1. Protein                     
2. Vitamin C
3. Iron
4. Copper
5. Zinc

• Calcium
• Phosphorus
• Magnesium
• Sodium Potassium
• Carbonate Ions

Once the tooth has erupted no more enamel is formed.  However mineral exchanges do occur via the saliva.  These minerals are:

• Fluoride
• Sodium
• Zinc
• Strontium
• Calcium
• Phosphorus

•         Most abundant mineral- 99% of body calcium is in bones & teeth

•         Saliva is saturated with Ca to help with remineralization of enamel

•         Calcium  

•         Phosphorus

•         Magnesium

•         Fluoride

• 2^nd most abundant mineral – 85% in bones & teeth
• Abundant in foods, if you consume enough Ca & protein then these same foods include phosphorus.

3^rd most abundant mineral

Functions:

Important function of maintaining calcium home-ostasis & preventing skeletal abnormalities

Vital nutrient for muscles & nerves (esp. the heart muscle)

Important in energy production (ATP)

Sources: Bananas, Whole grains, nuts, beans, and leafy green veggies.

What type of patient would demonstrate a possible Mg over dose?

• Milk
• Dairy
• Leaf green veggies although not well absorbed

• Low vit D
• Fiber
• menopause
• diarrhea
• high pH
• aging
• caffeine
•  sodium
•  smoking
• alcohol
• stress
• polyphenols in tea

• Vit .D
• periods of rapid growth
• normal intestine motility
• parathyroid
• acidic environment 

absorption in the small intestine>  plasmaCa>

(a)Protein-bound calcium-

(b)urinary calcium-

(c)ionized calcium(blood, membrane, muscle, nerves, teeth, bones)

•         Definition: Excessive levels of calcium in the blood

•         Symptoms: dizziness, flushing, nausea, vomiting, constipation, xerostomia, fatigue, & can inhibit iron & zinc absorption

Definition: Low levels of calcium in the blood. 

Calcium Deficiency

This deficiency is frequently observed

It can effect:

• Increase in dental caries (only during tooth formation)
• Rickets (Ca intake may be adequate, but absorption is poor b/c of inadequate Vit D)
• Osteoporosis
• Periodontal Disease (breakdown of periodontal tissues can be exacerbated by Ca deficiency

Explain what it means.....

"Calcium & Phosphorus are inversely related"

If calcium increases then phosphorus decreases & visa versa.

• Transfer & release of energy stored as ATP
• Composition of phospholipids
• DNA, RNA
• Metabolism of fats, carbs, & proteins

Too much soda in place of milk

THIS IS VERY RARE

What is Phosphorus Deficiency

• Can occur w/ long term use of aluminum hydroxide antacids (they bind w/ phosphorus inhibiting absorption) DNC
• Sprue & Celiac Disease can result in phosphorus malabsorbtion.
• More prevalent in alcoholics, elder, long term diarrhea DHC

• Leafy green veggies are the best source
• Bananas
• Whole grains
• Nuts
• Beans

• Important function of maintaining calcium home-ostasis & preventing skeletal abnormalities
• Vital nutrient for muscles & nerves (esp. the heart muscle)
• Important in energy production (ATP)

Symptoms:

1. neuromuscular dysfunction
2. personality changes
3. muscle spasm
4. convulsion
5.  tremors
6. nausea
7. apathy 

Oral Effects:

1. Change in Ameloblasts & odontoblasts effect hyperplasia of enamel, inhibit alveolar bone formation, widening of the PDL, & gingival hyperplasia

• Eat a well balance diet which includes unrefined grains and veggies. 
• Decrease food intake decreases Mg levels

Mostly in the stomach and marginally in the small intestine

• Aluminum cantaining Antacids
• If Ca and Fl are given at the same time they can inhibit absorption of both

1. Essential for formation of red blood cells & CT
2. Catalyst in formation of collagen (pre-collagenous stage)
3. Production of neurotransmitters
4. Part of the tooth enamel

Main sources are:

Shell fish, Oysters, Crab, Liver, Nuts, Sesame & sunflower seeds, soy products, legumes, and cocoa.  Widely distributed in foods. 

Seldom encountered

But.....

• Excessive amounts cause nausea & vomiting
• High blood serum levels are found in clients with: Rheumatoid arthritis, M. Infarctions, estrogen supplements, & pregnancy

• Deficiencies cause profound effects on bones, brain, arteries, CT, hair & skin pigmentation.
• Causes low white blood cell count
• Lesions in CT & bone, so failure to grow adequately.
• Result in fractures, osteoporosis, arthritis, bone defects.

     Functions:

• Cofactor for antioxidant enzyme that protects lipids, proteins, & nucleic acids from oxidative damage
• Works closely with vitamin E
• Incorporated in enamel during amelogenesis

Sources:

Animal products, esp. seafood, dairy, eggs, whole grain, & nuts

Def or excessive amounts of selenium are

common/uncommon

uncommon

(too little)Decrease may cause heart damage & lead to heart attack

(too much) Essential for health but can be toxic

Carb & lipid metabolism (utilization of glucose, it increases the action of insulin)

Only under physician care for HIV, cancer, coronary artery disease, arthritis patients

GI disorders (Crohn’s) can cause mal-absorption

Functions: Improve bone matrix dev., prev. of osteoporosis, insulin production, amino acid, cholesterol, and carb metabolism

They are inversely proportional to each other

Large amounts of one causes reduction in other

Sources: whole grain, legumes, nuts, tea, leafy veggies

Bioavailability is great in meats, milk, & eggs

Smaller quantities but good absorption

Who might have hyper manganese?

What might be seen in a person with high levels of manganese in their system?

Miners dust can cause “manganese madness” similar to Parkinson's.  Manganese dust is toxic

Elevated concentration of Manganese in saliva can be  associated with increased caries. 

Hypo: Rare

• Signs are abnormal formation of bone, cartilage.
• Growth retardation, congenital malformations, impaired glucose tolerance, poor reproductive

• Co-enzyme factor
• Present in teeth
• Inhibits caries formation- not clinically recommended but may effect crown morphology (shape)

Source: Legumes, whole grain, milk, liver, veggies

High levels of molybdenum results in copper def.?

T/F

TRUE

Dental Hygiene Considerations: Large intake may result in copper def. Leading then to anemia b/c of iron absorption

1.       Boron

2.       Nickel

3.       Silicon

4.       Tin

5.       Aluminum

6.       Lead

7.       Lithium

8.       Vanadium

9. Mercury

Boron increases strong healthy bones

T/F

True

Osteoporosis pts. May be def. in boron

Found in veggies, fruits, nuts & legumes, wine

Found in dried beans, peas, grains, nuts, chocolate.

Important for resilience of collagen & elastin

Present in enamel

Whole grain and root vegetables

Tin- AKA Stannous

•  Affects bone metabolism b/c in builds up in bone. 
• Believed to be more cariostaic when mixed with fluoride than other fluoride compounds

Milk

Pitting hypoplasia

Lithium- Increase lithium causes decrease calcium in bones. Which can disturb Ca:P ratio

Vanadium- Incorporated in areas of mineralization, but it’s role is unknown

Mercury- Contaminant are often found in food & water supplies.

Osmosis is the diffusion of water through a semi-permeable membrane.  It is the movement of water across a semi-permeable membrane from an area of high water potential (low solute concentration) to an area of low water potential (high solute concentration).

1. Acts as a solvent
2. Maintains stability of all bodily fluids
3. Transport of nutrients to cells & excretion of waste
4. Lubricant between cells
5. Regulates body temperatures

3.7 liters per day (125oz) for Men

2.7 liters per day (91oz) for Women

2%

FVE

(fluid volume excess)

• Water follows sodium so ↑sodium = ↑ total body water (causing edema)
• CHF, Chronic renal failure, liver disease, ↑ steroids, = sodium retention so also water retention

FVD

(Fluid Volume Deficit)

• Vomiting, Diarrhea, diuretics, excessive urination, perspiration,  hypodipsia

Causes include some

• medicines
• vomiting
• diarrhea
• sweating
• kidney problems

Problems most often occur with levels of sodium, potassium or calcium. 

1. Maintain extracellular fluid (ECF) concentration
2. Regulating acid-base balance
3. Impulse nerve transmission in nerve & muscle fibers

What was the max amount of sodium recommended as part of the average diet?

•         Dietary Guidelines recommend less than 2300 mg/ day

2000mg

1 tsp of salt = 2000mg of sodium

•  Bottle water
• Baking powder/ soda
• Dentifrices
• Antibiotics
• Chewing tobacco
• OTC meds

•         Hypernatremia: elevated levels of serum sodium-Good to know!

•         Hyponatremia: low serum sodium levels 

Water & sodium are closely related.
A change in one causes a change in the other

Excessive thirst

Dry sticky tongue, & oral mucosa

Fever

Convulsions

• Decreased  salivary flow
• Nausea
• Abdominal cramps
• Headache
• Confusion
• Lethargy

Functions:

Intra Cellular Fluid (ICF) concentrations

Muscle contractions

Transmission of nerve impulses

Regulates acid-base balance

10 servings of fruits and veggies

Sources: Naturally in foods & beverages (more in fresh than processed)

• Impaired renal excretion (80% excreted out of kidney)
• Increase in shift of potassium out of cell
• Increase potassium intake
• Drugs that interfere with excretion (ACE inhibitors, potassium sparing diuretics)

Excessive sweating

Vomiting

Diarrhea

Diuretics

• Major component of hemoglobin (transports O2 from lungs to tissue)
• Catalyzes oxidative reactions in cells
• Converts beta-carotene to vitamin A
• Synthesis of collagen
• Formation of purines (part of nucleic acid)
• Removes lipid from blood
• Detoxifies drugs in liver
• Production of antibodies

Poorly absorbed like calcium, and poorly excreted

• Liver (best source), beef, egg yolk
• This is why a lot of things are fortified w/ iron

Most difficult mineral to obtain via diet

Ferrous & Ferric

Ferrous is better absorbed

NO....

Body can’t easily eliminate excess iron, so it is stored in organ tissue.

• Can be toxic – Hemosiderosis
• Gastric  acid helps absorb

1. Pallor lips & oral mucosa
2. Angular cheilitis
3. Atrophy of filiform papillae. Goes from patchy to smooth red tongue
4. Glossitis (most common)
5. Candidiasis
6. Burning soreness of tongue (most common)

increase acid can increase absorption

decreased acid can decrease absorption

Iron

Vit A deficiency can cause iron def. Vit A helps transport iron from storage sites

Avoid iron supplements with milk b/c calcium interferes with absorption

*Iron fortified cereals & milk??? Hmmmmm

Part of thyroxin (which regulates metabolic rate)

Enlarged thyroid gland

Goiter

Hypo levels of iodine are common in the US?

T/F

False

Non-existent in US b/c of iodine fortification of salt

1. GOITER-can also be caused by excess iodine
2. Cretinism
3. Delayed eruption of primary & secondary teeth,  & enlarged tongue

Hyperthyroidism (overactive thyroid) is a condition in which your thyroid gland produces too much of the hormone thyroxine.

• Graves Disease
• Thyroditis (inflammation of thyroid)
• Hyper functioning thyroid nodules

1. Fatigue
2. Goiter (visibly enlarged thyroid gland) or thyroid nodules
3. Increased appetite
4. Increased sweating
5. Weight loss (rarely, weight gain)

• Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone.
• Most common cause of hypothyroidism is inflammation of the thyroid gland, which damages the gland's cells

1. Being more sensitive to cold
2. Fatigue
3. Joint or muscle pain
4. Paleness or dry skin
5. Thin, brittle hair or fingernails
6. Weakness
7. Weight gain (unintentional)
8. Irregular menstrual cycle

1. Zinc is required for DNA, RNA, and protein synthesis
2. Essential for bone growth, mineral metabolism, & collagen synthesis

1. Meats
2. eggs
3. Peanuts

Vomiting

Diarrhea

Fatigue

Interfere with HDL levels and copper and iron absorption

Zinc deficiencies are assoc. with loss of taste, smell, poor appetite, & impaired wound healing

 and/or 

•  Thickening of epithelium on the tongue
•  Increased cell numbers
•  Increased susceptibility to periodontal disease
• Flattened filiform papillae
• Cleft Palate & lip

osteoclasts

Meats are good sources of phosphorus

T/F

True

Because phosphorus is found in nearly all foods containing Calcium and/or protein it is very unlikely that a person would be def in this mineral

The only nutrients essential for strong healthy bones are calcium and phosphorus?

T/F

False

Adequate amounts of Ca, phosphorus, and vit D intake is important in bone formation and maintenance

Tooth exfoliation may be an oral sign of osteoporosis?

T/F

T

Loss of Ca in the alveolar bone could contribute to tooth loss 

Systemic fluoride causes changes in tooth morphology that increase caries resistance?

T/F

True

Fluoride ions can replace hydroxyl ions in the hydroxyapatite crystal lattice.  The fluorapatite is less soluble and makes the tooth more resistant to acid

To obtain adequate calcium, a teenager needs to drink 2 cups of milk a day?

T/F

False

4 1/2 cups a day

table 8-1 pg 148 and table 8-2 pg 150 

All women should take Ca supplements to prevent osteoporosis?

T/F

Calcium absorption is increased when a sugar is present?

T/F

True 

Carbs

(ie lactose and glucose)

Caffeine intake might decrease Ca loss? 

T/F

False

  Caffeine decrease the ability of the body to absorb Ca

All bottled water contains fluoride?

T/F

False

Total parenteral nutrition

(TPN)

The institute of med (IOM) has established ULs for copper, manganese, chromium, and molybdenum?

T/F

False

Due to the lack of data

Lead in dental enamel can be used to determine environmental exposure to  to lead?

T/F

True

Excessive lead exposure can be seen as a pitting in tooth structure. Lead can be incorperated into the skelatal or tooth structure. Milk binds to lead.

Copper is important in the formation of collagen?

T/F

False

Copper is essential in RBC formation

Aluminum toxicity causes Alzheimer's disease?

T/F

Selenium functions as an antioxidant?

T/F

True and False 

It works as a cofactor with vit E to be an antioxidant

Refined food are good sources of traces minerals?

T/F

True

Generally refined food provide higher levels of trace mnerals than unrefined food

Aluminum is cariogenic?

T/F

True.....

by increasing the effect of fluoride 

Aluminum seems to be harmful in high doses but increase the cariogenic effect of fluoride.

The function of many trace elements present in the enamel and dentin is unknown? 

T/F

Sugar is a good source of chromium?

T/F

False

Chromium can be found in complex carbs

Selenium supplements are a good way to increase longevity? 

T/F

False

Although is has been show to have antioxidant abilities

Thirst is the primary regulator of fluid intake

T/F

Meats are more than half water 

T/F

true and false 

45- 65%

Water is the most abundant component in the  body?

T/F

True

pg199

Heme iron is provided by meat sources and its more readily absorbed than iron from vegetable or grain products?

T/F

Normal fluid requirements are eight 8oz cups of water daily?

T/F

False 

3.7L per day for men

2.7L per day for women

The RDA for sodium is 5000mg per day 

T/F

FALSE

2000mg or 1tsp salt

Taste alteration is a symptom of zinc deficiency? 

T/F

Potassium is principally found in extracellular fluid? 

T/F

False

intracellular

Broccoli is a good source of potassium?

T/F

False

Milk is the #1 source of potassium

Oral pallor is associated with iodine deficiency?

T/F