nutrition in orthodontics

Importance of Nutrition in Orthodontics

Effect Of Orthodontic treatment On nutrient Intake

As studied earlier, Diet can affect the periodontal health, oral microbial composition, wound healing, protein synthesis growth and I.Q. But when a person is undergoing orthodontic treatment, his or her dietary requirements and habits change which sjould be kept in mind before commencing the treatment.

The diet of adolescent patients becomes more important because moving teeth creates an increased nutrient demand. The physical and physiological and emotional stresses caused by orthodontic treatment sets in motion hormonal reactions that increase nutrient mobilization and utilization. This raises the nutritional requirement of the patient.maintenance of diet is especially important to mprevent infection, promote growth and development and allowing the  healing of periodontal tissues during treatment.

Giordan (1997) studied the effect of orthodontic treatment on nutritional intake of the patient and concluded that there was a significant decrease in the fiber content of diet and higher fat and low carbohydrate soft food consumption.

Strause and Saltzmann also concluded that there was a decrease in the Mn and Cu intakes during orthodontic treatment, which may lead to decreased bone remodeling.

NUTRITIONAL CONSIDERATION IN ORTHODONTIC TOOTH MOVEMENT

Tooth movement involves biologic responses to orthodontic forces, which may influenced by ascorbic acid. 17-72% of orthodontic patients are deficient in Vitamin C. lack of Vitamin C interferes with collagen synthesis thus affecting both periodontal ligament and the formation of osteoid. Animal studies have shown that vitamin C deficiency causes enlarged endosteal spaces with osteoclasts, uneven periosteal surfaces with osteoclastic activity.

Vitamin C deficiency also affects the stability of orthodontic correction (ie); it affects retention. This has been confirmed from experiments on guinea pig incisors, where the vitamin C deficient group experienced more relapse.

NUTRITIONAL CONSIDERATIONS IN SURGICAL PATIENTS:

The mouth is the portal for entry of food into the body thus maxillofacial surgery of these structures may result in impaired food intake both prior to and after surgery. We must ensure adequate nutritional support in such patients.

Patients require both an energy source and a protein source. Carbohydrates, proteins and fatty acids are sources of energy. Glucose is the energy source foe vital organs like brain. However hyperglycemia is not desirable. Fatty acids produce produce more energy and certain essential fatty acids must be supplied by the diet. Protein is not an energy source but its primary purpose is for cellular proliferation and protein synthesis. Protein is also important for imparting strength to the fracture repair. If it is absent then the wound healing is delayed.

Vitamin A helps in epithelialization, collagen synthesis & cross linking and fibroblast differentiation. Vitamin C deficiency leads to impaired wound healing and collagen synthesis. Vitamin D and Calcium help in the healing of the hard tissues. Vitamin E acts as an antioxidant and thus reduces the damage from the free oxygen radicals. Large doses of Vitamin E also inhibit healing. Vitamin K helps  in activation of various clotting factors and thus is essential for blood clot formation during healing.

Nutritional intake is dependant on several variables and one of them is Taste. Zinc and protein deficiency impairs taste bud regeneration, thus impairing the taste sensation of the patient which in turn affects the dietary intake of the patient.

GUIDELINES FOR EVALUATION AND ASSESSMENT OF NUTRITIONAL STATUS.

The evaluation of dietary and nutrient intake is an  important tool to help the practitioner help patients achieve an optimum state of oral and general health. Diet adequacy is usually assessed when one compares nutrient ingestion to the recommended intake for  a specific age group according to standards. One such standard is ‘Recommended Dietary Allowance’.

RDA is a list of nutrients in amounts  which provide  the daily nutritional requirement of healthy persons in different age groups. Other methods to assess dietary intake are

-physical appearance

-clinical evaluation

-biochemical analysis

-anthropometric data

CLINICAL SIGNS:

 Nutritional deficiencies may not always show clinical signs symptoms early on but may impair physiologic functioning.

An oral examination forms a vital part of nutritional assessment as is examination of the face, eyes, hair, glands, skin, nails, muscular and skeletal systems.

Biochemical Analysis:

Laboratory tests for the presence or absence of specific nutrients in biological fluids to determine the adequacy of biochemical functions can be a valuable tool when used with other parameters  in assessing the nutritional status. Laboratory tests have an advantage over clinical examination, as they can detect deficiency state or suboptimal nutrient level more precisely.

Routine lab tests include:

  1. Urine analysis
  2. Serum Protien
  3. Blood forming nutrients
  4. Vitamins
  5. Glucose
  6. Specific enzymes

Anthropometric Data:

It is indicative of the size of the body and its contours. Comparisons of the body weight to height are valuable indicators and are often used in assessing nutritional status. Height and weight when plotted over a period are indicative of growth rate in children and can be compared with percentile charts that represent standards developed for children of that age.

BALANCED DIET

A balanced diet is defined as one which contains a variety of foods in such quantities and proportions that the need for energy, amino acids, vitamins, minerals, fats, carbohydrates and other nutrients is adequately met for maintaining health, vitality and general well being and also makes small provision for extra nutrients to withstand short duration of leanness.

In constructing a balanced diet the dietary goals recommended by the  WHO should be borne in mind:

  1. Protien should account for appox. 15-20% of daily energy intake
  2. Dietary fats should be limited to approx. 20-30% of total daily intake
  3. Saturated fats should be avoided
  4. Excessive consumption of refined carbohydrates should be avoided
  5. Carbohydrates rich in natural fibre should be taken.

However diet should be adapted to the special needs of growth, pregnancy, lactation, physical activity and medical disorders.