Nutrition

Dr Hiten Kalra

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Definition
 Science of nourishing the body properly or
analysis of the effects of food on living
organisms.
 Relationship between man and his food and
implies the psychological and social as well
as the physiological and biochemical aspect
-Yudkin

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Definition
 Science devoted to the determination of
requirements of the body for food
constituents both qualitatively and
quantitatively and to the selection of
food in kinds and in quantity to meet
these requirements.

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Definition
 “The science of food, the nutrients and
other substances therein ,their action
,interaction and balance in relation to
health and diseases and the processes by
which the organism ingest, digest,
absorbs, transports ,utilizes and excretes
food substances”
- Council of food and nutrition of the
American Medical Association

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Historical Background
Schneider’s –
 Naturalistic era-(400 B.C-A.D 1750)

 Chemical analytic era(1750-1900)

 Biological era(1900-present)

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Historical Background
 Molecular\ cellular era-(1955 –present)

 Guilford -1874 was among the first to

advocate that dietary deficiencies could
be an underlying cause of dentofacial
irregularities

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Basic function of nutrients-

 Supply energy .
 To promote growth.
 Repair of the body tissues .
 Regulate body processes.

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Classification -
 Carbohydrates
 Fat\lipid
 Proteins
 Minerals
 Vitamins
 Water

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Carbohydrates
 Energy yielding nutrients, is the largest
single component ,aside from water ,of
most diets.
 Composed of –
-carbon
-hydrogen
-oxygen
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Carbohydrates
 Sources-
- rice - sweet potato
-wheat - honey
-bajra - jaggery
-pulses
-vegetables

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Carbohydrates
Classified as-
 Monosaccharides –eg glucose ,fructose

,galactose.
 Disaccharides -35% of the dietary

carbohydrates eg sucrose , lactose

,maltose
 Polysaccharides eg –starch, glycogen

,cellulose

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Carbohydrates
 Digestion
mouth – salivary amylase
C

stomach

small intestine

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Carbohydrates
 Sucrose glucose + fructose

 Maltose glucose +glucose

 lactose glucose +galactose

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Carbohydrates
 Absorption and storage –
small intestines
stored as glycogen in liver and
muscle
 Function –
main source of energy.
1 gm – 4 kcal of energy
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Carbohydrates
 Almost nothing is known of the effect of
carbohydrate deficient diet on the oral
cavity.
 There is a group of disease which
represents a primary genetically
determined disturbance of the
mucopolysaccharide metabolism

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Carbohydrates
 Hurler syndrome-
 Head -appears large with prominent
forehead
-puffy eyelids
-nasal congestion with noisy
breathing
-shortening and broadening of the
mandible
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Carbohydrates
- wide intergonial distance
- increased arch length from ramus to
ramus
 dentition-small and misshaped teeth.

 Soft tissue –gingival hyperplasia.

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Lipids
 These are the most concentrated
energy yielding group of nutrients.

 Basic structure –molecules of glycerol

to which one to three
fatty acid molecules

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Lipids
 Sources –
-fruits -egg yolk
-vegetables -butter
- milk - ghee
-meat -cereals
-fish

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Lipids
 Classified as
- saturated
-unsaturated
 Physical properties –
insoluble in water.
less dense than water.
not affected by temperature.
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Lipids
 Digestion-
stomach- naturally occurring emulsified
fat

small intestine-bile is secreted

-emulsification

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Lipids
 Pancreatic lipase and intestinal lipase
triglycerides
v

diglycerides

monoglycerides

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Lipids
 Absorption and storage
digested and divided molecules are
taken up from the GIT .
 30%-free fatty combine with bile salts

 70%-resynthesised immediately to form

triglycerides –lymph

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Lipids
Function –
 Source of energy -1gm-9kcal.

 Satiety value .

 Carrier of the fat soluble vitamins.

 Source of other essential fatty acids.

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Lipids

 Disturbances in the lipid metabolism are

not very common but they do occur
-Gauchers disease
-Neimann Pick disease

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Proteins
 The term proteins mean –”to take first
place”-Mulder -1983

 Half the dry weight and 20% of the

total weight of an adult is protein.

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Proteins
Basic structure –
complex substances made up of many
amino acids.
there are 20 different naturally occurring
amino acid that have been identified as
the building blocks for body protein.

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Proteins
Sources-
-wheat - peanut butter
-milk - peas
-egg white -cottage cheese
-legume -rice
-boiled ham -oatmeal

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Proteins
 Classified as-
functional point of view
-amino acids -essential amino acids
-non essential
 Proteins – complete

- incomplete

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Proteins
 Digestion and absorption
-attached to another substance or
surrounded by fat or carbohydrate
Stomach – gastric proteases (pepsin)

Small Intestine – pancreatic enzymes

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Proteins
 30 %-absorbed directly
 70%- chain of two or three AA

dipeptidases amino acids

 Amino acids –enters blood stream

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Proteins
Functions –
 Essential for growth-hair,skin,nail

 Formation of essential body compounds

 Regulation of the water balance

 Act as buffers

 Protective role

 Transport of nutrients.

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Proteins
 The inadequate consumption of protein
and energy as a result of primary
dietary deficiency conditioned deficiency
may cause loss of body mass and
adipose tissue ,resulting in protein
energy malnutrition-
 Kwashiorkor
 Marasmus

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Proteins
 Kwashiorkor –
Definition- protein deficiency with sufficient
calorie intake.
Age-6 months and 3yrs
Features -growth failure
-wasting of muscles
- edema
-enlarged fatty liver
-serum protein low
- flag sign
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Proteins

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Proteins
 Marasmus
 Definition –starvation in infants with a overall
lack of calorie.
 Age-infants under 1 yr of age
 Feature-wasting of all tissues
-no edema
-no hepatic enlargement
-monkey like face

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Vitamins
 Defined as organic substances not
made by the body ,which is soluble in
either fat or water and ordinarily is
needed in only minute quantities to act
in a variety of metabolic reactions.
 Classified as-
water soluble
fat soluble

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 Vitamins
Fat soluble Water soluble
 Intake is in excess Minimal storage of
of daily body needs dietary excess
 Not excreted Excreted in urine
 Deficiency symptoms Develop rapidly
slow to develop
 Not absolutely necessary Must be supplied in diet
 Contain C,H,Oxygen N,Co,S
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Vitamins
 Vitamin A
 Acidic ,alcoholic, aldehyde form.
 Sources –spinach
- carrot, broccoli
-peas ,cabbage
- milk ,cheese
-butter, meat ,fish
-egg, beef
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Vitamins
Functions-
-Vision –role in dark adaptation and
vision in dim light
-Growth-studies have shown that animals
deprived of vita A cease to grow once
the reserves are depleted.

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Vitamins
 Deficiency-night blindness
-keratinzation of cornea
-bitots spots
- xerosis conjunctiva
- xeropthalmia
- complete blindness
-loss of sense of taste
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Vitamins

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Vitamins
 Dentition-disturbances in differentiation
and growth of developing teeth
-calcification of teeth
-retardation of eruption
- disturbances in periodontal tissues.
-failure to form tooth enamel.

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Vitamins
 Vitamin D
- Group of compounds called as
cholicalceferol.
- Source –
- Endogenous synthesis-sunlight
- Exogenous synthesis-deep sea fish ,fish
oil, butter, milk.
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Vitamins

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Vitamins
 Function-
 Maintain normal plasma level of calcium
and phosphorus.
 It is necessary for all animals with a
bony skeleton ,since it facilitates
absorption and utilization calcium and
phosphorus for bone formation

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Vitamins
 Deficiency of vit D-
1.Rickets in growing child
-craniotabes
-harrisons sulcus
-Rickets rosary
-pigeon chest
-Bow legs
-Knock knees
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Vitamins
 Diagram

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Vitamins
2.Osteomalacia –in adults
-osteoid matrix which is laid down fails to
mineralize
-vague bony pain
-muscular weakness
-frequent fractures

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Vitamins
 Vitamin E-
 Anti sterility factor
 Sources –vegetable oils, yellow
cornmeal, wheat
bread, egg ,butter .
 Role in human nutrition is poorly
understood.

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Vitamins
 Vitamin K
 Basic structures consist of a group
called as quinones
 Sources-green vegetables
-fruits
 Function-it is necessary for the
synthesis of prothrombin.
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Vitamins
 Vitamin C(ascorbic acid)
 Sources-citrus fruits –orange ,lemon
,grape ,certain vegetables.
 Function-
-formation of the collagen .
-normal formation of dentin.
-utilization of iron and calcium .
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Vitamins
 Lesions of vit C deficiency-Scurvy
 Haemorrhagic diasthesis
 Skeletal lesions
 Delayed wound healing
 Teeth and gums.

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Vitamins

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Vitamins

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Vitamins
 B complex-these consist of a group of
essential compounds which are
biochemically unrelated but occur
together in some foods
 Sources-green leafy
vegetables,cereals ,yeast ,liver, and milk.

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Vitamins
 Thaimine(B1)
 Function-carbohydrate metabolism.
 Deficiency-beri beri
 Dry beri beri-neuromuscular symptoms
weakness, paresthesia, sensory
loss,polyneuritis.
 Wet beri beri-CV involvement
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Vitamins
 Riboflavin(B2)
 Function-cellular respiration
 Deficiency-ocular lesions
-cheilosis ,angular stomatitis
-glossitis.
-dermatitis.

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Vitamins
 Niacin
 Function-metabolism of fat
 Deficiency-pellagra-dermatitis.
-diarrhoea.
-dementia.

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Vitamins
 Pyridoxine(B6)
 Function-exact function not known
-fat and protein metabolism
-transmission of neural impulse
 Deficiency-dermatitis
-glossitis
-angular stomatitis
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Minerals
 Macronutrient elements-calcium
-phosphorus
-potassium
-sodium
 Micronutrient elements

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Minerals
Calcium
 Inert inorganic element which is associated
with bone and tooth formation.
 1.5-2.5 wt –of the adult body
 99% of the hard tissue.
 Sources-milk and milk products
green leafy vegetables
legumes
citrus fruits 62
Minerals
 Function –
1. Bone formation.
2. Tooth formation.
3. Essential for growth
4. Blood clotting.

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Minerals
Abnormalities of Ca Metabolism –
 Osteoporosis-middle aged women

decreased density of bone

shortening stature
bone fractures
 Osteomalacia –decrease in the mineral

content
lack of Vit D.
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Minerals

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Minerals
Phosphorus
 1% of the total body weight.

 Major constituents of bone and teeth

 Regulates the release of energy in the

form of ATP.
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Clinical Implications

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Nutrition deficiencies –and
dentofacial growth
Nutrition and Skeletal Maturation
 Studies have shown

 “prolonged nutritive failure in growing

child result in retardation of bone

growth centers in the hand and wrist
radiographs”.

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Nutrition deficiencies –and
dentofacial growth
 Malformations and prenatal
deficiencies-
Dietary intake of the expectant mother is
directly related to the condition of the
infant at birth.
 Warkany –showed riboflavin-cleft

palate, shortening of mandible

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Nutrition deficiencies –and
dentofacial growth
 Evans ,nelson-showed acute folic acid
deficiency-cleft palate.

Nutrition and teeth-

 Local effect

 Systemic effect

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Nutrition deficiencies –and
dentofacial growth
 Role of fluorides-

 Anticariogenic factor.

 Long continued exposure to excessive

amounts may result –dental fluorosis
-skeletal fluorosis
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Nutrition deficiencies –and
dentofacial growth
 Increased density of various bones .
 Increased calcification of ligaments,
tendons and vague pain in small joints
of the hands and feet
 In the most severest form –stiffening of
the spine virtually making the patient
immobile.

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Nutrition deficiencies –and
dentofacial growth
 Nutrition and malocclusion-
 results from various nutrient
deficiencies-abnormal bone growth
-loss of teeth.
-severe caries.
-periodontal breakdown.

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Nutrition deficiencies –and
dentofacial growth
 Vitamins in relation to growth and
dentition-
 VitA-disturbances in differentiation and

positional growth of the developing

teeth.
-defective calcification.
-Retardation of eruption.
-disturbances of periodontal tissues.
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Nutrition deficiencies –and
dentofacial growth
 Vit B-
-loss of apatite
-disturbed digestion.
-Retardation of growth
 Vit C

-disturbed calcification of teeth.

-retarded eruption.
-thickened jawbones.
-narrow maxilla.
-short mandible.
-High vault palate.

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Role of nutrition on the periodontium-
response to tooth movement
 Physical nature of the food-
-soft food vs. fibrous food.

 Vitamin deficiency
- Vit C
 Increased blood sugar levels.
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Role of Nutrition in Root Resorption
 Common iatrogenic problem associated
with orthodontic treatment
 Marshall et.al-greater degree of
resorption in deficient
diets.
 Beck –calcium deficiency were more
susceptible.

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Effects of consistency of food
 Throughout its various stages of growth
mouth is affected by complex system of
forces .
 Diet that does not supply food of a sufficient
hard consistency does not supply adequate
stimulus for proper mastication resulting in a
narrow maxillary arch .
 Similar observations have been made in
humans –arch collapse syndrome.
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Effects of consistency of food
1. Low level of eruption –posteriors
2. Maxillary arch are narrower.
3. Mandible are shorter and condyles are
thinner.
4. Less tonicity of temporalis and
masseter.
5. Reduced linear dimension of skull.
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Effects of consistency of food

 In humans-
 Some authors have proposed-
weakening of the
temporomandibular articulation
 Resulting in malocclusion.

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Bibliography
 Contemporary orthodontics-Proffit
 Current Principles and Techniques –Graber
Vanarsdall
 Nutrition and oral health-Pollack
 Introductory nutrition-Helen Andrews
 Principles of nutrition-Wilson,Fisher
 Clinical dietetics and nutrition-F.P.Antia
 Basic pathology-Robbins
 Pathology for dental students-Harsh Mohan

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