1. Seminar about :
Trace Elements And Dental Health
Submitted by : Marwan Ramadan
5th BDS
University Of Mousal
College Of Dentistry
POP Dep.

2. Introduction
The human body contains elements that can be classified as
1. abundant elements
2. trace elements

3. Introduction
What are the Abundant 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. Introduction
What are the trace elements ?
 Trace elements or micro-nutrients are chemical elements required in
minute amounts,
 usually as part of a vital element.
 There are 19 trace elements divided into three groups (WHO
classification):
1. Essential elements
2. Probably essential elements
3. Potentially toxic elements

5. Trace elements : Essential trace elements
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).

6. Essential trace element
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

7. Essential trace element

8. 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.

9. Trace elements in ENAMEL
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
Fluoride as a trace
element and its
exchanging with
surface

10. Biological Significance of Trace Elements
Enzymes of trace elements
They are an important part of certain
biological and chemical reactions
They work in harmony with
proteins and often with
certain other co-enzymes.
They attract substrate
molecules and enable
their conversion to any
specific end product

11. Homeostat 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

12. Homeostat of 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
Possible Concentrations of
an Essential Element in the
Diet

13. Factors Affecting Trace Elements Requirement
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

14. Trace Elements and Nutrition
 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.

15. The epidemiology of dental caries in relation to
environmental trace elements
 The best documented association is that between water borne fluoride and reduced
caries prevalence.
 fluoridation has been followed
by significant improvements
in dental health

16. The epidemiology of dental caries in relation to
environmental trace elements
 Other trace elements in food and water have now been linked with dental caries.
 Molybdenum has been
associated
with reduced caries prevalence
whereas selenium and lead
appear to have adverse effects

17. The epidemiology of dental caries in relation to
environmental trace elements
 It is possible that the incorporation of trace metals into the apatite microcrystals of
enamel may alter their physical properties, especially solubility, and hence their
susceptibility to degradation.
Likely substitutions in the
cationic sub-lattice for
biological apatite.

18. Caries and enamel
 The principal component of enamel is microcrystalline hydroxyapatite set in a
protein matrix .
 The protein represents about 1% of the enamel dry weight and appears to
resemble keratin except it contains less sulphur
 The apatite fraction approximates to composition (Ca,Mg,Na,H) (PO4)(CO3)(OH)2
 But apatite whether biogenic or geochemical contains traces of many other
elements which occur in the crystals structure through

19. Caries and enamel
 low prevalence was associated with raising concentrations of Ca,
Mg, Mo and V while concentrations of Cu, Fe, and Mn were higher in the samples
with higher prevalence
 A strong inverse relationship was found between caries prevalence and the
contents of Sr, Ba, K, Mg, Ca, and Li
 Probably Ni has a negative association with caries
 while Zn, Fe, Mn, Cd, Pb, and Cu are positively associated with dental caries

20. Trace elements and carcinogenesis
The role of trace elements in the carcinogenecity of
metals is evident in epidemiological surveys.
The list includes several elements such as, iron, zinc,
copper, cadmium, berilium boron and so on

21. Trace Elements in Oral Lesions
A. 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
Clinical photograph of a patient showing
reticular oral lichen planus in the right buccal
mucosa
Lichen Planus On Lips

22. Trace Elements in Oral Lesions
Gold Alloys and Base metal Alloys

23. Trace Elements in Oral Lesions
A. Trace metals and oral lichen planus and oral lichenoid
reactions
 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
A lichenoid reaction resulting from
a nutrient/drug interaction

24. Trace Elements in Oral Lesions
A. Trace metals and oral lichen planus and oral lichenoid
reactions
 There is a hypothesis on a
potential link of
(OLR's) with exposure to Cr, Co,
and Ni and amalgam alloys as
released into the oral cavity.
 the most common metal is nickel.
oral lichenoid reactions

25. Trace Elements in Oral Lesions
B. Trace elements and oral submucous fibrosis
 is a well-recognized potentially malignant condition of the oral cavity, leading to
oral cancer, a disfiguring and potentially fatal disease.
 The zinc levels in the tissue and serum of pre malignancies may be used in
understanding the pathogenesis, and in establishing treatment
oral submucous fibrosis characterized by gradual loss of normal mouth opening

26. Trace Elements in Oral Lesions
C. Trace Elements in Oral Precancerous and Oral Cancer
 copper and zinc have an role in the anticarcinogens defence system of the human
body.
 It was observed that mean
serum copper levels were
significantly higher in the
sera of patients with
oral premalignant and
malignant lesions intra-oral photograph showing white patch, with
crack mud appearance on the left buccal mucosa,
suggestive of homogenous leukoplakia

27. Trace Elements in Oral Lesions
C. Trace Elements in Oral Precancerous and Oral Cancer
 elevation of the serum copper in the oral leukoplakia and oral squamous cell
carcinoma
 Some studies have revealed lower
zinc level in serum of patients with potentially
premalignant disorders like in oral leukoplakia

28. Trace elements in sound and carious enamel of
primary and permanent teeth
Inverse relationship between caries prevalence and fluoride intake
indicates the potential effect a trace element can have on caries.

29. Trace elements in sound and carious enamel of
primary teeth
1. the concentrations (mean ± S.D) of Al, Si, and Cu were significantly higher in sound
enamel of primary teeth than the concentrations (mean ± S.D) sound enamel of
permanent teeth
2. The concentrations (mean ± S.D) of F, K, and Si were significantly higher in sound
enamel of primary teeth than the carious enamel of primary teeth.
3. The concentrations (mean ± S.D) of Sr and Al were significantly higher in carious
enamel of primary teeth than in sound enamel of primary teeth.

30. Trace elements in sound and carious enamel of
permanent teeth
1. The concentrations (mean ± S.D) of F, Sr, K, Al, and Fe were significantly higher in
sound enamel of permanent teeth than in carious enamel of permanent teeth.
2. The concentrations (mean ± S.D) of Si was significantly higher in carious enamel of
permanent teeth than in sound enamel of permanent teeth

31. the cariogenic effect of many of the minerals in a
list compiled to indicate relative carcinogenicity.
Cariostatic elements: F, P
Mildly cariostatic: Mo, V, Cu, Sr, B, Li, Au
Doubtful: Be, Co, Mn, Sn, Zn, Br, I
Caries inert: Ba, Al, Ni, Fe, Pd, Ti
Caries promoting: Se, Mg, Cd, Pt, Pb, Si

32. References
Trace elements in oral health and disease: An updated review
Noopur Kulkarni, Ketki Kalele, Meena Kulkarni, Rahul Kathariya1
Serum Copper and Zinc Levels in Premalignant and Malignant Lesions
of the Oral Cavity
Varghese I.a · Sugathan C.K.a · Balasubramoniyan G.b · Vijayakumar T.c
Oral cancer
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