Carbohydrates/ dental implant courses by Indian dental academy

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Definition: Carbohydrates are defined chemically as aldehyde or ketone derivatives of the higher polyhydric alcohols, or compounds which yield these derivatives on hydrolysis.

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Mainly divided into four major groups: Based on the number of carbon atom present:    

Monosaccharides Disaccharides Oligosaccharides Polysaccharides

Based on the sugar unit & other groups: Homopolysaccharides (homoglycans): polymer of same monosaccharide units. E.g.: starch, glycogen, inulin, cellulose etc..

Heteropolysaccharides (heteroglycans): polymer of different monosaccharide units or their derivatives. www.indiandentalacademy.com E.g.: heparin, keratin sulphate etc…


Monosaccharides

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The monosaccharides commonly found in humans are classified according to the number of carbons they contain in their backbone structures.

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The major monosaccharides contain four to six carbon atoms.

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The aldehyde and ketone moieties of the carbohydrates with five and six carbons will spontaneously react with alcohol groups present in neighboring carbons to produce hemiacetals or hemiketals, respectively. This results in the formation of five- or six-membered rings.

Because the five-membered ring structure resembles the organic molecule furan, derivatives with this structure are termed furanoses. Those with six-membered rings resemble the organic molecule pyran and are termed pyranoses.

Such structures can be depicted by either Fischer or Haworth style diagrams.

The numbering of the carbons in carbohydrates proceeds from the carbonyl carbon, for aldoses, or the carbon nearest the carbonyl, for ketoses. www.indiandentalacademy.com


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The rings can open and re-close, allowing rotation to occur about the carbon bearing the reactive carbonyl yielding two distinct configurations (a and b) of the hemiacetals and hemiketals.

The carbon about which this rotation occurs is the anomeric carbon and the two forms are termed anomers.

Thus an anomeric carbon atom has four different groups attached to it and it becomes asymmetric. www.indiandentalacademy.com


Mutarotation ď Ź

When an aldohexose is dissolved in water and the solution is put in optical path so that plane polarized light is passed, the initial optical rotation shown by sugar gradually changes until a constant fixed rotation of sugar is reached. this is called as mutarotation.

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E.g:conversion of alpha glucose to a mixture of alpha & beta forms. www.indiandentalacademy.com


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Other properties of carbohydrates 

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Osazone formation: Glucosazone crystals Lactosazone crystals Maltasazone crystals Enediol formation Action of acids: Uronic acids Action of HCL Ester formation: Action of reducing agents: Action of alkalis:

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Aminosugars ď Ź

Glucosamine: Found in HA, heparin, blood group products. Chief cell wall of fungi So called chitosamine.

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Galactosamine: present in chondritin of cartilage, bone & tendons. Also called as chondrosamine.

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Disaccharides ď Ź

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Covalent bonds between the anomeric hydroxyl of a cyclic sugar and the hydroxyl of a second sugar (or another alcohol containing compound) are termed glycosidic bonds, and the resultant molecules are glycosides. The linkage of two monosaccharides to form disaccharides involves a glycosidic bond. Important disaccharides are sucrose, lactose and maltose. www.indiandentalacademy.com


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Biomedical importance of glycosides 

Cardiac glycoside.

Glycosuria.

Streptomycin.

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Maltose ď Ź

Maltose: the major degradation product of starch, is composed of 2 glucose monomers in an a-(1,4) glycosidic bond.

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Lactose ď Ź

It is found exclusively in the milk of mammals and consists of galactose and glucose in a b-(1,4) glycosidic bond.

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Sucrose ď Ź

It is prevalent in sugar cane and sugar beets, is composed of glucose and fructose through an a-(1,2)b -glycosidic bond.

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Polysaccharides ď Ź

Most of the carbohydrates found in nature occur in the form of high molecular weight polymers called polysaccharides.

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The monomeric building blocks used to generate polysaccharides can be varied; in all cases, however, the predominant monosaccharide found in polysaccharides is D-glucose.

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When polysaccharides are composed of a single monosaccharide building block, they are termed homopolysaccharides . Polysaccharides composed of more than one type of monosaccharide are termed heteropolysaccharides www.indiandentalacademy.com


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Dextrin 

Dextrin is an un fermentable carbohydrate chain that is not large enough to be considered starch because it does not turn iodine black in the iodine reaction.

Dextrin occurs as an intermediate product of starch hydrolysis and is achieved by either enzymatic action or by cooking.

The term dextrin describes a class of intermediate ingredients produced by treating starches with heat, acid, or enzymes. www.indiandentalacademy.com


Synonyms fo dextrins include starch gum, vegetable gum, and even tapioca.

Dextrin is used as a diluting agent for pills and capsules, as well as a thickener in creams and foam stabilizer in beer. It can also be found in baked goods, candy, gravies, pie fillings, poultry, puddings, and soups.

Dextrins are increasingly finding application as "chlorine-free“ alternatives to oxidized starch in the paper industry. www.indiandentalacademy.com


Inulins ď Ź

It refers to a group of naturally occurring fructose-containing oligosaccharides. fructans., in addition to inulins, include another group of naturally occurring fructose-containing oligosaccharides called levans.

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Inulins are usually of plant origin, while levans are found in fungi and bacteria.

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Inulins are mainly comprised of fructose units and typically have a terminal glucose. www.indiandentalacademy.com


Mucopolysaccharides ď Ź

Definition A gel-like substance found in body cells, mucous secretions, and synovial fluids.

These are carbohydrates containing uronic acid and amino sugars. These have charged groups, they attract water molecules & produce viscous solutions.

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CLASSIFICATION  

Neutral Acidic: a) Sulphate free: 1)Hyaluronic acid 2)Chondroitin b) Sulphate containing acid MPS 1)Keratin Sulphate 2)Chondritin Sulphates 3)Heparin 4)Heparin Sulphate www.indiandentalacademy.com


Hyaluronic acid Present in synovial fluid, skin, umbilical cord, heamolytic streptococci • Occurs in combination with proteins and form so called ground substance of mesenchyme. Composition: D-glucosamine with D-glucornic acid and Acetic acid. •

Biomedical importance: Testicular secretions Pathogenic organisms Hyaluronidase enzyme activity

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Chondrotin ď Ź

Found in cornea, also isolated from cranial cartilages.

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Composition: N-Acetyl Galactosamine instead of N-Acetyl Glucosamine. Thus differs from hyaluronic acid.

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Keratin Sulphate 

Found in costal cartilage, cornea.

Found in the wall of aorta.

Composition: 

N-Acetyl Glucosamine with Galactose and Sulphuric acid

Types : I AND II

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Chondrotin Sulphates ď Ź

Occurs in ground substance of connective tissue, and are the components of cartilage ,tendon, skin.

Types: A, B, C & D

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Heparin An anticoagulant in liver.  Produced mainly by mast cells in the liver.  Also found in lungs ,thymus, spleen, walls of large arteries, skin and in small quantities in blood.  Structure:  Properties:  Functions: 

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Heparin Sulphate ď Ź

Isolated from Amyloid liver, also from certain normal tissues of aorta.

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From urine, liver, spleen of patients with gargoylism (Hurlers syndrome).

Blood group substance: A, B, H.

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FUNCTIONS OF MUCOPOLYSACCHRIDES: •Constituent of extra cellular matrix or ground substance. •Acts as polyanions. •Acts as a barrier in tissue. •Acts as lubricant in joints. •Role in release of hormone. •Role in cell migration in embryonic tissues. www.indiandentalacademy.com


Role in glomerular filtration. Role as anticoagulant. Role as a coenzyme. Receptor of cell. Role in compressibility of cartilages. Role in sclera of eye. Role in corneal transparency. www.indiandentalacademy.com


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When there is a deficiency of enzymes necessary to breakdown mucopolysaccharides, a condition called mucopolysaccharidosis (MPS) exists.

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Mucopolysaccharidoses are a group of genetic disorders that result in excessive accumulation of mucopolysaccharides in body tissues and results in many serious physical disorders. www.indiandentalacademy.com


Usually, this results in various genetic deformities such as skeletal deformities (bone, cartilage, and connective tissue), abnormal facial features, mental retardation, and decreased life expectancy. ď Ź Examples of these disorders are: Hunter syndrome, Hurler syndrome, Scheie syndrome, Sanfilippo syndrome, Maroteaux-Lamy syndrome, and Morquio disease. ď Ź

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Scientific Proof Carbohydrates Cause Disease 

Carbohydrates cause nearly all age-related diseases.

Many people consider it normal to get one or more of these diseases as they age.

Their health problems are most likely caused by their belief in myths and distortions about nutrition. Most likely they got hooked by the low-fat, high-carbohydrate diet craze and are now suffering as a result. www.indiandentalacademy.com


The most common excuse used instead of identifying the real culprit, carbohydrates, is heredity. People say, "It runs in my family," or "My mother also had diabetes," or "My father also had high blood pressure and heart disease.

" Age-related diseases could best be described as "Excessive Carbohydrate Consumption Syndrome.“

In fact, optimal health lies in keeping the amount of carbohydrates in the diet to a minimum. www.indiandentalacademy.com


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Carbohydrates, which turn to glucose, hype the metabolism and trigger the release of disease-causing hormones like insulin, cortisol and adrenaline.

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A low metabolism is ideal for long life and good health.

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A high metabolism excites hormones in the body that eventually cause age-related diseases. www.indiandentalacademy.com


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The pathogenic effects of carbohydrates are slow but sure. The "20-year rule" was coined to describe the length of time between the start of the high-carbohydrate diet and the onset of disease.

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The number of diseases, severity and time to develop are directly related to the percentage of carbohydrates in the diet.

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The consumption of carbohydrates generally begins showing the disease effects in either one of two directions. 1.Body fat accumulation leads to obesity, diabetes, heart disease, cancer, gallbladder disease, degenerative bone diseases and many others. 2.Damage to the intestinal tract leads to leaky gut syndrome, inflammatory bowel diseases.

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As the cells become resistant, the insulin assists in the conversion of the extra glucose into triglycerides, which raise the triglyceride level in the blood and are deposited as body fat.

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Carbohydrates cause obesity, not fat. The high carbohydrate diet is a natural killer for many reasons.

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Insulin is a Disease-Causing Hormone

Insulin is a hormone made by the beta cells in the islets of langerhans in the pancreas.

Glucose from the excessive consumption of carbohydrates is turned to body fat by the high insulin level and is also deposited in the arteries and organs causing arterial diseases, heart disease, strokes, blood clots and other diseases.

High blood glucose signals increasing insulin production until the pancreas becomes fatigued after many years, making the disease seem agerelated. www.indiandentalacademy.com


Glucose rises uncontrollably when insulin production drops. The result causes diseases of the eyes, kidneys, blood vessels and nerves.

Carbohydrates drive insulin production that causes cardiovascular heart disease (CHD). Blood insulin reaches high levels and remains high as one progresses from hypoglycemia to Type II diabetes where insulin production collapses. Insulin is a very strong anabolic hormone. It pushes blood glucose into cells. It turns blood glucose into triglycerides and stores them as body fat.

This sudden appearance of heart disease has been described "Instant Atherosclerosis Cycle“. www.indiandentalacademy.com


Cortisol is a Disease-Causing Hormone ď Ź

Glucocorticoids cause amino acids to be synthesized into new proteins, such as enzymes. They also raise blood pressure by constricting vessels, which is a benefit in case of injury. They are also anti-inflammatory. All of this is well and good in a healthy individual with normal glucose and insulin levels.

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Unfortunately, high cortisol levels cause many unhealthy reactions.

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An excessive ratio of carbohydrates to protein results in excess secretion of insulin, which often leads to intervals of hypoglycemia.

The body, in an attempt to normalize blood sugar, adrenals are stimulated to secrete increased levels of cortisol and adrenalin. It follows that an excessive intake of carbohydrates often leads to excessive secretion of cortisol.

Excess cortisol: Diminishes cellular utilization of glucose Increases blood sugar levels.

Decreases protein synthesis. Increases protein breakdown that can lead to muscle wasting.

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Causes demineralization of bone that can lead to osteoporosis Interferes with skin regeneration and healing

This immune system suppression may lead to increased susceptibility to allergies, infections, and degenerative disease.

High- cortisol levels caused by excessive carbohydrate consumption and high-insulin levels cause the body to extract high-tensile strength collagen protein fibers from bones, remove the mineral matrix by demineralization and weaken connective tissue at the joints.

All of this can be prevented by eating a highprotein, high-fat, low-carbohydrate diet. www.indiandentalacademy.com


Recent advances in the study and use of carbohydrates

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Pentasaccharides. The new anticoagulants. ď Ź

In Venous thromboembolism VTE, Low molecular weight heparins LMWH were the agents of choice in the treatment of deep venous thrombosis DVT and are increasingly used in the treatment of stable pulmonary embolism PE.

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Increasing focus on simplicity and efficacy has led to the discovery of the synthetic pentasaccharides, substances that specifically inhibit factor Xa activity, producing an antithrombotic effect without affecting other coagulation factors or platelets. www.indiandentalacademy.com


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Fondaparinux, the first pentasaccharide introduced into the market, was first tried as a prophylactic agent against VTE in patients undergoing major orthopedic procedures, such as hip fracture, total hip and knee replacements, such approach appeared to be more effective than LMWH.

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Pentasaccharides were recently tried in the treatment of both DVT and PE.

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It has shown that pentasaccharides are as safe and as effective as either unfractionated heparin UFH or LMWH, with the added convenience of once daily injection, no need for monitoring the anticoagulant effect and no major side effects such as thrombocytopenia.

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Therefore, the efficacy, the safety profile and the added convenience for both patients and physicians, made pentasaccharides as among new anticoagulants of the future.

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Recent advances in glycomics and glycogenetics. ď Ź

As the human genome sequence, it is important to turn the attention to the physiological functions of the genes.

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Thus, the study of the gene products, It has been shown that carbohydrates participate in post-translational modifications and in many other functional regulations of all genes, and will greatly enhance the field of chemical genetics. www.indiandentalacademy.com


Biomedical importance of carbohydrates Chief source of energy  Lactose principal sugar of milk  Antibiotics  Mucopolysaccharides  Storage  Nucleic acids  With proteins and lipids. 

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