1. NUTRITIONAL DISORDERS
Dr.linda Maher

2. NUTRITION:
is the supply of materials - food - required by organisms and cells to stay alive.
 NUTRITIONAL DISORDER:
  is a disease that results from excessive or inadequate intake of food and nutrients which leads to conditions

3. CAUSES OF NUTRITIONAL DEFICIENCIES (LACK OF NUTRIENTS):
1\inadequate intake
2\malabsorption (defect of absorption)
3\high secretion rate

4. Body requirements THE BASIC NUTRITONAL REQUIREMENT OF BODY GROWTH:
1\carbohydrates
2\ proteins
3\fats
4\vitamins(A, B complex ,C,D,E and K)
5\ minerals
6\water

5. The integrity of the oral mucous membrane is maintained by a wide-ranging complex of factors, including those dependent on adequate nutrition
The mouth is a uniquely sensitive indicator of nutritional information reflecting past and present nutritional insults to a degree unmatched by almost any other body site

6. Oral health Diet and nutrition play a key role in —Tooth development
—Gingival and oral tissue integrity
—Bone strength
__salivary production
—Prevention and management of diseases of the oral cavity

7. TEETH:
Teeth are made from organic protein matrix that is mineralized with collagen (requiring vitamin C), calcium, and phosphorus (requiring vitamins D and A)
Changes in the structural integrity of the teeth provide a history of exposure to deficiencies of vitamin A, vitamin C, vitamin D and iodine and to an excess of fluorides during the years of tooth formation

8. ORAL MUCOSA
Oral mucosa composed of epithelial cell layer and basal layer that are in continuous turnover and proliferation processes (requiring different vitamins and mineral supplements)
Changes in the structural integrity of the oral mucosa may signal ongoing deficiencies of riboflavin, niacin, folic acid, vitamin B6, vitamin B12, biotin, vitamin C, vitamin K, iron and protein calories

9. VITAMIN DEFICIENCIES
Vitamins help to regulate chemical reactions in the body.
There are 13 vitamins, including vitamins A, B complex, C, D, E, and K.
Because most vitamins cannot be made in the body, we must obtain them through the diet.

10. Vitamin deficiencies are not contributory cause of dental caries.
Several oral conditions of doubtful causes such as glossitis and periodontal diseases have been ascribed to vitamin deficiencies.
Vitamin deficiencies are not contributory cause of dental caries.

11. 1\VITAMIN (A)DEFICIENCY:
it is important for growth and development, for the maintenance of the immune system and good vision
SYSTEMIC EFFECT of vit A deficiency:
Night blindness , xerophthalmia(dry eye)
ORAL EFFECT of vit A deficiency:
Unconfirmed contribution to cancer

12. VITAMIN B
B vitamins are a group of water-soluble vitamins that play important roles in cell metabolism
They are 8 vitamins , B1,B2,B3,B5,B6,B7,B9 and B12
These vitamins are found in whole unprocessed food ,meets and nutritional yeasts

13. 2\RIBOFLAVIN(B2)DEFICIENCY
Mainly results from malabsorption syndrome
SYSTEMIC EFFECT:
cause dermatitis(inflammation of the skin)
ORAL EFFECT:
1\angular stomatitis, with painful red fissures at the angles of the mouth , and shiny redness of the mucous membranes.
2\glossitis: the tongue become magenta in color and granular or pebbly in appearance
*Gingiva is not usually affected

14. Treatment:
Riboflavin 5 mg tds

15. 3\VIT (B12) DEFICIENCY CAUSE: Caused by malabsorption of B12 vitamin
ORAL MANIFISTATIONS:
1\ Glossitis
2\ Aphthus ulcer
TREATMENT:
1\Vit B12 supplements
2\Topical covering agents for ulcers(orabase)

16. APHTHUS ULCER:
common type of ulcer found in the mouth, gums, sometimes the upper throat region.
It usually involves the breaking down of mucosal surface, and this exposes the underlying tissue, leading to severe pain especially with
contact or movement.
TYPES :
1\major Aphthus ulcer >1 cm
2\minor Aphthus ulcers <1 cm

17. MORPHOLOGY OF THE LESION:
yellow or whitish base where the tissue is exposed and a fiery red border is found around the ulcer
AETIOLOGY OF APHTHUS ULCER:
The true underlying cause  is not fully established but there are numerous factors which can contribute to development of such ulcers in the mouth
Vit B 12 deficiency ,iron deficiency ,folic acid deficiency ,local trauma , stress ,infections ,hormonal imbalance and food allergy.

19. Treatment of Aphthus ulcer
1\ Mostly are recurrent self –healing ulcers
2\ blood investigation to find out and treat the underlying cause if any.(vit b12 deficiency-folate deficiency ….etc)
3\corticosteroid pellets allowed to dissolve in the mouth . Tds (it does not fasten healing of existing ulcer but reduces inflammatory pain)
4\covering agent (e.g. orabase)
5\clorhexidine 0.2% mouth wash tds. (reduces duration and discomfort of ulcers)

20. 4\VITAMIN(C) DEFICIENCY(SCURVEY)
WAS common among crews of sailing ships and now is exceedingly rare.
Vitamin c is important in collagen synthesis , hence, it’s deficiency will lead to defective production of normal collagen fibers
This will lead to production of fragile blood capillaries causing abnormal bleeding and delayed wound healing
Collagen is an important part of bone, so bone formation is affected

21. SYSTEMIC MANIFISTATIONS:
1\Purpura ( appearance of red or purple discolorations on the skin )
2\Delayed wound healing
3\Bone lesion in children
ORAL MANIFISTATIONS:
Gingival swelling and bleeding
TREATMENT:
1\ eating food containing vit C (such as oranges, papaya, strawberries, lemon),
2\ vit c tablets

22. 5\VITAMIN (D)DEFICIENCY
Deficiency of vitamin D during skeletal development causes rickets(disease in which the bone tissue doesn't properly mineralize, leading to soft bones and skeletal deformities)

23. CAUSES:
1\inadequate intake
2\lack of sunlight(in strong sunlight vit D can be synthesized in the skin)
ORAL MANIFISTATIONS:
Dental defects occur only in exceptionally sever rickets

24. 5\FOLIC ACID DEFICIENCY
CAUSES:
1\inadequate intake (malnutrition)
2\pregnancy
3\mal absorption
SYSTEMIC MANIFISTATIONS:
Macrocytic anemia(folic acid is important in DNA synthesis and production of red blood cells)
ORAL MANIFISTATIONS:
1\glossitis
2\Aphthus ulcer

25. 6\IRON DEFICIENCY Iron deficiency causes IRON DEFICIENCY ANAEMIA
low red blood cell or hemoglobin level
CAUSES:
Usually results from chronic blood loss (menstrual blood loss-sever peptic ulcer….etc)
CLINICAL FEATURES:
1\Pallor
2\Fatigue
3\Breathlessness
4\Tachycardia and palpitation

26. ORAL MANIFISTATIONS:
1\Glossitis
2\Aphthuas ulcer
TREATMENT:
1\eating more iron-rich foods, such as beans, lentils or red meat,
2\ taking iron supplements
3\topical covering for ulcers (orabase)

27. THANK YOU .