Nutrition and Oral Medicine (Nutrition and Health)

274 Part IV / Select Diseases and ConditionsTable 1Role of Nutrients in the Wound-Healing ProcessNutrientProteinCarbohydrateFatty acidsVitamin CVitamin AVitamin DVitamin ECalciumZincIronCopperRole/functionCell multiplication; enzyme synthesis; collagen and other connective tissue synthesisSource of energy; part of ground substancePart of cell membrane; prostaglandin synthesisCofactor in hydroxylation of proline and lysine; collagen synthesisEpithelial maintenance; glycoprotein and proteoglycan synthesis; stimulation of cellulardifferentiation in fibroblast and collagen formationCalcium homeostasis; calcium and phosphate absorptionMaintenance of cell membraneRequired by tissue collagenases; bone and tooth formationTranscription of RNA; cellular proliferation; protein synthesisInvolved in hydroxylation of proline and lysineComponent of lysyl oxidase; erythropoiesisinflux and foreign material contact, which may impede healing (1). Connective tissuehealing proceeds through three classical phases that can be summarized as follows:1. Inflammatory phase: vascular and cellular response; hemostasis; cleaning of cellulardebris and removal of infectious agents; secretion of factors that stimulate new epithelium;and migration of polymorphonuclear neutrophils, macrophages, and lympohocytes2. Fibroblast phase: epithelial regeneration; new capillary formation; collagen synthesis;wound granulation; epithelialization and scar formation; vascularization3. Remodeling phase: tissue repair; collagen synthesis and degradation; scar formation;wound strengthening.Each step in the wound-healing process requires energy provided through carbohydrateand fat metabolism. Protein and amino acids contribute structurally to the woundas part of the ground substance in the form of proteoglycans and glycoproteins. Proteinis also necessary for synthesis and cellular multiplication. Normal cellular functionrequires electrolytes, minerals, and vitamins that serve as enzymatic cofactors for manyof the steps in the wound-healing process. Vitamin C, because of its function in collagensynthesis, plays a major role in wound healing. In the oral cavity, vitamin C is involvedin maintenance of tissue including the periodontal ligament, formation of bone matrixand teeth, and maintenance of the integrity of blood vessel walls (6). Table 1 summarizesthe role of nutrients involved in normal wound healing. The reader is also encouragedto review Chapter 7 for a more detailed discussion on nutrients and the oral cavity.3. INJURY TO THE ORAL CAVITYTissue damage in the oral cavity may be caused by physical (incision, crushing,extreme heat or cold), chemical (caustic materials applied to oral tissues, anti-cancerdrugs), mechanical (trauma during mastication, mucosal tearing from dental appli-