ROLE OF MINERALS

DEPARTMENT OF ORTHODONTICS AND

DENTOFACIAL ORTHOPEDICS

PRESENTED BY: DR. RAVITHEJA VADALI

 CONTENTS
• INTRODUCTION • COPPER
• CLASSIFICATION • IODINE
• CALCIUM • MANGANESE
• PHOSPHOROUS • ZINC
• MAGNESIUM • FLOURINE
• SODIUM • SELENIUM
• POTASSIUM • CHROMIUM
• CHLORINE • BONE METABOLISM
• SULFUR • STUDIES
• IRON • REFERENCES
 INTRODUCTION
The mineral elements constitute only a small proportion of
the body weight.

General functions:
 Calcification of bone
 Blood coagulation
 Neuromuscular irritability
 Acid-base equilibrium
 Fluid balance
 Osmotic regulation
 CLASSIFICATION
 The minerals are classified into principal and trace elements.

 The 7 prinicipal elements compose of 60-80% of the body’s

inorganic material. They are: calcium, phosporous,

magnesium, sodium, potassium, chlorine and sulfur.
 The trace elements are subdivided into 3 categories:
Essential:
Iron, Copper, Possibly Non Essential:
Iodine, Manganese, Essential: Aluminium, Lead,
Zinc, Molybdenum, Nickel, Mercury, Boron,
Cobalt, Flourine, Vanadium, Silver, Bismuth
Selenium And Cadmium And etc.
Chromium Barium
 CALCIUM
Most abundant mineral in the human body.

Biochemical functions:
 Required for the development of bones and teeth
 Muscle contraction
 Blood coagulation
 Nerve transmission
 Membrane integrity and permeability
 Activation of enzymes
 Release of hormones
 Acts on myocardium and prolongs
systole
Dietary Requirement:
 Adults : 800mg/day

 Women during pregnancy, lactation and post menopause: 1.5g/day

 Children: 0.8-1.2g/day

Sources:
 Milk and milk products, leafy vegetables,

beans, fish, cabbage, egg yolk.

Absorption
 The absorption of calcium mostly occurs in the duodenum

by an energy dependent active process.

Factors promoting Ca absorption:

 Vitamin D (AF-calcitriol) induces the synthesis of calcium

binding protein in the intestinal epithelial cells and promotes

absorption
 Parathyroid hormone enhances Ca absorption through the

increased synthesis of calcitriol.

Factors inhibiting Ca absorption:

 Phytates and oxalates form insoluble salts and interferes with Ca

absorption.

 High content of dietary phosphate results in the formation of

insoluble calcium phosphate and prevents Ca uptake.

 The free fatty acids react with Ca to form insoluble calcium soaps.

 Alkaline condition is unfavorable for Ca absorpion.


Calcium homeostasis

 Calcium homeostasis is the process by which mineral

equilibrium is maintained.
 Maintenance of serum calcium levels at about 10 mg/dl is

an essential life support function.

 When substantial calcium is needed to maintain the critical

serum calcium level, bone structure is sacrificed.

 The alveolar processes and basilar bone of the jaws also are
 Calcium homeostasis is supported by three mechanisms:

1. Rapid flux of calcium from the bone fluid (occurs in

seconds)

2. Short-term response by osteoclasts and osteoblasts

(extends from minutes to days) and

3. Long term control of bone turnover (over weeks to

months).
 Instantaneous regulation of calcium homeostasis is

accomplished in seconds by selective transfer of calcium

 A decrease in the serum calcium level stimulates secretion

of PTH, which enhances transport of calcium ions from bone

fluid into osteocytes and bone-lining cells.

 The active metabolite of vitamin D (1,25-DHCC) enhances

pumping of calcium ions from bone-lining cells into the

extracellular fluid.
 However, a sustained negative balance can be compensated

for only by removing calcium from bone surfaces.

 Short term control of serum calcium levels affects rate of

bone resorption and formation within minutes through the

action of three calcific hormones, PTH, 1,25-DHCC and

calcitonin.

 Calcitonin, a hormone produced by the interstitial cells of

 PTH, acting in concert with 1,25-DHCC, accomplishes three important tasks:

1. It enhances osteoclast recruitment from promonocyte precursors,

2. It enhances the resorption rate of existing osteoclasts, and

3. It may suppress the rate at which osteoblasts form bone.

 Long term regulation has profound effects on the skeleton.

 Biomechanical factors, noncalcific hormones, and the metabolite

mechanisms dictate mass, geometric distribution and the mean age of the

bone.
Excretion:
 Ca is excreted partly through kidneys and mostly through

the intestine.

Disease states:
 Hypercalcemia

 Hypocalcemia

 Rickets

 Pancreatitis


 PHOSPHOROUS
 An adult body contains of 1kg phosphate and is found in

every cell of the body.

 About 80% of it occurs in combination with Ca in bones and

teeth.

 10% is found in muscles and blood in association with

proteins, carbohydrates and lipids.

Biochemical Functions:
 Essential for the development of bones and teeth

 Plays a central role for formation and utilization of high energy

phosphate compounds like ATP, GTP etc.

 Required for the formation of phospholipids, phosphoproteins

and nucleic acids (DNA, RNA)

 Essential component of several nucleotide coenzymes. Eg: NAD

+
NADP+ ,ADP, AMP

Required Dietary Allowance:

Sources:
 Milk, cereals, leafy vegetables, meat, eggs.

Absorption:
 Phosphate absorption occurs from jejunum.

 Calcitriol promotes phosphate uptake along with Ca.

 Absorption of phosphorous and Ca is optimum when dietary

Ca:P is between 1:2 and 2:1.

 Acidity favors while phytate decreases phosphate uptake by

the intestinal cells.

Serum phosphate:

 The phosphate level of the whole blood is around 40mg/dl while

serum contains about 3-4mg/dl.

 This is because the RBC and WBC have very high content of

phosphate.

Excretion:

 About 500mg phosphate is excreted in urine per day.

Disease states:

 Increased in hypoparathyroidism and decreased in

hyperparathyroidism.

 In severe renal diseases, serum phosphate content is

elevated causing acidosis.

 Rickets is characterized by decreased serum phosphate.

 MAGNESIUM
 The adult body contains about 20g mg, 70% of which is

found in bones while the remaining is seen in soft tissues

and body fluids.

Biochemical functions:
 Essential for the excitability of muscles and nerves.

 Cofactor in several enzymes requiring ATP. Eg: hexokinase,

glucokinase, phosphofructokinase.
Required Dietary allowance:
 Adult man: 350gm/day

 Adult woman: 300gm/day

Sources: Cereals, nuts, beans, vegetables, meat, milk and

fruits.

Absorption:
 Mg is absorbed by the intestinal cells through a specific

carrier system.
 About 50% of dietary Mg is normally absorbed.
Serum Mg:

 Present in the ionized form(60%), in combination with other

ions(10%) and bound to proteins(30%)

Deficiency symptoms:

 Neuromuscular irritation

 Weakness

 Convulsions
 SODIUM
 Chief cation in the ECF.

 50% - bones, 40% - ECF, 10% - soft tissues.

Biochemical functions:
 Regulates acid-base balance in the body [in association with Cl and

(CO3)2].

 Maintenance of osmotic pressure and fluid balance.

 Normal muscle irritability and cell permeability.

 Intestinal absorption of glucose, galactose and amino acids.

 Initiating and maintaining heart beat.

Required dietary allowance:
 5-10mg/day

Sources:
 Common salt, bread, whole grains, leafy vegetable, nuts, eggs

and milk.

Absorption:
 Readily absorbed in the gastrointestinal tract.

Excretion:
 Kidney is a major route of excretion

 Extreme sweating also causes considerable amount of sodium loss

Disease states:
 Hyponatremia:

Serum sodium levels fall below the normal. Occurs due to

diarrhea, vomiting, chronic renal diseases, Addison’s disease.
 Hypernatremia:

Elevation in the serum sodium levels. Occurs due to

Cushing’s syndrome, prolonged administration of cortisone,
ACTH and/or sex hormones.
 POTASSIUM
 Principal intracellular cation.

Biochemical functions:
 Maintains intracellular osmotic pressure.

 Regulation of acid-base balance and water balance in the

cells.
 Transmission of nerve impulse.

 Adequate intracellular concentration of K+ is necessary for

proper biosynthesis of proteins by ribosomes.

Required Dietary Allowance: 3-4g/day

Sources: Banana, orange, pineapple, potato, beans, chicken,

liver. Coconut water is a rich source.

Absorption: Efficient absorption of K+ is from the

gastrointestinal tract.

Excretion: mainly through urine.

Disease states:
 Hypokalemia

 Hyperkalemia.
 CHLORINE
Biochemical functions:
 Regulation of the acid-base equilibrium.

 Formation of HCl in the gastric juice.

 Chloride shift.

 Enzyme salivary amylase is activated by chloride.

Required dietary allowance: 5-10g/day

Sources: Common salt, whole grains, leafy vegetables, eggs and milk.
Absorption:

Totally absorbed in gastrointestinal tract.

Excretion:

Kidney is the main route of excretion.

Disease states:

 Hypochloremia

 Hyperchloremia.
 SULFUR
Biochemical functions:
 Sulfur-containing amino acids are very essential for the structural

conformation and biological functions of proteins.

 The vitamins thiamine, biotin, lipoic acid and coenzyme A of

pantothenic acid contain sulfur.

 Heparin, chondroitin sulfate, glutathione, taurocholic acid are

some other sulfur containing compounds.

 Phosphoadenosine phosphosulfate is the active sulfate utilized

for several reactions like detoxification mechanism etc.

Recommended dietary allowance:
 There is no specific dietary requirement.

 Food proteins rich in methionine and cysteine are sources of

sulfur.

Excretion:
 The sulfur from different compounds is oxidized in the liver

to sulfate and excreted in urine.

 Urine contains inorganic sulfate(80%), organic or conjugated

or ethereal sulfate(10%).
 IRON
 The total content of iron in an adult body is 3-5g.

 About 70% of iron occurs in the erythrocytes as a constituent

of hemoglobin. 5% is present in myoglobin of muscle.

 Heme is the most predominant iron containing substance.

 It is constituent of several protiens/enzymes (hemoproteins)

like hemoglobin, myoglobin, cytochromes, catalase etc.

 Certain other proteins contain non-heme iron like transferrin,

ferritin, hemosiderin etc

Biochemical functions:
 Hemoglobin and myoglobin are required for the transport of

O2 and CO2.

 Cytochromes and certain non-heme proteins are necessary

for electron transport chain and oxidative phosphorylation.

 Peroxidase, the lysosomal enzyme, is required for

phagocytosis and killing of bacteria by neutrophils.

 Associated with effective immuno-competence of the body.
Recommended dietary allowance:
 Adult man – 10mg/day

 Menstruating woman – 18mg/day

 Pregnant and lactating woman – 40mg/day

Sources:
 Good sources: Organ meats, leafy vegetables, pulses,

cereals, fish, apples, dried fruits, molasses.

 Poor sources: Milk, wheat, polished rice etc.
Absorption, Transport and Storage:
 Iron is mainly absorbed in the stomach and duodenum.

 Normally, about 10% of the dietary iron is absorbed, but in

anemic conditions and growing children a much higher

proportion of dietary iron is absorbed to meet the increased
body demands.
 Iron is mostly found in the foods is in ferric form(Fe3+),

bound to proteins or organic acids. In the gastric medium

provided by gastric HCl, the Fe3+ is released from foods.
 Reducing substances like ascorbic acid and cysteine convert ferric

iron (Fe3+) to ferrous iron(Fe2+).

 Iron in the ferrous form is soluble and readily absorbed.

 Iron is regarded as a one way substance, as it is not excreted in urine

as other viamins and or other organic and inorganic substances.

 Overview of iron metabolism:
Disease states:

Iron deficiency

anemia

Hemosiderosis

Hemochromatosis.
 COPPER
Biochemical functions:
 Essential component in several enzymes like cytochrome

oxidase, catalase, tyrosinase, superoxide dismutase, uricase

etc.
 Necessary for synthesis of hemoglobin

 Ceruloplasmin serves as ferroxidase and is involved in the

conversion of Fe2+ to Fe3+.

 Necessary for synthesis of melanin and phospholipids.
Recommended dietary allowance:
 Adults – 2-3mg/day

 Infants and children – 0.5-2mg/day

Sources:
 Liver, kidney, meat, egg yolk, cereals, nuts and leafy vegetables.

Absorption:
 About 10% of dietary Cu is absorbed mainly in the duodenum.

 Metallothionine is a transport protein that facilitates Cu

absorption.
 Phytate, Zn and Mo decrease Cu absorption.
Disease states:
 Deficiency:

 demineralisation of bones,
 demyelinization of neural tissue,
 anemia,
 fragility of arteries,
 myocardial fibrosis,
 hypopigmentation of skin
 Menke’s disease
 Wilson ‘s disease
 IODINE
 80% is present in the thyroid gland and the remaining in muscles,

salivary glands and ovaries.

Biochemical functions:
 Required for the synthesis of thyroid hormones namely thyroxin

(T4)and triiodothyronine(T3).

Recommended dietary allowance:

 Adults – 100-150μg/day

 Pregnant women - 200μg/day

Sources: Sea foods, drinking water, vegetables and fruits

Absorption, Storage and Excretion:

 Iodine as iodide is absorbed from the small intestine. Iodine

absorption also occurs through skin and lungs.

 About 80% of body’s iodine is stored in the organic form as

iodothyroglobulin.

Excretion: Mostly through kidney and partly through saliva, bile, skin

and milk(in lactating women).

 MANGANESE
Biochemical functions:

 Cofactor of several enzymes involved in metabolism of carbohydrates

and gluconeogenesis.

 Required for the formation of bone, proper reproduction and normal

functioning of nervous system.

 Necessary for the synthesis of mucopolysaccharides and glycoproteins.

 Necessary for cholesterol biosynthesis.

Recommended dietary allowance: 1-9mg/day[approx]

Sources: Cereals, nuts, leafy vegetables and fruits.

Absorption:
 About 3-4% of Mn is absorbed in the small intestine.

 Iron inhibits Mn absorption.

Disease states:
 Retarded growth, bone deformities and sterility(severe conditions).

 Accumulation of fat in liver.

 Increased activity of serum alkaline phosphatase.

 ZINC
Biochemical functions:
 Essential component of several enzymes Eg: carbonic

anhydrase, alkaline phosphatase, carboxypepidase etc.

 Necessary to maintain normal levels of vitamin A in serum.

 Gusten(Zn containing protein) is important for taste sensation.

 Essential for proper reproduction.

Recommended dietary allowance: 10-15mg/day which is

increased by 50% in pregnant and lactating women.
Sources: Meat, fish, eggs, milk, beans, nuts.

Absorption: absorbed mainly in duodenum.

Disease states:
 Zinc deficiency is associated with growth retardation, poor

wound healing, anemia, loss of appetite, loss of taste

sensation, impaired spermatogenesis etc.
 Zinc toxicity is often observed in welders due to inhalation

of zinc oxide fumes. The manifestations are : nausea, gastric

ulcers, pancreatitis, anemia and excessive salivation.
 FLUORINE
 Fluoride is mainly found in bones and teeth.

 Its beneficial effects are overshadowed by its harmful effects

caused by excess consumption.

Biochemical functions:
 Prevents the development of dental caries by forming a

protective layer of acid resistant fluoroapatite with

hydroxyapatite of enamel.
 Necessary for proper development of bones
Recommended dietary allowance:
 < 2ppm/day.

Disease states:
 Dental caries

 Fluorosis

Prevention:
 Fluoridation of water and use of fluoride

toothpastes.
 MOLYBDENUM

 Consituent of the enzymes xanthine, oxidase, aldehyde

oxidase and sulfite oxidase.

 Effectively absorbed in small intestine.

COBALT

 Only important as a constituent of vitamin B12.

 SELENIUM
Biochemical functions:
 Along with vitamin E, prevents the development of hepatic necrosis and

muscular dystrophy.
 Maintains structural integrity of biological membranes.

 As selenocysteine is an essential component of the enzyme glutathione

peroxidase.
 Prevents lipid peroxidation

 Binds with heavy metals and protects the body from their toxic effects.

 Recommended dietary allowance: 50-200μg/day.

 Toxicity: Selenosis
 CHROMIUM
Biochemical functions:

 In association with insulin, Cr promotes the utilisation of glucose.

 Lowers total serum cholesterol levels

 Involved in lipoprotein metabolism.

 Participates in the transport of amino acids into the cells(heart and liver).

Required Dietary Allowance: 10-100mg/day

Deficiency causes disturbances in protein, lipid and carbohydrate

metabolisms.
 Bone Metabolism
 Orthodontists and dentofacial orthopedists manipulate bone.

 The biomechanical response to altered function and applied loads

depends on the metabolic status of the patient.

 The skeletal system is composed of highly specialized mineralized

tissues that have both structural and metabolic functions.

 Bone modeling and remodeling are distinct physiologic responses

to integrated metabolic and mechanical demands.

 Biomechanical manipulation of bone is the physiologic basis of

orthodontics and dentofacial orthopedics.

 Bone Remodelling
The basic sequences and mediators of bone remodeling are as
follows:
 Cells trapped within bone structure (osteocytes) initiate the
targeted remodeling in response to strain, load, or fracture which is
sensed by their long dendritic processes that course through bone.
 Osteocytes begin the sequence by signaling quiescent cells lining

the bone surface to become activated osteoblasts (bone forming

cells).
 Osteoblasts
Huskisson E, Maggini secrete
S, Ruf M. Thearolesubstance known
of vitamins and minerals as metabolism
in energy receptor-activator-
and well-being.
Journal of international medical research. 2007 May;35(3):277-89.
 RANK-L acts upon osteoclast (bone removing cells)

precursors in the marrow/ hematopoietic tissue to stimulate

the differentiation into mature osteoclasts which then attach

to the locally targeted area of bone to start resorption.

 Over a usual period of 2 weeks the osteoclasts secrete both

acids and proteases to dissolve both the mineral and

 At the completion of the resorption phase the osteoclasts

undergo apoptosis and resorption ceases.

 The osteoblast then follows behind the osteoclast and over a

3-month period, deposits new bone matrix which is then

mineralized in the presence of an osteoblast-derived matrix

vesicle where the enzyme alkaline phosphatase (ALP)

 STUDIES
Nutrition and Orthodontics-Interdependence and Interrelationship

 Orthodontic treatment involves the use of attachments and force

element that can negatively affect the dietary intake,

compromising the nutrition of the patient.

 On the other hand, for effective orthodontic treatment, a balanced

diet is required.
Singh N, Tripathi T, Rai P, Gupta P. Nutrition and Orthodontics-Interdependence and Interrelationship.
 Thus it becomes Journal a vicious cycle,
of dental which
sciences. should be taken into
2007 Aug;5(3):18-22.
 Effect of Orthodontic Treatment on Nutrition

 Orthodontists instruct patients to avoid sticky, gummy,

chewy or very hard food to circumvent appliance breakage

and bracket debonding.

 Preferential intake of soft diet during orthodontic treatment

result in dietary changes that lead to reduced fiber and

carbohydrate intake and increase in intake of fats.

 It was assigned to the non-consumption of nuts, whole

grains and reduced ingestion of fruits and vegetables.

 Copper is required for hemoglobin and red blood cell

production; component of enzymes of redox systems and

collagen crosslinking; and normal pigmentation.

 Manganese plays a crucial role in bone remodelling and

 Effect of Nutrition on Orthodontic Treatment

 The orthodontic therapy is highly dependent on the good

health of oral tissues.

 Frequent ulcerations, inflamed oral tissues and compromised

periodontal tissues negatively hamper the orthodontic

therapy.
 CONCLUSIONS:
There is a two way relationship between nutrition and orthodontic

treatment wherein the quality of nutrition affects the pace of

orthodontic treatment and the rendering of orthodontic treatment

affects the nutritional intake.

A well balanced diet provides all the essential elements to keep

the oral tissues healthy and aid in bone remodelling thus

enhancing orthodontic therapy.

Effects of drugs and systemic factors on Orthodontic treatment

 Orthodontic tooth movement and bone remodeling activity are

dependent on systemic factors such as nutritional factors,

metabolic bone diseases, age, and use of drugs.

 Therefore, a comprehensive review of the effects of these factors

on orthodontic tooth movement is attempted in this article.

 Systemic hormones such as estrogen, androgen, and calcitonin are

Tyrovola JB, Spyropoulos MN. Effects of drugs and systemic factors on orthodontic treatment.
associated withQuintessence
an increase in bone2001
international. mineral content, bone mass,
May 1;32(5).
 Consequently, they could delay orthodontic tooth

movement.

 On the contrary, thyroid hormones and corticosteroids might

be involved in a more rapid orthodontic tooth movement

during orthodontic therapy and have a less stable

orthodontic result.

 Drugs such as bisphosphonates, vitamin D metabolites, and

 Long-term administration of these drugs may therefore

delay the necessary bone response to respective tooth-

borne pressure and should not be administered for long

periods of time to patients undergoing orthodontic tooth

movement.

 Attention has also been focused on the effects of

prostaglandins and leukotrienes in orthodontic tooth

 REFERENCES
1. Satyanarayana U. in Biochemistry (Second Edition),2005.
Chemical constituents of life, Metabolisms.P113-64, 247-468.
2. Sembulingam K. in Essentials of Medical Physiology(Second
Edition),2004.Digestivesystem,Endocrinology.P155-218,271-344.
3. Joseph Feher, in Quantitative Human Physiology (Second
Edition),2017. Calcium and Phosphorus Homeostasis I.p924-32.
4. Tyrovola JB, Spyropoulos MN. Effects of drugs and systemic
factors on orthodontic treatment. Quintessence international.
2001 May 1;32(5).
5. Huskisson E, Maggini S, Ruf M. The role of vitamins and minerals
in energy metabolism and well-being. Journal of international
medical research. 2007 May;35(3):277-89.
THANK YOU!