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Effect of Nutrition and Diet on Periodontal health

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diet and nutritional effect on periodontium

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Effect of Nutrition and Diet on Periodontal health

  1. 1. Effect of N utritionandDiet on teethandPeriodontium Presented To: Dr. AhmadTarabaih PresentedBy: StéphanieChahrouk I D: 201501713 By: Stephanie Chahrouk
  2. 2. outline  Introduction  Definitions  Role of nutrition on PDL and Teeth  Diet History analysis  Diet History recommendation  Conclusion
  3. 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"
  4. 4. Definition
  5. 5. 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
  6. 6. 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
  7. 7. 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”
  8. 8. 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
  9. 9. Prevention of ECC:  Early evaluation of dietary habits  Anticipatory guidance  Appropriate transition to table food  Limited intake of sugared
  10. 10. Types of food Cariogenic Cariostatic anticariogenic
  11. 11. 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
  12. 12. 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
  13. 13. 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
  14. 14. A variety of nutrients have a major impact on periodontal health?!
  15. 15. 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
  16. 16. 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”
  17. 17. 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
  18. 18. 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.”
  19. 19. “  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”.
  20. 20. 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.”
  21. 21. 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
  22. 22. “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.
  23. 23. GINGIVA  Hyperplastic gingival epithelium In prolonged defi: shows keratinization
  24. 24. 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.
  25. 25.  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”
  26. 26. 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.
  27. 27.  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.”
  28. 28. 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”
  29. 29. “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.”
  30. 30. 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
  31. 31. 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.”
  32. 32. Preventive Mesures ???
  33. 33. Reducing Sugar intake
  34. 34. Trace Elements and Caries:
  35. 35. Recommendation Get your oral hygiene on. Seriously. Are you flossing yet? Are you brushing at least twice per day? If not, start.
  36. 36.  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.
  37. 37.  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.
  38. 38.  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.
  39. 39. 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

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