Nutrition & Oral Health

Dr. Gábor Varga

Department of Oral Biology

2016

What did we learn last fall?

• GERD and GU lead to oral symptoms

such as: bad breath, enamel erosion,

discolored teeth, altered taste, heart burn,

bloating

• As long as the underlying conditions are

controlled and understood the prognosis

of oral treatment is good. Any dental

treatment is preceeded by treatment of

GU and GERD

Components of the diet

(draft of the lecture)

Macronutrients

• Proteins and amino acids

• Carbohydrates

• Fats and oils

• Water

Micronutrients

• Vitamins

• Minerals

• Non-nutrients

• Insoluble and soluble fibers

Smoking and alcohol consumption

Energy requirements

• The energy of consumed food that is

necessary for long term balance of body

weight and body composition, and also

covering all acivities.

• Constituents:

basic metabolic rate

+ energy to cover all activities

Flow-chart for energy metabolism

A Energy

uptake

Energy store

(adipose tissue)

Organism (biological and

psychological regulation)

Energy

utilization

Causes of obesity

Intermedier metabolism of nutrients

and mobile energy stores

Characteristics of macronutrients

RQ ENERGY

kJ/g ENERGY

kcal/g

PROTEIN 0,8 16,8 4,0

CARBO- HYDRATE 1,0 16,8 4,0

FAT 0,7 37,8 9,0

ENERGY-

EQUIVALENT kJ/l O2

18,8

21,1

19,6

ENERGY-

EQUIVALENT kcal/l O2

4,5

5,0

4,7

Proteins

11-13% of total energy necessity

Protein necessities

• The minimal necessary quantity of

proteins that keeps nitrogen balance

steady (1,0 g/kg b.w.).

• Under balanced conditions, the uptake

and loss of nitrogen is equal.

Reasons for protein deficiency

• quantitative deficiency

• qualitative deficiency

(shortage of essential aminoacids)

• shortage in energy uptake

Usually a combination: qualitative and quantitative

deficiency, and also vitamin and mineral deficiency

together:

Protein-energy undernutrition - PEU

Patients with marasmus

have balanced starvation

Kwashiorkor patients, also known

as sugar babies

Carbohydrates

50-60% of energy necessity

Balance of deminerilasation and

remineralisation

Harmful effects of high

carbohydrate diet in the oral cavity

• Dental caries

mainly sucrose, but other sugars and even

starch can feed bacteria

• Dental malocclusion

reduction of mandibular in size, and

functional inactivity of masticatory muscles

Fat

20-40% of total energy necessity

Function of fats

• Energy supply

• Nutrient store

• Carrier of vitamins (vit. A and D)

• Saturated vs unsaturated: Unsaturated fats are favourable Omega-3 fatty acids – from fish – are healthy

(fats are – from a viewpoint of cariology – cariostatic)

VITAMINS

Vitamin A

A1 – retinol

A2 - 3-dehidroretinol

carotinoids (A provitamins, e.g. β-carotin)

Vitamin A deficiency

• Epithel cell hyperplasia

• Keratinization of epithelium, mucosa, gingiva, salivary gland ducts

• Inactivation of osteoclasts –

thickening of bones

• Degeneration of ameloblasts

enamel hypoplasia

• Experimental withdrawal in rodents: dentin development disturbance calcification of parodontal ligaments

Effect of vitamin A deficiency in rats:

asymmetric and abnormal dentin formation

in the incisors

B vitamins metabolic intermediers, cofactors

B2, B3, B6, B12, folic acid, etc

Deficiency leads to deformation of the lip and oral mucosa

Crack of lip commisure – Cheilosis angularis

Atrophy of tongue papillas

Deficiency symptoms of B vitamins

(1)

• B2 Riboflavin

Cheilosis angularis, atrophy of filiform papillas,

enlarged fungiform papillas, shiny-red lips &

tongue, painful tongue

• B3 Niacin

Cheilosis angularis, mucositis, stomatitis, pain &

burning feeling in the mouth, glossitis, aching &

swollen tongue, flushed tip of tongue, smooth &

dry back of tongue, gingivitis ulcerosa

• B6 Pyridoxin

Cheilosis angularis, pain & burning in the mouth,

glossitis, painful tongue

Deficiency symptoms of B vitamins

(2)

• B12 Cyanocobalamin Cheilosis angularis, pain & burning in the mouth, mucositis, stomatitis, glossitis, gingiva bleeding, oral paresthesia (numbnedd & itching in the mouth), slower recovery of wounds, aphta-like ulcers

• Folic acid Cheilosis angularis, mucositis, stomatitis, pain & burning in the mouth, glossitis, increasing disposition for oral candidiasis, swollen tip and back of tongue, bare & pale back of tongue

Vitamin C

Deficiency:

Scurvy

Disturbancies in bone and tooth development

Collagen – three polypeptide chains forming a rope

Overview of collagen biosynthesis

Hydroxylation during collagen

biosynthesis

Stages in collagen synthesis - rope formation

Effects of

vitamin C

deficiency on

tooth and

bone

development

in guinea

pigs

Vitamin D

Regulation of bone metabolism

Control of calcium balance:

parathormone, calcitonin, vitamin D

Effect of active vitamin D on epithelial

cells enhanced calcium absorption

+

Osteomalacia - Osteoporosis

Normal bone Osteomalacia Osteoporosis

Ca Ca

matrix matrix matrix

Ca

Changes in proportion of mineral (Ca)

matrix and water/air phases

Vitamin D deficiency in the oral

cavity • Predentin widens, calcification time is elongated

• Dentin-predentin outline becomes irregular

• Enamel hipoplasia after long-term D vitamin

deficiency (debatable, further proofs needed)

- No significant change in tooth calcification,

because their calcification activity is stronger

than that of bones; and because there is no

remodeling in the dental minerals (vs. bone).

Vitamin K

Cofactor of thrombosis factor- and

Gla protein synthesis

Deficiency effects on bones &

teeth not known

Formation of γ-carboxyglutamyl residue

Structural basis interactions between mineral

phase and Gla protein osteocalcin (BGP)

Minerals

Calcium és phosphate

and

magnesium, iron;

trace elements: fluor as most important

Phosphate metabolism in a young adult

Calcium homeostasis

Intake

1000 mg

Intestine

Faeces

850mg

300 mg

125 mg 175 mg

900 mg

ECF calcium

10000 mg 9825 mg

175 mg Kidney

500 mg

Bone

meta-

bolism

No saliva

• Erosion of enamel

• No remineralisation Ca2+ and PO43-

Ca-binding proteins

proline-rich proteins

statherin

Composition - inorganic

Na +

6 - 80 mmol/L

Cl -

17 - 30 mmol/L

K +

20 - 30 mmol/L

Ca 1 - 2 mmol/L

P 2 - 23 mmol/L

HCO3+

2 - 80 mmol/L

Smoking and alcohol

consumption

Effects on the oral precancerous

and tumor formation

Oral

leukoplakia

Oral

carcinoma

Bánóczy 1977

Annual new cancer cases for both gender, Hung. National Cancer Register in 2001 (58

772 tumor, 51 136 beteg)

Lung 8827

Colorectal (colon & rectum) 7600

Skin 6379

Breast 5730

Lymphatic- and haemopoietic system 3034

Oral cancer 2993

Prostate 2304

Stomach 2175

Urinary bladder 2091

Kidney 1535

Pancreas 1466

Melanoma 1286

Order of cancer mortality in Hungary (KSH 1999-2000) (for both gender)

Cancer 1999 2000

Lung 7883 7824

Colorectal 4912 4910

Breast 2387 2356

Stomach 2306 2167

Lymphatic- and haemopoietic system 1997 1895

Oral cancer 1618 1688

Pancreas 1562 1546

Prostate 1387 1399

Liver 972 946

Oesophagus 923 843

Gall bladder 867 815

Urinary bladder 795 722

Brain 712 723

Sum 34 255 33 679

Growth dynamics of six malignant tumours with great mortality rate in 25 years (1975-1999)

Cancer

No. of cases

Incre- ment

% 1975 1999

Oral cancer 462 1618 250

Trachea-, bronchus-, lungcancer 4169 7883 89

Colon- and rectumcancer 3025 4912 62

Pancreas 1076 1562 45

Breast cancer 1650 2381 44

Prostate cancer 1196 1387 16

Mortality rate in Hungary from 1960

0

100

200

300

400

500

600

1960

1964

1968

1972

1976

1980

1984

1988

1992

1996

%

száj-garat

daganatok

összes daganat

összhalálozás

year

Oral- and

pharynx cancers

All cancers

Total mortality

The ratio of smokers in

leukoplakia patients

Author Year n Leukoplakia

%

Renstrup 1958 90 25.5

Bruszt 1962 130 Nearly100

Pindborg 1971 365 32.3 (cheroots)

Roed-Petersen 1973 450 7.1 (snuff)

Sonkodi 1974 51 82.3

Bánóczy 1991 104 86.5

Dombi 1996 167 97

The prevalence rate of oral

leukoplakia among smokers and

non-smokers Authors Year Non-

smokers

Smokers All examined

persons

n Lpl.

%

n Lpl.

%

n Lpl.

%

Pindborg 1967 6669 0.03 3301 9.9 10000 3.2

Mehta 1969 674 - 2851 7.3 3785 5.5

Roed-Petersen 1972 5530 0.2 4452 6.3 9982 2.9

Baric 1982 443 3.8 482 22.8 925 13.7

Rosabal-Lopez 1985 110 - 199 19.1 309 12.2

Bánóczy 1991 5410 0.26 2410 3.73 7820 1.3

Dombi 1996 2350 0.22 2684 6.03 5034 3.3

Blot et al. 1988

Summary

Macronutrients

• Proteins and amino acids

• Carbohydrates

• Fats and oils

• Water

Micronutrients

• Vitamins

• Minerals

• Non-nutrients

• Insoluble and soluble fibers

Smoking and alcohol consumption