Professional Documents
Culture Documents
Nutritional Management of
Periodontal Disease
dr shabeel pn
By the end of the session, the
students should be able to
What is fluorosis
What are fluorides?
Fluoride is a mineral
{{ Ca
Ca10-x
10-x
(Na)
(Na)xx
(PO
(PO4 ))6-y
4 6-y
(CO
(CO3 ))
3 zz (OH)
(OH)
2-u
2-u
(F)
(F)u}
u}
Highly
Highly substituted
substituted carbonated
carbonated apatite
apatite
Most
Most soluble
soluble
Ca
Ca1010(PO
(PO44))66(OH)
(OH)22
hydroxyapatite
hydroxyapatite(less
(lesssoluble)
soluble)
Ca
Ca1010(PO
(PO44))66(F)
(F)22==fluoroapatite
fluoroapatite
Least
Least soluble
soluble
Mechanism of action
OLD
OLD concept
concept ::
Recent
Recent evidences
evidences That
That major
major inhibitory
inhibitory
shows
shows that
that the
the main
main effect
effect was
was thought
thought to to
effect
effect of
of fluoride
fluoride in
in be
be due
due to
to its
its
caries
caries prevention
prevention are
are incorporation
incorporation in in tooth
tooth
POST
POSTERUPTIVE
ERUPTIVE mineral
mineral during
during the
the
Through
ThroughTopical
Topical
development
development of of the
the
effect
effect tooth
tooth prior
prior to
to eruption
eruption
Mechanism of action
Fluoride
Fluoride incorporated
incorporated
Fluoride
Fluoride incorporated
incorporated
during
during mineral
mineral developmentally
developmentally into into
development
development at at the
the normal
normal tooth tooth
normal
normal levels
levels of
of 20-
20- mineral
mineral isis insufficient
insufficient
100
100 ppm
ppm doesdoes not
not to
to have
have aa measurable
measurable
alter
alter the
the solubility
solubility of
of effect
effect on
on acid
acid
the
the mineral.
mineral. solubility
solubility
Mechanism of action
Only
Only when when fluoride
fluoride is is
concentrated
concentrated into into aa new new
crystal
crystal surface
surface during
during Re Re
mineralization,
mineralization, is is itit sufficient
sufficient
to
to alter
alter solubility
solubility beneficially.
beneficially.
Mechanism of action
IfIf fluoride
fluoride isis present
present inin the
the plaque
plaque
fluids
fluids atat the
the time
time that
that bacteria
bacteria generate
generate
acids,
acids, itit will
will travel
travel with
with the
the acid
acid down
down
into
into the
the subsurface
subsurface of of the
the tooth,
tooth, adsorb
adsorb
to
to the
the crystal
crystal surface
surface and
and protect
protect itit
from
from being
being dissolve.
dissolve.
Source: Featherstone , 1999
Fluoride inhibits
plaque bacteria.
Fluoride inhibits plaque
bacteria
H+ + F - HF F-
Bacterial Cell
pH 7 H+ + F- HF
pH 4.5 H+ + F- HF
Acts on the enamel
surface to inhibit
bacteria adhesion
Sources of fluoride
Natural foods
Dentrifices
Tea, sea foods,
Professionally applied
Water
Fluoride supplements
Fortified
Milk
Salt
Sources of fluoride
Bottled Mineral
In beverages :
Tea ( raw tea leaves 400 ppm)
Brewed tea ( 0.1 to 4.2 ppm_
Daily consumption of 1 cup (200 ml) would yield 0.6
mg F/day
Sources of fluoride
Dental Products
Dentifrices
Fluoride mouth rinse
Professional applied fluorides
Dietary fluoride supplements
Fluoride metabolism and
excretion
Fluoride in 50 % of the
Food, water absorbed
fluoride will be
associated
75 to 90 % absorbed with calcified
from the alimentary tissue
tract, more from liquids
than solids (10 to 25% 50% excreted
excreted via feces) in urine
5 mg fluoride/kg (Whitford,1987)
Acute Fluoride Toxicity
Accidental poisoning with
Skeletal Fluorosis
Dental Fluorosis
Chronic Fluoride Toxicity
Chronic Toxicity:
other than dental fluorosis, there are no
known adverse effects of ingesting fluoride
in a chronic basis at levels associated with
drinking water concentrations of 4 p.p.m or
less.
Things you should know
Skeletal fluorosis
Osteosarcoma
Confined to individuals
exposed to very high
Studies have
fluoride failed to identify
Usually associated with
any correlation
industrial situation or with fluoride
unusually very high
fluoride level in drinking history
water of 10mg/l
Dental Fluorosis
Water fluoridation
Host
Environment
Pathogens
Microorganism
Periodontal disease
production
Healing
optimum wound
Zinc
Protien synthesis healing
2. Maintenance of Calcified
Tissues
Vitamins A, D,C,K
Ages 20 to 90 years
Dental Measurements
Dietary assessment
OR of having
Smokers, and former
periodontal disease is smokers with low
1.2 times greater in vitamin C intake are
those with low dietary at 1.6 times greater
Vitamin C intake risk of having
periodontal disease
Nishida, Grossi, Dunford, Ho,
Trevisan and Genco (2000)
Risk of periodontal
27% greater for
disease was 59%
those taking less
greater in women
with less than than 800 mg/day
500mg/day of
Calcium
Boyd and Lampi (2001)
Proteins:
Antioxidants
Vitamin A, C, E
Minerals : Zinc, Copper, Iron, and Selenium
3. Maintenance of Host Immune
Response
Collagen synthesis