Oral Manifestations Of Nutritional Disorders Question And Answers

Oral Manifestations Of Nutritional Disorders Essay Questions

Question 1. What are water-soluble vitamins? Describe their function, food sources, and oral manifestations of deficiency.
Answer:

• Vitamins are essential nutrients and perform specific vital functions hence crucial for health. Vitamin B complex and vitamin C are water-soluble.
• They dissolve in water and are eliminated in urine. The body cannot store the vitamins and therefore need to be supplied everyday. Cooking and food processing destroys the vitamins.
• Vitamin B complex: B complex group comprises a total of eight vitamins. They are thiamine (B₁), riboflavin (B₂), niacin (B₃), pyridoxine (B₆), vitamin B₁₂, folic acid, pantothenic acid, and biotin.

Read And Learn More: Oral Medicine and Radiology Question And Answers

Vitamin B1 —Thiamine:

• Functions: Acts as a coenzyme in the metabolism of carbohydrates, and release energy from food. They are essential for maintaining the proper functioning of muscles and nervous system.
• Food sources: Most commonly found in whole grains, cereals, legumes, liver, and enriched bread.

Manifestations of vitamin B₁ deficiency:

• Hyperesthesia (unusual sensitivity) of the oral mucosa.
• Atypical neuralgias
• Burning sensation in the oral mucosa and face.
• Dentinal hypersensitivity.
• Trigeminal neuralgia and delayed healing after extraction.
  Gingiva resembles an old rose in color.
• Vitamin B₁ deficiencies in infants begin with erythematous papillae over the anterior dorsum and tip of the tongue followed by glossitis.

Vitamin B₂—Riboflavin:

• Riboflavin acts as a coenzyme in the oxidation-reduction cycle, and metabolism of carbohydrates, proteins, and fat.
• Food sources: Green vegetables, legu¬mes, milk, whole grain products, egg, and liver.
• The riboflavin deficiency causes angular cheilitis and glossitis. The effects occur within 8 weeks of deficient status.
  • Angular cheilitis: The corners of the mouth become erythematous, and at the advanced stage, it leads to painful fissures and bleeding. Lips become red with multiple cracks and are known as cracked lips.
  • Glossitis: Swollen fungiform papillae give a pebbly texture to the tongue and vascular distension gives magenta color. Later there is atrophy of the papillae and the tongue becomes glazy, shiny, fissured, and painful.
• In young adults, B₂ deficiency causes interdental bone resorption and mobility of the incisors.
• Jaws deformities and retardation of condylar growth are rare complications.

Vitamin B3—Niacin, nicotinic acid, nicotin-amide:

• It is necessary for energy production, enzyme activities, and function of the nervous system.
• Food sources: Liver, fish, poultry, meat, peanuts, whole and enriched grain products.
• In nicotinic acid or niacin deficiency, the tongue appears beefy red and swollen with papillary hypertrophy. As the deficiency continues, the fungiform and filiform papillae become atrophic with superficial epithelial desquamation leading to a smooth, glossy, and red appearance on the dorsal surface.
• Diffuse patchy inflammation of the oral mucosa associated with burning sensation, soreness, and tenderness also occur. The interdental papillae undergo necrotic changes and spread to involve the other parts of the gingiva. Gingival ulceration is also evident.

Vitamin B₆—Pyridoxine:

• It is essential for protein metabolism, hemoglobin, and red blood cell synthesis.
• B6 also plays a role in the mechanism of insulin secretion.
• Food sources: Pork, meat, whole grains, cereals, legumes, and dark leafy vegetables.
• The pyridoxine deficiency has not yet been determined.

Vitamin B₁₂—Cobalamin:

• It aids in building genetic material, and RBC synthesis, and supports the functions of the nervous system.
• Food sources: It is found only in foods of animal origin, such as meat, liver, kidney, fish, eggs, and dairy products.
• Addisonian anemia is a severe form of vitamin B12 deficiency. The lips, buccal mucosa, and palate become pale yellow. The appearance of brown pigmentation and angular cheilitis with fissuring and yellow crustation are the typical findings.
• Hunter’s glossitis—it is the pathogno¬monic finding of B12 deficiency. Atrophic changes of the filiform papillae lead to a red, shiny, and smooth dorsal surface of the tongue. The patient reports soreness, burning sensation, and loss of taste sensation.

Folic acid:

• It aids in protein metabolism, promoting red blood cell formation and preventing neural tube defects.
• Food sources: Dark leafy vegetables, whole grains, cereals, legumes, and citrus fruits, liver, and kidney.
  • Folic acid deficiency causes glossitis, ulcerative stomatitis, and angular cheilitis.
  • Glossitis: The dorsum becomes red, swollen, and tender.
  • Ulcers: Occur either as superficial erosions or minor aphthous. The tongue is very painful and called the beefy tongue.
  • The filiform and then the fungiform papillae become atrophied. In the early stages, the atrophic changes are patchy and involve the lateral borders of the tongue. Multiple erosions and ulcers develop in the atrophic surface.
  • Gingiva may exhibit an exaggerated inflammatory response. There is a remote chance for necrotizing gingivitis. Periodontitis is also a feature of folic acid deficiency.

Biotin:

• It helps in the metabolism of carbohydrates, fat, and proteins.
• Food sources: Liver, kidney, egg yolk, fresh vegetables, cereals, and yeast bread.
• No noticeable oral changes occur in the deficient state.

Pantothenic acid:

• It is involved in the metabolism of fat, proteins, and carbohydrates, energy production, and hormone synthesis.
• Food sources: Liver, kidney, meat, egg yolk, whole grains. Intestinal bacteria also synthesize this vitamin.
• Deficiency may lead to glossitis and cheilosis.

Vitamin C—ascorbic acid:

• Vitamin C is essential for collagen syn¬thesis, wound healing, bone, and tooth formation, and strengthening of endothelial vessel walls. Vitamin C functions as an antioxidant which enhances the body’s immunity, iron absorption, and utilization.
• Food sources: Citrus fruits like lemon, kiwi, orange, etc.
  • Scurvy is the manifestation of severe vitamin C deficiency. The gingiva becomes swollen, purplish, spongy, and bleeds spontaneously. Vitamin C deficiency primarily aggravates the gingival reaction to plaque and manifests the signs of gingivitis.
  • Vitamin C deficiency during the development period causes atrophy of ameloblasts and odontoblasts. This results in the hypoplastic appearance of teeth.
  • In avitaminosis C, the osteoblasts exhibit functional deficiency. The bone formation and resorption are affected resulting in the less dense alveolus. Defective collagen synthesis reduces periodontal integrity. The periodontal fibers tend to break down easily and cause tooth mobility.

Oral Manifestations Of Nutritional Disorders Short Notes

Question 1. Describe orofacial manifestations of kwashiorkor disease.
Answer:

• Kwashiorkor is a condition of low-quantity protein in children’s diets.
• The child is affected by generalized edema, muscle wasting and shows characteristic moon face and potbelly appearance (Flow-chart 1). They also exhibit apathy, lethargy, and anorexia. The skin appeared thick and cracked with areas of denudation.
• Dental findings: If it occurs at the developmental stage, the following changes take place:
• Delayed eruption
• Retardation of mandible
• Smaller size molars
• Enamel hypoplasia
• Salivary glands:
  • Gland hypoplasia
  • Reduced salivary flow
  • Decreased salivary immune protec¬tion due to less amylase and amino peptides.

Question 2. Describe orofacial manifestations of marasmus.
Answer: Energy deficiency in children due to reduced food intake is known as marasmus. The affected child manifests low body weight and wasted muscles.

Marasmus Clinical Findings:

• Delayed eruption
• Decreased salivary flow
• Increased incidence of dental caries
• Defective formation of epithelium, bone, and connective tissues
• Reduced level of salivary IgA
• Necrotizing ulcerative gingivitis and noma due to low resistance to infections.

 

Question 3. Mention the role of vitamin A in oral health.
Answer:

Vitamin A in oral health Importance:

• Vitamin A is essential for the formation of ameloblasts, odontoblasts, and bone.
• Also, it is necessary throughout the life for maintenance of the epithelial integrity of oral mucosa.
• Have antioxidant properties.

Oral manifestations of deficiency in the pre-eruptive stage:

• Enamel hypoplasia and incomplete enamel calcification.
• Defective dentin formation.

Vitamin A in oral health Therapeutic Consideration:

• The scavenging activity of vitamin A on free radicals made to use this as a chemopreventive agent for oral precancer and cancer. Retinoids are used as a supplement because of their cancer growth-inhibiting character (apoptosis) and regulating the immune system.
• Topical retinoids are used in the treatment of leukoplakia and as adjunctive in the management of reticular and plaque-type leukoplakia.

Vitamin A in oral health Side Effects:

• Routine consumption of larger quantities may lead to:
  • Dryness of oral mucosa
  • Red gingiva
  • Cracking and bleeding lips due to epithelial atrophy.

Question 4. State the oral manifestations of vitamin D deficiency.
Answer: Vitamin D deficit causes rickets in children and osteomalacia in adults.

Manifestation in Rickets:

• The deciduous teeth are not affected. The permanent central incisors and first molars and sometimes the lateral incisors and canines show developmental defects in their crown structures.
• Poor calcification results in moderate to severe hypoplastic defects like pits, fissures, and grooves on the crown surface. Improper calcification of the dentine matrix leads to interglobular spaces. The dentine reveals a line of disturbed mineralization. The secondary dentine deposition is retarded.
• The jaw bones are markedly hypocalcified and weak. Open bite and malocclusion are the frequent manifestations.

Oral Manifestation of Vitamin D Deficiency in Adults: Diffuse pain in jaw bones and the tendency for fracture even for mild trauma.

Question 5. Briefly state the importance of anti¬oxidants in oral health.
Answer:

• Free radicals are reactive oxygen species and are capable of damaging all types of biomolecules. Antioxidants neutralize free radicals throughout the body and are essential for optimum health.
• An antioxidant may be a vitamin (beta-carotene, vitamin C, and E), mineral (selenium, zinc, copper), or fatty acids (omega 3 and omega 6) present in food. Other naturally occurring antioxidants include flavonoids, tannins, and phenols.
• Dietary antioxidants protect the cell membrane molecules from oxidative damage by destroying the oxidative radicals before they injure the tissues.
• They slow down the oxidation process and aid in repairing cellular damage. Some antioxidants have anti-inflammatory activity, and some other has antineoplastic properties.
• Antioxidants are provided through several supplements. In dentistry, toothpaste, mouth rinses or oral sprays incorporate antioxidants.

Role of Antioxidants in Oral Diseases:

• Antioxidants change the progress of periodontitis, and gingivitis by decreasing the production of collagenase.
• Antioxidants are used as both preventive as well as therapeutic agents in individuals diagnosed with precancer lesions. Toco- phenols and carotenoids are the effective antioxidants used for this purpose.
• Vitamin E, carotene, and glutathione inhibit tumor angiogenesis.
• Flavonoids act as histamine blockers and control allergic reactions in the oral cavity.
• Lycopene work to reverse hyperkeratotic changes in oral mucosa and is hence used in the treatment of leukoplakia.
• Retinoids had anti-inflammatory properties and used to treat lichen planus.

Question 6. Discuss oral manifestations of amyloi¬dosis.
Answer:

• Amyloidosis develops due to the deposition of insoluble extracellular protein, amyloid in the body tissues.
• The primary form of amyloidosis affects the oral cavity and is associated with the deposition of AL (amyloid light chain) in the oral tissues.

Amyloidosis Oral findings:

• The tongue is the most commonly affected organ. Macroglossia occurs due to amyloid deposition. An enlarged tongue causes difficulty in chewing and talking. Lateral borders of the tongue get pressed against lingual cusps of posterior teeth and show indentations.
• Other involved sites are the buccal mucosa, gingiva and the floor of the mouth, minor salivary glands, palate, and lower lip.

Amyloidosis Investigation:

• Incisional biopsy of the affected site. Congo-red staining of the specimen will demonstrate an apple-green birefringence on polarized light microscopy.
• Immunofixation electrophoresis of serum will detect light-chain immunoglobulins.

Amyloidosis Treatment: Systemic steroids—dexamethasone.

Question 7. Enumerate the oral manifestations of lipoid proteinosis (Urbach-Wiethe disease)
Answer: Lipoid proteinosis is caused by the deposition of a hyaline-like substance in various tissues due to a mutation in the extracellular glycoprotein.

Lipoid proteinosis Common oral findings:

• Commonly affected sites are labial, buccal, and palatal mucosa, posterior tongue, uvula, tonsils, and lingual frenum.
• The affected mucosa appears thickened and nodular.
• Yellow-white papules are seen in the oral mucosa.
• The tongue is enlarged (macroglossia) and the wood is hard in consistency.
• Lips are enlarged with nodules and fissures.
• Difficulty in tongue protrusion if the lingual frenum is involved.
• Gingival hyperplasia.

Oral Manifestations Of Nutritional Disorders Multiple Choice Questions

Question 1. RDA stands for.

1. Research and Development Association
2. Recommended dietary allowance
3. Radiation diagnostic appliances
4. Rare Disease Association

Answer: 2. Recommended dietary allowance

Question 2. In India, the body weight of a reference man is.

1. 60 kg
2. 70 kg
3. 75 kg
4. 85 kg

Answer: 1. 60 kg

Question 3. In India, the body weight of reference women is.

1. 60 kg
2. 70 kg
3. 50 kg
4. 65 kg

Answer: 3. 50 kg

Question 4. The average weight of Indian men is.

1. 60 kg
2. 70 kg
3. 52 kg
4. 45 kg

Answer: 3. 52kg

Question 5. The average weight of Indian women is.

1. 55 kg
2. 37 kg
3. 44 kg
4. 65 kg

Answer: 3. 44kg

Question 6. A major source of human energy is.

1. Unsaturated fatty acids
2. Carbohydrates
3. Trace minerals
4. Proteins

Answer: 2. Carbohydrates

Question 7. The noncariogenic sugar substitute is.

1. Aspartame
2. Saccharin
3. Xylitol
4. Corn-syrup

Answer: 3. Xylitol

Question 8. Protein malnutrition in children causes.

1. Kwashiorkor
2. Marasmus
3. Keshan disease
4. Ketosis

Answer: 1. kwashiorkor

Question 9. Energy deficiency due to reduced food intake is known as.

1. Kwashiorkor
2. Marasmus
3. Keshan disease
4. Ketosis

Answer: 2. Marasmus

Question 10. Keratin accumulation in the skin and oral mucosa occurs due to.

1. Albumin deficiency
2. Amino acid deficiency
3. Vitamin A deficiency
4. Zinc deficiency

Answer: 3. Vitamin A deficiency

Question 11. The vitamin is essential for the normal functioning of nerves and muscle is.

1. Vitamin A deficiency
2. Vitamin D deficiency
3. Vitamin K deficiency
4. Vitamin C deficiency

Answer: 2. Vitamin D deficiency

Question 12. Small noncalcified areas on skull bones are known as.

1. Osteotabes
2. Craniotabes
3. Callus
4. Osteophytes

Answer: 2. Craniotabes

Question 13. Craniotabes is a feature of.

1. Vitamin A deficiency
2. Vitamin D deficiency
3. Vitamin K deficiency
4. Vitamin C deficiency

Answer: 2. Vitamin D deficiency

Question 14. Enamel hypoplasia with pitted surface occurs in.

1. Vitamin A deficiency
2. Vitamin D deficiency
3. Vitamin K deficiency
4. Vitamin C deficiency

Answer: 2. Vitamin D deficiency

Question 15. Gingival bleeding is the first and most frequent finding of.

1. Vitamin A deficiency
2. Vitamin D deficiency
3. Vitamin K deficiency
4. Vitamin C deficiency

Answer: 3. Vitamin K deficiency

Question 16. The type of amyloidosis that is associated with chronic inflammatory destructive diseases is.

1. Primary form
2. Secondary form
3. Tertiary phase
4. Terminal phase

Answer: 2. Secondary form

Question 17. Amyloidosis associated with tuberculosis is characterized by the deposition of.

1. A amyloid
2. C amyloid
3. Alpha amyloid
4. Beta-amyloid

(Note: Amyloidosis associated with tuber¬culosis is a secondary form and is characterized by the deposition of A amyloid).

Answer: 1. A amyloid

Question 18. A common biopsy site preferred for the diagnosis of a generalized form of amyloidosis is.

1. Lip
2. Gingiva
3. Skin
4. Salivary gland

Answer: 2. Gingiva

Question 19. Discoloration of teeth in cutaneous porphyria affects the.

1. The cervical region of deciduous teeth
2. The cervical region of permanent teeth
3. The occlusal aspect of deciduous teeth
4. The occlusal aspect of permanent teeth

Answer: 1. Cervical region of deciduous teeth

Question 20. In cutaneous porphyria, deciduous dentition appears as.

1. Dark red colored
2. Deep red-brown colored
3. Deep brown-black colored
4. Light red colored

Answer: 2. Deep red-brown colored

Question 21. Porphyria-induced dental discoloration is differentiated from other types of discoloration by using.

1. Bunsen lamp
2. Slit lamp
3. Halogen lamp
4. Wood’s lamp

Answer: 4. Wood lamp

Question 22. Dental restorative material to be avoided in porphyria patients is.

1. Glass-ionomer cement
2. Amalgam
3. Gold
4. Metal-ceramic

Answer: 2. Amalgam

Question 23. The wavelength of light that is a hazard to porphyria patients is in the range between.

1. 100-220 nm
2. 200-450 nm
3. 400-550 nm
4. 500-650 nm

Answer: 3. 400-550 nm

Question 24. Local anesthetic agents contraindicated for porphyria patients is.

1. Lidocaine
2. Bupivacaine
3. Procaine
4. Prilocaine

(Note: Bupivacaine is the choice of local anesthetic drug in porphyria patients).

Answer: 1. Lidocaine

Question 25. Diclofenac is contraindicated for patients suffering from it.

1. Sarcoidosis
2. Tuberculosis
3. Porphyria
4. Lupus erythematosus

Answer: 3. Porphyria

Question 26. A metabolic disorder associated with intraoral bullae is.

1. Amyloidosis
2. Tay-Sachs disease
3. Wilson’s disease
4. Porphyria

Answer: 4. Porphyria

Question 27. Gargoylism is due to the deposition of mucopoly¬saccharides.

1. Epithelium
2. Blood vessels
3. Fibroblasts
4. Neurons

(Note: Gargoylism is the presence of clear or gargoyles cells).

Answer: 3. Fibroblasts

Question 28. Hurler syndrome is.

1. Mucopolysaccharidosis type 1
2. Mucopolysaccharidosis type 2
3. Mucopolysaccharidosis type 3
4. Mucopolysaccharidosis type 4

(Note: Hurler syndrome is mucopolysacchari¬dosis type I—gargoylism).

Answer: 1. Mucopolysaccharidosis type 1

Question 29. Hunter syndrome is.

1. Mucopolysaccharidosis type 1
2. Mucopolysaccharidosis type 2
3. Mucopolysaccharidosis type 3
4. Mucopolysaccharidosis type 4

Answer: 2. Mucopolysaccharidosis type 2

Question 30. Cutaneous ivory-white papules are seen in.

1. Hunter syndrome
2. Hurler syndrome
3. Scheie syndrome
4. Murphy’s syndrome

Answer: 1. Hunter syndrome

Question 31. The radiographic appearance of dentigerous cyst-like radiolucent follicles is seen in.

1. Hurler syndrome
2. Hunter syndrome
3. Maroteaux-Lamy syndrome
4. Carpal tunnel syndrome

(Note: Maroteaux-Lamy syndrome is muco¬polysaccharidosis type 6).

Answer: 3. Maroteaux-Lamy syndrome

Question 32. Blepharosis moniliformis or eyelid beadings are seen in.

1. Amyloidosis
2. Lipoid proteinosis
3. Krabbe disease
4. Sphingolipidoses

Answer: 2. Lipoid proteinosis

Question 33. The radiographic appearance of eosinophilic granuloma mimics.

1. Hamartoma
2. Teratoma
3. Malignancy
4. Marble bone disease

(Note: The radiographic appearance of eosinophilic granuloma mimics odontogenic cysts or malignancy).

Answer: 3. Malignancy

Question 34. Gaucher disease is due to poor function of the enzyme.

1. Phenylalanine
2. β-glucocerebrosidase
3. Sphingomyelinase
4. β-galactosidase

(Note: Metabolic disorders with a short course and fatal termination are Letterer-Siwe disease, type 2 Gaucher disease, and Niemann-Pick disease. The deposition of glucocerebroside characterizes Gaucher disease).

Answer: 2. β-glucocerebrosidase

Question 35. A universal antioxidant is.

1. α lipoic acid
2. Carotenoids
3. Lycopene
4. Vitamins

Answer: 1. α-lipoic acid

Oral Manifestations Of Nutritional Disorders Viva Voce

Question 1. Are lipids cariostatic or cariogenic? Why?
Answer:

Lipids are cariostatic because:

• Long-chain fatty acids decrease the acid dissolution of hydroxyapatite crystals.
• Fats lubricate the enamel surface and prevent acid penetration through it.
• Dietary fat increases fluoride absorption and increases tissue fluoride concentration.
• A lipid diet also prevents food retention in the mouth.

Question 2. Mention the role of vitamin A in the pathogenesis of potentially malignant oral diseases.
Answer: Vitamin A deficiency induces hyperkeratosis and metaplasia of epithelial cells of the oral mucosa and is hence related to the pathogenesis of leukoplakia and oral carcinoma.

Question 3. Name a few metabolic disorders.
Answer:

• Disorders of protein metabolism: Amyloidosis, porphyria.
• Disorder of carbohydrate metabolism: Mucopolysaccharidosis.
• Disorders of lipid metabolism: Histiocytosis X
• (Hand-Schuller-Christian disease, and Letterer-Siwe disease).

Question 4. What are free radicals?
Answer: Free radicals are chemical substances containing one or more unpaired electrons in the excitable state.

Oral Manifestations Of Nutritional Disorders Highlights

• The nutritional status of an individual is reflected in their oral mucosa. The oral cavity of malnourished individuals may reveal the findings of ulcers, microbial infections, dry mouth, and disturbed taste sensations.
• The deficiency of proteins, vitamins, and trace elements produces remarkable changes on the face, lips, tongue, and gingiva. This chapter highlights the oral and dental modifications associated with malnutrition, the pathogenesis associated with a deficient state of different nutrients, and information about the dietary sources of nutrients..