & sugar.
Drink adequate amount of fluids (including water, tea, clear
soup etc) every day.

43. Recommendations by the expert committee
of WHO are:-
Dietary fat should be limited to 15-30% of total dietary intake.
Saturated fats – not more than 10% of total energy intake.
Excessive consumption of refined carbohydrates to be avoided.
Salt intake reduced to not more than 5gm/ day.
Protein – 10-15% of daily intake.
Reduced consumption of colas, ketchups & other foods that supply
empty calories.

44. Effect of Nutrition on Oral Tissues
Nutrition & Dental Caries:-
Pre-eruptive effects :-
Enamel maturation, physical & chemical
composition, time of eruption, tooth
morphology & size are affected.
Inadequate quantities of calcium,
phosphorous & iron leads to caries.

45. Dental Dysplasia associated with
malnutrition.
1.Odontoclasia in deciduous dentition.
2.Yellow teeth in permanent dentition.
3.Infantile melanodontia.
4.Linear hypolpasia of deciduous incisior
teeth – due to deficiency of ascorbic acid
or Vit A Or neonatal infection.

46. Post – eruptive effects
Protein deficiency – decreased salivary Lysozyme
& secretary IgA levels leads to increased caries
susceptibility especially in children.

47. Trace elements in dental caries
Navia JM(1972) has summarized the cariogenic effect of
minerals as:-
Cariostatic elements : F, P.
Mildly cariostatic : Mo, V, Cu, Sr, B, Li, Au.
Doubtful : Be, Co, Mn, Sn, Zn, Br, I.
Caries inert : Ba, Al, Ni, Fe, Pd, Ti.
Caries promoting : Se, Mg, CD, Pt, Pb, Si.

48. Nutrition & Malocclusion
Tooth sizes are determined genetically in a much shorter time span.
Whereas, jaw size determination takes longer.
A chronic postnatal malnutrition would result in stunted jaw
development after the teeth have differentiated. This may result in :-
Class | malocclusion.
Poor tooth alignment & crowding resulting in increased caries &
periodontal diseases.

50. Nutrition & Periodontal diseases
Periodontal diseases involve episodic, progressive
disruption of several different tissues.
Iron :-obligate factor in collagen metabolism.
Deficiency leads to :-
Impaired neutrophils, bactericidal activity, reduced
lymphocyte proliferation & response to antigens –
increasing risk of infection.

51. Iron
 Reduced thickness of epithelium, reduced size
of its progenitor cells & delayed maturation of
the epithelial barrier.
 In iron deficiency anemia – gingiva is pale.
Protein:-
 Deficiency causes increased periodontal
infections while supplementation reduces
inflammation & tooth mobility.

52. Vitamin A & K
Vitamin A :- important in synthesis of proteoglycans,
fibronectin & type | procollagen & in epithelial tissue
differentiation.
Deficiency :- Decreased Salivary flow, hyperkeratosis &
gingival hyperplasia.
Vitamin K :- deficiency causes gingival bleeding & post
extraction haemorrhage.

53. Gingival bleeding

54. Vitamin C & B- complex
Vitamin C :- gingivitis with hemorrhagic, enlarged bluish red
gingiva & reduced salivary flow are the classical signs of scurvy.
In severe Ascorbic acid deficiency teeth may exfoliate.
Vitamin B complex :- deficiency affects epithelium of mouth &
lips.
Niacin deficiency predisposes gingiva to Vincent’s infection or
ANUG.

55. Bluish –red hemorrhagic
gingiva in Vit C deficiency
ANUG seen in Niacin deficiency

56. Calcium & phosphorous
Calcium decreases gingival
inflammation, calculus formation,
pocket depths & tooth mobility.
A low calcium & low calcium-to-
phosphate ratio is positively
correlated with severe alveolar ridge
resorption.

57. Amino acids
Linoleic acid deficiency causes dermatitis & impaired wound
healing while excess acts as an immunosuppresant.
Argininie deficiency:- compromises cellular immune mechanisms,
particularly T-cell function.
Omega-3 fatty acid deficiency:- neurological deficits, dermatitis
& immunological changes while excess improves cell mediated
immune response.

58. Nutrition & oral cancer
Food contain both initiators & modifiers of
carcinogenesis.
Most chemical carcinogens require enzymatic
activation.
The primary enzyme system responsible is the mixed
function oxidase system – significantly affected by
nutritional status.
High intake of saturated animal fats are associated
with an increased risk of cancer of mouth & pharynx.

59. Nutritional factors protect against
tumorogenesis by :-
Acting as blocking agent.
Altering metabolism of the carcinogens through decreased
activation.
Increased detoxification.
By scavenging the active molecular species of carcinogens.
Competitive inhibition.

60. Vitamin A & Retinoids
Inhibits chemically – induced tumors in various tissues.
Less toxic synthetic analogs, the retinoids are effective
in preventing carcinogenesis.
They are used topically & systematically & found
successful in the treatment of oral leukoplakia.

61. B carotene (which is metabolised
to vitamin A)
Is an antioxidant & free radical scavenger.
Inverse relationship is seen between incidence of oral
cancer & dietary availability of B carotene/ retinoids &
vit C.
They show reduction in lesion size or stabilization of
leukoplakia.

62. Vitamin C
It is an antioxidant.
Negatively associated with risk of oral cancer.
Inhibit formation of N-nitroso (nitrosamine)
compounds & mutagenicity of certain direct acting
mutagens.

63. Vitamin E
Users have half the risk of developing oral cancer
compared to non-users.
An antioxidant, also a free radical scavenger.
Blocks nitrosamine formation.
Influences humoral & cell mediated immunity.
Increases cell repair capacity.

64. Vitamin B Complex
Deficiencies include gross thiamin & moderate riboflavin
deficiencies.
Food stuffs :- risk of cancer of the mouth & pharynx is halved in
those who eat fruit or vegetables daily.
Fish, butter, milk, orange, cabbage, seafood are protective
against oral cancers.
They also reduces the risk of oral carcinogenesis in smokers &
betel nut chewers.

65. Nutrituon in elderly
An inability to chew food thoroughly because of an
inadequate or poorly Functioning dentition.
Appetite is diminished due to lacking of flavourful
tastes..
Dental & medical infirmities that interfer with chewing
digestion & metabolism.

66. Alveolar Osteoporosis
Alveolar bone participates in the maintenance of body
calcium balance making it susceptible to osteoporosis.
In the elderly there is a relative increase in bone disease
& resorption compared with deposition.

67. Preventive & social measures at
various levels
Action at family level :-
Thorough nutrition education about the selection of the right
kind of foods & planning for nutritionally adequate diets.
Promotion of breast feeding, improvement in infant & child
feeding practices.
Promoting kitchen garden & keeping poultry.
Community health workers & myltipurpose workers can impart
nutritional education.

68. Action at community level
Analysis of the extent, distribution & types of
nutritional deficiencies,population group at risk, dietary
& non-dietary factors contributing to malnutrition.
Conduct of diet & nutritional surveys.
Planning realistic &feasible approaches in developing
countries, direct intervention measures to be started.

69. Action at National level
By rural development.
Increasing agricultural production.
Stabilization of population.
Nutritional & intervention programs.
Nutrition related health activities (Malaria eradication
programme).

70. Action at International level
FAO, UNICEF, WHO, World Bank, UNDO & CARE
are some agencies helping national government
in different parts of the world in their battle
against malnutrition.