Calcium

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CALCIUM AND PHOSPHORUS METABOLISM IN GROWTH

INDIAN DENTAL ACADEMY

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CONTENTS


INTRODUCTION :-

Of all the minerals in our body, Calcium is present in the highest amount. Our body’s need for calcium is also the highest of any minerals or vitamins.

The Phosphorus is the other mineral element which is essential for the formation and development of bone and teeth along with Calcium.


Calcium, combined with phosphate to form hydroxyapatite, is the mineral portion of human and animal bones and teeth.

The mineral portion of some corals can also be transformed into hydroxylapatite.


MINERAL ELEMENTS

Minerals elements are present in animal body supplied by the diet.

Minerals elements can be classified as

1) Principal elements or Macronutrients

There are total seven essential elements-

calcium , magnesium, sodium, potassium, phosphorus, sulphur and chlorine.


2) Trace elements

Essential trace possibly essential non essential elements elements elements

Iron, iodine,copper nickle,tin, silicon aluminium,boron

zinc,manganese and lead and mercury

Cobalt etc….


CALCIUM :-

Calcium is essential for living organism, particularly in cell physiology, where movement of the calcium ion Ca2+ into and out of the cytoplasm functions as a signal for many cellular processes.

As a major material used in mineralization of bones and shells, calcium is the most abundantmetal by mass in many animals.


Calcium (Latin word calcis meaning "lime") was known as early as the first century when the Ancient Romans prepared lime as calcium oxide.

Calcium is an important component of a healthy diet and a mineral necessary for life..


The National Osteoporosis Foundation says, "Calcium plays an important role in building stronger, denser bones early in life and keeping bones strong and healthy later in life.“

Approximately ninety-nine percent of the body's calcium is stored in the bones and teeth


Normal value-

In a normal young adult there about 1100 gm. of calcium present in the body.

It forms about 1.5 % of total body weight.

99 % of calcium is present in the bone and the rest present in plasma.

Normal blood calcium level is 9.4 mg % /100 ml.


Types of calcium :-

Calcium in plasma- is of two type.

- Ionized or diffusible calcium

- Nonionized or nondiffusible calcium

Ionized form :- Is found freely in plasma.

essential for regulate vital function like neuronal activity, muscle contraction,cardic activity and blood coagulation..


Calcium in bones-

Small quantity of readily exchangeable calcium:-

It helps to maintain the plasma calcium level as it is removed from the bone.

Large quantity of stable calcium:-

It helps in bone remolding since it is constantly removed and deposited in bone.

Source of calcium:-

Rich source – Milk and Cheese

good source- Egg yolk,Nuts,Fish,Beans…


DIETARY CALCIUM RECOMMENDATIONS

Group Age mg/day

Infants 0-6 months 400

6-12 months 600

Children 1-5 years 800

6-10 years 800-1200

Adolescents and young adults 11-24 years 1200-1500

Men 25-65 years 1000

Women 25-50 years 1000

pregnant or lactating 1200-1500

Post menopausal

Receiving estrogen replacement therapy

1000

Not receiving 1500

Men and women >65 years 1500


IMPORTANCE OF CALCIUM

Calcium along with phosphorus is essential for the formation and development of bone and teeth.

Calcium is also required in blood coagulation process.

Calcium also regulate the neuronal activity.


It is essential for muscular contraction.

It regulates the permeability of membrane.

It is required as a activator for activate several enzymes like ATPasse,Proteolytic enzymes.


Absorption of Calcium:-

Calcium is taken in diet as – calcium phosphate,Carbonate,Tartrate and oxalate.

Calcium actively absorbed in upper intestine and regulated by 1,25 Dihydroxycholicalciferol(a metabolite of vit-D),which is produced in liver and kidney in response to decrease plasma concentration.


Calcium and phosphorus ratio of 1:2 (2:1 or 1:2 )is the most

convenient for the absorption of both.


PHOSPHORUS :-

The Phosphorus is the other mineral element which is essential for the formation and development of bone and teeth along with Calcium.

The crystalline salts present in bones are called “Hydroxy apatites ‘which contain Calcium and Phosphate.


Phosphorus was discovered by German alchemist Hennig Brand in 1674 or 1675. Working in Hamburg.

Phosphorus is a component of DNA, RNA, ATP, and also the phospholipids which form all cell membranes. It is thus an essential element for all living cells


It present in the blood in the form of :-

-Inorganic phosphorus - 2-5 mg /100 ml

Organic phosphorus -14-29 mg /100 ml

-phospholipids - 8-18 /100ml

Source :-

Milk,cheese,egg-yolk,meat,fish….


Daily requirement :-

Infants - 240 – 400 mg

Children - 800 – 1200 mg

Adults -800 mg.

Absorption:-

- Moderate amount of fats or acid increase absorption.

- high calcium decrease the absorption.


Importance of Phosphorus :-

It is essential for the formation and development of bone and teeth along with Calcium.

It is required for the formation of Phospholipids,Nucelic acids, and Phosphoproteins.

It is required for the formation of Organic phosphates.


It is required for the formation of Energy rich compounds like A.T.P.

It is required for the formation of Coenzyms such as NADP,ADP,AMP.

It is required for the Absorption of Glucose by phosphorylation.


CALCIUM AND PHOSPHORUS METABOLISM :-

Orthodontist and dentofacial orthopedists manipulate bone. The biomechanical response to altered function and applied loads depends on the metabolic status of the patients.

Bone metabolism is an important aspect of clinical medicine that is directly applicable to Orthodontics and Orthopedics.

Orthodontics is bone manipulative therapy and favourable calcium and phosphorus metabolism is an important consideration.


As we know the Calcium along with phosphorus are the essential major elements for the formation and development of bones and teeth, so we can explain the metabolism of Calcium and Phosphorus as Bone metabolism.


BONE METABOLISM :-

Orthodontics is bone manipulative therapy, and favorable calcium and phosphorus metabolism is an important role.

Calcium homeostasis is the process by which mineral equilibrium is maintained.


Maintenance of serum calcium levels at about 10 mg/dl is an essential life support function.

Calcium is taken through dietary sources.It is absorbed from the G.I.Tract in to Blood and distributed through out the body.


REGULATION OF BLOOD CALCIUM LEVEL :-

All these process are finely regulated by three hormones.

1.Parathormone

2. Vitamin-D

3.Calcitonin


PARATHORMONE :-

Secreted by the chief cells of parathyroid glands.

It is protein in nature.

Action of Parathormone :-

primary function is to maintain the blood calcium level.

It is regulated by the Calcium ion concentration in the Blood.


Parathormone acts through cyclic AMP, which acts as second messenger.

Effect on the bone :-

Responsible for Resorption of bone or calcium . It occurs in two phase.


Rapid flux of calcium from the bone fluid (occurs in seconds)

PTH---- Attached with receptors on the cell memb. of Osteoblast and Osteocytes.

Hormone –Receptors complex –increase permeability of the cell memb. For calcium ions

This increase the calcium pump mechanism allowing calcium ions to move from these cells to plasma.


Short-term response by osteoclasts and osteoblasts (extends from minutes to days)

In this phase the calcium resorption take place by the activation of osteoclast.

Osteoclast----released Proteolytic enzyme ----Digest or Dissolve the organic matrix

----- Calcium ions released and slowly move into Plasma.


Long term control of bone turnover (over weeks to months).

Long term regulation has profound effects on the skeleton.

Biomechanical factors, noncalcific hormones, and the metabolite mechanisms dictate mass, geometric distribution and the mean age of the bone.


EFFECT ON THE KIDNEYS :-

Increase the Reabsorption of Calcium from renal tubules along with magnesium ions and hydrogen ions

At the same time it also increases the excretion of Phosphates from renal tubules.


EFFECT ON GASTROINTESTINAL TRACT :-

By the formation of 1,25 dihydroxy cholecalciferol from vit-D it increase the Absorption of Calcium. Vit- D is essentiol for that.

Ortho consideration

It increases the tooth movement and consequently influence

orthodontic treatment.


VITAMIN D – 3

Vit. D3 with parathyroid and cacitonin hormone

regulates the amount of Ca and phosphorous in human body.

Parathyroid hormone convert the vit-D in its active metabolite which is known as

1,25 Dihydroxy cholecalciferol .


ACTION OF 1,25 DIHYDROXY CHOLECALCIFEROL

Increase the absorption of calcium from the intestine.

Increase the synthesis of calcium induced ATP in the intestinal epithelium.

increase the synthesis of alkaline phophatase in the intestinal epithelium.


It promotes interstitial Ca and phosphorous absorption

Vit.D3 increases the bone mass and thus reduces fractures in osteoporosis.

Ortho consideration

It can be assumed that they can inhibit tooth movement.


CALCITONIN :-

Peptide hormone, secreted by intra follicular or C- cells in the thyroid

gland. also called Thyrocalcitonin.

Actions of Calcitonin :-

Effect on Bone :-

It increase the deposition of calcium on bones and also suppress the activity of osteoclasts. Even it inhibits the development of new Osteoclasts.


It decreases the Blood Calcium level and thereby counteracts the action of Paratharmone.

It flows in bloodstream and attracts Ca to bone, thus reducing Serum calcium

It reduces bone resorption by reducing the no. of osteoclasts.


It is used in the treatment of Hypercalcemia and Osteoporosis.

Effect on Kidney :-

It increase the excretion of calcium through urine, by inhibiting the reabsorption of calcium from the renal tubules.


Effect on intestine :-

It prevent the absorption of Calcium from intestine into the Blood.

Ortho consideration

It inhibit tooth movement and consequently delays

orthodontic treatment



www.indiandentalacademy.comDisease state:-

Abnormalities in Calcium and Phosphorus metabolism are mainly associated with some Diseases.

-Hypercalcaemia

-Hypocalcaemia

-Rickets

-Osteoporosis


Calcium and Phosphorus metabolism in Growth:-

-The role of Calcium and Phosphorus metabolism is most effectively started in post natal period..

- Bone remodeling and Bone resorption (Bone metabolism ) procedure occurs continuously throughout life..


BONE GROWTH :-

The embryo has a cartilaginous skeleton. the conversion of cartilage

into bones is called the ossification.

At the time of birth skeleton consist of 50 % cartilage and 50 % bone.


BONE :-

Bone or osseous tissue is a specialized rigid connective tissue that

form the skeleton.

it consist of special type of cells and tough intercellular matrix of ground substance.

through out life the bone is renewed by the process of bone formation and bone resorption.


FUNCTION OF BONE :-

Protective function --

protect soft tissue and vital organs of the body.

Mechanical function --

Support the body and their attachment to the muscles and tendon.


Metabolic function –

Bone play an important role in the metabolism and Homeostasis of calcium and phosphorus in body.

Hemopoietic function –

Red bone marrow is the site of production of Blood.


COMPOSITION OF BONE :-

Bone matrix – bone matrix is composed of Protein fibers called Collagen fibers. These fibers form about 90% of bone.

- matrix is embedded in the gelatinous ground substance ,which is formed by extracellular fluid and proteoglycans.


Bone salt – The crystalline salts present in bones are called “Hydroxy

apatites ‘which contain Calcium and Phosphate.

-Some other salts present like sodium , potassium magnesium.

- The salt of the bone strengthen the bone matrix.


BONE REMODELING :-

- Bone remolding is a process that includes bone resorption

followed by bone formation.

-Bone remodeling occurs continuously throughout life.


-Usually bone remolding takes place in group of cells called Basic multicellular units (BMU)

-Significance of remodeling – in children the shape of bone is re altered in relation to growth of the body.


In adults the remoldeing of bone is responsible for the maintence of toughness of bone.This because of replacement of old matrix by new matrix.

Bone resorption :-

It is the process that involves the destruction of entire Bone matrix and Removal of Calcium.

The osteoclast responsible for bone resorption.


BONE FORMATION :-

The osteoblast activity or the process of bone formation involves the synthesis of collagen and formation of matrix that is mineralized.

Mineralization :-

The mineralization starts about 10 to 12 days after the formation of osteoid.


First large quantity of calcium phosphate is deposited . Afterwards , the hydroxide and bicarbonate ions are gradually added causing the formation of hydroxyapatite crystals.

The process is increased by the enzyme Alkaline phosphatase secreted by osteoblast.


Growth of maxilla

The Maxilla is carried out Downward and Forward growth.


GROWTH OF MANDIBLE :-

The Mandible is translated downwards and forwards and grows upwards and backwards.

Chin moves downwards Mandible grows upwards

And forwards. and backwards


ROLE OF CALCIUM AND PHOSPHORUS METABOLISM IN ORTHODONTIC TOOTH MOVEMENT.

Orthodontic tooth movement is a unique process where a solid object(tooth)is made to move through a solid medium (bone)

When force is applied on a tooth to bring about orthodontic movement , it result in formation of

-Area of pressure in the direction of the tooth movement.

-Area tension form in the opposite direction.



Bone resorption take place at the Pressure side.

Bone deposition take place at the Tension side.

Optimum orthodontic force :- Is one which moves teeth most rapidly in the desired direction, with the least possible damage to tissue and with minimum patient discomfort.


Optimum force is equivalent to the capillary pulse pressure which is 20-26 gm/sq.cm of root surface.

phases of tooth movement.

1. Initial phase

2. Lag phase

3. Post lag phase

www.indiandentalacademy.com Journal of Bone and Mineral Metabolism, 2004

Masayoshi Kawakami and Teruko Takano-Yamamoto Local injection of 1,25-dihydroxyvitamin D3 enhanced bone formation

for tooth stabilization after experimental tooth movement in rats

The present investigation evaluated the effect of 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) on alveolar bone formation during tooth movement in rats

Orthodontic elastics were inserted between the maxillary first and second molars on bilateral sides in male rats


1,25(OH)2D3 was injected locally, at the concentration of 10–10 M, once every 3 days in the sub mucosal palatal area of the root bifurcation of the molar on the right side.

Histomorphometric analysis revealed that tooth movement without application of 1,25(OH)2D3 decreased the mineral appositional rate (MAR) on the compression area at 7 days.

Repeated injections of 1,25(OH)2D3 in the orthodontically treated animals distinctly stimulated alveolar bone formation on the mesial side at 14 days. There was a significant increase in MAR associated with elevated osteoblast surface value on the tension surface.


These findings suggest that local application of 1,25(OH)2D3 enhances the reestablishment of supporting tissue, especially alveolar bone of teeth, after orthodontic treatment.


Source: AJO-DO on CD-ROM (Copyright © 1998 AJO-DO), Volume 1984 May (424 - 430): Root resorption and tooth movement in orthodontically treated, calcium-deficient, and lactating rats - Goldie and King

A study had been done by Goldie and King on , Root resorption and tooth movement in orthodontically treated, calcium-deficient, and lactating rats.

A 60-gm orthodontic force designed to tip maxillary molars mesially was applied for varying times.

Since the appliance force was similar for both groups.


The increased rate of tooth movement in the test animals can be attributed to increased bone metabolism and decreased bone density.

This study confirms earlier findings that lactation, coupled with a calcium-deficient diet, will produce

decreased bone density through secondary hyperparathyroidism.


Increased tooth movement was also found to correlate directly with increased bone turnover and decreased bone density.

Morphometric data indicated that animals stressed with lactation and dietary calcium deficiency had significantly less root resorption in the time course of this experiment.

.


These findings suggest that tooth movement and root resorption may be dependent upon bone density and calcium metabolism in

alveolar bone.

www.indiandentalacademy.comQuintessence Int. 2001 May;32

Tyrovola JB, Spyropoulos MN

Effects of drugs and systemic factors on orthodontic treatment.

Orthodontic tooth movement and bone remodeling activity are dependent on systemic factors such as nutritional factors, metabolic bone diseases, age, and use of drugs

Systemic hormones such as estrogen, androgen, and calcitonin are associated with an increase in bone mineral content, bone mass, and a decrease in the rate of bone resorption. Consequently, they could delay orthodontic tooth movement


On the contrary, thyroid hormones and corticosteroids might be involved in a more rapid orthodontic tooth movement during orthodontic therapy and have a less stable orthodontic result.

Drugs such as bisphosphonates, vitamin D metabolites, and fluorides can probably cause a reduction of tooth movement after the orthodontic force is applied.


Nonsteroidal anti-inflammatory drugs have also been shown to reduce bone resorption.

Long-term administration of these drugs may therefore delay the necessary bone response to respective tooth-borne pressure and should not be administered for long periods of time to patients undergoing orthodontic tooth movement.

The use of the above drugs should be considered by every dentist in evaluating the treatment time and in planning treatment when tooth movement is attempted.


CONCLUSION

Calcium and phosphorus are essential elements required for maintaining the integrity of the skeletal system and they assist in mineral metabolism as well. Their importance in orthodontics can never be denied.


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