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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.
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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.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 3
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.
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Physiological Roles and Requirements: Thiamin (B1)
RDAMen: 1.2 mg/dayWomen: 1.1 mg/day
No UL set at this time
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Sources: Thiamin (B1)
Lean meats and poultryWhole grain or enriched breads and cerealsEgg yolkAverage US intake 2 mg/day
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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
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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.
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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
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Sources: Riboflavin (B2)
SourcesMilk, cheddar cheese, and cottage cheeseFortified breads and cerealsLean meat, poultry, and fishLeafy green vegetables
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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.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 11
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.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 12
Sources: Niacin (B3)
SourcesLean meats, poultry, fishPeanuts and peanut butterBrewer’s yeastFortified breads and cerealsLegumesSeeds and nuts
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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
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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.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 15
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
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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.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 17
Requirements: Vitamin B6 (Pyridoxine)
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Sources:Vitamin B6 (Pyridoxine)
Meat, poultry, and fishNon-citrus fruitsWhole grainsDark green, leafy vegetablesLegumesNuts
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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
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 20
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.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 21
Sources: Folate (Folic Acid)
LiverKidney and lima beansDark green, leafy
vegetablesLean beefFortified breads and
cereals
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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.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 23
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
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.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 24
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.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 25
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.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 26
Sources:Vitamin B12 (Cobalamin)
Animal proteinOrgan meatsMilk, cheeseEggsFish
Bacterial synthesis in humans is not absorbed because it takes place in the colon
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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
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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
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.
Copyright © 2015, 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc. 29
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
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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
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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