Ludzkie koronawirusy - autor: Krzysztof Pyrć z Zakładu Mikrobiologii, Wydział Biochemii, Biofizyki i Biotechnologii, Uniwersytet Jagielloński, Kraków

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© Borgis - Nowa Stomatologia 2/2018, s. 84-89 | DOI: 10.25121/NS.2018.23.2.84
*Renata Chałas1, Angelika Kobylińska2, Magdalena Kukurba-Setkowicz3, Anna Szulik4, Elżbieta Pels5
The role of proper maternal nutrition during pregnancy for caries prevention in both mother and child. Opinion of the working group of the Polish Alliance for a Cavity-Free Future on dental prophylaxis in pregnant women
Rola prawidłowego żywienia w okresie ciąży w aspekcie profilaktyki próchnicy zębów u dziecka i matki. Stanowisko grupy roboczej ds. profilaktyki stomatologicznej u kobiet w ciąży Polskiego Oddziału Sojuszu dla Przyszłości Wolnej od Próchnicy
1Chair and Department of Conservative Dentistry with Endodontics, Medical University of Lublin
Head of Department: Barbara Tymczyna-Borowicz, MD, PhD
2Department of Pediatric Dentistry, Medical University of Warsaw
Head of Department: Professor Dorota Olczak-Kowalczyk, MD, PhD
3NZOZ Dentist Cracow
4Dental Practice Uśmiech in Zabrze
5Chair and Department of Developmental Dentistry, Medical University of Lublin
Head of Department: Professor Maria Mielnik-Błaszczak, MD, PhD
Streszczenie
Wstęp. Właściwe żywienie podczas ciąży ma wpływ na zdrowie i samopoczucie matki oraz jest kluczowym czynnikiem odpowiedzialnym za wzrost i rozwój dziecka, który rozpoczyna się w momencie zapłodnienia i trwa przez cały okres ciąży.
Cel pracy. Przedstawienie wiążących informacji na temat roli żywienia u kobiet w ciąży w aspekcie profilaktyki próchnicy u dziecka.
Materiał i metody. Przeszukano medyczne bazy danych Pubmed, EMBASE, MEDLINE z użyciem słów kluczowych: „diet”, „dentition”, „pregnancy”, „oral health in pregnancy” oraz zalecenia towarzystw stomatologicznych i Światowej Organizacji Zdrowia.
Wyniki. Odżywianie kobiet w ciąży powinno być zbilansowane i bogate w białko, wapń, fosfor, fluor oraz witaminy (A, C i D). Kobiety powinny unikać podjadania między posiłkami oraz w nocy, ponieważ prowadzi to do ciągłego odkładania płytki nazębnej i spadku pH w jamie ustnej. Zrównoważone żywienie wpływa na kształtowanie przyszłych nawyków żywieniowych dziecka, ponieważ już w 4. miesiącu życia płodowego zaczynają rozwijać się receptory smakowe płodu. Duże spożycie słodyczy w tym okresie przez matkę może w przyszłości zwiększyć skłonność dziecka do spożywania słodkich pokarmów.
Wnioski. Należy zintensyfikować działania na rzecz profilaktyki stomatologicznej u kobiet w ciąży poprzez wprowadzenie oraz propagowanie zasad prawidłowego żywienia w gabinetach stomatologicznych, w programach nauczania dla higienistek stomatologicznych oraz w programie edukacyjnym w szkołach rodzenia.
Summary
Introduction. Proper nutrition in pregnancy has effects on the health and well-being of the mother as well as is a key factor responsible for foetal growth and development, which are initiated at conception and last throughout pregnancy.
Aim. The aim of the paper was to present relevant data on the role of prenatal maternal nutrition for caries prevention in both mother and child.
Material and methods. Pubmed, EMBASE, MEDLINE, guidelines of dental associations and World Health Organization were searched using the following keywords: “diet”, “dentition”, “pregnancy”, “oral health in pregnancy”.
Results. The diet of a pregnant woman should be well-balanced and rich in proteins, calcium, phosphorus, fluorine and vitamins (A, C and D). Women should avoid sneaks between meals or at night to avoid dental plaque accumulation and oral pH decrease. Balanced nutrition influences the development of future nutritional habits of the child as taste receptors begin to develop already at month 4 of pregnancy. High maternal consumption of confectionery in this period may in the future increase the child’s tendency to consume sweet food products.
Conclusions. There is a need to intensify dental prophylaxis among pregnant women through introduction and promotion of proper nutrition in dental offices, up-dating teaching programs for dental hygienists and education in birth schools.
Słowa kluczowe: zalecenia.
Introduction
Proper nutrition in pregnancy has an impact on the health and well-being of the mother as well as is a key factor responsible for foetal development. After birth, the processes of growth and further development continue until early adulthood. Proper nutrition is of key importance for the general health at all stages of both pre- and postnatal life (1). The diet of a pregnant woman should contain all essential nutrients, which provide building material for the developing child as well as cover the energy needs of the mother. During pregnancy and lactation, there is an increased maternal demand not only for energy, but also for nutrients and the following minerals: calcium, phosphorus, magnesium, iron, zinc, copper, iodine, selenium and vitamins: A, B1, B2, niacin, choline, pantothenic acid, B6, B12, C, E, and folates. Improper nutrition during this period may involve excess consumption or inappropriate choice of food products (e.g. increased consumption of carbohydrates, products rich in protein and fats, insufficient fruit and vegetable consumption, replacing meals with confectionery), which may lead to insufficient vitamin and nutrient intake, and, consequently, maternal and foetal metabolic disorders. Although energy demand in the first trimester is the same as before conception, the requirement for different nutrients is much higher in this period. Since the foetus derives necessary compounds from the mother’s body, proper nutrition before conception, during pregnancy and lactation is necessary. The daily energy requirement increases by 360 kcal in the second trimester, and by 475 kcal in the third trimester compared to energy demand before pregnancy.
A well-balanced diet determines proper dental tissue formation and mineralisation as tooth buds begin to form during the embryonic period, with their further development and mineralisation continuing throughout pregnancy. Controlling maternal diet may help eliminate abnormalities in dental development associated with insufficient consumption of structural materials (1).
Furthermore, diet is an important element of caries prevention in pregnant women. The direct effects of nutritional habits on oral health status are due to the local action of food on the oral environment. Excessive consumption of carbohydrates is one of the risk factors for caries. Degradation of carbohydrates by cariogenic bacteria triggers the production of acids and oral pH drop, both of which affect dental tissue mineralisation. Consumption frequency and food consistency are also important for caries development.
Aim
The aim of the study was to develop dietary recommendations for prenatal maternal nutrition in the context of caries prevention in both mother and child.
Material and methods
We performed a review of research and recommendations of the World Health Organisation as well as teams of experts assessing the relationship between diet and oral hygiene in pregnant women and the presence of caries in their children was conducted by searching through databases, such as Pubmed, EMBASE and MEDLINE, using keywords such as “diet”, “dentition”, “pregnancy” and “oral health in pregnancy”. The following filters were used: English language, original papers, review paper, recommendations, and guidelines.
Results
The effects of nutrients on dental development
Proper nutrition before and during pregnancy may have an impact on child’s teeth. About 6 weeks after conception, deciduous teeth begin to form from foetal oral cells, which differentiate and divide to form a dental lamina, from which tooth buds will later develop. The process of dental mineralisation begins from the bell stage or at about 4 months gestation during dentin formation with enamel deposition (2, 3), which continues uninterrupted until adolescence (4).
Maternal systemic diseases, pharmacotherapy, nutrient deficiency or the effects of teratogens during pregnancy may affect deciduous and permanent teeth development both during pre- and postnatal life (5-8). For example, 83% of the enamel of central incisors, which erupt first, is already formed at birth. There is also a relationship between the dietary supply of different nutrients and the critical phase of dental mineralisation, which already begins at 4 months gestation. An insufficient level of mineralisation is a risk factor for early childhood caries (ECC) or enamel development disorders, which are also considered to be factors predisposing to ECC (9, 10).
Proper structure of mineralised dental tissues, which determines resistance to caries, primarily depends on the sufficient supply of mineral salts, such as calcium, phosphorus, fluorine, magnesium, molybdenum, manganese and vitamins, particularly vitamin A, C and D (11, 12).
The effects of different nutrients on oral health is reflected by the symptoms of their deficiency occurring during the development of dental buds. Vitamin A and D deficiency as well as protein and energy deficiency in pregnancy are risk factors for enamel hypoplasia and salivary gland atrophy in the child, which may result in decreased salivary buffer capacity, and, consequently, increased susceptibility to caries (13-15). Vitamin deficiency is observed in the case of malnutrition due to fat and carotene deficiency; elimination of dairy products, fresh fruit and vegetables; in the case of impaired fat digestion and absorption; as well as in patients with liver failure (16). Vitamin deficiency in pregnancy may lead to impaired tooth morphogenesis, dental hypoplasia, delayed eruption, enamel hypoplasia in the form of hypoplastic defects, as well as impaired odontoblast differentiation and function, manifesting in atypical dentin formation (14), and impaired dental mineralisation (13). The main sources of vitamin A include animal and fish liver, dairy products, eggs, yellow vegetables (carrot) and green leaves (spinach, cabbage, lettuce), tomatoes, red peppers, gooseberries, gooseberry, black currants, melon and mango. It should be noted that retinoids (vitamin A derivatives) have teratogenic effects, whereas carotene (a form of vitamin A found in fruit and vegetables) has no toxic effects. The daily requirement for vitamin A is increased during pregnancy and lactation, i.e. 0.9-2.7 mg, and its deficiency may lead to premature birth and low birth weight (17), which are also risk factors for ECC, as well as increased bleeding secondary to placenta praevia (16).
Vitamin D3 is an essential catalyst for the calcium-phosphate metabolism. Along with parathormone and calcitonin, it is responsible for mineralisation and resorption of bone tissue, absorption, as well as the use and regulation of phosphate and calcium levels in the body. The oral symptoms of vitamin D deficiency include reduced dental arches, malformation of the maxillary bones and the alveolar ridge leading to malocclusion, impaired tooth eruption or even primary retention. Vitamin D deficiency may result in ameloblast dysfunction with insufficient enamel, dentin and root cement mineralisation; delayed eruption and a reduced size of molars. Deciduous teeth hypomineralisation due to vitamin D, calcium and phosphate deficiency may increase the risk of EEC (2, 18). On the other hand, excess of this vitamin may induce structural changes in teeth, such as thinner enamel layer. The daily demand is 300-600 IU, and up to 800 IU in the third trimester and during lactation (18).

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otrzymano: 2018-04-04
zaakceptowano do druku: 2018-04-25

Adres do korespondencji:
*Renata Chałas
Katedra i Zakład Stomatologii Zachowawczej z Endodoncją Uniwersytet Medyczny w Lublinie
ul. Karmelicka 7, 20-081 Lublin
tel.: +48 (81) 528-79-20
renata.chalas@umlub.pl

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