Only recently I met a lady in the clinic, beautiful and neatly dressed, has all shades of color paint on her face and lips, she could actually pass for a miss world beauty pageant .Her complaint was that she has a painful and swollen tongue that started 2days prior to presentation. On examination I saw the tongue was fiery red and devoid of papillae with a shallow ulcer . I asked her few questions regarding the nature of the pain and the swelling .
When I asked about her nutritional status whether she eats balanced diet or not ,her response was that she’s feeding well and only came because of the painful tongue. She couldn’t relate what diet has to do with a sore tongue. However little did she know that the mouth is frequently involved in conditions that affect the skin or other multi-organ diseases in the body. In many occasions, the involvement of oral cavity usually precedes the appearance of other symptoms or lesions at other locations.
The oral cavity is one of the most sensitive indicators of nutritional state of the body, and nutritional diet syndromes are associated with changes in the integrity and the appearance of the oral mucous membrane, and these may frequently be the first clinical sign.
The question l want to ask is; how many of us fall into this category of people who do not see any connection between the mouth and the body system in general?
In the next few post on my blog, I will be intimating us with some of the diseases that affect our body systems and their effects on the oral cavity, but first lets start with nutrition and how its deficiency can manifest in the mouth.
What is balanced diet?
A balance diet is a diet that contains all the classes of food e.g protein, carbohydrate, fats, vitamins, minerals and water in the appropriate proportion necessary to maintain good health. Vitamins are essential components of our diet and when there is deficiency of these vitamin in our body . Today our focus will be on the Vitamins, their importance in the body system and how their deficiency manifest within the oral cavity.
What are Vitamins?
Vitamins are organic compounds that are needed in small quantities to sustain life. Most vitamins need to come from food and this is because the body either does not produce enough of these vitamins or does not produce any at all.There are different types of vitamin that plays different roles in normal metabolism of the body for proper functioning of the body system and if we do not take enough of any kind of vitamin, certain medical condition can result which are called Avitaminosis.
There are 13 known vitamins;
• Vitamins are either water-soluble or fat-soluble.
• Fat-soluble vitamins are easier for the body to store than water-soluble.
• Fat –soluble vitamins are A,D,E and K while water soluble vitamins are C and B
• Fat-soluble vitamins are stored in the fatty tissues of the body and the liver
• Water-soluble vitamins do not stay in the body for long. The body cannot store them, and they are soon excreted in urine, because of this, water-soluble vitamins need to be replaced more often than fat-soluble ones
• Vitamins always contain carbon, so they are described as "organic."
• Food is the best source of vitamins, but supplements are also available.
The vitamins and the diseases that can result from their deficiency are;
• vitamin A deficiency cause night blindness
• Thiamine deficiency causes beriberi
• Niacin deficiency causes pellagra
• vitamin B12 deficiency leads to megaloblastic anaemia
• vitamin C deficiency leads to scurvy
• vitamin D deficiency causes rickets
• vitamin K deficiency causes impaired coagulation
Lets now take each of the vitamins and look at their sources,function, deficiency state and oral manifestation as a result of their deficiency .
VITAMIN A
Function
Vitamin A is essential for the maintenance of the structure and function of epithelial and glandular tissue. It is required for the synthesis of visual purple in the retina.
Deficiency
Vitamin A deficiency causes night blindness and later xeropthalmia.
Oral manifestation
There is no effect on the teeth and the oral mucosa.
THIAMIN - VITAMIN B1
Sources
yeast, pork, cereal grains, sunflower seeds, brown rice, whole-grain rye, asparagus, kale, cauliflower, potatoes, oranges, liver, and eggs.
B1 deficiency causes Beri-beri (neuritis & cardiac failure) and Wernicke-Korsakoff syndrome
No oral changes.
VITAMIN B2 (RIBOFLAVIN)
Riboflavin is a water soluble vitamin
Sources: Milk, cheese, leafy green vegetables, liver, kidneys, legumes, tomatoes and yeast, okra, bananas
Deficiency causes Ariboflavinosis
Oral manifestations
Vitamin B2 deficiency causes inflammatory and degenerative changes in the mucous membranes of the lips and tongue.
Angular stomatitis consisting of red painful fissures at the angles of the mouth and
shiny redness of the mucous membranes are characteristics.
An uncommon manifestation of thiamine deficiency manifests on glossitis in the tongue was a magenta color and granular or pebbly appearance due to flattening and mushrooming of the papillae.
The gingiva are not affected.
A greasy dermatitis round the alae nasi, eyes, and conjunctivitis are other features
NIACIN (VITAMIN B3) AKA NICOTINIC ACID
Sources: synthesized from tryptophan, which is found in meat, dairy and eggs, lean meat, liver, potatoes and vegetables, fish, Chicken, heart, kidney, chicken, beef, fish (tuna, salmon), milk, eggs, avocados, dates, tomatoes, leafy vegetables, broccoli, carrots, sweet potatoes, asparagus, nuts, whole-grains, legumes, mushrooms, and brewer's yeast.
Deficiency of nicotinic acid gives rise to pellegra.
Pellagra can also be caused by decreased intake of niacin or tryptophan, and possibly by excessive intake of leucine.
A deficiency of the amino acid lysine can lead to a deficiency of niacin
Oral manifestations
Oral changes are frequently the initial clinical manifestation of this deficiency and the severe & painful oral manifestations may cause the patients to seek dental consultation first.
Glossitis & Stomatitis
Glossitis – the tongue is fiery red and usually devoid of papillae.
There may be shallow ulcerations on the dorsum and along the lateral margins of the tongue.
The tongue is very painful.
Stomatitis – the oral mucosa becomes fiery red and very painful.
The gingival margins may be red, swollen and ulcerated.
Secondary ulcero-necrotic gingivitis is a common finding.
Patients with pellagrous stomatitis frequently manifest clinical lesions associated with deficiency of other members of the Vitamin Bco group.
Herpes Labialis and angular cheilitis may be present.
FOLIC ACID (Vitamin B9)
Folic Acid is essential for Red Blood Cell production.
Source : leafy vegetables, legumes, liver, baker's yeast, some fortified grain products, and sunflower seeds.
Folic Acid deficiency can be the result of malnutrition or as a side effect of certain drug reaction e.g Phenytoin, malabsorption, and more commonly in pregnancy due to increased need in pregnancy.
Folate deficiency is accelerated by alcohol consumption.
Deficiency causes birth defects
Oral Manifestations
Angular chelitis
Glossitis
In severe cases ulcerative stomatitis & pharyagitis
VITAMIN B12 (The Antipernicious Anaemia factor,Cyanocobalamin)
Sources: liver (rich), milk & milk products, fish, shellfish, meat, poultry, eggs, milk and dairy products, some fortified cereals and soy products, as well as fortified nutritional yeast.
Deficiency of Vit B12 leads to Megaloblastic anaemia.
Causes of deficiency
-Food- cobalamin malabsorption syndrome (60%)
-Pernicioua anaemia (folic acid deficiency (15-20%)
-Insufficient dietary intake
-Malabsorption
Oral manifestation
Burning mouth (tongue, lips, buccal mucosa and other sites
Painful glossitis – the tip & lateral margins of the tongue are fiery red in colour & there is papillary atrophy of these areas.
Smooth tongue and mucosa with or without patchy areas of erythema
Taste alterations
Dysphagia
Sources - fresh vegetables, e.g cabbage, cornflower, tomatoes, citrus fruits.
Deficiency of Vitamin C causes Scurvy
Oral manifestation
Markedly enlarged, spongy bluish-red gingival tissues which bleed on slight pressure.
The connective tissue fibres of the alveolodental periosteum are affected with the result that the teeth become loose and in severe cases they are exfoliated.
The tissues are susceptible to infection.
Foul mouth odour.
VITAMIN D
Vitamin D is essential for the absorption of Calcium and Phosphorous from the Gastrointestinal tract and in their metabolism.
Sources: main source is fish liver oil, also present in eggs and butter
Vitamin D can be synthesized in the skin in strong sunlight.
Also some margarine are fortified with vit A & D
Deficiency of vitamin C during the period of bone development causes Rickets.
Oral manifestation
Dental defects hypocalcification of the teeth.
VITAMIN K (Phylloquinone, menaquinones)
Vitamin K is required for the formation in the liver of factors II (prothrombin) VII, IX, X which are necessary for the normal clotting of blood.
Sources: found in leafy vegetables, avocado, kiwi fruit and it is also manufactured from bacterial action in the colon.
Deficiency-- patient is liable to tissue bruising, gastrointestinal haemorrhage or haematuria, epistaxis & excessive menstrual loss.
Oral problems
Excessive bleeding often occur after tooth extraction or minor oral surgery.
Conclusion
The oral cavity is one of the most sensitive indicators of nutritional state of the body, and nutritional diet syndromes are associated with changes in the integrity and the appearance of the oral mucous membrane, and these may frequently be the first clinical sign of underlying disease condition.
I hope I have been able to highlight the importance of vitamins and their manifestation in the mouth in case of deficiency. So anytime you notice changes in your mouth, review your dietary chart and see if you are eating enough vitamins or not and also take supplements as recommended by your Doctor.
Thanks for reading.
.