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CHapters: 8(E and K), 9 fluoride 10The macrominerals11-


<ul><li>1.CHAPTER 8 Food SourcesVIT E and K onlyVITAMIN ESeed oils = major source wheat germ oilOne of the most misused and controversial nutrientsvegetable oilsbecause of many erroneous claims for its healing nuts and seedspowers in variety of ailmentswhole grains egg yolk Discovery leafy green vegetables1922- female rats and male rats were sterile unless Toxicitylettuce wheat germ and dried alfalfa were added totheir diet large doses may increase time required for blood1924- called this fertility vitamin, vitamin E coagulation1936 - vitamin E was isolated from wheat germ oil andsymptoms:called it alpha tocopherolgreek of child-birth and tooheadachecarryofatigue oweakness Absorption and metabolism oblurred vision otemporary nauseaBest absorbed on the presence of fat oflatulenceConditions that interfere with fat absorption: odiarrheao Bilary tract diseaseo Pancreatic insufficiencyVITAMIN Ko Excessive mineral oil digestionIntestinal absorption is between 20-30%1931 chickens were protected from bleeding whenVitamin enters lymph unchanged they were fed fish meal that was not extracted withAttaches to lipoproteins as they are being transported etherto bloodstream and become tocopherol 1935 found that VitK was essential for bloodStored in: coagulationo Adipose tissueo MuscleChemistryo Liver Derivative of 2-methyl-1,4-napthoquinone (in smaller amounts): K1&amp; K2o Natural forms oHeart o Yellowish ols oUteruso Unstable in UV light oTesteso Easily destroyed by strong acids and oAdrenalsalkaliso K1 occurs in green plants Function o K2 - produced by bacterial synthesis inintestineAntioxidant- limits free-radical chain reactionso K3 menadione; synthetic form of VitKProtect body cells from lipid peroxidationMake cell membranes more stable AbsorptionPrevents fat from becoming rancid Requires bile and pancreatic juice **vitE requirement is proportional to the amount and theCan also be synthesized by bacteria in GI tract in degree of unsaturation of polyunsaturated fatty acid in dietjejunum and ileum = less polyunsaturated fat, less vitE requiredFunction Deficiency Aids in blood clotting (main function)Rare Assist in Ca+ absorptionIf present, due to congenital or malabsorption disease Lowers risk of kidney stonesAnemia - For premature infants born w/ inadequatereserve of vitEDeficiency Treatment Rare30-100mg daily may be prescreibedOnly occurs in individuals with GI disordersMinor symptoms such as mausea and intestinal **breastfed infants have VitK due to immaturitydistress appears when ingesting 300IU per dayof liver and thus newborn babies are given Vit K suppelements and aor the mother is requested to</li></ul><p>2. eat recommended amount of green leafy Fluoride content of teeth increases rapidly duringvegetables dailyearly mineralization periods and continues toincrease with age, but at a slower rate. Food Sources Metabolism - Distribution Found in both extracellular and intracellular fluids of Spinachsoft tissues but at very low concentrations. Broccoli Found in saliva, 0.01 ppm. Cabbage Play a part in maintenance of fluoride Lettuceconcentrations in the outer layer of tooth Vegetable oils enamel. Metabolism - ExcretionCHAPTER 9 Principal route of excretion is urine (90 95%).FLUORIDE AND THEIR ROLE IN DENTAL CARIES Remaining 5 10% in the feces. PREVENTION Outstanding characteristic of fluoride excretion is itsFluoride speed.Compound form of fluorine. Reabsorption of fluoride from urine is less A trace element, halogen.efficient. Very reactive gas. Effective mechanisms for Not found in free elemental form inmaintaining low concentrations nature.of fluoride in the soft tissuesMajor source is from water artesian wells. and plasma.Found in soils rich in fluorspar, cryolite, and other Metabolism - Excretion minerals. Directly related to the degree ofFluoride active bone growth.Also found in plants, food, and human calcified Fluoride excretion is lower structures (teeth and skeleton). when a child is growing rapidlyNutrient beneficial to dental health.and is actively depositing boneDietary sources - drinking water material than in adults with aWaterborne fluorides are the most important source mature bone structure and fully of flouride for humans.mineralized teeth.Modern diets as a source of flouride. About half of the ingested fluoride is excreted in the Use of fluoridated water in preparation of urine each day. processed foods and beverages. Metabolism - storageFor temperate climates Deposited in calcified structures. Optimal fluoride level: 1 ppm of fluoride. Skeletons of older persons contain more fluoride thanDietary sources - drinking water those of younger ones.For infants and young children Amount of fluoride in bone gradually Intake of 2 4 glasses of water: 0.5 1 mg increases with age greatest during active of fluoride. growth years.For older children, adolescents and adults Metabolism - storage Intake of 6 8 glasses of water: 1.5 2 mg Factors that attract fluoride to bones: of fluoride. Presence of an active growth area at theIngestion of fluoride greater than optimal levels in ends of long bones. drinking water (2 ppm) cause fluorosis. Small size of the bone crystals. Dietary sources - foods Close contact between bones and theFluoride in foods by adultsblood supply Nonfluoridated communities: 1 mg/day. Metabolism - storage Fluoridated communities: 2 3 mg/day. Deposited in the enamel through diffusion.Not known to be a significant factor in fluorosis Carious enamel may take up 10 times more (mottled enamel).fluoride than adjacent healthy enamel toSmall amounts: fruits, vegetables, cereals.inhibit expansion of carious lesion.Rich amounts: seafoods and tea leaves. Dentin may contain even more fluoride. Dietary sources - foods Chemically similar to boneMetabolism - absorption Highest concentration found adjacent toMajor site of absorption: stomach. pulp: close to blood supply.Studies with animals suggest intestinal absorption Relative safety also occurs. Low and moderate intake results to:Soluble fluoride in drinking water is completely Skeletal fluorosis absorbed, whereas 50 80% of the fluoride in foods is Mottled enamel absorbed. Osteosclerosis (hardening of bone)Metabolism - Distribution Exostoses (bony projections)Teeth and skeleton have the highest concentrations Calcification of ligaments of fluoride. High intake may result to death. Due to the affinity of fluoride to calcium. Mottled enamel (Endemic Dental Fluoride) Cementum, bone, dentin, and enamel. White or brown spotty staining of tooth enamel. May be due to food, debris, or plaque. 3. Sometimes will have horizontal striations. Fluoride supplementation at birth gives Enamel is deficient in:some protection against caries to theNumber of cells producing enamel causes deciduous teeth. pitting (hypoplasia). No fluoride supplements must be given toHypocalcification causes chalkiness.infants less than 6 months of age ( Mottled enamel (Endemic Dental Fluoride) exception of infants consuming milk) Occurs only in teeth that are being formed.Fluoride and dental cariesWhen exposed to high concentrations ofFluoride Rinses fluoride, opaque spots will develop on the 3 years is necessary to achieve the enamel. maximum benefit from a rinse program. High intake of fluoride results to mottled enamel. Effective in children with a higher cariesProtection of fluoride is decreased bybaseline than low caries baseline. severe fluorosis.1. The lower the incidence of Mottled enamel (Endemic Dental Fluoride) caries, the more limited the Fluoride and dental caries effect of each preventive Communal Water Fluoridationmeasure.Most effective, practical, feasible and Fluoride and dental caries economical public health measure forSustained Release Delivery Systems preventing caries. Advantages: lower required dosage,Greatest resistance to caries and greatestreduced toxicity, release constant level of amount of fluoride deposition are acquiredfluoride, better use of fluoride and better by starting the intake as early as possible patient compliance. and using it continuously. Clinical studies showed exposure to low Fluoride and dental caries levels of fluoride is more effective inOther factors to the decline of caries: decreasing the incidence of caries. 1. Greater dental health Fluoride and dental caries awareness. Useful in children who tend to get caries 2. Expansion in dental resources. easily, xerostomia, adults with rampant 3. Application of preventiveroot or coronal caries. dentistry.Fluoride and dental cariesFluoride and dental cariesFluoridated Milk School Water Fluoridation Milk is used as an instrument for fluorideFluoridated with levels of three to seven administration. times the optimum for communal water Fluoridated milk was found to be as fluoridation resulting to reduction in caries effective as fluoridated water in reducing caries. Fluoride and dental caries Fluoride and dental caries Fluoride Tablets Fluoridated SaltIngestion daily beginning at 5 9 years: Use salt as a vehicle for fluoride in the diet. permanent teeth can still be significantly Salt is about 2/3 as effective as the water. protected from caries. Mechanisms of anticaries action of fluoride Fluoride and dental caries 1. Increase in the enamels resistance to acid solubilityLozenge is much preferred than tablets or Enamel formed has more perfect and drops.larger crystals, less soluble in acid, and less 1. Dissolves slowly, produces bothlikely to develop caries. topical and systemic effects.Fluoride favors formation ofAdvantage: specific and precise dosagefluorapatite, a more acid Disadvantage: assurance of continuous resistant apatite than daily ingestion and cost is greater.hydroxyapatite. 1. Fluoride and dental caries Mechanisms of anticaries action of fluoride Prenatal Fluoride Supplement 2. RemineralizationFluorides supplements are not Greater concentration of fluoride released recommended for adults, especiallyfrom the dissolved enamel or already pregnant women, for reducing dental present on the plaque, the more will caries. remineralization be favored and carious 1. The concentration of fluorideprocess be slowed. that reaches the fetus is Use of topical fluoride raises the fluoride generally lower than that in thelevel of tooth surface and underlying maternal blood. tissues to a level expected to protect 2. Infants exposed will have higher against caries. plasma, skeletal and developing Mechanisms of anticaries action of fluoride enamel fluoride levels. 3. Antibacterial effects of fluoride Fluoride and dental caries Inhibition of enzymes essential to cell Fluoride Supplements (Infants and Children)metabolism and growth. Lower the surface energy of the tooth. Can strip off bacteria from hydroxyapatite. 4. Fluoride can bind more Deficiency in Vit. D- decreased calciumeffectively to positively chargedabsorptionareas on the apatite crystal than 4) Lactosecan the bacteria. The disaccharide lactose found Dental benefitsin milk promotes calcium Fluorosis of the deciduous teeth is rarely seen and is absorption.not a problem.Lactose in ileum change the First 2 to 3 years of life are the most critical period forintestinal bacteria lowering thethe development of mottled enamel on the pH thus increase calciumpermanent anterior teeth and for this reason only. absorption 0.25 mg/day is prescribed from birth until6) Citric acid2 years of age. 6) Its low pH promotes calcium Dental benefitsabsorption 0.5 mg/day from 2 to 3 years of age.7) Oxalic and phytic acid 1.0 mg/day from 3 until 13 years of age.8) Intake of foods rich in oxalic Use of fluoridated water or fluoride supplements assuch as spinach and phytic acidsearly as 1 year of age enhance the formation of thefound in cereal grain and mealrelatively caries resistant fluorapatite in the enamel flour causes formation ofsurface. insoluble complexes (calciumThank you salts) within intestinal lumen that leads to increased calcium absorption.CHAPTER 107) Fat6) Decreased fat, bile or salts The Macrominerals:produces insoluble calcium thus Calcium, Phosphorus increase calcium absorption. and Magnesium7) Emotional reactions Their Role in the Health of the Body and Especialy the 8) Stress may cause hormonal Oral Cavity changes that affects calcium metabolism11) Exercise CalciumWeight-bearing exercise helps maintain calcium in bone.Storage Functions calcium and phosphorus are stored in the trabeculae Provides rigidity and strength to the bones and teeth but can be withdrawn out when it is needed in the Functions (cont) blood Serum calcium performs specific functions: The blood and tissue calcium serve as reserves Contraction and relaxation of heart muscle.The degree of bone development amount of calcium Helps in blood clotting deposited in are directly related to the amount of the Low blood calcium will increase the irritability of calcium available from the diet. nervous tissue and may cause tetany. Excretion Activate enzymes such as pancreatic lipase andOut of the 100og dietary intake of calcium, 700 800galkaline phosphatase.are excreted in feces but it could be less than that Activates rennin which causes curding of milkwhen the dietary intake is low.during its digestionDuring lactation, mother loses 150 -300mg of calcium Necessary for the release of NTs daily but normally, it is not affected because of(neurotransmitters)human adaptability. Regulates transport of ions across cell Excess calcium from the bone are excreted in themembranesurine Absorption Unimportant daily lost of 15mg of calcium through Active processperspiration Reqiures Vitamin D and calcium-binding protein Regulation of calcium balance 20-30% of calcium is absorbed and the rest are Calcium in serum is regulated by the: excreted in the feces, urine and perspiration. Parathormone (PTH) Factors affecting absorption of Calcium Calcitonin 1.Needs of the body -serum calcium rises, PTH is Growing child, pregnant, a person healing frominhibiteda bone fracture- increased calcium absorption -serum calcium falls, secretion 2.Gastric acidity of PTH increases Acidity in the stomach converts the -serum calcium rises, calcitonininsoluble calcium salts into more solubleincreasestypes Role of Bone, Kidney, and Intestine 3.Hormonal influences Kidney can resorb calcium Parathormone and cacitonin Intestine - acidity Vitamin D 5. Bone activity of the osteoblast and Depression osteoclast. How?Tremors Vitamin D Convulsions Necessary for normal intestinal absorptionChronic Renal Failure: of calcium and helps maintain bone cells, Definition: thus regulating serum calcium and serum Slow loss of kidney function over time phosphate levels. Signs &amp; Symptoms: Recommended Dietary Allowance and Sources Appetite loss Avrage adult- 800mg Nausea Infants- 360-450mgHeadache 1-10 yrs.old 800mgWeight loss 11-18 yrs.old- 1200mg Chronic Alcoholism During lactation- 1200mgDefinition: *all dailyPrimary disease with genetic, psychosocial, and environmenta...</p>