Fluids and Minerals Required for Oral Soft Tissues and Salivary Glands

MULTIPLE CHOICE

1. A person with a large amount of fat has a higher percentage of total body water than average because adipose tissue absorbs and retains water.

a.
Both the statement and the reason are correct and related.
b.
Both the statement and the reason are correct but are not related.
c.
The statement is correct, but the reason is not correct.
d.
The statement is NOT correct, but the reason is correct.
e.
Neither the statement nor the reason is correct.

ANS: E

Adipose tissue contains less water than muscle. Thus, a person with a large amount of fat has a lower percentage of total body water. Similarly, women’s bodies, with inherently larger fat stores, contain less water than do men’s bodies, which have a higher percentage of lean muscle tissue.

REF: p. 214

2. Equalization of solute concentration of intracellular fluids (ICFs) and extracellular fluids (ECFs) is accomplished by:

a.
semipermeable membranes.
b.
hydration.
c.
osmotic pressure.
d.
perspiration.

ANS: C

Osmotic pressure within the body equalizes the solute concentration of ICFs and ECFs by shifting small amounts of water in the direction of higher concentration solute. Semipermeable membranes separate one fluid compartment from another. Hydration and perspiration are important elements of fluid balance.

REF: p. 214

3. Each of the following describes physiological roles of water except one. Which one is the exception?

a.
Acts as a solvent for chemical reactions
b.
Maintains stability of body fluids
c.
Enables transport of nutrients and excretion of waste
d.
Regulates temperature by pooling as perspiration on skin

ANS: D

Water regulates body temperature by evaporating as perspiration from skin. Similarly, water regulates temperature by evaporating as vapor from the mouth and nose.

REF: p. 214

4. Water losses result in increased kidney output because increased kidney function stimulates thirst and encourages fluid intake.

a.
Both the statement and the reason are correct and related.
b.
Both the statement and the reason are correct but are not related.
c.
The statement is correct, but the reason is not correct.
d.
The statement is not correct, but the reason is correct.
e.
Neither the statement nor the reason is correct.

ANS: E

Water losses result in decreased kidney output as a means of conserving the body’s fluid content. Although it is true that water losses result in stimulation of water intake, this is not a result of increased kidney function.

REF: p. 215

5. Water loss can occur from each of the following except one. Which one is the exception?

a.
Respiration inflammation
b.
Strenuous exercise
c.
Diarrhea
d.
Perspiration
e.
Metabolism of fat

ANS: E

Water is liberated in the process of metabolism and becomes available for hydration of the cells and tissues of the body. Metabolism of fat produces approximately twice as much water as does the metabolism of protein or carbohydrate. Metabolism of fat supplies about 300 to 350 mL per day.

REF: p. 215

6. Dissolved substances that freely cross cellular membranes are:

a.
osmoreceptors.
b.
solutes.
c.
renin.
d.
cations.

ANS: B

Dissolved substances called solutes freely cross cellular membranes. Glucose, amino acids, and oxygen are examples of solutions. Osmoreceptors are neurons in the hypothalamus that register thirst when stimulated and increase release of antidiuretic hormone (ADH) from the pituitary gland. Renin is a hormone that leads to increased release of the hormone aldosterone by the adrenal cortex. This release of aldosterone ultimately results in an increase in blood pressure. Cations are positively charged ions related to electrolytes and the body’s hydration status.

REF: p. 214

7. Excess water is eliminated by the kidneys because antidiuretic hormone (ADH) secretion is increased when osmoreceptors detect excess water.

a.
Both the statement and the reason are correct and related.
b.
Both the statement and the reason are correct but are not related.
c.
The statement is correct, but the reason is not correct.
d.
The statement is not correct, but the reason is correct.
e.
Neither the statement nor the reason is correct.

ANS: C

Excess water is eliminated by the kidneys because ADH secretion is decreased when osmoreceptors detect excess water. ADH originates in the pituitary gland and is involved in the regulation of fluid levels. As in this question, during times of excess water, ADH is decreased causing increased urinary output. Conversely, if osmoreceptors detect a water deficit, ADH stimulation is increased. This causes the body to retain fluid by decreasing urinary output.

REF: p. 215

8. Approximately 25% of reputable producers of bottled water use groundwater as their water source. Plain tap water is the most natural source of fluids.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: D

Although the bottle water market has been increasing, as a result of environmental concerns and the revelation that approximately 75% of reputable producers of bottle water use groundwater (same source as the public water supply) or tap water, the rate of increase has declined. Environmental concerns include the energy required to produce plastic, nonbiodegradable bottles, the bisphenol A content of bottles, and the marketing and shipping costs.

REF: p. 217

9. Oolong and black teas provide higher levels of polyphenols and flavonoids than green teas do, because oolong and black teas are oxidized or fermented.

a.
Both the statement and the reason are correct and related.
b.
Both the statement and the reason are correct but are not related.
c.
The statement is correct, but the reason is not correct.
d.
The statement is not correct, but the reason is correct.
e.
Neither the statement nor the reason is correct.

ANS: D

Although teas provide beneficial polyphenols and flavonoids, oolong and black teas are oxidized or fermented, resulting in a lower concentration of polyphenols than in green tea. Polyphenols in tea appear to possess antioxidant and antiinflammatory actions. It is fairly well established that flavonoids have health benefits.

REF: p. 218

10. Each of the follow is a classic sign of fluid volume deficit (FVD) except one. Which one is the exception?

a.
Longitudinal fissures in dry tongue
b.
Sunken eyes
c.
Orthostatic hypotension
d.
Hypotension
e.
Pale urine

ANS: E

Pale yellow or almost colorless urine indicates adequate hydration. Dark yellow urine with strong odor, advancing to painful urination, are advancing signs of inadequate water intake and dehydration. A diminished salivary flow is also associated with inadequate fluid intake. Treatment of FVD involves replacing lost fluid. For mild FVD, oral fluids are likely sufficient. Intravenous solutions are needed with significant FVD.

REF: p. 221

11. Calcium and magnesium are among the nutrients added to sports drinks to restore fluid balance during exercise, because these minerals are not readily available in a well-balanced diet.

a.
Both the statement and the reason are correct and related.
b.
Both the statement and the reason are correct but are not related.
c.
The statement is correct, but the reason is not correct.
d.
The statement is not correct, but the reason is correct.
e.
Neither the statement nor the reason is correct.

ANS: C

It is true that calcium and magnesium are among nutrients added to sports drinks; however, there is no advantage to obtaining these minerals in this manner because they are readily available in a well-balanced diet. Other nutrients added to sports drinks, with the goal of optimizing athletic performance, include carbohydrates, electrolytes and sometimes vitamins or other nutrients, such as protein or amino acids. Endurance athletes can benefit from a sports beverage containing carbohydrates, and electrolytes, and protein, but sports drinks offer little to no advantage over plain water for most people. Note that some sources state that calcium added to sports drinks lessens the erosive potential of these acidic beverages.

REF: p. 220

12. High pH levels of sports and energy drinks resulting from hydrochloric acid content causes irreversible damage to teeth in just 5 days. Energy drinks cause twice as much damage to teeth as sports drinks do.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: D

Sports and energy drinks contain citric acid. Low pH levels indicate high acidity; high pH levels indicate alkalinity (base). The remainder of both statements accurately describes these products.

REF: p. 220

13. Loss of 1 pound of body weight during exercise means that at least 2 cups of water have been lost. High protein diets during exercise retain more water than do diets high in fruits and vegetables.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: C

High-protein diets, such as those in which fruit and vegetable intake is minimal, require larger amounts of water to eliminate higher levels of urinary waste products. Thus, patients on high protein diets need to increase fluid consumption with water being the preferred beverage. The dental hygienist can suggest adding slices of lemon, lime, or watermelon to make water more enticing. An important caveat is that the addition of citrus lowers the pH of water, making a beverage of neutral pH more acidic.

REF: p. 222 | Dental Considerations

14. The body’s hydration status depends on an electrolyte balance of equal concentrations of solutes to kilocalories. Electrolytes are an important in water balance and acid-base (pH) balance.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: D

The body’s hydration status depends on an electrolyte balance of equal concentrations of cations to anions. Sodium and potassium are the major cations while chloride and phosphate are the major anions. Solutes are substances that create a solution when dissolved in a solvent such as sugar dissolved in water. Note that solvents are involved in hydration via osmosis and cellular permeability.

REF: p. 223

15. The approximately 75% to 80% of sodium that is consumed from processed foods can be reduced by using sea salt, because the natural ingredients of sea salt provide more flavor, less sodium, and more minerals than table salt do.

a.
Both the statement and the reason are correct and related.
b.
Both the statement and the reason are correct but are not related.
c.
The statement is correct, but the reason is not correct.
d.
The statement is not correct, but the reason is correct.
e.
Neither the statement nor the reason is correct.

ANS: E

Most consumers believe that sea salt is lower in sodium than regular salt; however, this is solely due to marketing sea salt as “natural.” Sea salt provides miniscule trace elements with no known health benefits and similar taste intensity. A concern of dietitians, sea salt is not fortified with iodine, a nutrient important in thyroid health, especially during pregnancy. The 75% to 80% attributed to sodium consumption from processed foods includes foods prepared in restaurants and fast food establishments.

REF: p. 224

16. Cellular edema is present during hypernatremia because when sodium losses exceed water losses, sodium moves from the ECF to the ICF, and water enters the ICF.

a.
Both the statement and the reason are correct and related.
b.
Both the statement and the reason are correct but are not related.
c.
The statement is correct, but the reason is not correct.
d.
The statement is not correct, but the reason is correct.
e.
Neither the statement nor the reason is correct.

ANS: D

During hyponatremia, or low serum sodium level, cellular edema is present. The reason portion of the question provides a concise explanation. The detailed mechanism involves fluid retention during hyponatremia because sodium losses exceed water losses. This leads to a greater concentration of water than sodium, which decreases the extracellular fluid concentration (ECF). As a result, sodium moves from the ECF to the ICF and water enters the ICF. These events result in cellular edema (retention of fluids). The cause and mechanisms of hypernatremia (elevated serum sodium level) are reversed. Note that peripheral edema and cellular edema are not the same condition.

REF: p. 227

17. During heat exhaustion, a sodium deficit results in hyponatremia. Early symptoms include nausea, abdominal cramps, headache, hyperactivity, and excessive talking.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: C

During heat exhaustion, hyperactivity and excessive talking are not symptoms. Instead, patients are lethargic and may lapse into coma. Note that symptoms are the result of cellular edema, which is not the same as peripheral edema. The distinction is that with cellular edema, water is primarily retained within cells rather than in the interstitial compartment as occurs in peripheral edema.

REF: p. 227

18. Sodium deficiency can lead to an increased salivary flow rate. High levels of sodium (greater than 2 g/day) cause calcium retention in the kidneys.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: B

Sodium deficiency can lead to a decreased salivary flow because the body reverts to processes designed to conserve fluid. Conversely, high levels of sodium cause calcium less in the urine. Dental hygienists should routinely examine their patients for fluid volume deficit (FVD) and fluid volume excess (FVE) and stress the importance of appropriate sodium intake.

REF: p. 227

19. The RDA is higher for premenopausal women than for men or postmenopausal women because of the blood loss during menstruation.

a.
Both the statement and the reason are correct and related.
b.
Both the statement and the reason are correct but are not related.
c.
The statement is correct, but the reason is not correct.
d.
The statement is not correct, but the reason is correct.
e.
Neither the statement nor the reason is correct.

ANS: A

The Institute of Medicine (IOM) recommends 18 mg of iron per day for women 19 to 50 years old, 8 mg per day for women 51 years old and older and men 19 years old and older. Note that during the reproductive phase of a woman’s life, iron loss is at least twice that of a man or of a postmenopausal woman.

REF: p. 230

20. Each of the following interferes with zinc absorption except one. Which one is the exception?

a.
Calcium
b.
Fiber
c.
Higher quality protein
d.
Phytate
e.
Phosphate salts

ANS: C

Bioavailability of zinc varies widely. Absorption can be inhibited by calcium, fiber, phosphate salts and phytate (a plant fiber). Higher-quality protein improves zinc absorption. In developing countries, severe zinc deprivation has been related to excessive consumption of inhibitors, which adversely affect zinc absorption, rather than inadequate zinc intake.

REF: p. 233

21. Thyroxine is produced by iron. Thyroxin, produced by the thyroid gland regulates basal metabolic rate.

a.
Both statements are true.
b.
Both statements are false.
c.
The first statement is true; the second is false.
d.
The first statement is false; the second is true.

ANS: D

Iodine is required for production of thyroxine, a hormone secreted by the thyroid gland. Because iodine is related to the metabolic rate, needs are increased during periods of accelerated growth, especially during pregnancy and lactation. The best safeguard for an adequate intake of iodine is the use of iodized salt. Note that sea salt is not iodized.

REF: p. 234

MULTIPLE RESPONSE

1. Which of the following accurately describes requirements of fluids? (Select all that apply.)

a.
An adequate intake (AI) for total fluid for men is 15 to 16 cups (3.7 L) daily.
b.
Women require 11 to 12 (2.7 L) cups per day.
c.
An upper limit (UL)of 22 cups of fluid per day has been established.
d.
It takes approximately 5 days to compensate for loss of 1% of body fluid.

ANS: A, B

No tolerable upper intake level is established for water. Loss of 1% body water is usually compensated within 24 hours. The Institute of Medicine established the guidelines stated in the question for men and women.

REF: p. 214

2. Which of the following accurately describe thirst as it relates to physiologic aspects of hydration? (Select all that apply.)

a.
The early sign of the need for fluid is often mistaken for hunger.
b.
Older patients often have a reduced sensation of thirst.
c.
Increased blood pressure stimulates release of theanine, which leads to the release of aldosterone.
d.
Release of aldosterone by the adrenal cortex causes blood pressure to increase.
e.
The ability to regulate water balance is not precise in infants and older adults.

ANS: A, B, E

Theanine is an amino acid used to treat anxiety and high blood pressure. It is found in all teas and is not stimulated by increased blood pressure. The corrected statement reads “increased blood pressure stimulates release of renin, which increases release of the hormone aldosterone by the adrenal cortex.” These events result in retention of sodium and water by the kidneys, excretion of potassium and hydrogen ions, and a resultant increase in blood pressure.

REF: p. 215

3. Which of the following is true of bottled water? (Select all that apply.)

a.
Most bottled water contains fluoride.
b.
Bottle water also includes flavored and nutrient-added waters.
c.
Bottle water is regulated by the U. S. Food and Drug Administration (FDA).
d.
The USDA mandates that nutrient-added and flavored waters not contain kilocalories.

ANS: A, B, C

Many nutrient-added and flavored waters contain kilocalories. There is not an FDA or USDA mandate to this effect. In 2009, the FDA mandated that all manufacturers of bottled water test their water source weekly for the presence of coliforms which are bacterial indicators of sanitation. The FDA also established maximum levels for contaminants.

REF: p. 217

4. Which of the following ingredients in tea are considered beneficial to health? (Select all that apply.)

a.
Tannin
b.
Polyphenols
c.
Flavonoids
d.
Theanine

ANS: B, C, D

Tannin, found in teas, inhibits iron absorption, particularly when tea and iron are consumed at the same time. Theanine is an amino acid used to treat anxiety and high blood pressure. Polyphenols in tea appear to possess antioxidant and antiinflammatory mechanisms. Flavonoids are well accepted as beneficial to overall health. Note that herbal teas have lower concentrations of antioxidants than green, white, black, or oolong teas.

REF: p. 218

5. While assessing oral tissues, signs of fluid volume deficit (FVD) that a dental hygienist should look for include: (Select all that apply.)

a.
dry tongue with longitudinal fissures.
b.
xerostomia.
c.
edema of oral mucous membranes.
d.
increased salivary flow.
e.
use of ma-huang.

ANS: A, B, E

Mucous membranes in a patient with FVD will not appear edematous, because edema indicates fluid is present in the intracellular spaces. Instead, tissues will appear shrunken and skin will have decreased turgor. Salivary flow will be diminished. Ma-huang is another name for the ephedra, an herb that can cause xerostomia (dry mouth). Many patients use ma-huang as an appetite suppressant.

REF: p. 221

6. Which of the following accurately describes energy drinks? (Select all that apply.)

a.
Energy drinks contain stimulants.
b.
Although controversial, megadoses of vitamin B provide energy bursts.
c.
The use of energy drinks can increase risk for caffeine overdose.
d.
The amount of caffeine within the product is listed on the label.
e.
Sales have doubled in the past 5 years.

ANS: A, C, E

Marketers misuse science to lead people to believe that a megadose of vitamin B energizes. Although vitamins help the body use energy from foods, extra B vitamins do not provide additional energy bursts. The amount of caffeine in a product is not required on labels because it is not a nutrient. Energy drinks that contain “natural” ingredients, such as ginkgo or guarana, are considered a dietary supplement rather than a food or medication by the FDA.

REF: p. 221

7. Which of the following statements accurately describes a physiologic role or utilization pattern of iron? (Select all that apply.)

a.
Iron is present in every cell including both oral soft and hard tissues.
b.
This nutrient is involved in the conversion of beta-carotene to protein.
c.
Iron incorporates and distributes lipids within the blood.
d.
Approximately 4 g (less than 1 tsp) is present in the body.
e.
Lactoferrin, a salivary glycoprotein, is capable of binding iron.

ANS: A, D, E

Iron is involved in the conversion of beta-carotene to vitamin A. Protein is synthesized from amino acids. Iron aids in the removal of lipids from the blood. Note that lactoferrin, a salivary glycoprotein, has an antibacterial action by competing with iron-requiring organisms in the mouth for limited amounts of available iron.

REF: p. 230

8. Which of the following is true of requirements and regulation of sodium? (Select all that apply.)

a.
An RDA has not been established for sodium.
b.
The sodium-potassium pump regulates sodium and other electrolytes.
c.
Aldosterone released by the pituitary gland controls sodium reabsorption and excretion.
d.
The kidneys adjust sodium excretion to match sodium intake.
e.
The Dietary Guidelines and MyPlate encourage limiting consumption of sodium to 2300 mg/day.

ANS: A, B, D, E

Aldosterone, which controls sodium reabsorption and excretion, is released by the adrenal cortex depending on the body’s need. Note that the sodium-potassium pump is constantly moving sodium from the cell to the extracellular fluid. Because sodium is so readily available in foods, no RDA has been established.

REF: p. 223

9. Zinc is a component in more than 200 enzymes. Which of the following is true of physiologic roles, requirements, and hypo and hyper states of zinc? (Select all that apply.)

a.
Zinc deficiency is associated with increased susceptibility to periodontal disease.
b.
Zinc supplements are essential to supplement a well-balanced diet.
c.
Flattened filiform papillae are manifestations of zinc deficiency.
d.
Zinc deficiency is associated with increased acuity of taste and smell.
e.
Zinc performs functions in cell growth and replication, sexual maturation, night vision, and appetite.

ANS: A, C, E

If a well-balanced diet is consumed, zinc supplements are rarely needed and can be harmful. Note that small amounts of animal protein can significantly improve bioavailability of zinc from a legume-based meal. Zinc deficiency is associated with loss of taste and smell acuity, poor appetite, and impaired wound healing. Zinc deficiency also results in congenital defects, such as skeletal abnormalities, especially cleft palate and lip.

REF: p. 232 | p. 233

10. Which of the following is true of potassium deficiency? (Select all that apply.)

a.
Excessive loss or inadequate intake of potassium can result in hypokalemia.
b.
Excessive bowel sounds and muscle weakness in legs are associated with potassium deficiency.
c.
Vomiting and diarrhea contribute to potassium deficiency.
d.
Diminished insulin levels contribute to damage from potassium deficiency.
e.
Drugs such as diuretics are major contributors to potassium deficiency.

ANS: A, C, E

Although muscle weakness in the legs is associated with potassium deficiency, bowel sounds are absent. Excess insulin as well as Cushing syndrome, hyperaldosteronism, hypomagnesemia, alcoholism, and alkalosis all cause hypokalemia, which results from severe potassium deficiency. Note that although some potassium is lost through sweat, excessive perspiration can lead to hypokalemia. In addition, because potassium is contained in gastric and intestinal secretions, vomiting and diarrhea can cause hypokalemia.

REF: p. 229

MATCHING

The ability to assess and treat soft tissue diseases of the oral cavity demands an understanding of the fluids and minerals necessary for health. Match each item function, process, or element with its most appropriate description.

a.
Semi-permeable membrane
b.
Osmosis
c.
Hemochromatosis
d.
Metabolism of protein and carbohydrate
e.
Antidiuretic hormone
f.
Coliforms
g.
Chloride
h.
Peripheral edema
i.
Diaphoresis
j.
Anions
k.
Hypernatremia
l.
Myxedema
m.
Hyperkalemia