Nutritional Status and Oral Health
Dr. Rabia Noreen
Senior Registrar
Department of Oral
Medicine
Shifa College of Dentistry
 Vignette
A 40 years old woman of child bearing age comes to department of
oral medicine with chief complaint of recurring oral ulceration. She
also complains of fatigue, palpitations and burning of mouth and
tingling sensation of finger tips. On examination she has multiple
ulcers on different surfaces of oral cavity and glossitis. She was
advised complete blood count, serum iron & folate level and
vitamin B12 level for establishing diagnosis.
What are nutrients?
 Nutrients are biochemical substances that are
required for development, growth, repair and
maintenance of body.
Types of nutrients
 Carbohydrates
 Proteins
 Lipids
 Vitamins
 Minerals
 Water
Why do Nutritional Deficiencies Occur
 Reduced intake
 Faulty absorption or metabolism
 Increased excretion
Oral Manifestations of nutritional
deficiencies
 PROTEINS
1. Poor structural integrity of dentition.
2. Impaired wound healing
3. Small molars.
4. Dental caries.
5. Delayed eruption of teeth.
6. Atrophy of oral mucosa and ulceration.
7. Xerostomia.
8. Mandibular development issues.
9. Salivary gland development issues.
2. VITAMINS
A. Fat soluble
A,D,E,K
B. Water soluble
B and C
Vitamin A
Maintains the health of epithelial cells of skin and mucosa
1. Enamel Hypoplasia( It effects formation of ameloblasts and
odontoblast)
2. Defective dentin
Vitamin D
Enamel hypoplasia
2. Alveolar bone resorption
1.
ENAMEL HYPOPLASIA
VITAMIN K
 Important for normal coagulation pathways
1. Gingival bleeding
2. Petechiae
3. Ecchymosis
VITAMIN C
1. Hypoplastic teeth
2. Gingival swelling and bleeding
3. Tooth mobility and loss of teeth
VITAMIN B1, B2, B9 and B12
1. Edematous and enlarged tongue
2. Enlargement of fungiform papillae
3. Gingivitis
4. Glossitis
5. Magenta tongue
6. Angular cheilitus
7. Oral ulcers
Recurrent Apthous Stomatitis
Glossitis &
Angular Cheilitus
MINERALS
 Calcium, phosphorous, Magnesium, fluoride, zinc, Iron
 Ca & Phosporous
 Bone and tooth structure abnormalities
 Circum oral numbness
 Magnesium
 Enamel Hypoplasia
 Disturbance of Dentin Calcification
 Flouride
 Dental caries
IRON
 Iron deficiency anemia

Glossitis
Apthous ulcers
Angular cheilitus
Burning sensation in oral mucosa

Delayed wound healing



ZINC
Assessment
 Detailed History including dietary history and Clinical
examination.
 Clinical assessment
 Anthropometric ( size, weight, body proportion)
assessment.
 Biochemical assessment
Dietary History
 24 hrs recall
 7 days Food Diary.
 Diet modification
 Follow up after two weeks.
7 DAYS FOOD DIARY
Clinical Assessment
 Detailed Medical history to identify






comorbidities with nutritional implications
opportunistic infections
other medical complications
usage of medications with nutrition related side effects,
food and drug interactions,
risk factors for disease (e.g., smoking, alcohol use, overweight
 Checking for visible signs of nutritional deficiencies
 Bilateral pitting edema
 emaciation (a sign of wasting, which is loss of muscle and fat tissue as a
result of low energy intake and/or nutrient loss from infection)
 hair loss, and changes in hair color.
Anthropometric assessment
1.
2.
BMI
weight for height index
BMI = weight (kg)
___________
height (m2)
BMI Nutritional status
< 16.0 Severe malnutrition
≥ 16.0 to < 17.0 Moderate malnutrition
≥ 17.0 to < 18.5 Mild malnutrition
≥ 18.5 to < 25.0 Normal nutritional status
≥ 25.0 to < 30.0 Overweight
≥ 30.0 Obesity
Biochemical assessment
• Complete blood picture
• Serum iron and total iron bonding capacity
• Serum ferritin
• Serum folate levels
• Vit B12 level
Diet Counseling
 Objective is to prevent and control dental caries.
 Guidelines for Counselling should be followed.
 Based on individual needs.
 Patients should be encouraged to have fresh fruits, raw
vegetables and fibrous foods in diet.
 Community based nutritional programs.
School lunch Programme. ( 5 a day meal)
 It should be a supplement for home food and not a
substitute.
 Should supply one third of the total calories and half of
the protein requirements.
 Locally available food should be used.
Management
 Diet counselling
 Supplements
 Multivitamins
 Iron supplements
 Vitamin D supplements
 Ointments for oral ulcers
 Anti inflammatory mouth
washes