Effect of various nutritional deficiences on growth and development /certified fixed orthodontic courses by Indian dental academy

effect of various nutritional deficiencies on
human
growth and development

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INDIAN DENTAL ACADEMY
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Content

roduction
mponent of nutrient
ssification
bohydrates

teins
amins (a) fat soluble vitamins
(b) water soluble vitamins
nerals

INTRODUCTION

l status of a society varies according to the socioeconomic conditions. In the weste
ritional imbalance is more often a problem accounting for increased frequency of
hile in developing countries of Africa , Asia and south America , chronic malnutriti
s problem in children.
ate diet should provide
, in the form of carbohydrate , fat, protein;
al and non essential amino acid and fatty acids to be used as a building blocks for
hesis of structural and functional proteins
ns and minerals which functions as coenzymes or hormones in vital metabolic pathw


ROLE OF VITAMINS IN GROWTH
AND
DEVELOPMENT
Certain “CRITICAL PERIOD” exist during development of organ
characterized by HYPERPLASTIC AND HYPERTROPHIC
GROWTH
PHASES .Any dietary deficiency during these phases may cause
irreversible changes like growth retardation & orofacial alteration in
humans like:
1.
2.
3.
4.
5.
6.
7.
8.

Cleft lip and Palate
Reduced dental arch dimensions with inadequate spaces
Insufficient dental eruption
Short root and inter osseous rotation of per. Teeth
Shorter mandible in ant. And post. Direction
Reduction in ascending ramus
Dentoalveolar inclinations in the incisor region
Reduction in mesio – distal dimension of 3rd molar

tial nutrients
teins
s
bohydrates
amins
nerals
ter

Component of nutrients

nonessential nutrient
1. dietary fibres


CLASSIFICATIO
N
The nutritional deficiencies may be categories in two type

imary deficiency

(b) secondary

o lake of essential nutrients
in diet.

1. interference with ingestio
2. interference with abs
3. interference with ut
4. increased excretion
5. increased nutritional


deficiency

Primary deficiency
deficiency

secondary

nutritional deficiency
depletion of nutrient
reserves
biochemical changes
functional changes
morphologic lesions and growth
retardation


Protein energy malnutrition

quate consumption of protein and energy as a result of primary dietary deficiencies
ioned deficiency may cause loss of body mass and adipose tissue ,resulting in protein
alnutrition. the primary deficiency is more frequent due to socioeconomic factors
the quantity and quality of dietary intake , particularly prevalent in the developing
of Africa Asia and south America .

iorkor :

mus :

Which is related to protein deficiencies though calorie intake may be
sufficient.
It is a starvation in infants occurring due to over all lack of calorie.


Contrasting features
Kwashiorkor
: Protein deficiency with sufficient
Marasmus
calorie intake

Starvation in infants w
all lack of calories.

Occur in children between 6 month and
3 years of age
Growth failure
Wasting of muscle but preserved
adipose tissue
Oedema , localized or generalized
Enlarged fatty liver
Serum protein low
Anemia present
alternate band of light and dark
bands.

In infants under 1 yea


Growth failure
Wasting of all tissue
muscle and adipose
Oedema absent
No hepatic enlarge
Serum protein low
Anemia present
Monkey like face, prot
Abdomen ,thin lim

Disorder of vitamins

are organics substances which can not be synthesized with in the body and are esse
ance of normal structure and function of cell .Thus , these substance must be provide
uman diet .
eveloping countries, multiple deficiencies of vitamin and other nutrients are comm
alized malnutrition of dietary origin. In the developed country , individual vitam
ies are noted more often.


Fat soluble and water soluble vitamins

ble vitamins are vitamin A,D,E.K. They are absorbed from intestine in the prese
t and intact pancreatic function. Their deficiencies occur more readily due to
l factor ( secondary deficiency) . A state of hypervitaminosis may occur due to
vitamin A and D.

oluble vitamins are C and B complex group . These vitamins are absorb from sma
stine .being water soluble these vitamins are lost due to cooking or processing of f


Vitamin A

roup of related natural and synthetic chemicals that exert a hormone
ty or function.
nt dietary sources of vitamin A are
animal sources : liver , fish, eggs, milks, butter.
plant sources : yellow and leafy green vegetables eg
squash, spinach .
han 90% vitamin a is stored in liver. these reserve are adequate for 6
deprivation.
DFINED FUNCTIONS :
intaining normal vision in reduced light
fferentiation of specialized epithelial cells, mainly mucus secreting
nhancing immunity to infection.

Sign of deficiency
:

kening of corneal epithelium and eye become dry. Condition is called
pthalmia. Its leads to ulceraration of the cornea called keratomalacia ( softening o
ich may cause blindness.
ht blindness : ( nyctalopia) mostly seen in young adults. First sign of night vitamin
deficiencies
imal duct also shows hyperkeratosis . Corneal ulcer may occur which may get
fected and cause keratomalacia .
ots spots may appear which are focal triangular area of opacities due to
accumulation of keratinized epithelium..
us sign: skin develops papular lesions giving toad like appearance ( xeroderma )
sions : a. squamous metaplasia of respiratory epithelium.
b. Squamous metaplasia f pancreatic ductal epithelium .
c. Squamous metaplasia of urothilium.
d. Bone growth is retarded.

On jaws :
Excess of vitamin A during critical growth period markedly
inhibit the neural crest cell development and upset the
normal balance between bone formation and resorption –
CLEFT PALATE
Softening of cleft palate due to decrease in calcium
deposition

On Peridontium :
Leads to keratinizing metaplasia of epithelium .Increased
On teeth :
susceptibility

Deficiency during matrix formationgrowth, shape and
to infection .Disturbances in bone and matrix calcification
leads to ENAMEL HYPOPLASIA (atrophy of ameloblasts) &
texture.
hence increases caries susceptibility.


Hypervitamino
sis

arge dose of vitamin a can produce toxic manifestation in children. These may be a
nd chronic.

toxicity: single large dose of vitamin a. effects include neurological manifestation
ling brain tumour .eg headache, vomiting, stupor , papilloedema.

toxicity : a. neurological such as severe headache and distorted vision due to incr
intracranial pressure
b. Skeletal pains due to loss of cortical bone by increased osteoclasti
activity as well as due to exostosis .
c. Cutaneous involvement may be in the form of pruritus , fissuring,
sores, at the corner of the mouth and coarseness of hair.
d. Hepatomegaly with parenchymal damage and fibrosis .
e. hypercarotenaemia is yellowness of palm and skin due to excessive
of beta carotene containing food.

Vitamin
D

t soluble vitamin exit in 2 activated form
a. Vitamin D2 or calciferol
b. Vitamin D3 or cholecalciferol

2 main sources of vitamin D

(a) endogenous synthesis : 80 % body needs of vit
esis from 7 –dehydrocholestrol widely distributed in oily secretion of the skin.

(b) exogenous sources : such as sea fish , fish oil, egg


Main physiologic function

al absorption of calcium and phosphorus is stimulated by vitamin D.
: vitamin D is required for normal mineralization of epiphysis cartilage and
osteoid matrix . In hypocalcaemia vitamin D work synergistic with
parathyroid hormones and maintain the normal blood level of calcium and phosph
y : vitamin D stimulate reabsorption of calcium at distal renal tubular level.
regulation: it play an immune regulatory role due to presence of receptor for
lites


Lesions in vitamin D deficiencies

ed endogenous synthesis due to inadequate exposure to sunlight.
bsorption of lipids due to lack of bile salts such as intra hepetic biliary obstruction
gement of vitamin D metabolism as occur inkidney disorders.

deficiency of vitamin D from any of the above mechanism results in:

in growing children
malacia in adults
calcaemia tetany due to neuromuscular dysfunction.


Rickets

mary defect in rickets is : mineralization of bone ;
deranged endochondral and intramembranous bone g

ons occur from 6month to 2 years of age
changes

1. crainotabes : it is the earliest bony lesion occurring due to small roun
unossified area in the membranous bone of the skull ,disappearing wit
12 month of birth. The skull look like box or square .
2. Harrison sulcus : appear due to in drawing of soft ribs on inspiration.
3. rickety rosary :it is the deformity of chest due to cartilaginous over gr
at costocondral junction.
4. bow legs : occur in ambulatory children due to weak bone of lower leg
5. knock knees : it may occur due to enlarged ends of femur , tibia, and fi
6. lower epiphysis of radius may be enlarged.
7. lumbar lordosis is due to involvement of the spine and pelvis.

Vitamin D
deficiency
Retarded jaw, teeth and condoyle development
On jaws :
Maxillary dysplasia
Facial sutures difficult to close lead to open
bite
On teeth :
Hypoplastic changes during matrix
calcification
On Peridontium :
Osteoporosis of alveolar bone and cementaL
dysplasia


osteomalacia
Deficiencies in adult

ailure of mineralization of the osteoid matrix
may occur due to following (a) dietary deficiency
(b) poor endogenous synthesis of vit
eature : it is characterized by
(a) muscular weakness
(b) Vague bony pain
(c) fracture following trivial trauma
(d) green stick fracture
(e) psedofracture at weak places in bones


Hypervitaminosis D

mount of vit D causes increased intestinal absorption of calcium and phosphorus, lea
alcimia , hyper phosphatemia and increased bone resorption.

wing effects are seen :
increased urinary excretion of calcium and phosphate .
prediction of renal calculi.
osteoporosis
widespread metastatic calcification.


Vitamin E ( tocopherol)

y act as antioxidant activity . It prevent the oxidative degradation of cell membran
venges free radicals formed by redox reaction in the body .maintain the integrity of
mbrane.

n deficiency :
1) neurons with long axon develop degeneration in the posterior column of spi
2) peripheral nerve may also develop myelin degeneration in the axon ..
3) skeletal muscle may develop denervation.
4) retinal pigmentary degeneration .
5) reduced life span of RBC .
6) sterility in male and female.


Vitamin K

n two form :

vit k 1 or phylloquinine obtain from exogenous sources such as
green leafy vegetables .
vit k 2 or menadion : produced endogenously by normal intestinal f

nction of vit k is in hepatic microsomal carboxilation reaction for vitamin k depend

n vit k : (1) hemorrhagic diseases
(2) hypoprothrombina

f deficiencies
(a)
(b)
(c)
(d)
(e)

hemorrhagic disease of new born
biliary obstruction
malabsorption syndrome .
anticoagulant therapy.
antibiotic therapy.

Vitamin C

c function of ascorbic acid.

(a) hydroxilation of proline to form hydroxiproline
(b) necessary for ground substance of other mesenc
such as osteoid , chondroid sulphate ,dentiin and cement substance of endothilium.
(c) hydroxilation of dopamine to norepinephrine.
(d) maintanance of folic acid level .
vitamin C deficiency :
(a) haemorrhagic diathesis .
(b) skeletal lesions : deranged formation of osteoid matrix
not deranged mineralisation.
(c) delayed wound healing .
(d) anaemia .
(e) lesions in teeth and gums .
( f) skin rashes .

On Teeth :
Essential for dentin matrix formation
which take prior to enamel matrix formation.
Thereby deficiency of vit c
may lead to enamel hypoplasia
deficiency aggravates gingival response to plaque &
worsen edema,enlargement and bleeding .
On Peridontium :
Influence the metabolism of
collagen fibers thereby affect
Regeneration and Repair
It interfere with bone formation & remodelling
Its Study by McCanlies et al

Vitamin B complex

al member of vitamin B complex .
1 . Thiamin ( vit b1)
2. riboflavin ( vit b2 )
3. niacin ( nicotinic acid )
4. pyridoxine ( vit b 6)
5. foliate ( folic acid )
6. cynocobolamin ( vit b 12)
7. biotin
8. pantothenic acid .
9 . choline


Thiamine ( vitamin B1)

logic function is in carbohydrate metabolism , act as coenzyme for carboxylic so a
ate pyruvic acid , synthesizes ATP and synthesis of fat from carbohydrate .

hiamine deficiency .

1.dry beri beri ( peripheral neuritis) : weakness , paraesthesia
sensory loss , polyneuritis , myelin degeneration and fragment of axons
2. wet beri beri ( cardiac manifestation ) : gen oedema , serous
heart is enlarge and
3. cerebral beri beri ( wernicke – korsakoffs syndrome)
a. Wernickes encephalopathy - degeneration of ganglia ce
demyelination and haemorrhage in the region of ventr
aqueduct.
b. korsakoffs psychosis : from brain haemorrhage .


Riboflavin ( vitamin B 2)

logy : it is called yallow respiratory enzyme or
hrome oxidase which is important in cellular respiration .

in riboflavin deficiency :
lesions : vascularisation of cornea , conjunctivitis ,
titial keratitis , and corneal ulcer
osis and angular stomatitis .
ongue : glositis red cyanosed and shiny tongue due to
y of mucosa of tongue .
hanges : scaly dermatitis


Niacin (nicotinic acid)

gy :

1. NAD ( nicotinamide adenine dinucleotide) required for dehydrogenation
in the metabolism of fat , carbohydrate , and protein.
2. NADP ( nicotinamide adenine dinucleotide phosphates ) . It is essential
dehydrogenation in the hexose monophosphate shunt of glucose metab

n niacin : Pellagra ( rough skin)
mainly seen in maize diet person .
dermatitis ; diarrhoea ; dementia


Pyridoxine ( vitamin B6)

ne occur in 3 closely related structure : 1. pyridoxine 2. pyridoxal 3. pyridoxamine

gic function are related to 1. fat metabolism
2 . Protein metabolism .
3. amino acid metabolism.

1. convulsion in infant .
2. dermatitis .
3. cheilosis .
4. glossitis ( bald tongue)
5. sideroblastic anemia .


Folate ( folic acid) / Cynocobolamin ( vit B 12)
ed for Rbc formation so deficiency lead to megaloblastic anemia .

lination of nerve take place leading to hemiplasia or paraplegia


Trace elements

Iron : microcytic hypo chromic anaemia
Copper : muscle weakness ,neurologic defect .
Iodine : goiter and hyperthyroidism .
Zinc : growth retardation , infertility .
Selenium : myopathy ,cardiomyopathy .


Guidelines for evaluation and assessment of
Nutritional status
R.D.A
Physical appearance
Clinical evaluation
Biochemical analysis
Anthropometrical data


Referenc
es

Concise medical physiology by Chaudhary
Text book of pathology by Harsh Mohan.
oral pathology by Shafer .
co journals.


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Leader in continuing dental
education


Effect of various nutritional deficiences on growth and development /certified fixed orthodontic courses by Indian dental academy

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