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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: l 58% carbohydrates. l 30% fat. l 12% protein. Side effects : l l Overweight: excessive amount of bone, water and fat. Obesity: increased body fat. Etiology of nutritional deficiency: l l l l l l Inadequate intake Disorder of digestion. Defective absorption. Alteration of metabolism. Increased metabolic demands. Loss of nutrient. Oral Manifestations: l l l 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. l l l l Decreased amount of intake of essential nutrients. Impaired absorption from GIT Increased metabolism due to growth. Inadequate storage, pregnancy. B-Complex l l 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: – – – – 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. – – – – – – 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