2 The Link… Oral health is closely linked to an individuals diet and nutritional status. Nutrition is a vital factor---
The Link… Throughout life, nutritional deficiencies or toxicities can affect host resistance, healing, oral function, and oral-tissue integrity Growth, development, and maintenance of oral structures and tissues are dependent on nutrition
A little history….. Before your time http://www.choosemyplate.gov/food- groups/downloads/MyPlate/ABriefHistoryOfUSDAFoodGuides.pdf
17 VITAMINDEFICIENCY OR EXCESS Vitamin C Asorbic acid Collagen synthesis- helps with use/absorption of iron, B12 & folic acid; connective tissue synthesis; cell protector Deficiency: Scurvy-red swollen gingiva; gingival friability- spontaneous bleeding; periodontal destruction- including loose teeth; soft tissue ulceration; increased risk of candidiasis; malformed teeth (odontoblast/dentin); petechial hemorrages/gingivitis; cyanotic gingival tissues; essential for collagen formation (fibroblasts & odontoblasts too); slow wound healing Excess: Body increases metabolism of vitamin C when taken in excess; no oral effects noted Vitamin D Promotes growth & mineralization of bones/teeth; increases absorption calcium Deficiency: Abnormal bone regeneration (failure of bone to heal), osteoporosis; incomplete mineralization of teeth - (hypoplasia); rickets in children; osteomalacia in adults; delayed eruption; high caries rate; loss of lamina dura Excess: Pulp calcification; enamel hypoplasia Vitamin K Vital for blood clotting; involved in formation of prothrombin Deficiency: Increased risk of bleeding/gingival hemorraging; increased risk of candida Vitamin A Antioxidant- maintains epithelial tissues; involved in bone growth & remodeling; important for vision Deficiency: faulty bone & teeth formation, disturbed or arrested enamel development (ameloblast)- hypoplasia, keratosis, increased risk of candidiasis; gingival hypertrophy & inflammation; leukoplakia; decreased taste sensitivity; xerostomia; irregular tubular dentin formation and increased caries risk, cleft lip, salivary gland hardening/drying; cell differentiation impaired; Excess: cracking/bleeding lips, erythremic gingiva, cheilosis, hypertrophy of bone Riboflavin B2 Coenzyme in metabolism carbs, protein, fat Deficiency: Angular cheilosis; atrophy of filiform papillae; enlarged fungiform papillae; shiny red lips; sore tongue (glossitis); blue-to-purple mucosa; magenta tongue Vitamin E Antioxidant; involved in cellular respiration Deficiency: loss of resistance to inflammation Niacin B3 Coenzyme in energy production Deficiency: mucositis; stomatitis; oral pain; ulcerative gingivitis; tip of tongue is red & swollen; dorsum is dry & smooth (loss of filiform/fungiform); beefy sore tongue Deficiency versus excess: VITAMINS
18 Deficiency versus excess: VITAMINS VITAMINDEFICIENCY OR EXCESS Folic acid (Folate) Involved in RNA & DNA synthesis- also WBC/RBC formation Deficiency: Angular cheilosis; mucositis; stomatitis; sore or burning mouth; increased risk of candidiasis; inflamed gingiva; glossitis oral pain; ulceration- buccal mucosa/ gingivitis; denuded tongue; glossitis; glossodynia; tip or borders of tongue red & swollen; apthous ulcers; neural tube defects- very important for expectant mothers B6 Pyridoxine Coenzyme in amino acid metabolism; role in hemoglobin Deficiency: Angular cheilosis; sore or burning mouth; glossitis; glossodynia; stomatitis B12 Cobalamin Coenzyme for metabolism; important in RBC formation & DNA synthesis Deficiency: Angular cheilosis; mucositis; stomatitis; hemorrhage gingiva; halitosis; epithelial dysplasia of oral mucosa; oral parethesia; detachment of periodontal fibers; loss or distortion of taste; parasthesia; glossitis; ulcerative gingivitis; denuded tongue; glossodynia; tongue is "beefy", red, smooth, glossy & sore; delayed wound healing; xerostomia; bone loss; apthous ulcers; pernicious anemia; pale- yellow mucosa
19 MINERALDEFICIENCY OR EXCESS Fluoride Deficiency: Decreased resistance to caries Excess: Disturbed amelogenesis; mottled/stained enamel; enamel hypoplasia (fluorosis) Iron Deficiency: Angular cheilosis; pallor of lips and oral mucosa; sore, burning tongue; atrophy/denudation of filliform papillae; increased risk of candidiasis; glossitis around margins, anemia; fatigue; decreased immunity; thinning/ulcerated tissues Important for synthesis of hemoglobin; essential for immune function; most common deficiency in US Calcium Deficiency: Incomplete mineralization of teeth (hypomineralization), rickets; osteomalacia (bone softening); osteoporosis; excessive bone resorption & bone fragility; increased tendency to hemorrhage; increased tooth mobility & premature loss; delayed eruption; less than 1/3 intake absorbed esp with excess wheat/fiber – important for woman as they age- helps with muscle contraction & nerve impulse CopperDeficiency: Decreased trabeculae of alveolar bone; poor growth, low WBC, anemia; decreased tissue vascularity; increased tissue fragility Zinc Deficiency: Loss or distortion of taste & smell acuity; loss of tongue sensation; defective keratinization of tissues, delayed wound healing & growth; impaired keratinization of epithelial cells, increased susceptibility to periodontal disease & infection, candidiasis Required by cells- tissue growth & repair; regulates inflammation Magnesium Deficiency: Alveolar bone fragility; gingival hypertrophy & atrophy ameloblast/odontoblasts; tremors, cardiac arrhythmias, muscle spasms, convulsions; widening of perio ligament Phosphorus Deficiency: Incomplete mineralization/calcification of teeth; increased susceptibility to caries if deficient during tooth formation; increased susceptibility to periodontal disease due to effects on alveolar bone MINERALS
20 NUTRIENTDEFICIENCY OR EXCESS Carbohydrate Energy– brain food Deficiency: Caries rate generally decreases when carbohydrate intakes decreases Excess: Increased frequency of intake of all carbohydrates is a causative risk factor for caries Fats Source of energy; cariostatic Deficiency: difficult to have Excess: No direct effect orally but fats may coat teeth and protect them againts cariogenic challenge; if excess physically = obesity Protein Source of energy- esp when carb intake low; cariostatic; promotes growth, maint, & synthesis of body tissues Deficiency: Defects in tooth composition, eruption pattern delayed & resistance to decay lowered due to increase in tooth enamel solubility; increased susceptibility to soft tissue infection, poor healing/tissue regeneration due to impaired immune system; kwashiorkor if severe (3 rd world) Water Hydration & electrolyte balance Deficiency: Dehydration and fragility of epithelial tissue; decreased muscle strength for chewing; xerostomia; dry skin; burning/fissured tongue; common in elderly (lots meds) OTHER NUTRIENTS from Modern Nutrition in Health and Disease (9th ed) Editors: Shils; Olsen; Shike & Ross. Published by Williams & Wilkins. Mosbys Review of DH 7 th edition; Mosbys Dental hygiene case 2 nd edition
21 Role of Nutrition in Periodontal Disease * Certain nutritional deficiencies can modify gingival tissue resistance so that an inflammatory condition (initiated by BIOFILM) may be accelerated or increased in intensity * The effects of periodontal infection can alter the capacity of the tissues to utilize available nutrients-therefore, potential for healing and repair is modified *Malnutrition compromises tissue regeneration and healing which increases susceptibility to oral disease
Role of Nutrition in Periodontal Disease 22 Vitamin C-- effects collagen; immunity– increased risk of deficiency in smokers; increase risk for perio Zinc- response to inflammation; increase permeability tissues if deficient Others? B complex, Vitamin A, etc… Important to counsel PERIO pts on proper nutrition Calcium- increased risk for disease (bone) Protein- poor healing/regeneration; impairs immune system
Nutrition for a lifetime- through the Life Cycle….. 23
24 The Diabetic Patient Meals and snacks at regularly scheduled intervals, coordinated with medication and exercise Use of cariogenic fermentable carbohydrates should be infrequent Looks at carbs not just sugars Uncontrolled should be referred to M.D.- although even controlled should be under care of physician and nutrition professional Heal slower/periodontal disease can exacerbate diabetes control Periodontal disease much more advanced, harder to get control of & treat
25 The Aging Patient Considered particularly susceptible to malnutrition- WHY?
29 Obesity According to the National Center for Health Statistics, the number of overweight children has more than doubled since the 1960s. Children who gain too much weight are at high risk for developing risks for heart disease- and Type II Diabetes.
Why is it in foods? Is it habitual? Is it related to weight? What should I limit my diet to (in mgs)? Do organic foods or low fat foods usually have higher or lower salt? What recommendations can I make to patients?
39 The Vegetarian, Vegan Diet & Others? Can be extremely nutritious, since it is high in fiber and low in saturated fats However, care must be taken to get all nutrients needed for health Key is- balance & varied diet (not replacing meat with processed foods) Other things to consider... ? Tips for Vegetarians
40 Vitamin Supplements Never going to supplement what you get from a balanced diet! However, most dont have balanced diet– so multivitamin can be helpful (Up to 40% of adults have inadequate dietary intake of 3 or more nutrients) People tend to overuse supplements- can be detrimental & cost $$$ Vitamins should not exceed the recommended dosage and take in forms which can be metabolized properly Be wary of health claims! Many, many NOT standardized or backed by scientific research
Interactions? 42 OTC and herbal supplements have their own adverse reactions just like Rx medications OTC and herbal supplements interact with Rx medications and with each other Herbal supplements are not regulated by the FDA as OTC and Rx medications are Lack scientific studies
May increase the risk of bleeding – Garlic* – Ginger* – Gingko biloba* – Ginseng* – Green tea May induce coagulation – Vitamin K – Goldenseal – Dong quai – Garlic *These agents have multiple adverse reactions 43 These may increase blood pressure – Green tea – Ephedra/ma huang – Ginseng* – Licorice – Guarana
St. Johns Wort also contraindicated with psychoactive drugs, warfarin, estrogen, iron, & oral contraceptives Several have effects on blood glucose levels Melatonin may exaggerate an autoimmune response and suppress fertility 44 T or F? Herbal supplements are very safe to the human body because they are made from plants and other compounds naturally occurring in nature and are highly regulated by the FDA.
Eating Disorders Anorexia nervosa: self-starvation and excessive weight loss Bulimia nervosa: usually secretive cycles of binge eating extremely large quantities of food followed by purging through vomiting Binge-eating disorder (BED): has periods of uncontrolled, continuous eating much like bulimia, but no purging is involved. Body weight varies greatly in this group