Importance of Nutrition in Orthodontics

DIET:

Diet affects teeth in 2 distinct ways. One is the local effect and depends on the intra oral chemical or physical action on the external surfaces of the teeth of the . the other is the systemic nutritional factor , which is important during the period of tooth development.

 Effects of carbohydrates , proteins and fats on Dental Caries:

Carbohydrates:

They have been demonstrated to be important etiologic agents in dental caries. Immediately following the bathing of the teeth with carbohydrates there is a drop in pH of the plaque, the return of the tooth plaque to its original base line pH is rather slow, about an hour. This drop in pH is indicative of acid production and most investigators conclude that bacterially produced acids are a major factor in the production of incipient carious lesions.

Carbohydrates associated with formation of dental caries must:

  • Be present in the diet in meaningful quantities
  • Be cleared slowly or ingested frequently
  • Be readily fermented by cariogenic bacteria

Protiens:

Although it is well known that carnivorous animals rarely develop tooth decay and that persons ingesting high protein diet have no particular succeptibility to dental caries. It is too early to assess the importance of this finding in terms of dental caries etiology. However, it does point out to the possibility that under certain conditions modifications of the constituents dietary proteins may affect caries initiation.

Fats:

Dietary fats have a limited influence on dental caries. Experiments with animal suggest that the inhibition mechanism is a local one, very possibly associated with an oil film on the tooth surface. Thus altering the surface properties of the enamel and possible interference with the metabolism of oral microorganisms.

Demineralisation:
A  common concern in orthodontics is the potential development of decalcification, caries and periodontal problems. These problems can be associated with bonds or bands when combined with an improper diet involving unregulated sugar consumption and inadequate oral hygiene.

The relationship between dental caries and the ingestion of fermentable carbohydrates has known for a long time. Many foods contain substances called buffers that neutralize any acids formed for eg. Calcium from milk or protein from meat can neutralize or absorb acids.

Feathrstone and Glatz in 1985 showed that measurable demineralization occurred in 4 weeks time, especially gingival to bands or brackets.

Plaque accumulation has been shown to occur on brackets and some of the resins used to bond them. Brackets and some of the resins used to bond them. Bracket configuration, presence of wires, elastics, springs and other attachments interfere with the patients ability to keep some portion of the teeth and brackets clean. Clinical observation indicate that one of the most common sites for demineralization appear to lie at the junction between the bonding resin and the enamel, commonly gingival to the bracket base.

ACTION OF FLOURIDE IN LIMITING TOOTH DECAY

Fluoride in the concentration of 1ppm in drinking water is known to inhibit dental caries, primarily by altering the physical and chemical properties of the tooth. It is recognized that fluoride incorporated into the tooth at the time of calcification show a definite resistance to tooth decay, mechanism being the conversion of hydroxylappatite crystals of enamel to fluorapatite.

When dilute solution of fluoride is brought in contact with fully calcified enamel a union of fluoride and enamel results. When teeth are subjected to topical fluoride , fluorine displaces the hydroxyl ions from the hydroxyapatite crystal and forms fluorapatite which has reduced acid solubility. Also topical fluoride application decreases the permeability of the enamel.

But care should be taken against excess fluoride consumed in the diet as it can cause cause systemic manifestations like osteoflurosis and if consumed during the tooth development , it can lead to dental fluorosis characterized by brownish and corroded appearance of teeth.

Signs and Symptoms

  1. increased density of various bones particularly pelvis and vertebrae.
  2. increased calcification of ligaments, tendons and muscle insertions resulting in vague pains of hands and feet.
  3. in its severest form it can lead to joint stiffening virtually immobilizing the patient.

ROOT RESORPTION

Root resorption is a common iatrogenic problem associated with orthodontic treatment. Resorption can be external- as a reaction to periodontal tissue, or internal- as a reaction to pulp.

Many investigators have evaluated the effects of dietary factors on root resorption. Marshall as early as 1930 concluded that animals on deficient diets showed greater degree of resorption than do those on adequate diets, using the same appliance and the resorbed areas  are greater in extent and are repaired more slowly in animals with deficient diets. This was supported by the study of Beck in 1931 on dogs, the animals with calcium and vitamin deficient diets were more succeptible to root resorption.

Enstrom et al in 1988 investigated the effect of orthodontic force on periodontal tissues in normal and hypocalcaemic rats. Their observations gave the information that the increase in the occurrence and severity of root resorption in moderate hypocalcaemia was related to an increase in alveolar bone turnover.

Glodie and King in 1984 conducted a study to investigate the tooth movement cycle and the area of root surface resorption in rats stressed with lactaion and diets deficient in calcium. Their results showed greater magnitude of tooth movementand overall root resoption was less in the animals which were stressed with diet . this manifestation was attributed to increased bone metabolism and decreased bone density.

NUTRITIONAL INFLUENCE ON PERIODONTIUM

Majority of the research findings on the effects of nutrition on oral and periodontal tissues point to the following:

  1. There are nutritional deficiencies that produce changes in the oral cavity, these changes include alterations of the lips, oral mucosa, bone as well as the periodontal tissues.
  2. There are no  nutritional deficiencies that by themselves cause gingivitis or periodontal pocket.

There are however, nutritional deficiencies that can aggravate the injurious effects of the local irritants on the periodontium.

Physical character of diet:

Soft diet leads to plaque and calculus formation whereas hard and fibrous food provide surface cleansing action and stimulation which leads to decreased plaque and gingivitis.

Chewing of fibrous food s doesn’t increase gingival keratinisaton as believed, but it produces a type of oral muscular activity or physiotherapy  that can have a beneficial stimulatory effect on strengthening the periodontal ligament and increasing the density of the alveolar bone.

Effect of vitamin deficiency on periodontium.

  1. Vitamin A – deficiency leads to keratinizing metaplasia of the epithelium, increased susceptibility to infection and disturbances in bone growth, shape and texture. Animal experiments suggest that vit A deficiency may predispose to periodontal disease.
  2. Vitamin B – deficiency leads to gingivitis, glossitis and glossodynia, angular chelitis and inflammation of the oral mucosa.Folic acid deficient animals present necrosis of the gingival, periodontal ligament and alveolar bone without inflammation. The absence of inflammation ia the result of deficiency induced granulocytopenia.
  3. Vitamin C – its deficiency leads to Scurvy. It has been suggested that ascorbic acid may play a role  in periodontal disease by one of the following mechanisms:
    1. Low levels of ascorbic acid influence the metabolism of collagen within the periodontium, thereby affecting the ability of the tissue to regenerate and repair itself.
    2. Vit C deficiency interferes with bone formation and remodeling of the periodontal bone
    3. Its deficiency may aggravate the gingival response  to plaque  and worsen the edema, enlargement and bleeding

Mc Canlies et al studied the effect of Vit C on the mobility of pig incisors under orthodontic forces and observed increased osteoclastic activity and large resorption lacunae in pigs with decreased or no Vit C in diet.

  1. Vitamin D – It is essential for the absorption of calcium, for the maintenance of Ca and PO4 balance and for the formation of teeth and bones. Its deficiency is characterized by the osteoporosis of alveolar bone and cemental resorption.