nutrition and oral health

Question 1

What is diet?

Answer 1

Sum of food consumed by a person, it is the food that a person habitually eats

Question 2

What is nutrition?

Answer 2

Quality of food

Food that our body needs to consume daily for our bodies to function optimally

Question 3

What are developmental enamel defects?

Answer 3

Nutritional deficiencies- Vit A and D, malnutrition

Nutritional excesses- fluoride and tetracycline

Question 4

How can fluoride be ingested?

Answer 4

Water supplies  (1ppm)
Salt
School milk (2.65 ppm)
Naturally in tea
Naturally in oily fish

Question 5

What happens with an excess of fluoride?

Answer 5

Dental fluorosis
GIT upset
Respiratory arrest
Death

Question 6

What is tetracycline?

Answer 6

Broad spectrum antibiotic for perio disease, acne, chest infections (CF patients)
If given during enamel formation- sever intrinsic staining

Question 7

How does Vit D affect dental development?

Answer 7

deficiency-> delayed development, hypoplastic enamel

Patients w Vit D resistant rickets (hereditary hypophosphatasia) -> large pulp chambers and pulp horns, enamel hypoplasia, clefts and tubular defects in dentine
(Spontaneous dental abscesses due to tiny cracks and bacteria)

Question 8

How do calcium and phosphates affect dental development?

Answer 8

Reduced enamel hypoplasia in kids (1929-43) after cheap milk, cod liver oil for pregnant women and young children, bread fortified w calcifications

Disorders of calcium and phosphate metabolism-
X linked hypophosphatasia, hypoparathyroidism show increases in enamel defects

Question 9

How does Vit A affect dental development?

Answer 9

Animal studies-

Severe changes in ameloblasts with diet deficient in Vit A-> defective enamel/dentine formation

Question 10

How does malnutrition affect dental development?

Answer 10

Nigerian study (1973)- malnourished kids- enamel hypoplasia in primary incisors, delayed dental eruption

Question 11

What is erosion?

Answer 11

Loss of dental hard tissues by a chemical process that doesn’t involve bacteria
25% of 5 yr olds- loss of tissue into dentine
Risk factors- >2 citrus fruits/day, veg/vegans, >4 fizzy drinks/day (252% risk)

Question 12

Does a fibrous diet reduce periodontal disease?

Answer 12

Some animals- fibrous diet (no evidence in humans)

However, chewing- saliva flow- beneficial and PEG fed children- excessive calculus deposits

Question 13

Does Vitamin C reduce periodontal disease?

Answer 13

Deficiency- detrimental
Disturbed collagen formation
Bleeding, swollen gums, loose teeth

Question 14

Does folic acid reduce periodontal disease?

Answer 14

Most deficient nutrient in adults
DNA synthesis and cell turnover
Maintains epithelial integrity and attachment
Folate mouthwashes/supplements- reduce pregnancy gingivitis

Question 15

What are nutritional risk factors for oral cancer?

Answer 15

Alcohol, tobacco, betel quid, areca nut (seed from fruit of oriental palm)

Question 16

How do nutrient deficiencies have an effect on the oral mucosa?

Answer 16

Vit B12- glossitis, fissured tongue, burning mouth, erosive/ulcerative lesions, angular cheilitis
Vit C- haemorrhage, swelling
Vit K- gingival bleeding
Folic acid- ulcers, burning mouth, depapillation of tongue
Iron- ulcers, glossitis, burning mouth, angular cheilitis
Protein deficiency/kwashiorkor- oedema of tongue, atrophy of papillae, circumoral hypopigmentation

Question 17

What is orofacial granulomatosis?

Answer 17

Any age
Delayed hypersensitivity reaction to benzoates (E210-219), cocoa, cinnamon, carvone (found in essential oil, spearmint and dill)

Diffuse facial swelling
Lip enlargement and vertical fissures
Angular cheilitis
Oedema of buccal mucosa 
Mucosal tags (cobblestone)
Aphthous- like ulceration

Biopsy- non-caseating granulomata
Blood tests
Patch tests

Question 18

How is orofacial granulomatosis managed?

Answer 18

Referred to med team
Exclusion diet
Symptomatic relief (difflam, gengigel)
Immunosuppressants
Steroids (mouth wash, systemic)