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Nutrition for Oral Health and Oral Manifestations of Poor Nutrition and Unhealthy Habits

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Nutrition for Oral Health and Oral Manifestations of Poor Nutrition and Unhealthy Habits Nutrition for oral health and oral manifestations of poor nutrition and unhealthy habits Matthew Pflipsen, MD ¢ Yevgeniy Zenchenko, MD The availability of proper nutrients is critical for the utrition is critical to the oral health of the individual. growth, development, maintenance, and repair of From gestation through the end of life, nutrition influ- healthy dentition and oral tissues. Deficiencies particu- ences the integrity and function of the dentition and larly relevant to the dental practice are those in folate N supporting oral structures and has a direct effect on health in and other B complex vitamins; vitamins A, C, and D; general. A well-balanced diet is key to ensuring that individu- 1 calcium; fluoride; and protein. A lack of these nutrients als receive the nutrients they need (Box). If the diet does not affects nearly every structure in the oral cavity, causing supply enough of the vitamins, minerals, and other nutrients or contributing to scurvy, cleft palate, enamel hypo- needed to support healthy tissues, malnutrition develops. In plasia, poor mineralization, caries, and other pathoses. addition, some commonly prescribed medications are associated 2-6 Damage to the dentition can also be observed in indi- with nutritional deficiencies (Table 1). viduals with unhealthy habits; for example, a diet high in Poor nutrition and unhealthy habits “can affect the develop- sugars will promote processes such as demineralization ment and integrity of the oral cavity as well as the progression 7 and caries. Diabetes also can result from a poor diet of oral diseases.” Proper nutrition and avoidance of unhealthy and is associated with periodontitis and oral candidia- habits helps avoid oral pathoses associated with nutritional defi- sis. Finally, the use of tobacco products and excessive ciency, excess free sugar intake, diabetes, alcohol consumption, alcohol intake damage the dentition and contribute to a or tobacco use. Dentists who are knowledgeable about nutrition variety of oral diseases, including stomatitis, malnutri- are equipped to ask patients relevant questions about dietary tion, and squamous cell carcinoma. Knowledge of these habits that may affect oral and systemic health and to provide relationships will enable the dentist to question patients guidance that promotes healthy lifestyles. This article will review about dietary habits and provide guidance to encourage the roles of specific nutrients in oral health as well as the harm- a healthy lifestyle. ful effects of unhealthy habits. Received: July 17, 2017 Vitamins Accepted: August 8, 2017 Folate and B complex vitamins Folate (vitamin B9) is a critical component of certain biochemical reactions necessary to synthesize DNA and to power the amino acid metabolism required for cell division. It is an essential vita- min and cannot be created in the human body. Due to its role in nucleic acid synthesis and the rapid cell creation of the growing 8 fetus, the demands for folate increase during pregnancy. For this reason it is recommended that all women of child-bearing age, even if not currently pregnant, take a daily supplement contain- 9 ing 0.4-0.8 mg of folic acid. Although folate deficiency is most often associated with neural tube defects, recent studies have found a reduced occurrence of cleft lip with or without cleft 10,11 A collaboration between General Dentistry palate when pregnant women take supplemental folic acid. and American Family Physician Because B vitamins frequently exist in the same foods, they are commonly referred to as the B complex vitamins. A deficiency Published with permission of the Academy of General Dentistry. in one is likely to be accompanied by deficiencies in others. © Copyright 2017 by the Academy of General Dentistry. Although they may be accompanied by disparate systemic signs, All rights reserved. For printed and electronic reprints of this article deficiencies in B2, B3, B6, and B12 will typically manifest in the oral for distribution, please contact [email protected]. cavity as stomatitis, glossitis, and oral ulcers. Risk factors for vita- min B deficiencies include older age, medications, chronic alcohol abuse, malabsorptive syndromes, and vegetarian and vegan diets. Vitamin C Exercise No. 412, p. 44 Another essential nutrient, vitamin C is required for the syn- Subject code: Health and Nutrition (150) thesis of collagen, which almost exclusively constitutes the 36 GENERAL DENTISTRY November/December 2017 Box. Select key recommendations for healthy eating.a include smokers, those exposed to secondhand smoke, infants and children whose primary source of nutrition is cow’s milk, those with end-stage renal disease on chronic hemodialysis, and Use a healthy eating pattern, which includes: 13,16 • A variety of vegetables from all of the subgroups— those with malabsorptive conditions. dark green, red and orange, legumes (beans and peas), All fruits and vegetables contain vitamin C, but those with starchy, and other the highest content include oranges, berries, broccoli, and red peppers. Table 2 lists the foods with the highest content of the • Fruits, especially whole fruits 17 • Grains, at least half of which are whole grains vitamins and minerals pertinent to oral nutrition. • Fat-free or low-fat dairy, including milk, yogurt, cheese, Vitamin A and/or fortified soy beverages • A variety of protein foods, including seafood, lean meats Apart from its role in healthy vision, vitamin A functions as an important component required to maintain the mucosal mem- and poultry, eggs, legumes (beans and peas), nuts, seeds, 18,19 and soy products branes, salivary glands, and teeth. Animal studies have shown that a deficiency in this vitamin will result in various abnormali- Consume fewer than 10% of calories per day from added sugars. ties, including tooth brittleness, salivary gland degeneration, 20-22 If alcohol is consumed, consume it in moderation—up to and increased risk of caries. Vitamin A has been shown to 23,24 1 drink per day for women and up to 2 drinks per day for provide a protective effect against cleft palate. men—and only if you are an adult of legal drinking age. Although rare in the general population of developed coun- aAdapted from the US Department of Health and Human Services and tries, vitamin A deficiency is common in many developing coun- US Department of Agriculture.1 tries, often due to a paucity of food sources with adequate levels. In these countries, the populations most at risk are infants and 25 children. Other populations at risk include premature infants, those with cystic fibrosis, and those with other conditions caus- 26,27 Table 1. Medications associated with nutritional deficiencies. ing fat malabsorption. Vitamin D Medication Diseasea Deficiency A natural hormone of the human body, vitamin D plays an Proton pump inhibitors2 Gastroesophageal Vitamin B 12 important role in the absorption of calcium, phosphorus, and reflux disorder Vitamin C magnesium from the gut, allowing the proper mineralization 3 Metformin Diabetes Vitamin B12 of bones and teeth. Like insufficient vitamin A, a deficiency in 28 Furosemide4 Heart failure Calcium vitamin D is associated with enamel and dentin hypoplasia. Magnesium Inadequate levels of vitamin D during tooth formation may Levodopa/carbidopa5 Parkinson disease Vitamin B result in delayed eruption as well as lamina dura and cementum 12 loss that leads to tooth loss. Isoniazid6 Tuberculosis Vitamin B 6 Infants who are exclusively breastfed and infants consuming aDisease most commonly treated by the medication. less than 1 L of formula per day are at particular risk of vitamin D deficiency, as breastmilk alone contains insufficient levels of the vitamin, and most formula is not sufficiently fortified. Therefore, the American Academy of Pediatrics (AAP) recom- protein portion of teeth and bones and serves as the structural mends that all breastfed infants, and non-breastfed infants who scaffolding over which mineralization of these structures do not ingest at least 1 L of vitamin D–fortified formula daily, occurs. Collagen, and thus vitamin C, are necessary for the receive a supplemental 400 IU of vitamin D per day, which is 29 creation of dentin, pulp, cementum, periodontal fibers, blood readily available in liquid formulations. vessels, gingival nerves, connective tissues, and periodontal Other risk factors for vitamin D deficiency include older age ligaments. Vitamin C continues to be necessary for the (due to decreased efficiency of synthesis at the skin), living at 30 turnover of bone, tooth, and connective tissue throughout higher latitudes, medications, kidney disease, and vegan diets. 12 the life span. Because most foods do not contain it naturally, many foods, Inadequate intake of vitamin C will eventually manifest as including milk and grain products, are fortified with vitamin D. scurvy. Initial symptoms of scurvy include inflammation of the gingiva. As the deficiency progresses, collagen synthesis is Minerals impaired and connective tissues are weakened, causing poor Calcium and phosphorus wound healing; inflamed, bleeding gingiva; and loosening of The mineralization of the protein matrix is completed with the 13,14 teeth as a result of tissue and capillary fragility. Although deposition of hydroxyapatite, giving bones and teeth their com- uncommon in developed countries, vitamin C deficiency can pressive strength. Composed of calcium and phosphorus miner- occur in populations with limited food variety, which include als, hydroxyapatite is also
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