DENT2064 Module 4 PDF Micronutrients for Oral Tissues

Micronutrients Required for Hard and Soft Oral Tissues Module 4 Image courtesy of: https://encrypted- tbn0.gstatic.com/images?q=tbn:ANd9GcTTN3qQdF7cB_0xX4O9VmgoPCS4tS5zodZl4H5hojH3JyCJLQVudHsTcE tX2vJnONipsLc&usqp=CAU Module Four: Learning O...

Micronutrients Required for Hard and Soft Oral Tissues Module 4 Image courtesy of: https://encrypted- tbn0.gstatic.com/images?q=tbn:ANd9GcTTN3qQdF7cB_0xX4O9VmgoPCS4tS5zodZl4H5hojH3JyCJLQVudHsTcE tX2vJnONipsLc&usqp=CAU Module Four: Learning Objectives 1) List the minerals essential for calcified structures, along with their physiologic role, RDA, sources, and signs of deficiency. 2) List the vitamins essential for calcified structures, along with their physiologic role, RDA, sources, and signs of deficiency. 3) List the minerals essential for oral soft tissues and salivary glands, along with their physiologic role, RDA, sources, and signs of deficiency. 4) List the vitamins essential for oral soft tissues and salivary glands, along with their physiologic role, RDA, sources, and signs of deficiency. 5) Track student’s diet to assess for sufficiency of vitamins and minerals required for oral hard and soft tissue health.  MINERALS ESSENTIAL FOR CALCIFIED STRUCTURES __________________________________________________________ Bone Mineralization and Growth Calcified structures include bones and teeth; they undergo constant remodelling ØOrganic matrix of bone is 90%–95% collagen fibres Formation of collagen requires: protein, vitamin C, iron, copper, and zinc ØOnce collagen is formed, mineralization begins Mineral matrix is composed of: calcium, phosphorus, magnesium, sodium, potassium, and carbonate ions Image courtesy of: https://cdn.britannica.com/96/99196-050-ED0AA964/mandible.jpg Formation of Teeth Enamel has a crystalline structure; hardest structure in the body Ø96% inorganic weight (minerals) Dentin is softer than enamel Ø70% inorganic weight (minerals) Cementum is softer than dentin Ø45%-50% inorganic weight (minerals) Image courtesy of: https://histology-and-embryology.com/wp- content/uploads/2020/08/word-image-16.png Introduction to Minerals Minerals are inorganic elements that have many physiological functions Inorganic elements in body account for only about 4% of total body weight Minerals are subdivided into two categories: Those required in larger amounts (major minerals) Those required in smaller amounts (trace elements) Physiological Roles: Calcium Most abundant mineral in the body (~1200 g) 99% is found in teeth and bones Functions: üBone health üBlood clotting üTransmit nerve impulses üMuscle contraction and relaxation üMembrane permeability üActivate certain enzymes üSalivary calcium acts as *buffer  Calcium Requirements Image courtesy of: https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/dietary-reference-intakes/tables/reference-values-elements-dietary-reference-intakes-tables-2005.html Calcium-to-Phosphorus Ratio Serum levels of calcium and phosphorus inversely related If calcium level goes up, phosphorus level goes down Ideal calcium/phosphorus ratio for adults is 1:1 Excessive intake of phosphorus compared with calcium reduces *serum calcium concentration Calcium requirements are increased when dietary phosphate is high as in the typical Canadian diet Calcium Absorption Absorption regulated by hormones (parathyroid, estrogen, glucocorticoids, thyroid) Best absorbed when consumed in smaller amounts and ingested several times during the day Factors decreasing absorption: qOxylates and phytates in grains and vegetables qReduced gastric acidity qExcessive fibre qLow-protein, low-phosphorus diets Image courtesy of: https://o.quizlet.com/JemLnqoJu6wno0Db0uAy8A_b.jpg Calcium Sources Milk and milk alternatives Preferred sources of calcium because of high calcium and other nutrient content that enhances calcium absorption Fortified soy and rice milk Other fortified foods (orange juice) Dark green vegetables such as broccoli, kale and spinach Fish with soft bones that are eaten, such as canned salmon or sardines Supplements ØLimited bioavailability (low amount absorbed and used by body) ØBetter absorbed when taken with food ØCalcium citrate malate, calcium lactate, calcium citrate, and calcium sulfate have Image courtesy of: https://universityhealthnews.com/media/calcium-rich-foods-chart.jpg high absorption rates Effects of Calcium Deficiency Rickets Abnormal ossification due to calcium and Vitamin D deficiency Osteoporosis “Osteoporosis is a disease of adolescence” Image courtesy of: https://www.news- medical.net/image.axd?picture=2021%2F4%2Fshutt Ø90% of peak bone mass is attained by age 16.9 + erstock_1028456644_(2)_5fe436628bd2446a81719 de9beddb603-620x480.jpg 1.3 year and 99% by age 26.2 + 3.7 year د bone mineral density (BMD) associated with fractures in elder years, but also may predict fractures in children ØInadequate calcium intake in early life accounts for as much as 50% of difference in hip fracture rates in postmenopausal years Effects of Calcium Deficiency Reduction in total skeletal mass is directly related to reduction in mandibular bone density in women with osteoporosis Postmenopausal women who lost teeth also lost bone mineral of the whole body and femoral neck at greater rates than those who retained their teeth ØSystemic bone loss appears to be a predictor of tooth loss (tooth exfoliation) in dentate postmenopausal women Inadequate calcium intake and periodontal disease ØStudy of NHANES data suggests a 56% ­ risk of periodontal disease with calcium intakes ¯ 500 mg/day Ø27% greater risk for those women consuming from 500 to 800 mg/day of calcium 13 Physiological Roles: Phosphorus Second most abundant mineral in the body 85% is found in the skeleton and teeth Functions: üFormation of bones and teeth üMuscle contraction and nerve activity üComponent of phospholipids in cell membranes, DNA, and RNA üEnergy metabolism (ADP) üBuffer for the body Phosphorus Requirements and Sources Sources Abundant in foods (deficiency rare) Best sources are milk products and meats Also found in poultry, fish, eggs, and chocolate Food additive in baked goods, cheese, processed meats, and soft drinks Image courtesy of: https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/fn-an/alt_formats/hpfb-dgpsa/pdf/nutrition/dri_tables-eng.pdf Phosphorus Deficiency From long-term ingestion of aluminum hydroxide antacids Impacted by calcium-to-phosphorus balance Malabsorption conditions (sprue and celiac disease) During tooth development, phosphorus deficiency results in: üIncomplete calcification of teeth üFailure of reparative dentin formation üIncreased susceptibility to caries Physiological Roles: Magnesium Bones contain almost two thirds of body’s magnesium Facilitates parathyroid hormone secretion (helps control calcium in the body for various functions e.g., BP regulation) Important for both calcium and Vitamin D absorption üRole in bone and mineral physiology (bones *and teeth) Associated with vitamin D conversion in the liver Cofactor for more than 300 enzymes (involved in energy metabolism, insulin activity, glucose utilization) Necessary for DNA and RNA synthesis Regulates transmission of nerve impulses and muscle contraction Associated with vitamin D conversion in the liver Facilitates blood clotting *Mental health  Magnesium Requirements and Sources Sources Dark green, leafy vegetables Dried beans and legumes Whole grains, nuts, seeds Chocolate Image courtesy of: https://i0.wp.com/post.healthline.com/wp-content/uploads/2020/06/pumpkin-seeds-1296x728- header.jpg?w=1155&h=1528 Image courtesy of: https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/dietary-reference-intakes/tables/reference-values-elements-dietary-reference-intakes-tables-2005.html Magnesium Deficiency Deficiency rare in healthy people Can occur with prolonged vomiting, malabsorption, kidney disease, intestinal surgery, excessive use of over-the-counter medications (corticosteroids, diuretics) Present in nearly all chronic alcoholics Signs of deficiency: üFragility of alveolar bone, gingival hypertrophy, widening of PDL space, enamel hypoplasia üCardiac dysrhythmias üNeuromuscular hyperexcitability e.g., muscle spasms üPersonality changes Overview: Fluoride In a strict nutritional sense, fluoride is not a nutrient essential for health because it has no known metabolic function However, because of benefits to dental and bone health, fluoride is considered a desirable element for humans Fluoride ions can replace hydroxyl ions (OH-) in the hydroxyapatite crystal lattice, making it more resistant to caries (fluorapatite) Physiological Roles: Fluoride Forms fluorapatite, which is more caries resistant Fluoride in saliva also interferes with demineralization Higher concentrations of fluoride inhibit Streptococcus mutans and Lactobacillus species Stimulates osteoblast proliferation and increases new mineral deposition in cancellous bone Fluoride Requirements and Source Sources Fluoridated water Brewed tea Potatoes Ocean fish with bones (salmon, herring, sardines) https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/dietary-reference- intakes/tables/reference-values-elements-dietary-reference-intakes-tables-2005.html Image courtesy of: https://myhealth.alberta.ca/Alberta/Alberta%20Images/10-fluoride-facts/fluoride-facts-graphic-03.jpg  VITAMINS REQUIRED FOR CALCIFIED STRUCTURES __________________________________________________________ Overview of Vitamins Characteristics of fat-soluble vitamins: Includes A,D,E,K vitamins *Called fat-soluble because they dissolve in lipid solvents rather than water Fairly stable to heat, as in during cooking Organic substances (contain carbon) Absorbed in intestine along with lipids in foods Require bile for absorption Transported via the lymphatic system Stored in liver and adipose tissues Overview of Vitamins (cont’d) Characteristics of water-soluble vitamins: Includes B-vitamins and vitamin C Organic substances (contain carbon) B-vitamins contain nitrogen Act as coenzymes Readily absorbed in the jejunum Body stores very small amounts üDaily intake is necessary Overview of Vitamins Vitamins required for calcified structures: ØFat-soluble vitamins üVitamins A, D, E, and K ØWater-soluble vitamins üVitamin C Requirements vary according to: ØAge and gender ØUse of tobacco, drugs, and alcohol ØStress ØHealth status Overview of Vitamins Deficiencies result when adequate amounts of a nutrient are not available to sustain biochemical functions Groups at risk for deficiency: üPeriods of rapid growth üMedically compromised patients üClients with substance abuse issues (e.g., alcohol, tobacco, methamphetamine) üPsychological and physical stress üVegans e.g., vitamin B12 Vitamin A Classes: qRetinoids: in animal products *ameloblast/odontoblast formation Ø70%–90% absorption from foods qCarotenoids: fruits and vegetables * bone and skin Ø9%–22% absorption from foods Functions: üVision in dim light üGrowth: cell differentiation (DNA/RNA synthesis), bone, tooth development üIntegrity of skin and mucous membranes üMaintenance of immune function Vitamin A Requirements and Sources Sources Retinoids Ø Found in animal products ü Liver ü Fortified dairy ü Fish ü Fortified foods Carotenoids Ø Deep-coloured fruits and vegetables ü Carrots ü Cantaloupe ü Squash The liver stores approximately 90% of vitamin A. Image courtesy of: https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/dietary-reference- intakes/tables/reference-values-vitamins-dietary-reference-intakes-tables-2005.html Signs of Vitamin A Deficiencies Enamel hypoplasia Follicular Defective dentin hyperkeratosis of the formation skin Growth restriction in Sometimes death children Xerophthalmia, Impaired dark adaptation keratomalacia (build up and night blindness of keratin in conjunctiva) Keratinization of lung, GI tract, and urinary tract epithelia Susceptibility to infections Image courtesy of: https://upload.wikimedia.org/wikipedia/commons/4/4e/Dental_fluorosis_%28mild%29.png Vitamin D (Calciferol) Called a vitamin, but more appropriately classified as a hormone Skin cells able to make vitamin D precursor 7- dehydrocholesterol with further processing by liver and kidneys Physiological roles: üEnhances intestinal calcium and phosphorus absorption (important for strong bones) üHelps keep serum calcium in appropriate range for cardiac and neuromuscular function üMay be involved in cells in hematopoiesis (the formation of RBCs), the skin, cardiovascular function and immune response  Vitamin D Sources: *Sunlight (10-30 minutes) Food sources üFish liver oils üFatty fish üFortified foods qMilk qCereals qOrange juice Supplements Image courtesy of: https://upload.wikimedia.org/wikipedia/commons/thumb/0/05/Orangejuice.jpg/1200px- Image courtesy of: https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/dietary-reference-intakes/tables/reference-values- vitamins-dietary-reference-intakes-tables-2005.html Orangejuice.jpg Factors Affecting Vitamin D Requirements Aging Exposure to sunlight üFour-fold ¯ in production in üUse of sunscreen those over 65 years of age üSkin melanin Malabsorption conditions pigmentation üSprue, Crohn’s disease, üLatitude, time of day, cystic fibrosis season of year Kidney failure üHomebound or (kidneys are responsible for institutionalized elderly converting to active form of üReligious/cultural vitamin D) habits requiring covering the body Vitamin D Deficiency Deficiency in North America is common in adolescents and adults (linked to asthma, CVD, ­BP, diabetes, depression, autoimmune conditions) Rickets (usually occurs at 1 to 3 years of age) Most visible in radius and ulna Characteristic deformities result from bones bending at the cartilage-shaft junction Enamel hypoplasia Osteomalacia Decreased bone mineralization or softening; leads to deformities of limbs, spine, thorax, and pelvis Symptoms are skeletal pain and muscle weakness Loss of the lamina dura Vitamin D Deficiency (cont’d) Osteoporosis (*both Calcium & Vit D are important) Vitamin D deficiency interferes with mineralization â bone density and á risk for fracture Cancer and Cardiovascular risk ØVitamin D may be protective against some cancers Higher levels in blood associated with reduced colon and colorectal cancers In animal studies, tumour growth has been decreased with vitamin D supplementation ØLow levels may increase risk for heart attack Physiological Roles: Vitamin E Antioxidant ØProtects polyunsaturated fats in phospholipid cell membranes ØPrevents oxidation of fatty acids and vitamins A and C Enhances release of a prostaglandin that inhibits the aggregation of platelets, enhances vasodilation and immune response Promotes resistance of the periodontium to inflammation Anticoagulant Vitamin E Requirements and Sources Sources: Vegetable oils, especially soybean oil Unprocessed cereal grains or fortified cereals Nuts and seeds Wheat germ Green leafy vegetables Some fruits, such as apples, apricots, and peaches Image courtesy of: https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/dietary-reference-intakes/tables/reference-values-vitamins-dietary- reference-intakes-tables-2005.html Image courtesy of: https://www.myfooddata.com/printables/vitamin-e-foods-printable.png Vitamin E Deficiency Signs of deficiency: Mild hemolytic anemia associated with increased erythrocyte hemolysis Peripheral neuropathy Subsequent decline in physical function At-risk groups: Sickle cell anemia Smokers Those on an extremely low-fat diet Vitamin K Requirements and Sources Sources: Human gut contains bacteria that produce a form of vitamin K, but it is unclear how this contributes to maintenance of vitamin K status Green leafy vegetables ØAbsorption enhanced with presence of dietary fat Fats and oils Image courtesy of: https://www.canada.ca/en/health-canada/services/food-nutrition/healthy- Image courtesy of: eating/dietary-reference-intakes/tables/reference-values-vitamins-dietary-reference-intakes- https://i.pinimg.com/736x/27/09/75/270975101333138ad40ef3694f1c2670-- tables-2005.html vitamin-k-wednesday.jpg Vitamin K Deficiency Disease or drugs may cause deficiency: üConditions blocking bile flow (celiac disease, sprue) üDiarrheal diseases (ulcerative colitis) üHemorrhagic disease of the newborn üAdults with marginal dietary intake who have undergone trauma, extensive surgery, or long-term parenteral nutrition with or without treatment with broad-spectrum antibiotics üDrugs, including anticonvulsants, anticoagulants, certain antibiotics (particularly cephalosporins), salicylates, and megadoses of vitamin A or E Signs of deficiency: üReduced bone mass density üDefective blood clotting Physiological Roles: Vitamin C (Ascorbic Acid) Functions: Coenzyme involved in collagen synthesis Promotes capillary integrity Enhances iron absorption Aids in utilization of folic acid and vitamin B12 Coenzyme function in metabolism of amino acids and biosynthesis of bile acids, thyroxine, epinephrine, and steroid hormones Antioxidant  Vitamin C Requirements and Sources Sources: Citrus fruits Tomatoes Raw, leafy vegetables Strawberries Potatoes and sweet potatoes Image courtesy of: https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/dietary-reference-intakes/tables/reference-values- vitamins-dietary-reference-intakes-tables-2005.html Image courtesy of: https://i.pinimg.com/originals/48/43/ac/4843ac6d9e2d9d37e6e76f4cabd1f690.jpg Vitamin C Deficiency Delayed wound healing Poor bone and tooth development Scurvy üRed, swollen gingiva üSore, burning mouth üGingival inflammation, spontaneous bleeding üPeriodontal destruction/tooth mobility ü­ risk of candidiasis and susceptibility to infection üMalformed enamel and inadequate dentin  MINERALS REQUIRED FOR ORAL SOFT TISSUES AND SALIVARY GLANDS __________________________________________________________ Image courtesy of: Darby and Walsh Dental Hygiene Theory and Practice (5th ed.). Table 36.5  VITAMINS REQUIRED FOR ORAL SOFT TISSUES AND SALIVARY GLANDS __________________________________________________________ Image courtesy of: Darby and Walsh Dental Hygiene Theory and Practice, Fifth Edition, Table 36.4 Vitamin B Requirements Image courtesy of: https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/dietary-reference-intakes/tables/reference-values-vitamins-dietary-reference-intakes-tables-2005.html Review Questions 1. Describe the relationship between collagen and bone, and list the nutrients required for collagen formation 2. Describe the conditions associated with calcium deficiency. 3. What is the relationship between calcium and phosphorus that must be taken into consideration when determining the amounts of each mineral in the diet. 4. Compare fat-soluble and water-soluble vitamins. List the vitamins under each category. List the high-risk groups for vitamin deficiencies. 5. List the factors that affect the ability of a person to make vitamin D. Which conditions are associated with vitamin D deficiency? What is the relationship of vitamin D to bone health? 6. Carefully consider which nutrients impact both oral soft and hard tissue health. 7. Based on your own diet, which nutrients may be lacking? Which foods could aid you in obtaining those nutrients? References Government of Canada. (2010, November 29). Dietary reference intakes. https://www.canada.ca/en/health -canada/services/food-nutrition/healthy-eating/dietary-reference -intakes/tables/reference-values-vitamins-dietary-reference-intakes-tables -2005.html Harris, N., Garcia-Godoy, F., & Nielsen Nathe, C. (2014). Primary preventive dentistry (8th ed.). Pearson Education Inc. Sroda, R., & Reinhard, T. (2018). Nutrition for dental health. (3rd ed.). Jones & Bartlett Learning.