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Nutritional diseases
Body requirements
Vitamins&minerals
Oral manifestations
Chabohydrates,Proteins,Fats,Vitamins(A,B1,B2,B12,C,D)
Minerals,Fluoride,Sugars,& dental caries
Etiology of nutritional deficiencies
Body
requires
certain
amount of energy to
regulate and maintain the
involuntary essential life
processes.
Ideal dietary constituents:
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58% carbohydrates.
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30% fat.
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12% protein.
Side effects :
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Overweight: excessive amount
of bone, water and fat.
Obesity: increased body fat.
Etiology of nutritional
deficiency:
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Inadequate intake
Disorder of digestion.
Defective absorption.
Alteration of metabolism.
Increased metabolic demands.
Loss of nutrient.
Oral Manifestations:
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Carbohydrates.
Proteins: Kwashiorkor,
glossitis & angular
cheilitis.
Fat: defective growth.
VITAMINS:
Vitamins are organic substances that
occur in food in a small amounts and
is necessary for normal metabolic
functioning of the body.
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Decreased amount of intake of
essential nutrients.
Impaired absorption from GIT
Increased metabolism due to
growth.
Inadequate storage, pregnancy.
B-Complex
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Found bound in vegetables & animal
tissues.
Digestion > breakdown> storage
(except vit.12), mostly excreted in
the kidney.
Vitamin B 1 (Thiamine):
For calm nerves.
Absorption for 5mg/day, excess>
urine.
Daily requirements:
Men 1.3 mg
Women 1.0 mg
Children 1.1 mg
Pregnancy 2mg.
Function
Growth.
Protects heart muscles.
Stimulate brain
Normal nervous system function.
Digestion esp. carbohydrates & improves
digestion.
Diuretics.
Blood cell count & circulation.
Fatigue , aging & promotes healthy skin.
Deficiency Symptoms:
Nervous: mental depression &
insomnia, prepheral nuritis.
GIT: HCL> loss of appetite,
constipation…etc.
Heart > fatigue &lazy muscles>
hyperatrophy of heart.
Berberi: (can not)prolonged loss: two forms
Wet beriberi affects the heart; it is sometimes fatal,
as it causes a combination of heart failure and
weakening of the capillary walls, which causes the
peripheral tissues to become edematous.
Dry beriberi causes wasting and partial paralysis
resulting from damaged peripheral nerves. It is
also referred to as endemic neuritis.
– Oral manifestations: hypersensitive oral mucosa.
– Pain in tongue, teeth, jaws & face
Vitamin B 2 (Riboflavin):
Maintenance of epidermal tissue and
mucous membrane.
Deficiency :
Dermatitis, Scaling, greasy and red
lesions in the skin
Ocular lesions.
Oral effects:
Clefting (experimental).
Lips:
– Red & shiny (epith. desq.)
– Angular cheilitis & cracking.
Tongue:
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Glossitis with soreness.
Atrophy of the filiform papilla.
Fungi forms enlarged or normal
Severe cases: smooth glazed tongue.
Vitamin B3(Niacin)
Nicotinic acid.
Deficiency:
Fairy red oral mucosa.
Enlarged fungiform papilla.
Red tongue & in advanced cases blade
tongue
Vitamin B5 (Pyridoxine)
Nervous: peripheral neuropathy,
nervousness & mental retardation.
Blood: anemia & leuckopenia
Skin: dermatitis & eczema.
Headache, kidney stones…
Orally:
Angular chilitis.
Glossitis
Halitosis
Vitamin B9 (Folic acid)
Fairly rapidly destructed by heat &
alkaloids.
Functions:
– RBC formation, maturation & proliferation
– Nerves growth.
– Hair & skin (prevent premature graying).
– Helps in anti-bodies formation.
– Important for pregnancy & lactation
Deficiency causes
Decreased intake: dietary or
absorption.
Increased loss: hemodialysis.
Increased demands.
Clinical Features
Anemia
Skin: loss of hair & skin pigmentation
(brownish).
Reproductive disorder: abortion &
infant teeth.
Nervous: dementia, mental
depression & fatigue.
Functions:
RBCs production.
Nervous:  conc. memory & irritability.
Metabolism of carbohydrates & folic acid.
Promotes growth & apatite in children.
Causes of deficiency:
Congenital.
Systemic diseases of ileum.
Defective absorption.
Smoking.
Dietary.
Symptoms:
Megaloblastic anaemia.
Weakness & numbness.
Fatigue & abdominal pain.
Headache & dizziness.
Pallor.
Vomiting & nausea.
Orally
Painful tongue & glossodynia.
Beefy red tongue.
Small aphthous-like ulcers.
Atrophy of the tongue “hunters glossitis”.
Discomfort in wearing denture & muscle
weakness.
Vitamin C:
Antibiotic vitamin & ascorbic acid.
Powerful antioxidant.
 conc. in pituitary, adenoid, eye & WBC.
Stress  loss from adrenal cortex.
Vitamin C:
Functions:
Development of intracellular substance
of connective tissue (the osteoid tissue
of bone and dentin of teeth).
Maintenance of folate, neutrophils,
adrenal & thyroid gland.
Healing.
Deficiency:
– Weakness & infections.
– Hemorrhagic phenomena.
– Poor healing of the wounds.
– Systemic effect-Scurvy enlargement of the
marginal gingiva that cover almost all teeth.
Choline
Belongs to vitamin B.
Manufactured in body from
aminoacid+Vit.B12 + folic acid.
Helps fat transfer & prevent fat accumulation
in liver.
 memory
Def.  BP, liver fatty degeneration &
arthrosclerosis
Inositol
Fat transportation.
Brain nourishments.
 cholesterol
 falling hair & allows healthy hair.
Prevent eczema.
def.
Alopecia.
Gastritis.
Fatty liver & HTN
Vitamin A (Retinol):
Carotenoids
are
substances
found in yellow-oranges and
dark fruits and vegetables. It is
converted in the body to vitamin
A.
Functions:
Epithelial tissue maintenance (skin & mucosa &
mucous secreting structures).
Maintenance of cellular membrane permeability &
blood vessels(oxygenation).
Bone & teeth formation.
Aging & senility.
Maintenance of retina in the eye.
Promotion in normal reproduction (Experimental).
Maintaince
structures
of
the
health
of
oral
In the periodontium:
– Hyperkeratosis & hyperplasia of gingival
tissue.
– Periodontal pocket formation as a result of
basal cell proliferation, decreased cellular
infiltration and decrease capability for
repair.
In salivary gland:
– Atrophy & metaplasia reduction in
salivary flow and consequently caries.
Maintenance of the health of oral
structures
In the oral mucosa:
Vitamin A is associated with
epithelial metaplasia &
hyperkeratosis of oral mucosa.
Cleft lip and palate
Defective enamel, dentin &
hypoplastic teeth.
Vitamin D :
There are four types of vitamin D but only
two D 2 and D3 are of nutritional
significance.
Vitamin D2 is found in plants particularly
yeast.
Vitamin D3 is present naturally in the
tissue, fish liver oils & animal fats.
Functions:
It function as a vitamin and a hormone:
It allows absorption of the intestinal
calcium and phosphorus, which are
important in the function of muscles
and nerves.
With parathyroid it maintains calcium
level in the blood.
Necessary in bone & teeth formation.
Diseases associated with vitamin D
deficiency:
Rickets-deformities of bones in
children.
Osteomalacia-softening of bones in
adults.
Enamel hypoplasia-poorlycalcified
enamel.
Vitamin E
Anti-aging.
Vegetable oils.
Function:
Reproductive
Prevent clot formation & allows good blood flow.
Prevent scar formation in healing.
Def. oral manifestation:
Loss of pigmentation & degenerative changes in rats
Vitamin K
In plants & from intestinal bacteria
Essential for clotting
Oral manifestation: gingival bleeding.
Minerals:
Minerals are inorganic material
that are required by humans.
Fluoride:
Essential for dental health because it
reduces caries when ingested daily
at level of I PPM.
Above 2 PPM leads to fluorosis.
Management of osteoporosis
Calcium:
Calcium is found in bones and teeth
constitutes, 1.5 to 2% of body
weight.
Important for neuromuscular
controllability and irritability, blood
coagulation and myocardial function.
Iron:
Iron is important because iron in
blood is involved in oxygen
transport.
Deficiency: Iron deficiency anemia
(RBCs are microcytic and
hypochromic).
Oral manifestations includes:
atrophic glossitis, dysphagia and
fissuring of the mouth corners.
Zinc
Zinc for hair, nails & skin growth.
Wound healing.
Cell division.
Immune system.
Co-factor in many enzymes in the body.
Essential for taste.
SUGARS AND DENTAL CARIES:
Sucrose is the most commonly used.
role in caries development gnotobiotic
(germ free) environment, no caries
hereditary fructose intolerance caries
Bulk sweeteners (sugar alcohols):
sugar alcohols Also called polyols, chemical derivatives of sugars
that differ from the parent compounds in having an alcohol group
(CH2OH) instead of the aldehyde group (CHO); thus mannitol from
mannose, xylitol from xylose, lactitol from lactulose (also sorbitol,
isomalt, and hydrogenated glucose syrup).
Several occur naturally in fruits, vegetables, and cereals.
They range in sweetness from equal to sucrose to less than half.
They provide bulk in foods (called bulk sweeteners).
They are slowly and incompletely metabolized, and are tolerated by
diabetics (do not require insulin), and provide less energy than
sugars: they are less cariogenic than sucrose.
Intense sweeteners:
No energy but many times sweet
The non-sugar sweeteners are many times sweeter
than natural sugars and have no energy content
whatsoever.
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acesulfame K (150-200 times as sweet as sucrose: E950).
aspartame (200 times as sweet as sucrose: E951),
saccharin (300 times as sweet as sucrose: E954)
cyclamates (30 times sweeter than sucrose:E952)
thaumatin (E957)
neohesperidine dihydrochalcone (E959).
Chewing gum with noncariogenic
sweeteners.
Chewing 2gm/piece = one stick 3/day after
meals salivary function neutralize
acids & promotes remineralization.
Sorbitol
Used in tooth pastes, chewing gums,drugs…
Low cariogencity(slowly metabolized).
less effective because consumption of larger
amounts (>2sticks of chewing gum/day)
orbitol-fermenting microorganisms.
Less expensive.
Xylitol
Have no cariogencity(not metabolized).
Xylitol-sweetened gum reduces plaque
accumulation.
Aspartame “Nutra Sweet”
Popular in diet soft drinks, coffee and tea,
it’s not recommended for baking as it can
lose its flavor after being exposed to heat
for certain period of time.
Currently it has been linked to cancer.
adults need at least 10 cans of a drink fully
sweetened with aspartame to reach the
acceptable daily intake of 40 mg/kg/day.
Intakes over 1g/day  alter brain
neurotransmitters and provoke seizures in
monkeys.
Saccharine
“Sweet N Low,”
causes cancer in laboratory rats.
It’s not recommended for pregnant or
lactating women.
Use cocktails of sweeteners so it becomes difficult
for anyone to reach the acceptable daily intake of
any sweetener individually—
Honey
is a source of simple carbohydrates.
Its composed of (on average):
17.1 % water
82.4% carbohydrate
– The average carbohydrate content is mainly fructose (38.5
percent) and glucose (31percent). The remaining 12.9 percent
of carbohydrates is made up of maltose, sucrose and other
sugars.
– It supplies energy at 64 calories/tablespoon.
– has mild on its effects upon blood sugar compared to other.
0.5 % proteins, amino acids, vitamins minerals and
antioxidants (depending on floral variety).
Vitamin supplements if needed will be
absorbed in any form it's taken in and if not,
then it won't be absorbed as much.
When to give?
Look for the signs of a vitamin or mineral deficiency
through the history and physical examination.
Look at dietary intake to assess the nature, quality and
variety of the food.
During the winter months, slightly higher amounts of
specific vitamins such as C and B complex as
metabolism changes & provide protection from colds
and flu's.
Elderly should take slightly higher amounts of vitamins
and minerals as the ability to absorb nutrients becomes
less with age.
Everyday foods and vitamins can sometimes
dangerously interact with the prescription
Examples:
High doses of vitamin E inhibit blood clotting.
Coumadin users & foods high in vitamin K, such as
broccoli, spinach, and turnip greens, which reduce the
drugs effectiveness.
Grapefruit