Micronutrients and Oral Health

 Human beings require both macro and micronutrients for optimum health. Macronutrients are nutrients required in large amounts for normal growth and development, namely, carbohydrate, protein, and fat.  

 While micronutrients are needed in much smaller amounts, they are nonetheless crucial for human health. Micronutrients include a vast array of vitamins and minerals that play a pivotal role in tissue metabolism, hormone synthesis, and chemical signaling.
With regards or oral health, micronutrients play a strong role in the developmental and maintenance of a healthy oral system.  

 Micronutrients of Concern  

 A healthy oral system requires constant cellular maintenance and repair of oral tissues.  

 In order for the oral system to maintain a healthy system of cell turnover, adequate consumption of fat-soluble vitamins A and D and water soluble vitamins C and folate are crucial. Additionally, the minerals calcium and fluoride are essential.  

 Without adequate intake of these nutrients, the oral cavity becomes susceptible to dysfunction and disintegration.  

• Vitamin A.  Vitamin A is crucial is the functioning and maintenance of cellular membranes, the salivary glands, and the teeth themselves. In animal studies, deficiency of Vitamin A has been shown to increase the risk of dental caries and the degeneration of salivary glands. Vitamin A also plays a critical role in the production of Keratin, a component of enamel.  
• Vitamin D. Calcium and Vitamin D work together to create and sustain healthy bone tissue. Given the increased rate of bone metabolism that occurs during pregnancy and childhood, ensuring adequate Vitamin D consumption during these periods is critical. Older adults may also be at increased risk, as it has long been known that low Vitamin D intake serves as a risk factor for osteopenia and osteoporosis. Recently, a number of studies have indicated that Vitamin D also functions as an anti-inflammatory agent, stimulating antimicrobial peptides that reduce the risk of inflammation and infection of the oral cavity.   
• Vitamin C. Vitamin C plays a highly important role in the synthesis of collagen, and therefore, the formation of bone tissue. Vitamin C is essential for the formation of dentin and the connective tissues and ligaments of the oral cavity. Inadequate intake typically presents with diminished wound healing, inflamed gums, and weakened stability of the teeth and other oral tissues.  
• Folate.  Studies have shown that adequate folic acid consumption during pregnancy affects the oral health of the fetus. Infants born to mothers with insufficient folate consumption are more likely to be born with cleft lip, which may present with or without cleft palate. Some studies have shown that adequate folic acid consumption during pregnancy may reduce the risk of cleft lip and/or palate by as much as one third.  Insufficient folate consumption often presents in adults and children with inflammation and oral ulcers.  
• Calcium. Vitamin D and Calcium work together in the structure and maintenance of bone tissue, including the prevention of osteopenia and osteoporosis. Inadequate consumption of either nutrient increases susceptibility to weak or brittle teeth, dental caries, and tooth degeneration. There is a direct relationship between Calcium intake and severity of periodontal disease.   
• Fluoride. Fluoride is a mineral that plays a direct role in the development and maintenance of healthy enamel. Thanks in part to water fluoridation and fluoridated mouthwashes and toothpastes, adequate Fluoride consumption is typically not of issue, save for those in developing nations. However, in certain instances, low-income populations, minorities, and communities without fluoridated water may be at risk for low fluoride consumption, posing a risk to the structure and integrity of tooth enamel. For these populations, supplementation may be helpful.  

1. Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107. 13.  

1. Clark MB, Slayton RL; Section on Oral Health. Fluoride use in caries prevention in the primary care setting. Pediatrics. 2014;134(3):626-633. 

1. Harris SS, Navia JM: Vitamin A deficiency and caries susceptibility of rat molars. Arch Oral Biol 1980;25:415–421.  

1. Institute of Medicine of the National Academies, Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press; 2011.  

1.  Millacura N, Pardo R, Cifuentes L, Suazo J. Effects of folic acid fortification on orofacial clefts prevalence: a meta-analysis. Public Health Nutr. 2017;20(12):2260-2268.  

1. Nishida M, Grossi SG, Dunford RG, Ho AW, Trevisan M, Genco RJ. Calcium and the risk for periodontal disease. J Periodontol. 2000;71(7):1057-1066.  

1. Stein & Tipton, David. (2011). Vitamin D and its impact on oral health – an update. The Journal of the Tennessee Dental Association. 91. 

1. Touger-Decker R, Mobley C, Academy of Nutrition and Dietetics. Position of the Academy of Nutrition and Dietetics: oral health and nutrition. J Acad Nutr Diet. 2013;113:693‒701.  

1. Weinstein M, Babyn P, Zlotkin S. An orange a day keeps the doctor away: scurvy in the year 2000. Pediatrics. 2001;108(3):E55.  

1. Wilcox AJ, Lie RT, Solvoll K, et al. Folic acid supplements and risk of facial clefts: national population based case-control study. BMJ. 2007 Mar 3;334(7591):464.