NUTRITION AND ORAL HEALTH

BY

Dr. Medhat Al-Nayad (MD)

Lecturer of General Medicine
MTI- UNIVERSITY
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 CONTENTS

Nutrition 4
• Introduction 4
• Food 4
Nutrients 5
• Nutrients that Provide Energy 6

- Carbohydrates 6
- Fats 8
- Proteins 10

• Nutrients that Regulate body functions 11

- Vitamins 11
Fat-soluble Vitamins 15
Water-soluble Vitamins 16
- Minerals 28
- Water 35
Basic Nutrition 41
Daily Caloric Requirement 42
Food pyramid - guide for rational nutrition 43
Nutrition for Oral and Dental Health 45
Diet Assessment and Counseling in Dental Care 47
Nutrition and prevention of dental caries 48
Dietary Guidelines 49
Nutritional Factors Affecting the Oral Cavity 53
Oral Symptoms of Nutrient Deficiencies 54
Diet and Dental Caries 55
• Role of Carbohydrates 56
• Caries-Protective Foods and Nutrients 57
Nutrition and Periodontal Diseases 59

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 What I have to eat 62
Model Quiz Questions 65
QUIZ (1) ANSWER SHEET 68
QUIZ (2) ANSWER SHEET 69
FINAL ORAL EXAM ANSWER SHEET 70

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 Nutrition
Introduction
❖ There is an interdependent relationship between nutrition
and health of oral tissues.
• The well-being of the oral tissues, the quantity and quality
of saliva and the sense of taste depend on the nutrients.
• Oral health determines the type of food consumed and
ultimately the nutritional level.
❖ Nutrition is the study of how food affects the body. It is the
adequate provision of materials like vitamins, minerals, fiber,
water and other food components to cells to support life.
Many common health problems can be prevented or
alleviated with good nutrition.
Food
Food affects almost everything we do. It affects how we
look, feel, and act. It even affects our abilities and how well
we function every day.

Food has an impact on life because it supplies nutrients,

which are substances in food that body needs to function

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 properly such as in growing, in repairing itself, and in having
supply of energy.
Nutrition is both a pure science and a social science.
• As a pure science it looks at how the body uses nutrients.

• As a social science it looks at the relationship between

food and human behavior and the environment, or how
and why people eat.
Nutrients
There are six types of nutrients:
1. Carbohydrates

2. Fats

3. Proteins

4. Vitamins

5. Minerals

6. Water
Nutrients are classified according to their functions into 2 groups:
I. Nutrients that Provide Energy (Carbohydrates, Fats
and Proteins.
II. Nutrients that Regulate body functions (Vitamins,
Minerals and Water.

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 I. Nutrients that Provide Energy
❖ Carbohydrates, fats, and proteins provide energy and perform
other important functions.

❖ We need energy for all activities. When our body uses

carbohydrates, fats, and proteins, energy is released in the
form of calories.
1- Carbohydrates:

• Carbohydrates are the sugars and starches found in foods.

• Carbohydrates molecule is made up of carbon, hydrogen,
and oxygen (CHO).
• There are two general types of carbohydrates: simple and
complex.

a) Simple Carbohydrates
• Simple carbohydrates are the different forms of sugar, which
are easy for the body to process. Sugars are: glucose and
fructose (found in fruits and vegetables), lactose (found in
milk), and sucrose (refined and purified to produce table
sugar).

• The most important to the body is glucose which is the form

of the sugar that goes directly to the bloodstream and
provides quick energy.

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 • All other sugars must be changed into glucose by the body
before the cells can use them. The cells use glucose as their
primary source of energy. Glucose that is not needed
immediately is converted by body to glycogen; a form of
starch stored in the muscles and liver, or it is converted to and
stored as body fat.

b) Complex Carbohydrates
• Starches are complex carbohydrates that are made up of
many units of glucose or other sugars, which form long
chains. These chains must be broken down by the body
into single units of glucose before they can be used.
Starches take longer time than sugars to be broken down
into glucose. So, they provide energy to the body over

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 longer periods than do simple sugars. Breads, cereals,
pasta, and potatoes contain starch.

Complex carbohydrate

• Dietary Fiber is another complex carbohydrate, which

comes from non-digestible part of plants. There two types
of dietary fiber: soluble and insoluble.
- Soluble fiber combines with waste and other substances
to assist in their removal from the body. (Found in: oat
bran, beans, apples, carrots, and other vegetables).
- Insoluble fiber absorbs water and helps to provide
needed bulk to the diet. (Found in: whole grains and the
skins and seeds of fruits and vegetables).

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 2- Fats (Lipids):
• Fats are the nutrients that contain the most concentrated
form of energy. Fats are type of lipid.
• Lipids are substances that are somewhat similar to
carbohydrates, but they contain less oxygen and they do not
dissolve in water.
• Fat is one of essential nutrients important for proper body
functions. A small daily intake of fat is required. One gram of
fat provides more than twice as much energy as one gram
of carbohydrate.
• Fats are part of many body tissues and are important as
carriers of other nutrients, such as vitamins. Fats also carry
the flavor of foods, making foods tastier, but consumption of
fat should be closely monitored.

Types of Fates

a) Saturated fats are usually solid at room temperature. They

contain maximum number of hydrogen atoms. Tropical oils,
butter, and animal fats tend to be high in saturated fats. A
diet high in saturated fats can lead to an increased chance of
heart and vessel diseases, obesity, and some types of
cancer.

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 Saturated Fat

aturated
Fat
b) Unsaturated fats are those fats that are liquid at room
temperature. Olive oil and peanut oil are called
monounsaturated fats because they lack one pair of
hydrogen atoms. Fish oils and most vegetables oils, such as
corn, soybean, and sunflower oils, are called
polyunsaturated fats because they lack two or more pairs of
hydrogen atoms.
Cholesterol

• Eating foods high in fats, especially saturated fats may

increase the level of cholesterol, a waxy, fat-like substance
produced by body.

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 • Cholesterol is part of cell membranes and nerve tissues. It is
used by body to form vitamin D and other hormones. It is
found only in foods that come from animals, such as butter,
eggs, and meats. It is not an essential nutrient because the
body produces cholesterol in liver.
• As cholesterol levels in the body increase, the risk of heart
and arterial diseases increase. Some of the cholesterol
tends to be deposited on the walls of the arteries reducing the
flow of blood to the cells supplied by those arteries.
• Cholesterol is transported in the blood in two forms.
- LDL is the “bad” form that tends to deposit cholesterol on
the walls of the blood vessels.
- HDL is the “good” form that removes cholesterol from the
cells and brings it back to the liver and intestines to be
recycled or excreted.

• Exercise has been proven to raise HDL while low-fat diets

lower LDL.

Unsaturated Fat

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 3- Proteins
• Proteins are substances found in every cell. The body
needs proteins to build and repair all body tissues. Protein is
an important part of blood cells. Proteins are made up of
carbon, hydrogen, oxygen, and nitrogen atoms that are
formed into basic units called amino acids.
• There are 20 different amino acids:

- Essential 9 amino acids cannot be produced by the body.

- Non-essential 11 amino acids can be produced by the

body.

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 II. Nutrients that Regulate body functions

❖ Vitamins, minerals, and water are nutrients that work with the
energy-providing nutrients to be sure that the body functions
properly.

❖ Water is the most vital nutrient because it provides the means

for all other nutrients to be carried throughout the body.

❖ Eating a variety of foods in the right amounts is usually all that

is needed to get daily supply of vitamins and minerals.
1- Vitamins
• Tasteless, organic compounds required in small amounts.
• Functions:
a) Regulate metabolism.
b) Promote growth and reproduction.
c) Help to convert energy in fat, carbohydrate, and protein into
Adenosine Tri Phosphate (ATP).

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• Deficiencies can result in potentially serious consequences.

• Vitamins help to build bones and tissues, and they also help
to change carbohydrates and fats into energy.

• Because the body cannot make most vitamins, they must be

supplied by the foods we eat.
Naming Vitamins
• The naming of vitamins follows the letters of the
alphabet, starting with A up to K.
1. A, B, C, D, E, and K (B has many subscripts).

2. F, G, and H were dropped.

Criteria for Vitamins

• Cannot be synthesized in ample amounts in the body.

• Chronic deficiency is likely to cause physical

symptoms.

• Symptoms may disappear once the vitamin level in

the body is restored but sometimes permanent
damage may occur.
• 12 compounds meet the above criteria.

Classification of Vitamins
• Eight water-soluble: B vitamin complex and vitamin C.
• Four fat-soluble: vitamins A, D, E, and K.
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 • Solubility influences a vitamin’s digestion, absorption,
transportation, storage and excretion.

Vitamin Absorption and Storage

All absorption takes place in the small intestine.
• Fat-soluble vitamins storage:
1. Vitamin A is mainly stored in the liver.
2. Vitamins K and E are partially stored in the liver.
3. Vitamin D is mainly stored in the fat and muscle
tissue.
4. Can build up in body to point of toxicity
• Water-soluble vitamins
1. Absorbed with water and enter directly into the
blood.
2. Most absorbed in the duodenum and jejunum.
3. Most are not stored in the body.
4. Excess intake excreted through the urine.
5. Important to consume adequate amounts daily.
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 6. Dietary excesses can be harmful.

A) Fat-soluble Vitamins

❖ Fat-soluble vitamins are dissolved in fats. They are absorbed

by fat globules that travel through the small intestines and
distributed through the body in the bloodstream. Unlike water-
soluble vitamins, excess fat-soluble vitamins are stored in the
liver and fatty (adipose) tissues for future use They are found
most abundantly in high-fat foods and are better absorbed if
eaten with fat.

❖ They include 4 important vitamins: A,D, E and K:

• Vitamin A is integral to bone formation, tooth formation,
and vision. It contributes to immune and cellular function
while keeping the intestines working properly.
• Vitamin D aids in the development of teeth and bone
by encouraging the absorption and metabolism of
phosphorous and calcium.

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 • Vitamin E is an antioxidant that helps fight infection
and keeps red blood cells healthy.
• Vitamin K is central to blood clotting and also keeps
bones healthy.
Absorption of fat-soluble vitamins:
1. Food containing fat-soluble vitamins is ingested.
2. The food is digested by stomach acid and then travels to the
small intestine, where it is digested further. Bile is needed
for the absorption of fat-soluble vitamins. This substance,
which is produced in the liver, flows into the small intestine,
where it breaks down fats. Nutrients are then absorbed
through the wall of the small intestine.
3. Upon absorption, the fat-soluble vitamins enter the lymph
vessels before making their way into the bloodstream. In
most cases, fat-soluble vitamins must be coupled with a
protein in order to travel through the body.
4. These vitamins are used throughout the body, but excesses
are stored in the liver and fat tissues.
5. As additional amounts of these vitamins are needed, your
body taps into the reserves, releasing them into the
bloodstream from the liver.
Functions of fat-soluble vitamins :

Together this vitamin quartet helps keep your eyes, skin,

lungs, gastrointestinal tract, and nervous system in good
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 repair. Here are some of the other essential roles these
vitamins play:
• Build bones: Bone formation would be impossible
without vitamins A, D, and K.

• Protect vision: Vitamin A also helps keep cells healthy

and protects your vision.

• Interact favorably: Without vitamin E, your body would

have difficulty absorbing and storing vitamin A.

• Protect the body: Vitamin E also acts as an antioxidant

(a compound that helps protect the body against damage
from unstable molecules).
Characteristics of Fat Soluble Vitamins:

The Fat-soluble vitamin has specific characteristics that

help differentiate them from other vitamins.

Storage: The Fat-soluble vitamins are stored in our liver

and fatty tissue.

Longevity: The Fat-soluble vitamins last longer in our

body, because you do not need them every day. They can
be tucked away until it is required for such functions as
blood clotting, as in the case of vitamin K.

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 Absorption and Excretion: The fat-soluble vitamin is
absorbed through the small intestine with the dietary fat
and are excreted slowly.

Vitamin A
Vitamin A is also called retinol, has many functions in the body,
helping the eyes adjust to light changes, playIing an important
role in bone growth, tooth development, reproduction, cell
division, gene expression, and regulation of the immune system.
The skin, eyes, and mucous membranes of our mouth, nose,
throat and lungs depend on vitamin A to remain moist. Vitamin A
is also an important antioxidant that may play a role in the
prevention of certain cancers.
Types of Vitamin A:
• Vitamin A is not a single compound. Rather than , it is a
group of the fat-soluble compounds collectively that known
as retinoids.
• The most commonly dietary form of vitamin A is the retinol.
The Other forms are the retinal and retinoic acid — are
found in the body, but absent or rare in foods.
The Vitamin A2 (3,4-dehydroretinal) is an alternative, less
active form found in freshwater fish.

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Function of Vitamin A:
Vitamin A can supports many function, including:
) Vision maintenance: Vitamin A is important for
maintaining the light-sensing cells in the eyes and for the
formation of tear fluid.
) Immune function: Vitamin A deficiency impairs the
immune function, increasing susceptibility to infections.
) Body growth: Vitamin A is important for cell growth. The
Deficiency may slow or prevent growth in children
) Hair growth: It is also vital for the hair growth. The
Deficiency leads to alopecia, or hair loss.
) Reproductive function: Vitamin A maintains the fertility
and is vital for fetal development.
Sources of Vitamin A:
Eating a good sort of foods is that the best thanks to make
sure that the body gets enough vitamin A. The retinol, retinal,
and retinoic acid sorts of vitamin A are supplied primarily by
foods of animal origin like dairy products, fish and liver. Some
foods of plant origin contain the antioxidant, beta-carotene,
which the body converts to vitamin A. Beta-carotene, comes
from fruits and vegetables, especially people who are orange
or dark green in color. vitamin A sources also include carrots,
pumpkin, winter squash, dark green leafy vegetables and
apricots, all of which are rich in betacarotene.

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Vitamin A Deficiency:
The highest risk of deficiency is among:
❖ In preterm infants
❖ The infants and the children in developing countries
❖ The pregnant and lactating women in developing countries
❖ people with the cystic fibrosis
Symptoms:
1) Dry eyes: Severe deficiency may cause xerophthalmia,
the condition characterized by dry eyes caused by
reduced tear fluid formation.
2) Blindness: the serious vitamin A deficiency may lead to
total blindness. In fact, it is among the most common
preventable causes of the blindness in the world.
3) Hair loss: If you have vitamin A deficiency, you may start
to lose your hair.
4) Skin problems: vitamin A deficiency leads to a skin
condition known as hyperkeratosis or goose skin.
5) Poor immune function: vitamin deficiency makes people
prone to infections.

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 Vitamin D
What is Vitamin D?
1) It is the sunshine vitamin produced by your skin when it's
exposed to sunlight.
2) It is best known for its beneficial effects on the bone health,
and deficiency makes you highly susceptible to bone fractures.
3) Vitamin D plays a critical role in our body’s using of calcium
and phosphorous. It can work by increasing the amount of
calcium absorbed from small intestine, helping to form and
maintain bones.
4) Vitamin D plays a role in immunity and controlling cell growth
and may protect against osteoporosis, hypertension, cancer,
and other diseases. Children, especially, need adequate
amounts of vitamin D to develop strong bones and healthy
teeth.
Types:
Vitamin D is a collective term using to describe a few related
fat-soluble compounds. Also it is known as the calciferol,
vitamin D comes in two main dietary forms:
❖ Vitamin D2 (ergocalciferol): it is found in mushrooms and
some plants.
❖ Vitamin D3 (cholecalciferol): it is Found in animal-sourced
foods, such as eggs and fish oil, and produced by your skin
when exposed to sunlight.
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Function of Vitamin D:
Vitamin D has lots of roles and functions, but only a few are
well researched. These include the following:
❖ Bone maintenance: Vitamin D can regulate the circulating
levels of calcium and phosphorus, which are the most
important minerals for bone growth and maintenance. It can
promotes the absorption of these minerals from the diet.
❖ Immune system regulation: It can also regulates and
strengthens immune system function (23Trusted Source).
Once absorbed into the bloodstream, the liver and kidneys
change the calciferol into calcitriol, which is the biologically
active form of vitamin D. It can also be stored for later using in
the form of calcidiol.Vitamin D3 is more efficiently converted
into calcitriol than vitamin D2.

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Sources of Vitamin D:
The person can obtain some of vitamin D from the sun, but
most people will also need to use other sources, too. The
main alternative is food.
Dietary sources include:
Oily fish and fish oils, fortified dairy products, plant-based
milks, and cereals beef liver and eggs.

Deficiency of Vitamin D:
The main effects of vitamin D deficiency include:
1) Osteoporosis, or loss of bone mass.
2) Osteomalacia, when bones become soft.
3) Rickets, when a child’s bones do not develop as they
should increasing risk of infection and autoimmunity.

Rickets

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 Vitamin E
What is vitamin E:
Vitamin E is an antioxidant that can help the body destroy free
radicals. Free radicals are unstable atoms that can cause
oxidative stress. Oxidative stress can lead to cell damage,
and this can result in cancer and other diseases. Vitamin E
may help protect the body from a range of health issues.
Types:
There are eight forms of vitamin E, but only alpha-tocopherol
meets humans’ needs, according to the ODS.
Function:
Some of reasons why the body needs vitamin E are:
• as an antioxidant.
• to boost the immune system.
• to dilate the blood vessels and help prevent clotting.
Sources:
Good sources of vitamin E include:
• Wheat germ oil
• Sunflower seeds and oil
• Almonds, hazelnuts, and peanuts
• Spinach and broccoli.
• Kiwi fruit and mango.

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Deficiency of vitamin E:
Vitamin E deficiency is rare, but it can affect people with
Crohn’s disease or cystic fibrosis. These conditions can affect
the liver’s ability to absorb vitamin E.
The deficiency can result in:
• Nerve and muscle damage that can affects movement and
coordination.
• Vision problems.
• A weakened immune system.
• As vitamin E is an antioxidant, a long- term deficiency could
increase the overall risk of various diseases.

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 Vitamin K
What is vitamin K?
Vitamin K helps the body form blood clots. Blood clotting is
important to prevent excessive bleeding.

Types:
There are several types of vitamin K. The two most common
groups are:
• Vitamin K-1 (phylloquinone), that present in green, leafy
vegetables and some other plant sources.
• Vitamin K-2 (menaquinones), that present in animal
sources and fermented foods.
• There are also synthetic forms and other forms that the
body makes.

Function:
Apart from blood clotting, vitamin K may also:
• Lowers the risk of the heart diseases.
• Enhances the bone health.
Sources:
It is found in the green leafy vegetables, as in broccoli and
spinach, pulses, vegetable oils, cereals, milk, milk products,
meat, eggs and fruit. The Bacteria in the intestines can also
synthesis Vitamin K and contribute to the available pool.

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Deficiency of vitamin K:
The body is not able to store it as much of vitamin K as it does
vitamin A or D. This means the person needs a regular intake
of vitamin K, and there is a higher chance of a deficiency.
Vitamin K deficiency may result in:
- Excess bleeding.
- The lower bone density, in the long terms.

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 B) Water-soluble Vitamins
• Water-soluble vitamins dissolve in water. Because
water- soluble vitamins are not stored by the body
to any extent, foods rich in these vitamins must be
eaten more often than foods with fat-soluble
vitamins.

• Fruits and vegetables are good source of water

soluble vitamins.

• Water-soluble vitamins are:

- Vitamin B1 (Thiamin).
- Vitamin B2 (Riboflavin).
- Vitamin B3 (Niacin).
- Vitamin B6 (Pyridoxine).
- Vitamin B9 (Folic acid).
- Vitamin B12 (Cyanocobalamin).
- Pantothenic acid.
- Biotin.
- Vitamin C (Ascorbic acid).

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 Vitamin C
• Water soluble vitamin.
• Ascorbic acid.
• Essential for the formation of skin, ligaments, cartilage,
bone, and teeth.
• Required for wound healing and tissue repair.
• Metabolism of Iron and Folic acid.
• RBC formation.
• Synthesis of fats and proteins.
• Preservation of blood vessel integrity.
• Resistance to infection.
• Collagen formation

Vitamin C- Food Sources

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 • Citrus fruits-oranges, lemons, limes, grapefruits.
• Tomatoes
• Strawberries
• Cantaloupes
• Green peppers
• Chili peppers
• Raw Potatoes

Vitamin C-Deficiency
1. Mild deficiency: irritability, malaise, arthralgia, bleeding tendency.
2. Severe deficiency: Scurvy

- Gingivitis and bleeding gums.

- Poor wound healing.
- Hair changes and Anemia.
- Bleeding from the skin.

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 Vitamin B-1
• Water soluble vitamin
• Thiamine
• Essential for maintaining normal functions of circulatory,
digestive and nervous systems.
• A coenzyme in carbohydrate metabolism to produce energy.
Vitamin B-1-Food

- Meat, liver, poultry, fish, egg yolks, dried beans, whole

grains, cereal products, and peanuts.

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 Vitamin B-1- Deficiency
1) Mild deficiency: fatigue, anorexia, retarded growth, mental
depression, irritability, apathy, and lethargy.

2) Severe deficiency: Beriberi (wet or dry)

• Wet beriberi affects the heart and circulatory system
leading to:
- Tachycardia.

- Enlarged heart, heart failure, and edema.

• Dry beriberi affects the nervous system leading to:

- Peripheral neuritis.

- Personality disturbances.

- Confusion.

- Muscle wasting and may be paralysis.

Wet beriberi Dry beriberi

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 Vitamin B-2
• Water soluble vitamin.
• Riboflavin.
• Essential for RBC and antibodies formation.
• A coenzyme in metabolism.
• Necessary for growth.
• Aids in building nerve structures.
• Helps cells to utilize oxygen.
Vitamin B-2-Food Sources
• Milk and milk products.
• Meats and liver.
• Eggs.
• Green leafy vegetables.
• Enriched breads and cereals.
• Brewer’s yeast.
• Salmon.

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 Vitamin B-2-Deficiency

1) Eye disorders as burning, itching, lacrimation, photophobia,

and vascularization of the cornea.
2) Glossitis.
3) Stomatitis.
4) Seborrheic dermatitis.

Vitamin B-3
• Water soluble vitamin.
• Niacin.
• Essential for glycolysis, fat synthesis, and tissue respiration.
• A coenzyme in many metabolic processes.
• Aids in circulation, growth of body tissues.

• Requirements:
1. Women: 14mg/day.
2. Pregnancy: 18mg/day.
3. Lactation: 17-20mg/day.
4. Men: 16mg/day.
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 Vitamin-B-3-Food Sources

• Meat, poultry, fish, seafood, eggs.

• Whole grains, peanuts, legumes.

• Enriched cereals and breads.

Vitamin B-3-Deficiency
Pellagra:
1. Dermatitis erythematous skin lesions,
2. Diarrhea, stomatitis and glossitis.
3. Dementia and other nervous system problems like
headache, dizziness, insomnia and depression.
4. Death in severe deficiency due to malnutrition,
depression or encephalopathy.
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 Pellagra

Vitamin B-6
• Water soluble vitamin.
• Pyridoxine.
• Essential for RNA and DNA synthesis.
• Critical for hemoglobin production.
• A coenzyme in metabolism of carbohydrate, protein, and fat
formation.
• Helps to release glycogen from the liver and muscle tissue.
• Maintains antibody function.
• Balances nervous system function.

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 VitaminB-6-Food Sources
• Yeast and wheat germ.
• Liver and glandular meats.
• Whole grains, cereals and legumes.
• Potatoes and prunes.
Vitamin B-6-Deficiency
• Peripheral neuritis and mental depression.
• Seborrheic dermatitis and stomatitis.

VitaminB-9
• Water soluble vitamin.
• Folic acid (Folate).
• Essential for normal metabolism of all body cells.
• Needed for the formation of RBC’s.
• Needed for nervous system formation.
VitaminB-9-Food Sources
• Liver, kidney and dark green leafy vegetables( spinach,
broccoli, asparagus), orange juice, fortified grain products as
cereals and breads.

Vitamin B-9-Deficiency
• Megaloblastic anemia.
• Poor growth in children.
• Glossitis.
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 • GIT disturbances.
• Decrease intake during pregnancy can cause neural tube
defects.

Vitamin-B-12
• Water soluble vitamin.
• Cyanocobalamin.
• Essential for normal metabolism of all body cells.
• For the formation of RBC’s.
• Healthy nervous system.

Vitamin B-12-Food Sources

• Liver, kidneys, milk, eggs, fish, cheese, muscle meats,
cooked sea vegetables.
Vitamin B-12-Deficiency
• Pernicious anemia: megaloblastic anemia.
• smooth red beefy tongue,
• Neurological disorders-peripheral neuropathy.

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 2. Minerals
❖ Minerals are simple substances found in the environment
that are essential to the body’s functioning.

❖ Minerals are used to regulate a wide range of body

processes, from bone formation to blood clotting, and they
are important for the body structure.

❖ Most minerals are either quickly used or lost in waste

products; therefore we must eat mineral-rich foods daily to
replenish our supply.

❖ Iron is an exception as it tends to be kept and recycled by

the body, except when there is a blood loss.
Major Minerals :( Calcium, Phosphorus, Magnesium,
Potassium, Sulfur, Sodium, and Chlorine)
• Calcium keeps the nervous system working well and is
needed for blood clotting. Osteoporosis is disease caused by
calcium deficiency.

• Sodium and potassium help regulate the passage of fluids in

and out of cells. Too much sodium in the diet may aggravate
high blood pressure or hypertension, increasing the risk of
heart attack, stroke or kidney disease. Table salt is one
source of sodium in the diet. Most sodium comes in food.

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 • Deficiency of potassium can lead to muscle weakness and
abnormal heart beat.

Calcium
• Macro mineral
• Requirements:

1. Adults-800-1200mg/day.
2. Pregnancy-1000-1300mg/day.
3. Lactation-1300mg/day.
• Needed for proper function of all body cells and tissues.
• Essential for formation of bone and teeth.
• Maintains blood clotting mechanism.
• Regulates heart beats.
• Regulates nerve conduction and muscle contractions.
• Serum level is 9-10.5 mg.
Calcium-Food Sources
➢ Dairy products as milk, cheese, yogurt.
➢ Fish with bones as sardines, salmon.
➢ Nuts
➢ Beans and soy products.
➢ Green leafy vegetables.
➢ Fortified orange juice, cereals and breads.

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 Calcium- Deficiency
Hypocalcemia- Serum level less than 9 mg:
• Tetany,
• Dysrrhythmias.
• Pathological fractures of bones,
• Risk of bleeding,
• Brittle nails,
• Insomnia,
• Periodontal disease,
• Osteomalcia and Osteoporosis.

Sodium
• Macromineral.
• Requirements: adults (500mg-4000mg/day).
• Serum levels of sodium: (136-145 mEq/L).
• Necessary for normal nerve conduction and muscle contraction.
• Principal cation in extra cellular fluids.
• Essential for acid-base balance.

Food sources:
• Table salt.
• Processed foods (such as can foods).
• Seafood, cured meats, and even sodas.

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 Sodium deficiency
Hyponatremia (serum level less than136 mEq/L):
• Decreased cerebral function.
• Weakness.
• Nausea and vomiting.
• Hypotension.
Causes of hyponatremia:
1. GI losses.
2. Diuretics.
3. Burns.
4. Water intoxication.

Sodium- Excess
Hypernatremia: (serum levels more than145 mEq/L):
• Edema, weight gain, hypertension, fluid volume overload, thirst.
• Causes:
1. Too much sodium intake.

2. Renal failure.

3. Liver cirrhosis.

4. Steroid therapy.

5. Excess aldosterone.

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 Potassium
• Macro mineral.

• Requirements: Adults (2 grams/day).

• Serum level: (3.5-5.0 mEq/L).

• Necessary for transmission and conduction of nerve

impulses and contraction of skeletal, cardiac, and smooth
muscles.
• For enzyme action used to change carbohydrates to energy
and amino acids to protein.
Potassium- Food Sources
• Meat, Bran, Potatoes, Broccoli, Bananas, peanut butter,
green leafy vegetables, avocadoes, orange juice.
Potassium-Deficiency
• Hypokalemia (serum level under 3.5 mEq/L):
1. Muscle weakness.
2. Decreased reflexes.
3. Flaccid paralysis.
4. CNS depression.
5. ECG changes
6. Hypotension.

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 Potassium- Excess
Hyperkalemia: (Serum levels above 5.0 mEq/L):
7. ECG changes.
8. Skeletal muscle weakness.
9. Bradycardia and cardiac arrest.
10. Oliguria.
11. Intestinal colic and diarrhea.
• Causes:
1. Severe burns.
2. Crushing injuries.
3. Addison’s disease.
4. Renal failure.
5. Acidosis.
6. Excessive intake usually from IV administration or oral
supplements. Not from foods.

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[Type text] Page 47
 Trace Minerals: (iron, iodine, manganese,
Zinc, copper, and fluorine)
• The majority of the minerals needed for the body to function
is only required in very small, or trace amounts.

• Iron is a vital part of hemoglobin – a substance in red blood

cells that carries oxygen to all parts of the body. Insufficient
iron may cause anemia, a disease in which the body has
either too few red blood cells or too little hemoglobin. As a
result too little oxygen is carried to cells of the body.

• Iodine is needed for the thyroid gland to function properly.

The thyroid gland produces hormones that control how
quickly chemical reactions occur in our body. Too little iodine
leads to thyroid gland enlargement. The primary sources are
seafood and iodized table salt.

3. Water

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 • Water is found in every cell, in the spaces around the cells, in
the fluid tissues of the body, and in body cavities

• Water carries dissolved nutrients throughout our body and

assists in all of its functions such as: digesting foods,
removing wastes and regulating temperature.

• Each day we lose two to three liters of water and if this water
is not replaced the body can dehydrate.

• When minerals are dissolved, they break apart into ions. The
ions formed in body fluids are called electrolytes. These ions
play a central role in water balance in the body.
Overview:
• H2O
• Water is not a nutrient but is needed for life.

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 • A human can only live 3-5 days without water, but 10-14 days
without food.
• Calories: 0

Water -Sources
• Tap water and Bottle water.
• Fruits and vegetables.
• Juices.
• Some in meats, fish, gravies.
• IV fluids.
• Tea, coffee and soda may have caffeine (not good sources).

Water function in body

• It is part of body fluids:
1. Cellular fluids, blood, hormones, sweat, urine, tears,
lymph.

2. Lubricant.
3. Adult body fluid volume: 60%.
4. Infant (newborn) body fluid volume: 77%.
5. Embryo: 90%.

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 Adult body fluid volume
• Intracellular (cellular) fluid- ICF: 40%.
• Extra cellular fluid-ECF: 20%:
1. Interstitial fluid (tissue spaces): 15%.
2. Intravascular fluid (vascular fluid): 5%.

Water- Requirements
• Water requirements depends on:
1. Age
2. Activity
3. Temperature (both internal and external).
4. Losses.
• Adult requires 30ml/Kg/day.
Example: Adult of 70Kg X 30 ml= 2100 ml/day (10 glasses of
water per day). In hot climates, adult requires 2-3 liters per day.

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 Water deficit (dehydration)
Clinical manifestations of dehydration:

• Weight loss.
• Dry skin and mucous membranes.
• Poor skin turgor- tenting.
• Decrease urine output.

Normal body fluids loses per day

• Urine: 1000-1200 ml/day
• Sweat: 400-500 ml/day
• Respirations: 400-550 ml/day
• Stool: 100-200 ml/day.
• Tears: small amount.

Factors increasing of fluid Loss

• Burns.
• Sweating.
• Fever.
• Diarrhea.
• Inadequate intake.
• Diabetes Mellitus ( Increased blood sugar).

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 • Caffeine.
• Drugs as diuretics.
Water excess (Toxicity)
• Causes:
1. Excess intake usually because of IV fluids.
2. Decrease excretion as in renal failure.
• Clinical manifestations:
1. Weight gain.
2. Hypertension.
3. Edema- pitting.
4. Pulmonary edema.

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 Basic Nutrition
You are what you eat…so choose wisely!
• Eat the recommended amount of each of the food groups.
1. 60-65% Carbohydrates (not sugar).

2. 10-15% Protein.

3. 30% Fat (0.8g per kg of body weight).

• Eat a variety of foods low in fat, saturated fat, & cholesterol.
• Choose a diet with plenty of grains, vegetables, and fruits.
• Choose a diet low in sugars and salt.
• Read food labels.

Daily Caloric Needs

• Average kcal needed for women ages 20-40 years: 1600 to
2000 calories a day.

• Average kcal needed for men aged 20-40 years: 2400 to

2600 calories a day

• How many calories should I consume to maintain my current

weight?

1. Men: (weight in pounds x 11) x activity correction factor

2. Women: (weight in pounds x 10) x activity correction factor

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 • Activity correction factor:
1. Inactive = 1.2
2. Moderate= 1.5
3. Active= 1.8

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 Daily Caloric Requirement

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 Food pyramid - guide for rational nutrition
❖ “MyPyramid “is a symbol to the 6 food categories
represented as vertical bands.
❖ The new pyramid has a symbol - “a person climbing the side
of the pyramid” - it indicate the need for being physically active
every day.

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 ❖ Foods are grouped according to similar nutrient composition.
❖ The food categories are :
1. Whole grains.

2. Vegetables.

3. Fruits.

4. Milk.

5. Meats and beans.

6. Oils.
❖ Variety is essential to ensure adequate nutrition, because
each group provides some, but not all, essential nutrients.

❖ It is recommended people to eat more of some foods (fruits,

vegetables, whole grains, and fat-free or low-fat milk

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 products) and less of other foods (saturated and trans fats,
added sugars, cholesterol, salt, and alcohol).
❖ The narrowest part of the pyramid indicates foods that
should be minimized because they contain more added
sugars and fat.

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 Nutrition for Oral and Dental Health
• Oral health, Diet, Nutritional status and General health are
closely linked.

• Diet and nutrition play a key role in:

- Tooth development.
- Gingival and oral tissue integrity.
- Bone strength.
- Prevention and management of diseases of the oral cavity.
• During periods of rapid cellular growth, nutrient deficiencies can
have an irreversible effect on the developing oral tissues.

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 • Before tooth eruption, nutritional status can influence tooth
enamel maturation , chemical composition, tooth morphology
and size.

• Early malnutrition increases a child's susceptibility to dental

caries in the primary teeth.

• Throughout life, nutritional deficiencies can affect host resistance,

healing, oral function, and oral-tissue integrity.

• After tooth eruption, diet affects the dentition topically rather than
systemically.

• Dietary factors and eating patterns can: initiate, exacerbate, or

minimize dental decay.
• Fermentable carbohydrates are essential for the implantation,
colonization, and metabolism of bacteria in dental plaque.
• Factors such as eating frequency and carbohydrate retentiveness
on the dentition influence the progression of carious lesions, while
foods containing calcium and phosphorus, such as cheese,
enhance re-mineralization.
• Frequent intake of acidic foods or beverages can cause enamel
erosion.

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 Diet Assessment and Counseling in Dental Care
• A dietary assessment and screening can help to identify
potential nutritional problems that may affect, or be affected
by dental care.

• The role of the dental provider should be to:

1. Screen patients for nutritional risk.
2. Provide dietary guidance related to oral health.
3. Refer patients to nutrition professionals for treatment of
other nutrition-related systemic conditions.

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 Nutrition and prevention of dental caries
1- Primary Prevention
Patients should be taught:
- The role of diet in caries.
- What are cariogenic and non-cariogenic eating patterns.
- How to adapt the current diet to lower cariogenic risk.

2- Secondary Prevention
This strategy targets individuals showing early danger signs
of caries, such as extensive cervical demineralization.

Examples:

– Adolescents with cervical demineralization after removal

of orthodontic appliances.
– Adolescents with demineralization due to gastro-
esophageal reflux disease.
– These individuals need more-detailed guidance on how to
reduce cariogenicity of their current diet.
3- Tertiary Prevention
This strategy provides supportive and rehabilitative services
to maximize the quality of life.
Example (1):

- Patients with a history of caries and many restorations.

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 - This level of prevention should provide dietary advices to
promote long-term change to prevent recurrence of caries.

Example (2):

- Children with new orthodontic devices.

- This level of prevention may require dietary counseling to

identify methods of preparing foods to facilitate
consumption of a healthy diet when chewing may be
compromised by tooth loss or new orthodontic devices.

Dietary Guidelines
❖ Dietary Guidelines include 9 interrelated focus areas.
❖ Each of the focus areas has several recommendations.
❖ The Guidelines place emphasis on consuming a nutrient- dense
diet that does not exceed energy needs, having regular
physical activity, and maintaining a healthy weight.

1- Adequate Nutrients within Calorie Needs

• Consume a variety of nutrient-dense foods and beverages

in the basic food groups.

• Choos foods that limit the intake of saturated fats,

cholesterol, added sugars, salt, and alcohol.

• Choose a balanced eating pattern within energy need.

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 2- Weight Management

• To maintain body weight in a healthy range, have to

balance calories from foods and beverages with calories
expended.
• make small decreases in food and beverage calories and
increase physical activity.
3- Physical Activity

• Engage in regular physical activity and reduce sedentary

activities to promote health, psychological well-being, and
a healthy body weight.
• physical fitness achieve muscle strength and
endurance.
4- Food Groups to Encourage

• Consume a sufficient amount of fruits and vegetables

within energy needs.
• Choose a variety of fruits and vegetables each day.

• Consume 3 or more ounce of whole-grain products per

day.
• Consume 3 cups per day of fat-free or low-fat milk or
equivalent milk products.

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 5- Fats

• less than 10% of calories to be from saturated fatty acids

and less than 300 mg/day of cholesterol.
• total fat intake have to be 20% - 35% of calories; Most
fats coming from sources of polyunsaturated and
monounsaturated fatty acids.
• When selecting and preparing meat, poultry, dry beans,
and milk or milk products, make choices that are with, low-
fat, or fat-free.
• Limit intake of fats and oils high in saturated fatty acids,
and choose products low in such fats and oils.
6- Carbohydrates

• Choose fiber-rich fruits, vegetables, and whole grains

often.
• Choose and prepare foods and beverages with little
added sugars or caloric sweeteners.
• Reduce the incidence of dental caries.

• by practicing good oral hygiene and consuming sugar-

and starch-containing foods and beverages less
frequently.
7- Sodium and Potassium

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 • Consume less than 2,300 mg (approximately 1 teaspoon
of salt) of sodium per day.
• Choose and prepare foods with little salt.

8- Alcoholic Beverages

• Does not apply to children!!!

9- Food Safety

To avoid microbial foodborne illness:

• Clean hands, food contact surfaces, and fruits and

vegetables. Meat and poultry should not be washed or
rinsed.
• Separate raw, cooked, and ready-to-eat foods while
shopping, preparing, or storing foods.
• Cook foods to a safe temperature to kill microorganisms.

• Refrigerate perishable food promptly and defrost foods

properly.
• Avoid raw (unpasteurized) milk or any products made
from unpasteurized milk, raw or partially cooked eggs or
foods containing raw eggs, raw or undercooked meat and
poultry, unpasteurized juices, and raw sprouts.

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 Nutritional Factors Affecting the Oral Cavity
❖ Nutrition plays an important role in the initial growth and
development of oral tissues and in their continuous integrity
through the life-span.

❖ Optimal nutrition during periods of hard and soft tissue

development allow these tissues to reach their optimal
potential for growth and resistance to disease.

❖ Malnutrition, over- or undernutrition, during critical periods of

organogenesis can have irreversible effects on developing
tissues.

❖ Nutrients for which deficiencies or excesses have been

directly associated with oral conditions are :

- calories;
- protein;
- calcium;
- phosphorus;
- vitamins A, C, and D;
- iodine;
- Fluoride.

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 Oral Symptoms of Nutrient Deficiencies

• Nut • Oral Symptom of • Dietary Considerations-

rien Deficiency
t-

• Cheilosis or
angular stomatitis • Rule out other etiology
• Glossitis • Palliative treatment
• Riboflavin (vitamin B ) • Hyperemia and edema of
2
the pharyngeal and • Refer to MD/RD for treatment
or iron
oral mucous with diet modifications
membranes and/or supplements

• Rule out other etiology

• Palliative treatment
• Niacin (vitamin B3) • Bright red, sore • Refer to MD/RD for diet modifications:
or vitamin B12 avoiding spicy or acidic foods, eating foods
tongue at room temperature,eating nutrient and
energy-dense foods that are soft and moist

• Inflamed, bleeding
gingiva and • Rule out other etiology
• Vitamin C • Treat with diet modifications
impaired wound healing
and/or supplements
(symptoms of scurvy,
which is rare)

• Rule out other etiology

• Refer to MD/RD for treatment with
• Vitamin A • Changes in taste diet modifications to include nutrient and
energy-dense foods and/or supplements
• · Avoid foods that may cause
aversion

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 Diet and Dental Caries
Role of Carbohydrates:
❖ Dental caries is a diet-related, infectious, and transmissible
disease that is strongly affected by diet.

❖ Streptococcus mutans are the predominant oral bacteria that

initiate the caries process.

❖ To development of clinical caries is necessary the interaction

of three local factors in the mouth: a susceptible tooth,
cariogenic bacteria, and fermentable carbohydrate.

❖ Plaque bacteria ferment starches and sugars, producing

organic acids.

❖ These acids demineralize dental enamel.

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 ❖ Other dietary factors counteract the damaging effects of
carbohydrates.

❖ The presence of protective minerals and ions, such asfluoride,

calcium, and phosphorus in plaque and saliva, promote
remineralization of incipient lesions.

❖ In addition to transporting minerals, saliva contains buffering

agents, bicarbonate and phosphates, which neutralize organic
acids.

❖ Thus, the amount and composition of saliva affect the caries

process.

❖ Other host factors that influence caries risk include genetic

predisposition, immune status, malnutrition during tooth
formation, education level, and income status.

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 Caries-Protective Foods and Nutrients
❖ Some components of foods are protective against dental
caries - protein, fat, phosphorus, and calcium inhibit caries .

❖ Aged natural cheeses have been shown to be cariostatic.

❖ The protective effect of cheeses is attributed to their texture,
which stimulates salivary flow, and their protein, calcium, and
phosphate content, which neutralizes plaque acids. Many
dairy products are now fortified with probiotic Lactobacillus,
that has an inhibitory effect on a wide range of bacteria
including Streptococcus species.

❖ 37% to 56% reduction in caries risk after exposure, to these

probiotic dairy products.

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 ❖ Fluoride found in drinking water, foods, and dentifrices
increase a tooth's resistance to demineralization and
enhance remineralization of carious lesions.

❖ Lipids seem to accelerate oral clearance of food particles.

❖ Some fatty acids, linoleic and oleic, in low concentration,
inhibit growth of mutans streptococcus.
Lectins, proteins found in plants, appear to interfere with microbial
colonization and may affect salivary function.
Other Factors that Affect Diet Cariogenicity
1) Consistency: Liquids are cleared quickly while sticky foods
remain on the teeth.
2) Meal frequency: frequent meals and snacks increase
duration of exposure.
3) Food composition.

4) Food form: liquid, solid, slowly dissolving.

5) Sequence of eating: cheese or milk at the end of the meal
decreases the cariogenicity of the meal.

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 Nutrition and Periodontal Diseases

❖ Periodontal disease is Inflammation of the gingiva with destruction

of the tooth attachment apparatus.
❖ It is multifactorial in etiology, and occurs when virulence of the
bacterial challenge is greater than the host defense and repair
capability.
❖ The course of periodontal disease involves periods ofprogression
and remission.
❖ Unlike the direct causative relationship between carbohydrates and
caries, nutritional factors seem to play a much more subtle role in
periodontal status.
❖ Nutritional factors can alter host susceptibility to periodontal disease
and/or modulate its progress.

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 ❖ The nutritional factors related to preventing infection and enhancing
wound healing in general, applies to the prevention and
management of periodontal disease as well.
❖ If both challenges, and the defense and repair capabilities ofthe
periodontal tissues are in balance, nutrition could be the deciding
factor in whether health or disease results.
❖ Even when the periodontium is healthy, there is continual need for
nutrients to maintain the tissues.
❖ Once inflammation is established, the need for nutrients increases.
❖ There is a close relationship between malnutrition and infection, -
infection aggravate malnutrition and malnutrition help infection.
❖ Host defense in the gingival crevice and connective tissue requires
an adequate intake of all nutrients to ensure adequate production
and function of defense and supporting cells.
❖ With the increased needs of cellular immunity and the additional
demands by the tissue cells attempting to maintain and repair
damaged areas, a greater supply of all nutrients is needed.

❖ Epidemiologic research also indicates that increasing intake of

whole grains may reduce the risk for periodontitis.

❖ Whenever routine scaling, prophylaxis, and oral plaque- control

fail to reverse gingivitis and before any treatment for
periodontitis is attempted, a session involving good diet
evaluation and patient counseling is indicated.
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 ❖ The patient should be informed about the importance of
systemic nutrition in the defense and repair of oral tissues.

❖ Recommendations should be made to help ensure optimal

nutrition to help prevent and manage periodontal disease.

What I have to eat

One of the first areas to decline when your diet is less than ideal
is your oral health, according to the American Dental
Association (ADA). Use this healthy foods list to improve your
diet and the health of your mouth.

1- Cheese

Eating cheese raises the pH in the subjects' mouths and lowers

their risk of tooth decay. It's thought that the chewing required to
eat cheese increases saliva in the mouth. Cheese also contains
calcium and protein, nutrients that strengthen tooth enamel.

2- Yogurt

Like cheese, yogurt is high in calcium and protein, which makes it a

good pick for the strength and health of your teeth. The probiotics, or
beneficial bacteria, found in yogurt also benefit your gums because the
good bacteria crowd out bacteria that cause cavities. If you decide to

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 add more yogurt to your diet, choose a plain variety with no added
sugar.

3- Leafy Greens
Leafy greens typically find their way onto any healthy foods list.
They're full of vitamins and minerals while being low in calories.
Leafy greens such as kale and spinach also promote oral health.
They're high in calcium, which builds your teeth's enamel. They also
contain folic acid, a type of B vitamin that has numerous health
benefits, including possibly treating gum disease in pregnant women.
If you have trouble getting leafy greens into your diet, add a handful of
baby spinach to your next salad or throw some kale on a pizza.

4- Apples
While the ADA recommends steering clear of most sweet foods, there
are some exceptions. Fruits, such as apples, might be sweet, but
they're also high in fiber and water. The action of eating an apple
produces saliva in your mouth, which rinses away bacteria and food
particles. The fibrous texture of the fruit also stimulates the gums.

5- Carrots
Like apples, carrots are crunchy and full of fiber. Eating a raw carrot at
the end of the meal increases saliva production in your mouth, which
reduces your risk of cavities. Along with being high in fiber, carrots are

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 a great source of vitamin A. Top a salad with a few slices of raw
carrots, or enjoy some baby carrots on their own.
6- Celery

Celery might get a bad reputation for being bland, watery and full of those
pesky strings, but like carrots and apples, it acts a bit like a toothbrush,
scraping food particles and bacteria away from your teeth. It's also a good
source of vitamins A and C, two antioxidants that give the health of your
gums a boost. Make celery even tastier by topping it with cream cheese.

7- Almonds
Almonds are great for your teeth because they are a good source
of calcium and protein while being low in sugar. Enjoy a quarter
cup of almonds with your lunch. You can also add it to salad.

Along with adding more leafy greens, dairy products and fibrous
vegetables to your diet, pay attention to what you're drinking.
Since it has no calories or sugar, water is always the best pick,
especially compared to juice or soda. Your diet makes a big
difference when it comes to a healthy smile.

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 Quiz Questions Model
Chose the correct answer:

1- Saturated fats are characterized by all the following except:

a) Solid at room temperature.
b) Contain maximum number of hydrogen atoms.
c) Present in excess in animal fats.
d) Low in cholesterol content.
2- The most complex form of Carbohydrates to be
absorbed and utilized by the body is :
a) Starch.
b) Fructose.
c) Lactose.
d) Glucose.
e) Sucrose.
3- The richest source of energy among nutrients is:
a) Carbohydrates.
b) Fats.
c) Proteins.
d) Vitamins.

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 e) Minerals.
4- Cholesterol is characterized by all the following except:
a) It is part of cell membranes and nerve tissues.
b) It is used by body to form vitamin D and other hormones.
c) It is an essential nutrient to be included in food.
d) It is transported in the blood in two forms, the “bad”
form and “good” form.
e) It is present in excess in citrus fruits.
5- The harmful cholesterol is:
a) LDL (low density lipoprotein).
b) VLDL (very low density lipoprotein).
c) HDL (high density lipoprotein).
d) All of the above.
e) None of the above.
6- Water-soluble vitamins are characterized by the following
except:
a) Absorbed with water and enter directly into the
blood stream.
b) Most absorbed in the duodenum and jejunum.
c) Excess intake is excreted by the liver.
d) Not stored in the body.
7- Fat-soluble vitamins include all the following except:
a) Vitamin A.

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 b) Vitamin B.
c) Vitamin C.
d) All of the above.
e) None of the above.
8- Vitamin C- Food Sources are:
a) Meat.
b) Egg yolk.
c) Wheat germ.
d) Citrus fruits.
e) All of the above.
9- Vitamin B-12 is characterized by all the following except:
a) Water soluble vitamin.
b) Important for the formation of RBC’s.
c) Important for Healthy nervous system.
d) It is called Pyridoxine.
e) Its main source is food
10- Fat-soluble vitamins are characterized by:
a) All absorption takes place in the stomach.
b) All are not stored in the body.
c) Can accumulate in body to point of toxicity.
d) All of the above.
e) None of the above.

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 Complete the following sentences with the correct word:
1- One gram of protein contain… .................. calories.

2- Megaloblasitc anemia is caused by vitamin……deficiency.

3- Vitamin B3 deficiency leads to a disease called …………….

4- Milk sugar is called ……………………. .

5- Rickets is a disease caused by………………………………..

6- Exercise has been proven to increase…….type of cholesterol.

7- Beriberi is a disease caused by vitamin .......... deficiency.

8- Scurvy is a disease caused by vitamin .......... deficiency.

9- A patient with liver cirrhosis presented to your clinic by

bleeding gums, you have to treat him by injection of vitamin.…

10- Excess glucose taken in food is stored in liver as……..……

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[Type text] Page 83
 QUIZ (1)
Name:
ID:

1- a) b) c) d) e)

2- a) b) c) d) e)

3- a) b) c) d) e)

4- a) b) c) d) e)

5- a) b) c) d) e)

6- a) b) c) d) e)

7- a) b) c) d) e)

8- a) b) c) d) e)

9- a) b) c) d) e)

10- a) b) c) d) e)

MEDHAT ALNAYAD

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[Type text] Page 85
 QUIZ (2)

Name:
ID:

1- a) b) c) d) e)

2- a) b) c) d) e)

3- a) b) c) d) e)

4- a) b) c) d) e)

5- a) b) c) d) e)

6- a) b) c) d) e)

7- a) b) c) d) e)

8- a) b) c) d) e)

9- a) b) c) d) e)

10- a) b) c) d) e)

MEDHAT ALNAYAD

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