Ch. 16

• 1.) Nutrients affect Drugs
• 2.) Drugs affect Nutrients

• 1.) May alter extent of drug absorption by: alterations in GI pH & mobility; Formation of non-absorbable precipitates &/or chelates
• 2.) May alter drug metabolism: grapefruit juice increases bioavailability & potency of Calcium Channel Blockers; Cholesterol lowering drugs (statins), when taken with grapefruit juice can RAISE the pt's risk of muscle toxicity

• 1.) CHANGES in appetite
• 2.) CHANGES in senses of taste & smell
• 3.) ADVERSE GI effects

• 1.) Direct injury to the intestinal mucosa
• 2.) Alterations in GI pH & motility
• 3.) Modification of bacterial flora composition
• 4.) Formation of NON-absorbable precipitates &/or Chelates
• 5.) Solubilization

• 1.) DISPLACING nutrients from their binding sites
• 2.) Chelation
• 3.) REDUCED Renal (kidney) absorption

• Chelation is the use of a chemical substance to bind molecules, such as metals or minerals, & hold them tightly so they can be removed from the body.
• Chelation has been scientifically proven to REMOVE excess or toxic metals BEFORE they can cause damage to the body.

• 1.) Appetite
• 2.) Taste & Smell
• 3.) Ability to eat

• 1.) Gingival Hyperplasia
• 2.) Gingivitis
• 3.) Mucositis
• 4.) Oral Candidiasis
• 5.) Tooth discoloration
• 6.) Direct tooth damage
• 7.) Xerostomia

Warfarin (Coumadin): affects Vitamin K

• creates partial deficiency of the active form of Vitamin K involved in the posttranslational modification of Vitamin K dependent coagulation factors
• Requires diet control of Vitamin K intake
• NO specific oral effects

Phenytoin (Dilantin): Vitamin D; Calcium; Folate (Folic Acid)

• Vitamin D & Calcium: secondary impairment of Calcium absorption with INCREASED risk for Osteomalacia or Rickets; Gingival Hyperplasia
• Folate/Folic Acid: INCREASED risk for folate deficiency, cervical dysplasia, & elevated homocysteine levels associated with Cardiovascular Disease; NO specific oral effects

• 1.) Aspirin: Folate (Folic Acid), Vitamin C, Iron
• 2.) Sulindac (Clinoril): Folate (Folic Acid)
• 3.) Naproxen (Naprosyn): Folate (Folic Acid)
• 4.) Ibuprofen (Motrin/Advil) : Folate (Folic Acid)

Folate/Folic Acid: INCREASED risk for Folate deficiency implicated in birth defects, cervical dysplasia, & elevated homocysteine levels associated with Cardiovascular Disease; NO specific oral defects

Vitamin C & Iron: INCREASED risk of GI mucosa damage leading to Iron deficiency, Anemia, & DECREASED absorption of Vitamin C; NO specific oral effects

Warfarin (Coumadin): HIGH Vitamin K intake

HIGH Vitamin K intake: DECREASES drug effectiveness

• 1.) Amlodipine (Norvasc): HIGH Vitamin C intake
• 2.) Diltiazem (Cardizem): HIGH Vitamin C intake
• 3.) Nifedipine (Procardia): HIGH Vitamin C intake
• 4.) Verapamil (Isoptin): HIGH Vitamin C intake
• 5.) Benzodiazepines (Midazolam, Triazolam): Interact with Grapefruit Juice

• HIGH Vitamin C intake: DECREASES drug absorption; NO specific nutritional effects; Gingival Hyperplasia - encourage proper oral hygiene
• Grapefruit Juice: consumption with Grapefruit Juice can INCREASE the activity of the drug; NO specific oral effects

• 1.) Aluminum (Amphogel): Phosphorus, Vitamin B12, Folate/Folic Acid, Iron, Zinc
• 2.) Aluminum & Magnesium (Maalox, Mylanta): Vitamin B12, Folate/Folic Acid, Iron, Zinc
• 3.) Sodium Bicarbonate (Alka-Seltzer): Vitamin B12, Folate/Folic Acid, Iron, Zinc

• Phosphorus: INCREASES risk for Bone Demineralization & induced Hypophosphatemia with proximal limb muscle weakness; NO specific oral effects
• Vitamin B12 & Folate: INCREASED RISK for Folate deficiency implicated in Birth Defects, Cervical Dysplasia, & elevated Homocysteine levels associated with Cardiovascular Disease; NO specific oral effects
• Iron & Zinc: INCREASED RISK for Iron-Deficiency Anemia & immune function abnormalities/immunosuppression; NO specific oral effects

• 1.) Antihistamines: Terfenadine - INCREASES drug effects; INCREASES activity of drug; may contribute to Xerostomia
• 2.) Antihyperlipidemics: Atorvastatin (Lipitor) & Simvastatin (Zocor) - Muscle aches & weakness
• 3.) Antihypersensitives (Vasodilators): Felodipine (Plendil, Renedil) - INCREASES drug effects; INCREASES blood levels of drug
• 4.) Calcium Channel Antagonists: Benzodiazepines (Midazolam, Triazolam) - INCREASES activity of drug; NO specific oral effects
• 5.) Hormones: Conjugated estrogens (Premarin), Esterfied Estrogens (Ogen), Ethinyl Estradiol - INCREASES drug effects & cause Gingivitis

• OVERGROWTH of the gingival tissue
• COMMON complication of Phenytoin (Dilantin) therapy (Hydantoins or Anti-epileptic/Anti-seizure Drug) & Calcium Channel Blockers

Associated with the use of Hormone Therapy: Corticosteroids, Androgens, Estrogens, Progestins

Symptoms: tenderness, swelling, MINOR bleeding of gums

• 1.) Immune suppression
• 2.) Increased Fluid Exudation
• 3.) Stimulation of Bone Resorption
• 4.) Stimulation of Fibroblast activity

40 %

• 1.) Mucositis: DECREASE in surface thickness & keratinization of mucous membrane in mouth (ulcer)
• 2.) Bleeding: may compromise pt's nutritional status
• 3.) Infection: may compromise pt's nutritional status

• 1.) Mouthwashes w/Local Anesthetics: Lidocaine, Dyclonine
• 2.) Histamines: Diphenhydramine, Corticosteroids
• 3.) Antifungals: Nystatin

Treatment is palliative! (focused on relieving & preventing pain)

Tetracyclines can deposit in the Dentin & Enamel of developing teeth & cause PERMANENT tooth discoloration of yellow to gray-brown

Tetracycline Antibiotics should be AVOIDED in children < 8 years old

• 1.) Chlorahexadine (CHX) Mouthrinse: chewing Sugar-Free Gum for 20 minutes AFTER use of Chlorahexidine (CHX) Rinse may DECREASE staining
• 2.) Liquid Iron
• 3.) Tobacco

• Drugs that cause dry mouth can INCREASE caries risk
• Drugs with Anticholinergic side effects REDUCE saliva production: Tricyclic Antidepressants, Phenothiazine Antipsychotics
• Rx artificial saliva (saliva supplements), oral Pilocarpine, & use of sugarless candies or lozenges

• 1.) Medication induced
• 2.) Medical condition induced
• 3.) Therapy induced
• 4.) Recession from Periodontal disease
• 5.) Abrasion from poor brushing technique

• 1.) Inadequate intake of Nutrients
• 2.) Taste changes
• 3.) Lack of interest in eating
• 4.) Poor appetite

Rx appetizing & inviting foods; Presentation, appearance, appeal

• 1.) Vitamin A
• 2.) Vitamin C
• 3.) Vitamin B6
• 4.) Fiber
• 5.) Potassium
• 6.) Calcium
• 7.) Zinc
• 8.) Protein
• 9.) Fluids

• 1.) Fluids with & between meals
• 2.) Nutrient-dense, soft, moist foods
• 3.) Sauces & gravies
• 4.) Non-nutritive sweetener use
• 5.) Ice chips
• 6.) Sour, tart items to stimulate saliva
• 7.) Avoid: dry, crumbly, sticky, spicy, alcohol mouthrinses, alcohol, tobacco, caffeine - makes mouth dryer

• Certain drug treatments for Asthma may cause tooth damage
• Powdered form of most drugs: pH of 5.5
• Tooth enamel begins to dissolve(demineralization/caries): pH of 5.5
• Use mouthrinse after EVERY inhalation & use spacer devices to PREVENT Erosion

• is a fungal infection of the oral cavity
• caused by Candida albicans, a resident fungus of the normal oral flora

• 1.) Nasal Steroids (inhaled steroids)
• 2.) Systemic Steroids &/or Antibiotics concurrently (taking both together)

Rx pt's to use mouthrinse AFTER every use of those 2 medications (Nasal/inhaled Steroids & Systemic Steroids w/ OR w/out Antibiotics)

white plaque, usually NEAR the angle of mouth & cheek mucosa

• 1.) Antibiotic Therapy
• 2.) Corticosteroid Therapy
• 3.) Xerostomia
• 4.) Diabetes Mellitus
• 5.) HIV/AIDS
• 6.) Chemotherapy & Radiation
• 7.) Immunosuppression
• 8.) POOR Oral Hygiene

• 1.) Oral Contraceptives: DEPLETES many B Vitamins, Folic Acid/Folate, Vitamin C, Magnesium, Selenium, Tyrosine (amino acid), Zinc
• 2.) Anti-Diabetes Drugs: Sulfonylureas (Glipizide) -CoQ10; Biquanides (Metaformin)- Vitamin B12
• 3.) Anti-Ulcer & Heartburn Drugs: H2 Receptor Antagonists/H2 Blockers deplete Vitamin B12, Folate/Folic Acid, Vitamin D, Calcium, Iron, Zinc

• 1.) Anemia
• 2.) Birth Defects
• 3.) Cervical Dysplasia
• 4.) Depression
• 5.) INCREASED RISK of Breast & Colorectal Cancer

• Folic Acid, Vitamins B6 & B12: are necessary to metabolize homocysteine (toxic amino acid); elevated homocysteine is a MAJOR risk for plaque build-up in the arteries (Heart Attack, Stroke)
• Vitamin B6: converts Tryptophan to Serotonin; DEPLETION of B6 can cause Depression & Insomnia

• Birth Control causes up to 40% DECLINE in Vitamin C levels in the blood
• This leads to: WEAKENED immune system, POOR wound healing, EASY bruising

Zinc deficiency impacts the immune system (immunosuppression)

• 1.) Osteoporosis
• 2.) Muscle Cramps
• 3.) Weakness
• 4.) Insomnia
• 5.) Anxiety
• 6.) Depression
• 7.) Blood Clots
• 8.) HPT (Hyperthyroidism?)
• 9.) IRREGULAR Heartbeat (Heart Arrhythmia)
• 10.) INCREASED RISK of Heart Attack

• 1.) Sulfonylureas (Glipizide)
• 2.) Biquanides (Metformin)

inhibit enzymes necessary for CoQ10 synthesisCoQ10 is an antioxidant that is important for pancreatic production of insulin & for heart health

NEGATIVELY impacts the production of intrinsic factor & causes B12 depletion

• Acidity level of GI Tract is CRITICAL for the absorption of MANY nutrients
• H2 Receptor Antagonists (H2 Blockers) DEPLETE Vitamin B12, Vitamin D, Calcium, Folate (Folic Acid), Iron, Zinc
• Vitamin D depletion causes skeletal problems, muscle weakness, tooth decay, hearing loss
• Calcium depletion causes Osteoporosis, Heart & Blood Pressure irregularities, & Tooth Decay
• Iron deficiency causes hair loss, brittle nails, Anemia, weakness, fatigue, LOW energy

• 1.) Vitamin A
• 2.) Vitamin B3 (Niacin)
• 3.) Vitamin B6
• 4.) Folic Acid (Vitamin B9)
• 5.) Vitamin B12
• 6.) Vitamin C
• 7.) Vitamin D
• 8.) Vitamin E

• Fat-soluble vitamin that is crucial for: vision, cell growth, immune system function
• Can cause FAILURE of Periodontal surgery sites to heal at levels OVER 5,000 IU/day
• Do NOT take in EXCESS of 10,000 IU (2x RDA) ?

• WATER-soluble Vitamin
• > 3,000mg used for Heart Disease can cause flushing & redness of skin, Heartburn, Gastric Ulcers, INCREASED Blood-Glucose levels
• vision loss & injured Liver can ALSO occur with mega-doses

• WATER-soluble vitamin required for: protein metabolism, delivery of oxygen to cells, regulation of blood glucose
• EXCESSES can cause debilitating & dangerous Nerve damage
• Do NOT exceed 100 mg/day

• WATER soluble vitamin
• Contributes to development of DNA
• Necessary for metabolism of Amino Acids
• Crucial for pregnant women
• May MASK B12 deficiency anemia
• Do NOT exceed 1,000 mcg/day

• WATER soluble vitamin
• essential to:
• HEALTHY red blood cells & nerve cells
• creation of DNA
• Do NOT exceed 3,000 mcg/day

WATER soluble vitamin

• NECESSARY for:
• production of collagen
• growth & repair of tissues
• HEALTHY immune system

• TOO MUCH can cause harmful oxidation in body, GI upset, interfere with activity of Anticoagulants, cause Kidney Stone formation, Gout
• NO MORE than 2,000 mg/day

• FAT-soluble vitamin
• EXCESSIVE amounts can lead to Bone pain, Nausea, Vomiting, Kidney Stone, defects of developing teeth, & Hypercalcification of soft tissue, bones, brain, nerves, & arteries
• Do NOT take MORE THAN 10,000 IU

• 1.) Normal levels of Phosphorus & Calcium in blood
• 2.) Contributes to STRONG Bones & Teeth

FAT-soluble vitamin

• Antioxidant that PROTECTS against free radicals
• taking MORE THAN 1,000 mg/day can cause Heart problems, INCREASED Lipids, & EXCESSIVE bleeding
• If taken WITH Aspirin, it can cause gingival bleeding