CHAPTER 12 WATER AND MINERALS REQUIRED FOR ORAL SOFT TISSUES AND SALIVARY GLANDS Copyright © 2015,...
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Transcript of CHAPTER 12 WATER AND MINERALS REQUIRED FOR ORAL SOFT TISSUES AND SALIVARY GLANDS Copyright © 2015,...
CHAPTER 12CHAPTER 12
WATER AND MINERALS WATER AND MINERALS REQUIRED FOR ORAL SOFT REQUIRED FOR ORAL SOFT
TISSUES AND SALIVARY TISSUES AND SALIVARY GLANDSGLANDS
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 2
WaterWater
Most abundant component of the body Most abundant component of the body At birth 75% to 80% of body weightAt birth 75% to 80% of body weightIn an adult 50% to 60% of body weightIn an adult 50% to 60% of body weightAdipose tissue contains less water than lean body Adipose tissue contains less water than lean body
mass (LBM)mass (LBM)
Body fluidsBody fluidsIntracellular fluid (ICF)Intracellular fluid (ICF)Extracellular fluid (ECF)Extracellular fluid (ECF)Osmotic pressure equalizes theOsmotic pressure equalizes the
solute concentration of ICF and ECFsolute concentration of ICF and ECF
From Thibodeau GA, Patton KT: Anatomy & From Thibodeau GA, Patton KT: Anatomy & Physiology, ed 6. St. Louis: Mosby, 2007.Physiology, ed 6. St. Louis: Mosby, 2007.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 3
Physiological Roles: WaterPhysiological Roles: WaterSolvent enables chemical reactions to occur by entering Solvent enables chemical reactions to occur by entering
into some reactions, such as hydrolysisinto some reactions, such as hydrolysisMaintains stability of all body fluids, as the principal Maintains stability of all body fluids, as the principal
component and medium for fluids (blood and lymph), component and medium for fluids (blood and lymph), secretions (saliva and gastrointestinal fluids), and secretions (saliva and gastrointestinal fluids), and excretions (urine and perspiration)excretions (urine and perspiration)
Enables transport of nutrients to cells and provides Enables transport of nutrients to cells and provides medium for excretion of waste productsmedium for excretion of waste products
Acts as lubricant between cells to permit movement Acts as lubricant between cells to permit movement without frictionwithout friction
Regulates body temperature by evaporating as Regulates body temperature by evaporating as perspiration from skin and vapor from mouth and nose perspiration from skin and vapor from mouth and nose
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 4
Requirements: WaterRequirements: WaterAI for total fluid (beverages, water, and food)AI for total fluid (beverages, water, and food)
Men = 3.7 L (15 to 16 cups) per day Men = 3.7 L (15 to 16 cups) per day Women = 2.7 L (11 to 12 cups) per dayWomen = 2.7 L (11 to 12 cups) per day
Water is lost via a variety of routes Water is lost via a variety of routes 1.1. UrinationUrination
2.2. PerspirationPerspiration
3.3. ExpirationExpiration
4.4. DefecationDefecation
When as little as 2% of body water isWhen as little as 2% of body water is
lost, osmoreceptors are stimulated, creating a lost, osmoreceptors are stimulated, creating a physiological desire to ingest liquidsphysiological desire to ingest liquids
Fro Patton KT, Thibodeau Fro Patton KT, Thibodeau GA: Anatomy & Physiology, GA: Anatomy & Physiology,
ed 8. St. Louis: Mosby, ed 8. St. Louis: Mosby, 2013.2013.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 5
Sources: WaterSources: Water
Redrawn from Popkin BM et al: A Redrawn from Popkin BM et al: A new proposed guidance system for new proposed guidance system for beverage consumption in the United beverage consumption in the United
States. Am J Clin Nutr 2006 Mar; States. Am J Clin Nutr 2006 Mar; 83(3):529-542.83(3):529-542.
Plain tap water is the most natural sourcePlain tap water is the most natural source
of fluidsof fluids EPA regulates the levels of contaminants allowedEPA regulates the levels of contaminants allowed
in drinking water in public water systemsin drinking water in public water systems Use of bottled water has increasedUse of bottled water has increased
Other sources of water include soft drinks, sports and Other sources of water include soft drinks, sports and energy drinks, vitamin water, and other drinksenergy drinks, vitamin water, and other drinks Energy drinks containing high kilocalorie and caffeine levels are Energy drinks containing high kilocalorie and caffeine levels are
the fastest growing beverage categorythe fastest growing beverage category Beverages containing acidic flavorings may result in erosionBeverages containing acidic flavorings may result in erosion Americans consume 21% of their daily kilocalories (approxAmericans consume 21% of their daily kilocalories (approx.. 500 500
calories) from caloric beveragescalories) from caloric beverages
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 6
Hyperstates: WaterHyperstates: Water
Fluid volume excess (FVE)Fluid volume excess (FVE)Occurs in ECF compartments secondary to an Occurs in ECF compartments secondary to an
increase in total body sodiumincrease in total body sodiumResults in rapid weight gain, puffy eyelids, distended Results in rapid weight gain, puffy eyelids, distended
neck veins, and elevated blood pressureneck veins, and elevated blood pressureAt risk if:At risk if:
Congestive heart failureCongestive heart failure Chronic renal failureChronic renal failure Chronic liver diseaseChronic liver disease High levels of steroidsHigh levels of steroids
From Patton KT, Thibodeau GA: Anatomy & From Patton KT, Thibodeau GA: Anatomy & Physiology, ed 8, St. Louis: Mosby, 2013.Physiology, ed 8, St. Louis: Mosby, 2013.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 7
Hypostates: WaterHypostates: WaterFluid volume deficit (FVD)Fluid volume deficit (FVD)
Associated with excessive loss of fluids from:Associated with excessive loss of fluids from: Gastrointestinal tract (vomiting, diarrhea, drainage tubes)Gastrointestinal tract (vomiting, diarrhea, drainage tubes) Urinary tract (diuretics, polyuria, or excessive urination)Urinary tract (diuretics, polyuria, or excessive urination) Skin (sweating)Skin (sweating)
Classic signs are: Classic signs are: Dry tongue with Dry tongue with longitudinal fissures longitudinal fissures (slits or wrinkles that (slits or wrinkles that
extend lengthwise on the tongue)extend lengthwise on the tongue) XerostomiaXerostomia Shrinkage of oral mucous membranesShrinkage of oral mucous membranes Decreased skin turgorDecreased skin turgor Dry skinDry skin Decreased urinary outputDecreased urinary output
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 8
ElectrolytesElectrolytesCompounds or ions that dissociate Compounds or ions that dissociate
in solutionin solutionCation (positive charge)Cation (positive charge)
Sodium, potassium, calcium, and magnesiumSodium, potassium, calcium, and magnesium Principal cation in plasma and interstitial fluid Principal cation in plasma and interstitial fluid
is sodiumis sodiumAnion (negative charge)Anion (negative charge)
Chloride, bicarbonate, and phosphateChloride, bicarbonate, and phosphate Principal anion in plasma and interstitialPrincipal anion in plasma and interstitial
fluid is chloridefluid is chloride
Electrolytes are important in water Electrolytes are important in water balance and acidbalance and acid--base (pH) balancebase (pH) balance
From Patton KT, Thibodeau GA: From Patton KT, Thibodeau GA: Anatomy & Physiology, ed 8. St. Anatomy & Physiology, ed 8. St.
Louis: Mosby, 2013.Louis: Mosby, 2013.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 9
Physiological Role and Physiological Role and Requirements: SodiumRequirements: Sodium
Physiological rolesPhysiological rolesMaintain normal ECF concentration by affecting the Maintain normal ECF concentration by affecting the
concentration, excretion, and absorption of potassium and concentration, excretion, and absorption of potassium and chloride and water distributionchloride and water distribution
Regulate acid-base balanceRegulate acid-base balanceFacilitate impulse transmission in nerve and muscle fibersFacilitate impulse transmission in nerve and muscle fibers
RequirementsRequirementsAI for sodium is 1500 mg/day with the upper limits being AI for sodium is 1500 mg/day with the upper limits being
2300 mg/day for adults2300 mg/day for adultsMinimum intake 500 mg/dayMinimum intake 500 mg/day
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 10
Sources: SodiumSources: SodiumNatural constituent of most foods, including:Natural constituent of most foods, including:
MeatMeat Saltwater fishSaltwater fish EggsEggs Dairy products Dairy products Some vegetablesSome vegetables
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 11
HyperstatesHyperstatesHypernatremia (elevated serum sodium level)Hypernatremia (elevated serum sodium level)
Signs are extreme thirst; dry, Signs are extreme thirst; dry, ““stickysticky”” tongue and oral mucous tongue and oral mucous membranes; fever; and convulsionsmembranes; fever; and convulsions
HypostatesHypostatesHyponatremia (low serum sodium level)Hyponatremia (low serum sodium level)
Water intoxication or hyponatremia can occur when individuals Water intoxication or hyponatremia can occur when individuals drink too much waterdrink too much water
Early symptoms of hyponatremia are nausea and abdominal Early symptoms of hyponatremia are nausea and abdominal cramps, headache, confusion, lethargy, and comacramps, headache, confusion, lethargy, and coma
Hyperstates and Hypostates: Hyperstates and Hypostates: SodiumSodium
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 12
Overview: ChlorideOverview: ChloridePhysiological rolesPhysiological roles
Maintains ECF balance, osmotic equilibrium, and Maintains ECF balance, osmotic equilibrium, and electrolyte balanceelectrolyte balance
In gastric secretions to aid protein digestion and In gastric secretions to aid protein digestion and creating acidic environment to inhibit bacterial growth creating acidic environment to inhibit bacterial growth and enhance iron, calcium, and vitamin Band enhance iron, calcium, and vitamin B1212 absorption absorption
RequirementsRequirementsAI = 2300 mg/day for adultsAI = 2300 mg/day for adults
SourcesSourcesSaltSalt
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 13
Hyperstates and Hypostates: Hyperstates and Hypostates: ChlorideChloride
HyperstatesHyperstatesAt-risk groups include At-risk groups include
those with: those with: Excessive intakes of salt Excessive intakes of salt
(NaCl)(NaCl) DehydrationDehydration Renal failureRenal failure DiarrheaDiarrhea CushingCushing’’s syndromes syndrome
HypostatesHypostatesHypochloremiaHypochloremiaConditions placing at Conditions placing at
risk include:risk include: Persistent heavy sweatingPersistent heavy sweating Chronic diarrhea, vomitingChronic diarrhea, vomiting Chronic renal failureChronic renal failure
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 14
Overview: PotassiumOverview: PotassiumPhysiological rolesPhysiological roles
Maintain cellular (ICF) concentrationMaintain cellular (ICF) concentrationDirectly affects muscle contraction (especially cardiac) Directly affects muscle contraction (especially cardiac)
and electrical conductivity of the heartand electrical conductivity of the heartTransmission of nerve impulsesTransmission of nerve impulsesRegulates acid-base balanceRegulates acid-base balance
RequirementsRequirementsAI = 4700 mg/day for all adultsAI = 4700 mg/day for all adults
Equivalent to approximately 10 servings ofEquivalent to approximately 10 servings of
fruits and vegetables dailyfruits and vegetables daily
From Patton KT, Thibodeau GA: Anatomy & Physiology, ed 8. St. Louis: MosbyMosby, 2013.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 15
Sources: PotassiumSources: Potassium
DairyDairyMeatMeatGrainsGrainsFruitsFruitsVegetablesVegetablesProcessed foods Processed foods Potassium supplements and salt substitutes Potassium supplements and salt substitutes
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 16
Hyperstates and Hypostates: Hyperstates and Hypostates: PotassiumPotassium
HyperstatesHyperstatesHyperkalemia (elevated Hyperkalemia (elevated
serum potassium) is serum potassium) is life-threateninglife-threatening CausesCauses
Impaired renal Impaired renal excretionexcretion
Increased shift of Increased shift of potassium out of cellspotassium out of cells
Increased potassium Increased potassium intakeintake
HypostatesHypostates Hypokalemia Hypokalemia
CausesCauses Drugs, such as Drugs, such as
diuretics furosemide, diuretics furosemide, hydrochlorothiazidehydrochlorothiazide
CushingCushing’’s syndromes syndrome HyperaldosteronismHyperaldosteronism HypomagnesemiaHypomagnesemia AlcoholismAlcoholism
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 17
Physiological Roles: IronPhysiological Roles: IronComponent of hemoglobinComponent of hemoglobinCatalyzes many oxidative reactions within cellsCatalyzes many oxidative reactions within cellsConversion of beta-carotene to vitamin AConversion of beta-carotene to vitamin AFormation of purines as part of nucleic acidFormation of purines as part of nucleic acidRemoval of lipids from the bloodRemoval of lipids from the bloodDetoxification of drugs in the liverDetoxification of drugs in the liverSynthesis of collagenSynthesis of collagenProduction of antibodiesProduction of antibodies
From Patton KT, Thibodeau GA: Anatomy & From Patton KT, Thibodeau GA: Anatomy & Physiology, ed 8. St. Louis: Mosby, 2013.Physiology, ed 8. St. Louis: Mosby, 2013.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 18
Requirements: IronRequirements: IronRDA RDA
Men and postmenopausal women: 8 mg/dayMen and postmenopausal women: 8 mg/dayWomen: 19 to 50 yr: 18 mg/dayWomen: 19 to 50 yr: 18 mg/day
ULUL45 mg/day45 mg/day
From Mahan LK, Escott-Stump S: Krause’s Food and Nutrition From Mahan LK, Escott-Stump S: Krause’s Food and Nutrition Therapy, ed 13. St. Louis: Elsevier, 2011.Therapy, ed 13. St. Louis: Elsevier, 2011.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 19
Sources: IronSources: IronHeme ironHeme iron
Organ meats, meat, fish, poultryOrgan meats, meat, fish, poultry
Non-heme ironNon-heme ironEggsEggsMilkMilkWhole grains, enriched cerealsWhole grains, enriched cerealsGreen vegetablesGreen vegetablesDried fruitDried fruit
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 20
Hyperstates and Hypostates: IronHyperstates and Hypostates: IronToxicityToxicity
HemochromatosisHemochromatosisOrgan damageOrgan damageCoronary heart diseaseCoronary heart diseaseSkin pigmentationSkin pigmentationCirrhosis of the liverCirrhosis of the liver
DeficiencyDeficiencyMicrocytic anemiaMicrocytic anemiaAngular cheilosisAngular cheilosisPallor of lips and gingivaPallor of lips and gingivaSore, burning tongue; Sore, burning tongue;
glossitisglossitisAtrophy of filiform Atrophy of filiform
papillaepapillaeRisk of candidiasisRisk of candidiasisPossible increased Possible increased
caries susceptibilitycaries susceptibilityCourtesy of Robert W. McKenna, Department Courtesy of Robert W. McKenna, Department
of Pathology, University of Texas Southwestern of Pathology, University of Texas Southwestern Medical School, Dallas. In Kumar V, Abbas AK, Medical School, Dallas. In Kumar V, Abbas AK, Fausto N: Robbins and Cotran Pathologic Basis Fausto N: Robbins and Cotran Pathologic Basis of Disease, ed 7. Philadelphia: Saunders, 2005.of Disease, ed 7. Philadelphia: Saunders, 2005.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 21
Physiological Roles: ZincPhysiological Roles: Zinc
Physiological rolesPhysiological rolesComponent in >200 enzymes affecting cell growth and Component in >200 enzymes affecting cell growth and
replication (DNA/RNA synthesis)replication (DNA/RNA synthesis)Collagen synthesis, bone resorption, and remodelingCollagen synthesis, bone resorption, and remodelingSexual maturationSexual maturationNight visionNight visionImmune defensesImmune defensesTaste, smell, and appetiteTaste, smell, and appetite
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 22
Requirements and Sources: ZincRequirements and Sources: Zinc
RequirementsRequirementsRDARDA
11 mg/day for men and 8 mg/day for women 11 mg/day for men and 8 mg/day for women
ULUL 40 mg/day for adults40 mg/day for adults
SourcesSourcesLamb and beefLamb and beefOystersOystersEggsEggsPeanutsPeanuts
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 23
Hyperstates: ZincHyperstates: Zinc
High levels of zinc High levels of zinc cause: cause: Vomiting and diarrheaVomiting and diarrheaEpigastric painEpigastric painLethargyLethargyFatigueFatigueRenal damageRenal damagePancreatitis Pancreatitis DeathDeath
Excesses of zinc also: Excesses of zinc also: Reduces copper statusReduces copper statusAlters iron functionAlters iron functionDecreases immune Decreases immune
functionfunctionDecreases high-density Decreases high-density
lipoprotein (HDL)lipoprotein (HDL)
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 24
Hypostates: ZincHypostates: Zinc
Signs and symptomsSigns and symptomsThickening of epitheliumThickening of epitheliumImpaired keratinization of epithelial cellsImpaired keratinization of epithelial cellsIncreased susceptibility to periodontal diseaseIncreased susceptibility to periodontal diseaseFlattened filiform papillaeFlattened filiform papillaeLoss of taste and smell acuityLoss of taste and smell acuityPoor appetitePoor appetiteImpaired wound healingImpaired wound healing
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 25
Hypostates: ZincHypostates: Zinc
Groups at risk of deficiency Groups at risk of deficiency Those whose zinc requirements are relatively high (such as Those whose zinc requirements are relatively high (such as
during periods of rapid growth)during periods of rapid growth) Older adultsOlder adults VegansVegans Severe malabsorptionSevere malabsorption
(diarrhea) or other chronic(diarrhea) or other chronic
health problemshealth problems
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 26
Overview: IodineOverview: IodinePhysiological rolePhysiological role
Production of thyroxineProduction of thyroxine
RequirementsRequirementsRDA =150 µg/dayRDA =150 µg/dayUL =1100 µg/dayUL =1100 µg/day
SourcesSourcesSeafood/plants grown near the oceanSeafood/plants grown near the oceanMolassesMolassesYogurt and milkYogurt and milkIodized saltIodized salt
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 27
Hyperstates and Hypostates: IodineHyperstates and Hypostates: Iodine
Hyperstates: excessive amountsHyperstates: excessive amounts
result in thyroiditis, hypothyroidism, result in thyroiditis, hypothyroidism, hyperthyroidism, sensitivity reactionshyperthyroidism, sensitivity reactions
HypostatesHypostatesGoiter (enlargement of the thyroid gland) Goiter (enlargement of the thyroid gland) Spontaneous abortions and congenital anomaliesSpontaneous abortions and congenital anomaliesDelayed eruption of primary and secondary teethDelayed eruption of primary and secondary teethEnlarged tongueEnlarged tongueEndemic cretinismEndemic cretinism
From Fehrenbach MJ, Herring SW: Illustrated Anatomy of From Fehrenbach MJ, Herring SW: Illustrated Anatomy of the Head and Neck, ed 4. St. Louis: Saunders, 2012the Head and Neck, ed 4. St. Louis: Saunders, 2012
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 28
Nutritional DirectionsNutritional DirectionsEncourage water as beverage of choice to fulfill daily water Encourage water as beverage of choice to fulfill daily water
needs over consumption of caloric beveragesneeds over consumption of caloric beveragesAssess patients for electrolyte imbalances and nutrient Assess patients for electrolyte imbalances and nutrient
deficiencies/excesses and refer to medical providers as deficiencies/excesses and refer to medical providers as neededneeded
Consume less than 2300 mg (approximately 1 tsp salt) of Consume less than 2300 mg (approximately 1 tsp salt) of sodium per day by choosing and preparing foods with little sodium per day by choosing and preparing foods with little added salt added salt
Consume lean meats, whole grains, fruits, vegetables, and Consume lean meats, whole grains, fruits, vegetables, and low-fat dairy to meet nutritional needs low-fat dairy to meet nutritional needs
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.
HEALTH APPLICATIONHEALTH APPLICATIONHypertensionHypertension
Discuss the epidemiology & statistics of Discuss the epidemiology & statistics of Americans impacted by hypertensionAmericans impacted by hypertension
How is hypertension defined clinically?How is hypertension defined clinically?What are the health risks of having What are the health risks of having
hypertension?hypertension?What are causes of hypertension?What are causes of hypertension?What treatment(s) or lifestyle changes can be What treatment(s) or lifestyle changes can be
employed to reduce hypertension?employed to reduce hypertension?
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