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DMD3 > Nutritional Deficiencies and Oral Cavity > Flashcards

Nutritional Deficiencies and Oral Cavity Flashcards

1
Q

What kind of effects can nutritional deficiencies have on the body?

A

They may alter homeostasis affecting:

Development of the oral cavity

Reduce resistance to microbial insults

Lead to disease progression

Reduce capacity of the mouth to heal appropriately

Link suggested by studies to: dental caries, periodontal disease, potentially malignant disorders and oral cancer.

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2
Q

Why are patients often unaware of acute links between nutrition and optimal oral health?

A

The nutritional training of dentist and oral health professionals is limited and the oral health training of nutritionist inadequate

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3
Q

What should a balanced diet contain as a minimum?

A

A diet composed of adequate quantities of carbohydrates, proteins, fats and oils, vitamins and minerals. The proteins must also include the essential amino acids and the fats must include the saturated free fatty acids which the body cannot produce.

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4
Q

What is malnutrition?

A

Malnutrition or a nutritional deficiency is the cellular imbalance between the supply of the nutrients and energy, and the bodies demand for them to ensure growth, maintainence and these specific pathways or functions.

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5
Q

How does malnutrition develop?

A

It develops when the body does not get the right amount of the vitamins minerals and other nutrients which it needs to maintain healthy tissue and organ function

The intake of a balanced diet with which we showed before is not enough to ensure adequate nutrition.
The body must also be able to break down these food components to the basic units, absorb them and utilize them for proper body functions to be maintained.

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6
Q

How much of an issue is malnutrition for us in Australia?

A

44% children in rural and remote australia suffer from a nutritional deficiency.

35 - 43% of hospitalised patients

32 - 75% of aged care patients

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7
Q

How common is vitD deficiency in Australian population?

A

23% of the Australian population have a Vitamin D deficiency, ABS

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8
Q

How common is an iron deficiency in Australia?

A

10% of non pregnant women have an fe deficiency-higher levels for pregnant women

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9
Q

What effect does nutritional deficiency have on the pre-eruptive phase of teeth?

A

Can lead to enamel hypoplasia (some hypoplasia and pits correlate with vitA deficiency and more diffuse forms correlated with vitD deficiency)

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10
Q

What should be suspected in cases of recurrent apthous ulcers when high frequency?

A

Potential for deficiencies and long term effects on enamel.

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11
Q

What dental problem is associated with post eruptive nutritional deficiencies?

A

Dental caries

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12
Q

What biological factors are associated with caries?

A

Cariogenic bacteria in a complex ecological system

Fermentable carbohydrates

Host factors (External structural defects, salivary gland atrophy, and saliva composition alteration)

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13
Q

How does vitA and D deficiency lead to caries?

A

vitA and D can lead to hypoplasia of the enamel and hypomineralisation and these structural defects can provide a more cariogenic environment and less protective enamel increasing susceptibility to caries.

vitA deficiency and protein energy malnutrition are associated with salivary gland atrophy leading to decreased protective effect of saliva in the mouth, lower buffering capacity also increases demineralisation of enamel.

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14
Q

What effects does Protein Energy Malnutrition (PEM) have on the mouth?

A

Salivary gland attrophy

Changing composition of saliva limiting protective effects

Reduced salivary secretion rate, buffering capacity, lower calcium levels, lower protein secretion in stimulated saliva resulting in reduced defence.

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15
Q

How is calcium intake related to periodontal disease?

A

Low calcium intake is associated with an increased risk of periodontal disease

Increased calcium intake was associated with decreased risk of periodontal disease and tooth loss, in part due to its role in preventing bone loss

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16
Q

How is vitC related to periodontal disease?

A

Vitamin c plays the main role in maintaining and repairing the healthy connective tissue or the activation of reparative mechanisms thanks to its antioxidant properties

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17
Q

How is periodontal disease related to protein intake?

A

A retrospective study was conducted to examine whether early childhood protein energy malnutrition was related to worsened periodontal status in the permanent dentition. The study revealed that yes indeed it related to poorer periodontal status as an adult. It was postulated that as ECPEM is likely to effect the developing immune system, a persons ability to respond to colonization with the periodontal pathogens may be adversely affected.

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18
Q

Why is it important for dentists to understand nutritional deficiencies?

A

Oral mucosa has a slower turnover rate compared to the skin so observing the oral mucosa allows for early diagnosis of a nutritional deficiency and thus a quicker intervention before more adverse systemic effects are seen.

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19
Q

What are the risks associated with a B2 deficiency?

A

Patients who are deficient are at risk for developing:

Edema of the pharyngeal and oral mucous membranes

Angular cheilitis

Stomatitis

Glossitis

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20
Q

What are the risks associated with a B3 deficiency?

A

Deficiency, manifests as:

Bright red glossitis/atrophic

Burning mouth and possibly erythema of the gingiva

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21
Q

What are the risks associated with vit B6 deficiency?

A

Deficiency presents orally:

Glossitis

Cheilitis

Erythema of the gingiva

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22
Q

What is the function of vitB2?

A

Vitamin B2 (riboflavin), in its metabolically active form, is part of the flavin mononucleotide and flavin adenine dinucleotide coenzymes, which aid enzymes in several metabolism reactions

23
Q

What is the function of vitB3?

A

Vitamin B3 (niacin) is involved with cell repair, and its coenzymes serve in a variety of reactions, including tissue respiration and glycolysis.

24
Q

What is the function of vitB6?

A

Vitamin B6 is involved in carbohydrate, fat, and protein metabolism, as well as other key reactions such as converting tryptophan to niacin, heme biosynthesis, and neurotransmitter synthesis.

25
Q

What causes angular cheilitis?

A

Many vitamin deficiencies: B2, B6, Folic Acid, and iron

26
Q

How is angular cheilitis treated?

A

Barrier cream topical kenacomb with the antimicrobial antinflmmatory and antifungal effects plus or minours heamatolgical investigations and patch testing

27
Q

What is angular cheilitis?

A

Cheilitis inflammation of the lips and angular at the angles or more correctly the commissures

28
Q

What is the function of vitB9?

A

Vitamin B9 (folic acid) aids in DNA synthesis and is critical to cells with a rapid turnover rate that require continual DNA creation such as the oral cavity

29
Q

What are the symptoms of a vitB9 deficiency?

A

Clinical manifestations of a deficiency include:

Burning of the tongue and oral mucosa

A red and swollen tongue

Angular cheilitis.

30
Q

What is the function of vitB12?

A

Vitamin B12 is also required for DNA synthesis.

31
Q

What is the function of vitC?

A

Vitamin C (ascorbic acid) is a powerful antioxidant that is necessary for healthy collagen formation

32
Q

What are the symptoms of a vitB12 deficiency?

A

Vitamin B12 deficiency, along with folic acid and iron deficiencies, is associated with:

Recurrent aphthous stomatitis

Red, atrophic, burning tongue

33
Q

What are the symptoms of a vitC deficiency?

A

Scurvy presents with:

Hemorrhagic gingivitis with enlarged blue or red gingiva.

Gingival bleeding

Swollen gingiva.

34
Q

How are recurrent aphthous stomatitis and vitB12, folic acid, and iron deficiency related?

A

Deficiencies of these nutrients were found in 28% of individuals with recurrent aphthous stomatitis, which improves in some patients once the deficiency is eliminated.

35
Q

When does recurrent aphthous ulcers start typically?

A

Childhood or adolescence but can occur in late adulthood.

36
Q

What is the function of vitA?

A

Fat-soluble vitamin A is also critical to maintaining oral health. Vitamin A is responsible for photosensitive pigments such as rhodopsin, maintaining epithelial tissue, and preventing infectious diseases

37
Q

What are the oral manifestations of vitA deficiency?

A

The oral mucosal manifestations of vitamin A deficiency include xerostomia (dry mouth) and reduced resistance to infections.

38
Q

What are the oral manifestations of vitA toxicity?

A

The oral manifestations of toxicity include:

Cheilitis

Gingivitis

Carotenemia (orange discoloration of the mucous membranes due to excessive deposition of pigment, and impaired healing.

39
Q

Who is at risk for vitA toxicity?

A

Patients whose livers are compromised due to drug abuse, hepatitis, or excessive ingestion of carrots.

40
Q

What are the oral manifestations of vitE deficiency? Who is at high risk of this?

A

Vitamin E is an antioxidant whose deficiency may be associated with oral cancer. At high risk for vitamin E deficiency are premature infants and patients with malabsorption disorders or lipid transport abnormalities.

41
Q

What is the function of iron?

A

Component of haemoglobin

Essential for normal immune function

Cofactor with vitamin C in collagen production

42
Q

What are the oral manifestations of iron deficiency anaemia?

A

Atrophy of the lingual papillae

Burning and redness of the tongue

Angular stomatitis

Dysphagia

Pallor of the oral tissues due to underlying anemia.

Like folic acid and B12, iron deficiency may be associated with recurrent aphthous ulcers.

43
Q

What is the function of zinc?

A

Zinc plays a variety of critical roles in the cell:

Particularly acting as an enzymatic cofactor critical for cell growth. normal immune function, metabolism, and as a stabilizer of DNA, RNA and collagen synthesis

44
Q

What are the oral manifestations of zinc deficiency?

A

Oral manifestations of zinc deficiency include flattened filiform papillae

Xerostomia

Impaired wound healing

Decreased taste sensation

Burning mouth.

45
Q

What are nutritional deficiencies in general characterized by?

A

An increase in production and secretion of glucocorticoid

Decreased secretion of insulin

Elevated circulating glucocorticoid levels, even at physiological concentrations, elicit MACROPHAGE DYSFUNCTION and REDUCED CYTOKINE PRODUCTION in response to inflammatory stimuli.

Cytokines play a prominent role in growth, differentiation, host defences and tissue damage which ultimately impact the tissue healing process. (Enwonwu et al)

Specifically Vitamins C and A appear to have more of a direct link to IMPAIRED HEALING AND IMMUNE FUNCTION

Unknown connection between autoimmune disorders and nutritional deficiencies (might be due to increased homocysteine)

46
Q

What is the association between oral lichen planus and vitamin/mineral deficiencies?

A

Studies have found correlation between vit B12, folate, Fe, B6, vitD deficiency and OLP.

Evidence indicates that with OLP haematinic deficiency is probably not the main aetiology but just a systemic contributing factor. This is because following addressing the deficiencies we don’t see remission of OLP.

47
Q

How is homocysteine related to OLP?

A

As mentioned homocysteine levels appear to be more important than B12 and folic acid for OLP. These vitamins are required to convert homcysteien into methionine.
Epstein found significantly higher levels of homocysteien in erosive OLP patients with a statistically significant correlation between levels and severity of OLP.

Improvement is often seen with supplementation and corticosteriod therapy.

48
Q

Who is at risk of vitamin/mineral deficiencies?

A

Eating disorders (anorexia/bulimia)

Elderly (less nutritious meals/less meals)

Edentulous

Vegetarians and vegans (B12 deficiency common in these populations)

GI diseases (Crohn’s disease)

Alcoholics (interferes with thiamin absorption)

Drugs may alter nutritional health (folic acid impaired by methotrexate and phenytoin)

49
Q

How do dentures affect nutrition?

A

Dentures have a bidirectional effect on nutrition and oral health. Dentures may cause biting and chewing problems. The chewing function of a patient with complete dentures is only 20% that of a dentate person. Dentures also limit food selection, making the patient inclined to consume smooth soft foods that are easier to eat but often less nutritious.

50
Q

How does edentulism affect nutrition compared to dentures?

A

The problem appears to be worse for the Edentulous with studies showing these patients having less nutritional diets than partially dentate people. The most recent data notes that the intake of vitamin A, fiber, and calcium declines as number of teeth decline and Edentulous adults were found to have lower levels of retinol, β-carotene, ascorbate, tocopherol, and folic acid than dentate adults

51
Q

How does Crohn’s disease affect nutrient absorption?

A

impaired absorption of nutrients, particularly calcium, iron, folic acid, vitamin B12, and fat- soluble vitamins. These deficiencies lead to pallor, angular cheilitis, and glossitis. Oral lesions are found in 6% to 20% of patients with Crohn disease.

52
Q

How does ulcerative colitis affect nutrient absorption?

A

Ulcerative colitis results in the potential malabsorption of vitamin K, vitamin B12, and folic acid.
In addition to other malabsorption diseases, atrophic gastritis leads to pernicious anemia, manifested orally as an atrophic glossitis

53
Q

How should patients be educated about about nutrition?

A

Part of oral hygiene instruction

Go beyond fermentable carbohydrate and nursing bottle caries

More education required

DMD3 (53 decks)

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