Contents

• Introduction
• Definition
• Nutrients
Macronutrients
micronutrients
• Biochemistry of growth and development
• Theories of craniofacial growth
• Craniofacial development
• Nutritional factors in development of human orofacial skeleton
• Corelation of diet and orofacial growth.
• Effect of vitamins on growth and
development
• Influence of food consistency on orofacial
development.
• Effect of nutrition on teeth.
• Dietary recommendations
• Adequate nutrition is important for
proper body growth, it’s development and
maintenance.
• If diet is deficient in any as
essentials nutrients then it affects the
normal development of the organs.
• If the deficiency occur in early
period of development the damage will
be more. Severe and Ir-reversible.
• Major causes of malnutrition:
1. Decreased intake.
– Poor teeth
– Dysphagia
– Anorexia nervosa
– Restricted food habits.
2. Malabsorption
– Biliary and pancreatic diseases
– Enteric malabsorption syndromes
– Vitamin B12 malabsorption (pernicious
anemia).
3. Increased requirements
– Rapid growth in infancy, in
childhood,ofpuberty, pregnancy,
– Trauma
– Burns
– Excessive loss of in protein losing
enteropathies and nephropathies.
4. Special Category
– Total parenteral nutrition
– Drug induced interference with absorption
– Genetic disorders interfering with
conversion or utilization of nutrients
• Malnutrition affect the occlusion
through
1. Loss of teeth
2. Severe caries
3. Periodontal disease
4. Retarded Jaw development
• There is a special need for calcium,
phosphorus, Vitamin C, Vitamin D,
in relation to occlusion and dentofacial
development.
• Nutritional Deficiency:
• Assessed development and
growth, and faculty bone formation may
be the result of faculty physical and
chemical constituents of the food and
water supply which may be lacking in
essential elements.
• Physical nature of food as well as
method of mastication and deglutition
can be the causitive factor in jaw
development and in production of mal
occlusion.
• Dietary deficiency of mother during
gestation and lactation and of child during
growth period of the determinants of the
degree to which the inherent growth pattern
will be attained.
• Rickets may produce disturbed eruption
and arrangements of the teeth and ir-
regularities in the form of dental arches,
open bite and deficient growth of maxilla
are the characteristic of rachitic children.
Mandible may appear shortened in
anteroposterior-growth, the maxilla arch is
long and narrow. The deciduous and
permanent teeth are extremely subject to
carrier and early loss. Flattening of the
mandibular arch in the region of incisors is
frequently found in children with rickets.
• Nutrition:
It is the science of food the
nutrients and other substance and
balance in relation to health and
disease and process by which the
organism ingest, digest, absorbs,
transports, utilizes and excreats the
food substances.
• Malnutrition:
It is a pathological state,
resulting from ,a relative or absolute
deficiency of excess of iron, or more
essential nutrients.
 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 undernutrition constitute
globally the most important category of
environmental disease.
• There are several types of
nutrients that are

• Carbohydrates, fats, proteins greater part

of food is consisting of these nutrients so
they are also called as macronutrients

• Vitamins and minerals they are required in

small quantities and are called as
micronutrients
• Carbohydrates:
• They are the main source of
energy.
• They are the starch and sugars
in the food.
• Main source: wheat, rice, potato,
etc.,
• Carbohydrates are mainly classified as
1. monosaccharides eg., glucose
2. disaccharides, eg., sucrose, maltose
3. oligosaccharides eg. Maltotriose.
4. Poly saccharides eg. Starch.
• Any form of carbohydrate is gets converted to
glucose after ingestion and then gets absorbed in
to the blood, deficiency diseases underweight,
underheight R.D.A. is 440gms.
• Excess amount which is present in blood is
converted to the glycogen and storted into the
liver.
• Some form of the 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, ie., (60-90 mg/100ml).
• Lipids:
• Amount of lipids that should
presents in diet in is approximately 40%.
• These are the organic compounds
which are relatively in soluble in water.
• The various physiological function, of
lipids are.
1. Provide energy to the body.
2. Provide building blocks for different high
molecular weight substances.
3. Provide essential fatty acids which are not
synthesized in body.
• Lipids are stored in adipose tissues in
adequate amount. Main function of
dietary fat’s is to improve absorption of
fat soluble vitamins. Fat that is stored in
adipose tissue is hydrolysed to glycerol
and free fatty acids. Glycerol then enter
the glycolytic pathway for further
catabolism. Free fatty acids enter the
mitochondria and undergo a process
called as beta-oxidation for degradation
to acetyl co-A which enter the citric acid
cycle for further oxidation.
• Deficiency diseases:
Deficiency of fat soluble
vitamin’s A,D,E and K.

• Sources:
Butter, Margarine, Veg oils, fats,

• R.D.A.
50 gms.
• Proteins :
• There are necessary for the proper
growth and maintenance of body
structures.
• They are the ingredients of bone,
muscle, skin.
• They are made up of amino acids.
• Several amino acids are arranged
in large. Polymer chains to form proteins.
• Some amino acids are not
synthesized in human body and are
called as essential aminoacids.
• Deficiency diseases:
Underweight, underheight, weight loss,
lethargy, anemia, fatty liver, kwashiorkor,
marasmus.
• Sources:
Animals sources- eggs, fish and meat,
vegetable sources- beans, grains, nuts
and vegetables.
• R.D.A.
70gms
• Vitamins:
These are organic chemical
compounds, essential in small
amounts for normal growth and
nutrition of human body.
• If vitamins are absent then an
abnormal development results as
vitamins are parts of coenzymes
and they takes part in various
reactions as catalyst. If vitamin is
absent then effect of enzyme on
metabolic or biochemical activities
will not take place.
• These metabolic and biochemicals
activities are required embryonic
development.
• Vitamins are classified according to
their, solubility as.
1. Water soluble vitamins –Vit B
complex and C.
2. Fat soluble vitamins Vitamin A,D,E
and K.
• Minerals
• Calcium and phosphorus are the two
main minerals, which takes part in formation
and maintenance of bone.
• Calcium is normally presents in the
blood at a concentration of 9 mg to 11 mg per
100 ml.In order to maintain proper blood
calcium level body tends to pull calcium out of
osseous and dental deposits.
• Phosphorus is normally presents is
blood at a concentration of about 3.5 to 4.5 mg.
Per 100 ml.
• Blood level of calcium and phosphorus
may be higher in young children’s.
• Calcium promotes osteoblastic activity
that is involved with the formation of
osteoblast and new bone. Resorption of
bone releases phosphorus.
• Calcitonin decreased the amount of
calcium in the blood but antagonizing
resorption.
• A hydroxylated form of vitamin. D3 works
as bone harmone, this vitamin is essential
for intestinal absorption of calcium and
phosphorus, which increase the
availability of calcium in blood for the
process of deposition.
• High calcium allowances are
recommended during pregnancy and
lactation to provide for the growth of the
fetus and for milk production.
• Foods with high calcium content are
milk, cheese, cauliflower, celery, and beef-
greens.
• When calcium level rises above
normal, calcium is excreted in the feces
and urine.
• BIOCHEMISTRY OF GROWTH AND
DEVELOPMENT
• Miller has demonstrated that the pattern of
growth and development begins with the rapid
synthesis of DNA, followed by an increase in
synthesis of RNA with a subsequent increase in
synthesis activity, and rise in free amino acid pool in
the tissue.
• The free amino acid pool is regulated by diet.
Therefore, an extremely important relationship exists
between diet, growth and development.
• Diet can also influence the usual pattern of
biochemical events associated with cell and organ
growth.
• If an inadequate supply of vitamins,
minerals, amino acids and other
nutrients occur during the “critical period or
phase” or the Dietary imbalance at any
stage of growth can have different
hyperplastic growth phase or dividing
phase permanent, irreversible damage to
the tissue may occur.
• If the deficiency occurs at the stage when
cells and organs are enlarging in size. i.e.
hypertrophic growth period, they may
temporarily stop enlarging, but usually
catch up later when adequate amounts of
the missing nutrient become available. If
the deficiency occurs during dividing
phase when the new organ is developing
from the existing one, then the damage
may be of permanent nature as the new
organ may not develop to optimum size
and may not perform all normal
physiological function.
• Optimal maternal nutrition is
required for optimal growth,
development and calcification of the
primary dentition in utero. Proper
nutrition during infancy and
childhood is particularly important
for the growth, development and
maintenance of optimal orodental
structures in the permanent
dentition.
• Theories of craniofacial growth:
• Various theories have been
proposed concerning craniofacial
morphogenesis since early 1950’s
• Four major theories of them are
as follows.
1. The classic theory of Sicher’
2. Functional matrix theory of moss
3. The primary cartilage theory of Scott.
4. Multifactorial theory of van limborgh.
• Sicher’s theory:
• He suggested that sutural growth is a
reaction to the proliferations of
connective tissue in sutural area and
not merely apposition of bone on edge
to edge contact of two bones.
• Growth of maxillary complex is
occurred of four parallel sutures.
• Growth of which results in a downward
and forward displacement.
• Four sutures are:
1. Frontomaxillary sutures
2. Zygomatico temporal sutures
3. Pterygopalatine sutures
4. Zygomatico maxillary sutures
• Moss theory
• Moss proposed that head and neck
region have certain functions that must be
performed and growth of that area is
related to the function performed.
• These function include:
• Respiration, digestion, speech, olfaction,
audition, vision, balance, taste, etc.,
• Every function is carried out by functional
component.
Each functional components consist of two parts.
Functional matrix: carried out the functional
Skeletal unit: It’s biochemical function is to
protect and to give support to the specific
functional matrix.
Skeletal unit is composed of bone, cartilage or
even dense fibrous connective tissue.
There are two basic types of functional matrices.
• Periosteal matrices.
Eg. Attachment of muscle to bone
• Caspular matrices.
Eg. Brain and skull
• Scott’s theory:
• Scott forward the hypothesis that cartilage and
periosteum have intrensic genetic
determinants that regulate their growth.
• He claimed that cartilagenous area, such as
nasal septum and synchondroses of cranial
base acts as a growth centers for the skull and
face.
• Scott hypothesied that there is relationship
between growth of sutural complex and
growth of cartilage.
• He assigned a reactive secondary role to
sutures and primary motivating role to
cartilogenous tissues.
• He felt that synchondroses grow and place
tension upon sutures, will then stimulate the
suture to grow.
• Van-Lamborgh’s theory:
• Van limborgh synthesised an all
encompassing view from three previous
ones and based it upon following six
criteria.
• The growth of the synchondroses and
ensuing endochondral ossification are
almost exclusively controlled by intrensic
genetic factors.
• The intrinsic factors controlling
intramembranous bone growth are small
in number and general in nature.
• Cartilagenous skull part must be seen as
growth centers.
• Extents of sutural growth is controlled by
both cartilagenous growth and growth of
other head structures.
• The extent of periosteal bone growth
largely depends on growth of adjacent
structures.
• Intramembranous process of bone
formation can be influenced additionally by
local environment factors including muscle
force.
• Cranio facial development:
• Cranial Base
• The ethmofrontal and spenoethmoidal
sutures close by about sixth year of life, and
spheno-occipital suture ossifies and
becomes synostatic about 15 to 16 years of
age in females and 17 to 21 years of age in
males. The sutures between the bones in the
base of the skull, are regulated by growth of
encephalic mass. In hydrocephalus, the
enlargements of the encephalic mass
prevents the suture closing. In craniostenosis
the encephalic mass usually tends to grow
towards the occipital region because of
premature suture closing.
• Maxilla:
• The earliest maxillary ossification
occurs on both sides of the frontal superior
alveolar nerves and then on median line
immediately below the nasal septum.
• After the birth, the maxilla seems to
grow in a forward and downward direction,
away from the base of the skull, but it
actually grows in a backward and upward
direction, towards the base of skull. New
bone is added on the maxillary surface in
one direction but the enlarged maxilla
expands in opposite direction by “shifting”
it’s position.
• Most active areas of growth of
the maxilla are in the maxillary
tuberosity and nasal septum.
Bone growth in there areas
exerts pressure against the base
of the skull resulting in growth of
maxilla, downwards, and
forward.
• Palate:
• The palate develops primarily
forward and downward in response to
pressure from the increasing mass of the
nasal septum and as a result of bone
apposition on oral side and bone
resorption on nasal side of the palate.
Synarthosis of the palatal sutures occurs
untills about ossification begins .
• Mandible:
• The condyle plays a role in the
development of mandible about the 10th
week of fetal development, the nucleous
of condylar cartilage takes the shape of a
cone. The cartilaginous cells becomes
diffrentioned and the forms and important
center of growth for the ramus and the
body. During the second half of fetal
development a large part of the cone like
cartilage is replaced by the bone. The
growth process stops of about 20 years
of age.
• The shape and dimensions of the
fetal mandible undergo
considerable transformation during
the subsequent development. In the
newborn, ascending ramus is short
and wide, coronoid process is fairly
large. The symphysial line gradually
disappears between 4th and 12th
months of life, When ossification
turns syndesmosis into synostosis.
• The adult mandible looks like a single
bone but basically it is a composite of bony
subunits. The alveolar, coronoid, angular,
and condylar processe are all joined to the
basal bone.
• Development of temporal muscle
affects coronoid process, the masseter and
internal pterygoid muscle press on angle of
jaw, the lateral pterygoid muscle exerts
influence on condylar process. The
development of mandible is influenced by the
perioral muscles, tongue and also by
expansion of oropharyngeal cavity.
• The specific centers of growth of
mandible during the postnatal
period are the condylar cartilage,
upper margins of the ramus, and
the alveolar ridge.
• Proliferation of cartilage in upper part
of the condylar head causes condyle to
develop upwards and backwards. Ramus
is associates with growth in downward
and forward direction osseous resorption
below the head of condyle determines
the narrow shape of the neck. Insertion of
external pterygoid muscle on the neck
along with the other masticatory muscle
has strong influence on growth of
mandible in phase of it’s growth.
• Lesions in condylar cartilage
may interfere with balanced
mandibular growth ,it may results
into lateral mandibular deviations,
micrognathia, asymmetric
mandible. Etc.,
• Nutritional factors in development of the
human orofacial skeleton:
• 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 and 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 and orofacial
growth in animals:
• 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.
• A short period of malnutrition
(7-12 months) have resulted
in
1. An increase in ant. open bite.
2. A reduction in dimensions of dental
arches, with inadequate space for
teeth
3. In sufficient dental eruption.
4. Absence of natural diastema
between front decidious teeth.
5. Shorter roots
6. Interosseous rotation of permanent
teeth,
7. Shorter mandible in antero-post
dimensions.
8. Marked reduction in ascending ramus,
condylar region.
9. Changes in dentoalveolar inclination in
incisor regions.
10. Mineral in adequacies in the diet harm
bone more than tooth.
• 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.
• 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.
 • DIET AND OROFACIAL MALFORMATIONS

Animals
In addition with nutrition deficiency, excess
intake of vitamin A,D or K cause skeletal alterations
inanimals.
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 deficincy have been present. Congenital
abnormalities of dentofacial development and occlusion
are found in rats with riboflavin deficincy.
• 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
•RELATIONS OF VITAMINS WITH GROWTH
AND DEVLOPMENT
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.
•
 Vitamin B complex:
• 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
angler’s cl II malocclusion.
 Vitamin C
• 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 D.
• Deficiency of Vitamin D may result to
rickets, reduction in blood calcium and
phosphorus, delayed closure of fontanels.
Disproportionate growth occurs between
face and skull. It may cause interference
with bone growth.
• It causes retarded eruption of teeth
early loss of decidious teeth due to caries.
• Jaw bones become thick.
• Teeth are ir-regularly 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.
 • INFLUENCES OF 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 were
observed in histologic studies on animals, in which
alterations were seen in the haversian system of the
mandible.
• The following morphologic effects of
soft diet have been noted in animals:
1. There is a lower level of eruption,
especially posterior eruption.
2. Maxillary arches are narrower.
3. Mandibles are shorter, and condyles are
thinner.
4. Temporal and masseter muscles have less
tone.
5. The linear dimension of the skull is
reduced.
 In Human

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 Teeth

Diet affect teeth in two distinct ways. One is the

local effect and 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. The
other, or systemic nutritional, factors, is important
during the period of tooth development only.
However the periodontium is continuously
influenced by systemic factors.
• 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
deficiancy of calcium,phosphate and vit.d
producess osteoporosis of alveolar bone.
• If mother’s diet is deficient in
protein, will affect the child’s teeth
in the following ways.
1. Teeth will be smaller in size
specially third molars.
2. Teeth will be more caries prone.
3. Late eruption of third molars.
4. Rotated and crowded 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.
• Fluorides and dental caries

• 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.
• Dietary Recommendations
• Nutrition in prenatal and
early postnatal stages are very
important for subsequent growth
and development.
• Prenatal and early postnatal
periods are hyperplastic stage in
this period active mitosis takes
place and the number of cells
increase.
• Early infancy growth period is
combined hyperplastic and hypertrophic
stage in this period both the number and
size of cell increase.
• Late infancy stage is hypertrophic
stage in this period cell size increases but
cell number does not increase
significantly.
• Poor nutrition in the above first two
stages will adversely affect the
development of tissues and their abilities
of recovery and regeneration and damage
will be permanent.
• Balanced diet:
It is 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.
• The Balance Of Good Health
• five food groups should be present in
the regular diet to achieve Balanced
Diet
1. Bread, Cereals and Potatoes.
2. Fruits and Vegetables.
3. Milk and Diary Foods.
4. Meat, Fish and alternatives.
5. Food Containing Fat, Food
Containing Sugar.