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Nutrition in dentistry

This document provides information on nutrition and balanced diets. It defines key terms like nutrition, diet, and nutrients. It describes the classification of foods by origin, chemical composition, predominant function, and nutritive value. The major nutrients of proteins, fats, carbohydrates, vitamins, and minerals are explained. A balanced diet is outlined as one containing different types of foods in adequate quantities and proportions to meet energy and nutrient needs. Recommended dietary allowances and nutritional assessment methods are also summarized.”

Health & Medicine◦
Dept. of Public Health Dentistry PCDS & RC
LEARNING OBJECTIVES • Definitions • Classification of foods and nutrients • Balanced diet • Know about various nutrients and their RDA • Other Aspects of nutrition.
Nutrition : The Science Of Food And Nutrients, Their Action And Interaction For Health And Disease, And The Ways By Which The Organs Ingest, Digest And Excrete. DEFINITION… Diet : The Sun Total Of Food Taken By An Individual. Nutrients : The Substances That Enable Cells And Tissues To Carry Out Vital Functions.
BY ORIGIN CLASSIFICATION OF FOODS BY CHEMICAL COMPOSITION BY PREDOMINANT FUNCTION BY NUTRITIVE VALUE 1.Animal Food 2.Vegetable Food Proteins, Fats, Carbohydrates, Vitamins, Minerals 1.Body building foods : PROTEINS 2.Energy giving foods: CARBOHYDRATES/FATS 3. Protective foods : VITAMINS & MINERALS 1.Cereals & millets 2.Pulses 3.Vegetables 4.Nuts and oilseeds 5.fruits 6.Animal foods 7.Sugar and jaggery 8.Fats and oils 9.Condiments and spices 10.Misc.
PROTEINS FATS CARBOHYDRATES VITAMINS & MINERALS
ONE WHICH CONTAINS DIFFERENT T YPES OF FOODS IN SUCH QUANTITIES AND PROPORTIONS THAT THE ENERGY, AMINO ACIDS, VITAMINS, MINERALS IS ADEQUATELY MET FOR MAINTAINING HEALTH, VITALIT Y AND GENERAL WELL BEING. IT ALSO MAKES PROVISION FOR EXTRA NUTRIENTS REQUIRED DURING DIFFICULT PERIODS. BALANCED DIET THERE IS NO SINGLE FOOD THAT CONTAINS ALL THE NUTRIENTS. The Recommended Dietary Allowances (RDA) is a guideline for the nutrient intake setup by the Food and Nutrition Board. - RDA is the recommendation for the average daily amounts of nutrients which should be consumed over a period of time.
“The FOOD GUIDE PYRAMID” : a nutritional education guide emphasizes foods from the five major food groups shown in lower 3 sections of pyramid.
BALANCED DIETS :
REFERENCE BODY WEIGHTS
NUTRITIONAL ASSESSMENT ANTHROPOMETRY PRESCRIBED BY WHO/ICMR
BASAL METABOLIC RATE (BMR) NUTRITIONAL ASSESSMENT The amount of energy expended while at rest in neutral temperature environment, in past absorptive state (meaning that digestive system is inactive, which requires 12hrs. of fasting in humans).
PROTEINS Chief Body building foods. Formed from smaller components - Amino Acids. AA : 20 in number • Essential AA • Non-Essential AA Classified : 1. Animal proteins - eggs, meat, milk. 2. Vegetable proteins - pulses, cereals, nuts, beans etc. Functions : 1. body growth and maintenance 2. precursors of important compounds 3. maintain fluid balance 4. important role in nutrient transport
PROTEIN REQUIREMENTS 1gm/kg for an Indian adult, assuming a net protein utilization (NPU) =65. - ICMR
ASSESSMENT OF PROTEIN NUTRITION STATUS ▪ Protein nutrition status is measured by Serum Albumin Concentration. ▪ It should be more than 3.5 g/dl. ▪ Less than 3.5 g/dl shows mild malnutrition. ▪ Less than 3.0 g/dl shows severe malnutrition. Kwashiorkor : protein deficiency during 1-5 years. Marasmus : protein deficiency in infancy (0-1 year).
FATS - A concentrated source of energy. - Supplies double the energy furnished by either proteins or carbohydrates. THE MOST IMPORTANT ESSENTIAL FATTY ACID IS LINOLEIC ACID.
A total of 40-60gm of fat can be consumed daily, so that it contributes to 15-20% of the calories in diet. RDA for reference man and woman : 20gm/day.
CARBOHYDRATES - The main component of food. - Main source of energy. (1gm = 4Kcal) - Provide 85-90% of energy. - Carbohydrate reserve of human adult is 500gm.
CARBOHYDRATE REQUIREMENTS
VITAMINS “VITAL” (LIFE) “AMINE” (CHEMICAL COMPOUND)
MINERALS & TRACE ELEMENTS Inorganic substances required by the body. Elements, whose daily requirements is more than 1.0mg are grouped as minerals. (Ca, Ph, Fe) Other elements required in traces (Co, Cu, Mn)
WATER • Important constituent of diet- comprising both intra and extracellular component of the body. • Constitutes 2/3rd of human body. • A normal man of approx. 65kg contains 40 liters of water. The total fluid intake requirement is: 1200ml for 1 year olds. 1500ml for 5 year olds. >3000ml per day for adults. Water depletion: dehydration, mental confusion, vertigo, skin becomes doughy, RBF reduced.
OTHER ASPECTS OF NUTRITION FOOD BORNE DISEASES
FOOD FORTIFICATION The process whereby nutrients are added to foods to improve the quality of food. Eg : Common salt (NaCl) is fortified with Iodine. Vanaspati ghee is deficient in Vit. A &D (as compared to animal fat.), so it is fortified with Vit. A & D. FOOD ADULTERATION The process of mixing, substituting, concealing, putting up of decomposed foods for sale, misbranding or giving false labels. Eg: Mixing water with milk. Non-permitted colors used by sweet makers Green dye used in green peas packing.
Dept. of Public Health Dentistry PCDS & RC Part II
LEARNING OBJECTIVES • Carbohydrates and related diseases • Fats and related diseases • Proteins and related diseases • Vitamins and related diseases • Trace elements and related diseases
CARBOHYDRATES SYSTEMIC DISEASES • Obesity • Diabetes • Cardiovascular diseases • Glycogen storage disease • Fructosuria, Galactosemia • Pentosuria ORAL DISEASES • Increased incidence of caries and periodontal diseases • Refined carbohydrates : decalcification of enamel and dentin.
If ingested in excess, will be deposited in adipose tissue. ATHEROSCLEROSIS : cholesterol in arterial walls - CHD (LDL, VLDL: harmful, HDL: protective.) OBESITY leading to DM, Arterial HTN, etc. PHRENODERMA : rough n dry skin- “toad skin”. (Kerala, Karnataka, Gujarat) CANCER : increased risk of colon and breast cancer. Fat free diet produces essential fatty acid deficiency. FATS WHO/FAO expert group: total fat 15-30% energy is consistent with good health.
Protein deficiency usually occurs at age of 1-5 yrs. Early weaning and poor SES are common causes. MARASMUS : (0-1 yr) • wasting, nearly complete loss of body fat. • retarded development • mental changes • changed texture of hair • frequent diarrhoea KWASHIORKAR : (1-5 yr) • hypoalbuminemia • edematous fatty liver • dermatosis (skin shows diffused pigmentation) • GI disturbances, poor appetite • psychic changes • sparse and silky hair (Flag sign) PROTEINS
Protein deficiency in adults usually seen in hospitalized patients : Chronic alcoholics and other drugs addicts as they have irregular food habits. Patients suffering from GI disorders as they may not be able to eat, digest and absorb protein. Surgical patients with sever injuries, burns have increased nitrogen loss and are unable to feed normally. Chronic renal disease: patients lose large amount of protein through urine. Hepatic disease: patients are unable to synthesize proteins from amino acids.
SYSTEMIC DISEASES : Eyes- Xerosis (dryness), Keratomalacia (softness of cornea), Corneal Opacities, Night blindness. Skin- dry and rough with hyperkeratinization, atrophy of sweat glands. Respiratory Tract- keratinization of bronchopulmonary epithelium - increased susceptibility to infection. GIT - unhealthy GI mucosa - recurrent diarrhea Urinary Tract- increased tendency to urinary stone formation. Reproductive system- sterility due to faulty spermatogenesis. Growth Retardation Immune deficiency VITAMINS VITAMIN A (Beta Carotene) HYPOVITAMINOSIS A HYPERVITAMINOSIS A ACUTE: headache, drowsiness, irritability, rise in intracranial tension, vomiting, liver enlargement, shedding of skin. CHRONIC: weight loss, nausea, vomiting, dryness of mucosa of lips, bone and joint pain, hepatomegaly.
ORAL DISEASES Oral Mucosa : hyperkeratotic or follicular keratotic changes in oral epithelium. Gingival Epithelium : hyperplastic and hyperkeratotic. Enamel Organ : atrophy, degeneration of odontoblasts - poor calcification- enamel hypoplasia. Atrophy of salivary glands- reduced salivary flow. Cementum : irregular cemental resorption, ankylosis of teeth. Eruption Rate : retarded Alveolar bone: atrophy in severe cases HYPOVITAMINOSIS A HYPERVITAMINOSIS A ORAL DISEASES Mesenchymal tissues are highly sensitive. Rate of resorption of alveolar bone is reduced, as a result the bone becomes abnormally thin.
VITAMIN D D1 D2 : Calciferol D3 : CholecalciferolDEFICIENCY RICKETS in children. OSTEOMALACIA in adults. RICKETS • Overgrowth of epiphyseal cartilage. • Persistence of distorted, irregular masses of cartilage. • Deposition o osteoid matrix in inadequately mineralized cartilaginous remnants. • Disruption of orderly placement of cartilage by osteoid matrix. • Deformation due to loss of structural rigidity of developing bones. OSTEOMALACIA • Contours of bones are not affected. • Bone is weak and vulnerable to gross fractures. • most likely affected- vertebral bodies and femoral necks.
Oral Manifestations : Eruption of teeth is retarded. Enamel hypoplasia. Osteoporosis of alveolar bone • Reduction in width of PDL space. • Defective calcification of cementum • Distortion of growth pattern of alveolar bone.
HYPERVITAMINOSIS D Induces a very intense calcification of bone. Formation of renal calculi and adrenal dysfunctions. When ingested- most toxic vitamin. EFFECT ON TEETH AND PERIODONTIUM • Irregular dentin formation and pulp stones. • Alveolar bone, Periodontal membrane and gingiva become hypercalcified. Cementum deposition increases excessively leading to ankylosis. • Excessive amount of calculus. • Rampant caries, thinning of enamel, dentin and alveolar process. •Pulpal calcification.
DEFICIENCY Nervous System : Anatomic changes in nervous system. Clinical manifestations depend upon severity and extent of lesions. Most consistent- Depressed tendon reflexes, Ataxia, Dysarthria, Loss of pain sensation. Blood : Hemolytic and hypoplastic anemia. Mesenchymal Tissues : Degenerative lesions in skeletal muscles and heart. VITAMIN E (Alpha Tocopherol) HYPERVITAMINOSIS E Least toxic vitamin. Hypervitaminosis has yet not been described.
DEFICIENCY Development of a bleeding diathesis characterized by hematomas, hematuria, malena and ecchymoses. In neonates, most serious manifestation is intracranial hemorrhage. Bleeding may occur at any site, including skin, umbilicus, viscera. VITAMIN K K1 (Phytodione) K2 (Menadione) ORAL DISEASES Gingival bleeding (most common) Prothrombin levels <35% - Bleeding during brushing. Prothrombin levels <20% - spontaneous gingival hemorrhage.
Mainly hits the peripheral nerves, brain and heart. Beri Beri VITAMIN B1 (Thiamine) DEFICIENCY Dry Beri Beri (poluneuropathy) Non specific peripheral neuropathy with myelin degeneration and disruption of axons, involving motor, sensory and reflex arcs. Wet Beri Beri It leads to peripheral vasodilation, subsequently more rapid AV shunting of blood. Peripheral edema. Wernicke-Korsakoff Syndrome It is mostly encountered in chronic alcoholics. Opthalmoplegia, Nystagmus, ataxia of gait, derangement of mental function characterized by confusion, restlessness, disorientation.
No specific lesions. Hypersensitivity of oral mucosa seen. Oral and facial neuralgias and pain, herpes simplex, aphthous stomatitis can be treated by thiamine. Edematous swelling of gingiva and lingual papillae and taste impairment may be seen. Oral Diseases HYPERVITAMINOSIS Thiamine is non toxic when taken by mouth. Parenteral administration causes anaphylactic shock in H/S individuals. Contact dermatitis in patients allergic to thiamine.
DEFICIENCY Ariboflavinosis : in economically deprived and developing countries. Angular stomatitis, cheilosis, nasolabial seborrhoea. Eyes : circumcorneal vascularization. accompanied by lacrimation and photophobia. Skin : fine scaly dermatitis on hands, vulva, anus, perineum. VITAMIN B2 (Riboflavin) On Lips : Cheilosis and angular stomatitis. Chronic lesions may develop a yellow crust. Dryness and slight burning sensation. Both angles are equally involved. On Tongue : Lingual papillae are inflamed, flattened and mushroom shaped, giving the dorsum a granular appearance. Tongue may turn purplish red or magenta due to dilation and proliferation of capillaries. Painful and sensitive to food. Oral Diseases
DEFICIENCY Dermatitis : usually bilaterally symmetrical, found on exposed areas of body. Diarrhoea : Caused by atrophy of columnar epithelium of GI tract. Dementia : Due to degeneration of brain accompanied by degeneration of corresponding tracts of spinal cord. VITAMIN B3 (Niacin/Nicotinic Acid) Now fourth D : Death also added as disease is fatal if not treated. PELLAGRA (three D’s) HYPERVITAMINOSIS Due to its action as a vasodilator. Reddening and flushing of skin, increased skin temperature, dizziness, headache, nausea, vomiting, abdominal pain.
Oral Diseases • • Oral Mucosa : entire oral mucosa becomes red and painful. • Tongue : desquamation of epithelium, leaving a scarlet, smooth, dry, beefy tongue. Swelling of tongue with indentations on the margins. Extremely painful and sensitive to food and drinks. • Gingiva : Tenderness, pain, redness, ulcerations begin at interdental papillae and spread rapidly. Salivation becomes excessive, diminished taste sensation. Superimposed ANUG is common. • Dental Caries : Incidence of caries is reduced in niacin deficiency. May be because Nicotinic acid is an essential growth factor for oral microflora.
VITAMIN B4 (Adenine) Synthesized by human body. Does not have much nutritional value. VITAMIN B5 (Pantothenic Acid) Deficiency is rare; Burning feet syndrome No oral manifestations. Curative value in treatment of Glossitis and Cheilitis
VITAMIN B6 (Pyridoxin) DEFICIENCY Rare similar to riboflavin and niacin deficiency. ORAL MANIFESTATIONS: - On lips : bilateral angular cheilosis. - On tongue : glossitis with slight pain, edema, papillary atrophy, purple blue. - Glossitis begins as scalding sensation of tongue followed by redness and hypertrophy of filiform papillae. - Dental Caries : increased incidence of caries as it alters oral microflora to more cariogenic organisms.
VITAMIN B9 (Folic Acid)/Vitamin M DEFICIENCY SYSTEMIC MANIFESTATIONS: Macrocytic Anemia associated with megaloblastic erythropoiesis. Glossitis, stomatitis, diarrhoea. Steatorrhoea- foul smelling, copious, greasy appearing, light, liquid- semiliquid stools. ORAL MANIFESTATIONS: - Tongue : glossitis, seen as swelling and redness along tip and margins. - Minute, whitish aphthous ulcers with fiery red borders may emerge. - Filiform papillae are first to disappear, the fungiform papillae remaining as prominent spots. - Lips : stomatitis, cheilitis, cheilosis with ulcerative lesions.
VITAMIN B12 (Cyanocobalamin) DEFICIENCY SYSTEMIC MANIFESTATONS - Pernicious Anemia Weakness, glossitis, numbness and tingling of extremities. It may lead to severe psychosis. - Macrocytic anemia and homocysteinuria ORAL MANIFESTATONS- - On tongue : recurrent attacks of sore tongue. Tongue becomes fiery red and painful. - On Lips : Chelosis, chelitis, painful mucous membranes affecting buccal mucosa, pharynx, and gingiva.
VITAMIN C (L-ascorbic acid) DEFICIENCY SCURVY - Hemorrhages. - Defect in collagen synthesis resulting in purpura and ecchymosis in skin. - Extensive subperiosteal hematomas. - Skeletal changes in children. : disturbances in formation of osteoid matrix. - Both membranous and endochondral bone formation is affected. - Wound healing and localisation of focal infections are impaired.
ORAL MANIFESTATION GINGIVAL and PERIODONTAL TISSUES : interdental and marginal gingiva is bright red with swollen, smooth, shiny surfaces. Typical foul breath. Severe forms - hemorrhages and swelling in periodontal membranes followed by loss of bone and loosening of teeth.
CALCIUM DEFICIENCY SYSTEMIC MANIFESTATIONS - Rickets - Osteomalacia - Osteoporosis : increased porosity of bone. Seen in elderly patients. - Acidosis : this causes an increased excretion of calcium in urine, leading to rarefaction of skeleton. - Steatorrhoea : excretion of calcium in faeces. - Hypocalcemia : may occur if too much parathyroid tissue is removed, causing diminished mobilization of calcium from bone.
ORAL MANIFESTATIONS - Effect on alveolar bone : marrow spaces become hemorrhagic and get filled with fibro-osteoid tissue. As a result of alveolar bone resorption, teeth become loose. Destruction of PDL. - Effect on teeth : when serum calcium falls as low as 6-8mg/100ml, it results in enamel hypoplasia in developing teeth. - Dental Caries : positive correlation between hypo plastic enamel and dental caries incidence.
MAGNESIUM DEFICIENCY SYSTEMIC MANIFESTATIONS Alopecia, tropic skin lesions, hematoma. Mg interferes with protein synthesis. Depression, hyperirritability, cardiac arrythmias, muscular weakness and convulsions. ORAL MANIFESTATIONS On Enamel Organ : predentin becomes wider, causing dentin-predentin junction to be in different levels, leading to ‘Predentinstep’- characteristic of Mg deficiency. Dentin in labial portion is seriously affected. Incisal area becomes atrophied. On Gingival tissues : gingival hypertrophy with chronic destructive periodontitis - loosening of teeth.
IRON DEFICIENCY SYSTEMIC MANIFESTATIONS Hypochromic microcytic anemia. Chronic fatigue, slightly depressed blood hemoglobin. ORAL MANIFESTATIONS Fissures in labial commissures, superficial glossitis. Pappillae of tongue are atrophied - smooth, shiny and red appearance. Affected oral tissue becomes susceptible to oral cancer. Tongue: ‘patchy irregular denudation of papillae’.
SELENIUM DEFICIENCY SYSTEMIC MANIFESTATIONS Liver necrosis, degenerative changes in parenchymal organs, muscular dystrophy, degeneration of heart muscles, endocardial calcification and pancreatic atrophy. Effect on DENTAL TISSUES Low selenium conc. - Significant antibacterial effect on S. mutans, so it decreases cariogenicity of plaque. Combination of Se and Fluoride - effective as preventive agent against caries.
MANGANESE DEFICIENCY Marked hypocholestrolemia, transient dermatitis, change in color, slow growth of hair and weight loss. IODINE Deficiency - enlargement of thyroid gland causing hypothyroidism, goiter, myxedema. Iodine toxicity - thyrotoxicosis
COPPER DEFICIENCY SYSTEMIC MANIFESTATIONS Microcytic hypochromic anemia. Menke’s Kinkyhair Syndrome (in infants) • severe mental deficiency • steel hair • long metaphyseal abnormalities • micrognathism • neonatal ataxia • hypothermia ORAL MANIFESTATIONS Copper salts decrease plaque formation in humans, thus affecting pathogenesis of caries.
Dr. Aashna Dhingra MDS first year