Oral Manifestations of Nutritional Deficiency in Children Pedo

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INTRODUCTION : NUTRITION = NUTRINE (Latin word). \ue000

It means breast feed or nurse.

Nutrition is the one of the most major enviro factor that can affect the health of the individual.

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Lack of food or lack of essential constitutes can give rise to disease.

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Today nutrition deficiency constitute a major problem in India and other countries.

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In India gross malnutrition is said to kill arou of our infant and children every year.

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Around three fourth of pediatric population is from one or other nutritional deficiency.

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About 35 to 85% of hospitalized children in suffer from one or other type of malnutrition.

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Around 25% of the pediatric bed are occupie patient whose major problem is malnutrition.

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CLASSIFICATION OF NUTRIENTS :

NUTRIENTS

Water

Macronutrients

Micronutrients

Organic Energy yielding Inorganic Non Energy nutrients - Vitamins yielding nutrients -Electrolytes -Carbohydrate - Fates - Minerals - Protein www.FourthMolar.com

- Trace elements

CALSSIFICATION OF NUTRITIONAL DISORDER : UNDER NUTRITION :

There is not enough food energy in the diet.

MALNUTRTION :

There is a deficiency of either protein or other nutrie the diet.

OBESITY :

Excess of body fat results from positive energy balan

QUALITATIVE OVERNUTRITION :

Occurs due to too much or excess of one food compon e.g. Hypervitaminosis D. Effect of natural toxin in the food :

- Some foods contain small amount of toxin substance w www.FourthMolar.com

ETIOLOGY OF NUTRITIONAL DEFICIENCY :

Primary

Secondary

(Due to dietary deficiency) (Due to such disease) PRIMARY NUTRITIONAL DEFICINCY :

(1)Bad Economy :

Poor socioeconomic status of the family contributes a development of malnutrition in the developing region

With very low income it is a tough task to provide nut diet to the children. (2) Ignore, Faulty food habit, Feeding :

Many deep rooted beliefs, customs, practices, supers food taboos and ignorance causes malnutrition. www.FourthMolar.com

Decline in the good practice of breast feeding just bec ignorant mother wish to ape the sophisticated city wom leading to wide spread practice of artificial feeding contribute considerably to malnutrition. (3) Medical Reason :

Infection and disorders such as diarrhea, malaria or m may prove major contributory factor in development o malnutrition. (4) Large Families :

Nutritional status is adversely affected by the large siz the family.

Malnutrition is much higher among children of birth o fourth and higher than with first three children of sub (5) Closely Spaced Families : When pregnancy occur rapidly perhaps every year or www.FourthMolar.com

(6) Working Mother :

A higher proportion of the mothers of malnourished c are daily labours who find little time to take care chi feeding and rearing. (7) Bad Start :

A low birth weight infants start life with a handicap. T are difficulty in feed and is vulnerable to infant.

Born usually to malnourished such infant have high m SECONDARY MALNUTRITION :

The cause are such disease as intestinal malabsorptio tuberculosis, intestinal parasitic infection and other metabolic disorders.

Mismanagement of diarrhoea with starvation therapy hypo caloric diet is an important cause of malnutriti www.FourthMolar.com

(1) CARBOHYDRATE :

SOURCE : Cereals, vegetable, fruits, monosacchrides, etc

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DAILY REQUIREMENT : 400gms/ day

ORAL MANIFESTATION OF CARBOHYDRATE DEFICI IN CHILDREN :

Altered carbohydrate metabolism is contributing factor for periodontal disease. Shorting, broadening of the mandible. Gingival hyperplasia. Teeth causing typical spacing of teeth. MANAGEMENT :

Carbohydrate rich diet should be given at regular int www.FourthMolar.com

(2) PROTEIN :

Prolonged deficiency of protein can cause “Kwashior “Marasmus”

“Kwashiorkor” is protein energy malnutrition in which deficiency protein or aminoacid. “Marasmus” is child hood version of starvation. - It is characterised by severe form of protein energy malnutrition. SOURCE : Milk, meat, egg, fish, cheese, cereals, etc. DALIY REQUIREMENT :

75gms/ day

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ORAL MANIFESTATION OF PROTEIN DEFICIENCY IN CHILDREN : Adversely effect periodontium, fibroblast, osteoblas cementoblast. Delayed eruption of teeth. Caries prone teeth. Retarded cementum deposition. Degenerative change in gingiva and periodontal ligam Teeth with irregular predentin layer. Poor calcification of dentin and matrix. Reddening of tongue with loss of papilla. MANAGEMENT : - In acute cases; protein intakes of 3-4 gm/ kg/day.

- If child is unable to take feed, spoon feeding or feedin naso-gastric tube may be given. www.FourthMolar.com

(3) FAT : SOURCE : Cheese, ghee, butter, eggs, meat, etc. DAILY REQUIREMENT :

55gms/ day

ORAL MANIFESTATION OF FAT DEFICIENCY IN CHILDREN :

Sore mouth with or without ulcerative lesion, ha

Unpleasant taste, loose teeth precocious exfoliat failure of healing of tooth socket. Loss supporting alveolar bone.

MANAGEMENT :

Fat rich diet should be given. www.FourthMolar.com

VITAMINS

Vitamins are complex organic molecules required amounts for normal metabolic function. Strictly speaking a vitamin should be a dietary that cannot be synthesized in the body.

Vitamins can exist as "vitamers" - different chem structures having the same biological activity. For exa vitamin A consists of 4 vitamers.

Vitamins can be divided into two broad classes soluble and lipid soluble. Vitamins A, D, E and K are lipid soluble, Vitamin B complex and Vitamin C are the water soluble. www.FourthMolar.com

VITAMIN A :

SOURCE : Carrot, tomato, cheese, liver, fat ,fish, papaya, etc. DAILY REQUIREMENT : Children : 600 mcg/ day Adult : 600 mcg/ day ORAL MANIFESTATION OF VITAMIN A DEFICIENCY CHILDREN : Hyperkeratosis, hyperplasia of gingival tissue. Atrophy of salivary gland. Hypoplasia of teeth. Increase susceptibility of caries. Delay eruption of teeth. Alveolar bone is retarded in its rate of formation. MANAGEMENT : Depending upon deficiency symptoms it is given in t www.FourthMolar.com

VITAMIN D :

Vitamin D deficiency causes rickets in children. In ca rickets bone matrix continues to be deposited but d fully mineralized due to disturbed calcium and phos metabolism. SOURCE :

Sun light, liver, egg, yolk, butter, milk, etc

DAILY REQUIREMENT : Children-200IU/ day Adult- 100IU/day During lactation and pregnancy- 400IU/day

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ORAL MANIFESTATION OF VITAMIN D DEFICIENCY CHILDREN : Developmental anomalies of dentin and enamel, eruption of teeth. Higher caries index as compare to normal. Hypoplasia of enamel.

MANAGEMENT : - Dietary enrichment of vitamin D in the form of milk. All infants should regularly be given vitamin D supplem until they reach two years of age. - Curative treatment include 2000 to 4000 IU of calciu daily for 6 to 12 week followed by a daily maintenance of 2000 to 4000 IU for a prolonged period. www.FourthMolar.com

VITAMIN E:

It is also called as anti aging factor.

The word tocopherol is derived from word tocos : child pherol : bear

Vitamin E is an antioxidant and protects against oxida cell components (e.g. polyunsaturated fatty acids). SOURCE : vegetable, cereals, meat, eggs, etc .

DAILY REQUIREMENT : Children : 7 mg/ day Adult : 8-10 mg/ day ORAL MANIFESTATION FO VITAMIN E DEFICIENCY CHILDREN : Loss of pigmentation.

Chalky white teeth. www.FourthMolar.com

Disarrangement of ameloblast.

MANAGEMENT : Vitamin E is given in the dose of 100 to 400 mg daily.

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VITAMIN K (PHYLOQUINONE) :

It is essential for the production of a type protein call prothrombin and other factor involve in the clotting mechanism. It also known as antihaemorrhagic vitamin. FORMS : K1 – it is the form which occur in the plant.

K2 – it is produced by most bacteria present i human intestine if it is not supplied in diet. SOURCE : spinach, cabbage, turnip green. DAILY REQUIREMENT : Children : 35 – 75 mcg/ day Adult

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: 70 – 140 mcg/ day

ORAL MANIFESTATION OF VITAMIN K DEFICIENCY CHILDREN : Gingival bleeding can occur in case of vitamin K defic MANAGEMENT : It is given in dose of 10 – 20 mg daily.

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VITAMIN B1 (THIAMINE) :

Prolonged gross deficiency can cause Beriberi.

SOURCE : Cereals, pulses, meat, fish, eggs, etc. DAILY REQUIREMENT : Children – 1.1 mg/ day

Adult – 1.5 mg/ day ORAL MANIFESTATION OF VITAMIN B1 DEFICIENC CHILDREN :

Hyperesthesia of oral mucosa. Burning sensation of tongue.

Loss of taste sensation. Pain in tongue, teeth, jaws.

MANAGEMENT : Infantile Beriberi can be treated by mother’s milk. Mother should be receive thiamine 10,0 twice a daily www.FourthMolar.com

VITAMMIN B2 (RIBOFLAVIN) :

SOURCE : Milk, kidney, rice bran, vegetable, etc. DAILY REQUIREMENT : Children – 1.5 mg/ day Adult – 1.3 mg/day ORAL MANIFESTATION OF VITAMIN B2 DEFICIENCY CHILDREN : Angular stomatitis. Glossitis Filiform papilla become atrophic. Lips become red and shiny. Ulcer in the mouth. As the disease progress, angular cheilitis spread to the cheek. MANAGEMENT :

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VITAMIN B3 (NIACIN) :

Deficiency of vitamin B3 causing pellagra. SOURCE: cereals, pulses, vegetables, nuts, fruits, fish, milk. DAILY REQUIREMENT :

Children – 15 mg/ day Adult – 17 mg/day

ORAL MANIFESTATION OF VITAMIN B3 DEFICIENY CHILDREN : The epithelium of the entire tongue is desquamated.

Glossitis. Tongue become red swollen and beefy. Angular stomatitis. Ulceration in the mouth. MANAGEMENT : Niacin 10mg/ day. www.FourthMolar.com

VITAMIN B6 (PYRIDOXINE) :

It is white crystalline substance soluble in water and a

SOURCE :cereals, pulses, vegetables, cauliflowers, nuts, fruits. DAILY REQUIREMENT :

Children - 2mg/ day Adult -1.7 mg/ day

ORAL MANIFESTATION OF VITAMIN B6 DEFICIENC CHILDREN : Glossitis.

More prone to tooth decay. Angular stomatitis. Halitosis. MANAGEMENT :

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VITAMIN B12 (CYNOCOBALAMINE) :

Vitamin B12 is only synthesized by micro-organisms. It is water soluble vitamin. SOURCE : Fish, Meat, Milk, vegetables, etc. DAILY REQUIREMENT :

Children – 0.2-1 mcg/ day Adult – 1.5 mcg/ day

ORAL MANIFESTATION OF VITAMIN B12 DEFICIENC CHILDREN : Glossitis, pain full tongue.

Tongue is inflamed and red in colour. Burning sensation in the tongue. MANAGEMENT :

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VITAMIN C (ASCORBIC ACID)

:

Prolonged deficiency of vitamin C may result in scurv SOURCE :Amla, orange, tomato, green chilly. DAILY REQUIREMENT : Children – 40 mg/ day Adult - 40 mg / day ORAL MANIFESTATION OF VITAMIN C DEFICIENCY CHILDREN :

Interdental and marginal gingiva is bright red, be ulcerated and bleed. Poor tissue healing. Atrophy of odontoblast. Poor resistance to infection. Typical fetid breath. MANAGEMENT : Vitamin C given in the dose of 250mg two times daily. www.FourthMolar.com

CONCLUSIO N www.FourthMolar.com

REFERENCES The short Textbook of Pediatrics

- Suraj gupte

Clinical Pedodontics Text of Oral Medicine

- FINN - Anil Govindrao Ghom

Burket’s ORAL MEDICINE Diagnosis and treatment

- Greenberg . Glick

WEBSITE : www.dentistry.leeds.ac.uk.com www.FourthMolar.com

THANK YOU!

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