Nutrients Present in Calcified Structures

MULTIPLE CHOICE

1. Each of the following is a physiologic role of copper except one. Which one is the exception?

a.
It is essential for formation of red blood cells and connective tissue.
b.
Copper is involved in carbohydrate and lipid metabolism, especially in the use of glucose.
c.
Copper-containing enzymes encourage production of neurotransmitters.
d.
It is readily incorporated into tooth enamel.

ANS: B

Copper is not involved in carbohydrate metabolism; this is a function of the trace element chromium. Neurotransmitters that benefits from copper-containing enzymes include norepinephrine and dopamine. Epidemiologic data suggest that a deficiency of copper is cariogenic, but bacteriological studies cite copper as having cariostatic abilities to reduce acidity of plaque.

REF: p. 179

2. Approximately what percentage of copper is absorbed?

a.
10%
b.
25%
c.
33%
d.
45%

ANS: C

Approximately one third (33%) of copper is absorbed, with absorption occurring in the stomach and duodenum. Absorption is enhanced by a low (acidic) pH and is decreased with large amounts of calcium and zinc.

REF: p. 179

3. The mineral most likely to occur in shellfish, oysters, crabs, sesame, and sunflower seeds is:

a.
copper.
b.
selenium.
c.
chromium.
d.
molybdenum.

ANS: A

Copper is widely distributed in foods. The richest sources include shellfish oysters, crabs, liver, nuts, sesame and sunflower seeds, soy products, legumes, and cocoa. Although selenium is also found in seafood and nuts, it is not found in sesame and sunflower. Molybdenum is found in nuts but not in seafood.

REF: p. 179

4. Which element is most likely to be found in a patient with extreme nausea, menopausal symptoms, and rheumatoid arthritis?

a.
Chromium
b.
Molybdenum
c.
Manganese
d.
Copper

ANS: D

Copper taken orally is an emetic, which is a substance that induces vomiting. Ten milligrams of copper can induce nausea. Patients with rheumatoid arthritis have elevated serum levels of copper. Serum copper levels are elevated in patients with rheumatoid arthritis, myocardial infarction, conditions requiring administration of estrogen, and pregnancy.

REF: p. 180

5. Copper deficiency causes lesions within connective tissues and bone. Lesions resemble those seen in vitamin A and vitamin D deficiencies.

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

Copper deficiency causes a variety of lesions within connective tissues and bone, resulting in failure to grow (in children), spontaneous fractures, osteoporosis, arthritis, and arterial disease. Lesions resemble those seen in vitamin C deficiency.

REF: p. 180

6. High doses of zinc supplements increase copper absorption. Large amounts of vitamin C supplements increase bioavailability of copper.

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

ANS: B

High doses of zinc supplements decrease copper absorption, possibly leading to anemia-related fatigue. Large amounts of vitamin C supplements decrease serum bioavailability of copper. Also pertinent, excess molybdenum produces a copper deficiency.

REF: p. 179 | p. 180

7. Each of the following is true of physiologic roles and reactions to selenium except one. Which one is the exception?

a.
Selenium functions mainly as a cofactor that protects membranes from oxidation.
b.
It works hand in hand with vitamin E.
c.
Deposition of large amounts during tooth formation enhance the mineralization process.
d.
Excessive selenium prior to eruption may promote dental caries.

ANS: C

Large amounts of selenium during tooth formation can be detrimental to the mineralization process. Animal studies indicate excessive selenium can promote dental caries when given before eruption; however, moderately high levels seem to have some cariostatic effects.

REF: p. 181

8. A moderate intake of selenium has been linked to reduced risks of prostate, lung, and colon cancers and heart disease because of its role as an antioxidant.

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

Selenium functions mainly as a cofactor for an antioxidant enzyme that protects membrane lipids, proteins, and nucleic acids from oxidative damage. It also contributes to the maintenance of normal immune function.

REF: p. 181

9. Keshan disease is metabolic disorder in which large amounts of copper accumulate in the liver, kidney, brain, and cornea. In parts of China, an endemic cardiomyopathy called Wilson disease is associated with severe selenium deficiency.

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

The diseases are reversed. Keshan disease occurs in parts of China and causes cardiomyopathy due to severe selenium deficiency. Wilson disease is a metabolic disorder in which large amounts of copper accumulate in the liver, kidney, brain, and cornea.

REF: p. 181

10. Each of the following is true of chromium except one. Which one is the exception?

a.
Chromium is poorly absorbed.
b.
It can facilitate insulin in assisting cellular glucose uptake and energy release.
c.
Chromium status increases with age.
d.
Sources of chromium include meats, whole-grain cereals, wheat germ, beer, wine, and tap water.
e.
The use of chromium supplements for patients with diabetes is controversial.

ANS: C

Chromium status decreases with age. This suggests that older individuals may be at high risk of deficiency. Chromium is involved in carbohydrate and lipid metabolism, especially in the use of glucose. Chromium potentiates the action of insulin and can facilitate insulin in assisting cells in glucose uptake and energy release.

REF: p. 181 | p. 182

11. Which mineral is most closely associated with insulin metabolism?

a.
Chromium
b.
Copper
c.
Molybdenum
d.
Boron

ANS: A

Chromium is involved in carbohydrate and lipid metabolism, especially in the use of glucose. Chromium potentiates the action of insulin and can facilitate insulin in assisting cells in glucose uptake and energy release. Supplementation can improve systemic insulin sensitivity, but the use of chromium supplements for individuals with diabetes is controversial.

REF: p. 181

12. Chromium supplements can cause serious renal impairment when taken in excess. Registered dietitians frequently recommend over-the-counter chromium supplements for weight loss and type 2 diabetes management.

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

Currently, the evidence is unclear that any type of supplemental chromium can help with fat loss or enhance lean body mass. More research is needed regarding the use of chromium supplements to manage glycemic control in diabetes.

REF: p. 182 | Dental Considerations

13. Aluminum, an essential nutrient, is added to intravenous solutions because it increases absorption and distribution of the medications.

ANS: E

Although aluminum is present in many body tissues, including all dental tissues, it is not considered an essential element because its presence seems harmful. A particular concern is that water used in intravenous solutions and dialysis fluid is sometimes contaminated with aluminum. The inability of the kidneys to remove aluminum has prompted reformulation of these solutions; however, aluminum content may still be high because of naturally occurring aluminum in the water used to make the solutions.

REF: p. 184

14. Aluminum exposure increases prevalence of dental caries because this element decreases the uptake and retention of fluoride. Aluminum accumulation can occur when taking antacids containing aluminum hydroxide.

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

Dental caries can be reduced because aluminum enhances the uptake and retention of fluoride and enhances the cariostatic activity of fluoride. Aluminum accumulation can occur from the diet and through oral ingestion of aluminum hydroxide antacids. This is particularly pertinent for dental hygienists to appreciate, because many people take antacids as calcium supplements.

REF: p. 184

15. Acidic foods such as pineapple and tomato packed in uncoated tin cans contain significant amounts of tin. Most Americans consume high amounts of tin because most foods contain moderate to high level of it.

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

Most Americans consume only small amounts of tin daily because most foods contain trace amounts of tin. Foods packed in tin cans that are totally coated with lacquer contain very little tin. Acidic foods packed in uncoated cans contain significant amounts of tin. Other sources of tin include stannous chloride, a food additive, and stannous fluoride, the active ingredient in some dentifrices and mouth rinses.

REF: p. 184

16. Each of the following is true of the effects of lead except one. Which one is the exception?

a.
Lead is more readily absorbed from the gastrointestinal tract during infancy and early childhood than in adulthood.
b.
Milk intake results in increased levels of lead.
c.
The EPA requires water systems to control the levels of lead to less than 15 parts per million (ppm).
d.
Lead toxicity damages the central nervous system, kidneys, and ability to produce red blood cells.
e.
The effects of lead stored in bones and teeth are unknown.

ANS: B

Milk intake results in reduced lead absorption. Note that infants and children are more susceptible to detrimental effects of lead absorption, because it is more readily absorbed during early years. Although the effects of lead in bones and teeth are unknown, elevated serum (blood) levels may be associated with periodontitis.

REF: p. 184

17. Each of the following is considered an ultratrace element except one. Which one is the exception?

a.
Molybdenum
b.
Boron
c.
Nickel
d.
Lithium
e.
Vanadium

ANS: A

Molybdenum is not considered an ultratrace element. Ultratrace elements include boron, nickel, silicon, tin, aluminum, lead, lithium, vanadium, and mercury. Note that aluminum and mercury are not nutrients, because they provide no beneficial effect to the body.

REF: pp. 183-185

18. Each of the following accurately describes aspects and treatment of Alzheimer disease except one. Which one is the exception?

a.
Alzheimer disease is the most common type of dementia.
b.
Known risk factors include age, family history, head trauma, and genetic disposition.
c.
Although a specific cause has not been determined, aluminum is considered a primary causative agent.
d.
Vitamin E supplementation is sometimes prescribed because it is an antioxidant.

ANS: C

An earlier hypothesis that aluminum toxicity might cause Alzheimer disease is now considered inaccurate. Brain lesions and neurotransmitter changes seem in aluminum toxicity differ from those in Alzheimer disease. In contrast to the subtle cognitive changes associated with Alzheimer disease, aluminum toxicity manifests with motor dysfunction. Vitamin E is frequently advised because its antioxidant properties may protect nerve cells from certain kinds of chemical wear and tear. It should only be used under guidance of a healthcare provider.

REF: pp. 185-186

19. Which seafood is most likely to have the least amount of mercury?

a.
Shark
b.
Swordfish
c.
Mackerel
d.
Salmon
e.
Fresh tuna

ANS: D

Salmon is considered the safest seafood listed in the question. Note that canned tuna is likely to have less mercury than fresh tuna. Large, older fish higher up on the food chain such as shark, swordfish, king mackerel, and tilefish are the leading source of mercury in the diet. Note that although mercury is an ultratrace mineral, it is not a nutrient because of its inherent toxicity. Even trace amounts can cause neurologic and developmental problems in infants and young children.

REF: p. 185 | Dental Considerations

20. What is the best advice a dental hygienist can give a patient concerning ingestion of trace elements?

a.
Consumption of a variety of foods and fluids help obtain trace minerals.
b.
Refined foods are a good source of trace minerals.
c.
Multimineral supplements safely supply adequate amounts of trace minerals to support health.
d.
Deficiencies of trace minerals are common and can be prevented by taking supplements.

ANS: A

Consumption of a variety of foods and fluids help to obtain trace minerals and avoid excessive amounts. Supplements of trace elements are not encourages. Unrefined foods generally provide more trace minerals than highly refined foods do. Additional helpful advice for the dental hygienist to impart, well water can be test for contaminants by local health departments.

REF: p. 185 | Nutritional Directions

21. Which mineral is most important for carbohydrate and fat metabolism?

a.
Selenium
b.
Manganese
c.
Chromium
d.
Molybdenum

ANS: C

Chromium, an odorless and tasteless metallic element, is involved in carbohydrate and lipid metabolism, especially in the use of glucose. Chromium can facilitate insulin in assisting cells in glucose uptake. Although supplementation can improve systemic insulin sensitivity, research has not established cause-and-effect relationship. The use of chromium supplements for individuals with diabetes is controversial.

REF: p. 181

MATCHING

Very small amounts of minerals and trace minerals are needed to maintain optimal health. As with all nutrients, deficiencies and excesses of one mineral affect absorption and utilization of the others. The dental hygienist should understand and appreciate the relationships between nutrients present in calcified structures and optimal oral health. Match the nutrient or disorder with its appropriate action or result.

a.
Keshan disease
b.
Excess selenium
c.
Tin
d.
Copper
e.
Aluminum
f.
Manganese
g.
Excess molybdenum
h.
Chromium
i.
Selenium