nutrition part1 / orthodontic courses by indian dental academy

INDIAN DENTAL ACADEMY

Leader in continuing dental education www.indiandentalacademy.com

www.indiandentalacademy.com

NutritionNutrition

The science of food, nutrients and other

substances and balance in relation to health

and disease and process by which the

organism ingest, digest, absorbs, transports,

utilizes and excretes the food substances.


NutrientNutrient Food consists of certain chemical substances, which

are called as nutrients.

Function of nutrients may be one of following Regulation of different body process

Provide materials for development repairing and maintaining of different body tissues.

Serves as fuel to provide energy.

Malnutrition and under-nutrition constitute globally the most important category of environmental disease.


Types of NutrientsTypes of NutrientsMacronutrients – greater part of food

Carbohydrates

Fats

Proteins

Micronutrients - required in small quantities

Vitamins

Mineralswww.indiandentalacademy.com

Defined as one which contains different types of foods in such quantities and proportions that need for energy, amino acids, vitamins, minerals, fats, carbohydrates ,and other nutrients is adequately met for maintaining health, vitality ,and general well being and also makes small provisions for extra nutrients to withstand short durations of leanness.


MalnutritionMalnutrition

It is a pathological state, resulting from ,a relative or absolute deficiency or excess of one or more essential nutrients.


Decreased intake

Poor teeth ?

Dysphagia

Anorexia nervosa

Restricted food habits

Malabsorption

Biliary and pancreatic diseases

Enteric malabsorption syndromes

Vitamin B12 malabsorption (pernicious anemia) www.indiandentalacademy.com

Increased requirements Rapid growth in infancy, in childhood, of puberty,

pregnancy, Trauma Burns Excessive loss of in protein losing enteropathies

and nephropathies. Special Category

Total parenteral nutrition Drug induced interference with absorption Genetic disorders interfering with conversion or

utilization of nutrients www.indiandentalacademy.com

Malnutrition – Occlusion Malnutrition – Occlusion Loss of teeth

Severe caries

Periodontal disease

Retarded Jaw development

There is a special need for Calcium, Phosphorus, Vitamin C & Vitamin D, in relation to occlusion and dentofacial development


Over ConsumptionOver ConsumptionObesity

Diabetes type 2

Obstructive sleep apnea

Hypertension

Coronary heart disease

Some cancers


CarbohydratesCarbohydrates


Any form of carbohydrate gets converted to glucose after ingestion and then gets absorbed in to the blood

R.D.A. is 440gms Excess amount which is present in blood is

converted to the glycogen and stored into the liver


CarbohydratesCarbohydrates

Glucose enter the circulation to supply requirement to the other parts of body.

Certain amount of glucose is converted to glycogen for storage in other parts of body like muscle

Blood sugar level is maintained with in the physiologic limits, i.e. (60-90 mg/100ml).


LipidsLipids

Classification - chemical structure

Triglycerides

Phospholipids

Sterols

3% of daily calories

9 kcal/g

Fat substitutes - Simplesse & Olestrawww.indiandentalacademy.com

ProteinsProteins

1/2 - muscles

1/5 - bone & cartilage

1/10 - skin

Amino acids - cytoplasm, nuclei, cell membrane & tissue

Source of energy


ProteinsProteins Proteins :

Simple

Conjugated

Derived

Amino acids

Non-essential

Essential - Histidine, Leucine, Isoleucine, Lysine, Methionine, Phenlyalanine, Threonine, Tryptophan & Valine


ProteinsProteins

Functions

Building, repair & replacement

Enzymes & hormones

Regulators of fluid & acid-base balance

Transport of molecules & Ab

4kcal/gRDA: 0.8 g/kg


ProteinsProteins Sources:

Animal proteins - eggs, meat, fish, milk

Plant proteins – soya beans, wheat, corn & rice

Effect on formation, eruption, alignment:

During pregnant

During active period of growth & development

Protein calorie malnutritionwww.indiandentalacademy.com

Co-enzyme + Apoenzyme - Holoenzyme

2 forms - active & inactive (provitamin)

Classification

Water soluble : Vit B-complex & C

Fat soluble : Vit A, D, E, K


Metabolism of CHO, protein & fats


Source : cereals ,meat, milk, egg, fruitsBeri-Beri :1.Dry 2.Wet 3.Infantile - inc sensitivity, burning tongue,

loss/diminution of tasteWernicke’s Korsakoff Synd


Ariboflavinosis - angular stomatitis, glossitis, chelitis, seborrheic dermatitis


Maintains integrity of skin & mucous membrane, normal func of CNS

RDA - 13 niacin equiv for a diet of 2000kcal


RDA: 0.9 - 1.6 mg - children 1.8 - 1.2 mg - adoloscence Deficiency:

altered nerve function, cheilosis glossitis stomatitis


Functions: coenzyme metabolism

fetal neural tube formation

RDA: 0.4 mg/day - adoloscent

Defc: Megaloblastic anemia


RDA : 0.003 mg/day - adoloscent & adults

Defc: Pernicious anemia


Release of energy - catabolism of CHO, protein & fats

RDA: 3-4 mg - child 4-7 mg - adults

Sources - yeast, liver, eggs, whole-grain cereals & legumes


Active biologic substance

RDA: 100-200 µg/day

Sources - liver, milk, egg, yolk & yeast


Oral signs of B-complex def:

Commisures - inflammatory changes

Tongue - ulcerations

In alcoholics - atrophy of papillae

Buccal & palatal mucosa - inflammatory changes


Collagen synthesisIntegrity of cells - fibroblasts, osteoclasts,

odontoblastsFe absorptionRDA: - 1-20 yrs - 45 - 50 mg/day- Adults - 60 mg/day- Pregn - 80 mg/day


Animal studies – Animal studies – odontoblast atrophy,odontoblast atrophy, irregular dentin, irregular dentin, dilated pulp,dilated pulp,entrapped odontoblasts entrapped odontoblasts


2 sources:1. Preformed Vit A: animal food- Vit A1 - liver, fish, milk, butter, egg yolk- Vit A2 - fresh water fish

2. Provitamin A (precursor carotene) : plant foods


Deficiency:

Periodontium -

hyperkeratosis, hyperplasia - gingiva

Periodontal pocket

Teeth - rare

Salivary glands - atrophy

OMM - epimetaplasia & hyperkeratinization

Cleft lip & palate www.indiandentalacademy.com

3 types: D1, D2, D3 Vit D2 - ergocalciferol - plants Vit D3 - cholecalciferol - animals

Function: Vitamin & hormone

Ca & PO4 absorption

RDA: 10µg - birth - 22yrs

7.5µg - pregn & lactwww.indiandentalacademy.com

VITAMIN D…VITAMIN D…

Deficiency:

Rickets

Osteomalacia

Enamel hypoplasiawww.indiandentalacademy.com

VITAMIN EVITAMIN E

Deficiency: premature infants - anemiaRodent studies: maintenance integrity of

enamel, disarrangement of ameloblasts, chalky white appearance


3 Forms:

- K1 - plants

- K2 - intestinal bacteria

- K3 - menadione


4% body wt

Macro minerals (>100mg/day) Ca, P, Na, K, Mg, Cl, S

Micro minerals (.004 - .00004%) Fl, Fe, I, Cu, Co, Mn, Mo, Se, Cr, Zn


Distribution

1) Bones and Teeth (99%)

- amorphous form – young teeth

- crystalline form – mature teeth

2) ECF, soft tissues & membrane structures


Function: Bone and teeth

Blood coagulation, muscle contraction…

Irritability of nervous tissue - tetany

Release of neurotransmitter

Transport of ions across membrane


RDA:

- Infant <1yr – 360 - 540 mg

- 1 - 10 yrs – 800mg

- 11 - 18 yr – 1200 mg

- Pregnancy & lactation – 1200 mg

- Adult – 800 mg


80-90% + Ca - bone & teeth

Functions… Formation of bone & tooth

Absorption & transport of nutrients

Regulation of acid - base balance


RDA:- 800-1200 mg/day

Sources:- Animal foods - meat, fish, poultry, eggs &

milk- Nuts, legumes, whole grains cereals


Distribution.. 60% - PO4 ions & CO3

40% - cells, soft tissue, body fluids

Functions: Cellular respiration, energy production

Metabolism of CHO and protein

Regulation of acid-base balance


Present in dentine twice > enamel Animal studies :

enamel & dentin hypoplasia decrease alveolar bone formation, widening

of PDL, gingival hyperplasia

Symptoms: Hyper excitability, behavior disturbance,

weakness,depression,tremor,convulsionswww.indiandentalacademy.com

Inorganic nutrients that are required by humans in very small amount

0.001mg - <100mg/day


Carrier of oxygen in Hb for cellular respiration

RDA:- 0-2yrs - 10 -15mg/day- 11-18yrs - 18mg/day- 19 + - 10mg/day


Sources:

1) Heme (fish, meat)

2) Non heme (animal protein, fruits, green leafy veg..)

3) Additive proteins (fortified food)


Fe deficiency Anemia- Inadequate intake & increase loss - Infants & children… low content of Fe in milk & less Fe reserve at birth- Pregnant women- Pathological blood loss


C/F- Anemia - weakness, fatigue, pallor, tingling extremities- KolionychiaO/M - glossitis, fissures, smooth shiny tongue (atrophied papillae)- Plummer- Vinson Syndrome


2-3 mg

Functions…

- Integral part of metallo-enzymes

- Synth of RNA, DNA & Protein

- Wound healing & growth of all tissues

- Production of hormones


C/F:

- Poor appetite, slow healing of wounds

- Loss of taste sensation & co-ordination

- Pregnancy-abnormal taste sensation, high risk to fetus


RDA: - Adult – 15mg/day- Pregnancy lactation- 20-25mg/day- <6mth- 3mg/day- 6mth-1yr- 5mg/day- 1-10yr – 10mg/dayClinical application:

- ANUG


Function…- Synthesis of Hb- CNS - Pigments Deficiency :- Infants .. Anemia Sources : - liver, kidney- chocolate, poultry, dried fruits


Synthesis of thyroid hormone Imbalance :1. Hypothyroidism - goiter, cretinism.. C/F Enlarged tongue, thick lips, arrested

sk.dev, mental retardation


Oral effects :Severe hypothyroidism:- small jaws- Retarded rate of tooth eruption- Predisposition to root resorptionHyperthyroidism :- D.C - inc. need & use of excess caloriesSource : sea food, veg- depend on soil


Nutritional factors & orofacial skeleton development

All tissues in human organism develop in sequential phase like.

Hyperplastic phase (proliferation)

Hypertrophic phase (cellular organization)

DNA formation

RNA formation.

Formation of proteins.

Any interference with proper development during these early phases can lead to alteration of ultimate tissue development. www.indiandentalacademy.com

Nutrition & Skeletal MaturationProlonged nutritive failure in growing

children’s shows a retarding influence on bone centers

Correction of dietary deficiencies of bone-forming nutrients brings an acceleration in the over all rate of skeletal maturation.


Dietary requirements in growing children’s vary with age and body size. Body size being more important than age in this relation.

Dietary correction alone is not sufficient to ensure normal calcium metabolism.

Other factor that influences the teeth by nutritional means are abnormalities of digestion, assimilation, endocrine disturbances and infections diseases. www.indiandentalacademy.com

Co-relation of diet & orofacial growth

Retardation of growth and morphologic alteration of orofaical areas can occur in both humans and animals because of deficiency of essential nutrients.

Animals on diet deficient in folic acid, riboflavin, and zinc have born offspring’s with increased risk of cleft palate and lips. www.indiandentalacademy.com

Short Period of MalnutritionShort Period of Malnutrition7-12 months An increase in anterior open bite

A reduction in dimensions of dental arches, with inadequate space for teeth

Insufficient dental eruption Absence of natural diastema between

front deciduous teethwww.indiandentalacademy.com

Short Period of MalnutritionShort Period of Malnutrition Shorter roots

Shorter mandible in antero-posterior dimensions

Marked reduction in ascending ramus, condylar region

Changes in dentoalveolar inclination in incisor regions

Mineral inadequacies in the diet harm bone more than tooth www.indiandentalacademy.com

Removal of CASIEN from diet of young animals has resulted in the substantial reductions in mandibular dimensions.

A deficiency of ESSENTIAL FATTY ACIDS has interfered with the formation of mineralized tissues, mostly with dentin, development.


AnimalsIn addition with nutrition deficiency, excess

intake of vitamin A,D or K cause skeletal alterations in animals.

Osseous damage has been observed in breast fed animal offspring’s when maternal milk has been deficient in micro minerals, or when hypoglycemia or folic acid deficiency have been present. Congenital abnormalities of dentofacial development and occlusion are found in rats with riboflavin deficiency. www.indiandentalacademy.com

Deficiency of riboflavin has been found in experimental animals to results in shortening of mandible, cleft palate and other skeletal malformations

Clefts of the palate and general growth retardation and deformities of bone in rats with acute folic acid deficiency is seen


Human: Fetus may suffer from Gregg’s viral

syndrome. In this condition a pregnant woman who has been affected by German measles, causes the fetus to suffer from osseous malformations. Such as microcephaly and maxillary and mandibluar alterations associated with poor dental alignment.

Fetal rickets can also occur when mother is suffering from Vitamin D deficiency


Inadequate intake of Vitamin. A and C has resulted in dentin reduction, and it has caused osteoblast to turn into fibroblast, thus preventing the periodontal ligament from relaying tension to the bone and causing the breakdown of dental arches.


Vitamin C. is essential in formation of intercellular substance, fibrous tissue matrices of bone, tendon and cartilage.

In severe deficiency, the gums may become retracted, formation of periodontal pockets. Loosening of teeth and loss teeth.

Vitamin C deficiency produces sub-clinical scurvy which is related with damage in development and eruption of the teeth and formation of hypodimensional osseous bases. www.indiandentalacademy.com

Vitamin B2 deficiency produces retardation of growth of dentofacial structures.

A prenatal matarnal riboflavin (B2) deficiency produces anomalies of jaw and teeth; which shows shortness of mandible, and maxilla, cleft palate, severe anomalies of incisor teeth, dentofacial malformations resembled Angles class II malocclusion.


Deficiency of Vitamin D may result to rickets, reduction in blood calcium and phosphorus, delayed closure of fontanelles. Disproportionate growth occurs between face and skull. It may cause interference with bone growth.

It causes retarded eruption of teeth early loss of deciduous teeth due to caries.

Jaw bones become thick.

Teeth are irregularly arranged www.indiandentalacademy.com

Maxilla become narrow and palate becomes high.

Mandible becomes short.

Infants with low vitamin D intakes showed delayed eruption of teeth.

Increased susceptibility of osseous tissue to muscular traction as undesirable oral habits.

Open bite, transverse hypodimensions and misshapen palate are frequently observed in vitamin D deficiency.


Vitamin A The principal effect of vitamin A deficiency

is reduction in size of skull, changes in shape of skull distort the face as well. The bones of face particularly mandible, malar and zygomatic process of temporal bone are thickened and coarse.


Disturbances of differentiation and appositional growth of developing teeth.

Disturbances in calcification of teeth, pulp stones.

Retardation of eruption.

Retardation of general dental growth and development.

Disturbances of periodontal tissue.


FOOD CONSISTANCY ON FOOD CONSISTANCY ON OROFACIAL DEVLOPMENTOROFACIAL DEVLOPMENT

In AnimalsIt has been shown in animals that a diet that does not supply food of a sufficiently hard consistency does not supply adequate stimulus for proper mastication, resulting in narrower maxillary arches. Similar observations have also been made in humans, and a genuine arch collapse syndrome has been described. This type of pathologic condition was observed in histologic studies on animals, in which alterations were seen in the haversian system of the mandible. www.indiandentalacademy.com

There is a lower level of eruption, especially posterior eruption.

Maxillary arches are narrower.

Mandibles are shorter, and condyles are thinner.

Temporal and massetter muscles have less tone.

The linear dimension of the skull is reduced. www.indiandentalacademy.com

Soon after birth, the newborn learns that food results from the action of sucking, as a result of the sucking and pressing actions that are associated breast feeding, the baby develops the earliest important functional influences on both the thrust and physiologic growth of the mandible.On the other hand, the mandible may be compelled to withdraw as a result of bottle-feeding because its physiologic thrust effort is missing.




According to anthropologic studies, the exertion of the masticatory function has been progressively decreasing in people from industrialized area, probably because of the use of softer diets. But the diets of rural populations, which usually contain an abundance of raw vegetables, offer adequate masticatory muscular stimulation, and orthodontic problems in this group are at a minimum.

The consistent use of a too soft diet is a major factor in the occurrence of dental malpositioning.


Nutrition and TeethNutrition and TeethDiet affect teeth in two distinct ways.LOCAL EFFECT - depends on the intraoral chemical or physical action on the external surfaces of the teeth and oral tissues of the products of masticatory and bacterial action on the various foodstuffs. SYSTEMIC NUTRITIONAL factors is important during the period of tooth development only. periodontium is continuously influenced by systemic factors.


Nutrition and TeethNutrition and Teeth Critical periods exist in the development of teeth during which time any nutritional imbalance will lead to irreversible change in teeth.

Nutritional deficiency is also associate with periodontal dieses deficiency of calcium, phosphate and vitamin D produces osteoporosis of alveolar bone.


If mother’s diet is deficient in protein, will affect the child’s teeth in the following ways.

Teeth will be smaller in size specially third molars.

Teeth will be more caries prone.

Late eruption of third molars.

Rotated and crowded teeth.

Nutrition and TeethNutrition and Teeth


Optimal and harmonious growth and development of maxilla and mandible are necessary to maintain a harmonious dental arch.

Deficiency of required nutrients will results in inadequate bone growth patterns with concomitant malalignment and malocclusion of the teeth.

Nutrition and TeethNutrition and Teeth


Extensive epidemiologic studies show that children calcifying their permanent teeth while using a domestic water containing about 1 part per million of fluoride show only about 40 to 60 per cent as much dental caries as comparable groups of children using fluoride-free water.


Caries resistance, produced by fluorides during tooth calcification, is due to the incorporation of the fluoride ion in the enamel

Fluoridation of water supplies, or topical application of fluorides, and good oral hygiene can prevent caries in spite of the presence of sugar in the diet.


• Dentistry for child & adolescent - Mc Donald• Nutrition in Clinical Dentistry - Abraham E. Nizel• Craniofacial Embryology – Fourth Ed. – G.H.Sperber• Contemporary Orthodontics – Fourth Ed. – Proffit• Essentials of Facial Growth – Donald H. Enlow• Handbook of Orthodontics – Fourth Ed. – Moyers• Textbook of Orthodontics –Samir E Bishara• Orthodontics- Principles &Practice- Third Ed -

T.M.Graber• Color Atlas of Dental Medicine - Orthodontic

Diagnosis – ThomasRakosi, Irmtrud Jonas, Thomas M Graber

• Textbook of Orthodontics - Salzmannwww.indiandentalacademy.com

nutrition part1 / orthodontic courses by indian dental academy

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