ЛЕКЦІЇ LECTURE


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УДК: 612,31:611-018.73:612.392].013


NUTRITION AND DISEASE: IMPLICATIONS FOR ORAL HEALTH*


Roksolana Tymiak-Lonchyna


Chicago, Illinois, USA, roksolanatl@gmail.com


There is a strong link between oral health and general health. In the past, physicians taking care of patients about to undergo cardiac surgery did not consider referring them to a gum specialist (periodontist) for an oral evaluation. Recent data demonstrates the impact that pathologic oral conditions have on heart disease, diabetes, pregnancy, malnutrition, etc. The oral cavity serves as the main portal to the body. The type of nutrition that enters this portal will either enhance or detract from the health of not only the teeth, gums, tongue, mucosa but also is important in the proper development and well being of other bodily structures. Proper dietary habits and hygiene need to be learned early and are crucial for the laying down of the foundation of good bodily health. The regular and proper use of nutrients (vitamins, micro elements, bioflavonoids, etc.) and their mechanisms of action are discussed. If the teeth and oral mucosa are compromised, this can exacerbate existing medical conditions, can lead to development of new diseases and create other health complications. Physicians and dentists need to work hand in hand in treating and educating their patients. No one particular strategy will solve every problem, nor will one person be the solution to medical care. Cooperation amongst professionals, openness and flexible in communication and reliance upon the most recent scientific data, will help to maintain our patients’ health and well being.


Key words: oral health, nutrition, oral hygiene, cytoprotection, malnutrition


ХАРЧУВАННЯ І ХВОРОБИ: НАСЛІДКИ ДЛЯ ЗДОРОВ’Я РОТОВОЇ ПОРОЖНИНИ


Роксолана Тим’як-Лончина

Чикаго, штат Іллінойс, США, roksolanati@gmail.com

Представлений огляд літератури та власних спостережень стосується тісного зв’язку між станом здоров’я ротової порожнини та здоров’ям людини загалом. Багато років тому лікар, який мав пацієнта з серцево-судинними захворюваннями, не розглядав питання про скерування пацієн- та до лікаря-пародонтолога або стоматолога. Останнім часом багато різних літературних даних показали значення розладів функціонування та патологій структур порожнини рота для розвит- ку кардіологічних хвороб, а також для вагітності, діабету, порушень харчування тощо. Ротова порожнина служить основним порталом для здорового тіла. Тип харчування людини буде або покращувати, або запобігати порушенню здоров’я наших зубів, ясен, язика, слизової оболонки ротової порожнини та сприяти належному розвитку та функціонуанню решти усіх вісцеральних органів. Ранні правильні харчові звички та гігієна ротової порожнини мають вирішальне значен- ня для встановлення основ майбутнього здоров’я організму. Правильні поживні речовини (віта- міни, мікроелементи, біофлавоноїди тощо) та їх регулярність споживання, оптимальна кількість, а також їхні найбільш ефективні способи дій обговорюються у статті. Проте, якщо зуби та слизові оболонки порожнини рота будуть скомпрометовані, це може призвести до посилення наявних захворювань, розвитку нових захворювань і багатьох медичних ускладнень.

Лікарі та стоматологи повинні співпрацювати разом під час лікування та навчання своїх пацієнтів основам профілактики захворювань. Ні одна конкретна стратегія не вирішить кожну проблему. Також не можливо одним фахівцем вирішувати усі питання, пов’язані з лікуванням. Співпраця з іншими фахівцями, здобування знань з наукової та науково-популярної літератури, відкритість та гнучкість у спілкуванні, дозволить підтримувати здоров’я та добре самопочуття.


Ключові слова: здоров’я, харчування, гігієна порожнини рота, цитопротекція, недоїдання

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* Лекцію виголошено під час майстер класу 78-ої загальноуніверситетської студентської науково-практичної кон- ференції (м. Львів, 2017)

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Лекція Lecture


NUTRITION AND DISEASE: IMPLICATIONS FOR ORAL HEALTH


Roksolana Tymiak-Lonchyna


Chicago, Illinois, USA


The oral cavity contains the strongest structures in the human body: teeth. Teeth function in our body just as any organ, yet they are often neglected and not respected for their worth. Since early childhood teeth and the oral cavity function twenty four hours a day seven days a week while being taken for granted during eating, drinking, sleeping, talking, breathing, swallowing, singing, playing musical instruments and even crying. Nutrition has significant implication on oral health.


TOOTH DEVELOPMENT

Primary teeth start develop in utero. Children have 20 baby (primary, deciduous) teeth. These teeth eventually are replaced by 32 permanent teeth. By age 6-10 months most infants cut their first tooth. At 10 months-3 years they start developing their permanent teeth. The lower (mandibular) teeth develop first, followed by the upper (maxillary) teeth. Teeth erupt in pairs. Girls develop their teeth earlier then boys. By age 3 years, most primary teeth are in. By age 5-6 years children begin to shed their deciduous teeth. By age 12-13 years most primary teeth have been shed and are replaced by permanent teeth.


ANATOMY OF THE TOOTH

Teeth are divided into three categories:

  1. INCISORS: are used to cut food we eat, aid in speech and are important in aesthetics.

  2. CUSPIDS: (canines) are used in ripping and tearing food and guiding the jaw in lateral movements (as a protection of other teeth from wearing down).

  3. MOLARS: are flat surfaced teeth located in the back of the oral cavity and are used for grinding-mashing of food.


MASTICATION

If any one of these teeth are missing (single tooth or a combination of teeth) the process of mastication is affected and therefore it affects the types of food one can eat.


Certain foods serve certain age groups and once there are any disruptions in the oral cavity the process of mastication and digestion is affected.


“COMMON DENTAL MISCONCEPTIONS”


There are innumerable fallacies concerning teeth and mastication. Patients may develop or allow

problems to occur as a result of misinformation and this affects the proper caring of their dentition. Some of these fallacies are:

  1. Loss of teeth as one gets older is a natural process and one’s should not worry about this. Tooth loss is not related to age. One can live to an old age and maintain ones teeth

  2. Primary teeth are a temporality and thus we do not need to take care of them.

    Good hygiene habits start at an early age. If you neglect your teeth at an early age you can expect to neglect your permanent teeth later in life. Primary teeth also serve as spacers for the permanent dentition, If you loose primary teeth prematurely you can expect to have problems latter with proper alignment of the permanent teeth.


  3. The health and strength of teeth is hereditary, thus we cannot improve on their condition.

    Health and strength of teeth is not altogether hereditary but more important determinant of health are good oral hygiene habits.


  4. You need to change your tooth paste often. There is no need to change toothpaste at all. There is no expiration date or loss of activity with the long-term use of a tube of tooth paste.


  5. The more foam is created by your toothpaste, the better the quality of the product.

    Foam of a toothpaste has no effect on the quality of the product.


  6. Once you finish brushing it is important to rinse very well to get rid of all the toothpaste from the oral cavity.

    On the contrary. one rinse is sufficient and some leftover paste in the saliva is good for fluoridating the teeth.

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  7. The best tooth brushes are hard.

    The best toothbrushes are soft to medium bristled. Hard bristles cause abrasion to the gingiva and can even erode enamel and ce- mentum causing cervical abrasions.


  8. When gums bleed it is an indication of a serious problem and “only then” you should visit your dentist.

    One should visit a dentist regularly (twice/year). If your gums bleed this could just be an indica- tion that you are not brushing often or properly.


  9. Cigarette smoke is favorable because it kills bacteria in the mouth.

    Cigarette smoke is harmful to the mucosa of the oral tissue and can lead to various cancers of the oral cavity.


  10. When you have a toothache, the tooth has to be removed.

    When one has a toothache, one should see a dentist to establish a diagnosis on the basis of the symptoms and the x-ray evaluation and then a treatment plan is established.


  11. A sick tooth has no connection to the gen- eral health of the human.

    The tooth/oral mucosa can both be a manifes- tation of systemic disease and can be a cause of disease processes in the human body.


    Hygiene is important and it should start from the moment the first tooth appears in the oral cavity. Once a tooth has emerged, one may clean off the plaque off of the baby tooth and massage the gum with a soft cloth or gauze. Similarly, a physically and mentally challenged child, a debilitated individual, and the elder- ly, should all have regular dental care as de- scribed above. Tooth paste should not be used for children under 2 years of age.


    Children should be taught to brush their own teeth by age 4-5 years. They should brush af- ter every meal and if they are in school they


    should be encouraged to rinse with water if it is not possible to brush.


    The time needed for an adequate brushing is 3 minutes.


    Most people do not spend even a minute brush- ing their teeth and for this reason the pathologic film called plaque remains on the tooth surface.

    What is Plaque?

    Plaque is the white film that can be scrapped off of the tooth surface. It is a sticky sub- stance that houses multiple bacteria, inor- ganic compounds (such as calcium and phos- phorous), leukocytes, macrophages, and an extracellular matrix of protein, polysaccha- rides and lipids.


    In this milieu, when sugar is introduced into the oral cavity, it readily adheres to the tooth sur- face. If it is not removed physically by a brush or wiped off with gauze or cloth bacteria have an opportunity to adhere to the tooth and pro- duce acid. The acid then begins to demineral- ize the tooth and destroys the enamel. Demin- eralization can be seen as white spots on the teeth and crescent like formations close to the gingiva. This is the start of dental caries. Poor nutrition can cause gum disease to progress and become more severe in children whose diet does not supply the necessary nutrients. Poor nutrition affects the entire immune sys- tem leaving one at higher risk for gum disease and many other diseases.


    If plaque is not removed it will become min- eralized (hard) and is then called calculus or tartar (Fig.1). Calculus cannot be removed by just mere brushing or wiping; it has to be physically scraped away with special dental instruments. It is formed by the presence of saliva, debris and minerals. Its rough surface provides an ideal attraction for the growth of bacteria.


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    Figure 1. Calculus formation in a child


    Saliva cannot penetrate plaque or calculus to neutralize the acids. This then leads to the start of gingivitis, periodontal disease and even in extreme cases, tooth loss (Fig.2).

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Other symptoms which may occur with dry mouth can are: difficulty swallowing, prob- lems with taste, sore throat, bad breath (hal- itosis), dry nasal passages, yeast infections (candidiasis), loss of glistening moist mucosa, red raw tongue, angular chealitis, sores in the mouth, and cracked lips.



Figure 2. Demineralized enamel, caries and tooth loss


ROLE OF SALIVA

Saliva is necessary to maintain the health of the oral cavity. Food mastication reduces the production of saliva and causes “dry mouth”. Some of the medications that can cause dry mouth side effects are antihistamines, decon- gestants, antihypertensives and antidepres- sants. One of the unfortunate side effects of radiation therapy for cancers of the head and neck area is severe xerostomia (dry mouth). The salivary glands are destroyed by radia- tion, leading to severe dental decay, dry mu- cosa and difficulty in eating and swallowing.


THE IMPORTANCE OF SALIVA

Saliva supports good health in three ways:

  1. Saliva contains enzymes and antibodies that can directly attack the bacteria of the dental plaque.

  2. Saliva neutralizes acids released by de- cay-causing bacteria

  3. Saliva contains minerals (including cal- cium, phosphate and fluoride) needed to replace lost minerals from tooth surfaces. Therefore, good saliva production is im- portant for dental health. Any factor that compromises good saliva production con- tributes to dental decay.


A lack of saliva causes a condition called xero- stomia or dry mouth. This condition can lead to stomatitis (inflammation of the oral cavity).


Decreased salivary flow may be caused by any of the following conditions:

earlier good dental hygiene is established and maintained the healthier will be the child’s dentition.


Summary

There is a strong link between oral health and body health. Years ago, a physician who had a patient with heart disease would not consider referring the patients to a gum specialist (peri- odontist) . The same would be true for many other medical conditions for example pregnancy, diabetes, malnutrition just to name a few.

The oral cavity serves as the main portal to a healthy body. The type of nutrition we practice will either enhance or deter the health of our teeth, gums, tongue, mucosa and help in the proper development and well being of other bodily structures. Early, proper dietary hab- its and hygiene are crucial in laying down the foundation for future bodily health.


Proper nutrients need to be delivered in the most effective way. However, if the teeth and oral mucosa are compromised this can lead to augmenting the preexisting medical con- ditions, creating new diseases and leading to many health complications.


Physicians and dentist need to work hand in hand in treating and educating their patients. No one particular strategy will solve every problem. Nor will one person be the solution to treatments. We need to work with other professional, read, ask questions, be open and flexible


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