Diseases of trace elements and 1

diseases
of proteins, amino acid
metabolism

Name -RAHUL KUMAR

YADAV
Roll no. - 19
BDS 2nd YEAR
ORAL PATHOLOGY
 OBJECTIVES 2

* Trace elements
- Types
- Sources
- Requirements
- Related disorders
- Treatment
* Protein and Amino acid
- Metabolism and it’s defects
 TRACE ELEMENTS 3

A trace element, also

called minor element, is
a chemical element
whose concentration is very
low (a "trace amount")
* Measured in micro/milligrams
COMPOSITION OF ELEMENTS 4
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IMPORTANCE

• Essential in the energy metabolism

• Important for normal growth and

development

• Building blocks of hundreds of enzymes

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IODINE
* Iodine is an essential element for life
* Heaviest element commonly needed by
living organisms
Dietary Intake
RDA for adults = 150 micrograms/day
RDA for pregnant/breastfeed woman = 200 micrograms /day

Sources
* Sea food * Seaweed
* Eggs * Oysters
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Clinical Manifestations
Oral manifestations 10
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Treatment :-

HYPOTHYROIDISM HYPERTHYROIDISM
Removal of most of the
Use of iodized salt in part of throid
diet gland(thyroidectomy)

Replacement of thyroid Introduction of

hormone radioactive iodine and
(levothyroxine) anti-thyroid medicine
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copper
* Copper is the third most abundant trace
element in the human body
Dietary Intake
• RDA for adults = 2-2.5 mg/day
• RDA for children and infants = 0.7 mg/day.

Sources
* Sea food * Fruits and Vegetables
* Meat * Beans
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Clinical Manifestations 14
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Treatment
• Wilson's disease is typically treated with dietary changes and medication.
• Dietary changes involve eating a low-copper diet and not using copper
cookware.
• Medications used include chelating agents such as trientine and d-
penicillamine and zinc supplements.
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Treatment of wilson

.
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Treatment

• There is no cure for Menkes disease.

• Early treatment with injections of copper supplements (acetate or
glycinate) may be of some slight benefit.
• Among 12 newborns who were diagnosed with MNK, 92% were alive at age
4-6.
• Other treatment is symptomatic and supportive.
 IRON 18

Iron is one of the most essential trace element

in the body

Dietary intake RDA for

adults = 10-20 mg/day
RDA for children = 10-15 mg/day

Sources
* Spinach * Kale
* Sesame seeds * Kidney beans
* Sunflower seeds * Black beans
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Absorption 20
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Clinical Manifestations
• Plummer-Vinson syndrome
is defined by the classic triad of
dysphagia, iron-deficiency
anemia and esophageal webs.

• The disease is very rare and

genetic
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•
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Oral Manifestations

• Atrophic glossitis
• Angular chelitis
• Burning sensation
• Recurrent apthous ulcer

Treatment
Introduction of iron suppliments
through diet and tablets in iron
deficiency anemia
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zINC
* Second most abundant trace element
Dietary Intake
RDA for adults = 15-20 mg/day

Sources
* Legumes * Dark Chocolates
* Sweet potato * Dairy products
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Clinical conditions

Acrodermatitis enteropathica
(AE) is an autosomal recessive
condition resulting in severe zinc
deficiency. The deficiency is caused
by a defect of dietary zinc absorption
in the duodenum and jejunum.

Symptoms
Alopecia
Diarrhea
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Oral Manifestation

• Xerstomia
• Oral ulcer
• Glossitis

• Treatment
• Zinc suppliments are given
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MANGANESE

Manganese is an essential element which is widely

distributed in crust of
the earth.

Dietary intake
RDA for adults = 1.8-2.3 mg/day
 Functions 29

• Manganese helps the body to form

connective tissue, bones, blood clotting
factors, and sex hormones.

It also plays a role in fat and carbohydrate

metabolism, calcium absorption, and blood
sugar regulation.
 Clinical conditions 30

• Treatment – Introduction of manganese suppliments

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COBALT

Cobalt is an constituent and an integral part of

vitamin B12

Sources
Sea food, meat and diary products

Dietary intake
RDA for adults = 5-8 micrograms/day
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Functions
* Formation of cobamide enzyme
* Required to maintain normal bone marrow
function and maturation of RBCs

Clinical features
Cobalt deficiency leads to Pernicious anemia

Symptoms
Numbness
Tiredness(fatigue)
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Oral Manifestation
• Mucosal pallor
• Angular cheilitis
• Burning tongue
• Loss of papillae on dorsum of
tongue

• Treatment-Pernicious
anemia usually is easy to
treat with vitamin B12
shots or pills
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CHROMIUM

• Chromium was first identified as a necessary dietary

• ingredient for normal glucose metabolism of rats

• Dietary intake
• RDA for adults = 25-35 micrograms/day

• Sources
• Grapes juice, orange juice, apples
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Functions

• Chromium is important in the breakdown of fats and carbohydrates.

• It stimulates fatty acid and cholesterol synthesis.
Chromium also aids in insulin action and glucose breakdown.

Clinical
Symptoms of chromium deficiency may include weight loss, confusion,
impaired coordination, and a reduced response to sugar (glucose) in
blood, increasing the risk of diabetes.
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SELENIUM

First reported when it was described to prevent liver cell necrosis

Dietary intake for adults = 55 micrograms/day

Sources- Mushroom, brazil nuts, chicken

Functions-
* Selenium is incorporated in the enzyme Glutathione peroxidase
(GTH-Px), that plays important role in normal immune system
function

* Vitamin-E also catalyses the activity of GTH-Px

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Clinical conditions

Deficiency include:
Liver cell necrosis, pancreatic degeneration,
Muscular dystrophies
Treatment- Selenium suppliments are given

Toxicity include:
Nausea, vomiting, loss of hair, fatigue,
irritability
Treatment- No specific treatment
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FLUORIDE

Fluoride is an ionic form of fluorine

Dietary intake
RDA for adults = 2.9-3.4 mg/day

Sources
Fluoridated water
Tea
Sea food
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Maintenance of oral health

• Fluoride prevents tooth decay by making the enamel more resistant
to the action of acids.
• They can accelerate the buildup of healthy minerals in the enamel, further
slowing the occurrence of decay.

Dental fluorosis
Dental fluorosis is a common disorder, characterized
by hypomineralization of tooth enamel caused by ingestion of excessive
fluoride during enamel formation.
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Causes
Ingestion of fluoride toothpaste
making food with fluoridated
water
Use of fluoride tablets
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Treatment
No specific treatment required
METABOLIC DISTURBANCE OF PROTEINS 41

• PROTEIN ENERGY MALNUTRITION(PEM)

• PEM is a spectrum of diseases .
• Most affected countries are South East Asia, Africa,
• Carribean Islands and South and Central America

Causes of PEM
- Dietary deficiency - Serious illness
- Low socio-economic status - Infection in babies
- Indequate breast feeding
by mother
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KWASHIORKOR SYMPTOMS

It’s a maladaptive response to starvation

due to lack of physiological adaptation
to unbalance where body which utilizes
proteins and conserve fat.

Occurence- Seen between 1-5 years of age

Cause-
Lack of protein in diet
Use of of formula milk
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Oral manifestations

• Bright reddening of tongue

• Fissuring of lips
• Mouth is dry, dirty and easily traumatized epithelium

• Treatment
• Provide adequate nutrition with
dietary suppliments

Prevention
Public health program should be
promoted
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MARASMUS

Maladaptive response to starvation

Occurrence : seen mostly in 1st year

Causes
Due to lack of both proteins and calories

Biological manifestations
Immune deficiency anemia
Multi vitamin deficiency
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Oral Manifestation

• Cracked and red lips

• Oral ulcers
• Delayed tooth eruption

• Treatment
• Introduction of nutrious diet

• Prevention
• Breastfeeding for atleast 6 months
is necessary
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AMYLOIDOSIS
Disorder characterized by extracellular deposition of
fibrillar insoluble proteinaceous substance called amyloid.
Amyloid
Aggregation of abnormal misfolded proteins.
Amyloid is insoluble and is structurally dominated by β-sheet structure.

Most Common Forms

AL(Primary) ATTR
AA(Secondary) Aβ2-microglobulin
Aβ-peptide
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 CLASSIFICATION
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•
• SYSTEMIC
* (AL protein accumulation)
reactive systemic amy(AA PROTEIN)

Familial mediterranian fever(AA protein)

Senile Amy (ATTR protein)

LOCALIZED
Senile cardiac (ATTR protein)
Clinical manifestation 49

Multiple myeloma
Primary Amyloidosis
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ORAL MANIFESTATION

• Macroglossia
• Dry mouth(xerostomia)
• Xeropthalmia
• Localised amy in gingiva
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PORPHYRIA
• Porphyria are the metabolic disorders of haem synthesis, characterized
by increased excretion of porphyrin or other prophyrin precursor

• Either inherited or acquired

• Most common acquired form of porphyria is due to lead poisoning

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ERYTHROPOIETIC PORPHYRIA
•
Congenital erythropoietic porphyria is inherited as an autosomal recessive
genetic condition.
• It is a rare disorder
• It is also known as Gunther’s disease

• Cause
• Enzyme defect – uroporphyrinogen III cosynthase
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Clinical manifestation
• Excretion of red urine due to uroporphyrin(first
sign in infants)

• Severe photosensitivity in early childhood

• Bullous euption appears on face and back of

hand
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Oral Manifestation

• Reddish brown discolouration of teeth

called as erythrodontia

• Treatment
• No such treatment available for CEP
1) A 3 year old girl child was brought to the pediatric
department with chief complaints of failure to thrive,
diarrhoea and respiratory tract infection , on
examination there is bilateral pitting edema on ankle
and knee joint , moon face and sparse hair.

Child is suffering from which disease ?

ANSWER :- KWASHIORKOR
2) Plummer-Vinson Syndrome is associated
with deficiency of which element ?
ANSWER:- IRON
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