1. CHAPTER 12 WATER AND MINERALS REQUIRED FOR ORAL SOFT TISSUES AND SALIVARY GLANDS Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

2. 2 Water Most abundant component of the body Most abundant component of the body At birth 75% to 80% of body weight At birth 75% to 80% of body weight In an adult 50% to 60% of body weight In an adult 50% to 60% of body weight Adipose tissue contains less water than lean body mass (LBM) Adipose tissue contains less water than lean body mass (LBM) Body fluids Body fluids Intracellular fluid (ICF) Intracellular fluid (ICF) Extracellular fluid (ECF) Extracellular fluid (ECF) Osmotic pressure equalizes the Osmotic pressure equalizes the solute concentration of ICF and ECF From Thibodeau GA, Patton KT: Anatomy & Physiology, ed 6. St. Louis: Mosby, 2007.

3. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.3 Physiological Roles: Water Solvent enables chemical reactions to occur by entering into some reactions, such as hydrolysis Solvent enables chemical reactions to occur by entering into some reactions, such as hydrolysis Maintains stability of all body fluids, as the principal component and medium for fluids (blood and lymph), secretions (saliva and gastrointestinal fluids), and excretions (urine and perspiration) Maintains stability of all body fluids, as the principal component and medium for fluids (blood and lymph), secretions (saliva and gastrointestinal fluids), and excretions (urine and perspiration) Enables transport of nutrients to cells and provides medium for excretion of waste products Enables transport of nutrients to cells and provides medium for excretion of waste products Acts as lubricant between cells to permit movement without friction Acts as lubricant between cells to permit movement without friction Regulates body temperature by evaporating as perspiration from skin and vapor from mouth and nose Regulates body temperature by evaporating as perspiration from skin and vapor from mouth and nose

4. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.4 Requirements: Water AI for total fluid (beverages, water, and food) AI for total fluid (beverages, water, and food) Men = 3.7 L (15 to 16 cups) per day Men = 3.7 L (15 to 16 cups) per day Women = 2.7 L (11 to 12 cups) per day Women = 2.7 L (11 to 12 cups) per day Water is lost via a variety of routes Water is lost via a variety of routes 1. Urination 2. Perspiration 3. Expiration 4. Defecation When as little as 2% of body water is When as little as 2% of body water is lost, osmoreceptors are stimulated, creating a physiological desire to ingest liquids Fro Patton KT, Thibodeau GA: Anatomy & Physiology, ed 8. St. Louis: Mosby, 2013.

5. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.5 Sources: Water Redrawn from Popkin BM et al: A new proposed guidance system for beverage consumption in the United States. Am J Clin Nutr 2006 Mar; 83(3):529-542. Plain tap water is the most natural source Plain tap water is the most natural source of fluids EPA regulates the levels of contaminants allowed EPA regulates the levels of contaminants allowed in drinking water in public water systems Use of bottled water has increased Use of bottled water has increased Other sources of water include soft drinks, sports and energy drinks, vitamin water, and other drinks Other sources of water include soft drinks, sports and energy drinks, vitamin water, and other drinks Energy drinks containing high kilocalorie and caffeine levels are the fastest growing beverage category Energy drinks containing high kilocalorie and caffeine levels are the fastest growing beverage category Beverages containing acidic flavorings may result in erosion Beverages containing acidic flavorings may result in erosion Americans consume 21% of their daily kilocalories (approx. 500 calories) from caloric beverages Americans consume 21% of their daily kilocalories (approx. 500 calories) from caloric beverages

6. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.6 Hyperstates: Water Fluid volume excess (FVE) Fluid volume excess (FVE) Occurs in ECF compartments secondary to an increase in total body sodium Occurs in ECF compartments secondary to an increase in total body sodium Results in rapid weight gain, puffy eyelids, distended neck veins, and elevated blood pressure Results in rapid weight gain, puffy eyelids, distended neck veins, and elevated blood pressure At risk if: At risk if: Congestive heart failure Congestive heart failure Chronic renal failure Chronic renal failure Chronic liver disease Chronic liver disease High levels of steroids High levels of steroids From Patton KT, Thibodeau GA: Anatomy & Physiology, ed 8, St. Louis: Mosby, 2013.

7. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.7 Hypostates: Water Fluid volume deficit (FVD) Fluid volume deficit (FVD) Associated with excessive loss of fluids from: Associated with excessive loss of fluids from: Gastrointestinal tract (vomiting, diarrhea, drainage tubes) Gastrointestinal tract (vomiting, diarrhea, drainage tubes) Urinary tract (diuretics, polyuria, or excessive urination) Urinary tract (diuretics, polyuria, or excessive urination) Skin (sweating) Skin (sweating) Classic signs are: Classic signs are: Dry tongue with longitudinal fissures (slits or wrinkles that extend lengthwise on the tongue) Dry tongue with longitudinal fissures (slits or wrinkles that extend lengthwise on the tongue) Xerostomia Xerostomia Shrinkage of oral mucous membranes Shrinkage of oral mucous membranes Decreased skin turgor Decreased skin turgor Dry skin Dry skin Decreased urinary output Decreased urinary output

8. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.8 Electrolytes Compounds or ions that dissociate in solution Compounds or ions that dissociate in solution Cation (positive charge) Cation (positive charge) Sodium, potassium, calcium, and magnesium Sodium, potassium, calcium, and magnesium Principal cation in plasma and interstitial fluid is sodium Principal cation in plasma and interstitial fluid is sodium Anion (negative charge) Anion (negative charge) Chloride, bicarbonate, and phosphate Chloride, bicarbonate, and phosphate Principal anion in plasma and interstitial Principal anion in plasma and interstitial fluid is chloride Electrolytes are important in water balance and acid-base (pH) balance Electrolytes are important in water balance and acid-base (pH) balance From Patton KT, Thibodeau GA: Anatomy & Physiology, ed 8. St. Louis: Mosby, 2013.

9. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.9 Physiological Role and Requirements: Sodium Physiological roles Physiological roles Maintain normal ECF concentration by affecting the concentration, excretion, and absorption of potassium and chloride and water distribution Maintain normal ECF concentration by affecting the concentration, excretion, and absorption of potassium and chloride and water distribution Regulate acid-base balance Regulate acid-base balance Facilitate impulse transmission in nerve and muscle fibers Facilitate impulse transmission in nerve and muscle fibers Requirements Requirements AI for sodium is 1500 mg/day with the upper limits being 2300 mg/day for adults AI for sodium is 1500 mg/day with the upper limits being 2300 mg/day for adults Minimum intake 500 mg/day Minimum intake 500 mg/day

10. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.10 Sources: Sodium Natural constituent of most foods, including: Natural constituent of most foods, including: Meat Meat Saltwater fish Saltwater fish Eggs Eggs Dairy products Dairy products Some vegetables Some vegetables

11. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.11 Hyperstates Hyperstates Hypernatremia (elevated serum sodium level) Hypernatremia (elevated serum sodium level) Signs are extreme thirst; dry, “sticky” tongue and oral mucous membranes; fever; and convulsions Signs are extreme thirst; dry, “sticky” tongue and oral mucous membranes; fever; and convulsions Hypostates Hypostates Hyponatremia (low serum sodium level) Hyponatremia (low serum sodium level) Water intoxication or hyponatremia can occur when individuals drink too much water Water intoxication or hyponatremia can occur when individuals drink too much water Early symptoms of hyponatremia are nausea and abdominal cramps, headache, confusion, lethargy, and coma Early symptoms of hyponatremia are nausea and abdominal cramps, headache, confusion, lethargy, and coma Hyperstates and Hypostates: Sodium

12. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.12 Overview: Chloride Physiological roles Physiological roles Maintains ECF balance, osmotic equilibrium, and electrolyte balance Maintains ECF balance, osmotic equilibrium, and electrolyte balance In gastric secretions to aid protein digestion and creating acidic environment to inhibit bacterial growth and enhance iron, calcium, and vitamin B 12 absorption In gastric secretions to aid protein digestion and creating acidic environment to inhibit bacterial growth and enhance iron, calcium, and vitamin B 12 absorption Requirements Requirements AI = 2300 mg/day for adults AI = 2300 mg/day for adults Sources Sources Salt Salt

13. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.13 Hyperstates and Hypostates: Chloride Hyperstates Hyperstates At-risk groups include those with: At-risk groups include those with: Excessive intakes of salt (NaCl) Excessive intakes of salt (NaCl) Dehydration Dehydration Renal failure Renal failure Diarrhea Diarrhea Cushing’s syndrome Cushing’s syndrome Hypostates Hypostates Hypochloremia Hypochloremia Conditions placing at risk include: Conditions placing at risk include: Persistent heavy sweating Persistent heavy sweating Chronic diarrhea, vomiting Chronic diarrhea, vomiting Chronic renal failure Chronic renal failure

14. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.14 Overview: Potassium Physiological roles Physiological roles Maintain cellular (ICF) concentration Maintain cellular (ICF) concentration Directly affects muscle contraction (especially cardiac) and electrical conductivity of the heart Directly affects muscle contraction (especially cardiac) and electrical conductivity of the heart Transmission of nerve impulses Transmission of nerve impulses Regulates acid-base balance Regulates acid-base balance Requirements Requirements AI = 4700 mg/day for all adults AI = 4700 mg/day for all adults Equivalent to approximately 10 servings of Equivalent to approximately 10 servings of fruits and vegetables daily Mosby From Patton KT, Thibodeau GA: Anatomy & Physiology, ed 8. St. Louis: Mosby, 2013.

15. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.15 Sources: Potassium Dairy Dairy Meat Meat Grains Grains Fruits Fruits Vegetables Vegetables Processed foods Processed foods Potassium supplements and salt substitutes Potassium supplements and salt substitutes

16. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.16 Hyperstates and Hypostates: Potassium Hyperstates Hyperstates Hyperkalemia (elevated serum potassium) is life-threatening Hyperkalemia (elevated serum potassium) is life-threatening Causes Causes Impaired renal excretion Impaired renal excretion Increased shift of potassium out of cells Increased shift of potassium out of cells Increased potassium intake Increased potassium intake Hypostates Hypostates Hypokalemia Hypokalemia Causes Causes Drugs, such as diuretics furosemide, hydrochlorothiazide Drugs, such as diuretics furosemide, hydrochlorothiazide Cushing’s syndrome Cushing’s syndrome Hyperaldosteronism Hyperaldosteronism Hypomagnesemia Hypomagnesemia Alcoholism Alcoholism

17. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.17 Physiological Roles: Iron Component of hemoglobin Component of hemoglobin Catalyzes many oxidative reactions within cells Catalyzes many oxidative reactions within cells Conversion of beta-carotene to vitamin A Conversion of beta-carotene to vitamin A Formation of purines as part of nucleic acid Formation of purines as part of nucleic acid Removal of lipids from the blood Removal of lipids from the blood Detoxification of drugs in the liver Detoxification of drugs in the liver Synthesis of collagen Synthesis of collagen Production of antibodies Production of antibodies From Patton KT, Thibodeau GA: Anatomy & Physiology, ed 8. St. Louis: Mosby, 2013.

18. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.18 Requirements: Iron RDA RDA Men and postmenopausal women: 8 mg/day Men and postmenopausal women: 8 mg/day Women: 19 to 50 yr: 18 mg/day Women: 19 to 50 yr: 18 mg/day UL UL 45 mg/day 45 mg/day From Mahan LK, Escott-Stump S: Krause’s Food and Nutrition Therapy, ed 13. St. Louis: Elsevier, 2011.

19. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.19 Sources: Iron Heme iron Heme iron Organ meats, meat, fish, poultry Organ meats, meat, fish, poultry Non-heme iron Non-heme iron Eggs Eggs Milk Milk Whole grains, enriched cereals Whole grains, enriched cereals Green vegetables Green vegetables Dried fruit Dried fruit

20. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.20 Hyperstates and Hypostates: Iron Toxicity Toxicity Hemochromatosis Hemochromatosis Organ damage Organ damage Coronary heart disease Coronary heart disease Skin pigmentation Skin pigmentation Cirrhosis of the liver Cirrhosis of the liver Deficiency Deficiency Microcytic anemia Microcytic anemia Angular cheilosis Angular cheilosis Pallor of lips and gingiva Pallor of lips and gingiva Sore, burning tongue; glossitis Sore, burning tongue; glossitis Atrophy of filiform papillae Atrophy of filiform papillae Risk of candidiasis Risk of candidiasis Possible increased caries susceptibility Possible increased caries susceptibility Courtesy of Robert W. McKenna, Department of Pathology, University of Texas Southwestern Medical School, Dallas. In Kumar V, Abbas AK, Fausto N: Robbins and Cotran Pathologic Basis of Disease, ed 7. Philadelphia: Saunders, 2005.

21. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.21 Physiological Roles: Zinc Physiological roles Physiological roles Component in >200 enzymes affecting cell growth and replication (DNA/RNA synthesis) Component in >200 enzymes affecting cell growth and replication (DNA/RNA synthesis) Collagen synthesis, bone resorption, and remodeling Collagen synthesis, bone resorption, and remodeling Sexual maturation Sexual maturation Night vision Night vision Immune defenses Immune defenses Taste, smell, and appetite Taste, smell, and appetite

22. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.22 Requirements and Sources: Zinc Requirements Requirements RDA RDA 11 mg/day for men and 8 mg/day for women 11 mg/day for men and 8 mg/day for women UL UL 40 mg/day for adults 40 mg/day for adults Sources Sources Lamb and beef Lamb and beef Oysters Oysters Eggs Eggs Peanuts Peanuts

23. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.23 Hyperstates: Zinc High levels of zinc cause: High levels of zinc cause: Vomiting and diarrhea Vomiting and diarrhea Epigastric pain Epigastric pain Lethargy Lethargy Fatigue Fatigue Renal damage Renal damage Pancreatitis Pancreatitis Death Death Excesses of zinc also: Excesses of zinc also: Reduces copper status Reduces copper status Alters iron function Alters iron function Decreases immune function Decreases immune function Decreases high-density lipoprotein (HDL) Decreases high-density lipoprotein (HDL)

24. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.24 Hypostates: Zinc Signs and symptoms Signs and symptoms Thickening of epithelium Thickening of epithelium Impaired keratinization of epithelial cells Impaired keratinization of epithelial cells Increased susceptibility to periodontal disease Increased susceptibility to periodontal disease Flattened filiform papillae Flattened filiform papillae Loss of taste and smell acuity Loss of taste and smell acuity Poor appetite Poor appetite Impaired wound healing Impaired wound healing

25. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.25 Hypostates: Zinc Groups at risk of deficiency Groups at risk of deficiency Those whose zinc requirements are relatively high (such as during periods of rapid growth) Those whose zinc requirements are relatively high (such as during periods of rapid growth) Older adults Older adults Vegans Vegans Severe malabsorption Severe malabsorption (diarrhea) or other chronic health problems

26. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.26 Overview: Iodine Physiological role Physiological role Production of thyroxine Production of thyroxine Requirements Requirements RDA =150 µg/day RDA =150 µg/day UL =1100 µg/day UL =1100 µg/day Sources Sources Seafood/plants grown near the ocean Seafood/plants grown near the ocean Molasses Molasses Yogurt and milk Yogurt and milk Iodized salt Iodized salt

27. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.27 Hyperstates and Hypostates: Iodine Hyperstates: excessive amounts Hyperstates: excessive amounts result in thyroiditis, hypothyroidism, hyperthyroidism, sensitivity reactions Hypostates Hypostates Goiter (enlargement of the thyroid gland) Goiter (enlargement of the thyroid gland) Spontaneous abortions and congenital anomalies Spontaneous abortions and congenital anomalies Delayed eruption of primary and secondary teeth Delayed eruption of primary and secondary teeth Enlarged tongue Enlarged tongue Endemic cretinism Endemic cretinism From Fehrenbach MJ, Herring SW: Illustrated Anatomy of the Head and Neck, ed 4. St. Louis: Saunders, 2012

28. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.28 Nutritional Directions Encourage water as beverage of choice to fulfill daily water needs over consumption of caloric beverages Encourage water as beverage of choice to fulfill daily water needs over consumption of caloric beverages Assess patients for electrolyte imbalances and nutrient deficiencies/excesses and refer to medical providers as needed Assess patients for electrolyte imbalances and nutrient deficiencies/excesses and refer to medical providers as needed Consume less than 2300 mg (approximately 1 tsp salt) of sodium per day by choosing and preparing foods with little added salt Consume less than 2300 mg (approximately 1 tsp salt) of sodium per day by choosing and preparing foods with little added salt Consume lean meats, whole grains, fruits, vegetables, and low-fat dairy to meet nutritional needs Consume lean meats, whole grains, fruits, vegetables, and low-fat dairy to meet nutritional needs

29. Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. HEALTH APPLICATION Hypertension Discuss the epidemiology & statistics of Americans impacted by hypertension Discuss the epidemiology & statistics of Americans impacted by hypertension How is hypertension defined clinically? How is hypertension defined clinically? What are the health risks of having hypertension? What are the health risks of having hypertension? What are causes of hypertension? What are causes of hypertension? What treatment(s) or lifestyle changes can be employed to reduce hypertension? What treatment(s) or lifestyle changes can be employed to reduce hypertension? 29