PRESENTED BY: Ms. S.V. Shekade M. Pharm (Pharmaceutics ) DYPIPSR, Pune

1. PRESENTEDBY: Ms. S.V. Shekade M. Pharm (Pharmaceutics) DYPIPSR, Pune

2. CONTENTS • INTRODUCTION • DEFINITION • CLASSIFICATION • LOCAL EFFECT OF DIET ON PERIODONTALHEALTH • INTERACTION OF IMMUNITY, INFECTION & NUTRITIONAL STATUS • NUTRITION AND PERIODONTAL HEALTH INTERRELATIONSHIP • EFFECT OF NUTRITION UPON ORALMICROORGANISMS. • HOST NUTRITION AND PLAQUEBIOFILM • CONCLUSION • REFERENCES

3. INTRODUCTION • The diet plays primarily a modifying role in the progressionof periodontaldisease. • Nutrient deficiencies, excesses, or imbalances do not initiate periodontal disease nor do mega doses of supplements cureor prevent periodontaldisease. • However, nutrition may alter development, resistance,and/or repair of theperiodontium.

4. DEFINITIONS • DIET: pattern of individual food intake, habit, kind andamount • of foodeaten. • NUTRITION: science of how the body uses food to meet its requirement of growth, repair, development andmaintenance. • NUTRITIONAL STATUS: condition of health as it relates to food and nutrient intake, absorption andutilization. • MALNUTRITION: impaired health related to nutrient orcaloric deficiency, absorption, utilization orexcretion.

5. BALANCEDDIET A BALANCED DIETis defined as one which contains a variety of foods in such quantities and proportions that the need for energy, amino acids, vitamins, minerals, fats, carbohydrates and other nutrients is adequately met for maintaining health, vitality and general well being and also makes a small provision for extra nutrients towithstand short duration ofleanness. – Park. A balanced diet has become an accepted means to safeguard a population from nutritionaldeficiencies.

6. Inconstructingbalanceddiet,following principleshastobe followed--- • Daily requirement of protein should be 15-20 % of daily energy intake. • Fat requirement should be limited to 20-30 % of daily energy intake. • Carbohydrates richinnaturalfibersshould remaining energyintake. • Requirements of micronutrients should bemet. constitute

7. INTRODUCTION Nutrition may be defined as the science of food and its relationship to health. It is concerned primarily with the part played by nutrients in body growth, development and maintenance . The word nutrient or “food factor” is used for specific dietary constituents such as proteins, vitamins and minerals. Dietetics is the practical application of the principles of nutrition; it includes the planning of meals for the well and the sick. Good nutrition means “maintaining a nutritional status that enables us to grow well and enjoy good health.”

8. Protein, carbohydrate and fat had been recognized early in the 19th century as energy-yielding foods and much attention was paid to their metabolism and contribution to energy requirements.

9. CLASSIFICATION OF FOODS • Classification by origin: - Foods of animal origin - Foods of vegetable origin • Classification by chemical composition: - Proteins • Fats • Carbohydrates • Vitamins • Minerals

10. CLASSIFICATION BY PREDOMINANT FUNCTION Body building foods: -meat, milk, poultry, fish, eggs, pulses etc Energy giving foods: -cereals, sugars, fats, oils etc. Protective foods: -vegetables, fruits, milk, etc

11. NUTRIENTS Organic and inorganic complexes contained in food are called nutrients. They are broadly divided in to: Macronutrients: -proteins -fats -carbohydrates Micronutrients: -vitamins -minerals

12. Protein, carbohydrate and fat had been recognized early in the 19th century as energy-yielding foods and much attention was paid to their metabolism and contribution to energy requirements.

13. NUTRIENTS • Organic and inorganic complexes contained infood. • About 50 different nutrients are normally supplied throughthe foods we eat. • Each nutrient has specific functions in thebody. • Most natural foods contain more than onenutrient. • may be divided into:

14. PROTEINS • Complex organic nitrogenous compounds composing of carbon, hydrogen, oxygen, nitrogen and sulphur in varying amounts. Some proteins also contain iron andphosphorous. • Made up off smaller units called aminoacids. • SOURCES • Animal sources– milk, meat, eggs, cheese,fish. • Vegetable sources– pulses, cereals, beans, nuts, oilseeds. • DAILY REQUIREMENT:60-65 gms/day foradults.

15. FUNCTIONS: • Necessary for growth and repair of thebody. • Build upnew tissues during the period of growth or pregnancy & lactation. • Required for the formation of digestive enzymes, hormones, plasma proteins, hemoglobin andvitamins. • Provide 10-15% of the energy during emergenciese.g., starvation, inadequate foodintake. • Act as buffers helping to maintain the PH of plasma at aconstant level.

16. PROTEIN DEFICIENCY &PERIODONTAL • DISEASE • Degeneration of the connective tissue of the gingivaland periodontalligament. • Osteoporosis of alveolarbone. • Retardation in the deposition ofcementum. • Delayed woundhealing. • Atrophy of tongueepithelium. • Kwashiorkor • Marasmus

17. CARBOHYDATES • DAILYREQUIREMENT: 300-500gm/day

18. FUNCTIONS • Primary function is to provide a source of energy tofacilitate • body metabolism (1200kcal). • Brain and nervous tissue utilize only glucose as energysource (5 grams perhour). • Muscles including the heart muscles derive energyfor • contraction from storedglycogen. • Protein sparing effect- adequate carbohydrate spareprotein during metabolism which can be utilized for growth and repair of thebody. • Major components of the ground substance are derivedfrom carbohydrates.

19. FATS ANDOILS • Fats are solid at 20 degc. • Called oils if they are liquid at thattemperature. • Fats and oils are sources ofenergy. • Fats yield fatty acids and glycerol onhydrolysis. • Poly unsaturated fatty acids are found in vegetable oilsand saturated fatty acids in animalfats. • Coconut oil and palm oil contain saturated fattyacids. • SOURCES: • Animal fats: ghee, butter, milk, cheese, egg, meat,fish. • Vegetable fats: ground nut, mustard,coconut. • Others: cereals, pulses, nuts,vegetables.

20. FUNCTIONS • Provide energy -- 9kcal every gram. • Serve as vehicle for fat solublevitamins. • Act as thermal insulators forskin. • Essential fatty acids are required for the body growthand structuralintegrity. • DAILYREQUIREMENTS: • 10-20 gms/day

21. FATAND ITS ROLEINDISEASE • OBESITY • PHRENODERMA- deficiency of essential fatty acids in diet is associated with rough and dry skin(toad skin) • CORONARY HEARTDISEASE • CANCER • ATHEROSCLEROSIS • CHRONIC SWELLING OF PAROTID GLANDS due to disturbances in lipidmetabolism.

22. VITAMINS • Vitamins are essential and biologically active constituents ofa diet. • The absence or scarcity of certain vitamins has beenimplicated as being a primary etiological factor in the pathogenesis of periodontaldiseases. • Vitamins are divided into 2groups: • FAT SOLUBLE VITAMINS- A, D, E andK • WATER SOLUBLE VITAMINS – B complex andC

23. VITAMIN A(RETINOL) VITAMIN A AND PERIODONTALDISEASE: Deficiency: marginal gingivitis, gingival bone hypoplasia, pocket formation, alveolar resorption . periodontaldisease,night blindness,

24. VITAMIND AND PERIODONTALDISEASE • A small number of patientsw enamelhypoplasia. • The enamel does not appear t surface may facilitate adhere residue. • No studies demonstrate a rela periodontaldisease. h evidence of ricketsdevelop be weakened, but therougher ce of dental plaque andfood onship b/w vit D defand it o n ti

25. VITAMIND AND PERIODONTALDISEASE

26. VITAMINE • ACTION OF THE NUTRIENT: anti oxidant and maintainscell • membrane. • No effect on periodontaltissues.

27. VITAMINK • Daily requirement : about 0.03 mg/kg for theadult. • DEFICIENCY: • Prolonged clotting time and bleedingtime. • Gingivitis and periodontaldisease.

28. VITAMINC (ASCORBICACID) • DAILYREQUIREMENT:around 30 – 40 mg perday

29. POSSIBLE ETIOLOGICFACTORS: • Low levels of ascorbic acid influence the metabolism of collagen within the periodontium, affecting the abilityof tissue to regenerate or repairitself. • Interferes with the bone formation, leading to lossof periodontal bone. • Deficiencycan lead to defect in epithelialbarrier. • Megadoses of vit C seem to impair the bactericidal activity of leukocytes. • An optimal level of ascorbic acid is required to maintainthe integrity of periodontal microvasculature, as well as the vascular response to bac plaque and woundhealing. • Depletion of vit C may interfere with the ecologic equilibrium of bac in plaque and thus inc itspathogenicity.

30. ASCORBIC ACID AND PERIODONTALDISEASE

31. VITAMINB1(Thiamine) • The earliest symptoms of thi constipation, appetitesuppre depression, peripheralneuro • Chronic thiamin deficiency l symptoms and tocardiovascu (Winston et al.2000). • Oral manifestationsinclude: n deficiencyinclude on, and nausea asmental hy, and fatigue. s to more severeneurological and musculaturedefects ami ssi pat ead lar hypersensitivity of oral mucosa, under the tongue or on the palate, and erosion of the oral mucosa.

32. VITAMINB1

33. VITAMIN B2(RIBOFLAVIN) • Symptoms associated with riboflavin deficiencyinclude glossitis, seborrhea, angular stomatitis, cheilosis, and photophobia.

34. ANGULARSTOMATITIS CHEILOSIS SEBORRHEA

35. VITAMIN B3(NIACIN) • A diet deficient in niacinle loss, diarrhea,depression • The severe symptoms of d are associated with thecon • Several physiological cond malignant carcinoidsyndr therapies (e.g. isoniazid) c (Carpenter1983). s to glossitis, dermatitis,weight dementia. ression, dermatitis, anddiarrhoea ion known aspellagra. ons (e.g. Hartnup diseaseand me) as well as certaindrug ead to niacindeficiency ad and ep dit iti o anl

36. VITAMIN B3(NIACIN)

37. FOLICACID • Folate deficiency causes gingivalenlargement. • Lack and Thomson, studied the effects of supplementation with folic acid on pregnancy gingivitis concluded that topical folate application produces significant improvement in gingivalhealth compared to systemic administration andplacebo.

38. TONGUE IN VITAMIN BDEFICIENCY • Chronic glossitis has been associated with deficiency ofmost of the B complex vitamins particularly niacin, riboflavin, folicacid.

39. MINERALS • COPPER: • A positive correlation has been demonstrated between serum copper and severity of periodontal disease by Freeland et alin 1976. • Copper is also essential for the development and maturationof • connectivetissues. (O’Dell et al1961). • A copper metalloenzyme contributes to the stabilization of collagen. (Burchetal 1975). • Freeland et al (1976) suggested that if this enzyme accumulates in blood or if copper is not transferred to the periodontaltissues, then an elevation of serum levels of copper willresult.

40. ZINC: • Zinc levels are found to decrease with an increase in alveolar boneresorption. (Frithiof et al1980). • Zinc ions can stabilize the cell membranes of PMNs andinhibit the release of lysosomalenzymes. • The reduction in serum zinc in periodontal disease maystimulate both leucocyte function and the release of potent enzymes,which will enhance the inflammatory process and lead to loss of periodontalcollagen. • (Chapvil et al1977). • Kilgore et al. (1969) failed to find a relationship betweenserum levels and periodontalstatus.

41. CALCIUM ANDPHOSPHATE: • Hypocalcaemia and hypophosphataemia that result fromdietary imbalance of these ions will produce a nutritional, secondary hyperparathyroidism, which initiates alveolar boneresorption. • A hypocalcaemic diet can produce inter – radicular alveolar osteoporosis and thinning of individual trabeculae but it will not initiate inflammation, migration of the epithelial attachment,loss of periodontal fibers or resorption of the alveolar margin – Svanberg et al1973.

42. LOCAL EFFECT OF DIET ON PERIODONTAL HEALTH • Vigorous masticatory function is associated with a wideningof thePDL. (Collidge 1937) • Aukes et al (1987) suggest that chewing pattern depends onthe texture of the masticated food, hard and tough food requiring more vertical movements and soft food requiring less vertical movement.

43. Undernutrition • The manifestation of inadequate nutrition • Common in sub-Saharan Africa • 1/3 of all children < 5 years old underweight • 38% of children with low height for age • Many causes • Inadequate access to food/nutrients • Improper care of mothers and children • Limited health services • Unhealthy environment

44. Conditions Associated with Under- and Overnutrition • Vitamin deficiency disorders • Scurvy (deficiency of vitamin C) • Rickets (deficiency of vitamin D) • Mental, adrenal disorders (deficiency of B vitamins) • Mineral deficiency • Osteoporosis (deficiency of calcium) • Diet-related non-communicable diseases • Diabetes • Coronary heart disease • Obesity • High blood pressure

45. Causes of Undernutrition

46. Nutritional StatusDetermined by Anthropometry Underweight: Low weight for age compared to reference standard, a composite measure of stunting and wasting Stunting: Low height for age compared to reference standard, an indicator of chronic or past growth failure Wasting: Low weight for height, an indicator of short-term nutritional stress

47. Other Anthropometric Measurements • MUAC (mid-upper arm circumference) • BMI (body mass index): Compares height and weight BMI = Weight (kg) ÷ height (m)2

48. Manifestations of Protein-Energy Malnutrition (PEM) • Marasmus: Severe growth failure • Weight < 60% weight for age • Frailty, thinness, wrinkled skin, drawn-in face, possible extreme hunger • Kwashiorkor: Severe PEM • Weight 60−80% weight for age • Swelling (edema), dry flaky skin, changes in skin and hair, appetite loss, lethargy • Marasmic kwashiorkor: Most serious form of PEM, combining both conditions above • Weight < 60% weight for age

49. Strategies to Prevent and Control Undernutrition Improve household food security. Improve diversity of diet. Improve maternal nutrition and health care. Improve child feeding practices. Ensure child health care (immunization, medical care, growth monitoring). Provide nutrition rehabilitation.

50. Nutritional Anemia Most common type of anemia Caused by malaria, hookworm, and inadequate iron and vitamin intake resulting in low hemoglobin levels Affects mainly children < 5 years old and pregnant women Detected by measuring blood hemoglobin levels