lec16

Nutrition

and oral health


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وقاية نظري / خامس اسنان كركوك
د. جيهان lec (16+17)----
7/4/2019
430

Nutrition is an essential for the growth, development, and maintenance of oral structures and tissues.

During periods of rapid cellular growth, nutrient deficiencies can have an irreversible effect on the developing oral tissues.

Early malnutrition increases a child's susceptibility to dental diseases in the deciduous teeth,
Throughout life, nutritional deficiencies can affect host resistance, healing, oral function, and oral-tissue integrity.
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The oral cavity is a mirror of the nutritional status of the body.

Nutrition plays an important role in tooth formation and in bone development and metabolism

• Nutrition & dental caries

During the pre-eruptive period of development of teeth, food exerts a systemic (nutritional) effect on the formation of the dental matrix and its mineralization.
The first sign of tooth development of dental tissue occur around 28 days of intrauterine life

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mineralization of dentin and enamel of primary teeth occur about 4-6 months in uteri so formation of teeth pass through a number of stages these are:

 Secretary phase when the organic matrix is formed

 Mineralization phase: consist of crystal formation and growth
 Maturation phase : water and organic matter withdrawn and the mineral content increase

• These stages are considered critical periods

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(critical period of human development) that define as:

time interval when specific nutrient are needed by a particular tissue programmed to develop at prescribed time and rate,


inappropriate supply of nutrient at such time can result in sever irreversible changes that affect the growth of the organ
these changes in turn can result in permanent defects in function and decreased resistance to disease.
• Aberrations that occur during period of formation may have irreversible effect on the developing organism.

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Malnutrition during these critical periods of growth can result in a dentition that is more susceptible to dental caries.
Systemic effect:
In the first half of previous century there were believes that good nutrition during tooth formation was the principal way to prevent dental caries
and caries was considered to be a deficiency disease.

Nutritional factors may have an effect on the following:

 Morphology of the teeth
 The quality of dental hard tissues
 The quality of saliva
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Morphology of the teeth

The morphology of the tooth is largely determined by genetic factors
but in many studies nutritional imbalance of protein, fat and carbohydrate affect the morphology of the teeth
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Enamel defect The process, which follows a well-defined chronological pattern, involves several critical stages.
Nutritional insult to protein synthesis or mineralization may disturb the tooth structure as well as the form of the teeth.

 If matrix formation is affected enamel, hypoplasia will ensue

 If maturation is lacking or in complete hypocalcification of enamel will result in
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Poor nutrition is one of many causes of dental defect, clear relationship between specific dietary nutrients deficiency during critical periods of developments and poorly calcified tooth had been demonstrated.
Based on many studies awareness has arisen that nutritional disturbances, such as
deficiencies of calcium, phosphate, vitamin A, D and C and protein-energy, affect tooth tissue formation according to their biological roles.
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Protein energy relation

When dietary energy intake is adequate, the amino acids derived from dietary protein are immediately used for whatever protein synthesis is required such as for growth and maintenance of the body tissue.
While when dietary energy intake falls inadequate, amino acids produced by body are used as a source of energy.
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Vitamin D, calcium, phosphorus

Vitamin D is intimately involved with calcium metabolism and its intestinal absorption and therefore, it has a role in tooth formation.


Lady May Mellanby in the first half of previous century showed that vitamin D deficiency led to hypoplastic teeth
(she recognized that children with vitamin D deficiency had delayed development of teeth, had very poorly calcified enamel).
She noticed improved appearance of teeth by
provision of milk or cod liver oil to pregnant and lactating mother, infants, and young children also
addition of vitamin D to margarine and
calcium carbonate to bread
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The quality of the hard tissues:

In many studies deficiency of protein energy, vitamin A, zinc and iron during pre-eruptive period are reported to cause increased caries development that claimed to be related to impaired tooth tissue.
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It has been shown that

Feeding a diet high in sugar during pregnancy and lactation will result in changes in the offspring dental tissues namely higher level of carbonate, mucopolysaccharides in the enamel that later in life made them more susceptible to caries.
Feeding diet high in protein during pregnancy and lactation resulted in offspring with lower level of carbonate; mucopolysaccharides in the enamel were found to be more resistance to caries
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Quality of saliva

it has been shown that :
individual on lacto-vegetarian , high protein or high fat diet produce saliva with a high buffering capacity


individual on a high carbohydrate diet produce saliva lower buffering ability.
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Salivary lactoferrin, lysozyme, sialin and statherin (secreted by salivery glands) are part of the defense arsenal can be diminished in volume or altered in structure during sever periods of malnutrition.

Marginal protein energy deficiency during pre-eruptive period; impair the development of the salivary glands, which causes a decreased secretion rate and amount of protein secreted per minutes.

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Evidences of the effect of some nutrients on dental caries

-Vitamin A deficiency is known to:
impair enamel and dentin formation,
impair immune function,
reduces synthesis of specific glycoprotein such as salivary bacteria agglutinating glycoprotein (BAGP)
and in sever deficiency to reduce saliva secretions rate.
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Concerning people living in primitive village who were still not exposed to European civilization, demonstrating:

strong inverse association between the prevalence of dental caries and concentration of calcium in soil.


also found an inverse association with phosphorus composition of local food in that village.
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Iron was classified as caries inert element,

of iron during pre-eruptive period of tooth development in animal caused caries development.

-Caries susceptibility is increased among children with chronic malnutrition (stunted means deficient height for age).
and acute malnutrition (wasting means deficient weight for height)
as a result of systemic effect of protein energy malnutrition during pre-eruptive period.

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Nutrition and eruption of teeth

Protein deficiency may be the reason for delayed eruption of children’s deciduous teeth,
early eruption of teeth were noted among children whose height and weight were greater than average.

Several studies reported that the rate of dental development and dental eruption affected by
prenatal malnutrition
pre-term birth.
children with the lowest birth weight have lowest rate of dental development.
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The weaning period, which is a critical time, during which the infants diet mostly liquid and soft food, begins to include more solid and usually going from a law protein to a high protein diet.

If solid protein rich food intake (meat with 20% protein compared to with milk 5% protein) is not adequate, jaw and tooth mal-formation occur.
As protein nutrition is a basic consideration in the growth and development of the oral cavity, if the diet include too little essential amino acids during critical period of active growth, permanent structural damage can occur, synthesis of protein in the cell disrupted, resulting in a disturbed tissue growth and development, this will affect the maxillary and mandibular bone, resulting in adverse effect on tooth alignment and alveolar bone integrity
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All proteins are synthesized from amino acids molecules;

these can be classified into two groups:
Essential amino acids that cannot be synthesized by the body,
These can be provided in the diet.
Nonessential amino acids that the body can make adequate amounts from other compounds if necessary.
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Rickets associated with unduly delayed eruption of teeth that is caused by vitamin D deficiency,
Vitamin D regulates the level of calcium in serum.
So in a condition where the level of calcium is lower than normal, found delayed tooth eruption.

From epidemiological view:

Under nutrition result in :
delays shedding of the primary teeth and
delays eruption of the permanent teeth
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