LO 2 - Part 2 Flashcards
Oral calcified structures refer to _________
teeth and bone
Oral soft tissue refers to _________
gums, tongue, inner lining of cheeks, lips (everything other than teeth & bone)
How are gingivitis and heart disease related?
- When bacteria grow in the mouth, inflammation may occur and spread throughout the body, including plaque that forms on the lining of arteries
- Recent studies suggest that gingivitis may be a risk factor for heart disease
What are signs of nutrient deficiencies in the soft tissues?
- Changes in oral soft tissues can be caused by deficiencies in vitamins, minerals, protein, salivary flow, as well as many other factors.
- Common symptoms of nutrient deficiencies include: pain; swelling & redness
You should look for changes in ________ in the soft tissue to detect nutrient deficiencies
- Colour
- Size
- Shape
- Texture
- Functional integrity of tissues
Describe the importance of saliva
- Lubricating the oral cavity to facilitate chewing, swallowing and speech
- Cleansing the oral cavity by washing away food debris from the teeth & mouth
- Remineralizing - saliva is rich in minerals and also has antimicrobial properties that act as a buffer to help maintain pH levels
How and when is saliva produced?
- Saliva is produced in response to reflexes triggered by smell and taste stimulation and the movement of the jaw muscles, joints and pressure on teeth due to chewing
- 90% of saliva is produced & secreted by three principal glands - Parotid; Sublingual, Submandibular
The _________ and inner lining of the __________ are also lined with minor salivary glands.
lips; cheeks
How much saliva should a healthy adult produce every day?
1 to 1.5 L of saliva
What is the name of the condition associated with lack of salivary flow?
Dry mouth/xerostomia
What factors may reduce salivary flow?
- Stress
- Anxiety
- Depression
- Age
- Cancer treatment/radiation
- Medications
Describe the role of stress in oral health
- Depending on which system is activated there will either be a stimulation (increase) or inhibition (decrease) of glandular secretions.
- The activation of the sympathetic nervous system generally decreases salivary output
- While the activation of the parasympathetic nervous system generally increase salivary output
Describe taste buds
- Taste buds are located on the papillae (bumpy projections) of the tongue
- There are 4 types of papillae - Foliate; Fungiform; Filiform; Circumvallate also known simply as “Vallate”
How are nutrient deficiencies and taste related?
- Chronic severe nutrient deficiencies may result in a loss of papillae and a smooth red tongue will be visible
What factors affect taste?
- Age - there is a natural reduction in taste buds as we age. Due to loss of taste buds, a change in taste acuity, appetite and satisfaction may occur.
- Glossitis (inflammation of the tongue)
- Oral Candidiasis (fungal infection, the tongue will be covered in a cottage-cheese like substance)
- Other tongue infections (viral, example: oral herpes simplex)
- Smoking
- Nerve injury, Irritation, Trauma (example: burn)
- Oral Cancer
How many taste buds do adults have?
The average adult has approximately 10,000 taste buds but children have even more!
________ is inflammation of the tongue associated with vitamin B deficiency
Glossitis
________ is cracks at the corners of the mouth commonly associated with vitamin B deficiency
Angular Cheilitis or Cheilosis
Describe xerostomia
- Xerostomia- the medical term for “dry mouth”
- A sticky, dry feeling in the mouth or thick, stringy saliva
- Trouble chewing, swallowing, tasting, or speaking
- Decayed teeth/increased sensitivity of teeth
Describe stomatitis
Inflammation of the oral mucosa ie: inflammation of the mucous lining of any of the structures in the oral cavity: cheeks, gums, tongue, lips, throat and roof or floor of the mouth – associated with vitamin B deficiency
Describe gingivitis
Inflammation of the gums specifically (as opposed to stomatitis)
What are the Principal Nutrients required for healthy Oral Soft Tissues & Salivary Glands
- Water-Soluble Vitamins - the B family & Vitamin C
- Fat-Soluble Vitamins - Vitamins A & E
- Minerals - Iron, Zinc & Iodine; Water & Electrolytes: sodium, potassium & chloride
Describe the primary role and sources of B vitamins
- Primary Role: Assist in macronutrient metabolism (help break-down and utilize carbohydrates, proteins & fats)
- Primary Source: Grain Products (whole & enriched); Meat & Milk Products
Why is toxicity from B vitamins rare?
Easily Destroyed: Overcooking will destroy B vitamins
When does the need for B vitamins increase?
With increased stress
What does B vitamin deficiency result in?
vitamin B deficiencies can give rise to glossitis, stomatitis, loss of papillae (where taste buds are located); angular cheilitis
Describe vitamin B1 (Thiamine)
- Role - Acts as a coenzyme (supports enzymes) in metabolism of energy nutrients particularly carbohydrate metabolism.
- Crucial for normal function of the brain & nervous system (thiamin helps break down carbohydrates into glucose
How much thiamine is required by adults? When is more needed?
- Adult males – 1.2 mg/day
- Adult females – 1.1 mg/day
- More needed during exercise, pregnancy, sickness (remember as stress levels increase so do nutritional needs)
What are the dietary sources for vitamin B1 (Thiamine)
whole grains, meat products, nuts & legumes.
Describe thiamine deficiency
- Severe deficiency results in “Beriberi” impairment of both sensory and motor function making it difficult to move
- Signs of deficiency: mental confusion/aberrations in brain function
Describe vitamin B2 (Riboflavin)
- Role - Acts as a coenzyme (supports enzymes) in metabolism of energy nutrients particularly protein
- Needed in increased amounts when protein is required (during growth spurts, recovering from injury)
- Needed for healthy eyes and mucous membranes
- Has shown promise in preventing migraine headache when used prophylactically
What are the daily riboflavin requirements for adults?
- Males – 1.3 mg/day
- Females – 1.1 mg/day
What are the dietary sources for vitamin B2 (riboflavin)
Whole grains, milk & milk products, meat, poultry & fish
Describe riboflavin deficiency
- Primary Riboflavin deficiency is uncommon but seen in those with multiple nutrient deficiencies as a result of poor nutrient absorption (secondary deficiency)
- Oral Symptoms of Vitamin B2 deficiency:
Angular cheilitis (cuts in corner of mouth); Glossitis (smooth inflamed tongue)
Describe vitamin B3 (Niacin)
- Role - Acts as a coenzyme (supports enzymes) in metabolism of energy nutrients
- Shown promise in improving cholesterol levels
What are the daily requirements for niacin for adults?
- Adults 14-16 mg/day
- Adult UL 35 mg/day in supplement form (concern: vasodilating effect)
What are dietary sources for niacin?
whole grains, nuts, seeds, legumes & tryptophan (milk, eggs, meat)
Describe niacin deficiency
- Primary niacin deficiency is usually associated with a maize (corn) diet, since corn contains all essential amino acids except tryptophan – (tryptophan is a precursor to niacin – the body uses it to make niacin)
- Deficiency may result in “pellagra” –the 3 Ds: dermatitis, diarrhea & depression.
Describe excess of niacin
Too much niacin (for therapeutic treatment of LDL for example – 250 mg plus) can lead to “niacin flush” = flushing of the skin, nausea, itching, tachycardia, fainting, blurred vision.
What are the oral symptoms of niacin deficiency?
- Stomatitis (inflamed oral mucosa)
- Gingivitis
- Red mucosa
- Swelling of the tip and borders of the tongue (may be painful) - later becomes smooth and shiny
- Fissures may develop on the tongue
- Pale corners of lips, with fan-like fissures
Describe vitamin B6 (Pyridoxine)
- Role - Acts as a coenzyme in metabolism of energy nutrients
- Assists in hemoglobin synthesis (RBCs)
- Assists in proper functioning of the brain & nervous system – including synthesis of neurotransmitters - serotonin, epinephrine, norepinephrine - Helpful for PMS!
What are the daily requirements for B6?
- 1.3-1.7 mg/day
- UL – 100mg/day
Describe excess of vitamin B6
consuming high-doses over time can have side effects - Notably: Loss of sensation to fingertips (sensory neuropathy – usually in therapeutic doses in excess of 1,000 mg/1 g per day)
What are dietary sources of vitamin B6?
Meat, poultry fish, whole grains, some fruits, nuts, vegetables
Describe the signs of vitamin B6 deficiency
- Dermatitis (inflamed skin)
- Anemia
- CNS abnormalities (headache, nausea, dizziness) or convulsions
Oral symptoms of deficiency
1. Cheilosis (cracked skin on corners of mouth)
2. Glossitis (swollen tongue)
3. Pain, swelling and papillary changes
4. Scalded sensation of the tongue and possibly reddening of the tip
Describe Vitamin B9 - Folate/Folic Acid
- Role - Acts as a Coenzyme for at least 20 enzymes
- Important in the synthesis of RNA and DNA
- Helps maintain normal level of mature RBC (works in conjunction with B6 and B12 in this regard)
What are the daily requirements for vitamin B9 - Folate/Folic Acid?
- Adults 400 ug (mcg)/day (.4 mg)
- UL 1000 ug/day (supplement) 1 mg
- More needed for periods of growth, and pregnancy 400-600 ug/day (.4 - .6 mg/day)
What are dietary sources of folate?
- dark leafy greens, liver, fortified cereals and grain products, some fruits (esp: oranges)
- Folate is destroyed by prolonged cooking and food processing
Describe folate deficiency
- Folate deficiency: is the most common deficiency among the B vitamins – may occur as result of alcoholism, pregnancy/lactation, gastrointestinal disease or medications that interfere with absorption
- Folic acid deficiencies during pregnancy can lead to a risk of neural tube defects such as spina bifida (“split spine” – incomplete closure of embryonic neural tube) and other defects (notably: cleft palate – pic below of cleft palate and lip), low birth weight and premature births.
- Folate deficiency can give rise to megaloblastic anemia – inability of RBCs (red blood cells) to transport oxygen to cells.
4.Glossitis will often be present with folate deficiency.
Remember that vitamins _________ are fundamental to the health of RBCs and oxygen transport.
B6, B9 (folate) & B12
Describe vitamin B12 (cobalamin)
- Role - The only vitamin to contain a mineral – cobalt
- Essential for making RBCs and for the synthesis of the myelin sheath (insulates nerve fibres and aids in transmission of nerve impulses)
What are the daily requirements for vitamin B12?
- 2.4 ug (mcg)/day (.0024 mg)
What are dietary sources for vitamin B12
only in meat & milk products (animal products)
Describe vitamin B12 (cobalamin) deficiency
- B12 deficiency can cause pernicious anemia
- Injections of B12 are a popular treatment for fatigue & for those who cannot absorb the nutrient due to gut impairment
- Oral symptoms: glossopyrosis (unexplained pain of the tongue “burning of the mouth”) followed by swelling & loss of papillae
- Other symptoms: weakness; fatigue; numbness or tingling as a consequence of demyelination of the nerves.
Describe vitamin B5 (Pantothenic Acid)
- Role - Similar to the other B vitamins in its metabolic role – ie: macronutrient metabolism
- Used in the formation of certain hormones and nerve-regulating substances
What are the daily requirements for vitamin B5?
Adults 5 mg/day & No UL
What are dietary sources for vitamin B5?
whole grains & animal products
Describe vitamin B5 deficiency
naturally occurring dietary deficiency (ie: primary deficiency) of pantothenic acid has not been documented
Describe B7 (Biotin)
- Role - Coenzyme in metabolism of carbohydrates, fats and proteins
What are the daily requirements for vitamin B7 (biotin)
- AI (adequate intake) Adults: 30 ug/day ( microgram)
- No Upper Limits
What are dietary sources for Vitamin B7 (biotin)
grain products, peanut butter, egg yolk, yogourt, liver
Describe vitamin B7 deficiency
Pallor of the tongue
What is an antioxidant with examples
- Antioxidants a substance that inhibits oxidation, especially one used to counteract the deterioration of stored food products.
- Examples of an antioxidant is vitamin A, C, E and Selenium.
Describe vitamin C’s role as an antioxidant
- Improves the host defense mechanisms
- Protects soft tissues from infections
- Fundamental in collagen formation – synthesis, maintenance and repair
- Deficiencies: can cause improper/weakened collagen formation, inability to maintain strength of connective tissue as one ages and may lead to gingivitis and poor wound healing - May also see parotid gland (largest salivary gland) enlargement
Describe vitamin A’s role as an antioxidant
- Antioxidant necessary for maintaining the integrity of epithelial tissues and is significant factor in the development and maintenance of salivary glands.
- A deficiency causes decreased saliva & associated with development of some oral cancers
Describe vitamin E’s role as an antioxidant
- As an antioxidant vitamin E plays a major role in neutralizing free radicals - in this way it also prevents inflammation of the periodontium and promotes the integrity of the cell membranes of the mucosa.
Describe selenium’s role as an antioxidant
- Selenium functions mainly as a cofactor for an antioxidant enzyme that protects membrane lipids, proteins, and nucleic acids from oxidative damage.
- It also has an impact on skeletal integrity and contributes to maintenance of immune function.
- Selenium is present in tooth enamel and dentin.
- Sources are animal products, seafood, dairy products and eggs.
Describe the importance of water in the oral cavity
- Water and several minerals are essential for the maintenance of oral tissues.
- Deficiencies have an impact on the oral cavity and nutritional status.
- Example xerostomia (“dry mouth”) may contribute to caries and eventually tooth loss.
Describe the functions of water
- Water is the most abundant component in the human body
- Acts as a solvent enabling chemical reactions to occur water is the hub of all biochemical processes in the body
- Enables secretions and excretions
- Enables the transport of nutrients to the cells
- Acts as a lubricant between cells
- Regulates body temperature (perspiration and evaporation)
What are daily water requirements for adults?
- Men – AI (adequate intake): 3.7 liters or 15-16 cups a day
- Women – AI: (adequate intake) 2.7 liters or 11-12 cups a day
- No digestion is required for water absorption
- Transported through the intestinal membrane
- As much as 1 liter can be absorbed from the small intestine in 1 hour
List the ways water can be lost from the body
- Urination
- Expiration (breathing out)
- Perspiration (sweat/ shedding tears)
- Defecation
- Besides tap water, what are other good dietary sources of this fluid?
Describe fluid balance in the body
- Fluid intake and excretion is balanced by the kidneys.
- Water follows sodium and excess sodium will lead to increase in total body water (sodium makes us “retain water”).
- Chronic renal failure, liver disease & high levels of steroids may make a person more susceptible to excess fluid because of sodium retention
What are the signs of fluid retention?
- Weight gain
- Puffy eyelids
- Edema of the legs and feet
- Distended neck veins
- Elevated blood pressure – strongly linked to sodium intake
What are the signs of dehydration?
- Weight loss
- Confusion
- Fatigue
- Sunken eyes
- Hypotension
- Xerostomia (“dry mouth”)
- Dry skin
- Decreased urinary output & Dark urine with a strong odor
- Treatment – Replace fluids orally or in some cases by IV
What are tips you can give clients for staying hydrated?
- Encourage clients with dry mouth to increase fluid intake and consider sugar-free gum to encourage salivary flow
- Look for hidden sources of sodium in the diet
- Beverages containing caffeine and alcohol increase urine output (they act as diuretics in the body) – 2:1 is the ratio most nutritionists recommend – 2 glasses of water for every glass of diuretic fluid
- Remind clients to rehydrate both during & after exercise
Describe electrolytes
- Electrolytes are substances that acquire the capacity to conduct electricity.
- The balance of the electrolytes in our bodies is essential for the normal functioning of our cells and our organs - our kidneys work hard to maintain this balance
- Proper electrolyte balance is also essential for muscle coordination, heart function, nerve signaling and concentration.
- Sweat from exercise depletes electrolytes, particularly: sodium and potassium
Describe sodium
- Sodium is present in calcified structures in the body, and in saliva though its function in bones and teeth is unclear
- Excess sodium may reduce salivary flow
- AI Adult : 1,500 mg/day (or 1.5 grams)
- UI: 2,300 mg/day (or 2.3 grams)
- Canadians currently consume approximately 3,100 mg of sodium daily, more than the safe upper limit. Ironically, this excess salt does not come from salt shakers.
How much salt is contained in 1 tsp?
One teaspoon of salt contains about 2,300 mg of sodium which is the current upper tolerable daily limit.
Describe the result of excess sodium intake.
Elevated serum sodium levels (Hypernatremia) – due to poor diet, insufficient fluids) 🡪 high blood pressure!
Symptoms of hyper & hypo are similar: headache, confusion, nausea, cramps.
Describe the result of deficient sodium intake.
Low serum sodium levels (Hyponatremia) – (sweating, diarrhea, vomiting or meds 🡪 this will be the case for ALL electrolytes) 🡪 low blood pressure
Symptoms of hyper & hypo are similar: headache, confusion, nausea, cramps.
Describe potassium
- Standard electrolyte functions
- Readily available in most foods but contrary to sodium, processed foods contain lower levels
- Potassium has opposite effect on blood pressure
- Sources: Fruits & vegetables, beans, whole grains
Describe high and low potassium levels
- Elevated serum potassium levels (Hyperkalemia) – (renal failure, supplements)
- Low serum potassium levels (Hypokalemia) – excess secretion – illness/vomiting, sweating; insufficient dietary intake
- Symptoms of hyper/hypo similar: muscle weakness, tingling, numbness in extremities, diarrhea, cramps, confusion & electrocardiographic changes
Describe chloride
- Standard electrolyte functions
- Chloride is important for protein digestion and may also create an environment that inhibits bacterial growth
- Chloride can also enhance the absorption of iron, calcium, and vitamin B12
- Sources: salt or sodium chloride and salt sources, water
- Requirement: 2,300 mg/day
Describe high and low chloride levels
- Excess Chloride - can result from excessive salt intake - Symptoms include: dehydration, renal fatigue, diarrhea
- Low Chloride – can result from excessive sweating, diarrhea or vomiting
Describe iron
- best known as the main constituent of hemoglobin the red-pigmented protein molecule that gives blood its characteristic colour
- The function of hemoglobin is to pick up oxygen and carry it through the bloodstream to our body tissues where it is used to carry out our day-to-day functions.
- Everything we do from breathing, moving, growing, making our hearts beat and staying warm requires oxygenated blood.
Describe daily iron requirements
- 18 mg/day for women
- 8 mg/day for men
- Pregnancy: 27 mg/day
- Less in older women (post menopausal)
- Absorption & Excretion: Calcium interferes with absorption and vitamin C helps (by up to 4-fold!)
What are dietary sources for Iron?
- Heme (animal iron – best absorbed): liver, meat, oysters & clams
- Non-heme (veg sources): soybeans, pumpkin seeds, spinach, blackstrap molasses, apricots, legumes
Describe iron toxicity
- In the absence of hereditary hemochromatosis, iron overload or toxicity from the diet alone is extremely rare.
- Iron toxicity typically arises from the inappropriate use of iron supplements.
- For this reason, iron status should always be determined prior to taking iron supplements.
Describe iron deficiency
- The most common signs of iron deficiency anemia include: fatigue, paleness, lack of endurance, heart palpitations, cold hands and an increased susceptibility to infection.
- Behaviorally, this may express as: lethargy, poor work performance, decreased immunity, irritability and even depression.
List the oral symptoms of iron deficiency
- Pallor of the lips and mucosa
- Angular cheilosis
- Loss of papillae
- Glossitis – Inflammation of the tongue
- Candidiasis
Describe zinc
- Zinc supports over 200 enzymes that affect cell growth and replication, fertility, reproduction (particularly male prostate health), night vision, immune system, taste, smell and appetite
- Essential for bone growth
Describe high and low zinc levels, including dietary sources
- Insufficient zinc may affect nutrient intake from loss of taste & smell
- Excess zinc (from supplementation) can cause vomiting & diarrhea & decrease copper levels in body
- Sources: liver, beef, lamb (similar to iron sources); to a lesser extent: nuts/seeds
Describe iodine
- Role - Its principal function is to help manufacture thyroid hormones which are essential for regulating metabolism
- Iodine is therefore closely linked to basal metabolic rate (BMR)
- About 60% of iodine is stored in thyroid gland
- Sources: iodized salt, seafood, plants grown near the ocean (seaweed)
Describe Hypothyroidism
- occurs when thyroid gland is not producing sufficient hormones possibly due to insufficient iodine
- Symptoms: weight gain or difficulty losing weight; fatigue with or without Goiter - an enlargement of the thyroid gland that often produces a noticeable swelling in the front of the neck
Describe hyperthyroidism
- most common type is Graves’ Disease - occurs when the immune system mistakenly attacks the thyroid gland and causes it to overproduce the hormone thyroxine.
- Symptoms: delayed eruption of primary and secondary teeth, enlarged tongue, anxiety, irritability, difficulty sleeping, weight loss, frequent bowel movements, sensitivity to cold, dry skin, fine tremor in hands or fingers
