By

Dr. Smitha B K
Post Graduate Student
Department of Preventive and
Community Dentistry
INTRODUCTION
 Everybody enjoy food. Although they eat primarily
because they are hungry, they also find eating pleasant because
the taste of the food is pleasing to them. Unfortunately many
people make their food selections only on those bases and are
not aware of their bodies’ nutritional needs.
Once foods have been eaten the body must process
them before they can be used. Nutrition is the result of the
processes whereby the body takes in and uses food for growth,
development and maintenance of health.
 DEFINITIONS
NUTRITION:
The science of how the body uses food to meet its
requirements for growth, development, repair and maintenance.
DIET:
The pattern of individual food intake, eating habits,
kinds and amounts of food eaten.
NUTRIENTS AND THEIR
FUNCTION
THE SIX ESSENTIAL NUTRIENTS AND THEIR
FUNCTIONS
ORGANIC NUTRIENTS FUNCTION
Carbohydrates Provide energy
Fats Provide energy
Proteins Build and repair body
tissues
Provide energy
Vitamins Regulate body processes
INORGANIC FUNCTION
NUTIENTS
Minerals Regulate body processes
Water Regulate body processes
MALNUTRITION
 Malnutrition merely means bad nutrition. The term is
usually used to describe the undernutrition seen in nutrient and
calorie deficiency.
Obesity is also a form of malnutrition.
Primary malnutrition results from inadequate food intake.
Secondary malnutrition occurs when there is interference
with adequate digestion, absorption and utilization of food.
 The development of a nutritional deficiency or toxicity is a
gradual and progressive process. Problems begin with
inappropriate food intake. This leads to decrease or increase in
the nutrients throughout the body. At some point, the deficiency
or excess impairs body functioning such as enzyme activity,
growth and development.
Finally in the most advanced stages there may be clinically
observable signs and symptoms and eventually leading to
death.
 NUTRITION IN THE GROWTH AND
DEVELOPMENT OF ORAL STRUCTURES
 EFFECTS OF NUTRITION ON ORAL
DEVELOPMENT AND CARIES RISK
The effects of diet adequacy on growth and development of oral
structures have been studied in both animals and humans.
Malnutrition has been related to decreased tooth size and a
delayed eruption sequence in mice.
According to Tinanoff and Palmer in children prenatal nutrition
and the health of the pregnant mother may have an important
impact on the child’s developmental mineralization and the
subsequent caries susceptibility of the child’s teeth.
Malnourished children have been shown to have retarded
maxillary growth and general delays in tooth development and
eruption in comparison to nutritionally normal children.
 EFFECTS OF SPECIFIC NUTRIENTS
VITAMINS
Vitamin C
Deficiency : Increased risk of infection
Increased periodontal signs and symptoms
Delayed wound healing
Red swollen gingiva
Petechiae
Sore burning mouth
Increased risk of candidiasis
Periodontal destruction
Soft tissue ulceration
Increased tooth mobility and exfoliation
Excess : Chronic overdosing can increase metabolism of
Vitamin C and rebound scurvy can occur.
Vitamin D
Deficiency : Abnormal bone regeneration
Osteoporosis
Osteomalacia
Incomplete calcification of teeth and alveolar
bone
Rickets
Excess : Pulp calcification and enamel hypoplasia
Vitamin K
Deficiency : Increased risk of bleeding and candidiasis
Vitamin A
Deficiency : Inadequate differentiation of cells leading to
impaired healing and tissue regeneration
Desquamation of oral mucosa
Increased risk of candidiasis
Gingival hypertrophy and inflammation
Leukoplakia
Xerostomia
Irregular tubular dentin formation
Increased caries risk
Excess : Impairment of cell differentiation and epithelialization
resulting in delayed and impaired healing of oral tissues
mimicking the signs and symptoms of deficiency.
Vitamin B Complex In General
Deficiency : Angular cheilosis of lips
Leukoplakia
Burning tongue
Papillary atrophy
Magenta tongue
Fissuring
Glossitis
B2 Riboflavin
Deficiency : Angular cheilosis
Atrophy of filiform papillae
Enlarged fungiform papillae
Shiny red lips
Magenta tongue
Sore tongue
B3 Niacin
Deficiency : Angular cheilosis
Mucositis
Stomatitis
Oral pain
Ulceration
Denuded tongue
Glossitis
Glossodynia
Ulcerative gingivitis
Folic Acid
Deficiency: Angular cheilosis
Mucositis
Stomatitis
Sore or burning mouth
Increased risk of candidiasis
Apthous ulcers.
B6 Pyridoxine
Deficiency : Angular cheilosis
Sore or burning mouth
Glossitis
Glossodynia.
B12 Cyanocobalamin
Deficiency: Angular cheilosis;
Mucositis;
Stomatitis;
Sore or burning mouth;
Hemorrhage gingiva;
Halitosis;
Epithelial dysplasia of oral mucosa;
Oral Paresthesia;
Detachment of periodontal fibres;
Loss or distortion of taste
glossitis oral pain;
ulceration;
ulcerative gingivitis;
denuded tongue;
glossodynia
tongue is "beefy", red, smooth & glossy;
delayed wound healing;
xerostomia
bone loss;
apthous ulcers
MINERALS
Fluoride
Deficiency : Decreased resistance to caries
Excess: Disturbed amelogenesis;
mottled/stained enamel;
enamel hypoplasia (fluorosis)
Iron
Deficiency: Angular cheilosis;
pallor of lips and oral mucosa;
sore, burning tongue;
atrophy/denudation of filliform papillae;
increased risk of candidiasis;
glossitis.
Calcium
Deficiency: Incomplete mineralisation of teeth;
rickets;
osteomalacia;
osteoporosis;
excessive bone resorption & bone fragility;
increased tendency to hemorrhage;
increased tooth mobility & premature loss.
Thinning of cortical plate
Copper
Deficiency: Decreased trabeculae of alveolar bone;
decreased tissue vascularity;
increased tissue fragility
Zinc
Deficiency: Loss or distortion of taste & smell acuity;
loss of tongue sensation;
delayed wound healing;
impaired keratinisation of epithelial cells;
epithelial thickening;
atrophic oral mucosa,
increased susceptibility to periodontal disease,
candidiasis,
xerostomia & caries if deficient during tooth
formation.
Magnesium
Deficiency: Alveolar bone fragility;
gingival hypertrophy
Phosphorus
Deficiency: Incomplete mineralisation of teeth;
increased susceptibility to caries if deficient during
tooth formation;
increased susceptibility to periodontal disease due
to effects on alveolar bone
OTHER NUTRIENTS
Carbohydrate
Deficiency: Caries rate generally decreases when carbohydrate
intakes decreases
Excess: Increased frequency of intake of all carbohydrates
(except fibre) is a causative risk factor for caries
Proteins
Deficiency : Defects in composition, eruption pattern and
resistance to decay during periods of tooth development
Increased susceptibility to infections
Poor healing
Water
Deficiency : Dehydration and fragility of epithelial tissue
Decreased muscle strength for chewing
Xerostomia
Burning tongue

Ref: Modern Nutrition in Health and Disease (9th ed) Editors:

Shils; Olsen; Shike & Ross. Published by Williams & Wilkins
DIET AND DENTAL CARIES
 A number of classic studies in human specific
population have shown a clear relationship between sucrose
consumption and caries prevalence and incidence.
These include Vipeholm study, Hopewood House study, and the
Turku sugar study.
The Vipeholm study remains the most influential study of diet
and dental caries to date.
VIPEHOLM STUDY
This prospective study was conducted in Sweden between 1945
and 1953 with 436 patients at the Vipeholm Hospital.
The objective was to determine the effect on caries activity on
of the consumption of either a retentive or non-retentive
carbohydrate with or between meals.
They also received the same total daily amount of supplemental
carbohydrate but in different forms.
The conclusions were as follows:
Increased frequency of sugar consumption results in increased
caries incidence.
The increase is greater when sugar is consumed in a retentive
form, particularly between meals.
The total amount of sugar consumed is not critical when
consumed at mealtimes.
Even under uniform experimental conditions,caries activity
shows wide interpersonal variation.
Withdrawal of a caries promoting agent from the diet causes
caries activity to drop, although new lesions may continue to
develop despite severe dietary restriction of carbohydrate.
This study showed “not only the quantity of sugar
consumed but also the form in that it is served and whether it is
consumed at meals or between meals” are the important factors
HOPEWOOD HOUSE STUDY
This was conducted in New South Wales over a 15 year period,
compared 52 children who followed a regimented
lactovegetarian diet devoid of refined carbohydrate and rich in
uncooked vegetables(Hopewood Group) with children who
followed a more refined diet.
Neither group practiced adequate oral hygiene nor had
significant dental care,but the Hopewood group had significantly
lower caries incidence.
These findings concur with the Vipeholm study conclusion that
caries incidence is related to the form of carbohydrate
consumed.
THE TURKU SUGAR STUDY
This was conducted in Finland in the early 1970s.
A total of 125 subjects divided into 3 groups received all
sweetened food items with sucrose,fructose or xylitol.
After 1 year caries development in the xylitol group was
insignificant compared with the other groups.
There was no significant difference between the sucrose and
fructose group initially but the sucrose group had significantly
more caries than the fructose group after 2 years.
NON OR LOW ACIDOGENIC(From
ACIDOGENIC lesser to greater)
Raw vegetables e.g: Cooked vegetables
broccoli, Fresh fruits
cauliflower,carrot Fruit juices
Meat,poultry,fish Sweetened beverages
Nuts,natural peanut Nondairy creamers
butter
Ice cream,pudding,
Milk,cheeses
Gelatin
Flavored yogurts
Bread,rice,pasta,
Corn chips
French fries
Peanuts
Candy
Popcorn
Bananas,dried fruits
Fats,oils,butter
Mints and candies
Non-sugar sweeteners
NUTRITION AND THE PERIODONTIUM
NUTRIENT FUNCTIONAL
CHANGES RESULTING
DUE TO DEFICIENCY
Protein Antibacterial properties
of saliva are
compromised
Decreased neutrophil
function
Decreased collagen
synthesis
Vitamin A Decreased collagen
synthesis
Decreased
epithelialization
Decreased production of
gamma interferon
NUTRIENT FUNCTIONAL
CHANGES RESULTING
DUE TO DEFICIENCY
Vitamin B Complex Decreased protein
synthesis

Vitamin C Decreased neutrophil

function
Decreased collagen
synthesis
Vitamin D Impaired absorption of
calcium
NUTRIENT FUNCTIONAL
CHANGES RESULTING
DUE TO DEFICIENCY
Vitamin E Decreased overall
immune response
Decreased antibody
production
Vitamin K Decreased bone density

Calcium Inadequate formation of

bone mass
Osteoporosis
Iron Decreased neutrophil
phagocyte activity
Decreased proliferation
of lymphocytes
NUTRIENT FUNCTIONAL
CHANGES RESULTING
DUE TO DEFICIENCY
Copper Increased bone fragility
Decreased proliferation
of neutrophils

Zinc Increased susceptibility

to infection
Decreased protein
synthesis
COMMUNITY NUTRITION RESOURCES
FOR WOMEN AND CHILDREN
RESOURCE ELIGIBILITY BENEFITS WHERE TO
CALL

Special Low income Nutrition City or Country

supplemental pregnant and assessment health
food program breast feeding Nutrition department
for women, women and education Community
infants and children who action agency
children are at risk for
poor nutrition

Commodity Pregnant, Nutrition Food and

supplemental postpartum and education nutrition
food program breast feeding Supplemental services
women and foods State agencies
children(6 years Indian tribes
old)
RESOURCE ELIGIBILITY BENEFITS WHERE TO
CALL

School Lunch All eligible school Nutritious lunch Local school

Program children Education about district
nutritious food
habits
School Milk Children at Milk Local school
Program school not district
participating in
school lunch
program
Child care Food Children in care Cash Food and
Program centers reimbursements Nutrition service
Commodities State educational
agencies