ORAL HEALTH AND DISEASES

1. TRACE ELEMENTS IN
NUTRITION

2. CONTENTS
INTRODUCTION
CLASSIFICATION
ESSENTIAL TRACE ELEMENTS
IRON
IODINE
FLUORIDE
ZINC
COPPER
CHROMIUM
CONCLUSION
REFERENCES

3. Nutrition is the process of taking food into the body,
absorbing the nutrients in those food and using it for
growth, metabolism and repair.

4. TRACE ELEMENT
A naturally occurring, homogeneous, inorganic
substance required in humans in amounts less than
100 mg/day
TRACE ELEMENTS

5.  Essential trace elements : Iodine, Zinc,
Selenium, Copper, Molybdenum, Chromium, Cobalt,
Iron
 Trace elements that are probably essential :
Manganese, Nickel, Silicon, Boron, Vanadium
 Potentially toxic elements with possible
essential functions in low doses : Fluoride,
Lead, Cadmium, Mercury, Arsenic, Lithium, Tin,
Aluminium
Classification (WHO, 1996)

6. ESSENTIAL TRACE ELEMENTS
• Trace elements
Iron, zinc and copper
• Ultra trace elements
Manganese, selenium, cobalt, chromium,
fluoride, iodine, and molybdenum

8. Most essential trace element
• Body content – 4-6g
• Hb – 68%
• ferritin – 13 %
• haemosiderin – 12%
• myoglobin – 3%
• iron enzymes – 0.2%
 Body requirement
 Daily requirement – 0.5 - 2 mg/day
 3 - 5mg/day (pregnancy)
 Daily excretion – 0.9mg/day
 1.3mg/day (during menses)

9. Sources
Haem Iron Sources: Nonvegetarian sources of iron
e.g. meat, fish and eggs.
Milk a poor source of iron but breast milk an
efficient source for the infant.
Non-haem Iron Sources : vegetarian sources,
Eg:cereals, dark green leafy vegetables, pulses,
nuts and dry fruits

10. WHY DO WE NEED IRON?
Functions :
• component of haemoglobin and myoglobin.
• constituent of important enzymes like
cytochromes, catalase, peroxidase,etc.
• important functions in oxygen transport
and cellular respiration.
• involved in cellular immune response for
functioning of phagocytic cells

11. IRON ABSORPTION

12. Absorption and bioavailability
 Factors in food that increase absorption of
iron:
• Vitamin C
• Amino Acids
• Factors in food that decrease iron
absorption
• Phytates
• Oxalates
• Tannins
• Phosphates

13. IRON DEFICIENCY
Iron deficiency is the most common nutrient
deficiency worldwide
• Can occur if inadequate intake or blood loss
Stages of iron deficiency
Iron stores diminish
Transport iron decreases
Hemoglobin production declines
• Females are prone due to menstruation,
lower iron intake &pregnancy
• Preschoolers also at risk

14. Deficiency symptoms
•Microcytic, hypochromic anemia: weakness, fatigue, headaches
• Impaired work performance and cognitive function
• Impaired immunity
• Pale skin, nailbeds, and mucous membranes
•Finger nails that become thin, brittle and white may grow
abnormally with a spoon-shaped appearance
• Tongue may become sore, smooth and reddened
•Decrease in appetite
•Shortness of breath during exercise
• Inability to regulate body temperature
• Pica (craving for ice, clay, paste, and other
non-food substances)

15. Iron deficiency anaemia
 Who are at risk for developing IDA?
 Women of childbearing age
 Pregnant women
 Low birth weight infants
 Older infants and toddlers
 Teenage girls
 Individuals with kidney failure (on Dialysis) because
failing kidneys cannot produce enough erythropoietin to
make RBC in the blood
 Intestinal worm infestation (hook worm etc.)
Causes of IDA
Inadequate ingestion
Increased requirement
Inadequate absorption
Inadequate utilization
Increased blood loss or excretion
Defects in release from stores

18. TREATMENT
National anemia prophylaxis programme in India in
1970
•100 mg of iron +500 microgram of folic acid for
pregnant women
•20 mg of iron+100 microgram folic acid to children

19. •More common in men
•Hemochromatosis –
genetic defect
•Hemosiderosis – chronic
ingestion of too much
iron; more common in
alcoholics
•Iron poisoning – acute
toxicity from overdose
of iron supplements; can
be deadly in small
children
TOXICITY – “IRON OVERLOAD”;

21. IRON SUPPLEMENTS
Oral preparations of iron:
Ferrous sulphate
Ferrous fumerate
Ferrous gluconate
Ferrous succinate
Iron calcium complex
Ferric ammonium citrate
Parenteral preparations:
Iron dextran
Iron sorbitol citric acid
complex

22. Glossitis Angular cheilitis candidal infections
Oral manifestations of iron deficiency anemia
•Angular cheilitis,
•Atrophic glossitis,
•Generalised oral mucosal atrophy,
•Candidal infections, pallor, and stomatitis
Plummer-vinson syndrome or paterson-kelly syndrome is a rare
condition characterized by iron deficiency anemia
ROLE IN ORAL HEALTH AND DISEASES

23.  Oral premalignant lesions and conditions
OSMF:
•A significant decrease in serum iron
concentrations with elevated total iron-binding
capacity .
• The decreased iron levels in OSMF patients
might be due to utilization of iron in collagen
synthesis.
• deficient iron in the oral tissues results in
decreased vascularity which further facilitates
percolation of arecoline . which enhances
fibroblastic proliferation and collagen formation

25.  Body content: 50mg
 Blood conc: 8-12mcg/dl
 Sources of iodine
 i. Seafood
 ii. Vegetables grown on iodine-rich soils
 iii. Milk products
 iv. Eggs
 v. Cereal grains
 vi. Legumes
 vii. Green leafy vegetables

26. •Iodine is an integral component of the thyroid
hormones thyroxine(T4) and tri-iodothyronine (T3).
• In foetus and neonate normal protein metabolism in
the CNS requires iodine

27. REQUIREMENT OF
IODINE Absorption :
 Dietary iodine absorbed from the small
intestine.
 Approximately 30 % used by the thyroid
gland for the synthesis of thyroxine
hormone; rest excreted in urine
Goitrogens :Vegetables of Brassica
group (cabbage, cauliflower and radish)
contain goitrogens -thiocyanates and
cynoglycosides.
Consumption of large quantities of these
may lead to development of goiter by
making the iodine present in food
unavailable to the body.
Goitrogens inactivated by heating

30. Toxicity of Iodine
 Consumption of seaweed
 Upper Level is 1.1 mg/day
“Toxic goiter” results

31. ROLE IN ORAL HEALTH AND DISEASES
Dietary deficiency or excess of
iodine plays an imperative role in
oral mucosa

32. Hypothyroidism
 thick lips
 macroglossia
 impacted tooth
 poor periodontal health
 delayed wound healing
 enlarged salivary gland
 glossitis
Hyperthyroidism;
 increased susceptibility to caries
 periodontal disese
 osteoporosis
 burning mouth syndrome
 sjogrens syndrome
 accelerated dental eruption

33. FLUORIDE

34.  96% of fluorides in the body found in bone and
teeth.
 An essential for normal mineralisation of bones and
formation of dental enamel
 Source:
 Drinking water : Fluorine in the drinking water is
0.5 mg per ltr.
 Excess of fl > 3mg causes flourosis.
 Foods: Sea fish, cheese, Tea

35. • Role in prevention of cavities
• Resists acid and dental caries
• Fluoride inhibits bacterial growth that may cause
cavities
• Fluoridated water (1ppm)
Toxicity of Fluoride
• Fluorosis
• Mottling of the teeth in children
• In high amounts can weaken teeth in
children
• Upper Level is 10 mg/day

36.  Dental fluorosis : chalky white teeth, transverse
yellow bands on teeth
 Skeletal fluorosis: severe pain and stiffness in
joints , stiffness in neck and backbone, bow legs

37. Role in Oral Health and Diseases
 Dental decay: Low levels of fluoride in
drinking water.
 Enamel hypoplasia :The excessive
concentrations of fluoride during
calcification stage of the teeth
 The overall effect of excessive fluoride
intake on the dental structure depends on many
factors such as
• concentration of fluoride in drinking water,
stage of calcification of teeth when exposure
occurred, duration of exposure, and amount of
exposure

38. --------------------------------------------------------------------------------------Zinc is present in small amounts in all
tissues of the body.
Total content of the body is 1.4 to 2.3 g.
Sources :
a. Meat
b. Whole grains
c. Legumes.
d. Nuts
ZINC

39. ABSORPTION AND BIOAVAILABILITY
Zinc absorbed mainly from jejunum
 Absorption affected by
• Phytates in diet
• Proteins in diet
• Total zinc content
• Calcium and other divalent ions in diet
• Chronic iron supplementation decreases zinc
absorption
• Fermentation of food digests phytates: zinc
availability increases

41. Functions :
 Part of over 100 enzymes
 Protein and carbohydrate metabolism,
 Bone metabolism
 Oxygen transport.
 Immune response and gene expression.
 Structural constituent of leucocytes
 Role in the synthesis of nucleic acids
 Lymphoid tissue contains zinc.
 Efficient storage of insulin in pancreas.
 Powerful antioxidant.

42. clinical features of zinc deficiency
 Growth retardation
 A delay in sexual and skeletal maturation
 Alopecia
 A failure of appetite/ affects voluntary food
intake
 Appearance of behavioural changes.
 An increased susceptibility to infections (reflects
the development of
defects in the immune system)
 Altered taste
 Delayed wound healing
 Restricts utilization and storage of vitamin A

44. ZINC TOXICITY
Acute zinc poisoning:
 After ingestion of 4-8 g of zinc.
 Nausea, vomiting, diarrhoea, fever and lethargy
 Long-term exposure to high zinc intakes result in
interference With the metabolism of other trace
elements.
 Copper utilization is especially sensitive to an
excess of zinc.
 Copper/zinc interaction may cause copper deficiency
 changes in serum lipid patterns and immune response
have also been associated with zinc supplementation

45. Role in Oral Health and Diseases
 Loss or distortion of taste
 Loss of tongue sensation
 Delayed wound healing
 Zinc plays an important role in cell structure
architecture, maintaining the cell membrane
integrity, and functions of various cytoplasmic
and membrane enzymes
 Increesed susceptibility to periodontal
disease,candidiasis,xerostomia and caries if
deficient during tooth formation.

47. COPPER
An essential trace element:component of many
metallo-enzyme systems
 Role in iron metabolism
 The amount of copper in the adult body is
estimated to be 80 -100mg.
 Sources : Meat, nuts, cereals and fruits are
good sources
RDA of copper :

48. Functions of Copper
• Increases iron absorption
• Formation of connective tissue
• Immune system, blood clot, brain development,
cholesterolmetabolis
Many metalloenzymes contain Copper

49. ABSORPTION:
Decreased with high intakes of
vitamin C, phytic acid, fiber, zinc,
iron, certain amino acids
• Rapid growth increases Cu
demands in infancy.
•The adult body contains
approximately 100 mg of copper –
the highest concentrations are in
liver, kidney,and heart.

50. COPPER DEFICIENCY
 Deficiency : Copper deficiency is rare.
 Hypocupraemia : serum copper level <= 0.8mcg/ml
 in patients with nephrosis
 Wilson’s disease and
 protein energy malnutrition.
 Neutropaenia
 Infants, especially premature, may develop copper
deficiency usually presenting as chronic diarrhoea.
Neutropaenia and later anaemia develop and they do
not respond to iron.
 coronary heart disease and heart-related abnormalities

51.  hypochromic anemia, neutropenia,
hypopigmentation of hair and skin, abnormal bone
formation with skeletal fragility and
osteoporosis, joint pain, lowered immunity,
vascular aberrations
 Bone abnormalities and pain: bone changes in
copper deficiency include a loss of trabecular
formation with thinning of the cortex. There may
be osteoporosis and occipital horn formation

52.  Oral lesions: serum copper levels were significantly
higher in the patients with oral potentially malignant
disorders such as oral leukoplakia and oral submucous
fibrosis and also malignant tumors such as squamous cell
carcinoma.
 In oral submucous fibrosis patients, the serum levels of
Cu gradually increase as the clinical stage of the disease
progresses.
 Cu is also believed to possess caries promoting property.
Role in Oral Health and Diseases

54. CHROMIUM
 Chromium is an essential nutrient that potentiates insulin
action and thus influences carbohydrate, lipid and protein
metabolism.
Sources:
 Processed meats, whole grain products, pulses and spices
are the best sources of chromium
 while dairy products and most fruits and vegetables
contain only small amounts
 Deficiency also associated in infants with PEM
 Requirement: 33 μg/day

55. CHROMIUM DEFICIENCY
 Deficiency produces a state similar to diabetes
mellitus
 So far seen only in patients on long term parentral
nutrition
 Symptoms include:
 Impaired glucose tolerance and glucose utilization
 weight loss
 Neuropathy
 Elevated plasma free fatty acids,
 Depressed respiratory quotient
 Abnormalities in nitrogen metabolism.
 All symptoms alleviated by chromium supplementation

56. CHROMIUM TOXICITY
 Toxicity not seen with excess intake of
trivalent chromium.
 Hexavalent chromium is much more toxic than the
trivalent form
 oral administration of 50 μg/g diet has been
found to induce growth depression together with
liver and kidney damage in experimental animals
 Not seen in humans so far

57. ROLE IN ORAL HEALTH AND DISEASES
 delayed wound healing,
 suppurative periodontitis,
 various oral fungal infections,
 premature periodontal diseases, and
hyposalivation

58. CONCLUSION
 Human body requires certain essential elements in small
quantities and their absence or excess may result in
severe malfunctioning of the body and even death in
extreme cases.
 Essential trace elements directly influence the metabolic
and physiologic processes of the organism.
 Needs for these trace elements are easily met by eating a
variety of foods from the different food groups.

59. REFERENCES
 Textbook of biochemistry-DM VASUDEVAN third edition
 Essentials of biochemistry- U Satyanarayana
 Nutritional Aspects of Essential Trace Elements in Oral
Health and Disease: An Extensive Review