By: Dr. Abhishek Kr. Pandey, Medical Correspondent-ICN
LUCKNOW: All of us understand that food and water are the necessities for life but the micronutrients which the body needs on a daily basis for sound metabolism are none other than the hard working- ‘Vitamins’. Vitamins are micronutrients which play a crucial role in general and oral health as well as in maintaining various biological processes in human body. They are essential for development, maturation and functioning of oral tissues at every stages of life.
There are a number of nutritional deficiencies that manifests within the oral cavity. Therefore the interference of nutritional deficiencies may be first discovered upon an oral examination by the dentists. Today a total 13 vitamins are known and each one of it has its own specific function, making them unique and irreplaceable. Vitamins do not provide energy and they cannot be used without an adequate supply of fats, carbohydrates, proteins and even minerals. Fat soluble vitamins (A, D, E, and K) are different from water soluble vitamins (B, C) mainly, because larger amounts can be stored in the body.
VITAMIN A (RETINOL) – Vitamin A is an important member of fat soluble vitamins group which plays a vital role in maintaining good vision and also helps in cellular growth. Discovered in the year 1913, it was initially termed as the ‘’anti-infective vitamin”, mainly because it was found to confer resistance against various infectious diseases. It exists in 2 main forms- vit.A retinol and provitamin carotenoids. Carotene acts as an antioxidant and protects cell damage by free radicals. It is first solubilized in the intestinal lumen and further absorbed by duodenal mucosal cells. The major sources for this powerful vitamin include Spinach, carrots, tomato, boiled egg, chicken, salmon etc. Its deficiency in the body causes Xerophthalmia, Night blindness, bitots spot, conjuctival and corneal xerosis, corneal scars etc. In dentistry, Vitamin A also has an important role in the development of teeth, especially in the formation of ameloblasts (in enamel) and odontoblasts (in dentin). Vitamin A deficiency during pre-eruptive stages of tooth development leads to enamel hypoplasia and defective dentin formation. Enamel hypoplasia involves defects in the enamel matrix and incomplete calcification of the enamel and dentin. Odontoblasts lose their ability to arrange themselves in normal parallel linear formation, resulting in degeneration and atrophy of ameloblasts. The normal deposition of dentin is thus altered. Vitamin A is also involved with normal teeth spacing and promotes osteoblast function of the alveolar bone.
VITAMIN D– It is the only vitamin which the body makes on its own and can also be gained from sun exposure and is vital for our blood, bones and teeth. It is also known as the “sunshine vitamin”. The major source includes cereals, milk, cheese, orange juice, yogurt, fish liver oil etc. Vit.D exists in several forms D1, D2, D3, D4 and D5. Vitamin D may also be involved in the functioning of cells involved in the formation of red blood cells, skin, cardiovascular function, and immune response. Deficiency of vitamin D causes rickets in children and osteomalacia in adults. In rickets, the alveolar bone is affected just like other bones in the body. The trabeculae of the alveolar bone will also be affected. Delayed dentition and small molars are also observed in vitamin D deficiency. In osteomalacia, the oral manifestations include loss of the lamina dura around the roots of the teeth. A small number of patients with evidence of rickets develop enamel hypoplasia as a result of vitamin D deficiency.
VITAMIN C (Ascorbic acid) – Vit.C was discovered by a Hungarian biochemist Albert Szent-Gyorgyi. Vitamin C functions as an antioxidant in numerous bodily reactions. As a coenzyme, it also has numerous metabolic roles. It is important in the production of collagen which plays a vital role in wound healing. Scurvy, caused by vitamin C deficiency can occur in as quickly as 20 days. It is characterized by spontaneous gingival hemorrhaging, petechiae, follicular hyperkeratosis, diarrhea, fatigue, depression and cessation of bone growth. Skeletal and vascular lesions related to scurvy probably arise from a failure of osteoid formation. Inadequate amounts of vitamin C during tooth development may result in changes similar to scurvy or scorbutic changes in the teeth because of changes in the ameloblasts and odontoblasts. Atrophy of ameloblasts and odontoblasts also occurs in vitamin C deficient environment. Gingivitis, caused by ascorbic acid deficiency, also affects the periodontium, resulting in tooth mobility. The effect is probably related to weakened collagen secondary to vitamin C deficiency, which results in resorption of the alveolar bone. Major sources of vit.C include oranges, lemons, grapefruits, strawberries, amla, cabbage, cauliflower etc.
VITAMIN E – Eight different compounds are collectively called vitamin E; four tocopherol and four tocotrienols. It is widely known to be the “antioxidant” vitamin. It helps not only to eliminate the free radicals but also plays a key role in maintaining strong immunity, healthy skin and eyes. Almonds, peanuts, sunflower seeds, spinach, kiwi, green olives, pumpkins etc. contains rich source of vit.E. The antioxidant property of vitamin E is its most important function. It facilitates the normal functioning of B and T cells thus aiding the body to fight against bacterial and viral infections. Vitamin E plays a crucial role in treatment of oral mucosal lesions like oral leukoplakia, oral lichen planus, oral sub mucous fibrosis and oral cancer. It reduces the risk of developing oral cancer and inhibits oral cavity carcinogenesis.
VITAMIN K- Vitamin K is an essential fat-soluble micronutrient. Vitamin K dependent proteins have been identified in bone, kidney and other tissues. It has a key role to play in blood clotting and is also essential to maintain homeostasis. Vitamin K functions as a catalyst for synthesis of blood clotting factors primarily in maintaining prothrombin levels, which is the first stage in forming a clot. A low prothrombin level results in impaired blood coagulation. Vitamin K improves bone health and reduces risk of bone fractures. Newborn infants may develop hemorrhagic disease secondary to vitamin K deficiency because the gut is sterile during the first few days after birth. Newborn infants are usually given a single dose of vitamin K intramuscularly immediately after birth to prevent hemorrhage. Spinach, cabbage, olive oil, broccoli, eggs, milk, etc. are rich sources of vitamin k.
VITAMIN B COMPLEX- Elmer V.Mc Collum has been credited with the discovery of B vitamins between 1915-1916. The B complex is a group of vitamins; each has a different function in human body. These are 12 in number and 8 of them are considered to be essential. These are vit.B1 (Thiamine),B2(Riboflavin),B3(Niacin),B5(Pantothenic acid) ,B6 (Pyridoxine), B7(Biotin), B9(Folic acid),B12 (Cobalamine).
- Thiamine deficiency is evident in oral tissues is controversial. Some clinicians have associated a flabby, red, and edematous tongue with thiamin deficiency. The fungiform papillae enlarge and become hyperemic. Gingival tissues sometimes present an “old rose” color.
- Riboflavin is also essential for healthy eyes and maintenance of mucous membranes. Riboflavin deficiencies include angular cheilosis, dermatitis and anemia. Along with angular cheilosis, the lips may become extremely red and smooth. Fungiform papillae become swollen and slightly flattened and mushroom shaped during early stages of riboflavin deficiency; the tongue has pebbly or granular appearance. Severe chronic deficiencies lead to progressive papillary atrophy and patchy, irregular denudation of the tongue. The tongue may become purplish red or magenta colored because of vascular proliferation and decreased circulation. In more advanced cases, the entire tongue may become atrophic and smooth.
- Niacin (nicotinic acid) deficiency classically results in pellagra. Deficiency also affects mucous membrane: painful stomatitis causes diminished food intake, and lesions in the gastrointestinal tract. Pellagrous glossitis begins with swelling of the papillae at the tip and lateral borders of the tongue. The tongue becomes painful, scarlet, and edematous. Atrophic changes involve loss of filliform and fungiform papillae, and the tongue becomes smooth and shiny. The mucosa is also reddened. Fissures occur in the epithelium and along the sides of the tongue. The gingiva may become inflamed, resembling that found in ulcerative gingivitis.
- Folic acid deficiency causes Glossitis. The tongue becomes fiery red and papillae are absent. Marked chronic periodontitis with loosening of teeth may occur. Periodontitis is an inflammatory disease of the periodontium. Folic acid deficiency impairs immune responses and resistance of the oral mucosa to penetration by pathogenic organisms such as candida.
- Vitamin B12 is essential for making red blood cells. Oral symptoms of vitamin B12 deficiency present with glossopyrosis (unexplained pain of the tongue), followed by swelling and pallor with eventual disappearance of the filiform and fungiform papillae. The tongue may be completely smooth, shinny, and deeply reddened with a loss or distortion of taste. Bright red, diffuse, excruciating painful lesions may occur in the buccal and pharyngeal mucosa and undersurface of the tongue. An oral examination may reveal stomatitis or a pale or yellowish mucosa, xerostomia, cheilosis, hemorrhagic gingiva and bone loss.
CONCLUSION- Vitamins are vital for our survival. Diet containing vitamins play an important role in normal health of the oral structures. Deficiencies cause oral diseases such as developmental defects, oral mucosal diseases and periodontal diseases. The commonly affected oral structures as a result of vitamin deficiency are soft tissues like tongue, gingiva and lining mucosa. However, fat soluble vitamin deficiency affects hard tissues, by impaired development of teeth and bony support. A well- balanced nutritious diet is the key for good health and vitamins definitely form an important cog in that wheel. Vitamins are definitely a blessing in all senses for a stress-free life.
