CHAPTER 12 WATER AND MINERALS REQUIRED FOR ORAL SOFT TISSUES AND SALIVARY GLANDS Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier

CHAPTER 12CHAPTER 12

WATER AND MINERALS WATER AND MINERALS REQUIRED FOR ORAL SOFT REQUIRED FOR ORAL SOFT

TISSUES AND SALIVARY TISSUES AND SALIVARY GLANDSGLANDS

Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 2

WaterWater

Most abundant component of the body Most abundant component of the body At birth 75% to 80% of body weightAt birth 75% to 80% of body weightIn an adult 50% to 60% of body weightIn an adult 50% to 60% of body weightAdipose tissue contains less water than lean body Adipose tissue contains less water than lean body

mass (LBM)mass (LBM)

Body fluidsBody fluidsIntracellular fluid (ICF)Intracellular fluid (ICF)Extracellular fluid (ECF)Extracellular fluid (ECF)Osmotic pressure equalizes theOsmotic pressure equalizes the

solute concentration of ICF and ECFsolute concentration of ICF and ECF

From Thibodeau GA, Patton KT: Anatomy & From Thibodeau GA, Patton KT: Anatomy & Physiology, ed 6. St. Louis: Mosby, 2007.Physiology, ed 6. St. Louis: Mosby, 2007.


Physiological Roles: WaterPhysiological Roles: WaterSolvent enables chemical reactions to occur by entering Solvent enables chemical reactions to occur by entering

into some reactions, such as hydrolysisinto some reactions, such as hydrolysisMaintains stability of all body fluids, as the principal Maintains stability of all body fluids, as the principal

component and medium for fluids (blood and lymph), component and medium for fluids (blood and lymph), secretions (saliva and gastrointestinal fluids), and secretions (saliva and gastrointestinal fluids), and excretions (urine and perspiration)excretions (urine and perspiration)

Enables transport of nutrients to cells and provides Enables transport of nutrients to cells and provides medium for excretion of waste productsmedium for excretion of waste products

Acts as lubricant between cells to permit movement Acts as lubricant between cells to permit movement without frictionwithout friction

Regulates body temperature by evaporating as Regulates body temperature by evaporating as perspiration from skin and vapor from mouth and nose perspiration from skin and vapor from mouth and nose


Requirements: WaterRequirements: WaterAI for total fluid (beverages, water, and food)AI for total fluid (beverages, water, and food)

Men = 3.7 L (15 to 16 cups) per day Men = 3.7 L (15 to 16 cups) per day Women = 2.7 L (11 to 12 cups) per dayWomen = 2.7 L (11 to 12 cups) per day

Water is lost via a variety of routes Water is lost via a variety of routes 1.1. UrinationUrination

2.2. PerspirationPerspiration

3.3. ExpirationExpiration

4.4. DefecationDefecation

When as little as 2% of body water isWhen as little as 2% of body water is

lost, osmoreceptors are stimulated, creating a lost, osmoreceptors are stimulated, creating a physiological desire to ingest liquidsphysiological desire to ingest liquids

Fro Patton KT, Thibodeau Fro Patton KT, Thibodeau GA: Anatomy & Physiology, GA: Anatomy & Physiology,

ed 8. St. Louis: Mosby, ed 8. St. Louis: Mosby, 2013.2013.


Sources: WaterSources: Water

Redrawn from Popkin BM et al: A Redrawn from Popkin BM et al: A new proposed guidance system for new proposed guidance system for beverage consumption in the United beverage consumption in the United

States. Am J Clin Nutr 2006 Mar; States. Am J Clin Nutr 2006 Mar; 83(3):529-542.83(3):529-542.

Plain tap water is the most natural sourcePlain tap water is the most natural source

of fluidsof fluids EPA regulates the levels of contaminants allowedEPA regulates the levels of contaminants allowed

in drinking water in public water systemsin drinking water in public water systems Use of bottled water has increasedUse of bottled water has increased

Other sources of water include soft drinks, sports and Other sources of water include soft drinks, sports and energy drinks, vitamin water, and other drinksenergy drinks, vitamin water, and other drinks Energy drinks containing high kilocalorie and caffeine levels are Energy drinks containing high kilocalorie and caffeine levels are

the fastest growing beverage categorythe fastest growing beverage category Beverages containing acidic flavorings may result in erosionBeverages containing acidic flavorings may result in erosion Americans consume 21% of their daily kilocalories (approxAmericans consume 21% of their daily kilocalories (approx.. 500 500

calories) from caloric beveragescalories) from caloric beverages


Hyperstates: WaterHyperstates: Water

Fluid volume excess (FVE)Fluid volume excess (FVE)Occurs in ECF compartments secondary to an Occurs in ECF compartments secondary to an

increase in total body sodiumincrease in total body sodiumResults in rapid weight gain, puffy eyelids, distended Results in rapid weight gain, puffy eyelids, distended

neck veins, and elevated blood pressureneck veins, and elevated blood pressureAt risk if:At risk if:

Congestive heart failureCongestive heart failure Chronic renal failureChronic renal failure Chronic liver diseaseChronic liver disease High levels of steroidsHigh levels of steroids

From Patton KT, Thibodeau GA: Anatomy & From Patton KT, Thibodeau GA: Anatomy & Physiology, ed 8, St. Louis: Mosby, 2013.Physiology, ed 8, St. Louis: Mosby, 2013.


Hypostates: WaterHypostates: WaterFluid volume deficit (FVD)Fluid volume deficit (FVD)

Associated with excessive loss of fluids from:Associated with excessive loss of fluids from: Gastrointestinal tract (vomiting, diarrhea, drainage tubes)Gastrointestinal tract (vomiting, diarrhea, drainage tubes) Urinary tract (diuretics, polyuria, or excessive urination)Urinary tract (diuretics, polyuria, or excessive urination) Skin (sweating)Skin (sweating)

Classic signs are: Classic signs are: Dry tongue with Dry tongue with longitudinal fissures longitudinal fissures (slits or wrinkles that (slits or wrinkles that

extend lengthwise on the tongue)extend lengthwise on the tongue) XerostomiaXerostomia Shrinkage of oral mucous membranesShrinkage of oral mucous membranes Decreased skin turgorDecreased skin turgor Dry skinDry skin Decreased urinary outputDecreased urinary output


ElectrolytesElectrolytesCompounds or ions that dissociate Compounds or ions that dissociate

in solutionin solutionCation (positive charge)Cation (positive charge)

Sodium, potassium, calcium, and magnesiumSodium, potassium, calcium, and magnesium Principal cation in plasma and interstitial fluid Principal cation in plasma and interstitial fluid

is sodiumis sodiumAnion (negative charge)Anion (negative charge)

Chloride, bicarbonate, and phosphateChloride, bicarbonate, and phosphate Principal anion in plasma and interstitialPrincipal anion in plasma and interstitial

fluid is chloridefluid is chloride

Electrolytes are important in water Electrolytes are important in water balance and acidbalance and acid--base (pH) balancebase (pH) balance

From Patton KT, Thibodeau GA: From Patton KT, Thibodeau GA: Anatomy & Physiology, ed 8. St. Anatomy & Physiology, ed 8. St.

Louis: Mosby, 2013.Louis: Mosby, 2013.


Physiological Role and Physiological Role and Requirements: SodiumRequirements: Sodium

Physiological rolesPhysiological rolesMaintain normal ECF concentration by affecting the Maintain normal ECF concentration by affecting the

concentration, excretion, and absorption of potassium and concentration, excretion, and absorption of potassium and chloride and water distributionchloride and water distribution

Regulate acid-base balanceRegulate acid-base balanceFacilitate impulse transmission in nerve and muscle fibersFacilitate impulse transmission in nerve and muscle fibers

RequirementsRequirementsAI for sodium is 1500 mg/day with the upper limits being AI for sodium is 1500 mg/day with the upper limits being

2300 mg/day for adults2300 mg/day for adultsMinimum intake 500 mg/dayMinimum intake 500 mg/day


Sources: SodiumSources: SodiumNatural constituent of most foods, including:Natural constituent of most foods, including:

MeatMeat Saltwater fishSaltwater fish EggsEggs Dairy products Dairy products Some vegetablesSome vegetables


HyperstatesHyperstatesHypernatremia (elevated serum sodium level)Hypernatremia (elevated serum sodium level)

Signs are extreme thirst; dry, Signs are extreme thirst; dry, ““stickysticky”” tongue and oral mucous tongue and oral mucous membranes; fever; and convulsionsmembranes; fever; and convulsions

HypostatesHypostatesHyponatremia (low serum sodium level)Hyponatremia (low serum sodium level)

Water intoxication or hyponatremia can occur when individuals Water intoxication or hyponatremia can occur when individuals drink too much waterdrink too much water

Early symptoms of hyponatremia are nausea and abdominal Early symptoms of hyponatremia are nausea and abdominal cramps, headache, confusion, lethargy, and comacramps, headache, confusion, lethargy, and coma

Hyperstates and Hypostates: Hyperstates and Hypostates: SodiumSodium


Overview: ChlorideOverview: ChloridePhysiological rolesPhysiological roles

Maintains ECF balance, osmotic equilibrium, and Maintains ECF balance, osmotic equilibrium, and electrolyte balanceelectrolyte balance

In gastric secretions to aid protein digestion and In gastric secretions to aid protein digestion and creating acidic environment to inhibit bacterial growth creating acidic environment to inhibit bacterial growth and enhance iron, calcium, and vitamin Band enhance iron, calcium, and vitamin B1212 absorption absorption

RequirementsRequirementsAI = 2300 mg/day for adultsAI = 2300 mg/day for adults

SourcesSourcesSaltSalt


Hyperstates and Hypostates: Hyperstates and Hypostates: ChlorideChloride

HyperstatesHyperstatesAt-risk groups include At-risk groups include

those with: those with: Excessive intakes of salt Excessive intakes of salt

(NaCl)(NaCl) DehydrationDehydration Renal failureRenal failure DiarrheaDiarrhea CushingCushing’’s syndromes syndrome

HypostatesHypostatesHypochloremiaHypochloremiaConditions placing at Conditions placing at

risk include:risk include: Persistent heavy sweatingPersistent heavy sweating Chronic diarrhea, vomitingChronic diarrhea, vomiting Chronic renal failureChronic renal failure


Overview: PotassiumOverview: PotassiumPhysiological rolesPhysiological roles

Maintain cellular (ICF) concentrationMaintain cellular (ICF) concentrationDirectly affects muscle contraction (especially cardiac) Directly affects muscle contraction (especially cardiac)

and electrical conductivity of the heartand electrical conductivity of the heartTransmission of nerve impulsesTransmission of nerve impulsesRegulates acid-base balanceRegulates acid-base balance

RequirementsRequirementsAI = 4700 mg/day for all adultsAI = 4700 mg/day for all adults

Equivalent to approximately 10 servings ofEquivalent to approximately 10 servings of

fruits and vegetables dailyfruits and vegetables daily

From Patton KT, Thibodeau GA: Anatomy & Physiology, ed 8. St. Louis: MosbyMosby, 2013.


Sources: PotassiumSources: Potassium

DairyDairyMeatMeatGrainsGrainsFruitsFruitsVegetablesVegetablesProcessed foods Processed foods Potassium supplements and salt substitutes Potassium supplements and salt substitutes


Hyperstates and Hypostates: Hyperstates and Hypostates: PotassiumPotassium

HyperstatesHyperstatesHyperkalemia (elevated Hyperkalemia (elevated

serum potassium) is serum potassium) is life-threateninglife-threatening CausesCauses

Impaired renal Impaired renal excretionexcretion

Increased shift of Increased shift of potassium out of cellspotassium out of cells

Increased potassium Increased potassium intakeintake

HypostatesHypostates Hypokalemia Hypokalemia

CausesCauses Drugs, such as Drugs, such as

diuretics furosemide, diuretics furosemide, hydrochlorothiazidehydrochlorothiazide

CushingCushing’’s syndromes syndrome HyperaldosteronismHyperaldosteronism HypomagnesemiaHypomagnesemia AlcoholismAlcoholism


Physiological Roles: IronPhysiological Roles: IronComponent of hemoglobinComponent of hemoglobinCatalyzes many oxidative reactions within cellsCatalyzes many oxidative reactions within cellsConversion of beta-carotene to vitamin AConversion of beta-carotene to vitamin AFormation of purines as part of nucleic acidFormation of purines as part of nucleic acidRemoval of lipids from the bloodRemoval of lipids from the bloodDetoxification of drugs in the liverDetoxification of drugs in the liverSynthesis of collagenSynthesis of collagenProduction of antibodiesProduction of antibodies

From Patton KT, Thibodeau GA: Anatomy & From Patton KT, Thibodeau GA: Anatomy & Physiology, ed 8. St. Louis: Mosby, 2013.Physiology, ed 8. St. Louis: Mosby, 2013.


Requirements: IronRequirements: IronRDA RDA

Men and postmenopausal women: 8 mg/dayMen and postmenopausal women: 8 mg/dayWomen: 19 to 50 yr: 18 mg/dayWomen: 19 to 50 yr: 18 mg/day

ULUL45 mg/day45 mg/day

From Mahan LK, Escott-Stump S: Krause’s Food and Nutrition From Mahan LK, Escott-Stump S: Krause’s Food and Nutrition Therapy, ed 13. St. Louis: Elsevier, 2011.Therapy, ed 13. St. Louis: Elsevier, 2011.


Sources: IronSources: IronHeme ironHeme iron

Organ meats, meat, fish, poultryOrgan meats, meat, fish, poultry

Non-heme ironNon-heme ironEggsEggsMilkMilkWhole grains, enriched cerealsWhole grains, enriched cerealsGreen vegetablesGreen vegetablesDried fruitDried fruit


Hyperstates and Hypostates: IronHyperstates and Hypostates: IronToxicityToxicity

HemochromatosisHemochromatosisOrgan damageOrgan damageCoronary heart diseaseCoronary heart diseaseSkin pigmentationSkin pigmentationCirrhosis of the liverCirrhosis of the liver

DeficiencyDeficiencyMicrocytic anemiaMicrocytic anemiaAngular cheilosisAngular cheilosisPallor of lips and gingivaPallor of lips and gingivaSore, burning tongue; Sore, burning tongue;

glossitisglossitisAtrophy of filiform Atrophy of filiform

papillaepapillaeRisk of candidiasisRisk of candidiasisPossible increased Possible increased

caries susceptibilitycaries susceptibilityCourtesy of Robert W. McKenna, Department Courtesy of Robert W. McKenna, Department

of Pathology, University of Texas Southwestern of Pathology, University of Texas Southwestern Medical School, Dallas. In Kumar V, Abbas AK, Medical School, Dallas. In Kumar V, Abbas AK, Fausto N: Robbins and Cotran Pathologic Basis Fausto N: Robbins and Cotran Pathologic Basis of Disease, ed 7. Philadelphia: Saunders, 2005.of Disease, ed 7. Philadelphia: Saunders, 2005.


Physiological Roles: ZincPhysiological Roles: Zinc

Physiological rolesPhysiological rolesComponent in >200 enzymes affecting cell growth and Component in >200 enzymes affecting cell growth and

replication (DNA/RNA synthesis)replication (DNA/RNA synthesis)Collagen synthesis, bone resorption, and remodelingCollagen synthesis, bone resorption, and remodelingSexual maturationSexual maturationNight visionNight visionImmune defensesImmune defensesTaste, smell, and appetiteTaste, smell, and appetite


Requirements and Sources: ZincRequirements and Sources: Zinc

RequirementsRequirementsRDARDA

11 mg/day for men and 8 mg/day for women 11 mg/day for men and 8 mg/day for women

ULUL 40 mg/day for adults40 mg/day for adults

SourcesSourcesLamb and beefLamb and beefOystersOystersEggsEggsPeanutsPeanuts


Hyperstates: ZincHyperstates: Zinc

High levels of zinc High levels of zinc cause: cause: Vomiting and diarrheaVomiting and diarrheaEpigastric painEpigastric painLethargyLethargyFatigueFatigueRenal damageRenal damagePancreatitis Pancreatitis DeathDeath

Excesses of zinc also: Excesses of zinc also: Reduces copper statusReduces copper statusAlters iron functionAlters iron functionDecreases immune Decreases immune

functionfunctionDecreases high-density Decreases high-density

lipoprotein (HDL)lipoprotein (HDL)


Hypostates: ZincHypostates: Zinc

Signs and symptomsSigns and symptomsThickening of epitheliumThickening of epitheliumImpaired keratinization of epithelial cellsImpaired keratinization of epithelial cellsIncreased susceptibility to periodontal diseaseIncreased susceptibility to periodontal diseaseFlattened filiform papillaeFlattened filiform papillaeLoss of taste and smell acuityLoss of taste and smell acuityPoor appetitePoor appetiteImpaired wound healingImpaired wound healing


Hypostates: ZincHypostates: Zinc

Groups at risk of deficiency Groups at risk of deficiency Those whose zinc requirements are relatively high (such as Those whose zinc requirements are relatively high (such as

during periods of rapid growth)during periods of rapid growth) Older adultsOlder adults VegansVegans Severe malabsorptionSevere malabsorption

(diarrhea) or other chronic(diarrhea) or other chronic

health problemshealth problems


Overview: IodineOverview: IodinePhysiological rolePhysiological role

Production of thyroxineProduction of thyroxine

RequirementsRequirementsRDA =150 µg/dayRDA =150 µg/dayUL =1100 µg/dayUL =1100 µg/day

SourcesSourcesSeafood/plants grown near the oceanSeafood/plants grown near the oceanMolassesMolassesYogurt and milkYogurt and milkIodized saltIodized salt


Hyperstates and Hypostates: IodineHyperstates and Hypostates: Iodine

Hyperstates: excessive amountsHyperstates: excessive amounts

result in thyroiditis, hypothyroidism, result in thyroiditis, hypothyroidism, hyperthyroidism, sensitivity reactionshyperthyroidism, sensitivity reactions

HypostatesHypostatesGoiter (enlargement of the thyroid gland) Goiter (enlargement of the thyroid gland) Spontaneous abortions and congenital anomaliesSpontaneous abortions and congenital anomaliesDelayed eruption of primary and secondary teethDelayed eruption of primary and secondary teethEnlarged tongueEnlarged tongueEndemic cretinismEndemic cretinism

From Fehrenbach MJ, Herring SW: Illustrated Anatomy of From Fehrenbach MJ, Herring SW: Illustrated Anatomy of the Head and Neck, ed 4. St. Louis: Saunders, 2012the Head and Neck, ed 4. St. Louis: Saunders, 2012


Nutritional DirectionsNutritional DirectionsEncourage water as beverage of choice to fulfill daily water Encourage water as beverage of choice to fulfill daily water

needs over consumption of caloric beveragesneeds over consumption of caloric beveragesAssess patients for electrolyte imbalances and nutrient Assess patients for electrolyte imbalances and nutrient

deficiencies/excesses and refer to medical providers as deficiencies/excesses and refer to medical providers as neededneeded

Consume less than 2300 mg (approximately 1 tsp salt) of Consume less than 2300 mg (approximately 1 tsp salt) of sodium per day by choosing and preparing foods with little sodium per day by choosing and preparing foods with little added salt added salt

Consume lean meats, whole grains, fruits, vegetables, and Consume lean meats, whole grains, fruits, vegetables, and low-fat dairy to meet nutritional needs low-fat dairy to meet nutritional needs

Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

HEALTH APPLICATIONHEALTH APPLICATIONHypertensionHypertension

Discuss the epidemiology & statistics of Discuss the epidemiology & statistics of Americans impacted by hypertensionAmericans impacted by hypertension

How is hypertension defined clinically?How is hypertension defined clinically?What are the health risks of having What are the health risks of having

hypertension?hypertension?What are causes of hypertension?What are causes of hypertension?What treatment(s) or lifestyle changes can be What treatment(s) or lifestyle changes can be

employed to reduce hypertension?employed to reduce hypertension?

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CHAPTER 12 WATER AND MINERALS REQUIRED FOR ORAL SOFT TISSUES AND SALIVARY GLANDS Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier