CHAPTER NO. 11
VITAMINS – THE MICRONUTRIENTS
The body
of the animals grows by eating different foods e.g meat, Bread, vegetables,
fats etc. they all help to build the body of animals and maintain it. They are
termed as “nutrients” . In Addition to these basic nutrient e.g . fats,
proteins or carbohydrates, there are certain other things, special chemicals
which are eaten by the animal-termed as “micro-nutrients”. They are
termed so because they are required in very small quantities but are very important
for “the life “. They make a part of certain molecules or they may be necessary
for some reactions to take place or we can say that some of the reactions
cannot take place without these chemicals substances. That is the reason why
the micro-nutrients are important to life.
Vitamins are important micro-nutrients. They
help in the maintenance and propagation of life and the wellbeing of a person. They
have got their effect on the body in general and some special findings may be
observed in the oral tissues, by deficiency or excess of them. Following pages
small help explore the signs and symptoms in and around the oral cavity both in excess or
deficiency of different vitamins.
VITAMIN-A RTINOL
It is
only found In animals kingdom. I n plants only its precursors e.g B-carotene, may be found. It is an alcohol and is absorbed
in body through as fats in the form of chylomicron and is stored in liver which
may be maintain the blood level for year.
In
blood, it is bound to a “RBP” (retinal building protein) and for its
mobilization, Zn is necessary. A pseudo deficiency may be seen in liver
disease. Zn deficiency and in protein deficiency.
ACTIONS:
It has
an important role in maintenance of the epithelial surfaces. It helps produce
glycoproteins which are integral part of cell membrane. Deficiency shows in
form of changes in glands, eye and mucous surfaces as well as other signs.
It
plays an important role in color vision and vision in dim light. The rods of
retina have rhodopsin which is destroyed by light and is regenerated in dark
with the help of Vitamin A. In deficiency states, there is difficulty in vision
in dark which may lead to blindness. The cones are concerned with colour
differentiation and which in turn are dependent upon vit-A.
Sources: Fat,
kidney, liver, lung, carrots, green vegetables, yellow fruits
Daily requirement: Adult
2500 i.u. Pregnancy 6000 i.u.
Stability: Vit-A
is destroyed by U.V light, Oxygen and high temperature.
Deficiency may be due to :
(1)
Improper intake (2)
Improper digestion due to (a) low fat
diet (b) deficiency of bile salts
(c) intestine disease. (3) Improper conversion of carotene to Vit-A (4) Impaired mobilization.
Effects of
Deficiency
Night and color blindness (2) Ulceration of eyes (3) Skin is scaly and hyper keratinized. (4) Oral manifestation: includes (a)
heperkeratinization of oral tissues
which show as white patches (b)
Metaplasia of salivary glands, may cause xerostomia (c) there may be change in taste and smell. There
has been no evidence of much important dental changes in human beings.
HYPER VITAMINOSIS-A: Peeling off of
the skin, Alopecia, coarse hair and generalized bone and joint pain. Oral mucus
membrane shows atrophy, gingival inflammation and scaling of lips.
VIAMIND-D
CALCIFIROL
It is a fat soluble Vitim found in animal kingdom.
Its precursor is present in plants & yeasts which can be converted to Vit-D
in human beings by action of U.V. rays of sunlight.
ACTION: It
is an important vitamin and has a role in the normal grow of body through its
action on bone formation and absorption of Ca & PO4 from gut and kidneys. The absorption in
mediated through production of a Ca binding protein.
Vitamin D plays a part in normal mineralization and demineralization of bones.
PTH (Parathyroid hormone) exerts its action through Vit D.
Sources: (1) From fungi (2) Fish
liver oil (3) Egg yolk and liver of
animals etc.
Daily Dose: (1) Pregnancy and adolescence 400 i.u. (2) Adult 100 i.u.
Hypovitaminosis D: Causes
rickets in children and ostemalacia in adults.
Rickets: There is
disruption of normal bone formation. There are areas of hypo mineralization in
skulls of the patient. The normal joint cartilage cannot get mineralized giving
an enlarged shape to wrists, knee joints and costochondral joints (rickety
rosery), long bones (weight bearing) shows some bending:
Dental Correlation: Two types of
the diseases:
1. Caleiferol Sensitive: No. effect on amaclogenesis or
dentinogenesis has been shown.
2. Calcified Insensitive: This condition seems to be due
to a dfect of kidney tubules. Some changes in the pulp chamber and dentine have
been shown. There may be delayed eruption of teeth. Loss of density of lamina
dura and loss of erestal bone may be seen.
OSTEMALACIA: This type of
disease is now uncommon. It occurred in adult to Vit-D deficiency. It shows an enlargement
of cortex and trabeculation of bones with some islands of osteoid tissues. Bone
is soft and easy to fracture.
Hyper Vitaminosis-D
Deposition
of calcium in various tissues e.g. lungs
and kidneys may be seen.
VITAMIN E
TOCOPHEROL:
Vitamin E has got following actions.
1)
Antoxident prevents molecular oxygen attacking of
plounsatured acid component of tissue
lipids and thus explains its role in tissue maintenance and weakness.
2)
In infants : Milk
secretion of Vit E is more which prevents infants of destruction of
erythrocytes.
3)
Prevent liver
necrosis.
4)
he effects on oral
and germinal layer have been demonstrated in animals but not proved in man.
VITAMIN-K
The naturally occurring K1 & K2
are fat soluble while the synthetic Vit-K is water soluble.
Actions: It is necessary
for the production and action of blood factors II, VII & X in liver. It also plays an action in
bone mineralization.
Antagonist: Dicumoral reduces oxidation reduction of Vit K and
thus reduces prothrombin which leads to a defected clotting mechanism.
Dicumoral is helpful in certain types of surgery and in some heart diseases.
Sources: (1) Green leaves – best sources (2) Synthetic in
injection form
Requirement: Not
known
Deficiency may be caused by steatorrhoea or obstructive
jaundice, which causes prolonged bleeding.
ORAL SIGNIFICANCE
Deficiency may cause gingival bleeding. Post
extraction/surgical bleeding is the main problem. So Prothrombin time may be
evaluated before any surgery and that must be at least 50%. If and when
required, Vit K injection may be used which gives effects in 8-12 hours.
BIOTIN
A widely distributed factor in nature but may be
antagonized by certain factors e.g. the rats fed on raw egg gave rise to sign
of “dermatitis” retarted growth and loss
of muscle control”. The antagonizing factor is called “avidin” but this is agglutinated/
precipitated by boiling etc. so it is not harmful. Daily requirement is not
known and the deficiency has not been identified clinically.
ASCORBIC ACID VIT-C
It is a white crystalline substance soluble in water
but is oxidized readily and loses its potency. Oxidation may be inhibited by
low pH and presence of metals like Iron & Cu and that is the reasons of
Vit-C estabillity in fruit.
Action:
The main function is its role in formation of collagen
which is the main fiber of connective tissue (2) It takes part in hydroxylation processes of
many of the compounds (3) It plays some
role in iron absorption (4) Some part must be played in body’s reaction to
stress as there are large quantities in adrenal cortex which are depleted
during stress.
Source: Dark
green leaves, fresh fruits.
Daily Dose: Adult dose is 30-60 mg per day
Any physical and mental stress, pregnancy and lactation
etc increases its demand upto 500 mg daily. Vit –C is excreted through urine
Deficiency
Deficiency
of Vitamin-C leads to “scurvy” which may be described as a disease of collagen
deficiency. Acute deficiency of Vit-C causes haemorrhagic tendency due to
capillary fragility due, in turn, to loss of connective tissue support in the
vessel wall. Skin patechies occur around hair follicles, lower extremities and
arms. Sub-periosteal haemorrhage may be evident. Anaemia may result from
chronic bleeding and hemolysis.
Subacute scurvy: impaired wound healing,
hyperkeratiosis, pecechias and
gingivitis with a tendency of haematoma formation.
Oral manifestations
Oral
manifestations are evident both in acute and sub-acute states. Gingivitis is
the first sign with marginal bleeding, swelling and ulceration. On progression of
the disease, condition worsens and bleeding occurs with slight pressure.
Secondary infection may occur and mostly occurs
e.g. vincents infection. Local
factor e.g. tartar and poor oral hygiene add to the dilemma.
Recent
studies show that animal fed on low Vit-C diet are more susceptible to
periodontal disease as compared to the control.
Therapeutic Dose: 300-500 mg per
day
Clinical Uses:
1)
Promotion of wound bleeding
2)
Mega doses of Vita
C may alleviate bone pain
3)
When used in common
cold, may reduce the severity of signs and symptoms.
THIAMINE
It is
a white crystalline alcohol which is stable in heat and acid media.
Action: It has got an
important role in utilization of carbohydrates (Production and elimination of
pyruvates and lactic acids). Its deficiency complications may be explained on
the basis of this action.
Sources: whole
cereals, Rice, Meats and eggs etc.
Daily Requirement: is 1.5 mg per day, and as it cannot be stored in body,
it is excreted through urine.
Deficiency: (1) May be caused due to improper intakes
(2) In alcoholies (3) Disorders of metabolisms.
ü There is a variety of deficiency sings and
symptoms. E.g. Beri-beri, wermicker
encephalopathy, Korsakoff’s syndrome.
ü Heart failure with clear lungs, dependent edema,
elevated venus pressure and enlarged heart.
ü Beri-beri – weakness of muscles, numbness and
paresthesia of legs, paralysis may occur.
ü Wernick’s encephalopathy: apathy, confusion, loss of
memory, ataxia, delirium etc, eye signs,
nystigmus, paralysis of extraoccular muscles.
All above can be corrected by parental thiamin. Initial
symptoms include irritability, loss of appetite, nausea and vomiting and diarrhea
due to inflammation of gut.
ORAL MANIFESTATION
Oral manifestation is
rarely severe. Hypersensitivity of teeth and oral mucosa,
Enlargement of fungiform
papillae of tongue. Small vesicles or cracks may be seen on
Vermilion border or
commissars of lips.
VITAMIN B-2 RIBOFLAVIN
It is also called
lactoflavin. It is yellow crystalline, heat stable substance and is stored in liver, heart and kidneys.
Action: Acts
as co-enzymes for dehydrogenases and
acts as carrier of Hydrogen ion.
Source : (1) whole cereal (2)
liver (3) Milk (4) egg etc.
Daily Requirement : (1) adults – 1.5 mg per day (2) during pregnancy 2.5 mg
DEFICIENCY
Severe oral signs and
symptoms are caused.
1.
Angular chelitis
with more horizontal fissures and with
super added infections (candidiasis).
2.
Glossitis-enlargement of fungi form and
degeneration of flibriform papillae giving a granular appearance of the tongue.
3.
The oral mucosa may
acquire publish hue (resembling cyanosis). Prolonged deficiency may cause “ bullas lichen planus” and “ painful
periodontitis ”
4.
General: Anaemia,
seborhic dermatitis, conrneal vascularization.
VITAMIN B-3:
NOCTANIMIDE
It
is a white crystal, soluble in water and is stable in heat, acid and alkali.
ACTIONS: It
acts as NAD and NADP in dehydrogenesis (carrier of hydrogen).
Sources: (1) Whole cereals (except corn) (2) Rice (3) Liver,
thin meats etc.
Daily requirement: adults
require 20 mg per day and it is excreted in urine.
Deficiency: Causes pellagra which is characterized by symmetric red
scaly dermatitis of the stocking and gloves areas which may darken &
desquamate. Lesions are aggravated by heat and sunlight, accompanied by
diarrhea, numbness and burning sensation, vertigo nervousness, progressive
weakness and anorexia.
ORAL MANIFESTATION
There
is generalized erythema of the oral mucosa; papillary atrophy of tongue with
discomfort tongue may become fiery red, with ulcers on dorsum and borders.
Secondary ulceronecrotic gingivostomatitits, herpes labiallis and angular
cheilosis may occur.
Treatment: of
the symptom is done with 150 300 gm nicotionamider per day.
PYRIDOXINE VIT B-6
It is
a colorless crystal which is soluble in water.
Bio functions: It plays an important action in amino acid metabolism.
Antagoist: INAH used in treatment of tuberculosis is its
antagonist.
Sources: As
thiamine & riboflavin, it is available from (1) meats (2) liver (3) cereal
Requirement: (1)
Infant 0.3 mg/d (2) Adults 2.0 mg/d
Deficiency: Deficiency is not seen on normal food habits,
due to its wide natural distribution but may occur due to alcoholism which may
results in dermatitis peripheral neuropathy and a microcytic; hypochromic anemias
with high serum iron levels may also be seen.
Oral Changes: Are not specific, may be like that of iron deficiency,
e.g angular chelitis glossitis and generalized stomatitis.
The
Vit B6 deficiency disease run
in families, so it may be called a genetic disorder
FOLIC ACID
A
group of related compounds, bright yellow in color and is heat labile.
Sources: Include
green leafy vegetable and organ meats e.g liver.
Requirement: 50
ug/d
Deficiency: Although
it is destroyed by cooking, but gross deficiency may only be seen in elders,
alcoholics or in digestive system problems etc.
During
pregnancy, in certain tumors and in process of certain cell turnover,
deficiency may be seen. Certain drugs e.g trimethoprim and phenytoin may cause
competitive antagonisms and thus a pseudo deficiency state may develop.
Effects: Folic
acid deficiency symptoms are similar to B6
deficiency e.g
megaloblastic anemia. Oral manifestation is also similar. Severe oral ulceration
beings the most prominent symptoms.
COBALAMIN VIT B12
A
group of related compounds laid cobalamin, cynocobalamin. Hdhroxy cobalamin and
methyl cobalamisn are included Vit B12. Clinically cobalt is attached to
certain amino acids. It is a red crystalline substance and is heat stables.
Source: It
is produced solely by bacteria and then eaten by animals. It is available to
human beings from (1) Meat (2) Liver (3) Kidney (4) Egg (5) Milk
Requirement: 2-5
ug/d
Absorption: In gut, its absorption depends upon the intrinsic
factor “IF” and is absorbed in ileum at certain receptors. It is stored in
liver which is enough for 3-4 years.
Deficiency: May
occur due to deficiency of IF which anemia. There is initially an inflammation
with rawness, tenderness, edema of mucosa and difficulty in eating. A trophy
occurs withy degeneration of fungi form and filo form papilla. Recurrent ulcers
of oral cavity without angular chelates may also be seen.
Supplements of Vit B-12 Corrects
the symptoms like burnings and loss of taste, quickly and safely.
PANTOTHENIC AND
It
is very widely distributed in nature and its deficiency is never seen
practically, it is yellow oil and is heat labile. It makes a part of coenzyme
A, so helps in different reaction in a body.
ACTIONS OF CO-A
1.
It helps in
oxidation of (a) glucose (b) fatty acids (c) amino acids (d) acetic acid.
2.
It helps in
synthesis of (a) choline (b) triglycerides (c) phospholipids (d) bile acids (e)
cholesterol
3.
It helps in
detoxification of certain molecules.
Deficiency: Occurs
only in experimental animals. The signs and symptoms are (1) Alopecia (2)
Graying of hair (3) Resorption of root
of teeth (4) Resorption of supporting tissue of teeth (5) Osteoporosis.
I man, it acts in combination with folic acid and
biotin.
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