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INTRODUCTION :
NUTRITION = NUTRINE (Latin word).
 It means breast feed or nurse.
 Nutrition is the one of the most major environmental
factor that can affect the health of the individual.
 Lack of food or lack of essential constitutes in the food
can give rise to disease.
 Today nutrition deficiency constitute a major public health
problem in India and other countries.
 In India gross malnutrition is said to kill around 5,00,000
of our infant and children every year.

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 Around three fourth of pediatric population is suffering
from one or other nutritional deficiency.
 About 35 to 85% of hospitalized children in our experience
suffer from one or other type of malnutrition.
 Around 25% of the pediatric bed are occupied by the
patient whose major problem is malnutrition.

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CLASSIFICATION OF NUTRIENTS :
NUTRIENTS

Water Micronutrients
Macronutrients

Organic
Energy yielding Inorganic
nutrients Non Energy
- Vitamins
yielding nutrients -Electrolytes
-Carbohydrate
- Fates - Minerals
- Protein - Trace
elements
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CALSSIFICATION OF NUTRITIONAL DISORDER :
 UNDER NUTRITION :
There is not enough food energy in the diet.
 MALNUTRTION :
There is a deficiency of either protein or other nutrients in
the diet.
 OBESITY :
Excess of body fat results from positive energy balance.
 QUALITATIVE OVERNUTRITION :
Occurs due to too much or excess of one food component
e.g. Hypervitaminosis D.
 Effect of natural toxin in the food :
- Some foods contain small amount of toxin substance which
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can lead disease .e.g. Lathyrism.
ETIOLOGY OF NUTRITIONAL DEFICIENCY :

Primary Secondary
(Due to dietary deficiency) (Due to such disease)
PRIMARY NUTRITIONAL DEFICINCY :
(1)Bad Economy :
Poor socioeconomic status of the family contributes a lot to
development of malnutrition in the developing region.
With very low income it is a tough task to provide nutritional
diet to the children.
(2) Ignore, Faulty food habit, Feeding :
Many deep rooted beliefs, customs, practices, superstitions,
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food taboos and ignorance causes malnutrition.
Decline in the good practice of breast feeding just because
ignorant mother wish to ape the sophisticated city women,
leading to wide spread practice of artificial feeding
contribute considerably to malnutrition.
(3) Medical Reason :
Infection and disorders such as diarrhea, malaria or measles
may prove major contributory factor in development of
malnutrition.
(4) Large Families :
Nutritional status is adversely affected by the large size of
the family.
Malnutrition is much higher among children of birth order
fourth and higher than with first three children of sub ship.
(5) Closely Spaced Families :
When pregnancy occur rapidly perhaps every year or every
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other year incidence of malnutrition is much higher.
(6) Working Mother :
A higher proportion of the mothers of malnourished children
are daily labours who find little time to take care child’s
feeding and rearing.
(7) Bad Start :
A low birth weight infants start life with a handicap. They
are difficulty in feed and is vulnerable to infant.
Born usually to malnourished such infant have high mortality.

SECONDARY MALNUTRITION :
The cause are such disease as intestinal malabsorption,
tuberculosis, intestinal parasitic infection and other
metabolic disorders.
Mismanagement of diarrhoea with starvation therapy or
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hypo caloric diet is an important cause of malnutrition.
(1) CARBOHYDRATE :
SOURCE : Cereals, vegetable, fruits, monosacchrides, etc.
DAILY REQUIREMENT : 400gms/ day
ORAL MANIFESTATION OF CARBOHYDRATE DEFICIENCY
IN CHILDREN :
 Altered carbohydrate metabolism is contributing etiological
factor for periodontal disease.
 Shorting, broadening of the mandible.
 Gingival hyperplasia.
 Teeth causing typical spacing of teeth.
MANAGEMENT :
Carbohydrate rich diet should be given at regular interval.
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(2) PROTEIN :
Prolonged deficiency of protein can cause “Kwashiorkor” or
“Marasmus”
“Kwashiorkor” is protein energy malnutrition in which there is
deficiency protein or aminoacid.
“Marasmus” is child hood version of starvation.
- It is characterised by severe form of protein
energy malnutrition.
SOURCE : Milk, meat, egg, fish, cheese,
cereals, etc.
DALIY REQUIREMENT : 75gms/ day

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ORAL MANIFESTATION OF PROTEIN DEFICIENCY IN
CHILDREN :
 Adversely effect periodontium, fibroblast, osteoblast,
cementoblast.
 Delayed eruption of teeth.
 Caries prone teeth.
 Retarded cementum deposition.
 Degenerative change in gingiva and periodontal ligament.
 Teeth with irregular predentin layer.
 Poor calcification of dentin and matrix.
 Reddening of tongue with loss of papilla.
MANAGEMENT :
- In acute cases; protein intakes of 3-4 gm/ kg/day.
- If child is unable to take feed, spoon feeding or feeding by
naso-gastric tube may be given.
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(3) FAT :
SOURCE : Cheese, ghee, butter, eggs, meat, etc.
DAILY REQUIREMENT : 55gms/ day
ORAL MANIFESTATION OF FAT DEFICIENCY IN
CHILDREN :
 Sore mouth with or without ulcerative lesion, halitosis.
 Unpleasant taste, loose teeth precocious exfoliation and
failure of healing of tooth socket.
 Loss supporting alveolar bone.
MANAGEMENT :
Fat rich diet should be given.

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VITAMINS
 Vitamins are complex organic molecules required in small
amounts for normal metabolic function.
 Strictly speaking a vitamin should be a dietary essential
that cannot be synthesized in the body.
 Vitamins can exist as "vitamers" - different chemical
structures having the same biological activity. For example
vitamin A consists of 4 vitamers.
 Vitamins can be divided into two broad classes - water
soluble and lipid soluble. Vitamins A, D, E and K are lipid
soluble, Vitamin B complex and Vitamin C are the water
soluble.

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VITAMIN A :
SOURCE : Carrot, tomato, cheese, liver, fat ,fish, papaya,
etc.
DAILY REQUIREMENT : Children : 600 mcg/ day
Adult : 600 mcg/ day
ORAL MANIFESTATION OF VITAMIN A DEFICIENCY IN
CHILDREN :
 Hyperkeratosis, hyperplasia of gingival tissue.
 Atrophy of salivary gland.
 Hypoplasia of teeth.
 Increase susceptibility of caries.
 Delay eruption of teeth.
 Alveolar bone is retarded in its rate of formation.
MANAGEMENT :
Depending upon deficiency symptoms it is given in the dose
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of 7500 to 15,000 mcg/ day for one month.
VITAMIN D :
Vitamin D deficiency causes rickets in children. In cases of
rickets bone matrix continues to be deposited but does not
fully mineralized due to disturbed calcium and phosphate
metabolism.
SOURCE : Sun light, liver, egg, yolk, butter, milk, etc.
DAILY REQUIREMENT :
Children-200IU/ day
Adult- 100IU/day
During lactation and pregnancy- 400IU/day

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ORAL MANIFESTATION OF VITAMIN D DEFICIENCY IN
CHILDREN :
 Developmental anomalies of dentin and enamel, delayed
eruption of teeth.
 Higher caries index as compare to normal.
 Hypoplasia of enamel.

MANAGEMENT :
- Dietary enrichment of vitamin D in the form of milk.
All infants should regularly be given vitamin D supplements
until they reach two years of age.
- Curative treatment include 2000 to 4000 IU of calcium
daily for 6 to 12 week followed by a daily maintenance dose
of 2000 to 4000 IU for a prolonged period.
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VITAMIN E:
It is also called as anti aging factor.
The word tocopherol is derived from word tocos : child birth
pherol : bear
Vitamin E is an antioxidant and protects against oxidation of
cell components (e.g. polyunsaturated fatty acids).
SOURCE : vegetable, cereals, meat, eggs, etc.
DAILY REQUIREMENT : Children : 7 mg/ day
Adult : 8-10 mg/ day
ORAL MANIFESTATION FO VITAMIN E DEFICIENCY IN
CHILDREN :
 Loss of pigmentation.
 Chalky white teeth.
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 Disarrangement of ameloblast.
MANAGEMENT :
Vitamin E is given in the dose of 100 to 400 mg
daily.

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 VITAMIN K (PHYLOQUINONE) :
It is essential for the production of a type protein called
prothrombin and other factor involve in the clotting
mechanism.

It also known as antihaemorrhagic vitamin.

FORMS : K1 – it is the form which occur in the plant.

K2 – it is produced by most bacteria present in

human intestine if it is not supplied in diet.

SOURCE : spinach, cabbage, turnip green.

DAILY REQUIREMENT : Children : 35 – 75 mcg/ day

Adult
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: 70 – 140 mcg/ day
ORAL MANIFESTATION OF VITAMIN K DEFICIENCY IN
CHILDREN :
Gingival bleeding can occur in case of vitamin K deficiency.

MANAGEMENT :
It is given in dose of 10 – 20 mg daily.

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VITAMIN B1 (THIAMINE) :
Prolonged gross deficiency can cause Beriberi.

SOURCE : Cereals, pulses, meat, fish, eggs, etc.

DAILY REQUIREMENT : Children – 1.1 mg/ day
Adult – 1.5 mg/ day
ORAL MANIFESTATION OF VITAMIN B1 DEFICIENCY IN
CHILDREN :
 Hyperesthesia of oral mucosa.
 Burning sensation of tongue.
 Loss of taste sensation.
 Pain in tongue, teeth, jaws.
MANAGEMENT : Infantile Beriberi can be treated by
mother’s milk. Mother should be receive thiamine 10,000 mcg
twice a daily
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VITAMMIN B2 (RIBOFLAVIN) :
SOURCE : Milk, kidney, rice bran, vegetable, etc.
DAILY REQUIREMENT : Children – 1.5 mg/ day
Adult – 1.3 mg/day
ORAL MANIFESTATION OF VITAMIN B2 DEFICIENCY IN
CHILDREN :
 Angular stomatitis.
 Glossitis
 Filiform papilla become atrophic.
 Lips become red and shiny.
 Ulcer in the mouth.
 As the disease progress, angular
 cheilitis spread to the cheek.
MANAGEMENT : www.FourthMolar.com
Riboflavin 25 to 50 mg is given daily in divided dose.
VITAMIN B3 (NIACIN) :
Deficiency of vitamin B3 causing pellagra.
SOURCE: cereals, pulses, vegetables, nuts, fruits, fish, milk.
DAILY REQUIREMENT : Children – 15 mg/ day
Adult – 17 mg/day
ORAL MANIFESTATION OF VITAMIN B3 DEFICIENY IN
CHILDREN :
 The epithelium of the entire tongue is desquamated.
 Glossitis.
 Tongue become red swollen and beefy.
 Angular stomatitis.
 Ulceration in the mouth.
MANAGEMENT : Niacin www.FourthMolar.com
10mg/ day.
Vitamin B complex.
VITAMIN B6 (PYRIDOXINE) :
It is white crystalline substance soluble in water and alcohol.
SOURCE :cereals, pulses, vegetables, cauliflowers, nuts, fruits.
DAILY REQUIREMENT : Children - 2mg/ day
Adult -1.7 mg/ day
ORAL MANIFESTATION OF VITAMIN B6 DEFICIENCY IN
CHILDREN :
 Glossitis.
 More prone to tooth decay.
 Angular stomatitis.
 Halitosis.
MANAGEMENT :
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Pyridoxine given in the dose of 10-15 mg daily in divided dose.
VITAMIN B12 (CYNOCOBALAMINE) :
Vitamin B12 is only synthesized by micro-organisms.
It is water soluble vitamin.
SOURCE : Fish, Meat, Milk, vegetables, etc.
DAILY REQUIREMENT : Children – 0.2-1 mcg/ day
Adult – 1.5 mcg/ day
ORAL MANIFESTATION OF VITAMIN B12 DEFICIENCY IN
CHILDREN :
Glossitis, pain full tongue.
Tongue is inflamed and red in colour.
Burning sensation in the tongue.
MANAGEMENT : www.FourthMolar.com

Given orally in the dose of 6mcg.

VITAMIN C (ASCORBIC ACID) :
Prolonged deficiency of vitamin C may result in scurvy.
SOURCE :Amla, orange, tomato, green chilly.
DAILY REQUIREMENT : Children – 40 mg/ day
Adult - 40 mg / day
ORAL MANIFESTATION OF VITAMIN C DEFICIENCY IN
CHILDREN :
 Interdental and marginal gingiva is bright red, become
ulcerated and bleed.
 Poor tissue healing.
 Atrophy of odontoblast.
 Poor resistance to infection.
 Typical fetid breath.
MANAGEMENT : Vitamin C given in the
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dose of 250mg two times daily.
CONCLUSIO
N
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 REFERENCES
 The short Textbook of Pediatrics
- Suraj gupte
 Clinical Pedodontics
- FINN
 Text of Oral Medicine
- Anil Govindrao Ghom
 Burket’s ORAL MEDICINE
Diagnosis and treatment - Greenberg . Glick
 WEBSITE :
www.dentistry.leeds.ac.uk.com
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 THANK YOU!

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