GOOD MORNING

VITAMINS FOR ORAL HEALTH

GUIDED BY: DR.MAHMOOD MOOTHEDATH

DR.AZEELA.DEPARTMENT OF COMMUNITY

DENTISTRY

SUBMITTED BY:LUBNA K.P

Vitamins Discovery of vitamins

Classification of vitamins Vitamins and oral health

Vitamins are important for oral health – study results

Vitamins deficiency and tooth decay

INDEX

Vitamins essential for oral health VITAMINS ESSENTIAL FOR ORAL HEALTH

1. Vitamins c sources Average requirements Functions Deficiency manifestations Oral manifestations Treatment Prevention

2. Vitamin B (B1,B2,Niacin,B6,Biotin)

Sources Average daily requirement

Functions Deficiency manifestations

Oral manifestations Causes of deficiency

Treatment Prevention

3. Vitamins D Sources Average daily requirement Functions Deficiency Oral manifestations Treatment

4.Vitamine E Sources

Average daily requirement Functions

Oral manifestations Treatment

5.Vitamine K Sources Average daily requirements Functions Deficiency Oral manifestation Treatment 6.Vitamine A Sources Average daily requirement Functions Causes of deficiency Deficiency Oral manifestation

During the 19th century , scientist found that main

constituents present in different foods were carbohydrates, fats,

protein ,minerals and water. At the beginning of 20th century

feeding experiment were conducted on mice by some

physiologists with synthetic diet based on blends of pure

carbohydrates,protiens,fats and mineral salts.The results showed that animals would not grow on

such synthetic diets .

INTRODUCTION

. There were called ‘acessory food factors’ by Hopkins (1912)and ‘vitamins by Fank in 1912 . Other lines of investigations which helped to focus attentions of scientists regarding existence of vitamins in foods were : 1) cure of scurvy , beriberi and rickets in human beings by changes in the diet ,and2) production of scurvy ,beriberi and rickets in experimental animals by feeding on faulty diets .

It was evident that natural foods contained certain unknown substances , which are essential for the growth of animals

1. Cure of scurvy , beriberi and rickets in man by foods. .

1601 Lancaster cured scurvy in mariners by oranges and lemons .

1882 Takoki prevented the occurrence of beriberi among

Japanese sailors by replacing rice by wheat bread and adding milk and

vegetables . 1865 Trousseaus cured rickets

in children by means of cod liver oil .

DISCOVERY OF VITAMINS

2. Productions of deficiency diseases in experimental animals by feeding on faulty diets

1838 Guerin produced rickets in puppies by feeding on diets free from animal fat

1901 Gyrins produced polyneuritis in fowls by feeding on polished rice diet and postulated that polished rice lacked some accessory food factor

1907-12 Holst and Frolich produced scurvy in guinea by feeding them on cereal diets

3. Feeding of animal on purified diets 1881 Lunin :Diets on starch , proteins ,

fat and minerals inadequate for promoting growth of mice .

1905 Pekelharing :small amounts of milk added to purifield diets suffice to promote good

growth . 1909 Stepp :Bread and milk products

extracted with alchohol and ether not adequate for promoting growth of rats.

1912 Hopkins : convincing quantitative evidence for the presence of accessory food

factors in milk and the beneficial effects of the small amount of milk in promoting good growth

of rats on purified diets 1912 Funk : propounded the ‘vitamin

theory’ 1915 Mc Collum : Evidence for presence

of least two types of accessory food factors 1.Fat soluble and 2.Water soluble

Vitamins may be defined as organic components occurring in small

quantities in the different natural foods and necessary for the growth and maintenance of good health in

human beings and certain experimental animals.

If vitamins are not present in sufficient quantities in the

diet,vitamin deficiency disease occur.So far about 15 different

vitamins have been isolated in a pure state from natural foods. Almost all of them are essential for human being.

CLASSIFICATIONS OF VITAMINS

a.Fat soluble vitamins:that is vitamins soluble in fats and fat solvents but insoluble in

Water.

b.Water soluble vitamins:that is vitamins soluble in water but insoluble in fats or fat solvents.

VITAMINS MAY BE BROADLY CLASSIFIED INTO TWO GROUPS

a. Fat soluble vitamins 1. vitamin A and carotine (provitamin a) 2.vitamin D vitamin D2(calceferol, artificial vitamin

D) and vitamin D3(lrradiated dihydro

cholesterol, natural vitamin D) 3.vitamine E and 4.vitamine K

b. Water soluble vitamins I. vitamin B complex

1.vitamin B1 (thiamin, aneurin) 2.riboflavin

3.nicotinic acid and nicotinamide (niacin and niacinamide)

4.pyridoxin (vitamin B6) 5.pantothenic acid

6.folic acid 7.biotin 8.choline

9.p-amenobenzoic acid 10. inositol

11.vitamin B12 II. Vitamin C (Ascorbic acid or civitamic acid)

III. Vitamin P (Bioflavonoids)

IV. Lipoic acid, carnitine and taurine

Nutrition is one of the most basic process of human life. Body needs many different nutrients to support the variable systems that functions in the

body. These nutrients are absorbed through digestion when the right kind of food is fed to the body.

Vitamins are nutrients that are required by human body in small quantities. Eventhough the quantity

required is low, their importance to the body and to the health of the individual cannot be underestimated. These substances in small quantities provide the body

with vital tools for various different processes performed by it .Each specific function of the body depends on a combinations of different nutrients

including some different type of vitamin.

VITAMINS AND ORAL HEALTH

Good nutrition and diet promote oral health that act as channel to encourage over all health and development. This is because mouth is the beginning of gastrointestinal tract and has the ability to chew and swallow potentially, providing essential nutrients to the body for good health.

Following a healthy diet is important for your mouth and for your whole body. Some vitamin difeciencies could have severe effects on your teeth and mouth. If you have sore mouth or if your gums bleed frequently, then you may not be able to eat properly. This will eventually make your vitamin deficiency even worse.

Older people are more likely to have vitamin deficiencies because they have problems absorbing nutrients from their food. Younger people can also have problems in absorbing their nutrients.

1. Vitamin C It is a water soluble anti scurvy vitamin . It is a modified simple sugar

not synthesized by human body. • Functions

1.It helps in collagen formation of connective tissues by hydroxylation of

proline to hydroxyproline, the characteristic aminoacid of collagen. By this action it helps in healing of

wound.

VITAMINS ESSENTIAL FOR ORAL HEALTH

2. It is the most active reducing agent in aqueous phase of

living tissues. Helps to reduce binding agents, protect cells,

reduce bacteria and strengthen the immune system.

3.Antioxidant property Vitamin C and oral health

Prevent oral cancer,prevent bleeding gums

There are two main reasons that gum disease is so closely

linked to vitamin C status. Vitamin C is required for the development of collagen,the

ground substances between our cells ,that give tissues their integrity, and our gums are

fragile tissues to begin with. That is why bleeding gums is a

symptom of scurvy.

Our mouths are exposed to outside world and its flood of nasty things like bacteria. Vitamin C is required for the development of our immune systems specialized disease fighting

cells. Infections is much more likely if yours vitamin intake is optimum. The saying “long in the tooth”

referring to something getting old Originate from the appearance that

our teeth get longer as we get older. The fact is that gums of people with

subclinical scurvy recede with age ,exposing more tooth.

Many studies upon the gingival health have shown that saturation

with ascorbic acid have never failed to effect a cure.

Another study in which gum status was graded in terms of gingival bleeding, tenderness, redness and swelling also showed that the greater the amount of

vitamin C, the greater the degree of improvement.

At window nook, Arizona 168 Navajo students were paired according to age,

sex and gingival status. One group received 300mg of C daily in tablet form,

the other a placebo.Marked gum improvement was reported in the C

supplement group .Similar results were obtained in fifty three dental students observed over a

twelve month period by A.E Thomas and colleagues in Bermingham.

Half the students refrained from taking citrus fruits , the other half received

daily supplementation of frozen orange juice. The report says that there is a noticeable worsening of gingival hue

(gum colour is good due to gum health) in the non supplemented group and a “significant improvement in gingival

hue”in those subject who drank orange juice.

Another university of Alabama team headed by Gamol EL Ashiry randomly

chose subjects who would receive a 100 mg lactose placebo with each meal for twenty one days , and an equal number who where given 100 mg of synthetic

vitamin C at the same meal time points . Each subject received a thorough

scaling of the teeth on one side of the mouth.

There are four possibilities : prophylaxis (cleaning and polishing) with C, no

prophylaxes with c, prophylaxis with placebo, no prophylaxis with placebo. Gingival

assesment for the twelve front tooth was made before scaling and after 20 days of the

placebo. Neither the examiner, nor parents were aware for the initial scores of the nature

of the supplement.As one might expect, there was no significant change in group with no prophylaxes and no

C. At the opposite end of the pole, Improvement was greatest with prophylaxes

plus C – a 58% reduction In gingal inflamation.

The other two groups also showed improvement so EL Ashery and his colleagues concluded that both prophylaxes and vitamin C are valuable tools in combating gum diseases, but the combination of two works best of all .

One of the vitamins essential for oral health is vitamin B, or more specifically B complex vitamins

which include thiamin(B1), riboflavin(b2), niacin(B3),pyridoxine(B6),folic acid,pantothenic

acid, (B9),cyanacobalamin(B12) and biotin.1.Thiamin (B1)

Functions:Decarboxylation of pyruvate to acetyl coenzyme

A .This act as a bridge between anaerobic glycolysis and trans carboxylic acid cycle(Krebs cycle).

It act as a coenzyme for transketolase in HMP shunt.Thus normal energy metabolism during development

and maintenance of oral tissues is maintained.

VITAMIN B COMPLEX(B1,B2,NIACIN,B6,BIOTIN)

Wheat flour(bran),bread.Yeast,legumes,nuts.

Pork,duck.Oat meal or fortified cereals.

Meat.Daily requirement:

In adults it is about 1.5 mg/day.Causes of deficiency:

Alchoholism,malnutrition,malabsorption,antidiabetic

therapy,dialysis,folate deficiency,intake of machine

milled rice or cereals.

DIETARY SOURCES

Clinical deficiency:Wet and dry beriberi.Infantile beriberi.Wernicks encephalopathy.Korsakoff psychosisTreatment:Include prompt administration of thiamin when beriberi is suspected or diagnosed.Initially 50 mg i.m is given for several days after which 2.5 to 5 mg is given orally by mouth.

Formed in our body from the essential aminoacid Tryptophan in the diet .

Functions:It take part in many oxidation reduction

reactions in the form of coenzyme nicotinic acid dinucleotide(NAD) and nicotinic acid

dinucleotide phosphate(NADP).Daily requirement:

14 to 18 mg/day.Clinical features;

Pellegra ,a chronic disease characterized by diarrhoea,dementia and dermatitis.

Treatment:Niacin 10mg/day oral is sufficient to treat

endemic pelligra.

NIACIN(NICOTINIC ACID)

Dietary sources: widely distributed in all foods

i.e meat,liver,vegetables,and whole grain cereals.

Functions cofactor for many enzymes.It is required for synthesis of

heam precursor.It plays a role in neuronal

excitation. Daily requirement:2mg

PYRIDOXINE(VITAMIN B6)

Clinical features: deficiency rareTreatment of deficiency:supplementation of diet with 30mg pyridoxine returns the tryptophan metabolism to normal in pregnancy,in oral contraceptive users and persons taking isoniazide for tuberculosis.High doses upto 100mg/day may be required for persons taking penicillamine.

Function: participate in many oxidation reduction reactions.

Normal energy metabolism of oral tissues.Daily requirement: 1.2 to 1.6mg.

Deficiency symptoms: sore throat , angular

stomatitis,cheilosis,glossitis,seborrhic dermatitis ,normocytic normochromic anemia.

RIBOFLAVIN(B2)

Haemopoitic vitamins.Function: integrity of nerve

tissue and normal red blood cell formation in oral tissues.

As a whole deficiency of B complex vitamins can result

in:Burning sensation in the

mouth ,this cause difficulty in swallowing and damage to

tissues of inner cheeks.Develops

sore ,red,fissured,beefy red tongue.

Tongue may become atrophic and smooth.

FOLATE AND VITAMIN B12

Increases the risk of angular cheilitis,recurrent aphthous stomatitis,chronic

oral mucosal candidiasis and atrophic glossitis.

Susceptibility to infection is increased.To combat these symptoms rich source of

vitamin B must be added.

Sources meat ,poultry,milk,fish,eggs,fortified

cereals(b12)Asparagus,nuts,vegetables,legumes,ora

nge juice,broccoli,fortified cereals(folate)

Natural form of vitamin D( cholecalceferol or vitamin D3)is synthesized in skin by action of UV light on 7 dehydrocholesterol .Ergocalceferol, a non natural form of vitaminD is also synthesized

in plants by UV light on Ergosterol.Dietary sources:

Fish liver oil(cod liver oil)Fatty fish(herring, salmon,sardines,tuna etc…)Infant milk formula(fortified with vitamin D)

Egg,liver etc…Normal dietary intake:

For infants and children upto 5 years:10microgram.

For pregnant women lactating mothers:10microgram.

For old children and adults:2.5microgram.

VITAMIN D

Regulates calcium and phosphorous metabolism and is influenced by feedback system like hormones.

Control calcification of dentin and enamel by regulating calcium absorption at the intestines.Deficiency manifestations:

Rickets and osteomalacia :both are metabolic bone diseases produced

due to deficiency of vitaminD leading to defective formation and

malabsorption.

FUNCTIONS OF VITAMIN D

Review of studies investigating the relationship between vitamin intake and periodontal health in adults suggest that

vitamin promotes periodontal health.Using cross sectional data from over 11,000

subjects that was collected as part of the National Health and Nutrition Examination Survey(known as NHANES III),investigators

showed an inverse relationship between attachment loss and serum 25 hydroxy

vitamin D in men and women over age 50 but not among those under 50.As noted by the authors ,this finding may be explained

by the fact that periodontal disease is more prevalent at old age. Study subjects over 50

years of age has a fairly wide range of serum 25 hydroxyvitamin D levels,ranging

from less than 40.2nmol/l

VITAMIN D AND ORAL HEALTH

. From the further studies the authors also reported that there was no relashionship between bone mineral density and attachment loss.This was a somewhat surprising finding as loss of BMD at the wrist ,spine and hip are associated with a greater number of lost teeth due to loss of alveolar bone in the jaw.This finding also suggest that the potential immunomodulatory effects of vitamin D may be the predominant mechanism linking vitamin D with attachment loss..

Another study using the NHANES III data showed that subjects with the highest intake of vitamin D were less likely to bleed on probing.The relashionship was such that for every 30nmol/l increase in serum 25 hydroxyvitamin D,there was a 10%lower odds for bleeding upon probing.

The NHANES III has also been used to examine if intake of diary products relates to periodontal health.As diary foods represent a major dietary source of vitamin D as well as calcium.Over 12000 individuals were included in this analysis and the prevalence of periodontitis was markedley lower for subject with the highest quantity Of diary intake compared to those consuming low amounts of diary foods.

A strong relashionship exists.Dozens of studies were conducted in 1930s and 1940s.More than 90% of the studies

concluded that supplementing children with Vitamin D prevent caries.

Vitamin D helps the body to attack and kill the bacterial infections that destroy the

gum and lead to conditions such as gingivitis and tooth loss.

Latest study also found that vitamin D is involved in expressing some genes that

were not believed to be part of the vitamin D pathway ,but now may help in fighting

infection.It was also discovered that gum cells can activate inactive forms of vitamin D ,and

according to Gill Diamond “this means that we may even be able to use vitamin D therapy topically,if that proves true”.

VITAMIN D DEFICIENCY AND TOOTH DECAY

Supply calcium and vitamin D adequately to compensate the deficiency.

Milk is adequate source of vitamin D and calcium,so should be given in ample quantity.Therapeutic dose of vitamin D varies from 25

to 125 microgram daily orally for 6 to 12 weeks followed by 200 to 400 IU daily.In

infants and children ,such treatment causes improvement in muscle tone and strength.

MANAGEMENT OF VITAMIN D DEFICIENCY

Eight naturally occuring tocopherols possess vitamin E activity.It is a lipid soluble

vitamin ,which is transported from gastrointestinal tract by lipoprotiens and distributed widely in all

cell membranes throughout the bodyFunctions:

It act as an antioxidant rather than a cofactor,prevents oxidation of PUFA in all

membranes by free radicals.Believed to be effective in protecting against

atherogenesis by its anti oxidant effect.Daily requirement:

7 to 10 mg/day in man,5 to 8 mg/day in women.

VITAMIN E

• Sources: whole grain cereals ,vegetable oils and nuts.• Clinical deficiency: manifestations include mild hemolytic anemia,ataxia,gait disturbances,visual scotomas and decreased proprioceptive vibratory sensations .All these symptoms and signs respond to vitamin E replacement.

Vitamin E and oral healthVitamin E is a nutrient that is found in many foods.one important role vitamin E plays in the body is acting as an anti oxidant. Vitamin E is also important for boosting the immune system inorder to help fight off bacteria and viruses. Thus vitamin E helps in preventing gingivitis.Prevent luekoplakia and oral cancer.

Depending on the source of this vitamin ,it has two forms,i.e vitamin K1(phytomenedione)present in most

green leafy vegetables and K2(menequinone)synthesized by

intestinal bacteria.Daily requirement: 80microgram/daySources: high levels are found in liver,

green leafy vegetables(spinach),milk,eggs and

soyabeans,avocado. Functions and deficiency:

Best known for the role in blood clotting.plays a part in bone

health.Helps to produce osteocalcin ,a key protien used in bone remodelling.It

blocks substances that speeds breakdown of bone and helps to

regulates calcium excretion from the body in urine.When too much calcium is excreted ,the body draws what it needs

from bones.

VITAMIN K

Deficiency hinder blood coagulation process. This results in excessive bleeding from gums and teeth even in case of minor injury of tooth extraction.Deficient individuals are susceptible to damage caused by brushing or by professional teeth cleaning.This damage does not heal quickly ,leading to continued bleeding from the site of injury.

Vitamin K and oral health Plays a part in promoting bone health in people of all ages and supports tooth development during pregnancy and childhood.Producing a key protein used in bone restoration called osteocalcin ,vitamin K slows down the breakdown of bones and regulates calcium excretion from the body.Maintaining healthy bone structure is important in warding off gum diseases and keeping your teeth healthy for a life time.

Vitamin K has also found to be effective against caries by reducing gingivitis (quinone compounds have a powerful tanning activity) and by helping in healing of gums by improved circulation.

This is a fat soluble vitamin.Functions:

1. Vision:by forming prosthetic group of a series of carotenoid protiens that provide molecular

basis for visual excitation.2. Cell differentiation:retinoic acid ,another form of vitamin A

induces epithelial cell differentiation by binding to

specific receptors which run on responsive genes.In vitamin A

deficiency ,mucus producing cells are replaced by keratin producing

cells.

VITAMIN A

1.Anti infective vitamin:deficiency predisposes to respiratory and gastro intestinal tract infection in children.

2.Essential for growth,reproduction,and maintenance of life.

3.Anti oxidant.

Daily requirement:

ageInfantsChildrenAdult maleAdult femalePregnant womenLactating mothers SourcesRetinol(animal source):milk,butter,cheese,egg yolk,fish liver oil etc…Carotene(plant source):carrot(richest source),dark green leafy vegetables,yellow fruits,red palm oil …..

Requirement400400 to 700100080010001200

Deficiency: night blindnessXerosisXerophthalmiaHyperkeratosis of skinKeratomalaciaBitots spotsVitamin A and oral healthWill cause delayed healing in the mouth.Prevent dry mouth and oral cancer.

Bioflavanoids ,also called Vitamin P are not strictly speaking a vitamin,but for easy classification it is listed as vitamin

P.The term bioflavanoids refers to many different ingredients and include hesperin,hesperidin,eriodictyol,quercet

in,rutin etc…This nutrient cannot be manufactured by the body and must be

supplied in the diet.FUNCTION

Enhance the action of vitamin C and for this reason they should be taken

together.Bioflavanoids are effectively used in the treatment of spot injuries as they

are pain relieving.In the oral cavity they can lessen the

symptoms of oral Herpes..

VITAMIN P(BIOFLAVANOIDS)

DEFICIENCY manifests as bruising.SOURCESAll citrus fruits ,berries,onions,pulses,tea,dark chocolate

Vitamin C absorptionIndicated in treatment of cataracts.Lowering blood cholesterol levels.Production of bile.

Preserve structure of capillaries ,have an anti bacterial effect and promote circulation

Vitamin FEssential fatty acids are sometimes referred to as vitamin F and are composed of two fatty acids :linoliec acid and alpha linoic acid,with linoliec acid being the most complete fatty acid. the body is not able to manufacture essential fatty acids.Vitamin F and oral healthVitamin F(sunflower oil)containing tooth pastes were found to be effective in maintaining healthy and strong gums.

Vitamins are essential for oral health,as for any other part of the

body.vitamin deficiencies can make it harder for your immune system to fend off diseases in the

mouth.since mouth is the beginning of gastrointestinal

tract any disease of mouth can have systemic manifestations.so oral health should be adequately maintained by taking proper diet

and vitamin supplements.

CONCLUSION

Advanced textbook on food and

nutrition:Dr.M.SwaminathanWilliams basic nutrition and

diet therapyAmerican Dental Journal

International Dental JournalWikipedia

Online Library.com

REFERENCE