Included mico, macro nutrients: daily requirements of all for adults as well as children.Also covered deficiencies related to same and their management
3. Content
1. Introduction
2. Terminologies
3. Classification of Foods
4. Functions of Food & Their Deficiencies
5. Food Group Guides
6. Diet & Dental Caries
7. Types of Diet Survey
8. Diet Counseling
9. Conclusion
10. References 3
4. 1. INTRODUCTION
Through centuries, diet has been recognized important for
human beings in health and disease.
Every part of the body is derived from nutrients contained in
the diet.
A healthy diet should provide us with the right amount of
energy, from foods and drinks to maintain energy balance.
Energy balance is where the calories taken in from the diet are
equal to the calories used by the body.
4
5. We need these calories to carry out everyday tasks such as walking
and moving about, but also for all the functions of the body we may not
even think about.
Processes like breathing, pumping blood around the body and
thinking also require calories.
The nutrients form an essential and continuing component in the
complex process of maintaining optimal health throughout life.
5
6. 2. TERMINOLOGIES
Diet is defined as the types and the amount of food eaten daily by an
individual. (FDI, 1994)
Oxford dental dictionary : referred to as food & drink regularly
consumed.
Nizel (1989): Total oral intake of a substance that provides
nourishment.
NUTRTION:
Nutrition is defined as the sum of processes by which an individual takes
and utilizes food. (FDI, 1994).
6
7. Balanced diet
A balanced diet is one in which each nutrient from each food
group in recommended servings is present for the optimal
functioning of the human.
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 to withstand short duration
of leanness.
7
8. Nutrients
Nutrients are substance that provides nourishment essential for
the maintenance of life & for growth.
There are about 50 different nutrients which are normally supplied
through the foods we eat.
Each nutrient has specific functions in the body.
Types: Macronutrients & Micronutrients
8
9. 3. CLASSIFICATION OF FOODS
By origin:
Foods of animal origin
Foods of vegetable origin
By chemical origin:
Proteins, fats, carbohydrates, vitamins, minerals
By predominant function:
Body building foods – milk, meat, poultry
Energy-giving foods – cereals, sugars, roots
Protective foods – vegetables, fruits, milk
By nutritive value:
Cereals and millets, pulses, vegetables, nuts and oilseeds, fruits, animal foods, fats
and oils, sugars andjiggery.
9
16. Title Protein Energy Malnutrition in India: The Plight of Our Under Five Children
Author
Journal
Dechenla Tshering Bhutia
Journal of Family Medicine and Primary Care.January 2014 : Volume 3 : Issue 1
Abstract Protein energy malnutrition (PEM) is a major public health problem in India. This affects the child at the most
crucial period of time of development, which can lead to permanent impairment in later life. PEM is measured
in terms of underweight (low weight for age), stunting (low height for age) and wasting (low weight for
height). The prevalence of stunting among under five is 48% and wasting is 19.8% and with an underweight
prevalence of 42.5%, it is the highest in the world. Undernutrition predisposes the child to infection and
complements its effect in contributing to child mortality. Lalonde model (1974) is used to look into the various
determinants of PEM in under five children and its interrelation in causation of PEM. The determinants of PEM
are broadly classified under four distinct categories: Environmental factors including the physical and social
environment, behavioral factors, health-care service related and biological factors. The socio-cultural
factors play an important role wherein, it affects the attitude of the care giver in feeding and care practices.
Faulty feeding practice in addition to poor nutritional status of the mother further worsens the situation. The
vicious cycle of poor nutritional status of the mother leading to low birth weight child further exposes the
child to susceptibility to infections which aggravates the situation. However, it is seen that percapita income
of the family did not have much bearing on the poor nutritional status of the child rather lack of proper
health-care services adversely contributed to poor nutritional status of the child. PEM is a critical problem with
many determinants playing a role in causing this vicious cycle of undernutrition. With almost half of under five
children undernourished in India, the Millennium Development Goal (MDG) of halving the prevalence of
underweight by 2015 seems a distant dream.
16
17. Protein and dental caries
Caries in rodents have been reduced significantly by adding
casein to an otherwise cariogenic diet.
Since casein is a phospho-protein, it is possible that phosphate
in this protein compound may have exerted some anti cariogenic
effect.
Several animal studies show that the aminoacids such as lysine
and glycine help prevent caries.
* (Nizel et al 1970 ; McClure et al 1955; Harris et al 1967).
17
21. Preventive Measures
Consume less than 10% of calories from saturated fatty acids and less
than 300 mg/day of cholesterol, and keep trans fatty acid consumption
as low as possible.
Keep total fat intake between 20%-35% of calories, with most fats
coming from sources of polyunsaturated and monounsaturated fatty
acids, such as fish, nuts, and vegetable oils.
When selecting and preparing meat, poultry, dry beans, and milk or
milk products, make choices that are lean, low-fat, or fat-free.
Limit intake of fats and oils high in saturated and/or trans fatty acids,
and choose products low in such fats and oils.
21
23. Fats and dental caries
There is indirect evidence that dietary fats may help prevent caries in
humans.
For example those Eskimos whose diets are almost solely of animal origin
and furnish about 70-80% of their total calories as fat experience less decay.
It is only when the fat content of the diet is reduced to 25% or less that
decay starts to appear.
23
24. 24
Title Dental caries and childhood obesity: analysis of food intakes, lifestyle
Author
Journal
Costacurta M, DiRenzo Sicuro, Gratteri, De Lorenzo, Docimo.
Eur J Paediatr Dent. 2014 Dec;15(4):343-8. Level of Evidence - 4
Aim The aims of this cross-sectional statistical study were to evaluate the association between obesity
and dental caries and to assess the impact of food intake, oral hygiene and lifestyle on the
incidence of dental caries in obese paediatric patients
Method A sample of 96 healthy patients, aged between 6 and 11 years (mean age 8.58±1.43) was classified
in relation to body composition assessment and McCarthy growth charts and cut- offs. Body
composition analysis, to obtain body fat mass (FM) and body fat free mass (FFM) measurements,
was determined by means of a DXA fan beam scanner. The subjects underwent dentalexamination
to assess the dmft/DMFT, and completed a questionnaire on food intake, oral hygiene habits and
lifestyle. The sample was subsequently subdivided into four groups: Group A (normal weight -
caries-free), Group B (normal weight with caries), Group C (pre-obese/obese - caries-free), Group D
(pre-obese/obese with caries)
Result The mean surface area of type I and II etching pattern values for Group- I was 39608.18 μm2 and
Group- II was 45051.34 μm2.
Conclusion This study shows a direct association between dental caries and obesity evident from a correlation
between prevalence of dental caries and FM%. The analysis of food intake, dmft/DMFT, FM%,
measured by DXA, demonstrates that specific dietary habits (intake of sugar-sweetened drinks,
frequency of sugar intake limited to main meals, frequency of food intake between meals) may be
considered risk factors that are common to both dental caries and childhood obesity.
33. d. Vitamins
These are micro- nutrients.
Vitamins do not yield energy but enable the body to use other nutrients.
Vitamins are divided into 2 groups
1. FAT SOLUBLE VITAMINS - A D E and K
2. WATER SOLUBLE VITAMINS – B and C
33
34. Vitamin A
RETINOL, RETINOIC ACID
FUNCTIONS- Contributes to the formation of retinal pigments which are needed
for vision.
Necessary for maintaining the integrity and normal functioning of glandular and
epithelial tissue which lines intestinal, respiratory and urinary tracts as well as
skin.
It supports growth especially skeletal growth.
It helps in building up immune response.
May prevent epithelial cancers.
Promotes bone remodeling, normal reproduction, health of oral structures.
VITAMIN A DEFICIENCY AND ITS CONSEQUENCES A field guide to detection and control WHO 34
35. Sources
Animal Foods- Liver, Eggs, Fish, Meat, Cod Liver Oil
Plant Foods- Green Leafy Vegetables, Yellow Fruits, carrot.
Fortified Foods- Vanaspati, Margarine, Cheese, Icecreams.
35
INDIVIDUAL TIMING
CHILDREN < 12 MONTHS
ORAL DOSE OF
RETINOL PALMITATE
55 mg ONCE EVERY 4 MONTHS
CHILDREN > 12 MONTHS 110 mg ONCE EVERY 6 MONTHS
NEW BORN 28 mg AT BIRTH
DELIVERED MOTHERS 165 mg WITHIN 1 MONTH OF
GIVING BIRTH
PREGNANT AND
LACTATING MOTHERS
11 mg ONCE EVERY WEEK
VITAMIN A PROPHYLAXIS SCHEDULE
36. VITAMIN A DEFECIENCY AND ORAL DISEASE
Vitamin A deficiency produces hyperkeratosis and hyperplasia of gingiva.
Disturbs the function of ameloblasts and hence retards enamel formation.
Leads to crowding of teeth.
Reduces salivary flow and increases chances of dental caries.
Epithelial metaplasia of oral mucous membrane.
Excess of vitamin A causes enlarged liver and spleen, yellow orange discoloration of
skin and oral mucosa, and sclera of eyes.( hyper carotenemia).
VITAMIN A DEFICIENCY AND ITS CONSEQUENCES A field guide to detection and control WHO
36
37. XEROPHTHALMIA
Means dry eyes.
Serious nutritional disorder due to vitamin A deficiency.
Can cause blindness in children below 3 yrs.
Risk factors include poor nutrition, ignorance, faulty feeding
practices, infections particularly measles and diarrhea.
VITAMIN A DEFICIENCY AND ITS CONSEQUENCES A field guide to detection and control WHO
37
Laboratory investigations: Retinol level blood
test
Normal: 15 to 60mg/dl
38. MANAGEMENT OF VITAMIN A DEFECIENCIES
Groups Retinol
B-
Carotene
Adults
600-
800mcg
3000mcg
Infants 350mcg
500mcg
700mcg 2400mcg
2000mcg
1200mcg
Children
Adolescence
VITAMIN A DEFICIENCY AND ITS CONSEQUENCES A field guide to detection and control WHO
38
39. Vitamin B1
Also called thiamine.
SOURCES
Whole grains, cereals, wheat, grams, yeast, pulses ,oil seeds, nuts,
meat, fish, eggs, vegetables, milk, fruits.
Thiamine is lost during milling of rice, washing and cooking rice.
Thiamine in fruits is lost due to storage.
NORMAN JOLLIFFE. THE DIAGNOSIS, TREATMENT, AND PREVENTION OF VITAMIN B1 DEFICIENCY 39
40. RECOMMENDEDALLOWANCE
Daily requirement of thiamine is 0.5 mg per 1000 k cals
of energy intake.
NORMAN JOLLIFFE. THE DIAGNOSIS, TREATMENT, AND PREVENTION OF VITAMIN B1 DEFICIENCY
40
Laboratory investigations: Whole blood test
Normal: 2.5 to 7.5μg/dl
41. NORMAN JOLLIFFE. THE DIAGNOSIS, TREATMENT, AND PREVENTION OF VITAMIN B1 DEFICIENCY
41
42. • VITAMIN B1DEFECIENCY
BERIBERI –
DRY FORM( NEURAL),
WET(CARDIAC),
INFANTILE FORM
ORAL MANIFESTATIONS include sensitivity of oral mucosa,
burning tongue, loss of taste.
NORMAN JOLLIFFE. THE DIAGNOSIS, TREATMENT, AND PREVENTION OF VITAMIN B1 DEFICIENCY
42
Tongue in BERIBERI
43. PREVENTION
Diet modification and avoidance of alcohol.
NORMAN JOLLIFFE. THE DIAGNOSIS, TREATMENT, AND PREVENTION OF VITAMIN B1 DEFICIENCY
43
Management
The treatment of vitamin B1 deficiency consists of rest, diet,
vitamin B1 supplements, and correction of the factors
responsible for the deficiency.
daily supplement of either 2 mg.
Rs. 112
44. Vitamin B2
Riboflavin has a fundamental role in cellular oxidation.
It is a cofactor in number of enzymes involved with energy
metabolism.
Helps in the metabolism of carbohydrates, proteins, and fats.
SOURCES
Milk, eggs, liver, kidney, green leafy vegetables, fish, cereals,
pulses, almond, soybean & broccoli.
REQUIREMENT
Daily requirement 0.6 mg per 1000 k cal of energy intake.
Ranjodh Singh Gill. Riboflavin Deficiency. 44
46. Management
Riboflavin replenishment
Dosages of riboflavin for deficiency treatment are as follows:
Age < 3 years: not established
Age 3-12 years: 3-10 mg PO divided daily
Age >12 years: Administer as in adults (see below)
Adult dose: 6-30 mg PO divided daily for replacement when
deficiency is suspected
Ranjodh Singh Gill. Riboflavin Deficiency.
46
Lab Investigation
Levels of urinary catecholamines & red
blood cell glutathione reductase activity
47. Vitamin B3
Also Known as Niacin or Nicotinic Acid
Niacin or Nicotinic acid is essential for metabolism of carbohydrate, proteins,
and fat.
It is also essential for normal functioning of skin, intestinal and nervous
system.
It is not excreted in urine, but is metabolized to at least 2 major methylated
derivatives N- METHYL NICOTINAMIDE and N- METHYL PYRIDONES.
SOURCES
Liver, kidney, meat, fish, legumes, cereals, maize.
Requirement
6.6 mg / 1000 k cal of energy intake
47
48. Vitamin B3
Deficiency
PELLAGRA – dermatitis, diarrhea,
dementia. Glossitis
Stomatitis
Depression and irritability
PREVENTION
improval of living conditions
diet modification
48
49. Management
The ideal dosage is 250-500 milligrams per day.
Side Effects
low blood pressure
irregular heartbeat
worsening liver disease
Essentials of pediatrics by OP Ghai 7th Edition 49
50. Vitamin B6
Also called as PYRIDOXINE
Exists in 3 forms PYRIDOXINE, PYRIDOXAL, PYRIDOXAMINE.
Plays an important role in the metabolism of amino acids, fats, and
carbohydrates.
Widely distributed in milk, liver, meat, fish, cereals, vegetables, legumes.
Pyridoxine deficiency is associated with peripheral neuritis, convulsions and
rashes on the nasolabial fold.
daily requirement is 2 mg per day.
Mary J. Brown; Kevin Beier Vitamin B6 Deficiency (Pyridoxine)
50
51. Fetal brain development requires adequate B6, and this
continues throughout infancy.
As a coenzyme, B6 is involved as a cofactor in over 100 enzyme
reactions including amino acid metabolism, particularly
homocysteine; carbohydrate metabolism, including
gluconeogenesis and glycogenolysis; and lipid metabolism.
B6 has a role in cognitive development through neurotransmitter
synthesis, immune function with interleukin-2 production, and
hemoglobin formation.
Mary J. Brown; Kevin Beier Vitamin B6 Deficiency (Pyridoxine) 51
52. Required Allowance
RDA or recommended dietary allowance for B6 in adults is 1 to
1.7mg per day.
Children ages 1 to 3: 0.5 mg per day.
3 to 13 are recommended to have 1 mg per day.
During pregnancy and lactation: 1.9 mg and 2 mg per day.
Excessive amounts exceed 250 mg per day and, on a chronic basis,
may result in toxicity leading to untoward effects on skin, GI, and
the neurologic system.
Mary J. Brown; Kevin Beier Vitamin B6 Deficiency (Pyridoxine) 52
53. Vitamin B6 Deficiency
Vitamin B6 deficiency may present with seizures in the young.
Severely deficient adults commonly present with rashes and mental status
changes.
Additional clinical findings of deficiency may include normocytic anemia, a
nonspecific pruritic rash, cheilitis with scaly lip skin and cracks in the corner of
the mouth and glossitis (swelling of the tongue).
Depression is associated with a severe B6 deficiency as well.
Mary J. Brown; Kevin Beier Vitamin B6 Deficiency (Pyridoxine) 53
Vitamin B6 Deficiency
Laboratory Investigations
Direct serum measurement of the active vitamin Pyridoxal 5′-phosphate
(PLP)
54. • Management of Vitamin B6 Deficiency
treatment dosage is variable and depends on the severity of
symptoms.
The vitamin is available therapeutically in both oral and
parenteral formulations.
Neonates with B6 deficiency seizures may require 10 to 100 mg
intravenous (IV) for effective treatment of active seizures.
Less serious or less acute presentations can be supplemented
with doses ranging from 25 mg to 600 mg per day orally
depending on symptom complex.
Mary J. Brown; Kevin Beier Vitamin B6 Deficiency (Pyridoxine) 54
Rs. 143
55. Vitamin B12
Also known as cobalamin.
Vitamin B 12 is a complex organo – metallic compound with a cobalt atom.
Helps in the synthesis of DNA.
Maintains the myelin sheath around the nerve fibers.
• SOURCES
Liver, meat, fish, eggs, Vegetables
DAILY REQUIREMENTS
NORMAL ADULTS – 1mcg per day
PREGNANCY – 1.5mcg per day INFANTS – 0.2mcg per
day
55
56. • Vitamin B12 Deficiency
Pernicious anemia
folate deficiency anaemia
Weakness and tingling in extremities.
Ankle swelling, difficulty in walking, peripheral
neuritis.
Bright, smooth beefy red tongue.
Headache
Pale skin
Loss of Appetite & weight loss
56
57. Management of Vitamin B12 Deficiency
Depends on cause of condition
Replacing vitamin by injections or tablets (hydroxocobalamin)
Initial- injections alternate day for a week
Tablets everyday between meals & hydroxocobalamin injection twice a
year
People who follow vegan diet- B12 tablets for life
Dairy products in daily diet
Neurological cause- injection every two months
57
60. Vitamin C
Also Known ascorbic acid.
Sources
Fresh fruits, green vegetables, amla, Guava,
Sprouts, Pulses, Tomatos.
Functions
Helps in tissue oxidation
Formation of body collagen
Provides matrix for the blood vessels
Maintains integrity of the bones and capillaries
Facilitates absorption of iron
Inhibits nitrosamine formation from intestinal
mucosa
Prevention against common cold and infections.
60
61. Daily requirement is around 30 – 40 mg per
day
Vitamin C Deficiency
Scurvy – swollen and bleeding gums
Delayed wound healing
Anemia and weakness
61
Rs 213
63. Vitamin D
The nutritionally important forms of vitamin D in man are ERGO
CALCIFEROL (V D2)and CHOLECALCIFEROL (V D3).
Calciferol may be derived from irradiation of plant sterol, ergo
sterol.
Cholecalciferol is naturally occurring.
It is also derived from exposure to UV rays of sunlight which
convert the cholesterol of skin to vitamin D.
Vitamin D is stored largely in fat deposits.
63
64. Sources:
Liver, egg, yolk, fish, meat, cheese, butter, Sunlight.
Functions:
Promotes intestinal absorption of calcium and phosphorous.
Stimulates bone mineralization, collagen maturation.
Increases tubular re-absorbtion of calcium and phosphorous.
Permits growth of the tissues.
Maintains serum calcium and phosphorous levels.
64
65. Daily Requirements:
ADULTS – 2.5 mcg
INFANTS – 5.0 mcg
PREGNANCY – 10 mcg
Laboratory investigations: Vitamin D blood test
Normal: 20-50ng/ml
Less than 12 ng/ml indicates vit. D deficiency
65
66. Vitamin D Deficiency
RICKETS
Observed in young children between 6 months to two years.
There is reduced calcification of growing bones.
Disease is characterized by growth deformity,
Muscular hypotonia, tetany, convulsions.
There is elevated level of serum alkaline phosphatase.
Bony deformities include curved legs, pigeon chest.
66
67. Osteomalacia
It occurs in adults especially women during pregnancy and
lactation when VITAMIN D needs are not met.
Bone deformity and joint pains are the most common
symptoms.
legs bend creating a waddling gait.
Excitability of the nerves (tetany) may develop.
67
69. Vitamin E
Vitamin E serves as a biological antioxidant and protects cells from
destruction.
Fat soluble
Stored in liver before released into blood stream
Comes in Eight chemical forms
Daily requirement of Vitamin E is 0.8 mcg per day.
Sources:
69
70. Vitamin E deficiency
Deficiency of Vitamin E is rare in humans, might cause anemia in infants if Vitamin
E stores is depleted.
Vitamin E deficiency may cause derangement of ameloblasts.
Muscle weakness, co-ordination & walking difficulties, numbness &
tingling, vision deterioration, low immunity.
Causes: Genetic & Medical Conditions
70
71. Management of Vitamin E deficiency
Vitamin E supplement- Newborns & premature babies through tube in
stomach or Iv Administration.
Children & adults- if condition is inherited require high doses vitamin E.
Diet- vegetable oil (wheat germ oil, peanut oil, olive oil)
Nuts, seeds, milk, whole grains, spinach, swiss cheese, red peppers &
avocado.
71
72. Vitamin K
Vitamin K occurs in 2 forms K1 and K2.
K1 occurs in green plants, K2 is produced by bacterial synthesis in the
intestine.
Vitamin K3, a synthetic form of vitamin is known as MENADIONE.
FUNCTIONS
The primary function of vitamin K is to catalyze the synthesis of blood
clotting factor, prothrombin by the liver.
Vitamin K is helpful in treating HEMOPHILIAC patients.
vitamin K is also essential in production of other clotting factors like
FACTOR 7 ,FACTOR 9 and FACTOR 10.
72
73. Daily requirement: 0.03 mg/kg body weight.
Symptoms
Easy bruising, oozing from nose or gums.
Bleeding from GIT
Prolonged clotting time and bleeding time.
Gingivitis and periodontal disease.
Blood in urine or stool.
Lab Investigations: Prothrombin Time
Normal: 11 to 13.5 seconds
73
74. Management of Vitamin K deficiency
Drug Phytonadione adult dose- 1-25 mg.
Infants: single shot 0.5 to 1mg at birth.
Prevention:
Nutrients 120mg for male & 90mg for female.
Leafy green vegetables
74
75. 75
NUTRIENT METHOD OF TEST NORMAL VALUE
VITAMIN A SERUM RETINOL TEST 20 mcg/dl
THIAMINE TPP STIMULATION OF RBC ACTIVITY 1.00-1.23
RIBOFLAVIN RBC GLUTATHIONE ACTIVITY 1.0-1.2
NIACIN URINE N-METHYL NICOTINAMIDE Not reliable
FOLATE SERUM FOLATE 6.0 mcg/ml
VITAMIN B12 SERUM VITAMIN B12 CONCENTRATION 160 mcg/ml
VITAMIN C LEUCOCYTE ASCORBIC ACID 160 mg/l
VITAMIN K PROTHROMBIN TIME 11-16 secs
PROTEIN SERUM ALBUMIN CONCENTRATION 35g/l
76. Vitamins and dental caries
In Vitamin A deficient animals, atrophic changes in the ameloblasts,
subsequent abnormalities in tooth morphology has been observed.
In man, severe Vitamin A deficiency during tooth formation does not
necessarily lead to defective enamel.
76
77. 77
Title Assessment of Vitamin B12 and Its Correlation with Dental Caries and Gingival Diseases in
10- to 14-year-old Children: A Cross-sectional Study
Authors
Journal
Shivayogi M Hugar, Neha S Dhariwal, Andleeb Majeed, Chandrashekhar Badakar, Niraj
Gokhale, Laresh Mistry
International Journal of Clinical Pediatric Dentistry, April-June 2017;10(2):142-146
Results Vitamin B12 levels were deficient in 64% of the children. In boys, vitamin B12 deficiency was
found in about 76.2%, whereas, in girls it was 57.1%, which was not statistically significant.
The vitamin B12 deficient children showed a significantly high DMFT scores than the children
with normal vitamin B12 levels. The Pearson’s correlation was –0.614 for DMFT, PI value –0.663,
and GI value of –0.477. The negative correlation stated that there was a reverse relation
between these indices and vitamin B12.
Conclusion In children with systemic vitamin B12 deficiency, there is increased dental caries prevalence
and associated gingival problems.
78. e. Minerals
CLASSIFICATION
Major Minerals: Calcium, Phosphorous, Sodium, Potassium,
magnesium
Trace Elements: These are the elements required by the body in
quantities less than a few milligrams per day, ex: Iron, Iodine, Fluorine,
Molybdenum, Selenium, Nickel, zinc, Tin, Silicon, Chromium, Copper.
Trace Elements With No Known Function: Lead,mercury,
Aluminum.
78
79. i. Calcium
Calcium is a major element of the body.
98% of calcium is found in bones.
Amount of calcium in blood is 10 mg/dl.
The dynamic equilibrium between calcium in blood and that in skeleton is
maintained by the interaction of vitamin D, Parathormone, calcitonin.
Daily requirement of calcium is around 400 mg to 500 mg.
SOURCES
Milk and milk products
Green leafy vegetables, Cereals, Fruits, Eggs and fish.
Diet and nutrition in pediatric dentistry. Teresa A. Marshall. Dent Clin N Am 47 (2003) 279–303
79
80. Functions of Calcium
Provides rigidity and strength to bones and teeth.
Calcium is deposited in the trabeculae of long bones as a store to release
during pregnancy and lactation.
Calcium plays an important role in blood coagulation, muscle contraction,
myocardial action, and neuro muscular irritability and is responsible for
integrity of various membranes.
Diet and nutrition in pediatric dentistry. Teresa A. Marshall. Dent Clin N Am 47 (2003) 279–303
80
81. ii. Phosphorous
Phosphorous is the second most abundant mineral in the body after calcium.
Phosphorous is found in bones, enamel, red blood cells, plasma.
FUNCTIONS
Formation of bone and tooth mineral.
Absorption and transport of nutrients.
Regulates acid – base balance.
Energy released due to metabolism of carbohydrates, fats and proteins is
accomplished by phosphates (ADP).
Phosphates play an important role in cell protein synthesis. It is a part of
DNA and RNA.
Diet and nutrition in pediatric dentistry. Teresa A. Marshall. Dent Clin N Am 47 (2003) 279–303
81
82. Daily Requirement: 800 – 1200 mg for adults
9-18 years: 1250 mg
4- 8 years: 500 mg
1-3 years: 460 mg
7-12 months: 275 mg
0-6 months: 100 mg
Sources: meat, fish, eggs, milk, nuts, legumes, cereals, potato,
garlic, dried fruits.
Excess dietary phosphorous in animals will increase bone loss
and bone porosity, significantly decrease bone mineral and cause
calcification of kidney, tendons, heart and thoracic aorta
Diet and nutrition in pediatric dentistry. Teresa A. Marshall. Dent Clin N Am 47 (2003) 279–303
82
83. iii. Magnesium
Adult human body contains 30 to 65 g of magnesium.
It is the third most abundant mineral in teeth.
Recommended daily dietary allowance for normal adults is 350 mg
for males and 300 mg for females.
Magnesium is present in enamel and dentin but more in dentin.
Best food sources of magnesium are whole grains, nuts,
soybeans, green leafy vegetables, spinach.
Diet and nutrition in pediatric dentistry. Teresa A. Marshall. Dent Clin N Am 47 (2003) 279–303
83
84. FUNCTIONS
Magnesium is essential for cellular respiration, functioning chiefly as an
activator for numerous important coenzymes such as Cocarboxylase
and Co enzyme A.
Plays an important role in synthesis of carbohydrates, fats and proteins.
Helps in regulation of acid base balance of the body and transfer of
water in and out of cells.
DEFICIENCY
Magnesium deficiency causes malabsorption, acute diarrhea, renal failure, weakness,
tremors, convulsions, hyper excitability.
Diet and nutrition in pediatric dentistry. Teresa A. Marshall. Dent Clin N Am 47 (2003) 279–303
84
85. iv. Iron
• The adult human body contains between 3-4 g of iron, of which 60-70 % is present in
blood as circulating hemoglobin and the rest is stored as storage iron.
• Each gram of Hemoglobin contains 3.35 mg of iron.
FUNCTIONS
Iron is necessary for formation of hemoglobin, brain development and function.
Iron regulates body temperature and muscle activity.
Iron improves immune system as it increases the production of T CELLS.
It helps in the production of antibodies.
Iron binds oxygen to blood cells, and helps in oxygen transport and cell
respiration.
Diet and nutrition in pediatric dentistry. Teresa A. Marshall. Dent Clin N Am 47 (2003) 279–303
85
86. SOURCES:
There are 2 types of iron, haem iron and
non haemiron.
Haem iron is better absorbed than non
haem iron.
Foods rich in haem iron are liver,
meat, poultry, fish. Iron content in
milk is very low.
Foods containing non haem iron are
green leafy vegetables, legumes, oils,
nuts, legumes, jaggery, dry fruits.
Diet and nutrition in pediatric dentistry. Teresa A. Marshall. Dent Clin N Am 47 (2003) 279–303
86
• 0.7 mgInfants
• 1.0 mgChildren
• 2.0 mgAdolescence
• 1.0 mgMale adults
• 3.0 mgFemale Adults
• 1.5-3.0 mgPregnancy
• 2.5 mgLactation
87. IRON DEFICIENCY
3 stages of iron deficiency are identified.
Decreased storage of iron without any detectable
abnormalities.
Intermediate deficiency of iron stores getting exhausted but no
evidence of anemia.
Overt iron deficiency with decreased hemoglobin
concentration.
Iron-deficiency anaemia: hypochromic microcytic
anemia characterized by low serum iron, increased
serum iron-binding capacity, decreased serum ferritin,
and decreased marrow iron stores.
Diet and nutrition in pediatric dentistry. Teresa A. Marshall. Dent Clin N Am 47 (2003) 279–303
87
88. Trace elements and dental caries
Caries promoting elements : Selenium, magnesium, Cadmium, Platinum, Lead, Silicon.
Elements that are mildly cariostatic: Molybdenum, Vanadium,Strontium, Calcium,
Boron, Lithium, Gold.
Elements with doubtful effect on caries: Beryllium, Cobalt, Manganese, Tin, Zinc,
Bromine, Iodine.
Caries inert elements : Barium, aluminum, nickel, iron, palladium, titanium.
Elements that are strongly cariostatic: Fluorine, phosphorous.
Diet and nutrition in pediatric dentistry. Teresa A. Marshall. Dent Clin N Am 47 (2003) 279–303
88
89. Management of Iron Deficiency Anaemia
Children: One tablet of iron and folic acid containing 20 mg of
elemental iron (60 mg of ferrous sulphate) and 0.1 mg of folic
acid should be given daily.
Mothers: One tablet of iron and folic acid containing 60 mg of
elemental iron (180 mg of ferrous sulphate) and 0.5 mg o folic
acid should be given daily
Diet and nutrition in pediatric dentistry. Teresa A. Marshall. Dent Clin N Am 47 (2003) 279–303
89
90. Nutritional Aspects of Essential Trace Elements in Oral Health and Disease: An Extensive Review, Tomar
P Bhattachary, Misra S, Hussain M. Hindawi Publishing Corporation scientifica Volume 2016, Article ID
5464373.
90
91. v. Fluorides
Fluorine a trace element, is a halogen and a very reactive gas.
It is not found in free elemental form in nature.
appears in a compound form.
DIETARY SOURCES:
Drinking water- 1 ppm,
Sea foods- 2 ppm – 10 ppm
Vegetables like jowar, banana, potato and tubers- 0.3 ppm – 1 ppm.
Tea leaves- 75 – 100 ppm
Wine and beer- 0.2 ppm – 0.9 ppm
Cereals- 0.15 ppm – 3 ppm.
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92. Benefits of Fluoride
Fluoride is known to prevent dental caries formation.
Mechanisms involved in prevention of dental caries are
1} an increase in the enamels resistance to acid solubility as a result of high concentration
of fluoride in outer enamel surface,
2} ability to remineralize demineralized and hypo mineralized enamel,
3} fluorides anti bacterial effects on plaque growth, glycolysis, glycogen synthesis,
acid production
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93. ENDEMIC FLUOROSIS OR MOTTLED ENAMEL
Mottled enamel is characterized clinically as white or brown spotty
staining of tooth enamel surfaces due to exposure of tooth surfaces
to high concentrations of fluoride{2 ppm or more.
SKELETAL FLUOROSIS
At fluoride water levels over 8 ppm skeletal fluorosis develops.
Severe pain in bones, joints, hips, stiffness in joints and spine.
Outward bending of legs hands in advanced stages called as
KNOCK KNEE SYNDROME can occur.
Pregnant ladies, lactating mothers and children are the most
vulnerable group.
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96. Vegetables include carrots, broccoli, beans, peppers,
lettuce, and tomatoes
green, orange, and red – vary your colors for the best
balance of vitamins and nutrients
Children need 2½ cups of vegetables a day
Fruits contain a wide variety of vitamins
Fruit like pineapples apples,
oranges, peaches, apricots,
and pears are readily available
Children need 1½ cups of fruit every day
96
97. • Some examples of grains are:
oatmeal, wheat, rye, and barley.
• Whole grain wheat bread is
better for you than white bread.
• Children should have 6 servings
of grains a day.
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98. • Calcium rich foods include milk
and cheese.
• Calcium builds strong bones
and teeth, and helps your
muscles become stronger.
• Children need 3 cups of milk or
cheese a day.
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99. • Meats and beans give you protein
to grow strong muscles and improve
brain function
• Chicken , meat , fish, sea food ,etc.
• Children need 5 ounces of protein
a day
99
100. Food Group Guide
Definition:
Is a guide of healthy foods divided into sections to show the
recommended intake for each food groups.
Basic Seven
Basic Four
Five Group Guide
Food Pyramid
My Plate
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101. Basic Seven
1943, during World War II, The USDA introduced
a nutrition guide promoting the "Basic 7" food
groups to help maintain nutritional standards
under wartime food rationing .
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FOOD GROUP
Green and yellow-Vegetables
Orange -Tomato, grape fruits
Potato and other vegetables and fruits
Milk and milk products
Meat ,poultry, fish or egg
Bread, flour and cereals
Butter and fortified margarine
102. Basic Four
1992 the United States Department of
Agriculture recommended its "Basic Four" food
groups.
"Other foods" were said to round out meals and
satisfy appetites.
These included additional servings from the
Basic Four, or foods such as vegetables and
fruits , milk , meat, cereals and breads.
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103. Five Group Guide
In 1979 USDA recommended a five
food groups daily food guide.
In the five food groups guide fats,
sweets and alcohol groups were
added to the basic four.
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104. Food Guide Pyramid
104
Food Servings
Vegetables 3 to 5
Fruits 2 to 4
Milk, Yogurt And
Cheese
2 to 3
Meat, Poultry, Fish,
Dry Beans, Eggs, And
Nuts
2 to 3
Fats, Oils And Sweets 0 to 1
Bread, Rice 6 to 11
The introduction of the USDA's food guide pyramid in
1992 attempted to express the recommended servings of
each food group Inside each group were several images
of representative.
105. My Plate
My Plate is the current nutrition guide
published by the United States
Department of Agriculture consisting of a
diagram of a plate and glass divided into
five food groups . It replaced the
USDA's MyPyramid diagram on June 2,
2011, ending 19 years of food pyramid
iconography.
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112. 8. DIET COUNSELLING
Optimal growth and development are the primary objectives of
pediatric nutrition.
Food is merely a vehicle for nutrient delivery; the nutrients
provide energy for growth, serve as structural components, and
participate in all metabolic functions of the body.
Dietary counselling can help putting a healthy diet in place, for an
individual and/or a family, losing weight, or simply feeling better
by eating better.
Textbook of paediatric dentistry by Nikhil Marwah 3rd Edition
112
113. Patient Selection
Food Diary
Calculation of dental Health Diet Score
Communication Techniques
Interviewing
Teaching & learning
Counselling
Motivation
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113
114. • Patient selection
When providing dietary counseling in pediatrics, identification of the ‘patient’’
requires careful consideration.
Individual recommendations are appropriate during infancy and the transition stage
of infant nutrition when dietary patterns and food choices differ sufficiently from
other family members.
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Diet and nutrition in pediatric dentistry. Teresa A. Marshall. Dent Clin N Am 47 (2003) 279–303 114
• Food Diary
Record of all food & beverages consumed during a specific period.
Patient is instructed to be as accurate as possible in determining quantities & to
record in detail eaten or drunk during or in between meals.
It can be 24 hour, 3 days, 5 days or one week diary.
118. • Calculation
of dental
health diet
score
Simple scoring procedure that can
disclose a potential dietary
problem that is likely to adversely
affect dental health.
Textbook of paediatric dentistry by Nikhil Marwah 3rd Edition
118
119. Communication Techniques
Basic tool in paediatric practice.
It is giving and receiving information which involves knowledge, thoughts,
opinion of patient as well as counselor.
Necessary to give diet counselling when indicated.
Communication can be verbal or non verbal.
To communicate with the patient a combination of interviewing, teaching,
counselling & motivation is used.
Interviewing: To understand the problem, contributing factors & patients
personality.
Serves as a valuable diagnostic aid.
Ask questions that will encourage the patient.
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Diet and nutrition in pediatric dentistry. Teresa A. Marshall. Dent Clin N Am 47 (2003) 279–303 119
120. Teaching & Learning: Educate patient more than just giving
information.
Use of teaching aids e.g. booklet on nutrition, dental health.
Counselling: Can be directive or non directive
Textbook of paediatric dentistry by Nikhil Marwah 3rd Edition
120
-Parents role passive
-Decisions made by
counsellor
-Parents can make his/
her decisions
-counsellor provides
guidence
• Non directive type of counselling is recommended for diet
counseling
121. • Guidelines for counselling
Not the counsellor but patient is responsible for making changes in food
selection & eating habits.
1. Gather information: Personal identifying data, likes, dislikes & patients
perception.
2. Evaluate & interpret Information: Relative adequacy of diet & eating habits.
3. Develop & Implement a plan of action: Qualitative modification of the diet
4. Seek active participation of the patients family in all aspects of dietary
changes.
5. Follow up to assess the progress made.
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Textbook of paediatric dentistry by Nikhil Marwah 3rd Edition
122. Pre requirements of Counselling
Elicit a true response: if the counsellor is hoping for truthful responses to his
questions, he must follow some simple rules.
It is important to give neither positive nor negative response when the patient
is recalling his intake.
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Counselling Visits
1. Step 1: Pursue diary for completion
2. Step 2: Determine daily routine
3. Step 3: Explain cause of decay
4. Step 4: Isolate sugar factor
5. Step 6: Determine adequacy of diet
6. Step 7: Diet Prescription & Suggested menu
7. Step 8: Reinforcement for follow-up.
Motivation
Textbook of paediatric dentistry by Nikhil Marwah 3rd Edition
124. Conclusion
• Diet counselling makes the patient aware of the fact that diet plays an
important role in prevention & treatment of the disease.
• With today’s emphasis on prevention of disease, diet counselling helps to
reduce the risk of some illness by appropriate counselling.
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