DENT 267: LO1 LS3- Plan Perio Therapy for Gingival Diseases Modified by Malnutrition

nutritional deficiencies

-biofilm is the initiating factor

-modifies response to biofilm

-most studies completed w/ vitamin C

-modifies the immune response

-oral cavity changes (oral mucosa, lips, tongue, gingiva, alveolar bone, teeth)

antioxidants

-counteract damaging effects of oxidation

-sources: fruit, veggies, nuts, whole grains, legumes

-include vitamins, minerals and enzymes

research suggests that antioxidants

-influence perio disease and wound healing

-important in downregulation of proinflammatory responses

who is at risk for nutritional deficiencies?

-underdeveloped nations

-infants

-institutionalized elderly

-alcoholism

-fad diets

-eating disorders

-malabsorption disorders (Crohn's, colitis, Celiac)

fat soluble vitamins

-vitamin A (eyes)

-vitamin D (bones, teeth)

-vitamin E (wound healing)

-stored in body

vitamin A

-fat-soluble vitamin needed for epithelial cell differentiation, bone remodelling, cell-mediated immunity and T-helper cell differentiation

-plays a key role in epithelial maintenance

-no significant relationship w/ risk for perio

-found primarily in animal fats & fish oils as retinoids

case report: 20 year old woman with gingival ulcerations, bleeding, swelling and xerostomia

-reported taking 200,000 IU of vit A daily for 6 months

-gingival improvement in 1 week; tissue normal at 2 months

vitamin D

-obtained from diet & synthesized via sun exposure

-helps enhance calcium and phosphate absorption and maintain blood calcium levels

-aids calcification of teeth and osseous tissues

-acts as anti-inflammatory agent

-good sources: egg yolk, liver, oily fish, fortified milk

-promotes differentiation of monocytes to macrophages

what may vitamin D help

-reduce gingival inflammation and BOP

-reduce susceptibility to gingival inflammation

-prevent tooth loss when taken with calcium

vitamin E

-protects cell membranes from oxidative damage

-reduces prostaglandin E2 production in macrophages

-has mitigating effects on gingival inflammation

-supplementation shown to have positive effect on immune response

-good dietary sources: nuts, seeds, wheat germ

water-soluble vitamin deficiencies

-not stored in body in significant amounts (includes vitamin B & C)

-B-complex deficiencies (thiamin, riboflavin, niacin, pyridoxine (b6), biotin, folic acid, cobalamin (b12(

-glossitits, angular cheilitis and may intensify biofilm induced gingivitis

folic acid

-belongs to b-complex group of vitamins

-involved w/ DNA synthesis

-deficiency may reduce ability of gingival tissue to act as barrier to bacteria

-dietary sources: enriched grains, broccoli, asparagus, brussel sprouts, peas, brown rice

calcium

-involved in calcification process

-RDA 1000mg for adults aged 19-50

-plays important role in formation & maintenance. of alveolar bone

-higher daily intake may decrease risk for tooth loss

-dietary sources: milk, yogurt, cheese

magnesium

-found in all cells

-concentrated in mitochondria

-supplementation may improve perio health in individuals aged 40 years and older

vitamin C (abscorbic acid)

-water soluble & cannot be stored in body

-must be obtained through dietary sources

-found in fresh fruit & veggies

-has curative effect on scurvy

-RDA 90mg for men, 75mg for non-pregnant/non-lactating women

vitamin C (ascorbic acid) deficiency

-uncommon in undeveloped countries

-scurvy (systemic disorder caused by severe and prolonged, vitamin C deficiency, oral and systemic changes)

-fresh fruits, vegetables, fortifying diet with vitamin C supplements

what can vitamin C deficiencies cause

-defective formation/maintenance of collagen-osteoblast function, wound healing, bone cell function, blood vessel wall, platelet function

-metabolism of folic acid, iron

-affects RBC production

-increase in bleeding, bruising, poor wound healing

clinical characteristics: ascorbic acid deficiency related gingivitis

-gingiva changes (redness, enlarged, soft, gingival pockets, increased bleeding, surface necrosis)

-systemic symptoms (fatigue due to anemia), dermatitis, purpura (platelet problems)

-histopathology (increased tendency for internal gingival hemorrhage, degeneration of collagen fibers, edema of the CT)

ascorbic acid deficiency related gingivitis etiology

-gingivitis is not caused by the vit c deficiency

-caused by bacterial biofilm

-deficiency aggravates the condition

-in absence of biofilm, the deficiency will not tend to have a profound effect on the tissues

what is the perio therapy for ascorbic acid-deficiency gingivitis

1. diagnosis facilitated by a nutritional assessment

2. consult/referral to physician/dietician regarding blood cell counts and to correct vit C and other deficiency, assess for need for addiction counseling (may request bloodwork)

3. client education: OHI, dietary counseling, smoking cessation

4. removal of local irritants (similar tx plan as biofilm induced gingivitis

5. eval

6. frequent CC intervals

rebound scurvy

-extremely rare condition that can occur w/ abrupt cessation of vic C intake after routinely taking excessive dosages for prolonged period

-can reverse by reinstituting vic C allowance

-high risk for newborns whose mothers had taken heavy doses of vit C during pregnancy

what are some effects of nutritional deficiencies on the perio tissues

-protein deficiencies may affect the host defenses/immune response

-more common in developing countries

-more susceptible to perio infections