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CHAPTER 8 MINERALS ESSENTIAL FOR CALCIFIED STRUCTURES Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

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Presentation on theme: "CHAPTER 8 MINERALS ESSENTIAL FOR CALCIFIED STRUCTURES Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc."— Presentation transcript:

1 CHAPTER 8 MINERALS ESSENTIAL FOR CALCIFIED STRUCTURES Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

2 2 Bone Mineralization and Growth Calcified structures include bones and teeth Calcified structures include bones and teeth Collagen and bone undergo constant remodeling Collagen and bone undergo constant remodeling Organic matrix of bone is 90%–95% collagen fibers Organic matrix of bone is 90%–95% collagen fibers Formation of collagen requires protein, Formation of collagen requires protein, vitamin C, iron, copper, and zinc Once collagen is formed, mineralization begins Once collagen is formed, mineralization begins Calcium, phosphorus, magnesium, sodium, potassium, and carbonate ions form mineral matrix Calcium, phosphorus, magnesium, sodium, potassium, and carbonate ions form mineral matrix Calcium reserve: 0.4%–10% of total bone calcium in shapeless (amorphous) form Calcium reserve: 0.4%–10% of total bone calcium in shapeless (amorphous) form From Bath-Balogh M, Fehrenbach MJ: Illustrated Dental Embryology, Histology, and Anatomy, ed 2. St. Louis: Saunders, 2006.

3 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 3 Formation of Teeth Crystalline structure of enamel is one of the most insoluble and resistant proteins known Crystalline structure of enamel is one of the most insoluble and resistant proteins known Comparable to hardness of quartz Comparable to hardness of quartz Dentin contains the same constituents as bone, but its structure is more dense Dentin contains the same constituents as bone, but its structure is more dense Cementum is another bone-like substance, but because contains fewer minerals, is softer than bone Cementum is another bone-like substance, but because contains fewer minerals, is softer than bone From Nanci A: Ten Cate’s Oral Histology, ed 7. St. Louis: Mosby, 2008.

4 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 4 Introduction to Minerals Minerals are inorganic elements that have many physiological functions Minerals are inorganic elements that have many physiological functions Inorganic elements in body account for only about 4% of total body weight, or 6 lb for a 150-lb person Inorganic elements in body account for only about 4% of total body weight, or 6 lb for a 150-lb person Minerals subdivided into two categories Minerals subdivided into two categories Those required in larger amounts (major minerals) Those required in larger amounts (major minerals) Those required in smaller amounts (micronutrients or trace elements) Those required in smaller amounts (micronutrients or trace elements)

5 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 5 Physiological Roles: Calcium Most abundant mineral in the Most abundant mineral in the body (~1200 g) 99% in teeth and bones 99% in teeth and bones Functions Functions Bone health Bone health Blood clotting Blood clotting Transmit nerve impulses Transmit nerve impulses Muscle contraction and relaxation Muscle contraction and relaxation Membrane permeability Membrane permeability Activate certain enzymes Activate certain enzymes Salivary calcium acts as buffer Salivary calcium acts as buffer From Fehrenbach MJ, Herring SW: Illustrated Anatomy of the Head and Neck, ed 3. St. Louis: Saunders, 2007.

6 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 6 Requirements : Calcium AI AI 9–13 yo boys and girls 9–13 yo boys and girls 1300 mg/day 1300 mg/day 19–50 yo men and women 19–50 yo men and women 1000 mg/day 1000 mg/day 51–70+ yo men and women 51–70+ yo men and women 1200 mg/day 1200 mg/day Only 1 in 4 Americans meets AI Only 1 in 4 Americans meets AI for calcium

7 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 7 Requirements: Calcium Current levels of intake Current levels of intake Males ages 9 and older Males ages 9 and older Average intake ~925 mg/day (71% of AI) Average intake ~925 mg/day (71% of AI) Females ages 9 and older Females ages 9 and older Average intake ~657 mg/day (51% of AI) Average intake ~657 mg/day (51% of AI) AI for those with self-diagnosed lactose intolerance ~320 mg/day (25% of AI) AI for those with self-diagnosed lactose intolerance ~320 mg/day (25% of AI) At high risk of inadequate intakes to build At high risk of inadequate intakes to build peak bone mass and prevent osteoporosis

8 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 8 Calcium-to-Phosphorus Ratio Serum levels of calcium and phosphorus inversely related Serum levels of calcium and phosphorus inversely related If calcium level goes up, phosphorus level goes down If calcium level goes up, phosphorus level goes down Ideal calcium/phosphorus ratio for adults is 1:1 Ideal calcium/phosphorus ratio for adults is 1:1 Excessive intake of phosphorus compared with calcium reduces serum calcium concentration Excessive intake of phosphorus compared with calcium reduces serum calcium concentration Calcium requirements are increased when dietary phosphate is high as in the typical American diet Calcium requirements are increased when dietary phosphate is high as in the typical American diet

9 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 9 Absorption: Calcium Absorption regulated by hormones (parathyroid, estrogen, glucocorticoids, thyroid) Absorption regulated by hormones (parathyroid, estrogen, glucocorticoids, thyroid) Best absorbed when consumed in smaller amounts and ingested several times Best absorbed when consumed in smaller amounts and ingested several times during the day Factors decreasing absorption: Factors decreasing absorption: Oxylates and phytates in grains, Oxylates and phytates in grains,vegetables Reduced gastric acidity Reduced gastric acidity Excessive fiber Excessive fiber Low-protein, low-phosphorus diets Low-protein, low-phosphorus diets From Thibodeau GA, Patton KT: Anatomy & Physiology, ed 6. St. Louis: Mosby, 2007.

10 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 10 Sources: Calcium Milk and dairy products Milk and dairy products Preferred sources of calcium because of high calcium, lactose, and other nutrient content that enhances calcium absorption Preferred sources of calcium because of high calcium, lactose, and other nutrient content that enhances calcium absorption Fortified soy and rice milk Fortified soy and rice milk Other fortified foods (orange juice) Other fortified foods (orange juice) Supplements Supplements Limited bioavailability Limited bioavailability Better absorbed when taken with food Better absorbed when taken with food Calcium citrate malate, calcium lactate, calcium citrate, and calcium sulfate have high absorption rates Calcium citrate malate, calcium lactate, calcium citrate, and calcium sulfate have high absorption rates

11 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 11 Hyperstates: Calcium Hypercalcemia-excess calcium levels in the blood Hypercalcemia-excess calcium levels in the blood Caused by: Caused by: Hyperparathryoidism Hyperparathryoidism Overdoses of cholecalciferol Overdoses of cholecalciferol Vitamin D poisoning Vitamin D poisoning Excessive calcium intake results in: Excessive calcium intake results in: Dizziness, flushing, nausea/vomiting, severe constipation, kidney stone formation, irregular heartbeat, tingling sensations, xerostomia, fatigue and high blood pressure Dizziness, flushing, nausea/vomiting, severe constipation, kidney stone formation, irregular heartbeat, tingling sensations, xerostomia, fatigue and high blood pressure May inhibit iron and zinc absorption May inhibit iron and zinc absorption

12 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 12 Hypostates: Calcium Rickets Rickets Abnormal ossification from Abnormal ossification from vitamin D, calcium deficiency Osteoporosis Osteoporosis “Osteoporosis is a disease of adolescence” “Osteoporosis is a disease of adolescence” 90% of peak bone mass is attained by age 16.9 + 1.3 yr and 99% by age 26.2 + 3.7 yr 90% of peak bone mass is attained by age 16.9 + 1.3 yr and 99% by age 26.2 + 3.7 yr  BMD associated with fractures in elder years, but also may predict fractures in children  BMD associated with fractures in elder years, but also may predict fractures in children Inadequate calcium intake in early life accounts for as much as 50% of difference in hip fracture rates in postmenopausal years Inadequate calcium intake in early life accounts for as much as 50% of difference in hip fracture rates in postmenopausal years From Kumar V, Abbas AK, Fausto N: Robbins and Cotran Pathologic Basis of Disease, ed 7. Philadelphia: Saunders, 2005.

13 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 13 Hypostates: Calcium Reduction in total skeletal mass is directly related to reduction in mandibular bone density in women with osteoporosis Reduction in total skeletal mass is directly related to reduction in mandibular bone density in women with osteoporosis Postmenopausal women who lost teeth also lost bone mineral of the whole body and femoral neck at greater rates than those who retained their teeth Postmenopausal women who lost teeth also lost bone mineral of the whole body and femoral neck at greater rates than those who retained their teeth Systemic bone loss appears to be a predictor of tooth loss in dentate postmenopausal women Systemic bone loss appears to be a predictor of tooth loss in dentate postmenopausal women Inadequate calcium intake and periodontal disease Inadequate calcium intake and periodontal disease Study of NHANES data suggests a 56%  risk of periodontal disease with calcium intakes  500 mg/day Study of NHANES data suggests a 56%  risk of periodontal disease with calcium intakes  500 mg/day 27% greater risk for those women consuming from 500 to 800 mg/day of calcium 27% greater risk for those women consuming from 500 to 800 mg/day of calcium

14 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 14 Physiological Roles: Phosphorus Phosphorus: second most abundant mineral in the body; about 85% in the skeleton and teeth Phosphorus: second most abundant mineral in the body; about 85% in the skeleton and teeth Functions Functions Formation of bones and teeth Formation of bones and teeth Muscle contraction and nerve activity Muscle contraction and nerve activity Component of phospholipids in cell membranes, DNA, and RNA Component of phospholipids in cell membranes, DNA, and RNA Energy metabolism (ADP) Energy metabolism (ADP) Buffer for the body Buffer for the body

15 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 15 Requirement and Source: Phosphorus RDA RDA Men and women: 700 mg/day Men and women: 700 mg/day Sources Sources Abundant in foods—deficiency rare Abundant in foods—deficiency rare Best sources are milk products and meats Best sources are milk products and meats Food additive in baked goods, cheese, processed meats, and soft drinks Food additive in baked goods, cheese, processed meats, and soft drinks

16 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 16 Hyperstates: Phosphorus Hyperphosphatemia (serum level above 2.6 mg/dl) may occur in: Hyperphosphatemia (serum level above 2.6 mg/dl) may occur in: Hypoparathyroidism Hypoparathyroidism Renal insufficiency Renal insufficiency Excessive amounts of phosphorus bind with calcium, resulting in tetany and convulsions Excessive amounts of phosphorus bind with calcium, resulting in tetany and convulsions From Thibodeau GA, Patton KT: Anatomy & Physiology, ed 6. St. Louis: Mosby, 2007.

17 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 17 Hypostates: Phosphorus Hypostates: Phosphorus Long-term ingestion of aluminum hydroxide antacids Long-term ingestion of aluminum hydroxide antacids Stress conditions in calcium-to-phosphorus balance Stress conditions in calcium-to-phosphorus balance Malabsorption conditions (sprue and celiac disease) Malabsorption conditions (sprue and celiac disease) During tooth development, phosphorus deficiency results in: During tooth development, phosphorus deficiency results in: Incomplete calcification of teeth Incomplete calcification of teeth Failure of dentin formation Failure of dentin formation Increased susceptibility to caries Increased susceptibility to caries

18 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 18 Physiological Roles: Magnesium Bones contain almost two thirds of body’s magnesium Bones contain almost two thirds of body’s magnesium Role in bone and mineral physiology Role in bone and mineral physiology Cofactor for more than 300 enzymes Cofactor for more than 300 enzymes Necessary for DNA and RNA synthesis Necessary for DNA and RNA synthesis Regulates transmission of nerve impulses and muscle contraction Regulates transmission of nerve impulses and muscle contraction Associated with vitamin D conversion in the liver Associated with vitamin D conversion in the liver Facilitates blood clotting Facilitates blood clotting Facilitates PTH secretion Facilitates PTH secretion

19 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 19 Requirements and Sources: Magnesium RDA (19-30 yr) RDA (19-30 yr) Men: 400 mg/day Men: 400 mg/day Women: 310 mg/day Women: 310 mg/day UL UL 350 mg/day from nonfood sources 350 mg/day from nonfood sources Sources Sources Dark green, leafy vegetables Dark green, leafy vegetables Whole grains and nuts Whole grains and nuts Chocolate Chocolate

20 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 20 Hypostates: Magnesium Deficiency rare in healthy people Deficiency rare in healthy people Can occur w/prolonged vomiting, malabsorption, kidney disease, intestinal surgery, excessive use of OTC and medications (corticosteroids, diuretics) Can occur w/prolonged vomiting, malabsorption, kidney disease, intestinal surgery, excessive use of OTC and medications (corticosteroids, diuretics) Present in nearly all chronic alcoholics Present in nearly all chronic alcoholics Symptoms of deficiency: Symptoms of deficiency: Fragility of alveolar bone and gingival hypertrophy Fragility of alveolar bone and gingival hypertrophy Cardiac dysrhythmias Cardiac dysrhythmias Neuromuscular hyperexcitability Neuromuscular hyperexcitability

21 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 21 Hyperstates: Magnesium No evidence of overconsumption of magnesium from food sources No evidence of overconsumption of magnesium from food sources Kidney regulates magnesium and toxicity may cause kidney failure Kidney regulates magnesium and toxicity may cause kidney failure Symptoms: Symptoms: Diarrhea Diarrhea Nausea Nausea Cramping Cramping

22 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 22 Nutrition Directions: Magnesium Evidence suggests that magnesium may play an important role in regulating blood pressure Evidence suggests that magnesium may play an important role in regulating blood pressure The DASH study (Dietary Approaches to Stop Hypertension) suggests HBP can be lowered by diet high in magnesium, potassium, and calcium, and low in sodium and fat The DASH study (Dietary Approaches to Stop Hypertension) suggests HBP can be lowered by diet high in magnesium, potassium, and calcium, and low in sodium and fat The diet includes whole grains, fruits, vegetables and low-fat dairy The diet includes whole grains, fruits, vegetables and low-fat dairy http://dashdiet.org http://dashdiet.org

23 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 23 Overview: Fluoride In a strict nutritional sense, fluoride is not a nutrient essential for health because it has no known metabolic function In a strict nutritional sense, fluoride is not a nutrient essential for health because it has no known metabolic function However, because of benefits to dental and bone health, fluoride is considered a desirable element for humans However, because of benefits to dental and bone health, fluoride is considered a desirable element for humans Fluoride ions can replace hydroxyl ions in the hydroxyapatite crystal lattice, making it more resistant to caries Fluoride ions can replace hydroxyl ions in the hydroxyapatite crystal lattice, making it more resistant to caries

24 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 24 Physiological Roles: Fluoride Forms fluorapatite, which is more caries resistant Forms fluorapatite, which is more caries resistant Systemic fluoride results in changes to tooth morphology; increases tooth’s resistance to adherence of plaque biofilm Systemic fluoride results in changes to tooth morphology; increases tooth’s resistance to adherence of plaque biofilm Fluoride in saliva also interferes with demineralization Fluoride in saliva also interferes with demineralization Higher concentrations of fluoride Higher concentrations of fluoride inhibit Streptococcus mutans, Streptococcus sobrinus, and Lactobacillus species Stimulates osteoblast proliferation and increases new mineral deposition in cancellous bone Stimulates osteoblast proliferation and increases new mineral deposition in cancellous bone From Bird DL, Robinson DS: Torres and Ehrlich Modern Dental Assisting, ed 9. St. Louis: Saunders, 2009.

25 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 25 Requirements: Fluoride Absorption occurs in the stomach Absorption occurs in the stomach AI AI 6–12 mo: 0.5 mg/day 6–12 mo: 0.5 mg/day 1–3 yr: 0.7 mg/day 1–3 yr: 0.7 mg/day 2–8 yr: 1.1 mg/day 2–8 yr: 1.1 mg/day 9–13 yr: 2.0 mg/day 9–13 yr: 2.0 mg/day 14–18 yr: 2.9–3.2 mg/day 14–18 yr: 2.9–3.2 mg/day 19+ yr: 3.1–3.8 mg/day 19+ yr: 3.1–3.8 mg/day

26 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 26 Requirements: Fluoride UL UL 6–12 mo: 0.9 mg/day 6–12 mo: 0.9 mg/day 1–3 yr: 1.3 mg/day 1–3 yr: 1.3 mg/day 4–8 yr: 2.2 mg/day 4–8 yr: 2.2 mg/day 9+ yr: 10 mg/day 9+ yr: 10 mg/day Sources Sources Fluoridated water Fluoridated water Brewed tea Brewed tea Ocean fish w/bones (salmon, herring, sardines) Ocean fish w/bones (salmon, herring, sardines)

27 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 27 Hyperstates: Fluoride Dental fluorosis (hypomineralization of enamel) directly related to fluoride exposure during tooth development Dental fluorosis (hypomineralization of enamel) directly related to fluoride exposure during tooth development Varies from white flecks, to white or brown staining, to brownish discoloration and varying degrees of enamel pitting Varies from white flecks, to white or brown staining, to brownish discoloration and varying degrees of enamel pitting Ingestion of large amounts of fluoride in adults can result in adverse effects on skeletal tissue and kidney function Ingestion of large amounts of fluoride in adults can result in adverse effects on skeletal tissue and kidney function Courtesy Alton McWhorter, DDS, MS; Associate Professor Pediatric Dentistry; The Texas A&M University System; Baylor College of Dentistry; Dallas.

28 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 28 Nutritional Directions Encourage use of fluoridated water for those >6 months of age and topical fluorides for adults and children Encourage use of fluoridated water for those >6 months of age and topical fluorides for adults and children Encourage low-fat dairy, whole grains, and vegetables as calcium and magnesium sources Encourage low-fat dairy, whole grains, and vegetables as calcium and magnesium sources Evaluate use of supplements and refer to a medical provider and/or registered dietitian as needed Evaluate use of supplements and refer to a medical provider and/or registered dietitian as needed Stress need to minimize use of antacids and seek medical care for chronic heartburn Stress need to minimize use of antacids and seek medical care for chronic heartburn


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