Diet And Diet Counselling

2
DIET AND DIET
COUNSELING
Dr Susmita Shah
First Year MDS
Department of
Paedodontics &
Preventive Dentistry
KMSDCH

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

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

 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

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

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

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

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

Vitamins
Minerals
Micronutrients
Proteins
Fats
Carbohydrates
Macronutrients
10

a. Proteins
 Proteins are complex organic nitrogenous compounds composing of carbon,
hydrogen, oxygen, nitrogen and sulphur in varying amounts. Some proteins
also contain iron and phosphorous.
 Proteins are made up off smaller units called amino acids.
 There are 24 amino acids of which 9 are essential amino acids and the
remaining are non essential amino acids.
 Proteins are classified onto 3 types
a. SIMPLE
b. CONJUGATED
c. DERIVED
Betty Kovacs Harbolic , Diet and Nutrition . ©2019 WebMD, Inc. 11

Betty Kovacs Harbolic , Diet and Nutrition . ©2019 WebMD, Inc.
12
Proteins Source
Animal sources– milk, meat, eggs, cheese, fish.
•Vegetable sources– pulses, cereals, beans, nuts, oil seeds.
•Functions
•-Body building
•-Repair and maintenance of
body tissues
•-Immune Mechanism
•-Synthesis of certain
substances like antibodies,
plasma proteins,
hemoglobin, enzymes,
hormones and coagulation
factors
Daily Requirements
GMS/DAY
-Man 60
-Woman 50
-Pregnant woman 65
-Lactating woman 75
-5-12 Year children 30
-Adolescent boy 65
-Adolescent girl 60
Laboratory Test
- serum albumin
concentration.
-It should be more than 3.5
gm/dl, a level of 3.5 gm/dl is
considered a mild degree of
malnutrition, a level of 3.0
gm/dl is considered severe
malnutrition.

Protein Energy Malnutrition (PEM)
 Introduction
 It occurs primarily in first few years of life due to inadequate intake of food
both in quantity and quality.
 2 clinical forms MARASMUS and KWASHIORKOR DISEASE
 Etiology
 Poor environmental conditions, poor sanitation, poor maternal health, failure
of lactation, unhealthy diet.
 Clinical features
 infections like diarrhea, measles, respiratory infections and intestinal worms
during growth of a infant or a small child.
 The first indicator of PEM is under weight.
 Phenyl Ketonuria & Nutritional Liver disease are the other effects of PEM.
13

PROTEINS AND ORAL HEALTH
 Adequate protein diet during pregnancy influences proper bone &
dental development
 Teeth of children with deficient protein results in crowded & rotated
teeth.
 Delayed eruption and hypoplasia of deciduous teeth.
 Teeth are smaller and more prone to caries in PEM CHILD
 Atrophy of the gingiva seen in protein deficient individuals.
 Degeneration of cementum and supporting periodontal tissues in PEM
child.
14
Malocclusion
Hypoplasia

• PREVENTIVE MEASURES FOR PEM
-Measures directed to pregnant
and lactating women
(education, distribution of
supplements)
-Promotion of breast feeding
-Measures to improve family diet
-Nutrition education
-Family planning and spacing of
births
-Family environment
15
• SPECIFIC PROTECTION
-Protein and energy rich foods
-Food fortification
• EARLY DIAGNOSIS AND
TREATMENT
-Periodic surveillance
-Early treatment of infections
and diarrhea.
-De worming of heavily infested
children
-Development of feeding
program's during epidemics

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.
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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).
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b. Fats & Oils
Fats are solid at 20 deg c. They are called oils if they are liquid
at that temperature.
Fats and oils are sources of energy.
 They are classified as:
(a)Simple lipids- triglycerides.
(b)Compound lipids- phospholipids
(c)Derived lipids- cholesterol
 Fats yield fatty acids and glycerol on hydrolysis.
18

Fat Source
Animal sources–ghee, butter, milk, cheese, egg, meat, fish
Vegetable sources–ground nut, mustard, sesame, coconut
Others: cereals, pulses, nuts, vegetables
Functions
-They provide energy 9 kcal/grm
-Serve as vehicle for fat soluble
vitamins.
-Fats support viscera such as kidney,
heart and intestine.
-Act as thermal insulators for skin.
-Essential fatty acids are required
for the body growth and structural
integrity.
Daily Requirements
kcal/day
-total blood cholesterol less than
200 mg/dL;
• LDL less than 100 mg/dL; and
• HDL greater than 40 mg/dL for
men and 50 mg/dL for women.
-
Fat Measurements
-Blood Cholesterol levels
19

Fats & Diseases
 OBESITY
 PHRENODERMA- deficiency of essential fatty acids in diet is associated with
rough and dry skin (toad skin )
 CORONARY HEART DISEASE
 CANCER
 ATHEROSCLEROSIS
 CHRONIC SWELLING OF PAROTID GLANDS due to disturbances in lipid
metabolism
 Indirect evidence of reducing caries.
20

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

 The following are Dietary Reference Intakes for fat
consumption:
 • Adults should get 20%-35% of their calories from fat.
 • Infants and younger children should get 25%-40% of
calories from fat.
22

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
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.

c. Carbohydrates
 Carbohydrates are one of the essential nutrients.
 This means that they are essential for your health, so there is no
way that omitting them from your diet would be beneficial.
 An excess intake of any nutrient will cause weight gain.
 The key is to consume the appropriate sources and amounts of
carbohydrates.
 Carbohydrates are the primary source of fuel for your body.
 Your red blood cells and most parts of your brain derive all of their
energy from carbohydrates.
25

 An adequate consumption of carbohydrates also allows your body to use
protein and fat for their necessary requirements, it prevents ketosis, it
provides fiber, and it's the source of sweetness in your foods.
 Carbohydrates are all made up of carbon, hydrogen, and oxygen, but they
are not equal in terms of their nutritional value.
 Based on the structure, carbohydrates are divided into two categories:
Marwah NTextbook of pediatric dentistry 3rd edition 26

1. Simple carbohydrates
• Monosaccharide
Fructose (fruit sugar)
Glucose (blood sugar)
Galactose (part of milk sugar)
• Disaccharide: two monosaccharides combined
Sucrose: a combination of fructose and glucose (table sugar)
Maltose: a combination of glucose and glucose
Lactose: a combination of galactose and glucose (milk sugar)
2. Complex carbohydrates
• Polysaccharide: a combination of thousands of glucose units (starch, glycogen,
fiber)
27

 Complex carbohydrates take longer to digest and provide fiber, so
they are the best source of carbohydrates.
 This does not mean that fruit or milk is not a healthy source.
 The skin and the seeds in the fruit are sources of fiber, so they
contain both simple and complex carbohydrates.
 Milk sugar has been shown to enhance calcium absorption, making it
an asset to your health.
28

 Source:
grains,
fruits,
milk/yogurt, and
vegetables.
Dietary Guidelines for carbohydrate consumption:
 Choose fiber-rich fruits, vegetables, and whole grains often.
 Choose and prepare foods and beverages with little added sugars or caloric
sweeteners, such as amounts suggested by the USDA Food Guide and the DASH
Eating Plan.
 Reduce the incidence of dental caries by practicing good oral hygiene and
consuming sugar-and starch-containing foods and beverages less frequently.
29

Dietary Reference Intakes for carbohydrate consumption:
 Adults and children should get 45%-65% of their calories from
carbohydrates.
 Added sugars should comprise no more than 25% of total calories
consumed.
 Added sugars are those incorporated into foods and beverages during
production which usually provide insignificant amounts of vitamins,
minerals, or other essential nutrients.
30

 Major sources include soft drinks, fruit drinks, pastries, candy,
and other sweets.
 The recommended intake for total fiber for
 toddlers is 18 grams per day.
 6-11 years age – 13 grams per day
 adults 50 years and younger is set at 38 grams for men and 25 grams
for women, while for men and women over 50 it is 30 and 21 grams
per day, respectively, due to decreased food consumption.
 No Recommendation under 2 years of age
British nutrition Foundation
31

d. Vitamins
 These are micronutrients.
 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

 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

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

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

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.
37
Laboratory investigations: Retinol level blood
test
Normal: 15 to 60mg/dl

MANAGEMENT OF VITAMIN A DEFECIENCIES
Groups Retinol
B-
Carotene
Adults
600-
800mcg
3000mcg
Infants 350mcg
500mcg
700mcg 2400mcg
2000mcg
1200mcg
Children
Adolescence
38

 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

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

• VITAMIN B1DEFECIENCY
 BERIBERI –
 DRY FORM( NEURAL),
 WET(CARDIAC),
 INFANTILE FORM
 ORAL MANIFESTATIONS include sensitivity of oral mucosa,
burning tongue, loss of taste.
42
Tongue in BERIBERI

PREVENTION
 Diet modification and avoidance of alcohol.
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

 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

RIBOFLAVIN DEFECIENCY
 Angular stomatitis
 Glossitis
 Cheilosis
 Inflammation of conjunctivae
 Dermatitis of the facial skin
 Cleft lip & palate
 Migraine
 Anaemia
 Vomiting
Ranjodh Singh Gill. Riboflavin Deficiency.
45

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

 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

Vitamin B3
Deficiency
 PELLAGRA – dermatitis, diarrhea,
dementia. Glossitis
 Stomatitis
 Depression and irritability
 PREVENTION
 improval of living conditions
 diet modification
48

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

 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

 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

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.

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.
Vitamin B6 Deficiency
Laboratory Investigations
Direct serum measurement of the active vitamin Pyridoxal 5′-phosphate
(PLP)

• 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.
Rs. 143

 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

• 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

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

Management of Vitamin Deficiencies
58
Rs. 115Rs. 119 Rs. 125 Rs. 143

 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

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

 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

 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

 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

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

 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

 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

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

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

 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

 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

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
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

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
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.

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

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

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.
80

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.
81

 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
82

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.
83

 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.
84

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.
85

 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.
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

 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.
87

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.
88

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
89

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

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.
91

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
92

 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.
93

Management of Fluoride Deficiency
 Most common dietary fluoride supplements are:
 Fluoride drops with/without vitamins.
 Fluoride tablets with/without vitamins.
 Lozenges.
 Oral rinse supplements.
 Fluoridated salts.
 Fluoride milk.
94

5. FOOD GROUP GUIDES
95
THE MAIN FOOD GROUPS

 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

• 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.
97

• 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.
98

• 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

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
100

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 .
101
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

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.
102

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.
103

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.

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.
105

7. TYPES OF DIET SURVEY
 24 Hour Recall Diet Surveys
 Food Frequency Questionnaire
 Diet History
 Food Diary
107

108
Textbook of paediatric dentistry by Nikhil Marwah 3rd Edition

109

110

111

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.
112

 Patient Selection
 Food Diary
 Calculation of dental Health Diet Score
 Communication Techniques
 Interviewing
 Teaching & learning
 Counselling
 Motivation
113

• 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.
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.

Fundamentals of Pediatric dentistry by Richard mathewson & Robert Primosch 3rd edition 115

Fundamentals of Pediatric dentistry by Richard mathewson & Robert Primosch 3rd edition
116

Fundamentals of Pediatric dentistry by Richard mathewson & Robert Primosch 3rd edition
117

• Calculation
of dental
health diet
score
 Simple scoring procedure that can
disclose a potential dietary
problem that is likely to adversely
affect dental health.
118

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.
Diet and nutrition in pediatric dentistry. Teresa A. Marshall. Dent Clin N Am 47 (2003) 279–303 119

 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
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

• 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.
121

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.
122
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

123

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.
124

REFERENCES
 Diet and nutrition in pediatric dentistry. Teresa A. Marshall. Dent Clin N Am 47 (2003) 279–303
 Textbook of paediatric dentistry by Nikhil Marwah 3rd Edition.
 Dentistry for child & adolescent by MacDonald, Avery’s. 10th edition.
 Essentials of pediatrics by OP Ghai 7th Edition.
 Betty Kovacs Harbolic , Diet and Nutrition . ©2019 WebMD, Inc.
 Costacurta M, DiRenzo Sicuro, Gratteri, De Lorenzo, Docimo. Dental caries and childhood
obesity: analysis of food intakes, lifestyle. Eur J Paediatr Dent. 2014 Dec;15(4):343-8.
 VITAMIN A DEFICIENCY AND ITS CONSEQUENCES A field guide to detection and control WHO
 British nutrition Foundation.
 NORMAN JOLLIFFE. THE DIAGNOSIS, TREATMENT, AND PREVENTION OF VITAMIN B1 DEFICIENCY.
 Ranjodh Singh Gill. Riboflavin Deficiency.
 Mary J. Brown; Kevin Beier Vitamin B6 Deficiency (Pyridoxine).
 Shivayogi M Hugar, Neha S Dhariwal, Andleeb Majeed, Chandrashekhar Badakar, Niraj Gokhale,
Laresh Mistry. Assessment of Vitamin B12 and Its Correlation with Dental Caries and Gingival
Diseases in 10- to 14-year-old Children: A Cross-sectional Study. International Journal of
Clinical Pediatric Dentistry, April-June 2017;10(2):142-146
125

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