Nutrition part1 /certified fixed orthodontic courses by Indian dental academy

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Nutrition
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.

Nutrient
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 Nutrients
Macronutrients – greater part of food
Carbohydrates
Fats
Proteins

Micronutrients - required in small quantities
Vitamins
Minerals

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.

Malnutrition
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)



Increased requirements



Trauma



Burns





Rapid growth in infancy, in childhood, of puberty,
pregnancy,

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

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 Consumption
 Obesity
 Diabetes type 2
 Obstructive sleep apnea
 Hypertension
 Coronary heart disease
 Some cancers


Carbohydrates


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


Carbohydrates
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).


Lipids
Classification - chemical structure


Triglycerides



Phospholipids



Sterols

3% of daily calories
9 kcal/g
Fat substitutes - Simplesse & Olestra

Proteins
 1/2 - muscles
 1/5 - bone & cartilage
 1/10 - skin
 Amino acids - cytoplasm, nuclei, cell membrane &

tissue
 Source of energy

Proteins
 Proteins :
 Simple
 Conjugated
 Derived

 Amino acids
 Non-essential
 Essential - Histidine, Leucine, Isoleucine, Lysine,

Methionine, Phenlyalanine, Threonine, Tryptophan & Valine

Proteins
 Functions
 Building, repair & replacement
 Enzymes & hormones
 Regulators of fluid & acid-base balance
 Transport of molecules & Ab

 4kcal/g
 RDA: 0.8 g/kg

Proteins
 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 malnutrition



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, fruits
Beri-Beri :
1. Dry
2. Wet
3. Infantile - inc sensitivity, burning tongue,

loss/diminution of taste
Wernicke’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 synthesis
Integrity of cells - fibroblasts, osteoclasts,

odontoblasts
Fe absorption
RDA:
- 1-20 yrs - 45 - 50 mg/day
- Adults - 60 mg/day
- Pregn - 80 mg/day


Animal studies –

odontoblast atrophy,

irregular dentin,
dilated pulp,
entrapped odontoblasts




1.
-

2 sources:
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

 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 & lact

VITAMIN D…

Deficiency:




Rickets



Osteomalacia



Enamel hypoplasia


VITAMIN E

 Deficiency: premature infants - anemia
 Rodent 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,convulsions

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
- Kolionychia
O/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/day
Clinical 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 resorption
Hyperthyroidism :
- D.C - inc. need & use of excess calories
Source : 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.

Nutrition & Skeletal Maturation
Prolonged 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.

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.

Short Period of Malnutrition
7-12 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 teeth

Short 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

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.


Animals
In 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.



Deficiency of riboflavin has been found in

experimental
mandible,

animals to results in shortening of
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.

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

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
OROFACIAL DEVLOPMENT
In Animals
It 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.

FOOD CONSISTANCY ON




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.

FOOD CONSISTANCY ON
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.

FOOD CONSISTANCY ON
 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 Teeth
Diet 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 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.


Nutrition and Teeth
 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 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.


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 - Salzmann
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Nutrition part1 /certified fixed orthodontic courses by Indian dental academy

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