Nutritional+disorders

The starter kit includes a meal plan with a shopping list that tells you everything you will need to buy. [|diet solution]List the Three Take Away or Big ideas From Carranza =Nutritional Deficiencies=

If a nutritional deficiency is suspected in a patinet during a clinical examination, the patient should be sent to their physician to evaluate their nutritional status. Periodontal disease that is modified by a nutritional deficiency is best determined by a Nutritionist. Although their are common signs and symptoms seen in specific nutritional deficiencies, many of these patients do not exhibit these signs and symptoms so to determine a definitive diagnosis a combination of information is required such as the patients history, clinical and laboratory findings, and therapeutic treatment. Nutrition is the process by which food is used to provide energy and sustain, restore, and maintain tissue of living organisms (Carranza, 2006). As a person ages their risk of developing a nutritional deficiency increases, this occurs mainly because of an unbalanced diet. Diet changes in adults commonly occur due to diseases and medication, as well as their social and economic status. In addition aging causes changes in metabolic, hormonal, and neural changes which are associated with poor quality diets. **Nutritional disorders:** Are caused by two different factors: 1.) The patient has a nutritional deficiency that is by itself is causing gingivitis or periodontitis 2.) Changes in the oral cavity are produced by nutritional deficiencies

Carranza states the majority of research finds that there are no nutritional deficiencies that can cause periodontal disease. In theory an individual who has a nutritional deficiency is less able to combat bacteria as one who is not deficient. There is a debate about what nutritional deficiencies do to oral health. Carranza (2006) states that there are clinicians that think oral signs can be seen with nutritional deficiencies while research does not support this thinking. As clinician we have to consider whether the research conducted is done properly to disapprove the correlation between oral health and nutrition. Nutritional deficiency can cause changes to the oral cavity to the lips, gingiva, bone and oral mucosa. There are three major categories of deficiency water soluble, fat soluble and protein.(Carranza Ch. 12 pages 301-305) == Protein deficiency- accentuates the destructive effects of bacterial plaque and occlusal trauma on the periodontal tissue, but the initiation of gingival inflammation and it's severity depend on the bacterial plaque.
 * Types of water soluble vitamin deficiencies include B-complex vitamins and vitamin ‘C’ also known as ascorpic acid.
 * Some oral manifestations of the B-complex deficiencies include gingivitis, glossitis, glossodynia, angular cheilitis and inflammation of the oral mucosa( Carranza).
 * Clinical manifestations of vitamin C deficiency include hemorrhagic lesions, petechial hemorrhages, delayed wound healing and susceptibility to disease. Oral manifestations would include swollen gingiva that bleeds and loose teeth.
 * Types of fat soluble vitamin deficiencies include vitamin A, D and E.
 * Research with oral affects of vitamin A have been observed with animals include increased pocket depth, hyperkeratosis, hyperplasia of the gingiva and delayed wound healing.
 * Vitamin D deficiency has been observed radiographically by a loss of bone density, partial or complete loss of lamina dura and loss of trabeculae.
 * Deficiency in vitamin E has not been shown to have any great affect on oral disease.

1. Vitamin A deficiency: Vitamin A is used to maintain health of epithelial cells of the skin and mucous membranes. Some other functions of Vitamin A is vision in dim light, mucosal epithelium integrity, tooth development, and endocrine functions. When deficient in vitamin A the results are dermatologic, mucosal, ocular manifestations, night blindness, ecreased color adjustment, keratinization of epithelial tissue, and poor bone growth. Without vitamin A degeneration occurs in epithelial tissues in a keratinizing metaplasia. Therefore vitamin A may play a large role in protecting against invading microorganisms.
 * Fat Soluble Vitamin Deficiency**

2. Vitamin D deficiency: Vitamin D is essential for the absorption of calcium from the GI tract and the maintenance of calcium-phosphorus balance. Deficiency may result in rickets in children and osteomalacia in adults. According to Ibsen & Phelan (2009), osteomalacia is a disease of bone that develops over a long period of time due to the the result of calcium deficiency. Delayed tooth eruption and periodontal disease have been associated with osteomalacia (Ibsen & Phelan, 2009). There could be changes in the trabecular pattern in patients with osteomalacia and pathologic fractures; however, it might be difficult to detect (Ibsen & Phelan, 2009). Treatment for the disease is to first identify the cause of the vitamin deficiency, followed by supplements of Vitamin D and dietary calcium are given. No studies show a correlation between vitamin D deficiency and periodontal disease.

3. Vitamin E deficiency: Vitamin E serves as an antioxidant in order to limit free-radical reactions and to protect cells from lipid peroxidation. There is no correlation between vitamin E deficiency and oral disease, though in rats systemic deficiency appears to accelerate gingival wound healing.

I believe vitamin B complex are water soluble vitamins. GE Vitamin B complex-
 * Water-Soluble Vitamin Deficiency**
 * 1) Thiamine deficiency: Thiamine deficiency usually results from an inadequate diet of vitamin B1. It could also results from alcoholism, prolonged diarrhea, during pregnancy and lactation, and hyperthyroidism. An example of a very serious thiamine deficiency disease is Beriberi. In time of stress such as during pregnancy and malnourished children may develop Beriberi. This vitamin deficiency causes small minute vesicles on the buccal mucosa, under the tongue, or on the palate, erosion of the oral mucosa and hypersensitivity
 * 2) Riboflavin deficiency- severe lesions on the oral mucosa, gingiva, and periodontal tissue, glossitis, sore throat, and angular cheilitis.
 * 3) Niacin deficiency- can result in pellegra which can result in dermatitis, gastrointestinal disturbances, neurologic and mental disorders, glossitis, gingivitis, and generalized stomatitis. Pellegra is sometimes called the "3-D syndrome:" dementia, dermatitis, and diarrhea. If not treated, pellegra can lead to death. Glossitis and stomatitis are the earliest signs. The gingiva may be involved in aniacinosis with or without changes. The most common finding is NUG, usually in areas of local irritation. (Carranza, 2006). In the advanced stages, the mouth, tongue, and lips become red and sore which could interfere with eating.

4. Folic acid deficiency: According to Carranza (2006), folic acid deficiency results in macrocytic anemia. Some signs and symptoms are pallor, weakness, and fatigue. Oral manifestations are glossitis, angular cheilitis, and beefy red tongue.

5. Vitamin C (Ascorbic acid) deficiency: Vitamin C (ascorbic acid) deficiency leads to scurvy or inadequate production of collagen. Vitamin C is essential for wound healing and some common features of scurvy are bleeding, swollen gingiva, and loosened teeth.

According to Carranza (p. 303-304), ascorbic acid may play a role in periodontal disease through one or more of the following suggested mechanisms:

a. Low levels of ascorbic acid influence the metabolism of collagen within the periodontium, affecting the ability of the tissue to regenerate and repair itself.

b. Ascorbic acid deficiency interferes with bone formation, leading to loss of periodontal bone.

c. Ascorbic acid deficiency increase the permeability f the oral mucosa to triated endotoxin and tritiated inulin and of normal human crevicular epithelium to tritiated dextran.

d. Increasing levels of ascorbic acid enhance both the chemotactic and the migratory action of leukocytes without influencing their phagocytic activity.

e. An optimal level of ascorbic acid is required to maintain the integrity of the periodontal microvasculature and the vascular response to bacterial plaque and wound healing.

f. Depletion of vitamin C may interfere with the ecologic equilibrium of bacteria in plaque and increase its pathogenicity. There is no evidence that demonstrates this effect.

One of the signs for Vitamin C deficiency is the change in color of the gingiva to bluish red gingiva that are enlarged and hemorrhagic. However, gingivitis is not caused by Vitamin C deficiency. Gingivitis in Vitamin C deficient patient is caused by bacterial plaque. The deficiency could increase the severity of gingivitis in response to plaque, increasing the likelihood of the gingival tissue being enlarged, edematous, and bleeds on probing. Gingivitis will remain as long as the bacterial factors such as plaque are present (Carranza, p.304.) Regarding periodontal disease, it needs to be stressed that deficiency in Vitamin C also does not cause periodontal disease alone, but bacterial factors. Again, it needs to be understood that being deficient in Vitatmin C could increase likelihood of gingival inflammation which could lead to the destruction of the periodontal ligament and alveolar bone; thus, attachment loss and bone loss.

Lack of protein results in hypoproteinemia with many changes such as "muscular atrophy, weakness, weight loss, anemia, leukopenia, edema, impaired lactation, decreased resistance to infection, slow wound healing, lymphoid depletion, and reduced ability to form certain hormones and enzyme systems" (Carranza, Klokkevold, Newman, & Takei, 2006). Several changes have been observed to the periodontium such as degeneration to the gingival and periodontal fibers, decrease in alveolar bone density, impaired deposition of cementum, atrophy of the tongue epithelium, and delayed wound healing (Carranza, Klokkevold, Newman, & Takei, 2006). Also noted by Carranza, Klokkevold, Newman, & Takei (2006) is the increased destruction of the gingival and periodontal tissues from destructive factors such as plaque. This is because of the formation of tissues are suppressed resulting the inability to heal properly. The periodontal tissues are broken down by the bacterial plaque as well as occlusal trauma.
 * Protein Deficiency**

**References** Carranza, F. A., Klokkevold, P. R., Newman, M. G., & Takei, H. H. (2006). //Carranza's clinical periodontology 10th edition//. St. Louis, MO: Saunders Elevier. Stegeman, C. A., & Davis, J. R. (2010). //The dental hygienist's guide to nutritional care//. St. Louis, MI: Saunders Elsevier. Ibsen, O. A.C. & Phelan, J.A. (2009). //Oral Pathology for the Dental Hygienist// 5th edition. St. Louis, MO: Saunders Elsevier.