H.P. GOVT.

DENTAL COLLEGE SHIMLA

SEMINAR

ON

Role of nutrition in oral health

Submitted by:

Dr. SHAILEE FOTEDAR

P.G. Student

Department of Preventive
& Community Dentistry

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 CONTENTS

Introduction

Nutrition

Goals of nutrition

Nutrients

Relationship Of Nutrition And Oral Health

Impact Of Nutrition On Oral Cavity

Proteins

Carbohydrates

Fats

Vitamins

Minerals

Trace Elements

Conclusion

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INTRODUCTION: There is an interdependent relationship between the good nutrition and
good general and oral health. Both are defined in multiple ways and described by complex,
interrelated measurements. On the other hand, poor nutritional health is associated with poor
general and oral health, and vice versa.

NUTRITION :-can be defined as the science of how the body utilizes food to meet the
requirements for growth and development, repair and maintenance or as the science of food and
its relationship to health.

FOOD:-means “any substance which when taken into body of an organism may be used either
to supply energy or to build tissue.

DIET:-is referred to as “food and drink regularly consumed.

 GOALS OF NUTRITION;-

1. To provide adequate energy (calories) to the individual required to support the body’s life
sustaining processes.

2. To build and maintain all body cells.

 NUTRIENTS:- are the organic and inorganic complexes contained in the food.

NUTRIENTS

Macronutrients Micronutrients
1.Proteins 1.Vitamins
2.Fats 2.Minerals
3.Carbohydrates 3.Trace elements

 MACRONUTRIENTS:-

------Also called proximate principles.

------In the Indian diet, they contribute to the total energy intake in the following proportion:

Proteins ----- 7-15 %

Fats ----- 10-30%
Carbohydrates ----- 65-80%

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MICRONUTRIENTS:-
--------Called so because they are required in small amounts i.e, fraction of a mg to several
grams.

Relationship of nutrition and Oral health.

 The relationship of nutrition and oral health is multidirectional.

 Oral diseases like dental caries, periodontal disease, tooth loss and oral cancer may
compromise the conditions of teeth and supporting tissues, which in turn impacts the food
choice and nutritional intake.

 Nutritional status, on the other hand affects the development and progression of oral
disease.

 This cyclic nature is of importance at all stages of life.

Impact Of Nutrition On Oral Cavity

Nutrition has both local and systemic impact.

 1. Local impact : The diet and the eating patterns have a local effect on teeth, saliva and
soft tissues.

 2. Systemic impact: which is the impact of nutrients consumed, on general health,

growth and development, cell renewal, ability of the tissues to repair and resistance to
disease also has considerable implications on oral health.

Macro nutrients: These include

1. Proteins:- are complex organic nitrogenous compounds, composed of C, H,O,N

and S in varying amounts.

----May also contain P and Fe.

----Constitutes about 20 % of body weight.

----Made of smaller units called amino acids.

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 ----AMINOACIDS

Essential Non essential

 Sources;-

a.Animal sources:-Milk, meat ,cheese ,fish and eggs.

b.Veg sources:- Pulses, cereals, beans, nuts, oilseeds

 Requirement:-
For adults:- 1- 1.2 gms of protein per Kg body weight.

 Functions:-Proteins are needed by the body for:-

a. Body building
b. Repair and maintenance of body tissues.
c. Maintenance of osmotic pressure.
d. Synthesis of certain substances like antibodies, plasma proteins, hemoglobin, enzymes,
hormones and coagulation factors.

e. Proteins can supply energy when the calorie intake is inadequate, but this is not their
primary function.

f. It forms collagen which is the major organic component of teeth, bone, periodontal
ligament and muscle .

Applied clinical aspects:-

1.Protein Energy Malnutrition:-

 It occurs particularly in children in the first years of life.

 The incidence of PEM in India in pre school age children is 1-2 %.

 It occurs in two clinical forms.

1.Marasmus
2.Kwashiorkar

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  Marasmus Kwashiorkor

– Occurs when the energy in the - Occurs when the diet has

diet is limited due to inadequate low protein to energy ratio.

food intake .

- Complete muscle wasting - variable muscle wasting

– No edema - bilateral edema

– Normal serum albumin - low serum albumin

Oral Manifestations In PEM:

 Caries of the primary dentition : due to salivary gland hypofunction and salivary
compositional changes. Salivary compositional changes are:

a. These patients show significant reduction in salivary protein component and thus
reducing its bacteriostatic properties.

b. Bacteria agglutinating glycoprotein in saliva is decreased by malnutrition, which

may promote the dental plaque.

 Bright red tongue with loss of papillae.

 Bilateral angular cheilosis.

 Fissuring of the lips

 Easily traumatized epithelium of the mouth and delayed wound healing

 Loss of circum oral pigmentation.

 Osteoporosis of the alveolar bone due to reduced deposition of osteoid.

 These manifestations in PEM are associated with impaired immune response

particularly cell mediated immunity, phagocyte function, antibody affinity and
compliment system.

 Carbohydrates:-are long chains of sugar molecules that are used for energy. Chemically
they contain the elements C,H & O, the later two in the same ratio as in water and hence
the name carbohydrates.

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 CARBOHYDRATES

Monosaccharides Disaccharides Polysaccharides

E.g Fructose sucrose Cellulose

Glucose lactose Glycogen

 Sources :- Whole grains, vegetables like potatoes, legumes root vegetables and fruits
Requirements:-The dietary guidelines recommend 45%--- 65% of daily calories should
come from carbohydrates.

Functions:-
1. Sugars and starch act as the perfect fuel for various activities of the body .

2. Necessary for the regulation of nervous tissue and is the only source of energy for the
brain.

3.Some carbohydrates are high in fibre which helps prevent gastrointestinal diseases and lower
the risk of certain diseases.

Applied clinical aspects:

---CHO deficiency rarely occurs as it is present in wide variety of foods.

---Effects on oral health:

Carbohydrates play an important role in oral health as the presence of fermentable

carbohydrates are considered to be responsible for Dental Caries.

 Dental caries:is defined as a progressive, irreversible microbial disease of multifactorial

nature affecting the calcified tissues of the teeth, characterized by demineralization of the
inorganic portion and destruction of the organic portion of the tooth.

These dietary sugars diffuses into the plaque rapidly and are fermented to lactic and other
acids which cause demineralization of the tooth.

The cariogenicity of a carbohydrate depends upon:

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 a. the frequency of ingestion

b. Physical form

c. Chemical form

 Frequency of intake: is directly proportional to increased susceptibility to dental caries.

 Physical form: Carbohydrates that are retained over a longer periods of time are most
cariogenic. Such diets include small particle food or food that is viscid and sticky.

 Chemical Form: Complex carbohydrates are larger molecules and cannot diffuse into
the plaque and are less caries producing as compared to monosaccharides and
disaccharides.

 Mono and disaccharides can diffuse freely in the plaque and are available as energy
source for bacteria.

 Among all the sugars sucrose is the most cariogenic --- Arch Criminal because.

---- Most common dietary sugar.

---- Freely diffusable in dental plaque and readily metabolised for the production of organic
acids in sufficient conc to lower the pH of plaque.

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 ----It is the only sugar involved in the synthesis of soluble and insoluble extra cellular glycans.
Thus it favours the colonization by oral microorganisms and increases the thickness of plaque.

Sugars alcohols like mannitol, sorbitol and xylitol are hypoacidogenic and poor substrates for
acidogenic microorganisms as they are slowly and incompletely metabolized .

FATS:-are the organic substances insoluble in water but soluble in inorganic solvents like
chloroform, ether and benzene.

 They form important dietary constituents on account of their high calorific value.

 Present in the cytoplasm as well as plasma membrane and also in specialized areas in the
body as depots of fat in which energy is stored.

 Adipose tissue constitutes 10-15% of body weight.

 Triglycerides are the basic unit of fat.

 Sources:-

Animal fats:-Ghee,butter,milk,cheese,eggs and fat of meat and fish.

Vegetable fats;-ground nut,mustard,coconut.

 Requirements;- Not more than 25% of the calories consumed per day should come from
fats.

 Functions:-Fats are concentrated sources of energy.

---- Fat deposits are present under the skin as subcutaneous fat around the vital organs.

----It provides insulation from temperature extremes.

----It is required for cell membrane structure and cell functions.

---- Fats serve as a vehicle for fat soluble vitamins.

 Applied aspects:-

Effects of Excess Dietary Fat Intake:-

Obesity:-. They are more prone to develop

1.Atherosclerosis CHD

CVA

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2.Diabetes mellitus

3.Hypertention.

 Oral Manifestations in obesity: Obesity has been considered as a risk factor for
periodontal disease in human studies. The patho physiology has not been clearly
understood but recent evidence has demonstrated that adipose tissue secretes a variety of
molecules that affect the metabolism of entire body and contribute to low grade systemic
inflammation.

 Molecules secreted are interleuken-6,tumor necrosis factor-∞,complement factor C3 and

plasminogen activator inhibiter-1.

 Secreted in proportion to the amount of adipose tissue present.

 So it is believed that obesity may have the potential of modulating the host response and
inflammatory system rendering the patient more susceptible to the effects of microbial
plaque.

 Apart from systemic impact of fats, they also have local impact on teeth.

 Dietary fat may act to form a physical barrier on the susceptible tooth surface and thus act
to prevent demineralization as well as isolate the plaque from carbohydrates.

 Dietary fat accelerates the clearance of food from the mouth, thereby reducing the
exposure time of the oral bacteria to fermentable carbohydrates.

Vitamins:-are the organic nutrients that are required in small quantities for a variety of
biochemical functions and cannot be synthesized by the body and must therefore be
supplied by the diet to maintain the health, growth and state of well-being of a person.
They supply very little energy by themselves, but play an important role in several energy
transformation reactions of the body.

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 Classification:-

VITAMINS

Fat soluble Water soluble

vit A Vit B complex
Vit D Vit C
Vit E
Vit K

Vitamin A:-Naturally occurring vit A----Retinol

Pro-vitamin ------ ß-carotene

 Sources:- sea-fish liver oils like cod liver oil,shark liver oil,butter & egg yolk.
Plants are the sources of ß carotene.

 Requirement:-In adults-------------- 750µgms

During lactation------ 1500µgms
Applied aspects:- Vit A def may lead to:
1.Eye Signs:
a Bitots spots
b Xeropthalmia
c Keratomalacia
2.Night blindness

 3. Skin changes
--- hyperkeratinisation of the skin

---attrophy of sweat glands resulting in dry hyperkeratinized skin called toad skin.

 4.Bones :-Deficiency of vit A may result in lowered osteoblastic activity and bones
become cancellous.

 5.Oral Manifestations:-

 Inadequate cell differentiation, impaired healing & tissue regeneration

 Desquamation of oral mucosa.

 Increased risk of candidiasis

 Leukoplakia

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  Gingival hypertrophy & inflammation

 Compromised salivary flow

 Enamel hypoplasia

Hypervitaminosis A: Increased bone resorption as it may trigger an increase in osteoclasts.

VITAMIN D

Sources: Natural dietary sources Include butter ,cheese, milk,egg yolk.

Requirements:Pregnant,lactating women, infants and persons confined within indoors

may require a supplement of 400 IU daily.

Functions:-

--It increases the absorption of calcium and phosphorous from the jejunum.

--It is necessary for the deposition of calcium- phosphate in the bone.

-- It increases the re-absorption of both calcium and phosphorous from the renal tubules.

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Applied Aspects:-

1.Rickets 2.Osteomalacia

 Rickets:-Occurs in children before the closure of epiphysis.

 Clinical Features:-

----- Bossing of parietal and frontal bones.

-----Rickety rosary

-----Bowing of legs

-----Serum Ca is low.

 Osteomalacia:- in full grown adult

-----Bones become soft and fragile leading to deformity

-----Serum Ca is low

Effect on teeth:

 The eruption rate of deciduous and permanent teeth is retarded.

 Developmental abnormalities of teeth.

 Mal-alignment of teeth.

Vit D acts on teeth as indirect factor by regulating serum calcium and phosphorous which act
directly on teeth.

Vitamin K:

Sources:-leafy vegetables like spinach,alpha grass, cauliflower,and is synthesized by the bacteria

of the human intestinal flora.

 Requirements:- 1µg/Kg body weight.

 Functions:-It promotes the biosynthesis of coagulation factors by the liver.The factors

which require vit K for their synthesis are i) Prothrombin

ii)Factor VII

iii)Factor IX

iv) Factor X

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 The deficiency of vit K leads to delayed coagulation which in turn can lead to bleeding
disorder.

Oral Manifestations:-

---Gingival bleeding.

 Water soluble vitamins

i)B complex ii) Vit C

Thiamine
Riboflavin
Niacin
Pyridoxine
Biotin
Choline
Inositol
Para amino benzoic acid
Petothenic acid
Folic acid
Vit B12
Thaimine

 Sources:Rich sources are polishing of rice and husks of wheat & yeast.

 Requirements:

Infants 0.3 mg

Adults 1.5 mg

Pregnant & lactating 2 mg

 Functions: involved in carbohydrate metabolism.

 Deficiency: Beri-beri

--- multiple neuritis, often

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 --- associated with congestive heart failure,

--- generalized edema.

 Oral Manifestations:

 Hypersensitivity of oral mucosa.

 Apthous ulceration.

 Loss of gingival stippling

 Gingiva becomes dusty rose in colour.

Riboflavin

 Sources: liver, eggs, milk and germinating seeds are good sources.

 Requirements: 1 mg /day

 Functions: Acts as a co-enzyme in oxidation-reduction reactions.

 Deficiency:

--- Dermatitis of the face, trunk and extremities

--- Corneal vascularisation.

--- Anemia

 Oral Manifestations: Glossitis

Angular cheilitis

Glossitis: is characterized by painful magenta discoloration of the tongue and atrophy of the
papillae.
Angular chelitis: begins as aninflammation of the commissures of lips, followed by erosion,

ulceration and fissuring.

Naicin: (Nicotinic acid)

 Sources:liver,yeast,eggs,cheese & bran of wheat are good sources.

 Requirements: Infants 6mg

Adults 10mg

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  Functions: used as Co-enzyme in intermediate metabolism.

 Deficiency:-

Pellagra: characterized by dermatitis,diarrhea,dementia and if not treated may lead to

death.

 Oral Manifestations: Stomatitis, Glossitis & Gingivitis

Stomatitis: In acute stages,

--- Entire oral mucosa becomes fiery red and painful.

--- Patient feels as if his mouth has been scalded.

--- Salivation is profuse.

Glossitis: is characterised by bright red and painful tongue ---raw beefy tongue. Initially
there is patchy atrophy of filliform papillae but as the disease progresses the entire
dorsum becomes dry and bright red.

In chronic deficiency, the tongue is thinned and fissured,with surface crevices and
marginal serrations.

Gingivitis: is characterised by extremely painful, wedge shaped, punched out ulcers

involving interdental papillae and marginal gingiva.It is superimposed by ANUG

Pyridoxine:B6

 Sources: Rich sources include meat, fish, potatoes and banana.

 Requirements: 1.5 mg in adults.

 Function: Plays an important role in protein metabolism.

 Deficiency: Seen in patients receiving heavy dose of anti TB drug isoniazid as it acts as
a chemical antagonists to pyridoxine and cause deficiency of vit B6.

Deficiency may lead to peripheral neuritis..

Oral manifestations; The oral lesions may resemble the glossitis due to niacin def.

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Folic acid:

 Source: Leafy vegetables like spinach, lettuce , broclee & liver.

 Requirements:

Infants 30mcg

Adults 100mcg

Pregnancy 400mcg

 Functions: Reqd for the synthesis of DNA.

 Deficiency :

Manifested as: Macrocytic ,megaloblastic anemia

Diarrhea

Glossitis and angular chelitis

Def during pregnancy can lead to oro facial defects.

 Glossitis: appears initially as a swelling and redness of the tip and lateral margins of
the tongue. The filliform are the first ones to disappear, the fungiform papillae
remaining as prominent spots. In adv cases, the tongue becomes dry and fissured and
bright red.

Vit B12:

Sources: Liver, muscles, egg and milk

Requirements:

Adults 3-5 µgm

Functions: For the synthesis of DNA

Deficiency: may be due to

Lack of intrinsic factor

Severe disorders of small intestinal

epithelium, malabsorption syndrome and sprue.

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 Clinical features: Megaloblastic anemia

Peripheral neuropathy

Oral manifestation:

Glossitis associated with glossodynia, glossopyrosis are characteristic features.

Associated with numbness

Condition is aggravated by extreme temperatures of food as well as salty and highly

seasoned meals.

The fiery red appearance of the tongue may undergo periods of remission, but the
recurrent attacks are common.

Vitamin C:

Sources: fresh citrus fruits like amla, lemon, orange and guava.

Requirements:

Adults 75mg

Pregnancy and lactation 100mg

Functions:

1.Synthesis of collagen which in turn helps in wound healing and imparting stability in
the capillary wall.

Hydroxylation
Aminoacid proline Hydroxyproline Collagen
VitC
in food

2. It is intimately related to the production of supporting tissues of mesenchymal origin

such as osteoid and dentine.

3.It facilitates the iron absorption by reducing the food ferric iron into ferrous iron.

4. Because of its reducing nature, it prevents oxidative injuries and thus aid in
maintaining the integrity of oral mucosa.

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 Deficiency:

Scurvy :

-----Tendency to bleed even on minor pressure.

-----Subcutaneous hemorrhage may be manifested as petechiae in mild deficiency and

echymosis in severe conditions.

-----Patient is usually anaemic.

-----Fresh wounds fail to heal

Oral manifestations: Generalized gingival swelling with spontaneous hemorrhage,

ulceration, increased severity of periodontal infection and periodontal bone loss followed
by mobility and exfoliation of tooth. Gingival lesions are termed as scorbutic gingivitis.

Minerals: Nutritionally imp are Na, K, Cl, Ca, P, Mg & S

Calcium :-is an imp mineral found mainly in bone and teeth.

Sources: Milk, cheese, egg yolk, beans ,nuts.

Requirements:

new borns 360mg

children& Adults 800mg

Adolescents 1000mg

pregnancy & 1300mg

lactation.

Functions: Calcification of bones and teeth.

Role in blood coagulation.

Role in neuromuscular

transmission.

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 Role in excitation of nerves.

Role in muscular contraction.

Deficiency symptoms:-

Rickets and osteomalacia

Cramp pain in legs

Nerves become extremely irritable

Oral manifestations:

Hypoplastic Enamel

Low serum calcium may be a risk factor in the progression of periodontal disease (PPD)
in elderly patients.

Resorption of the bone

Phosphorous

Phosphorus is the second most abundant mineral in the body and 85% of it is found in the
bones.

Sources:- cheese, milk ,nuts ,beans

Requirements: Infants 250mg

adults 800mg

pregnancy 1200mg

Functions:-

In the bone and teeth it forms Ca-phosphate which is the fundamental mineral for giving
strength to them.

It is a component of ATP and CAMP

Maintains the pH level (acidity-alkalinity) of the blood

It is an important constituent of DNA and RNA molecules.

Deficiency:-Incomplete mineralization of teeth and bone.

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 Increased susceptibility to caries if def

occurs during tooth formation

Trace Elements: These are elements required by the body in quantities of less than a few
milligrams /day. These include Fluoride, copper, Iron, zinc, manganese, cobalt, chromium,
Iodine and selenium

Fluoride: One of the important trace elements for dental health.

Sources: Drinking water, fish, jowar, bananas, potatoes, tea and turmeric.

Requirement:-0.05-0.07 mg/kg body wt

Functions:

1. It is important mineral that increases the resistance of tooth to decay. It acts on the tooth by
two mechanisms.

a. Pre-eruptive mechanism

b. Post-eruptive mechanism

 Pre-eruptive mechanism:

– Reduces enamel solubility by forming fluoroapatite which is less soluble.

– Modification of tooth morphology.

 Post-eruptive mechanism:

– Increased rate of post eruptive maturation.

_ Interference with plaque micro-organisms.

2. It is also important in maintaining the bone structure.

Fluoride is often considered as a ‘double-edged sword’ as inadequate ingestion is

associated with dental caries, and excessive intake leads to dental and skeletal fluorosis.

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 Toxicity: The most important toxic effect of fluoride on human beings is skeletal and
dental fluorosis, which is endemic in areas with soils and water containing high fluoride
concentrations.

 Dental Fluorosis: A specific disturbance of tooth formation caused by excessive

fluoride intake.

Clinically characterized by:

– Lusterless, opaque white patches in the enamel which may become mottled,
striated and/or pitted.

– In severe cases, the normal tooth form is lost.

Skeletal Fluorosis: Occurs at fluoride levels over 8.0 ppm. Its symptoms may vary
from:

Severe pain in the back bone, joints, hips.

– stiffness in joints and spine.

– Outward bending of legs and hands in advanced stages.

– Severest form is ‘crippling fluorosis’, in which the spine becomes rigid and
joints stiffen, causing immobilization of the patient.

Iron:- is one of the essential trace elements in the body.

Sources: Green leafy vegetables, liver, meat, fish and eggs.

Requirements: infants 0.7mg/day

males 1mg/day

females 2.8mg/day

pregnancy 3.5mg/day.

Functions: Formation of Hb

Development of RBC

Brain development and function

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  Deficiency: leads to iron deficiency anemia.

Fatigue, anorexia, pallor of the skin, neurological disorders &

koilonychias

Oral manifestations of Iron def anemia:

1.Oral mucous membrane is atrophic & shows loss of normal keratinization, since the
integrity of epithelium is dependent upon adequate serum iron levels.

2.Glossitis characterized by smooth red painful tongue.

3. Plummer Vinson syndrome characterized by the above findings as well as dysphagia

resulting from an esophageal stricture or web.

Zinc

Sources: meat and pumpkin.

Requirements: 5-10 mg/day

Functions:- Role in wound healing

Role in growth and reproduction

Important for healthy immune system

Deficiency:- Retarded growth

Retarded wound healing

Altered taste sensations

Role of Zinc on Oral Health: There is some evidence that zinc sulphate supplements will
decrease wound healing time significantly. When zinc peroxide powder was used topically on
acute gingival lesions in acute necrotizing gingivitis, the soreness disappeared sooner than
expected, and the mouth was quickly restored to normal health.

Copper: The normal amount of copper found in human body is 100-150 mg.

Requirements: Adults: 2-3 mg /day.

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 Sources: Liver, kidney ,oysters, nuts, dried legumes, dried fruits.

Functions: Aid in the synthesis of hemoglobin in the bone marrow,

Form and maintain compounds having enzymatic activity ,

Influence central nervous system physiology and aid in the formation of pigments.

Deficiency: is seen in Australian lambs and is called swayback disease characterised by the
degeneration of motor nerves in the CNS.

Selenium:

Sources: animal protein.

Requirements: Adults -0.05 to 0.2 mg

Selenium and dental caries: One of the commonest problems occurring in persons who ingest
foods grown in soils rich in selenium is a higher than usual dental caries experience.

Molybdenum:

Sources: Beaf, kidney, some cereals and legumes are good sources.

Requirements: Adults: 0.15-0.5mg.

Role of molybdenum on Oral health: There has been a conflicting reports of the relative caries
inhibiting property of molybdenium when used as a dietary supplement in animal feeding
experiments.

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Conclusion: Nutrition and diet has major influences on oral and dental health. Conversely , poor

oral and dental health can adversely affect food choice. Nutritional status and dietary habits can

affect and be affected by all oral conditions. Nutrition can affect the structure of teeth, with

malnutrition and excessive ingestion of fluoride clearly identified as risk factors. The post

eruptive, local intra oral effect of diet is the main cause of dental caries, and dietary sugars are of

paramount significance. In order to reduce the risk of caries ,both frequency and amount of

consumption pf non milk extrinsic sugars should be reduced .Malnutrition has specific effects on

the oral health. The diet not only affects the number and kind of carious lesion, but also is an

important factor in the development of periodontal diseases.

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