LO 2 - Part 1 Flashcards
Describe the importance of collagen in tooth formation
- Calcified structures in the teeth – dentin, cementum and bone - depend on proper collagen deposition.
- Immediately after collagen formation, mineralization begins.
- Adequate nutrients are necessary during both collagen formation & mineral deposition in order to prevent structural imperfections.
Describe collagen
- Tough bundles of fibre
with great tensile strength - Collagen is a fibrous structural protein that is the main protein of connective tissue
- Is the main component of teeth and bone - 90-95% of bone matrix is made up of collagen
___________ is the deposition of inorganic materials (no carbon) on an organic matrix (protein & lipids)
Mineralization
Describe the importance of minerals in the body
- Minerals account for only 4% of total body weight but are essential to human health
- Minerals provide compression strength over the tensile strength of collagen
- Resembles reinforced concrete
How are minerals classified?
- Major (“Macro” Minerals) – body needs larger amounts > 100 mg/day – calcium, phosphorus, sodium, potassium, magnesium, chlorine, sulfur.
- Trace Elements (“Micro” Minerals) – body needs in smaller amounts <100 mg/day – iron, copper, zinc, manganese, iodine, fluorine, etc.
- 100 mg is dividing line between Macro and Micro Minerals
- Ultra-Trace Elements (Minerals) –No DRI - required, if at all, in minute amounts: boron, nickel, silicon, tin, aluminum, lead, lithium, & mercury
Describe where calcium is found in the body
- Calcium is the most abundant mineral in the human body
- More than 99% of total body calcium is stored in the bones and teeth where it functions to support their structure
- The remaining 1% is found throughout the body in blood, muscle, and the fluid between cells.
What is the ideal calcium-to-phosphorus ratio for adults required for proper mineralization of bone?
1:1
Phosphorous levels go ___________ calcium levels go ___________ –contributing to potential loss of bone mass.
up; down
How much calcium is required by adults? Children?
- Most adults require in the range of 1,000 mg/day (1,200 if over 50)
- For growing children aged 9 -18 1,300 mg/day
How is calcium absorbed?
- Calcium is principally absorbed in the small intestine
- Under normal conditions, less than 1/3 calcium consumed is absorbed – best absorbed in small amounts throughout the day
List some good sources of calcium
- Milk and Dairy products
- Salmon, Sardines, Oysters
- Almonds
- Seeds – poppy, sesame, chia
- Beans & legumes
- Dark Green leafy vegetables: spinach, all the Chinese cabbages: kale, bok choy, collard greens, broccoli
- Calcium & Vitamin D Fortified Beverages: soy, rice and almond beverages; orange juice
From which sources are calcium best absorbed?
Calcium from dairy is absorbed better than calcium from dark leafy vegetables because oxalates in vegetables (ex: spinach) bind the calcium and interfere with absorption
___________ is the excess levels of calcium in blood seen most frequently in infants 5-8 months old due to inappropriate use of vitamin D preparations (ie: supplements)
Hypercalcemia
What can hypocalcemia lead to?
Hypothyroidism as well as bone diseases
Describe osteoporosis
Refers to the degeneration of already constructed bone (brittle bones) seen in adults/seniors
Describe Osteomalacia (Rickets in children)
- Is an abnormality in the building process of bone (defective bone mineralization), making them soft - attributed to vitamin D deficiency
What are the oral consequences of calcium deficiency?
- During tooth formation deficiency could result in incomplete calcification of teeth, failure of dentin formation, delayed dentition; small molars
- After tooth eruption: deficiency could result in Weakened alveolar bone; The breakdown of healthy periodontal tissue (alveolar bone; cementum, gingiva); Increased risk of decay
What may calcium deficiency result from?
- Lack of education & false belief that adults do not require calcium
- The fact that it may be difficult to achieve required intake from diet alone
- Acidifying influences in the diet & insufficient vitamin D
- Lactose intolerance coupled with food allergies/aversions
Describe phosphorus in the body
- Phosphorous is the second most abundant mineral in the body
- It makes up 1% of a person’s total body weight.
- It is present in every cell of the body, but most – 85% - is found in the bones and teeth.
What is phosphorus needed for?
- The metabolism of macronutrients
- The composition of phospholipids
How much phosphorus do adults require? Where is it absorbed?
- Adults (over 18) 700mg/day
- Phosphorous is absorbed in the small intestine like calcium
List the food sources of phosphorus
- Primary sources include milk products and meats – it is also used widely as a food additive in baked goods, cheese, processed meats & soft drinks
- A diet adequate in calcium and protein will contain sufficient phosphorous
___________ may be seen in cases of persons with thyroid disease (hypo) or renal insufficiency – body is not able to clear excess
Hyperphosphatemia
___________ may result from long term ingestion of antacids which binds to phosphorous interfering with absorption
Hypophosphatemia
__________ can also result in phosphorous malabsorption deficiencies. Insufficient dietary sources may also be at play. Principal clinical symptom = muscle weakness.
Intestinal conditions (notably IBS)
During tooth formation deficiency of phosphorus could result in ___________
incomplete calcification of teeth, failure of dentin formation and increased susceptibility to caries.
Describe the physiology of magnesium
- Almost 2/3 of total body magnesium is found in bone, the other 1/3 is found predominantly inside cells of body tissues and organs.
- Like calcium, 1% of magnesium is found in blood
- It is vitally important to the structural integrity of heart muscles as well as all muscles and nerves (magnesium is a natural muscle relaxant).
How much magnesium do adults require per day?
For adults DRI in the range of 420 mg/day
What are good sources of magnesium?
- Whole grains, nuts/seeds, beans and leafy greens
Describe magnesium deficiency
- In certain disease states deficiencies may occur – GI issues; malnutrition; alcoholism and meds
- Symptoms of deficiency include: neuromuscular dysfunction, muscle spasm and convulsions.
How is the body impacted by too much or too little magnesium?
- Teeth and periodontium may be affected by deficiencies (hypoplasia of enamel and dentin, widening of periodontal ligament space, gingival hyperplasia)
- Alveolar bone formation may be reduced
- Excess magnesium (in supplement form) at toxic levels is associated with kidney failure (kidneys regulate plasma magnesium levels) not from diet
What trace elements are found in calcified structures?
- Copper
- Selenium
- Manganese
- Fluorine
Describe copper
- Essential for the formation of red blood cells and connective tissue
- Readily absorbed in tooth enamel.
- Found in shellfish, organ meats nuts and seeds.
Describe selenium
- Cofactor present in tooth enamel & dentin
- Found in animal products – meats & dairy.
Describe Manganese
- Essential for enzyme systems, optimal bone matrix & macronutrient metabolism.
- Found in whole grains, legumes, nuts and leafy greens.
What is the importance of fluorine?
- Element from which fluoride is derived
Describe the physiology of fluoride
- Technically not an essential nutrient for health – (no known metabolic function) but is advantageous to dental health
- Primary sources include: Fluoridated water, marine fish & fluoridated dental products
- Our municipal water contains approximately 1 mg/L of fluoride.
How much fluoride should adults have per day?
DRI is 3 mg/day for women and 4 mg/day for men
Describe what happens when too much fluoride is consumed
- Mottling of tooth enamel can result from overexposure (approximately 3 to 4 times the amount necessary to prevent caries) during tooth formation.
- Dental fluorosis (the hypomineralization of enamel) may result from overexposure during tooth development.
Describe ultra-trace elements
- Elements are required, if at all, in minute amounts - less than one microgram.
- (microgram is 1/1000 milligram or 1/1,000,000 of a gram ).
- These dietary requirements are easily met through common foods
- Ultra-trace elements include: boron, nickel, silicon, tin, aluminum, lead, lithium, vanadium & mercury
- Deficiencies in ultra-trace minerals have not been established nor have fixed human requirements.
Describe vitamins
- Vitamins are considered organic substances (contain carbon) that are essential to life (metabolism) in small quantities
- They are required in all metabolic reactions using proteins, fats and carbohydrates for energy, growth and cell maintenance.
- They do not provide energy and cannot be used without adequate supply of macronutrients, enzymes & minerals
- They must come from outside sources (diet or the sun) because they cannot be produced by the body or synthesized in adequate amounts
- Absorption is highest when stores are depleted
What are the 2 types of minerals?
- Water-soluble (C&B)
- Fat-soluble A, D, E, K
Describe the characteristics of fat-soluble vitamins (FSVs)
- They are soluble (ie: dissolve) in fat
- Bile assists in the absorption of FSV
- They are not lost to heat (ie: cooking)
- FSV are absorbed in the small intestine along with fats in foods
- They are stored in the fat tissues in the body & liver until the body needs them.
Describe the characteristics of water-soluble vitamins (WSVs)
- They are soluble (ie: dissolve) in water
- They are lost to heat (cooking)
- Unlike fat soluble vitamins, water soluble vitamins don’t get stored in the body.
- WSV have vital role as coenzymes (necessary for cellular reaction in the body)
- WSV are absorbed in the small intestine like FSV
What factors influence vitamin requirements?
- Smoking
- Use of alcohol
- Medication (the contraceptive pill diminishes B vitamins)
- Caffeine or drugs
- Stress - As our stress levels increase so do our nutritional needs
Describe nutritional deficiencies
- Arise when inadequate amounts of nutrients are available to sustain biological functions.
- Primary deficiency: insufficient intake from diet or environment
- Secondary deficiency: intake may be sufficient, but the body is unable to adequately absorb or utilize the nutrients.
Describe vitamin A (retinol)
- From animal sources & plant sources in the form of beta-carotene - The liver stores 90% of vitamin A
- In addition to helping eyes adjust to light changes, vitamin A plays an important role in bone growth and tooth development
- Skin, eyes and mucous membranes of the mouth, nose, throat and lungs depend on vitamin A to remain moist.
- Development of teeth –formation of ameloblast (enamel) and odontoblasts (in dentin)
- Normal teeth spacing and promotes osteoblast (bone) function of alveolar bone
- Antioxidant (potential cancer-fighting properties)
List the food sources of vitamin A
- Milk fortified with vitamin A
- Liver & fish oils
- Orange fruits and vegetables (like cantaloupe, peaches, apricots, carrots, sweet potatoes)
- Dark green leafy vegetables (like kale, collards, spinach)
- Supplementation outside the diet is not normally advisable for healthy individuals (potentially toxic at high doses)
What can vitamin A excess cause?
- Excess can cause hypercarotenemia- yellowing of the palms of the hands and soles of the feet (too much carotene in the fat stores)
- Vitamin A supplements are not advisable during pregnancy can cause birth defect (no more than 5000 IU per day in pregnancy– some multies have more)
What can vitamin A deficiency cause?
- Night blindness and very dry, rough skin decreased resistance to infections, faulty tooth development, and slower bone growth.
Describe vitamin D (Calciferol)
- Vitamin D plays a critical role in the mineralization of bones and the body’s use of calcium and phosphorous.
- It increases the amount of calcium absorbed from the small intestine and helps form and maintain bones.
- Children and adults both need adequate amounts
What are the sources of vitamin D?
- Sunlight is our primary source of vitamin D. Our skin makes vitamin D in response to the sun’s light.
- Vitamin D occurs naturally in animal foods such as fatty fish, eggs, liver, some cereals and butter but in small and insignificant amounts. Vitamin D fortified foods can be helpful.
What can an excess of vitamin D cause?
- As is the case with most vits & mins, Vitamin D excess rarely occurs from diet – it is almost always the result of supplementation
What can a deficiency of vitamin D cause?
- Vitamin D deficiency can lead to osteomalacia and Osteoporosis
- Dentally, delayed dentition and small molars are observed.
Describe vitamin E
- Vitamin E acts as an antioxidant
- Protects vitamins A,C, red blood cells and unsaturated fatty acids from oxidation.
- Promotes resistance of periodontium to inflammation
List the dietary sources of vitamin E
- Vegetable oils, sunflower, canola, corn, soybean, and olive oil
- Nuts, seeds & wheat germ
What can an excess of vitamin E cause?
Large doses of vitamin E may pose a hazard to people who take blood-thinning medications. People taking statin (cholesterol lowering) drugs are also not advised to take supplemental vitamin E because it may interfere with how the medication works.
What can a deficiency of vitamin E cause?
Vitamin E deficiency is rare and generally only occurs in premature infants and people unable to absorb fats.
Describe vitamin K
- found in bones, kidneys and other tissues
- K is from the German word for “coagulation” or clotting of the blood
- Naturally produced by the bacteria in the intestines
- vitamin K plays an essential role in normal blood clotting & helps promote bone health (it binds with calcium and is involved in bone formation).
List the dietary sources of vitamin K
Vitamin K is mostly found in vegetables especially greens – cruciferous vegetables (broccoli, Brussels sprouts and cabbage), kale and Swiss chard.
What can an excess of vitamin K cause?
- Although a tolerable upper intake level has not been established for vitamin K, excessive amounts can cause the breakdown of red blood cells and liver damage.
- No toxicity symptoms have been documented.
What can a deficiency of vitamin K cause?
- Deficiency is uncommon but disease or drug therapy may cause deficiencies)
- A deficiency may cause a delay in blood clotting times
Describe vitamin C (ascorbic acid)
- Functions as an antioxidant and works with vitamin E as a free-radical scavenger.
- Acts as a coenzyme and is vital in the production of collagen
- Important in wound healing by strengthening tissues and promoting capillary integrity
- Helps development of RBC
- Dentally it is important in the development of connective tissue, teeth and bones in the formation of fibroblasts (collagen forming cells) osteoblasts and odontoblasts.
- Vitamin C is quickly depleted during times of stress, healing and infections – it is also negatively affected by tobacco, alcohol, oral contraceptives and aspirin.
List the dietary sources of vitamin C
Red bell pepper, broccoli, papaya, strawberry, orange, kiwi, grapefruit, cantaloupe & peach
What can an excess of vitamin C cause?
- Excess amounts of ascorbic acid can cause gastrointestinal upset and may affect the absorption of B12.
What can a deficiency of vitamin C cause?
- The scientific name of vitamin C, ascorbic acid, is derived from the Latin name of “scurvy”.
- A deficiency in vitamin C can lead to scurvy which manifests in the formation of spots on the skin, spongy gums, bleeding from mucous membranes, fatigue, depression and cessation of bone growth.
- Inadequate vitamin C during tooth development can lead to ameloblasts and odontoblasts atrophy and affect the integrity of the hard tissue.
- Gingivitis caused by ascorbic acid deficiency can affect the periodontium resulting in tooth mobility
