CONTENTS

Introduction Terminologies Functions of food Energy needs of the body Nutrients classification Classification of foods Carbohydrates Proteins Lipids Vitamins Minerals Water Healthy eating habits

CONTENTS
Dietary guidelines by age Nutritional risk assessment Disordered eating Conclusion

DEFINITIONS
NUTRITION:

NIZEL: the science which deals with the study of nutrients and foods and their effects on the nature and function of the organism under different conditions of age, health and disease.

 DIET

Total customary allowance of food and drink taken by any person day to day.

 Nutrients
 Functions :  Energy needed for body is measured in calories -1food calorie = 1 kilo calorie  It is the amount of energy required to raise the temperature of 1000gm of water through 1degree c

FUNCTIONS OF THE FOOD

PHYSIOLOGICAL FUNCTION SOCIAL FUNCTION PSYCHOLOGICAL FUNCTION
PHYSIOLOGICAL FUNCTION:

ENERGY NEEDS OF THE BODY

 Basal metabolism  Energy for physical activity  Energy used for body heat  Specific dynamic action of food (SDA)

CALORIES AND ENERGY

CHEMICAL for chemical reactions in body MECHANICAL for physical activity ELECTRICAL for neural transmission THERMAL for metabolic processes

BASAL METABOLIC RATE Basal metabolic rate (BMR) the number of calories expended by the organism per square meter of body surface per hour (kcal/m2/hr).

NORMAL BMR VALUES

Age in years 5 10 15 20 30 40 50 60 Male (kcal) 53 49 46 41 39 38 37 35 Female (kcal) 51 46 40 36 36 36 34 33

 SOCIAL FUNCTIONS OF FOOD:

Social rapport. Is an integral part.

PSYCHOLOGICAL FUNCTIONS OF FOOD:

Satisfies of certain emotional needs. Used to express feelings:
a) Token of friendship b) Serving of favorite foods - expression of special attention. c) Withholding of wanted foods - punishment.

Nutrients classification
Classification : 1) Macronutrients ; proteins, CHO, fats 2) Micronutrients ; vitamins & minerals

BALANCED DIET

 Def : Diet consisting of variety of food in such quantities & proportions that the need for carbohydrates, proteins, fats is adequately met for maintaining health, vitality & general well being along with a small provision for extra nutrients like vitamins & minerals.

 Need for balanced diet :  It delay & minimize degenerative changes & medical problems such as diabetes, hypertension & atherosclerosis as well as dental problems  It is prerequisite for specific therapy to have an optimal effect

CARBOHYDRATES
Latin word C,H,O Main source of energy 4kcal/1gm Oxidation.. Contributes to structural elements of body..

CARBOHYDRATES

CARBOHYDRATES
SIMPLES SUGARS
Monosaccharides Disaccharides

COMPLEX SUGARS
starch
amylopectin amylose soluble

fibers
insoluble

Oligosaccharides

3 main sources : 1)Starch, 2)Sugar, 3)Cellulose

ROLE IN DENTAL CARIES

Vipeholm study
7 groups Contol group A sucrose group A bread group A chocolate group A caramel group A 8 toffee group A 24 toffee group

Hopewood house study

(sullivan-Harris)

Turku sugar studies Scheinin-Makinen

PROTEINS
Protein means Mulder in 1840 Complex organic nitogenous compounds 20% Made of smaller units Two forms Both are required for synthesis of tissue proteins A protein is complete if it contains all the Essential Amino Acids Animal proteins-complete Soy-

Nonessential AAs Arginine Asparginic acid Serine Glutamic acid Proline Glycine

FUNCTIONS:
1. 2. 3. 4. 5. 6. GROWTH, REPAIR AND MAINTENANCE. Essential component of enzymes and hormones Transport molecules (eg; hemoglobin) & antibodies Source of energy Regulators of fluid & acid-base balance Maintenance of osmotic pressure

Sources
Requirement 1g/kg

NITROGEN BALANCE
Nitrogen Balance Negative Nitrogen Balance Depends on amount and proportion of essential amino acids and total nitrogen intake

 NET PROTEIN UTILISATION = nitrogen retained X 100 nitrogen intake Grades of malnutrition :< 3.5 g/dl.severe 3.5 g/dlmild > 3.5 .adequate

PROTEIN ENERGY MALNUTRITION

PEM in young children
Inadequacy of food (both quantitative & qualitative) Frequent infections, neglect or lack of proper care Assessment of subclinical PEM wt-for-age ht- for-age Clinical presentation of severe PEM may be either Kwashiorkor Marasmus Marasmic kwashiorkor

KWASHIORKOR:
the sickness of the older child when the next baby is born 2nd year Adequate in calories but deficient in protein Growth retardation Edema Mental apathy Wasting of muscles but preserved adipose tissues flaky-paint skin rash or crazy-paving dermatosis Distended abdomen and enlarged liver Hair-sparse and depigmented Diarrhoea, hypothermia, bradycardia and hypotension Low serum albumin

FLAKY PAINT SKIN RASH

ORAL SYMPTOMS:
Tongue is bright & red with loss of papillae Bilateral angular cheilosis Fissuring of lips Loss of circum oral pigmentation Decreased growth of jaws

MARASMUS:
Greek word marasmos Both protein and calorie deficiency Occurs in children less than 1 year Gross muscle and subcutaneous fat wasting. ABSENCE OF EDEMA Withdrawn and apathetic Skinfold thickness and mid-arm circumference markedly reduced. The marasmic infant lives on his own meat

Two phases

PROTEIN NUTRITION IN ORAL HEALTH AND DISEASE

During tooth development mild to moderate protien deficiency Diminished salivary flow Poor nutrition results in delayed eruption & delayed exfoliation of deciduous teeth Increased rate of caries Also epithelium, connective tissue & bone may be poorly developed PEM may be a major reason for the increased incidence of noma & NUG

LIPIDS
Fats & oil C,H,O CLASSIFICATION Saturated, eg; palmitic & stearic acids unsaturated Monounsaturated, eg; oleic acid Polyunsaturated, eg; linoleic, linolenic, arachidonic acids
Saturated fatty acids contain only single bonds, with each carbon atom having 2 hydrogen atoms attached to it PUFA has two or more double bonds (poly unsaturated fatty acids) On hydrolysis fatty acids yield fatty acids & glycerol

 FUNCTIONS: Excellent source of energy Inflammatory mediators. Provide essential fatty acids fat soluble vitamins. Maintain body temperature Cushioning mechanism against injury Pleasant flavor and consistency to food Sense of fullness and satisfaction

Based on chemical structure classified as; Monoglycerides = glycerol + one fatty acid Diglycerides Triglycerides

Cholesterol ; is a fatlike, waxy substance classified as a sterol, with a complex ring structure

Dietary fats & dental health

Important for initiation of calcification and mineralization of teeth.

Dental caries: anticariogenic effect Local rather than systemic influence Form coating on tooth & prevent acid penetration
Oleic acid are growth factors for lactic acid bacteria, whereas streptococcal organisms are inhibited by lauric acid Long chain fatty acids may reduce dissolution of hydroxyapatite by acids

VITAMINS

Vitamins are a group of essential nutrients required in very minute amounts to participate & regulate chemical reactions Catalysts Available in active & inactive form

CLASSIFICATION
FAT SOLUBLE:
Vitamin A Vitamin D Vitamin E Vitamin K

WATER SOLUBLE:
Vitamin B complex Vitamin C

 Food placed in the pyramid is according to the importance in ones diet Food groups placed at same level indicate the same nutritive value Food at one level cannot be interchanged with food at other level. Food pyramids differ for vegetarian & non vegetarian diet. Lowest group CHO occupy major share in a persons diet wheras the top most group of fats occupy the least n should be used sparingly

VITAMIN A
FUNCTIONS: Formation of visual purple Formation and maturation of epithelia Promotion of bone remodeling Oral health integrity RDA: Infant- 350microgm Children-400microgm Excessive intake hypercarotenosis

DEFICIENCY
Night blindness Xerophthalmia Keratomalacia Follicular hyperkeratosis Goose Flesh Ceasation of endochondral bone formation

 ORAL MUCOUS MEMBRANE: epithelial metaplasia, hyperkeratinization SALIVARY GLANDS: atrophy, reduction in salivary flow TEETH:
Severe deficiency may result in enamel hypoplasia, defective dentin formation Post eruptive Vit A def - caries scores

MANAGEMENT: 30,000 IU orally/ day

VITAMIN D
E. Mccollum 1922 Skin cells Vit D2 Vit D3

FUNCTION:
Ca2+ & PO4-2 absorption.

- Mineralization of bones & teeth, regulation of blood calcium & phosphorus levels

RDA: adults 2.5 microgm infants & children 5.0 mcg

Deficiency

Bowing of legs

Pigeons chest

Pot belly

Scoliosis..bending of spine

TEETH : Enamel hypoplasia In dentin spaces that represent uncalcified dentin matrix occur Calciotraumatic line in dentin ALVEOLAR BONE: Loss of lamina dura Reduced density of supporting bone Loss of trabeculae MANAGEMENT: 1000-5000 IU orally/day

VITAMIN E (TOCOPHEROL)
Tocopherols & tocotrienols

Physiological functions Fat soluble Anti-oxidant Protects integrity of cell membranes, prevents hemolysis of RBCs Protects vitA & C from oxidation Deficiency May occur in Premature infants & malabsorption syndromes & results in anemia & nervous degeneration MANAGEMENT: 300 IU/ day

VITAMIN K
3 forms phylloquinone, menaquinone, menadione FUNCTION: Catalyze synthesis of prothrombin by liver Essential for production of VII, IX and X clotting factors

RDA : 120 microgm DEFICIENCY : Gingival bleeding MANAGEMENT: 1-2 mg after birth 2-5 mg orally/ day

VITAMIN B COMPLEX
THIAMINE (VITAMIN B1) RIBOFLAVIN (VITAMIN B2) NIACIN (VITAMIN B3) PYRIDOXINE (VITAMIN B6) PANTOTHENIC ACID BIOTIN FOLIC ACID COBALAMIN (VITAMIN B12)

THIAMINE
R.R.Williams in 1936 Related to neural transmission RDA: 0.5 mg/1000 kcal
Deficiency

Beri-beri
Wet Dry
Paresthesia Wt loss weakness

Infantile
Dyspnea Cyanosis Cardiac failure

Edema

Oral manifestations: Hyperesthesia of oral mucosa Burning tongue Loss of taste Management: 5-10 mg/ day thiamine

RIBOFLAVIN
R.Kuhn in 1933
CELLULAR RESP. RDA: 0.7 mg DEFICIENCY: Dysphagia Cheilosis Angular stomatitis Tongue appears purplish red or magenta, relatively clean often surface is deeply fissured. If papilla are swollen- pebbled appearance of tongue Characteristic eye & skin changes

NIACIN
Crucial as a coenzyme. Essential for growth of cariogenic oral micro-organisms RDA ; 8mg

Deficiency
Degeneration of skin, GIT, nervous system PELLAGRA symptoms - 3 Ds

Mucous membrane

Large beefy-red tongue Fiery red and painful oral mucosa Profuse salivation Acute necrotizing ulcerative gingivits Dysphagia Management: 50-300 mg orally- 2weeks

PYRIDOXINE
Coenzyme in fat & protein metabolism Conversion of tryptphan to niacin Hemoglobin synthesis Energy production from glycogen

RDA: 0.9 mg DEFICIENCY:

Microcytic hypochromic anemia Growth retardation Diarrhea Peripheral neuropathy

ORAL MANIFESTATION: Cheilosis Glossitis Stomatitis Seborrheic dermatitis in nasolabial folds MANAGEMENT: 5mg IM

BIOTIN
Co enzyme in the synthesis of DNA. RDA: 100 microgm DEFICIENCY:
Lassitude Anorexia Depression Dermatitis Glossitis

MANAGEMENT: injection of 0.15-0.3 mg/ day

FOLIC ACID
Coenzyme DNA, RNA, Blood cells RDA: 40 microgm DEFICIENCY: Macrocytic anemia. Neural tube defects. ORAL MANIFESTATIONS: Glossitis Burning sensation of oral mucosa & tongue Angular cheilitis and gingivitis MANAGEMENT: 30 mcg infants

COBALAMIN (vit B12)

Represents complex group of compounds that contain cobalt Essential for making RBCs & myelin synthesis RDA:0.2- 1 microgm

DEFICIENCY:
Rarely caused by insufficient dietary sources Lack of intrinsic factor ORAL MANIFESTATIONS: Glossitis Glossodynia Glossopyrosis Slick denuded tongue MANAGEMENT: 1-3 microgm/ day

VITAMIN C
Anti-oxidant RDA ; 90mg Daily for adults 45-50mg daily for children Deficiency scurvy Spontaneous gingival hemorrhaging, petechia.

Delayed wound healing

SCORBUTIC ROSARY

Oral signs
Enlargement of marginal gingivae that envelops & almost completely conceals teeth Inadequate amounts during tooth development result in scorbutic changes in the teeth Enamel hypoplasia Dentine is irregularly laid down with irregularly arranged tubules. Involve those teeth that form within 1st yr of birth

MANAGEMENT: 50-100 mgms four times/ day

MINERALS
3 main groups Major minerals- Ca, P, Na, Mg, Cl, S 100mg/day Minor minerals- Fe, I, Cu, Zn, Co, etc less than 100mg/day Trace elements- Pb, Cd, Ba, Bo, Al etc

 FUNCTIONS:
Structural components for the body Nerve and muscle function Blood clotting Tissue growth and repair Acid- base balance of body fluids Cofactors for enzymes in chemical reaction within the body

CALCIUM
SOURCES: Milk & milk products Eggs ABSORPTION: principally upper part jejunum Other parts of the intestine as well.

DEFICIENCY: Incomplete mineralization of teeth Osteoporosis Excessive bone resorption and bone fragility Increased tendency to haemorrhage Increased tooth mobility Premature tooth loss

PEAK BONE MASS

FLUORIDE
FUNCTIONS: Incorporated into tooth structure Aids in resistance to caries Excess: Disturbed amelogenesis Mottled enamel

zinc
RDA:10-12mg. FUNCTIONS:
Integral part of many enzymes. Wound healing. Growth of all tissues. RNA & DNA synthesis.

SOURCES:
Foods rich in protein

DEFFICENCY:
Delayed wound healing. Retarded growth and sexual development. Loss of taste.

TRACE ELEMENTS AND CARIES

EFFECT CARIOSTATIC MILDLY CARIOSTATIC DOUBTFUL CARIES INERT CARIES PROMOTING MINERAL F, P Mo, V, Cu, Sr, B, Li, Au, Fe Co, Mn, Sn, Zn, Br, I Ba, Al, Ni, Pd, Ti Se, Mg, Cd, Pt, Pb, Si

WATER
Vital nutrient , Varies from-50-60%. 2 main compartmentsExtracellular , intracellular.

FUNCTIONS: Electrolyte balance. Metabolic reaction. Solvent. Stability Vehicle to transport. temp regulation. Lubricant in digestion

WATER REQURIMENT: Based on body size Determined by- per kg body wt.

Age in yrs
Infants Children Adolescents Adults Birth- 1yr 1-10 11-18 19-51

Water (ml/kg body wt

100-120 60-80 41-55 20-30

HOW ????

do u keep yourself healthy

FOLLOWING THE FOOD GUIDE PYRAMID. HEALTHY EATING HABITS. GOOD FOOD CHOICES.

FOOD GUIDE PYRAMID

DIETARY GUIDELINES BY AGE

AGE TEXTURE NUTRIENT S
Energy dense recomended dietary intake -

FOODS

MEAL PATTER NOTES N

On demand
Human milk can be supplemented with iron & vitD

0-6mts

liquid

Human milk Infant formula Home prepared food Toddlers formula Table foods Food guide pyramid.

6mts1y 1-2y

Liquid Transition mashed food Chopped table food Avoid foods presenting Chocking hazards

Initiate structured meals -

Introduce cup

Sources of iron

Transition to cup

2-5y

Reduce fat intake

6-12y

30% energy from fat -

Refusing milk require Ca & vitD

>12y

GUIDELINES FOR INDIANS

Aim for healthy weight Be physically active each day Let the food pyramid guide your food choices Choose a variety of grains daily, especially whole grains Choose variety of fruits & veg daily Keep food safe to eat Choose diet low in fat & cholesterol & moderate in total fat Choose beverages & foods to moderate your intakes of sugars Choose & prepare food with less salt If you drink alcoholic beverages, do so in moderation

Good food choices & dietary habits Structured meals

3 meals and 3 snacks. Meal environment

Skipping meals Snacking Drinking. Subconscious eating.

NUTRITIONAL RISK ASSESSMENT

 Pts complaints & medical & social histories.  Dietary history & evaluations  Physical examination- anthropometric measurements  Pertinent lab test.

 PATIENTS COMPLAINTS, MEDICAL & SOCIAL HISTORY General weakness Chronic fatigue Loss of appetite Dysphagia, nausea, vomiting Psychiatric history Painful bleeding gums Loss of wt Sore lips, tongue disorders Loss of ability to concentrate. Loss of manual dexterity Socio-economic status

DIETARY HISTORY & EVALUTION:

Ask specifically What do u eat in a typical day? Food dairy

24 hr recall 3day record 5 day record 7 day record

Adequacy of food = Nutrients consumed (nutritive values of food) RDA

PHYSICAL SIGNS OF MALNUTRITION

eyes

ANTHROPOMETRIC MEASUREMENTS
Measurements of physical characteristics such as ht, wt, & change in wt

Partially age independent: %weight for height = Values < 5th -10th percentile. >90th to 95th percentile. actual weightX100 expected weight for actual height

FOOD ASSISTANT PROGRAMS

It was developed for the individuals at risk for poor nutritional intakes Family food assistance program Child nutrition programs-funded by govt: local, state, federal level

1. 2.

School breakfasts School lunches special milk program Summer food program Mid-day meal program Urban special nutrition program Integrated child development services scheme.

DISORDERED EATING
CHILDREN:
RUMINATION. PSYCHOLOGICAL DWARFISIM. PICA CHILDHOOD OBESITY.

ADOLESCENTS:
ANOREXIA NERVOSA BULIMIA NERVOSA. ORTHOREXIA NERVOSA. ATHELETICA NERVOSA.

PSYCHOSOCIAL DWARFISM
18-48 months Deceleration of linear growth. Characteristic behavior patterns
Bizarre eating patterns. Sleep habits.

Severe food insecurity. Eating garbage / pet food.

RUMINATION
Voluntary regurgitation, chewing, & reswallowing of stomach contents. Self stimulatory behavior Psychosocial issues. Mental retardation Onset 3-12 months Risk of enamel erosion.

PICA
Pathologic craving for substance not commonly regarded as food Classic ex; starch, ice paint chips, dirt, paper, Risk of direct toxicity Pb poisoning

CHILDHOOD OBESITY
Risk for overweight: 85th% to 95th% Over weight: >95th % CAUSES:
T. V & Video games. Emphasis on education. Advertisements. Pampering parents.

EFFECTS MANAGEMENT:
Diet counseling. Changes in dietary habits. Referral.

ANOREXIA NERVOSA
0.5% - 1% teens are effected. FOUR DIAGNOSTIC CRITERIA:
Refusal to maintain body weight =/> 85th %. Intense fear of gaining weight. Distorted view of ones body. Absence of at least 3 consecutive menstrual cycles.

Two sub-categories Specific causes of death include..

PHYSICAL SIGNS MEDICAL COMPLICATIONS ASSOCIATED

BULIMIA NERVOSA
It literally means "ox hunger. 1-3 percent. Detection difficult Did u no dat she suffered fm bulimia??? DIAGNOSTIC CRITERIA:
Eating large amounts of food in less than 2hrs. Lack of control over eating. Compensatory behavior to prevent weight gain. Occurs twice in a week for 3 consecutive months. Concern about body size.

BINGING & PURGING CYCLE

 PHYSICAL SIGNS :
headaches red eyes darkness under the eyes damaged cuticles scarred and/or calloused knuckles weekly fluctuations in weight of five to ten pounds

MEDICAL COMPLICATIONS:
dehydration potassium imbalance gastric distension gastric ruptures gastrointestinal bleeding cardiac arrhythmias constipation

As with anorexia, the ultimate medical complication is death.

ORAL MANIFESTATIONS
PERMIOLYSIS:
pH of vomitus 2.9-5.0 Translucent glassy appearing enamel Raised margins of amalgam restorations.

 DENTAL CARIES. DENTINE HYPERSENSITIVITY. XEROSTOMIA. ENLARGED PAROTID GLAND SOFT TISSUE LESIONS.

 PREVENTIVE TREATMENT:

Fluoride rinse. Alkaline mouth rinse (NaHCO3). Soft tooth brush. Cheese, nuts, whole fruits and vegetables. Stimulate saliva sugar free chewing gums. Place temporary restoration.

 Anorexia and bulimia both arise from underlying psychological feelings that can be caused by:
Depression. Guilt. Low self-esteem. Death of a family member, unhappy family. Societal pressure. Feelings of isolation Physical or sexual abuse

Diagnosis method
2 questions:
1. Are you satisfied with your eating pattern? 2. Do you eat in secret?

MANAGEMENT:
Treatment 2 fold :
Management of underlying social situation / psychological disorder Environmental control of the feeding situation

Principles & practice of medicine....Davidson. Nutrition in clinical dentistry..Nizel-Papas Nutrition, diet, and oral health. Andrew J. Rugg- Gunn. Cariology..Ernest Newbrun. Dentistry for the child and adolescent..McDonald. Guide to nutritional care.Stegeman-Davis. Nutrition and oral health.. DCNA- 2003. Journal of dentistry for children sep-oct 1986 53(5). Google search

Thank you!!