trace elements in oral health

1. TRACE
ELEMENTS
IN ORAL
HEALTH
SUBMITTED BY,
Dr ASMIN P K
1st YEAR POST GRADUATE

2. CONTENTS
• INTRODUCTION
• ESSENTIAL TRACE ELEMENTS
• TRACE ELEMENTS AND NUTRITION
• FUNCTION OF TRACE ELEMENTS
• TRACE ELEMENTS AND CARCINOGENESIS
• CONCLUSION
• REFERENCES

3. INTRODUCTION
• The human body contains elements that can be classified as
• 1. Abundant elements
• 2. Trace elements
 ABUNDANT ELEMENTS
• are those that are involved in the formation of covalent bonds.
• They are important constituents of tissues and semi-major elements.
• often exist in the ionic state.
• involved in functions of the living body through maintenance of osmotic
pressure and membrane potentials.

4.  TRACE ELEMENTS / MICRO-
NUTRIENTS
• Are chemical micronutrients required
in minute quantity but play a vital role
in maintaining integrity of various
physiological and metabolic
processes occurring within living
tissues.
• with excess bioavailability having a
toxic effect on the living organism
• There are 19 trace elements divided
into three groups (WHO
classification):
1. Essential elements
2. Probably essential elements
3. Potentially toxic elements

6. They are :
1. zinc (Zn)
2. copper (Cu)
3. selenium (Se)
4. chromium (Cr)
5. cobalt (Co)
6. iodine (I)
7. manganese (Mn)
8. molybdenum (Mo).
ESSENTIAL
TRACE ELEMENTS

7. TRACE
ELEMENTS
AND
NUTRITION
The interactions of micro-nutrients are difficult to study,
since; they occur together in various forms and amounts;
their absorption from the intestinal tract may be exclusively
dependent on their relative concentrations; they can be
synergetic or antagonistic; the amount could depend on the
other essential trace elements in the diet.
Our diet today, comprises of refined food. This is a cause of
concern to a modern man as he may not be receiving
sufficient amount of trace elements in his food sources,
and dietary supplements may be of usage in combating
this shortage.

10. DIETARY
SOURCES AND
FUNCTION

12. • TRACE ELEMENTS:
• they account for only 0.02% of the total body weight .
• As each trace element is related to many enzymes ,deficiency of one trace
element is not associated with any specific clinical presentation, but rather
presents as a combination .
 TRACE ELEMENTS IN ENAMEL
• Because enamel crystals are so small, they have a very large surface area,
allowing great opportunity for the adsorption of foreign ions.
• It is likely that all the previously mentioned ions are to some extent also
• 1. adsorbed at the surface
• 2. or bound water layer, the ‘hydration shell’, including (HPO4)-2 and (Ca)2+
ions.
• These ions are readily exchangeable, unlike ions in the lattice.
• Also adsorbed on the crystal surface are enamel trace elements such as
potassium, zinc, lead and copper.

13. THE EPIDEMIOLOGY OF DENTAL CARIES IN
RELATION TO ENVIRONMENTAL TRACE
ELEMENTS
• Incorporation of trace elements into the appetite microcrystals may alter their physical
properties, especially solubility and hence their susceptibility to degradation

14. They attract substrate molecules and enable their
conversion to any specific end product.
They work in harmony with proteins and often
with certain other co-enzymes.
They are an important part of certain biological
and chemical reactions .
BIOLOGICAL SIGNIFICANCE OF TRACE
ELEMENTS :

15. HEMOSTAT OF
TRACE
ELEMENTS
Homeostatic
regulation is a
process involving
absorption,
storage, and
excretion.
The relative
importance of
these three
processes is
significantly
different among
each of these
trace elements.
Excretions
occurring
through sweat,
urine, bile, and
breathe is a
major
mechanism for
controlling the
quantity of these
elements in any
organisms .
To prevent
adverse
reactions, some
of these
elements are
stored in inactive
forms when
available in
excess
quantities.

16. FACTORS
AFFECTING
TRACE
ELEMENTS
REQUIREMENT
• Though trace elements play a vital role in a variety of processes
needed for life, the occurrence of their deficiencies of any of the
trace elements is relatively uncommon due to the strong
homeostatic mechanisms. However, there are situations that may
make a trace element nutritionally valuable.

17. FUNCTIONS OF
TRACE
ELEMENTS
1. CHROMIUM
• Chromium is an important mineral for obese people, and it is one of
the key minerals in controlling blood sugar and lipid levels.
• As the main ingredient of glucose tolerance factor (GFT), chromium
helps insulin in reducing the blood glucose, by stimulating glucose
uptake from the muscles and other tissues.
• When the chromium levels are less, the circulating level of (GFT) is
less, and as a result, insulin is less effective in reducing blood sugar.
• Hence, blood sugar remains high, stimulating further insulin release,
which is again blocked from being effective.

18. 2. COPPER third most abundant
mineral in the body,.
involved in the release
process of energy inside the
cell and contributes in the
functioning of many
antioxidants.
Controls the formation and
regulation of hormones like
melatonin, via a wide range
of neurotransmitters and
other neuroactive
compounds including the
catecholamine’s.
Helps in collagen
production, formation of red
blood cells and the oxidation
of fats.
Needed for the proper
functioning of vitamin C and
iron absorption.
Required for the production
of the thyroid hormone
thyroxin .
act as both an antioxidant
and a pro-oxidant.
As an antioxidant, Cu
scavenges or neutralizes free
radicals and may reduce
some of the damage they
cause.
As prooxidant :Cu promotes
free radical damage to the
tissues.

19. ROLE IN ORAL
HEALTH AND
DISEASES
osteoporosis and occipital horn formation due to
functional impairment of copper-requiring enzymes
such as ascorbate oxidase and lysyl oxidase
BONE ABNORMALITIES AND PAIN: include a loss of
trabecular formation with thinning of the cortex.
Deficiency of Cu in diet for a prolonged period leads to
anemia and defective keratinization in the oral cavity.
(The anemic effect -decreased ferroxidase activity of
ceruloplasmin and reduced iron oxidation).

20. 3. ZINC
• Is a mineral with a wide application in human health.
• It is needed for a healthy immune system.
• Also needed for cell division, hair, tissue, nails, skin, and muscle
growth, synthesis of protein and collagen- which are needed for
wound healing
4. SELENIUM
• are toxic in excess amounts, but trace amounts of selenium are
needed for cellular functioning in many organisms.
• biological role of selenium : Act as an ingredient of the
antioxidant enzymes glutathione peroxides and thioredoxin
reductase.

21. 5. MOLYBDENUM:
important role of
molybdenum is sharing a
common cofactor
,molybdoprotein, at the
active site in certain
enzymes.
Molybdoprotein is bound on
molybdenum atom through
adjacent sulphur atoms.
In humans, a process of
purine catabolism is
catalysed by a
molybdenum containing
enzyme.
Molybdenum
concentration also
affects protein synthesis,
the metabolism process,
and growth of the body.
6. IODINE:
plays a role in thyroid
hormones regarding the
growth and development of
humans.
The effects of
iodine-deficiency on growth
and development are
denoted by
iodine-deficiency disorders
that are seen at all stages
of development.

22. • Fluorine is only a minute part of the weight of man and enters
the body by both drinking water and foods.
• Body fluoride status depends on multiple factors.
• A low level of fluorine in drinking water is connected to tooth
decay.
• The dental tissue usually shows signs of toxicity, and mottling of
tooth enamel is a well-known feature of excess fluoride
ingestion.
• Long-term exposure to high levels of fluoride leads to dental
decay.
• Further, in the body ionic fluoride rarely exists in blood, most
ingested fluoride is trapped in the bone tissue.
7.FLUORIDE

23. MECHANISMS OF ANTICARIES ACTION OF
FLUORIDE
1. INCREASED ENAMEL RESISTANCE
2. INCREASED REMINERALISATION
3. POST ERUPTIVE MATURATION-1960
4. INTERFERENCE WITH ORAL BACTERIA
5. MODIFICATION IN TOOTH MORPHOLOGY

24. • The hydroxyapatite of tooth enamel -composed of phosphate ions (PO43–) and calcium
ions (Ca2+).
• Normal conditions - there is a stable equilibrium between the Ca and phosphate ions in
saliva and the crystalline hydroxyapatite that comprises 96% of tooth enamel.
• pH drops below a critical level (5.5 for enamel, and 6.2 for dentin)- causes the
dissolution of hydroxyapatite -DEMINERALIZATION.
• When the natural buffer capacity of saliva elevates pH, minerals are reincorporated into
the tooth - REMINERALIZATION.

25. • 1. Increase in the enamel’s resistance to acid solubility
• Fluoride reduces solubility of dental enamel by both systemic and topical action.
• Fluoride ingested prior to tooth eruption - development of florapatite at the enamel surfaces –
which are resistant to demineralizing acids.
• Caries – series of demineralization/remineralization cycles where, over time, demineralization
conditions prevail.
• It can be affected in several ways.
• most effective method is by promoting remineralization and slowing down demineralization. This
can be accomplished with fluoride therapy.

26. • 2. Remineralization −
 Greater concentration of fluoride released from
the dissolved enamel or already present on the
plaque, the more will remineralization be favored
and carious process be slowed.
 Use of topical fluoride raises the fluoride level of
tooth surface and underlying tissues to a level
expected to protect against caries
• .

27. • 3. Antibacterial effects of fluoride
 Inhibition of enzymes essential to cell metabolism and growth.
 Lower the surface energy of the tooth.
Can strip off bacteria from hydroxyapatite.
Fluoride can bind more effectively to positively charged areas on the apatite crystal than
can the bacteria
• 4. Increased rate of post-eruptive maturation:
• At the time of eruption enamel is not completely calcified and undergoes post eruptive
maturation ( 2 years) –enamel calcification continues.

28. DENTAL BENEFITS
• Fluorosis of the deciduous teeth is rarely seen and is not a problem.
• First 2 to 3 years of life are the most critical period for the development of mottled
enamel on the permanent anterior teeth and for this reason only.
• – 0.25 mg/day is prescribed from birth until 2 years of age.
• – 0.5 mg/day from 2 to 3 years of age.
• – 1.0 mg/day from 3 until 13 years of age.
• Use of fluoridated water or fluoride supplements as early as 1 year of age enhance
the formation of the relatively caries – resistant Fluor apatite in the enamel surface

29. • Supplemental fluoride dosage schedule in mg/day according to fluoride concentration of
drinking water.

30. 8.LEAD AND MERCURY
• Of the many dietary interactions influencing the uptake of lead
or its retention with calcium are important.
• Defects in hemoglobin synthesis and lessened erythrocyte life
span provide biochemical indication of lead exposure in the
absence of clinically detectable signs.

31. TRACE ELEMENTS AND CARCINOGENESIS
macro-nutrients and
micro-nutrients
promote the process of
carcinogenesis such as,
iron, zinc ,copper,
cadmium, berilium,
boron etc.
These metals act in
various ways in
synchronization
with each other
to bring out regulatory
mechanisms in the
human body.
Dysregulation of this
equilibrium leads to
uncontrolled adverse
reactions in the body

32. TRACE ELEMENTS IN ORAL LESIONS
1. TRACE METALS AND ORAL LICHEN PLANUS AND ORAL
LICHENOID REACTIONS:
• Lichen planus, contact allergy and hypersensitivity OLR’s can be
linked to its exposure with metals that are released from metal
alloys commonly used in dentistry.
• There is a hypothesis on a potential link of (OLR’s) with
exposure to Cr, Co, Ni and amalgam alloys as released into the
oral cavity - the most common metal is nickel.
• These trace metals when come into contact with oral mucosa
induce sensitivity reactions in response to the immune-mediated
damage of the basal epithelial keratinocytes.
• Some studies state that OLR due to amalgamation may have a
risk of malignant transformation

33. 2: Trace elements and oral sub mucous fibrosis:
• Is a well-recognized potentially malignant condition of
the oral cavity, leading to oral cancer.
• In developing countries, controlling the devastating,
widespread effects of oral cancer needs interventions
at-risk persons before the disease becomes invasive,
advanced or metastatic.
• So early detection of these pre-malignancies and
preventing them from malignant transformation seem
to be the best available tool in the fight against oral
carcinoma.

34. 3: Trace elements and oral pre cancer and cancer:
• India has highest incidences of OC in the world.
• Development of cancer is a multistep process ,seen arising from a pre-existing potentially
malignant lesion.
• Leukoplakia -most common precancer (85%).
• Alcohol, viruses, genetic mutations, candida infections, and chronic irritation have modifying
effects in the etiology of oral cancer.

35. Trace elements are considered as versatile
anti-cancer agents that help regulate various
biological mechanisms.
Many researchers observed a potential link
between the trace elements and cancer
mortality.
Reduction in the contents of Cu and Zn were
seen in the blood of patients with HN cancer.
The ratio of Cu to Zn is a reliable biomarker in
the development and progression toward
carcinogenesis.
Trace elements such as Cu and Zn have a role
in anticarcinogenic defense mechanism of the
human body

36. Cu is involved in
cell metabolic
activity, as a part
of various
enzymes, which
are chiefly
concerned with
oxidation
reactions.
In one recent
study, it was seen
that the levels of
serum Cu were
raised in OSMF
patients and
gradually
increased as the
clinical staging
OSMF progressed.
Some studies have
shown lower Zn
levels in the
serum of patients
with potentially
premalignant
disorders like in
oral leukoplakia.
This might be due
to consumption of
Zn in counter
reacting to
oxidants
generated from
tobacco or high
copper of areca
quid metabolism.

37. There is reduced
Fe levels in
OSMF patients
due to utility of
iron in collagen
synthesis.
Decreased Fe
content leads to
decreased
epithelial
vascularity
leading to an
increased
penetration of
arecoline, which
leading to
fibrosis.
Insufficient
nutrition due to
burning
sensation and
erosions in
OSMF patients
and raised
tumor burden in
OSCC patients
are considered
to be key factors
for Fe depletion.
Future studies
investigating
the levels of Cu
and Zn in
precancerous
and cancerous
tissue and
correlating them
with serum
changes would
be useful in
establishing the
role of these
micro-nutrients
in oral
carcinogenesis.
However, it can
be stated that
Cu and Zn could
be effectively
used as
biological
markers in the
process of oral
carcinogenesis.

38. Zinc levels in the tissue and serum of pre malignancies
may be used in understanding the pathogenesis, and in
establishing treatment.
Relatively less scientific literature has been documented
in the area of oral premalignant conditions.
Trace elements have been extensively studied in recent
years to assess if they have any modulating effects in the
predisposition of oral malignant conditions.

39. Cariostatic
elements:
F, P
01
Mildly
cariostatic:
Mo, V, Cu,
Sr, B, Li,
Au
02
Doubtful:
Be, Co,
Mn, Zn,
Br, I
03
Caries
inert: Ba,
Al, Ni, Fe,
Pd, Ti
04
Caries
promoting:
Se, Mg, Cd,
Pt, Pb, Si
05

40. Sample Footer Text 2/2/2019 40

41. CONCLUSION
Though trace
elements are
required in
minimal
quantities their
presence in the
optimal amount is
essential for the
normal
physiological
functioning of the
body.
They are one of
the corner stone’s
in maintenance of
biodynamic of the
body.
Both, excess and
the deficiency
states lead to
initiation,
promotion, and
progression to
various disease
processes.
Thus, a
comprehensive
understanding of
these trace
elements is
essential and
significant for
disease control
and maintaining
optimal health.

42. REFERENCES
• Darby, M.L., 2013. Mosby's Comprehensive Review of Dental Hygiene-E-
Book. Elsevier Health Sciences.
• Marya, C.M., 2011. A textbook of public health dentistry. JP Medical Ltd.
• Kulkarni N, Kalele K, Kulkarni M, Kathariya R. Trace elements in oral
health and disease: an updated review. Journal of Dental Research and
Review. 2014 May 1;1(2):100.
• Varghese I, Sugathan CK, Balasubramanian G, Vijayakumar T. Serum
copper and zinc levels in premalignant and malignant lesions of the oral
cavity. Oncology. 1987;44(4):224-7.

43. Thank you