What is nutrition?

The study of nutrition includes all of the processes involved in the selection,
intake, and utilization of nutrients.

What are nutrients?

Nutrients are the components in food that supply the elements necessary to meet the body’s requirements for energy, growth, maintenance, and well-being.

You probably have heard the expression “You are what you eat.” It is true, because food is used to build and repair the body. Food choices must therefore be based on sound information and knowledge.

Malnutrition

Malnutrition during crucial periods may result in physical or mental disabilities. Well-nourished persons are usuallybetter able to heal and ward off infections than poorly nourished individuals

The Role of the Dental Professional

In dentistry as a part of the Dental profession, a Dentist or a Dental Hygienist provides  nutrition counseling and helps patients with food choices in a variety of circumstances, including:

• Counseling patients about the prevention of tooth decay
• Counseling patients regarding their diet following oral surgery or other dental procedures
• Performing dietary analysis with patients
• Counseling patients who have orthodontic appliances on their teeth with regard to food choices

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Introduction

Geographical locations and nutritional intake may influence the risk of patients acquiring

MS. The impact that optimal nutrition management has on many disease -induced symptoms is an essential component in holistic patients. The treatment goal for MS patient is to reduce the number of relapses and severity and to increase the length of remission. Nutritional intervention’s has been studied for a long time with one and only intention, to improve the patient’s quality of life by reducing symptoms. Drug Therapy teamed with nutritional intervention take full advantage of symptom management.The disease -induced symptoms that can affect the nutritional status and the quality of MS patients lives are the secondary conditions that appear during the course of MS such as bowel problems, decreased ambulation, pressure sores, dysphagia, and reduced appetite. These secondary conditions can be reduced. Evidence has revealed that optimal nutrition can reduce the risk of developing these conditions.

Application of Nutritional Therapy in Patients with MS

Weight, disease and body metabolism state are influenced individually in MS patients. Individual nutritional counseling should be made by the dental professionals because nutritional requirement may vary form patient to patient. Lack of appetite will in most of the cases cause nutritional deficiencies which compromises the oral intake. Necessary recommendations need to be made especially for vitamin and mineral supplements so the unavoidable nutrients can be substituted.

Pressure Ulcers

MS patients who acquire secondary progressive disease such as Pressure Ulcers will happen due to lack of movement and activity levels drop. Patients with compromise nutritional status the problem worsens. Protein is a crucial essential macronutrient required. Vitamin C and Zinc are also involved in wound healing.

Dysphagia

Difficulties in swallowing in MS patients can become a real problem influencing nutritional intake. Shortly after the first dysphagia symptoms increase, weight loss and other symptoms like pale skin color, coughing while they try to eat or drink. Patients that experience dysphagia should be suggested to eat slowly,  maintain upright position and eat soft easy-digestible foods.

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Trace Elements – Overview

Copper

Copper is essential for RBC ( red blood cells), connective tissue & transmission of nerve impulses

It is readily incorporated in tooth enamel. It is enormously found in, oysters, liver, nuts, legumes, cocoa, sesame and sunflower seeds etc.

It is absorbed in stomach, and excreted in feces. Copper toxicity is very rare.

Copper deficiencies affect connective tissue, skin, hair, and cause reduction in the WBC (white blood cells) count.

Selenium (Se)

• Present in tooth enamel and dentin
• No concerns re: adequate intake
• Oversupply may interfere with tooth mineralization; inadequate amounts may cause heart damage

Chromium (Cr)

• Involved in carbohydrate metabolism
• Deficiency is rare
• Toxicity linked to industrial exposure causes liver damage and lung cancer

Ultratrace Elements – Overview

• More often a contaminant of food than as a nutrient
• Used therapeutically – e.g. Aluminum (Al) in antacids)
• Lead (Pb) toxicity in children and infants//CNS and kidney damage, and decreased RBC production
• Silicon (Si) in tooth enamel in large amounts

Dental considerations

• Tin (sn)found in Stannous fluoride  highest variostatic fluoride compound. It is active ingredient in toothpastes and mouthwashes
• Aluminum present in dental tissues; may reduce caries
• Lead is absorbed into the teeth, and its associated with enamel hypoplasia

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Phosphorus (P) is a major mineral of the same importance as Ca. 85% of the body Phosphorus isin skeleton and teeth. It is necessary for almost every aspect of our body metabolism. Some metabolic functions where phosphorus is an intermediate reactor are

1. The transfer and release of ATP (adenosine tri phosphate, )
2. Composition of phospholipids like DNA and RNA
3. Metabolism of fats carbohydrates and proteins.

All these processes are vital for our organism, because they provide energy and help in producing genetic material replication. The ratio between calcium and phosphorus is Ca/P= 1:1.P has the same dietary absorption as Ca by 65% which is absorbed in jejunum.

Kidneys excrete excess amounts of P to maintain optimum levels of P in the blood.

Phosphorus is abundant in foods like dairy, meat, vegetables etc. For more information on dietary products visit (Canada’s Food Guide).  Uncontrolled phosphorus levels in the blood bring to an Hyper State or Hyperphosphatemia which is related to hypoparathyroidism or renal insufficiency that can lead to blindness and convulsion.

Uncontrolled phosphorus levels in blood can also lead to an Hypo state or Hypophosphotemia  which is related to long term ingestion of aluminum hydroxide antacid, stress or malabsorbtion syndromes.  Most common symptoms of Hypophosphotemia is muscle weakness.

Dental considerations

• Patients with Hypophosphotemiacan lead to failure of reparative dentin formation and increase the risk of caries.
• Some things that need to be considered by the dentist or dental hygienist are:
• Clinical signs of eating disorder can effect P levels in blood. Patients with suspicious clinical symptoms  should be approached professionally and notified the risks associated whit unhealthy life style behaviors.
• Low Phosphorus levels affect the diuretics in complicating their kidney dysfunction symptoms.
• Alcohol decreases Phosphorus levels.
• Phosphorus has an important role in remineralization of the teeth and in arresting caries process.
• Researches show that Phosphorus supplements do very little in helping caries incidence.
• For clients that show similar symptoms nutritional counseling is an option that a dental clinician should attempt to try with the patient. Results cant be slow but that’s the only effective way to deal with people that suffer from eating disorders

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2/3 of body’s Mg is in bone. It’s the 3^rd most prevalent mineral in our teeth.

It plays and important role in maintaining calcium homeostasis, preventing skeletal abnormalities, structure of heart muscle, other muscles and nerves, and energy production. Mg deficiency is rare in healthy adults. The organ that is responsible for the Mg plasma levels is kidneys.

Nutritional sources for Magnesium are whole grains, nuts, beans, leafy vegetables (chlorophyll molecule), bananas etc.

Hyper-state of Magnesium in the body is due to different diseases that cause kidney failure since it is the organ that controls Mg levels in blood.

Magnesium hypo-state is related to stress, Gastro Intestinal ( GI) abnormalities, alcoholism and medications. Some symptoms of Hypo-State are:

• -        Neuromuscular dysfunction
• -        Personality changes
• -        Muscle spasms
• -        Convulsions (infants)
• -        Cardiac arrhythmias
• -        Teeth and supporting structures can be affected

Dental considerations

Nutritional counseling for patients that report Mg deficiency. A reason to suspect Mg deficiency is when clients are diuretics. A dentist or dental hygienist should be aware of oral manifestations associated with Mg deficiency. Some of the intraoral signs in these patients are :

• Enamel or dentine hyperplasia
• Reduced alveolar bone formation
• Widened periodontal ligaments space
• Gingival hyperplasia

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Fluoride (Fl) is a trace mineral and component of fluorides. Fluoride has an uknown metabolic function. The role of fluoride in dental health is very important. It has systemic effects during tooth formation children (1-13 years old), and local/topical after tooth eruption. Fluoride also affects early tooth development. Fluoride has also a role in disrupting demineralization process which means that it provides the client with less cariogenic oral environment. It also has positive effect on bone mass

Fluoride is highly toxic if swallowed in excessive amounts. Parents should always be aware of the risks that excessive fluoride consumptions lead not only to toxicity but fluorosis ( permanent intrinsic stains embedded in the tooth structure) as well.

Daily fluoride requirements depend on body weight, status of public water fluoridation etc.

Absorption and source

Absorption occurs mainly in stomach. Absorption from sodium fluoride in water is 100%.

60-70% of absorbed fluoride is excreted by kidneys; 5% excreted in feces

Sources of fluoride for personal consumption include water( IF FLUORIDATED READ THE LABEL) , food, beverages, dentifrices etc . Food isn’t a significant source of fluoride with an exception of some of the infant foods that can be fortified with fluoride.

Hyper state fluoride

When fluoride level is higher then normal the body is in a fluoride Hyper-state. Hyper-state can occur when consumption time is 3-4 times more then the necessary amount needed to prevent dental caries. So for example if a grade 4 child swallowed 4 times a pea size toothpaste needed to brush his teeth then this Hyper-state is considered high and can be toxic.

Dental considerations

One of the concerns associated with excessive fluoride intake during the tooth development period ( 1-13 years of age) is dental fluorosis. It affects the dental matrix within the tooth structure during the tooth development. It appears as white spots embedded in the tooth.

It can’t be removed with scaling or polishing. It has no effect in weakening the tooth. The only concern in dentistry with fluorosis is the cosmetical point of view. There are many ways to improve the appearance and client satisfaction when it comes to fluorosis. Some of the treatments available today are bridges and crowns, veneers, bleaching trays etc. In particular bleaching has shown to reduce or disappear fluorosis marks even though the results depend greatly from patient to patient, therefore it is strongly recommended from many dentists to try bleaching before considering any alternative treatment because it is more effective and low cost.

Steeps that a dentist or dental hygienist needs to take in educating patients about the benefits of fluoride are very important.

• Clients should be cautioned about the risk of the excess fluoride.
• A dentist needs to know the levels of the sodium fluoride in the water supply that will help him make accurate consideration of the fluoride supplement consumption that needs to be prescribed to his patients.
• Caution parents and child clients to use “pea” size amount of fluoride toothpaste and not to swallow it.
• Diet counseling to educate and caution clients about multiple sources of fluoride

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The total amount of inorganic elements in the body is about 4% of body weight. Growing children especially 1-13 years old require large amount of minerals. Some trace minerals are needed in smaller amounts though. Both types of minerals are of equal importance in producing quality of bone structures during the whole life time.

What is important to share with different age group patients (especially with parents) in a dental office is that dietary inadequacies can have negative impact on their teeth and bones.

Bone mineralization and Growth

Bones and teeth are calcified structures Composed of a bone matrix (organic + inorganic substances). The organic matrix of bone is 90-95 % collagen. The collagen in this the matrix is secreted directly by osteoblasts ( cells bone formation). During the formation of collagen and deposition of minerals ( bone development period) adequate nutrition is required to avoid structural bone defects in the future. The function of the so called crystalline matrix in teeth structure provides compresional strength to occlusion forces applied during mastication. Calcium is the most important mineral in bone formation process. It is the major mineral in the body.

99% of the body calcium is found in teeth and bones, whereas 1% in blood. Calcium controls blood clotting, transmission of nerve impulses, muscle contraction and relaxation, membrane permeability, enzyme activity. 4-10% of bone calcium is amorphous. This calcium amorphous provides calcium reserves for serum calcium levels. Calcium in saliva serves to mineralize and re-mineralize enamel, and calcium and phosphate in saliva. Recent researches also show that calcium inhibits development of caries. Development of normal, healthy teeth is affected by metabolic factors such as: Parathyroid hormone secretion and adequate calcium, phosphate, vitamin D, protein + other nutrients. Its balance in the human body is relatively constant, but with age or because of congenital parathyroid dysfunction, the calcium hormone secretion in the blood stream decreases making bones more fragile and easy to fracturing.

Calcium is absorbed in the upper intestine and is affected by bioavailability of food, physiologival states, age and estrogen levels in blood. The calcium absorbtion in the body is equal to excretion. Adequate sources of calcium are dairy produts, fortified foods, and calcium supplements.

Hypercalcemia (Hyper-State)  high calcium levels in the blood.

Sypocalcemia   ( hypo-state) is the low calcium level in the blood .

Both these states can cause critical metabolic conditions such as loss of consciousness, fatal respiratory failure, cardiac arrest etc. inadequate calcium intake is caused by lack of information, economic hardship and lactose intolerance. Consequences of inadequate intake effect teeth development , decreases bone density ( mass), rickets and cause osteoporosis.

Dental considerations

• A dentist or dental hygienist should consider the fact that patients with Hyperparathyroidism are prone to alveolar bone resorption.
• Osteoporosis indicates tooth loss and leads to unsuccessful implantologic and prosthetic interventions.
• Smoking effects the calcium uptake
• Nutritional counceling for clients who are :
• Lactose intolerant
• With decreased gastric acid
• Smokers.

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