vitamins

2. Vitamins and its oral
manifestations
Presented By
Dr. Priyanka Tompe
Date:28/09/2018

3. CONTENT
 Definition
 Classification
 Difference between fat soluble and water soluble
vitamins
 Water soluble vitamins
 Fat soluble vitamins
Properties
Functions
Deficiency
Oral manifestations
 summary

4. Definition
 Vitamins may be regarded as organic compounds
required in the diet in small amounts to perform
specific biological functions for normal maintenance
of optimum growth and health of organism.

5. Classification

7. Vitamin C
 It is also called as ascorbic acid.
properties
 Its highest concentration is seen in pituitary,
adenoids, eye and WBC.
 The acidic properties are due to enolic hydroxyl
group.
 Dehydroascorbic and ascorbic acid are its active
form.

8.  Absorption and excretion
Absorption of ascorbic acid is takes place in the
upper part of small intestine and it is excreted by
kidney through urine.

9. Dietary sources

10. Functions of vitamin c
Functions
of vit.c
synthesis
maintance
absorption
metabolism

11. Deficiency
scurvy

12. Oral manifestation
 Scurvy
 Prolonged deficiency of vit.c may result in scurvy.
 It is characterised by weakened blood vessels
particularly micro vessels having least muscular
support.

14.  Oral manifestations
 Site –gingival and periodontal region.
 Scurvy bud-interdental and marginal gingiva is bright red
swollen, smooth, shiny surface producing an appearance
known as scurvy bud.
 Breath-typical fetid breath of patient
With fusospirochetal stomatitis
• In severe cases haemorrhage and
• Swelling of periodontal membrane
With loss of bone can occur leading
To loosening of teeth

16.  Capillary fragility test
 The cuff of sphygmomanometer is placed around the arm.
It is inflated to a pressure approximately midway between the
subject's systolic and diastolic pressure (perhaps 100 mm Hg)
and left in place for four to six minutes
In a positive test, numerous small red spots appear in the skin
below the cuff; these are petechial haemorrhages arising from
capillary fragility.
• Bood plasma levels of vit.c
Diagnosis

17. Treatment
 Scurvy is prevented by a diet rich in ascorbic acid;
citrus fruits and juices are excellent sources.
 The administration of orange juice or tomato juice
daily will quickly produce healing but ascorbic acid is
preferable.
 The daily therapeutic dose is 100-200 mg orally or
parenterally.

18. VITAMIN B COMPLEX
Contains 11 well-characterized vitamins
 Thiamin,
 riboflavin,
 niacin, folic acid,
 vitamin B12,
 inositol,
 para-aminobenzoic acid,
 choline

20. THIAMINE
 Anti-beriberi or antineuritic vitamin.
 It is vitamin for calm nerves also known as
ANEURIN.
 Absorption and excretion
 It is readily absorbed from small and large intestine
 Excreted by kidney in urine.

22. Functions of vit.B1

23. Deficiency of vit.B1
 BERIBERI
 It is marked by cardiac manifestation with enlargment of
four chambers of heart ,pallor and myocardial flabbiness.
 it has two types
Wet beriberi
Dry beriberi
 Occurs essentially where highly polished rice is the
staple food
 Major targets are:
 Peripheral nerves (Dry beriberi)
 Heart (Wet beriberi)
 Brain (Wernicke-Korsakoff syndrome)

24. Oral manifestation
 Satinlike appearance of tongue and gingiva.(due to
atrophy of filliform papillae.)
 Angular cheilosis
 Management
Thiamine 50 mg IM for 3 days then 10mg 3 times daily
by oral route

25. RIBOFLAVIN
(Vitamin B2, Lactoflavin )
Functions
 Constituent of 2 coenzymes:
1) Riboflavin 5’-phosphate (flavin mononucleotide
or FMN)
2) Flavinadenine dinucleotide (FAD)
 Both are essential to the oxidative enzyme
systems in the electron transport system: role as
respiratory coenzyme & electron donor

27. Oral manifestation
Glossitis
 Soreness of the tip & the lateral margins of the
tongue
 Filiform papillae become atrophic
Fungiform papillae become engorged &
mushroom shaped
 A reddened, coarsely granular appearance,
called magenta tongue

28. Angular cheilosis
 Paleness of the lips
 laceration & fissuring at the angles of the mouth
 A dry yellow crust develops & lips become red &
shiny
 Fissures become deeper, bleed easily, painful
Angular cheilosis spreads to the cheek

29.  Dermatitis:
 Scaly, greasy dermatitis
 Nasolabial folds & the alae nasi extending into a butterfly
distribution to involve the cheeks & skin about the ears
 Ocular lesions:
 Photophobia, superficial & interstitial keratitis
 Erythroid hypoplasia with normocytic normochromic
anemia

30. NIACIN
(Vitamin B3, Nicotinic acid,Pellagra preventive factor
of Goldberg)
It is required for formation of
Coenzyme NAD and NADP
Which are important role in
Redox reaction involving
Carbohydrate ,protein,and
Lipid metabolism.

31. Sources of vit. B3

32. Pellagra
Pelle agra” = rough skin in Italian
3 D’s:
 Dermatitis,
 Diarrhea &
 Dementia
 Dermatitis:
 Symmetrical
 Areas of exposure to chronic irritation or sunlight
 Sharply outlined areas of depigmentation & increased pigmentation.
 Skin becomes markedly thickened by subcutaneous fibrosis & scarring
 Skin rashes in the neck region: Casal’s necklace

33.  Diarrhea
 Inflammation of the mucosal lining of esophagus, stomach &
colon
 Dementia
 Degeneration of the neurons in the brain & spinal cord tracts
 Periods of depression & apprehension with insomnia,
headache & dizziness
 Tremulous movements or rigidity of the limbs, loss of the
tendon reflexes & numbness of extremities
 In profound deficiency encephalopathy

34. Oral manifestation
 Tongue: Bald tongue
 Burning sensation
 Becomes swollen & presses against the teeth causing
indentations
 Tip & lateral margins become red
 Epithelium of entire tongue desquamates- ‘Raw beef’
appearance
 Entire mucosa becomes fiery red & painful
 Tenderness, pain & ulcerations at the interdental
gingival papillae

35. Managment
 Niacin 10 mg or 10,000 mcg per day and vitamin B
complex should also be given
 Alcohol consumption should stop in alcoholic patient

36. PANTOTHENIC ACID (B5)
• (Vitamin B5,Calcium Pantothenate )
• Water soluble,Helps in cell building, maintaining
normal growth, and development of the central
nervous system.
• Vital for the proper functioning of the adrenal
glands.
• Essential for conversion of fat and sugar to
energy.
• Necessary for synthesis of antibodies, for
utilisation of PABA and choline.

37.  The RDA is 10 mg. for adults. Can be synthesised in
the body by intestinal bacteria.
Best Natural Sources:

38.  Deficiency
 Fatigue, sleep disturbances, headache, malaise,
nausea, abdominal stress, fatty liver & anemia
 Parasthesia of hands & feet, cramping of leg
muscles & impaired coordination – Burning foot
syndrome
 Treatment
 It is given in the dose of 1000mg daily for 6 weeks.

39. PYRIDOXINE
(Vitamin B6 A complex of 3:Pyridoxine, Pyridoxal,&
Pyridoxamine)
 Functions
 Metabolism of Protein.
 Stabilization of muscle phosphrylase
 Transmission of neural impulses
 Role in the immune response
 Prevent hyperoxaluria & renal stones
 Anticaries agent

40. The recommended adult intake is 1.6 to 2.0 mg. daily,
with higher doses suggested during pregnancy and
lactation
BEST NATURAL SOURCES:
Brewer’s yeast, wheat bran, wheat germ, liver, kidney,
heart, cabbage, blackstrap molasses, milk, eggs,
beef.

41. Deficiency
• Mental depression
• irritability, confusion
• Seborrheic dermatitis
• cheilosis, glossitis, angular stomatitis
• Peripheral neuropathy
• convulsions
• Hypochromic anemia
• Impaired T-cell function & antibody synthesis

42.  Oral manifestations
 Cheilosis-cracking at corner of the lip.
 Glossitis-inflammation of the tongue.
 Others-angular stomatitis,tooth decay and halitosis.
 Treatment
 10 -50 mg daily in divided doses.

43. FOLIC ACID vit.B9
 It is also known as folacin or folate.
It is yellow crystalline substance.
Functions
 Functions in coenzyme system, particularly in amino
acid metabolism.
 Regeneration of enzymes.
 Essential for DNA synthesis & cell division.

44. DEFICIENCY
 Characterized by:
Glossitis, diarrhea & macrocytic anemia
 Glossitis appears initially as a swelling & redness of
the tip & lateral margins of the dorsum
 Filiform papillae are the first to disappear
 fungiform papillae remains as prominent spots
 Fungiform papillae are lost, tongue becomes slick,
smooth, & fiery red in color

45.  Management
A daily dose of 5000 mcg to 10000 mcg of folic acid is
sufficient and maintenance dose of 5000 mcg once in
week is given in cases of anaemia.

46. VITAMIN B 12
(Cyanocobalamin, Antipernicious anemia factor)
It is cobalt containing porphyrin.
 Functions
 Same as those of folic acid
 Plays a biochemical role in maintenance of myelin
 Conversion of RNA to DNA

47. Dose -
 Recommended adult dose is 3 mcg., with larger
amounts suggested for pregnant and lactating
women
 Sources-

48. Deficiency
 Pernicious anemia
 Hematological changes (megaloblasts in bone marrow &
macrocytic red cells in peripheral blood)
 Glossitis (hunters glossitis), glossodynia & glossopyrosis
 Gradual atrophy of the tongue papillae
 Smooth, bald tongue
 Detachment of periodontal fibers
 Bone loss
 Halitosis
 Angular chilitis

49.  Management
 Orally it is given in range of 6 to 150 mcg.
 Parentaral dose is 1000 mcg twice in week in cases
of anaemia.

51. Vitamin A
 Vitamin A is fat soluble. It requires fats as well as
minerals to be properly absorbed digestive tract.
 It occours in two forms —
performed Vitamin A, called retinol (Found only in
foods of animal origin ),and
Provitamin A,Known as carotene (provided by foods
of both plant and animal origin )

52. 10.000 IU daily is the average
adult dosage, though the need
increases with greater body
weight.

53. FUNCTIONS
 Maintains normal vision in reduced light
 For synthesis of rhodopsin (George Wald,1967)
 Potentiates the differentiation of specialized
epithelial cells, mainly mucus-secreting cells
 Retinyl phosphate synthesize mucus
 Maintenance of healthy epithelial tissue
 Retinol & retinoic acid prevent excess keratin synthesis
 Facilitates RNA transcription

54. • For maintenance of healthy oral mucosa
• Differentiation & function of ameloblasts,
odontoblasts & salivary gland acini .
• DEFICIENCY
• Eyes:Xerophthalmia, Bitot’s spots, Keratomalacia
• Night blindness (nyctalopia)
• Respiratory mucosa -airway infections
• Sebaceous & sweat glands -follicular hyperkeratosis

55. Oral Manifestations
 Oral mucosa - hyperkeratotic areas
 Salivary ductal epithelium - xerostomia
 Altered taste
 Odontogenic epithelium
 increased rate of cell proliferation epithelial i.e
invasion of pulpal tissue.
 Enamel hypoplasia
 Dentin lacks normal tubular arrangement & contains
cellular & vascular inclusions
 Eruption rate of tooth is retarded .

56. Hypervitaminosis A
 Acute-Headache, vomiting, papilledema
 Chronic- Anorexia, weight loss, nausea, vomitting;
dry skin with desquamation & itching;
hepatomegaly with parenchymal damage; bony
exostoses; visual & mental disturbances
 Atrophy of the oral mucosa with gingivitis & scaling
of the lips
 Treatment-
depending upon deficiency symptoms it is given in
the 7500-15,000mcg per day for month.

57. VITAMIN D
Sources
Vitamin D is known as sunshine vitamin because it is created
in the body when it is exposed to sunlight.
 Endogenous synthesis in the skin:
 Precursor 7-dehydrocholesterol in the oily secretions of the
skin ,UV light in sunlight converts it to vitamin D3
 The RDA for adults is 400 IU or 5-10 mcg.

58. Functions
 Absorption & maintenance of normal plasma levels
of calcium & phosphorous
 Collaborates with PTH in the resorption of calcium &
phosphorous from the bone
 For normal mineralization of epiphyseal cartilage &
osteoid matrix
 Immunity: Promote phagocytosis

59. Deficiency:
 Rickets: Any disorder in the vitamin D-calcium-
phosphorous axis resulting in hypomineralized bone
matrix
Types :-
 Vitamin D-deficient rickets (Juvenile rickets)
 Osteomalacia (Adult rickets)
 Renal rickets
 Vitamin D-resistant rickets
(Familial hypophosphatasia)

61. ORAL MANIFESTATION
 Developmental abnormalities of dentin & enamel
(hypoplasia)
 Abnormally wide pre dentin zone
 Increased interglobular dentin
 Higher caries index
 Retarded eruption rate of deciduous & permanent
teeth

62. Vitamin D-Resistant Rickets
 Isolated renal tubular defects
 Inability to reabsorb calcium & phosphate
 Hypocalcified dentin, elongated pulp horns
 Lamina dura absent or poorly defined
 Enamel hypoplasia
 Abnormal alveolar bone pattern

63. • Sorensen reported the results of a investigation
of 55 edentulous patients.
• She found a positive correlation between severe
ridge resorption and a combination of low
calcium intake and low dietary calcium-
phosphorus ratio.
• She also found a significant positive correlation
between minimal ridge resorption and a
combination of high calcium intake and high
calcium-phosphorus ratio in the diet.

64. Vitamin E
(Anti-sterility vitamin)
 Sources:
 Vegetables, grains, nuts & their oils, dairy products,
fish, meat, diets high in polyunsaturated fatty acids
(PUFA)

65.  Antioxidants:
 Olcott & Emerson recognized the antioxidant property of
vitamin E
 Prevent peroxidation of PUFA
 Protects against peroxide-induced hemolysis of RBCs
 Protects against heart diseases as prevent oxidation of LDL
 Absorption of amino acids
 Synthesis of nucleic acids
 Storage of creatinin in skeletal muscles

66. Deficiency
 Hemolysis & decrease in RBC life time
 Ataxia, dysarthria
 Loss of position & vibration sense
 Muscle weakness
 Impaired vision & disorders of eye movement
progressing to total ophthalmoplegia
 Atrophic, degenerative changes in the enamel organ
 Oral symptoms-loss of pigmnetation,atrophic
degeneration changes in enamel seen.

67. VITAMIN K
Three forms:
 Vitamin K1 or Phylloquinone:
 Derived from vegetable & animal sources
 Vitamin K2 or Menaquinone:
 Synthesized by bacterial flora
 Vitamin K3 or Menadione:
 Chemically synthesized provitamin
 Water-soluble
 Converted into menaquinone by the liver
 Most potent member

68. Functions
The principal function is in several steps of the blood-
clotting process in the liver these include Clotting
factors II, VII, IX, and X.
 Bone mineralization: Activation of osteocalcin

69.  Dose
approximately 300 mg. is generally considered
adequate. Newborn infants need more.
 Best Natural Sources:
Yoghurt, egg yolk, sunflower oil, soyabean oil, fish
liver oils, leafy green vegetables

70. Deficiency
 Oral manifestation
Gingival bleeding,
post-extraction hemorrhage

71. Summary
 Vitamins are essential for the normal growth and
development of a multicellular organism.
 These nutrients facilitate the chemical reactions that
produce among other things, skin, bone, and
muscle.
 If there is serious deficiency in one or more of these
nutrients, a child may develop a deficiency disease.
Even minor deficiencies may cause permanent
damage

72.  For the most part, vitamins are obtained with food,
but a few are obtained by other means.
 Once growth and development are completed,
vitamins remain essential nutrients for the healthy
maintenance of the cells, tissues, and organs that
make up a multicellular organism; they also enable a
multicellular life form to efficiently use chemical
energy provided by food it eats, and to help process
the proteins, carbohydrates, and fats required for
respiration

73. Refrences
 Davidson 9th edittion
 Harrison textbook of internal medicine 19 th edition
 Shafer’s Textbook Of Oral Pathology 20 th edition
 Harsh Mohan Text Book of Pathology 7th Edition
 Wical, K. E., & Brussee, P. (1979). Effects of a
calcium and vitamin D supplement on alveolar ridge
resorption in immediate denture patients. The
Journal of Prosthetic Dentistry, 41(1), 4–11.