Nutrition & Oral Health Dr. Gábor Varga

Transcription

1 Nutrition & Oral Health Dr. Gábor Varga Department of Oral Biology 2016

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5 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

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7 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

8 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

9 Flow-chart for energy metabolism Energy uptake A Organism (biological and psychological regulation) Energy utilization Energy store (adipose tissue)

10 Causes of obesity

11 Intermedier metabolism of nutrients and mobile energy stores

12 Characteristics of macronutrients RQ ENERGY kj/g ENERGY kcal/g ENERGY- EQUIVALENT kj/l O 2 ENERGY- EQUIVALENT kcal/l O 2 PROTEIN 0,8 16,8 4,0 CARBO- HYDRATE 1,0 16,8 4,0 FAT 0,7 37,8 9,0 18,8 21,1 19,6 4,5 5,0 4,7

13 Proteins 11-13% of total energy necessity

14 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.

15 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

16 Patients with marasmus have balanced starvation Kwashiorkor patients, also known as sugar babies

17 Carbohydrates 50-60% of energy necessity

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23 Balance of deminerilasation and remineralisation

24 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

25 Fat 20-40% of total energy necessity

26 Energy supply Nutrient store Function of fats 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)

27 VITAMINS Vitamin A A1 retinol A2-3-dehidroretinol carotinoids (A provitamins, e.g. β-carotin)

28 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

29 Effect of vitamin A deficiency in rats: asymmetric and abnormal dentin formation in the incisors

30 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

31 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

32 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

33 Vitamin C Deficiency: Scurvy Disturbancies in bone and tooth development

34 Collagen three polypeptide chains forming a rope

35 Overview of collagen biosynthesis

36 Hydroxylation during collagen biosynthesis

37 Stages in collagen synthesis - rope formation

38 Effects of vitamin C deficiency on tooth and bone development in guinea pigs

39 Vitamin D

40 Regulation of bone metabolism

41 Control of calcium balance: parathormone, calcitonin, vitamin D

42 Effect of active vitamin D on epithelial cells enhanced calcium absorption

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44 Osteomalacia - Osteoporosis Ca Ca Ca matrix matrix matrix Normal bone Osteomalacia Osteoporosis Changes in proportion of mineral (Ca) matrix and water/air phases

45 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).

46 Vitamin K Cofactor of thrombosis factor- and Gla protein synthesis Deficiency effects on bones & teeth not known

47 Formation of γ-carboxyglutamyl residue

48 Structural basis interactions between mineral phase and Gla protein osteocalcin (BGP)

49 Minerals Calcium és phosphate and magnesium, iron; trace elements: fluor as most important

50 Phosphate metabolism in a young adult

51 Calcium homeostasis Intake 1000 mg Intestine 300 mg 125 mg 175 mg 900 mg ECF calcium 500 mg Bone metabolism Faeces 850mg mg 9825 mg Kidney 175 mg

52 No saliva Erosion of enamel No remineralisation Ca 2+ and PO 4 3- Ca-binding proteins proline-rich proteins statherin

53 Composition - inorganic Na mmol/l Cl mmol/l K mmol/l Ca 1-2 mmol/l P 2-23 mmol/l + HCO mmol/l

54 Smoking and alcohol consumption Effects on the oral precancerous and tumor formation

55 Oral leukoplakia

56 Oral carcinoma

57 Bánóczy 1977

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

59 Order of cancer mortality in Hungary (KSH ) (for both gender) Cancer Lung Colorectal Breast Stomach Lymphatic- and haemopoietic system Oral cancer Pancreas Prostate Liver Oesophagus Gall bladder Urinary bladder Brain Sum

60 Growth dynamics of six malignant tumours with great mortality rate in 25 years ( ) No. of cases Cancer Increment % Oral cancer Trachea-, bronchus-, lungcancer Colon- and rectumcancer Pancreas Breast cancer Prostate cancer

61 % Mortality rate in Hungary from year Oral- száj-garat and daganatok összes All cancers daganat pharynx cancers összhalálozás Total mortality

62 The ratio of smokers in leukoplakia patients Author Year n Leukoplakia % Renstrup Bruszt Nearly100 Pindborg (cheroots) Roed-Petersen (snuff) Sonkodi Bánóczy Dombi

63 The prevalence rate of oral leukoplakia among smokers and non-smokers Authors Year Nonsmokers Smokers All examined persons n Lpl. % n Lpl. % n Lpl. % Pindborg Mehta Roed-Petersen Baric Rosabal-Lopez Bánóczy Dombi

64 Blot et al. 1988

65 Summary Macronutrients Proteins and amino acids Carbohydrates Fats and oils Water Micronutrients Vitamins Minerals Non-nutrients Insoluble and soluble fibers Smoking and alcohol consumption

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