CHAPTER 11 VITAMINS REQUIRED FOR ORAL SOFT TISSUES AND SALIVARY GLANDS Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc

CHAPTER 11CHAPTER 11

VITAMINS REQUIRED FOR ORAL VITAMINS REQUIRED FOR ORAL SOFT TISSUES AND SALIVARY SOFT TISSUES AND SALIVARY

GLANDSGLANDS

Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 2

Vitamins Required for Oral Soft Tissues and Salivary Glands

Oral cavity site of systemic disease manifestations for several reasons 1. Rapid cellular turnover rate

2. The constant assault by microorganisms

3. Trauma-intense environment

Saliva contains more than 20 proteins, glycoproteins, and electrolytes, including sodium, potassium, calcium, chloride, bicarbonate, inorganic phosphate, magnesium, sulfate, iodide, and fluoride

From Darby ML, Walsh MM: Dental From Darby ML, Walsh MM: Dental Hygiene: Theory and Practice, ed 4, Hygiene: Theory and Practice, ed 4,

St. Louis, 2015, Saunders.St. Louis, 2015, Saunders.


Vitamins Required for Oral Soft Tissues and Salivary Glands

Because of the rapid turnover rate of oral tissues, the first signs of nutritional deficiency (B-complex vitamins, vitamins C and K, iron, and protein) are frequently evident in the oral cavity Angular cheilitis or cheilosis (cracks around the

corners of the mouth) and glossitis (inflammation of the tongue) are commonly associated with nutrient deficiencies

From Ibsen OAC, Phelan JA: Oral From Ibsen OAC, Phelan JA: Oral Pathology for the Dental Hygienist, ed 6, Pathology for the Dental Hygienist, ed 6,

St. Louis, 2014, Saunders.St. Louis, 2014, Saunders.


Physiological Roles and Requirements: Thiamin (B1)

RDAMen: 1.2 mg/dayWomen: 1.1 mg/day

No UL set at this time


Sources: Thiamin (B1)

Lean meats and poultryWhole grain or enriched breads and cerealsEgg yolkAverage US intake 2 mg/day


Hypostates: Thiamin (B1)

Seldom seen in US because of enriched grains in foods, except in alcoholicsSeen predominantly in countries using refined,

polished rice as major dietary staple

Early symptomsAnorexia, indigestion, constipationMalaiseHeaviness and weakness of legs

Calf muscle tenderness Increased pulse rate and palpitations


Hypostates: Thiamin (B1)Beriberi

Peripheral neuropathy and muscle wastingCardiovascular symptoms include tachycardia and

enlarged heartWernicke-Korsakoff syndrome

Mental confusion Third leading cause of dementia in US

Nystagmus (involuntary rapidmovement of the eyeball)

Ataxia (a gait with uncoordinated muscle movements)50 to to 100 mg/day commonly prescribed for recovering

alcoholics

From McLaren DS: A Colour Atlas and Text of Diet-From McLaren DS: A Colour Atlas and Text of Diet-related Disorders, 2nd ed. London: Mosby-Yearbook related Disorders, 2nd ed. London: Mosby-Yearbook

Europe Ltd, 1992.Europe Ltd, 1992.


Physiological Role and Requirement:Riboflavin (B2)

Physiological roleInvolved in energy metabolismConversion of tryptophan to niacin

RDA Men: 1.3 mg/day Women: 1.1 mg/day

Median intake Men: 2 mg/day Women: 1.5 mg/day


Sources: Riboflavin (B2)

SourcesMilk, cheddar cheese, and cottage cheeseFortified breads and cerealsLean meat, poultry, and fishLeafy green vegetables


Hypostates: Riboflavin

From Ibsen OAC, Phelan JA: Oral From Ibsen OAC, Phelan JA: Oral Pathology for the Dental Hygienist, ed 6. Pathology for the Dental Hygienist, ed 6.

St. Louis: Saunders, 2014.St. Louis: Saunders, 2014.


Physiological Roles and Requirements: Niacin (B3)

Physiological roleCoenzyme in energy metabolism from CHOsFats, protein metabolism

RequirementsRDA

14 to 16 mg/day for adultsUL

35 mg/day

From Patton KT, Thibodeau GA,: Anatomy & From Patton KT, Thibodeau GA,: Anatomy & Physiology, ed 8. St. Louis: Mosby, 2013.Physiology, ed 8. St. Louis: Mosby, 2013.


Sources: Niacin (B3)

SourcesLean meats, poultry, fishPeanuts and peanut butterBrewer’s yeastFortified breads and cerealsLegumesSeeds and nuts


Hyperstates: Niacin (B3)

Pharmacological doses of nicotinic acid (3-6 g/day) to reduce cholesterol and triglycerides while increasing HDL cholesterol levelsDoses of 250 mg or more function as vasodilators

resulting in flushing, nausea, tachycardia, itching, fainting, and blurred vision

The body is able to store some niacin, so larger doses associated with supplements may lead to serious problems including abnormal liver function and gout

Extended-release forms of niacin produce fewer adverse effects


Hypostates: Niacin B3

Pellagra Occurs in areas where maize is the major part of the

dietClassic symptoms include “3 Ds”

1. Dementia2. Diarrhea3. Dermatitis

Mucous membrane symptoms Scarlet glossitis (entire tongue bright scarlet, sore; edema

develops) Ulcerations may appear under tongue, mucosa of lower lips,

and buccal mucosa Gingival inflammation may resemble ulcerative gingivitis

From Ibsen OAC, Phelan JA: Oral From Ibsen OAC, Phelan JA: Oral Pathology for the Dental Hygienist, ed 6. St. Pathology for the Dental Hygienist, ed 6. St.

Louis: Elsevier, 2014.Louis: Elsevier, 2014.


Overview: Pantothenic Acid B5

Physiological rolesMetabolism of carbohydrate, fat, and protein Synthesis and degradation of triglycerides,

phospholipids, and sterolsFormation of certain hormones and nerve-regulating

substances

RequirementsAI = 5 mg/day for adults

SourcesAbundant in foods from animal sources, whole grains

Dietary deficiency has not been documented


Physiological Roles: Vitamin B6 (Pyridoxine)

Coenzyme in protein metabolismConversion of tryptophan to niacinHemoglobin synthesisSynthesis of unsaturated fatty acids

from essential fatty acidsEnergy production from glycogenProper functioning of the nervous system including

synthesis of neurotransmitters

From Patton KT, Thibodeau From Patton KT, Thibodeau GA: Anatomy & Physiology, ed GA: Anatomy & Physiology, ed

8. St. Louis: Mosby, 2013.8. St. Louis: Mosby, 2013.


Requirements: Vitamin B6 (Pyridoxine)


Sources:Vitamin B6 (Pyridoxine)

Meat, poultry, and fishNon-citrus fruitsWhole grainsDark green, leafy vegetablesLegumesNuts


Hyperstates and Hypostates:Vitamin B6 (Pyridoxine)

DeficiencyGlossitis, atrophy of

filiform papillae, magenta tongue

Angular cheilosisPeripheral neuropathyImpaired immune

response

Toxicity symptoms from megadosesAtaxia Severe sensory

neuropathy (impairment of ability to sense touch, vibration, temperature, pinprick)

Bone pain and muscle weakness


Physiological Roles and Requirements: Folate (Folic Acid)

Physiological roleCoenzyme for

approximately 20 enzymes

Synthesis of DNA, RNAInvolved in maturation

of RBCsProper formation of

neural tubes during fetal development

RDA400 mcg/day

UL1000 mcg/day from

supplements

From Patton KT, Thibodeau GA: Anatomy & From Patton KT, Thibodeau GA: Anatomy & Physiology, ed 8. St. Louis: Mosby, 2013.Physiology, ed 8. St. Louis: Mosby, 2013.


Sources: Folate (Folic Acid)

LiverKidney and lima beansDark green, leafy

vegetablesLean beefFortified breads and

cereals


Hyperstates: Folate (Folic Acid)

ToxicityExcess intakes may

mask vitamin B12 deficiency

Kidney damageIncreased risk of

cognitive decline reported in elderly persons taking folic acid supplements From Applegate E: The Anatomy and From Applegate E: The Anatomy and

Physiology Learning System, ed 4. Physiology Learning System, ed 4. Philadelphia: Saunders, 2011.Philadelphia: Saunders, 2011.


Hypostates: Folate (Folic Acid)Deficiency

Neural tube defectsMegaloblastic anemiaElevated blood

homocysteine levelsGlossitis (fiery red;

denuded of papillae)Impairs immune

response

At risk if:Secondary to alcohol

abusePregnancy/lactationKidney dialysisInadequate dietary

intakeLiver diseaseGastrointestinal

diseaseMedications



Physiological Roles/Requirements: Vitamin B12 (Cobalamin)

Physiological rolesSynthesis of nucleic

acidsMetabolism of certain

amino acids, fatty acids, carbohydrates, folate

Formation and regeneration of red blood cells and for myelin synthesis

RDA2.4 µg/day

10% to 30% of elderly may be unable to absorb naturally occurring B12 because of stomach acidity/lack of intrinsic factor and may need supplementation

From Patton KT, Thibodeau GA: Anatomy & Physiology, From Patton KT, Thibodeau GA: Anatomy & Physiology, ed 8. St. Louis: Mosby, 2013.ed 8. St. Louis: Mosby, 2013.


Absorption:Vitamin B12 (Cobalamin)

Vitamin B12 in food released from protein bond by hydrochloric acid and enzymes in stomach and intestine

Free vitamin B12 combines with salivary R-binder (protein produced by the salivary glands) in stomach

In the small intestine, trypsin (pancreatic enzyme) removes R-binder and vitamin B12 combines with intrinsic factor

Absorption of B12 occurs at specific receptor sites in ileum only if bound to intrinsic factor

From Thibodeau GA, Patton From Thibodeau GA, Patton KT: Anatomy & Physiology, ed KT: Anatomy & Physiology, ed

6. St. Louis: Mosby, 2007.6. St. Louis: Mosby, 2007.


Sources:Vitamin B12 (Cobalamin)

Animal proteinOrgan meatsMilk, cheeseEggsFish

Bacterial synthesis in humans is not absorbed because it takes place in the colon


Hypostates:Vitamin B12 (Cobalamin)

Pernicious anemiaMacrocytic (large),

immature red blood cells

Glossopyrosis (unexplained pain of the tongue)

Altered taste sensationGlossitis (smooth,

beefy-red tongue)Cheilosis

Stomatitis or a pale or yellowish mucosa

Hemorrhagic gingiva and bone loss

Gastrointestinal disturbances

Neurologic manifestations, numbness and tingling

Stunted growth


Overview: Biotin B7

Physiological rolesCoenzyme in metabolism of proteins,

carbohydrates, and fatsRegulating gene transcriptionAids in utilization of protein, folic acid,

pantothenic acid, vitamin B12

RequirementsAI = 25 to 30 mcg/day for adults

SourcesRich sources: egg yolk, liver, cereals



Hypostates: Biotin B7

Deficiency can be produced by ingestion of avidin, the protein found in raw egg whitesAvidin is denatured with cooking12 to 24 egg whites per day can produce anorexia,

nausea, vomiting, glossitis, pallor, depression, and dry scaly dermatitis Oral signs of biotin deficiency are pallor of tongue and patchy

atrophy of lingual papillae along the lateral borders of the tongue


Important Functions in Soft Oral Tissues: Other Vitamins

Vitamin CImproving the host defense mechanismRole in collagen formation and optimal wound healing

Vitamin AMaintaining integrity of epithelial tissues

Vitamin EAntioxidant to neutralize free radicals and promote

integrity of cell membranes of the mucosa


Nutritional DirectionsA careful medical, social and dietary history,

including a clinical assessment of the oral cavity, alcohol consumption, and activity level helps identify those at risk for deficiency or excess intake of nutrientsRefer those at risk to medical provider and/or RD

Encourage intake of lean meats, dairy, eggs and enriched or whole grains per

MyPyramid guidelines

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CHAPTER 11 VITAMINS REQUIRED FOR ORAL SOFT TISSUES AND SALIVARY GLANDS Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc