Role of vitamins in orthodontics final /certified fixed orthodontic courses by Indian dental...

ROLE OF VITAMINS IN ROLE OF VITAMINS IN ORTHODONTICSORTHODONTICS

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Nutrition Nutrition

Nutrition is the science of food and its relationship to health.Nutrition is the science of food and its relationship to health. The nutritional sciences deal with the nature and distribution The nutritional sciences deal with the nature and distribution

of nutrients in food, their metabolic effects, and the of nutrients in food, their metabolic effects, and the consequences of inadequate food intake.consequences of inadequate food intake.

Nutrients are chemical compounds in foods that are absorbed Nutrients are chemical compounds in foods that are absorbed and used to promote health. Some nutrients are essential and used to promote health. Some nutrients are essential because they cannot be synthesized by the body and thus must because they cannot be synthesized by the body and thus must be derived from the diet.be derived from the diet.

Essential nutrients include vitamins, minerals, amino acids, Essential nutrients include vitamins, minerals, amino acids, fatty acids, and some carbohydrates as a source of energy. fatty acids, and some carbohydrates as a source of energy.

Nonessential nutrients are those that the body can synthesize Nonessential nutrients are those that the body can synthesize from other compounds, although they may also be derived from other compounds, although they may also be derived from the diet. from the diet.

Nutrients are generally divided into macronutrients and Nutrients are generally divided into macronutrients and micronutrients.micronutrients.


Macronutrients :Macronutrients :They constitute the bulk of the diet and supply They constitute the bulk of the diet and supply energy as well as essential nutrients needed for growth, energy as well as essential nutrients needed for growth, maintenance, and activity. Carbohydrates, fats (including maintenance, and activity. Carbohydrates, fats (including essential fatty acids), proteins, and water are macronutrients.essential fatty acids), proteins, and water are macronutrients.Vitamins, which are classified as water-or fat-soluble, and Vitamins, which are classified as water-or fat-soluble, and trace minerals aretrace minerals are micronutrients micronutrients Essential trace mineralsEssential trace minerals include iron, iodine, fluorine, zinc, include iron, iodine, fluorine, zinc, chromium, selenium, manganese, molybdenum, and copper. chromium, selenium, manganese, molybdenum, and copper. Except for fluorine and chromium, each of these minerals is Except for fluorine and chromium, each of these minerals is incorporated into enzymes or hormones required in incorporated into enzymes or hormones required in metabolism.metabolism.Nutritional RequirementsNutritional Requirements The objective of a proper diet is to achieve and maintain a The objective of a proper diet is to achieve and maintain a desirable body composition and a high potential for physical desirable body composition and a high potential for physical and mental work. The daily dietary requirements for essential and mental work. The daily dietary requirements for essential nutrients, including energy sources, depend on age, sex, height, nutrients, including energy sources, depend on age, sex, height, weight, and metabolic and physical activity. weight, and metabolic and physical activity.


VITAMINSVITAMINS

Vitamins are organic nutrients that are required in Vitamins are organic nutrients that are required in small quantities for a variety of biochemical small quantities for a variety of biochemical functions and which generally cannot be functions and which generally cannot be synthesized by the body and therefore be supplied synthesized by the body and therefore be supplied by the diet. by the diet.

Vitamins are not related chemically, but are Vitamins are not related chemically, but are considered as a group because of the similarity in considered as a group because of the similarity in their functions. their functions.

Vitamins being accessory food factors, are essential Vitamins being accessory food factors, are essential for metabolic reactions and form coenzymes to for metabolic reactions and form coenzymes to many enzyme systems.many enzyme systems.


The vitamins are named one after another as they were discovered as The vitamins are named one after another as they were discovered as A,B,C,D and so on, and each one of them has a different chemical A,B,C,D and so on, and each one of them has a different chemical nature. The nature of solubility was made use of, in classifying them nature. The nature of solubility was made use of, in classifying them into two groups. They are as followsinto two groups. They are as follows

vitaminsvitaminsFat soluble water solubleFat soluble water solubleVitamin A non B-complex vitamin B-Vitamin A non B-complex vitamin B-

complexcomplexVitamin D Vitamin C Vitamin D Vitamin C energy releasing hematopoiticenergy releasing hematopoitic

Vitamin E Thiamin B1 Folic acidVitamin E Thiamin B1 Folic acidVitamin K Riboflavin B2 Vitamin K Riboflavin B2

CyanocobalaminCyanocobalamin Niacin B3 (vitamin B12) Niacin B3 (vitamin B12) Pyridoxine B6 Pyridoxine B6 Biotin B7Biotin B7 Pantothenic acidPantothenic acid


Vitamin AVitamin A The fat soluble vitamin A is present only in foods of animal The fat soluble vitamin A is present only in foods of animal

origin, however its provitamins carotenes are found in plants.origin, however its provitamins carotenes are found in plants. Dietary sources:Dietary sources: animal sourcesanimal sources contain preformed vitamin A, contain preformed vitamin A,

like liver, kidney, egg yolk, milk, cheese, butter, fish (cod or like liver, kidney, egg yolk, milk, cheese, butter, fish (cod or shark) liver oils.shark) liver oils.

Vegetable sourcesVegetable sources contain provitamin A-carotenes. Yellow and contain provitamin A-carotenes. Yellow and dark green vegetables and fruits are good sources e.g. carrots, dark green vegetables and fruits are good sources e.g. carrots, spinach, amaranthus, pumpkins, papaya, mango etcspinach, amaranthus, pumpkins, papaya, mango etc

Biochemical functions: Biochemical functions: Vitamin A is necessary for a variety of functions like vision, Vitamin A is necessary for a variety of functions like vision, proper growth and differentiation, proper growth and differentiation, reproduction andreproduction and maintenance of epithelial cells.maintenance of epithelial cells. Carotenoids function as antioxidants and reduce the risk of Carotenoids function as antioxidants and reduce the risk of

cancers initiated by the free radicals and strong oxidants.cancers initiated by the free radicals and strong oxidants.www.indiandentalacademy.com

Recommended dietary requirementRecommended dietary requirement Adults-750ug,Adults-750ug, Infants and young children- 300ug,Infants and young children- 300ug, Women during pregnancy and lactation- 1200ugWomen during pregnancy and lactation- 1200ugDeficiency manifestationsDeficiency manifestations: they are mainly related to the eyes, skin : they are mainly related to the eyes, skin

and growthand growth Effect on eyesEffect on eyes: night blindness (nyctalopia), xeropthalmia, : night blindness (nyctalopia), xeropthalmia,

keratomalaciakeratomalacia On growthOn growth: retardation due to impairment in skeletal formation: retardation due to impairment in skeletal formation On reproductionOn reproduction: degeneration of germinal epithelium leads to : : degeneration of germinal epithelium leads to :

sterility in males, termination of pregnancy due to fetal deathsterility in males, termination of pregnancy due to fetal death On skin and epithelial cellsOn skin and epithelial cells: keratinization of epithelial cells.: keratinization of epithelial cells.Hypervitaminosis A:Hypervitaminosis A: Excessive consumption of vitamin A leads to Excessive consumption of vitamin A leads to

toxicity. Symptoms include dermatitis, hepatomegaly, skeletal toxicity. Symptoms include dermatitis, hepatomegaly, skeletal decalcification, tenderness of long bones and joints, loss of weight decalcification, tenderness of long bones and joints, loss of weight etc. ingestion of high quantities of vitamin A by pregnant women etc. ingestion of high quantities of vitamin A by pregnant women induces risk of congenital malformations in the developing fetusinduces risk of congenital malformations in the developing fetus www.indiandentalacademy.com

Vitamin DVitamin D Vitamin D is a fat soluble vitamin resembling sterols in structure Vitamin D is a fat soluble vitamin resembling sterols in structure

and functions like a hormoneand functions like a hormoneSources : Sources : include fatty fish, fish liver oils, egg yolk etc, by irradiating include fatty fish, fish liver oils, egg yolk etc, by irradiating

foods (yeast) that contains precursors of vitamin D, and natural foods (yeast) that contains precursors of vitamin D, and natural sunlight. sunlight.

Recommended daily requirement: Recommended daily requirement: Vitamin D is required for proper growth of the skeleton, Vitamin D is required for proper growth of the skeleton,

recommended doses arerecommended doses are Infants: 400 to 800 IU dailyInfants: 400 to 800 IU daily Children and adolescents: 400 IU dailyChildren and adolescents: 400 IU daily During pregnancy and lactation: 400 to 800 IU dailyDuring pregnancy and lactation: 400 to 800 IU dailyBiochemical functionsBiochemical functions: ergocalciferol and cholecalciferol are the : ergocalciferol and cholecalciferol are the

sources of vitamin D activity and are referred to as provitamins. sources of vitamin D activity and are referred to as provitamins. The biologically active form is calcitriol.The biologically active form is calcitriol.

Calcitriol regulates the plasma calcium levels of calcium and Calcitriol regulates the plasma calcium levels of calcium and phosphate. It acts on intestine, bone and kidney to maintain phosphate. It acts on intestine, bone and kidney to maintain calcium levels.calcium levels.


Deficiency manifestations:Deficiency manifestations:

Results in demineralization of bone . The result is rickets in Results in demineralization of bone . The result is rickets in children and osteomalacia in adults.children and osteomalacia in adults.

Rickets in children is characterized by bone deformities due to Rickets in children is characterized by bone deformities due to incomplete mineralization resulting in soft and pliable bones and incomplete mineralization resulting in soft and pliable bones and delay in teeth formation. In osteomalacia demineralization of delay in teeth formation. In osteomalacia demineralization of bone occurs making them susceptible to fracture.bone occurs making them susceptible to fracture.

Hypervitaminosis D: Hypervitaminosis D: toxic effects of hypervitaminosis include toxic effects of hypervitaminosis include demineralization of bone (resorption) and increased calcium demineralization of bone (resorption) and increased calcium absorption from the intestine, leading to hypercalcemia. absorption from the intestine, leading to hypercalcemia. Prolonged hypercalcemia leads to deposition of calcium in the Prolonged hypercalcemia leads to deposition of calcium in the soft tissues such as kidneys, blood vessels, forming renal calculi soft tissues such as kidneys, blood vessels, forming renal calculi (stones). High consumption of vitamin D is associated with loss (stones). High consumption of vitamin D is associated with loss of appetite, nausea, increased thirst, loss of weight etc.of appetite, nausea, increased thirst, loss of weight etc.


Vitamin E (Tocopherols)Vitamin E (Tocopherols) This is a naturally occurring antioxidant essential for normal This is a naturally occurring antioxidant essential for normal

reproduction and hence known s ‘anti sterility vitamin’.reproduction and hence known s ‘anti sterility vitamin’. Sources : occur abundantly in plants. Sources : occur abundantly in plants. All green plants, especially lettuce and Alfa alfa are rich sources.All green plants, especially lettuce and Alfa alfa are rich sources. vegetable oils like wheat germ oil and seed germ oil, vegetable oils like wheat germ oil and seed germ oil, milk, eggs and meat are also good sources.milk, eggs and meat are also good sources. Biochemical functions:Biochemical functions: vitamin E prevents the non enzymatic vitamin E prevents the non enzymatic

oxidation of various cell components by molecular oxygen and oxidation of various cell components by molecular oxygen and free radicals such as super oxide (Ofree radicals such as super oxide (O22

--) and hydrogen peroxide ) and hydrogen peroxide (H(H22OO22).).

Recommended requirement:Recommended requirement: 20-25mg . 20-25mg . Deficiency manifestations: Deficiency manifestations: associated with sterility, associated with sterility,

degenerative changes in the muscle, megaloblastic anemia and degenerative changes in the muscle, megaloblastic anemia and changes in the central nervous system.changes in the central nervous system.


Vitamin KVitamin K This is the only fat soluble vitamin with a specific coenzyme This is the only fat soluble vitamin with a specific coenzyme

function. It is required for the production of blood clotting function. It is required for the production of blood clotting factors, hence essential in coagulation.factors, hence essential in coagulation.

Sources:Sources: cabbage, cauliflower, tomatoes, Alfa alfa, spinach and cabbage, cauliflower, tomatoes, Alfa alfa, spinach and other green vegetables are good sources. It is also present in egg other green vegetables are good sources. It is also present in egg yolk, meat, liver, cheese and dairy products.yolk, meat, liver, cheese and dairy products.

Biochemical functionsBiochemical functions: concerned with the blood clotting process. : concerned with the blood clotting process. It brings about post-translational modification of certain blood It brings about post-translational modification of certain blood clotting factors.clotting factors.

Deficiency manifestations:Deficiency manifestations: leads to the lack of active prothrombin leads to the lack of active prothrombin in the circulation, adversely affecting the blood coagulation. The in the circulation, adversely affecting the blood coagulation. The blood clotting time is increased.blood clotting time is increased.

Hypervitaminosis KHypervitaminosis K: administration of large doses produces : administration of large doses produces hemolytic anemia and jaundice particularly in infants. The toxic hemolytic anemia and jaundice particularly in infants. The toxic effect is due to increased breakdown of RBC.effect is due to increased breakdown of RBC.


Vitamin C (Ascorbic acid)Vitamin C (Ascorbic acid) This is a water soluble vitamin playing an important role in This is a water soluble vitamin playing an important role in

human health and disease. human health and disease. SourcesSources: in plants abundantly seen in citrus fruits, berries, melons, : in plants abundantly seen in citrus fruits, berries, melons,

sprouting seeds, leafy vegetables, spinach, cauliflower, cabbage, sprouting seeds, leafy vegetables, spinach, cauliflower, cabbage, tomatoes, drumstick and guava. In animals present in liver, tomatoes, drumstick and guava. In animals present in liver, kidneys and adrenal cortex.kidneys and adrenal cortex.

Recommended requirementRecommended requirement: 75-100 mg per day. : 75-100 mg per day. Biochemical functions:Biochemical functions: most important function of vitamin C is its most important function of vitamin C is its

property to undergo reversible oxidation.property to undergo reversible oxidation. Vitamin C plays an important role in collagen formation, acting Vitamin C plays an important role in collagen formation, acting

as a coenzyme, thereby facilitating cross linkage of collagen as a coenzyme, thereby facilitating cross linkage of collagen fibers and increases its strength.fibers and increases its strength.

Helps in bone formation, plays a role in iron and hemoglobin Helps in bone formation, plays a role in iron and hemoglobin metabolism, takes part in the metabolic reactions of tryptophan, metabolism, takes part in the metabolic reactions of tryptophan, tyrosine, folic acid and cholesterol, enhances the synthesis of tyrosine, folic acid and cholesterol, enhances the synthesis of


Immunoglobulins and increases their phagocytic action and Immunoglobulins and increases their phagocytic action and also acts as a strong biological antioxidant.also acts as a strong biological antioxidant.Deficiency manifestations.:Deficiency manifestations.: leads to scurvy, characterized by leads to scurvy, characterized by spongy and sore gums, loose teeth, swollen joints, anemia, spongy and sore gums, loose teeth, swollen joints, anemia, fragile blood vessels, delayed wound healing, hemorrhage, fragile blood vessels, delayed wound healing, hemorrhage, osteoporosis etc.osteoporosis etc.Hypervitaminosis CHypervitaminosis C : mega doses of vitamin C are used in : mega doses of vitamin C are used in common cold, wound healing trauma etc. as an antioxidant, common cold, wound healing trauma etc. as an antioxidant, ascorbic acid certainly provides health benefits. However, the ascorbic acid certainly provides health benefits. However, the potential toxic effects of mega doses of vitamin C cannot be potential toxic effects of mega doses of vitamin C cannot be ignored. ignored. Ascorbic acid, as such, is not toxic. But, dehydroascorbic acid Ascorbic acid, as such, is not toxic. But, dehydroascorbic acid (oxidized form of ascorbic acid) is toxic. Further, oxalate is a (oxidized form of ascorbic acid) is toxic. Further, oxalate is a major metabolite of vitamin C. oxalates have been implicated major metabolite of vitamin C. oxalates have been implicated in the formation of kidney stones.in the formation of kidney stones.


Vitamin B-complexVitamin B-complex

B-complex group of vitamins comprise a large number of water B-complex group of vitamins comprise a large number of water soluble vitamins which are nutritional essentials for all forms of soluble vitamins which are nutritional essentials for all forms of life, from the lowest form of yeast and bacteria to the highest life, from the lowest form of yeast and bacteria to the highest form, the man. Apart from being important nutritionally, they form, the man. Apart from being important nutritionally, they form essential co enzymes to certain important intracellular form essential co enzymes to certain important intracellular enzyme systems. There are about individual components, most enzyme systems. There are about individual components, most of them are synthesized by the microbial flora.of them are synthesized by the microbial flora.

Components of vitamin B complex are:-Components of vitamin B complex are:-1.Thiamine 1.Thiamine 2.Riboflavin2.Riboflavin3. Niacin3. Niacin4.Pyridoxine4.Pyridoxine5.Pantothenic acid5.Pantothenic acid6.Biotin6.Biotin7.Folic acid group7.Folic acid group8.cyanocobalamin8.cyanocobalamin


Vitamin B1- Thiamin (anti beriberi, antineuritic Vitamin B1- Thiamin (anti beriberi, antineuritic vitamin)vitamin)

Free thiamin is basic and is heat stable. It has a specific Free thiamin is basic and is heat stable. It has a specific coenzyme, thiamine pyrophosphate (TPP), which is mostly coenzyme, thiamine pyrophosphate (TPP), which is mostly associated with carbohydrate metabolism.associated with carbohydrate metabolism.

Dietary sources:Dietary sources: cereals, pulses, oil seeds, nut and yeast are cereals, pulses, oil seeds, nut and yeast are good sources. Thiamine is mostly concentrated in the outer good sources. Thiamine is mostly concentrated in the outer layer (bran) of cereals. Also present in animal foods like pork, layer (bran) of cereals. Also present in animal foods like pork, liver heart, kidney, milk, etcliver heart, kidney, milk, etc

Biochemical functions:Biochemical functions: The enzyme thiamine pyrophosphate or The enzyme thiamine pyrophosphate or cocarboxylase is intimately connected with the energy cocarboxylase is intimately connected with the energy releasing reactions in the carbohydrate metabolism.releasing reactions in the carbohydrate metabolism.

TPP also plays an important role in the transmission of nerve TPP also plays an important role in the transmission of nerve impulse. This is because TPP is required for acetylcholine impulse. This is because TPP is required for acetylcholine synthesis and the ion translocation of neural tissue. synthesis and the ion translocation of neural tissue.

Recommended requirements:Recommended requirements: for an average man who takes for an average man who takes 3000 calories of food 1.5mg of thiamine is recommended.3000 calories of food 1.5mg of thiamine is recommended.


Deficiency manifestationsDeficiency manifestations : The deficiency of vitamin B1 results : The deficiency of vitamin B1 results in a condition called in a condition called beriberi. beriberi. The early symptoms of thiamine The early symptoms of thiamine deficiency are loss of appetite (anorexia), weakness, constipation, deficiency are loss of appetite (anorexia), weakness, constipation, nausea, mental depression, peripheral neuropathy, irritability etc.nausea, mental depression, peripheral neuropathy, irritability etc.In adults, two types of beriberi, namely wet and dry beriberi occur. In adults, two types of beriberi, namely wet and dry beriberi occur. Infantile type of beriberi is also seen.Infantile type of beriberi is also seen.Wet beriberiWet beriberi is characterized by cardiovascular manifestations is characterized by cardiovascular manifestations including edema of legs, face, trunk and serous cavities, with including edema of legs, face, trunk and serous cavities, with breathlessness and palpitations, along with increase in systolic and breathlessness and palpitations, along with increase in systolic and decrease in diastolic blood pressure.decrease in diastolic blood pressure.Dry beriberiDry beriberi is associated with neurological manifestations is associated with neurological manifestations resulting in peripheral neuritis, with progressive weakening in resulting in peripheral neuritis, with progressive weakening in muscles resulting in difficulty to walk.muscles resulting in difficulty to walk.Infantile beriberi:Infantile beriberi: seen in infants born to mothers suffering from seen in infants born to mothers suffering from thiamine deficiency, characterized by sleeplessness, restlessness, thiamine deficiency, characterized by sleeplessness, restlessness, vomiting, convulsions and bouts of screaming, these are due to vomiting, convulsions and bouts of screaming, these are due to cardiac dilatation. cardiac dilatation.


Riboflavin (vitamin B2)Riboflavin (vitamin B2)

Riboflavin through its coenzymes Flavin mononucleotide (FMN) Riboflavin through its coenzymes Flavin mononucleotide (FMN) and Flavin adenine dinucleotide (FAD) takes part in a variety of and Flavin adenine dinucleotide (FAD) takes part in a variety of cellular oxidation-reduction reactions. Enzymes that use flavin cellular oxidation-reduction reactions. Enzymes that use flavin coenzymes are called coenzymes are called flavoproteinsflavoproteins, many flavoproteins contain , many flavoproteins contain metal atoms and hence known as metal atoms and hence known as metalloflavoproteins.metalloflavoproteins.

Recommended requirement: forRecommended requirement: for adults- 1.5-1.8 mg. Pregnant and adults- 1.5-1.8 mg. Pregnant and lactating women and children require 2.0-2.5 mg daily.lactating women and children require 2.0-2.5 mg daily.

Dietary sources:Dietary sources: milk and milk products, meat, eggs, liver, kidney milk and milk products, meat, eggs, liver, kidney are rich sources. Cereals, fruits, vegetables and fish are moderate are rich sources. Cereals, fruits, vegetables and fish are moderate sources.sources.

Deficiency symptoms:Deficiency symptoms: includes cheilosis, glossitis, and dermatitis. includes cheilosis, glossitis, and dermatitis. Riboflavin deficiency as such is uncommon, it is seen along with Riboflavin deficiency as such is uncommon, it is seen along with other vitamin deficiencies. Chronic alcoholics are more other vitamin deficiencies. Chronic alcoholics are more susceptible to this vitamin deficiency.susceptible to this vitamin deficiency.


Niacin ( nicotinic acid)Niacin ( nicotinic acid)Also known as the pellagra preventive factor of Also known as the pellagra preventive factor of

Goldberg.Goldberg.The coenzymes of niacin are synthesized by the essential The coenzymes of niacin are synthesized by the essential

amino acid, tryptophan. These coenzymes NADamino acid, tryptophan. These coenzymes NAD++ and and NADPNADP++ are involved in a variety of oxidation-reduction are involved in a variety of oxidation-reduction reactions.reactions.

Recommended daily requirementRecommended daily requirement: for adults it is 17 to : for adults it is 17 to 21 mg. Increased amounts are required during 21 mg. Increased amounts are required during adolescence, pregnancy and lactation.adolescence, pregnancy and lactation.

Dietary sources:Dietary sources: the rich natural sources of niacin the rich natural sources of niacin include liver, yeast, whole grains, pulses like beans and include liver, yeast, whole grains, pulses like beans and peanuts. Milk, fish, eggs and vegetables are moderate peanuts. Milk, fish, eggs and vegetables are moderate sources. The essential amino acid tryptophan can serve sources. The essential amino acid tryptophan can serve as a precursor for the synthesis of nicotinamide as a precursor for the synthesis of nicotinamide coenzymes.coenzymes.


Deficiency manifestationsDeficiency manifestations: niacin deficiency results in a : niacin deficiency results in a condition called as pellagra. The disease pellagra involves condition called as pellagra. The disease pellagra involves skin, gastrointestinal tract and central nervous system. skin, gastrointestinal tract and central nervous system. Symptoms are commonly referred to as three D’s. the Symptoms are commonly referred to as three D’s. the disease also progresses in the order disease also progresses in the order dermatitis, diarrhea, dermatitis, diarrhea, dementia, dementia, and if not treated may rarely lead to and if not treated may rarely lead to deathdeath (4 (4thth D). D). The symptoms of dementia include anxiety, irritability, poor The symptoms of dementia include anxiety, irritability, poor memory, insomnia etc.memory, insomnia etc.Therapeutic uses:Therapeutic uses: administration of niacin in administration of niacin in pharmacological doses results in a number of biochemical pharmacological doses results in a number of biochemical effects in the body. These are believed to be due to the effects in the body. These are believed to be due to the influence of niacin on cyclic AMP levels.influence of niacin on cyclic AMP levels.


Pyridoxine (vitamin B6)Pyridoxine (vitamin B6)Vitamin B6 is sued to collectively represent the three compounds Vitamin B6 is sued to collectively represent the three compounds

namely namely pyridoxine, pyridoxal pyridoxine, pyridoxal and and pyridoxamine.pyridoxamine.The active form of vitamin B6 is the coenzyme pyridoxal phosphate The active form of vitamin B6 is the coenzyme pyridoxal phosphate

(PLP). PLP is closely associated with the metabolism of amino (PLP). PLP is closely associated with the metabolism of amino acids. The synthesis of certain specialized products like serotonin, acids. The synthesis of certain specialized products like serotonin, histamine, niacin coenzymes from amino acids are dependent on histamine, niacin coenzymes from amino acids are dependent on pyridoxine. PLP participates in reactions like transamination, pyridoxine. PLP participates in reactions like transamination, decarboxylation, deamination, transsulfuration, condensation etc.decarboxylation, deamination, transsulfuration, condensation etc.

Recommended daily requirementRecommended daily requirement: for an adult 2-2.2 mg/day. During : for an adult 2-2.2 mg/day. During pregnancy, lactation and old age an intake of 2.5mg/day is pregnancy, lactation and old age an intake of 2.5mg/day is recommended.recommended.

Dietary sources: Dietary sources: animal sources such as egg yolk, fish, milk, meat are animal sources such as egg yolk, fish, milk, meat are rich in B6. wheat, corn, cabbage, roots and tubers are good rich in B6. wheat, corn, cabbage, roots and tubers are good vegetable sources.vegetable sources.


Deficiency symptomsDeficiency symptoms: : pyridoxine deficiency is associated with pyridoxine deficiency is associated with neurological symptoms such as depression, irritability, nervousness neurological symptoms such as depression, irritability, nervousness and mental confusion. Convulsions and peripheral neuropathy are and mental confusion. Convulsions and peripheral neuropathy are observed in severe deficiency. These symptoms are related to the observed in severe deficiency. These symptoms are related to the decrease in the synthesis of biogenic amines like serotonin, nor decrease in the synthesis of biogenic amines like serotonin, nor epinephrine and epinephrine. Demyelination of neurons is also epinephrine and epinephrine. Demyelination of neurons is also observed. Decrease in hemoglobin levels, associated with observed. Decrease in hemoglobin levels, associated with hypochromic microcytic anemia, is seen in B6 deficiency, this is due hypochromic microcytic anemia, is seen in B6 deficiency, this is due to the decrease in heme production.to the decrease in heme production.


Biotin Biotin

Biotin, also called as anti-egg white injury factor, vitamin Biotin, also called as anti-egg white injury factor, vitamin B7 or vitamin H, is a sulfur containing B-complex B7 or vitamin H, is a sulfur containing B-complex vitamin.vitamin.

Biotin acts as a carrier of COBiotin acts as a carrier of CO2 2 in carboxylation reactions.in carboxylation reactions.Dietary sources:Dietary sources: biotin is widely distributed in both biotin is widely distributed in both

animal and plant foods. The rich sources are liver, animal and plant foods. The rich sources are liver, kidney, egg yolk, milk, tomatoes, grains, etc.kidney, egg yolk, milk, tomatoes, grains, etc.

Recommended daily requirement: Recommended daily requirement: 100-300 mg for 100-300 mg for adults, but this vitamin is abundantly synthesized by the adults, but this vitamin is abundantly synthesized by the intestinal bacteria.intestinal bacteria.

Deficiency symptoms: Deficiency symptoms: symptoms include anemia, loss of symptoms include anemia, loss of appetite, nausea, dermatitis, glossitis etc. biotin appetite, nausea, dermatitis, glossitis etc. biotin deficiency is not common since it is well distributed in deficiency is not common since it is well distributed in foods and also supplied by the intestinal bacteria.foods and also supplied by the intestinal bacteria.


Pantothenic acidPantothenic acid

Pantothenic acid, also known as chick anti-dermatitis Pantothenic acid, also known as chick anti-dermatitis factor or filtrate factor, is widely distributed in nature. factor or filtrate factor, is widely distributed in nature. The functions of pantothenic acid are exerted through The functions of pantothenic acid are exerted through coenzyme A or CoA. CoA is the central molecule coenzyme A or CoA. CoA is the central molecule involved in all the metabolisms (carbohydrate, lipid involved in all the metabolisms (carbohydrate, lipid and protein), acting as the carrier of activated acetyl or and protein), acting as the carrier of activated acetyl or acyl groups.acyl groups.

Recommended dietary requirementRecommended dietary requirement: 5-10 mg for : 5-10 mg for adults.adults.

Dietary sources:Dietary sources: widely distributed in plants and widely distributed in plants and animals, rich sources are egg, liver, meat, yeast, milk animals, rich sources are egg, liver, meat, yeast, milk etc.etc.

Deficiency symptomsDeficiency symptoms: no deficiency manifestations in : no deficiency manifestations in manman


Folic acid Folic acid

Folic acid or folacin is abundantly found in green leafy Folic acid or folacin is abundantly found in green leafy vegetables. It is important for one carbon metabolism and vegetables. It is important for one carbon metabolism and is required for the synthesis of certain amino acids, is required for the synthesis of certain amino acids, purines and the pyrimidine-thymine.purines and the pyrimidine-thymine.

Tetrahydrofolate (THF or FHTetrahydrofolate (THF or FH44), the coenzyme of folic acid ), the coenzyme of folic acid is actively involved in the one carbon metabolism. THF is actively involved in the one carbon metabolism. THF serves as an acceptor or donor of carbon units in a variety serves as an acceptor or donor of carbon units in a variety of reactions involving amino acid and nucleotide of reactions involving amino acid and nucleotide metabolism.metabolism.

Recommended daily requirementRecommended daily requirement: around 100ug. In the : around 100ug. In the women, higher intakes are recommended during women, higher intakes are recommended during pregnancy (300ug/day) and lactation (150ug/day).pregnancy (300ug/day) and lactation (150ug/day).

Dietary sources: Dietary sources: the rich sources are green leafy the rich sources are green leafy vegetables, whole grains, cereals, liver, kidney, yeast and vegetables, whole grains, cereals, liver, kidney, yeast and eggs. eggs.


Deficiency symptoms Deficiency symptoms :decreased production of purines :decreased production of purines and dTMP is observed which impairs DNA synthesis. and dTMP is observed which impairs DNA synthesis. Due to block in DNA synthesis, the maturation of Due to block in DNA synthesis, the maturation of erythrocytes is slowed down leading to macrocytic RBC erythrocytes is slowed down leading to macrocytic RBC leading to macrocytic anemialeading to macrocytic anemia


Vitamin B12Vitamin B12Vitamin B12 is also known as anti-pernicious anemia Vitamin B12 is also known as anti-pernicious anemia

vitamin and extrinsic factor of Castle. It has derived the vitamin and extrinsic factor of Castle. It has derived the names of cobalamine and cyanocobalamine due to the names of cobalamine and cyanocobalamine due to the presence of cobalt and cyanide groups. presence of cobalt and cyanide groups.

B12 helps in the formation of labile methyl groups, for the B12 helps in the formation of labile methyl groups, for the synthesis of thymine and therefore for synthesis of synthesis of thymine and therefore for synthesis of nucleic acids, and along with folic acid for the normal nucleic acids, and along with folic acid for the normal hemopoisis.hemopoisis.

Dietary sources:Dietary sources: not seen in plant foods. Animal sources not seen in plant foods. Animal sources are liver, kidney, eggs, milk, and meat.are liver, kidney, eggs, milk, and meat.

Deficiency symptoms: Deficiency symptoms: most important is pernicious most important is pernicious anemia characterized by low hemoglobin levels, anemia characterized by low hemoglobin levels, decreased number of erythrocytes and neurological decreased number of erythrocytes and neurological manifestations.manifestations.


Vitamin like compoundsVitamin like compounds

These are components present in food and act as These are components present in food and act as accessory factors. They areaccessory factors. They are

Choline :Choline : it is trimethylhydroxy ethylammonium it is trimethylhydroxy ethylammonium hydroxide. It is a component of phospholipids, acts as hydroxide. It is a component of phospholipids, acts as a lipotropic factor, takes part in one carbon a lipotropic factor, takes part in one carbon metabolism and in transmission of nerve impulse.metabolism and in transmission of nerve impulse.

Inositol: Inositol: is hexahydroxy-cyclohexane. Acts as a second is hexahydroxy-cyclohexane. Acts as a second messenger for the release of Camessenger for the release of Ca2+2+ ions, as a lipotropic ions, as a lipotropic factor and in synthesis of phosphotidylinositol- a factor and in synthesis of phosphotidylinositol- a constituent of cell membraneconstituent of cell membrane


Orthodontists and dentofacial orthopedists manipulate bone. Orthodontists and dentofacial orthopedists manipulate bone. The biomechanical response to altered function and applied The biomechanical response to altered function and applied loads depends on the metabolic status of the patient.loads depends on the metabolic status of the patient.

The skeletal system is composed of highly specialized The skeletal system is composed of highly specialized mineralized tissues that have both structural and metabolic mineralized tissues that have both structural and metabolic functions. Bone modeling and remodeling are distinct functions. Bone modeling and remodeling are distinct physiologic responses to integrated metabolic and mechanical physiologic responses to integrated metabolic and mechanical demands. Biomechanical manipulation of bone is the demands. Biomechanical manipulation of bone is the physiologic basis of orthodontics and dentofacial orthopedics.physiologic basis of orthodontics and dentofacial orthopedics.

Bone is the primary reservoir of calcium in the body. Bone is the primary reservoir of calcium in the body. Approximately 99% of the calcium in the body is stored on the Approximately 99% of the calcium in the body is stored on the skeleton. The continual flux of bone mineral responds to a skeleton. The continual flux of bone mineral responds to a complex interaction of endocrine, biomechanical and cell-level complex interaction of endocrine, biomechanical and cell-level control factors that maintain the serum calcium level at about control factors that maintain the serum calcium level at about 10 mg/dl.10 mg/dl.

Bone metabolismBone metabolism


Maintaining zero calcium balance requires optimal function of Maintaining zero calcium balance requires optimal function of the gut, parathyroid glands, bone, liver and kidney. PTH andthe gut, parathyroid glands, bone, liver and kidney. PTH andthe active metabolite of vitamin D, 1,25 dihydroxycholecalciferol the active metabolite of vitamin D, 1,25 dihydroxycholecalciferol (DHCC), are the major hormones involved(DHCC), are the major hormones involved


Calcium homeostasisCalcium homeostasisCalcium homeostasis is the process by which mineral Calcium homeostasis is the process by which mineral

equilibrium is maintained. Maintenance of serum calcium equilibrium is maintained. Maintenance of serum calcium levels at about 10 mg/dl is an essential life support levels at about 10 mg/dl is an essential life support function. When substantial calcium is needed to maintain function. When substantial calcium is needed to maintain the critical serum calcium level, bone structure is sacrifice. the critical serum calcium level, bone structure is sacrifice. The alveolar processes and basilar bone of the jaws also The alveolar processes and basilar bone of the jaws also are subject to metabolic bone loss. are subject to metabolic bone loss.

Calcium homeostasis is supported by three temporally related Calcium homeostasis is supported by three temporally related mechanisms: mechanisms:

1.1. Rapid flux of calcium from the bone fluid (occurs in Rapid flux of calcium from the bone fluid (occurs in seconds)seconds)

2.2. Short-term response by osteoclasts and osteoblasts Short-term response by osteoclasts and osteoblasts (extends from minutes to days) and(extends from minutes to days) and

3.3. Long term control of bone turnover (over weeks to Long term control of bone turnover (over weeks to months).months). www.indiandentalacademy.com

Instantaneous regulation of calcium homeostasis is Instantaneous regulation of calcium homeostasis is accomplished in seconds by selective transfer of calcium ions accomplished in seconds by selective transfer of calcium ions into and out of bone fluid.into and out of bone fluid.Bone fluid is separated from extracellular fluid by osteoblasts Bone fluid is separated from extracellular fluid by osteoblasts or relatively thin bone-lining cells. or relatively thin bone-lining cells. A decrease in the serum calcium level stimulates secretion of A decrease in the serum calcium level stimulates secretion of PTH, which enhances transport of calcium ions from bone PTH, which enhances transport of calcium ions from bone fluid into osteocytes and bone-lining cells. fluid into osteocytes and bone-lining cells. The active metabolite of vitamin D (1,25-DHCC) enhances The active metabolite of vitamin D (1,25-DHCC) enhances pumping of calcium ions from bone-lining calls into the pumping of calcium ions from bone-lining calls into the extracellular fluid. extracellular fluid. Within physiologic limits it is possible to support calcium Within physiologic limits it is possible to support calcium homeostasis without resorbing bone. However, a sustained homeostasis without resorbing bone. However, a sustained negative balance can be compensated for only by removing negative balance can be compensated for only by removing calcium from bone surfaces.calcium from bone surfaces.


Short term control of serum calcium levels affects rate of bone Short term control of serum calcium levels affects rate of bone resorption and formation within minutes through the action of resorption and formation within minutes through the action of three calcific hormones, PTH, 1,25-DHCC and calcitonin.three calcific hormones, PTH, 1,25-DHCC and calcitonin.

Calcitonin, a hormone produced by the interstitial cells of the Calcitonin, a hormone produced by the interstitial cells of the thyroid gland, is believed to help control hypercalcemia by thyroid gland, is believed to help control hypercalcemia by transiently suppressing bone resorption.transiently suppressing bone resorption.

PTH, acting in concert with 1,25-DHCC, accomplishes three PTH, acting in concert with 1,25-DHCC, accomplishes three important tasks: important tasks:

1. it enhances osteoclast recruitment from promonocyte 1. it enhances osteoclast recruitment from promonocyte precursors,precursors,

2. it enhances the resorption rate of existing osteoclasts, and2. it enhances the resorption rate of existing osteoclasts, and 3. it may suppress the rate at which osteoblasts form bone. 3. it may suppress the rate at which osteoblasts form bone. Long term regulation has profound effects on the skeleton. Long term regulation has profound effects on the skeleton.

Biomechanical factors, noncalcific hormones, and the Biomechanical factors, noncalcific hormones, and the metabolite mechanisms dictate mass, geometric distribution metabolite mechanisms dictate mass, geometric distribution and the mean age of the bone.and the mean age of the bone.


Flowchart of calcium homeostasis showing the roles of Flowchart of calcium homeostasis showing the roles of PTH, vitamin D, the kidneys, gut and bone.PTH, vitamin D, the kidneys, gut and bone.


Dietary calcium recommendationsDietary calcium recommendationsGroupGroup AgeAge mg/daymg/day

InfantsInfants 0-6 months0-6 months 400400

6-12 months 6-12 months 600600

ChildrenChildren 1-5 years 1-5 years 800800

6-10 years6-10 years 800-1200800-1200

Adolescents and young adultsAdolescents and young adults 11-24 years 11-24 years 1200-15001200-1500

MenMen 25-65 years25-65 years 10001000

WomenWomen 25-50 years25-50 years 10001000

pregnant or lactatingpregnant or lactating 1200-15001200-1500

Post menopausalPost menopausal

Receiving estrogen Receiving estrogen replacement replacement

therapytherapy

10001000

Not receivingNot receiving 15001500

Men and womenMen and women >65 years>65 years 15001500www.indiandentalacademy.com

ROLE OF VITAMINSROLE OF VITAMINS

Vitamin AVitamin A has a hormonal effect in the regulation of has a hormonal effect in the regulation of epithelial differentiation. One of the basic changes is epithelial differentiation. One of the basic changes is a keratinizing metaplasia of the epithelial cells, a keratinizing metaplasia of the epithelial cells, occurring throughout the body including the oral occurring throughout the body including the oral mucous membrane and salivary glands. The teeth of mucous membrane and salivary glands. The teeth of animals on a vitamin A deficient diet contains less animals on a vitamin A deficient diet contains less ash than the teeth of normal animals. Absence of this ash than the teeth of normal animals. Absence of this vitamin during the period when dental structures are vitamin during the period when dental structures are formed results in disturbance in the calcification of formed results in disturbance in the calcification of enamel and dentin, retards tooth eruption. The enamel and dentin, retards tooth eruption. The alveolar bone is retarded in its rate of formation. alveolar bone is retarded in its rate of formation.


A nutrient seldom discussed in terms of bone health is vitamin A nutrient seldom discussed in terms of bone health is vitamin K. There is, however, an association between vitamin K K. There is, however, an association between vitamin K insufficiency and reductions in bone density and possibly bone insufficiency and reductions in bone density and possibly bone strength. This may be of particular concern among people strength. This may be of particular concern among people taking vitamin K antagonists such as oral anticoagulants as a taking vitamin K antagonists such as oral anticoagulants as a significant decrease in bone mineral density has been significant decrease in bone mineral density has been observed.observed.

The most common oral manifestation of vitamin K deficiency The most common oral manifestation of vitamin K deficiency is gingival bleeding. Prothrombin levels below 35% will result is gingival bleeding. Prothrombin levels below 35% will result in bleeding following tooth brushing, however, when in bleeding following tooth brushing, however, when prothrombin level fall below 20%, spontaneous gingival prothrombin level fall below 20%, spontaneous gingival hemorrhages will occur.hemorrhages will occur.


The very structure of the body - the skin, bones, teeth, blood vessels, The very structure of the body - the skin, bones, teeth, blood vessels, cartilage, tendons and ligaments - depends on collagen. And the integrity cartilage, tendons and ligaments - depends on collagen. And the integrity of collagen, in turn, depends on vitamin C. of collagen, in turn, depends on vitamin C. In a report on ascorbic acid in In a report on ascorbic acid in Vitamin Intake and HealthVitamin Intake and Health, S.K. , S.K. Gaby Gaby and V.N. Singh explain that collagen protein requires vitamin C for and V.N. Singh explain that collagen protein requires vitamin C for "hydroxylation," a process that allows the molecule to achieve the best "hydroxylation," a process that allows the molecule to achieve the best configuration and prevents collagen from becoming weak and configuration and prevents collagen from becoming weak and susceptible to damage. Beyond that, they say, recent evidence indicates susceptible to damage. Beyond that, they say, recent evidence indicates that vitamin C increases the level of procollagen messenger RNA. that vitamin C increases the level of procollagen messenger RNA. "Collagen subunits are formed within fibroblasts as procollagen, which "Collagen subunits are formed within fibroblasts as procollagen, which is excreted into extra cellular spaces. Vitamin C is required to export the is excreted into extra cellular spaces. Vitamin C is required to export the procollagen molecules out of the cell. The final...structure of the procollagen molecules out of the cell. The final...structure of the collagen is formed after pieces of the procollagen are enzymatically collagen is formed after pieces of the procollagen are enzymatically cleaved," state Gaby and Singh.cleaved," state Gaby and Singh.


Type 1 - Connective tissue of skin, bone, teeth, tendons, Type 1 - Connective tissue of skin, bone, teeth, tendons, ligaments, fascia, organ capsules ligaments, fascia, organ capsules Type 2 - Cartilage Type 2 - Cartilage Without vitamin C, collagen formation is disrupted, Without vitamin C, collagen formation is disrupted, causing a wide variety of problems throughout the body.causing a wide variety of problems throughout the body.

The oral manifestations of vitamin C deficiency occur The oral manifestations of vitamin C deficiency occur chiefly in the gingival and periodontal tissues. The chiefly in the gingival and periodontal tissues. The interdental and marginal gingiva is swollen, bright red, interdental and marginal gingiva is swollen, bright red, with a smooth and shiny surface. In fully developed with a smooth and shiny surface. In fully developed scurvy, the gingiva becomes boggy, ulcerates and scurvy, the gingiva becomes boggy, ulcerates and bleeds. The color changes to a violaceous red. bleeds. The color changes to a violaceous red.


In severe chronic cases, hemorrhages and swelling of the In severe chronic cases, hemorrhages and swelling of the periodontal membranes occur, followed by the loss of bone periodontal membranes occur, followed by the loss of bone and loosening of teeth, which eventually exfoliate.and loosening of teeth, which eventually exfoliate.

Formation of intercellular cement substances in connective Formation of intercellular cement substances in connective tissues, bones, and dentin is defective, resulting in weakened tissues, bones, and dentin is defective, resulting in weakened capillaries with subsequent hemorrhage and defects in bone capillaries with subsequent hemorrhage and defects in bone and related structures. Hemorrhagic areas are organized and related structures. Hemorrhagic areas are organized avascularly, so that wounds heal poorly and break open easily. avascularly, so that wounds heal poorly and break open easily.

Endochondral growth ceases because osteoblasts fail to form Endochondral growth ceases because osteoblasts fail to form osteoid tissue, resulting in bone lesions. Instead, a fibrous osteoid tissue, resulting in bone lesions. Instead, a fibrous union forms between the diaphysis and the epiphysis, and union forms between the diaphysis and the epiphysis, and costochondral junctions enlarge. Densely calcified fragments costochondral junctions enlarge. Densely calcified fragments of cartilage are embedded in this fibrous tissue. of cartilage are embedded in this fibrous tissue.

Small ecchymotic hemorrhages within or along the bone or Small ecchymotic hemorrhages within or along the bone or large subperiosteal hemorrhages due to small fractures just large subperiosteal hemorrhages due to small fractures just shaftward of the white line complicate these lesions.shaftward of the white line complicate these lesions.


Oper Dent. 2003 Nov-Dec;28Oper Dent. 2003 Nov-Dec;28 Kaya.AD, Turkun.MKaya.AD, Turkun.MReversal of dentin bonding to bleached teeth.Reversal of dentin bonding to bleached teeth. Many studies have shown a considerable reduction in enamel bond Many studies have shown a considerable reduction in enamel bond

strength of resin composite restorations when the bonding procedure strength of resin composite restorations when the bonding procedure is carried out immediately after bleaching. These studies claim that is carried out immediately after bleaching. These studies claim that a certain waiting period is needed prior to restoration to reach the a certain waiting period is needed prior to restoration to reach the original bond strength values prior to bleaching. This study original bond strength values prior to bleaching. This study determined the effect of anti-oxidant applications on the bond determined the effect of anti-oxidant applications on the bond strength values of resin composites to bleached dentin. Ninety strength values of resin composites to bleached dentin. Ninety human teeth extracted for orthodontic purposes were used in this human teeth extracted for orthodontic purposes were used in this study. study.

The labial surface of each tooth was ground and flattened until dentin The labial surface of each tooth was ground and flattened until dentin appeared. The polished surfaces were subjected to nine different appeared. The polished surfaces were subjected to nine different treatments: 1) bleaching with gel (35% Rembrandt Virtuoso); 2) treatments: 1) bleaching with gel (35% Rembrandt Virtuoso); 2) bleaching with gel + 10% sodium ascorbate (SA); 3) bleaching with bleaching with gel + 10% sodium ascorbate (SA); 3) bleaching with gel + 10% butylhydroxyanisole (BHA); 4) bleaching with sol (35% gel + 10% butylhydroxyanisole (BHA); 4) bleaching with sol (35% hydrogen peroxide); 5) bleaching with sol + 10% sodium ascorbate; hydrogen peroxide); 5) bleaching with sol + 10% sodium ascorbate; 6) bleaching with sol + 10% BHA; 7) bleaching with gel + 6) bleaching with sol + 10% BHA; 7) bleaching with gel + immersed in artificial saliva for seven days; 8) bleaching with sol + immersed in artificial saliva for seven days; 8) bleaching with sol + immersed in artificial saliva for seven days; 9) no treatment.immersed in artificial saliva for seven days; 9) no treatment. www.indiandentalacademy.com

After bonding application, the resin composite in standard After bonding application, the resin composite in standard dimensions was applied to all specimens. The teeth were stored in dimensions was applied to all specimens. The teeth were stored in distilled water at 37 degrees C for 24 hours and a universal testing distilled water at 37 degrees C for 24 hours and a universal testing machine determined their resistance to shear bond strength. The machine determined their resistance to shear bond strength. The data was evaluated using ANOVA and Duncan tests. Bond strength data was evaluated using ANOVA and Duncan tests. Bond strength in the bleached dentin group significantly decreased compared to in the bleached dentin group significantly decreased compared to the control group. On the other hand, the antioxidant treatment had the control group. On the other hand, the antioxidant treatment had a reversal effect on the bond strength to dentin. After the bleaching a reversal effect on the bond strength to dentin. After the bleaching treatment, the 10% sodium ascorbate application was effective in treatment, the 10% sodium ascorbate application was effective in reversing bond strength. In the samples where antioxidant was reversing bond strength. In the samples where antioxidant was applied after the bleaching process, bonding strength in dentin applied after the bleaching process, bonding strength in dentin tissue was at the same level as those teeth kept in artificial saliva tissue was at the same level as those teeth kept in artificial saliva for seven daysfor seven days


•The B-complex vitamins, such as niacin, thiamin, riboflavin, The B-complex vitamins, such as niacin, thiamin, riboflavin, folic acid, and B12, are co-factors in energy metabolism and folic acid, and B12, are co-factors in energy metabolism and needed in DNA and RNA synthesis. This makes them needed in DNA and RNA synthesis. This makes them indispensable for tissue maintenance and the production of indispensable for tissue maintenance and the production of new cells during development and healing. new cells during development and healing. Descriptions of vitamin B deficiencies appear as early as 2600 Descriptions of vitamin B deficiencies appear as early as 2600 BC, but a majority of the reports of B vitamin deficiencies BC, but a majority of the reports of B vitamin deficiencies originate in the early 1900's when these conditions reached originate in the early 1900's when these conditions reached nearly epidemic proportions. nearly epidemic proportions. Epidemiologic and experimental studies conducted in the early Epidemiologic and experimental studies conducted in the early 1900's identified the most common symptom of B vitamin 1900's identified the most common symptom of B vitamin deficiencies to be the loss of the integrity of the oral mucosa. deficiencies to be the loss of the integrity of the oral mucosa. The oral manifestations of the loss of integrity include The oral manifestations of the loss of integrity include stomatitis, angular cheilitis, and glossitis.stomatitis, angular cheilitis, and glossitis.


Bone growth and the quality of osseous structures are Bone growth and the quality of osseous structures are very much dependent vitamin D. In deficiency states very much dependent vitamin D. In deficiency states enamel and dentin are poorly formed an eruption of enamel and dentin are poorly formed an eruption of teeth is delayed leading to misalignment of teeth in the teeth is delayed leading to misalignment of teeth in the jaws. In human rachitic teeth there is an abnormally jaws. In human rachitic teeth there is an abnormally wide predentin zone with much interglobular dentin. Jaw wide predentin zone with much interglobular dentin. Jaw growth is retarded and the alveolar processes are bulky growth is retarded and the alveolar processes are bulky and poorly calcified. In addition to abnormal cementum, and poorly calcified. In addition to abnormal cementum, the lamina dura around the teeth is frequently absent or the lamina dura around the teeth is frequently absent or poorly defined.poorly defined.


Journal of Bone and Mineral Metabolism, 2004Journal of Bone and Mineral Metabolism, 2004

Masayoshi Kawakami and Teruko Takano-Yamamoto Masayoshi Kawakami and Teruko Takano-Yamamoto Local injection of 1,25-dihydroxyvitamin D3 enhanced bone formation for Local injection of 1,25-dihydroxyvitamin D3 enhanced bone formation for

tooth stabilization after experimental tooth movement in ratstooth stabilization after experimental tooth movement in rats

The present investigation evaluated the effect of 1,25-dihydroxyvitamin D3 The present investigation evaluated the effect of 1,25-dihydroxyvitamin D3 (1,25(OH)(1,25(OH)22DD33) on alveolar bone formation during tooth movement in rats. ) on alveolar bone formation during tooth movement in rats. Orthodontic elastics were inserted between the maxillary first and second Orthodontic elastics were inserted between the maxillary first and second molars on bilateral sides in male rats. 1,25(OH)molars on bilateral sides in male rats. 1,25(OH)22DD33 was injected locally, at was injected locally, at the concentration of 10the concentration of 10–10–10 M, once every 3 days in the sub mucosal palatal M, once every 3 days in the sub mucosal palatal area of the root bifurcation of the molar on the right side.area of the root bifurcation of the molar on the right side.

Histomorphometric analysis revealed that tooth movement without Histomorphometric analysis revealed that tooth movement without application of 1,25(OH)application of 1,25(OH)22DD33 decreased the mineral appositional rate (MAR) decreased the mineral appositional rate (MAR) on the compression area at 7 days. Repeated injections of 1,25(OH)on the compression area at 7 days. Repeated injections of 1,25(OH)22DD33 in in the orthodontically treated animals distinctly stimulated alveolar bone the orthodontically treated animals distinctly stimulated alveolar bone formation on the mesial side at 14 days. There was a significant increase in formation on the mesial side at 14 days. There was a significant increase in MAR associated with elevated osteoblast surface value on the tension MAR associated with elevated osteoblast surface value on the tension surface.surface.

These findings suggest that local application of 1,25(OH)These findings suggest that local application of 1,25(OH)22DD33 enhances the enhances the reestablishment of supporting tissue, especially alveolar bone of teeth, after reestablishment of supporting tissue, especially alveolar bone of teeth, after orthodontic treatment.orthodontic treatment. www.indiandentalacademy.com

Department of Orthodontics, Gazi University Department of Orthodontics, Gazi University Faculty of Dentistry, Ankara, TurkeyFaculty of Dentistry, Ankara, Turkey..

Kale S, Kocadereli I, Atilla P, Asan E.Kale S, Kocadereli I, Atilla P, Asan E.Comparison of the effects of 1,25, DHCC and prostaglandin E2 Comparison of the effects of 1,25, DHCC and prostaglandin E2

on orthodontic tooth movement.on orthodontic tooth movement. This study compared the effects of local administrations of This study compared the effects of local administrations of

prostaglandin E2 (PGE2) and 1,25-dihydroxycholecalciferol prostaglandin E2 (PGE2) and 1,25-dihydroxycholecalciferol (1,25-DHCC) on orthodontic tooth movement in rats.(1,25-DHCC) on orthodontic tooth movement in rats.

Thirty-seven 6-week-old male Sprague-Dawley rats, weighing 160 Thirty-seven 6-week-old male Sprague-Dawley rats, weighing 160 +/- 10 g were used. Five rats served as the baseline control +/- 10 g were used. Five rats served as the baseline control group.group.

A fixed appliance system exerting 20 g of distally directed force A fixed appliance system exerting 20 g of distally directed force was applied on the maxillary incisors of 32 animals for 9 days. was applied on the maxillary incisors of 32 animals for 9 days. Eight rats served as the appliance control group; 8 received a 20-Eight rats served as the appliance control group; 8 received a 20-microL injection of dimethyl sulfoxide (solvent for 1,25-DHCC) microL injection of dimethyl sulfoxide (solvent for 1,25-DHCC) on days 0, 3, and 6; 8 received 20 microL of 10(-10) mol/L 1,25-on days 0, 3, and 6; 8 received 20 microL of 10(-10) mol/L 1,25-DHCC on days 0, 3, and 6; 8 received a single injection of 0.1 DHCC on days 0, 3, and 6; 8 received a single injection of 0.1 mL of 0.1 microgm PGE2 only on day 0. mL of 0.1 microgm PGE2 only on day 0.


There was no significant difference in tooth movement between There was no significant difference in tooth movement between the PGE2 and the 1,25-DHCC groups. Both PGE2 and 1,25-the PGE2 and the 1,25-DHCC groups. Both PGE2 and 1,25-DHCC enhanced the amount of tooth movement significantly DHCC enhanced the amount of tooth movement significantly when compared with the control group. The numbers of Howship's when compared with the control group. The numbers of Howship's lacunae and capillaries on the pressure side were significantly lacunae and capillaries on the pressure side were significantly greater in the PGE2 group than in the 1,25-DHCC group. On the greater in the PGE2 group than in the 1,25-DHCC group. On the other hand, the number of osteoblasts on the external surface of other hand, the number of osteoblasts on the external surface of the alveolar bone on the pressure side was significantly greater in the alveolar bone on the pressure side was significantly greater in the 1,25-DHCC group than in the PGE2 group. Thus, 1,25-DHCC the 1,25-DHCC group than in the PGE2 group. Thus, 1,25-DHCC was found to be more effective in modulating bone turnover was found to be more effective in modulating bone turnover during orthodontic tooth movement, because its effects on bone during orthodontic tooth movement, because its effects on bone formation and bone resorption were well balanced.formation and bone resorption were well balanced.


Quintessence Int. 2001 May;32Quintessence Int. 2001 May;32

Tyrovola JB, Spyropoulos MNTyrovola JB, Spyropoulos MN Effects of drugs and systemic factors on orthodontic treatment.Effects of drugs and systemic factors on orthodontic treatment.Orthodontic tooth movement and bone remodeling activity are Orthodontic tooth movement and bone remodeling activity are

dependent on systemic factors such as nutritional factors, dependent on systemic factors such as nutritional factors, metabolic bone diseases, age, and use of drugs. Therefore, a metabolic bone diseases, age, and use of drugs. Therefore, a comprehensive review of the effects of these factors on comprehensive review of the effects of these factors on orthodontic tooth movement is attempted in this article. orthodontic tooth movement is attempted in this article. Systemic hormones such as estrogen, androgen, and calcitonin Systemic hormones such as estrogen, androgen, and calcitonin are associated with an increase in bone mineral content, bone are associated with an increase in bone mineral content, bone mass, and a decrease in the rate of bone resorption. mass, and a decrease in the rate of bone resorption. Consequently, they could delay orthodontic tooth movement. Consequently, they could delay orthodontic tooth movement. On the contrary, thyroid hormones and corticosteroids might On the contrary, thyroid hormones and corticosteroids might be involved in a more rapid orthodontic tooth movement be involved in a more rapid orthodontic tooth movement during orthodontic therapy and have a less stable orthodontic during orthodontic therapy and have a less stable orthodontic result. result.


Drugs such as bisphosphonates, vitamin D metabolites, and Drugs such as bisphosphonates, vitamin D metabolites, and fluorides can probably cause a reduction of tooth movement fluorides can probably cause a reduction of tooth movement after the orthodontic force is applied. Nonsteroidal anti-after the orthodontic force is applied. Nonsteroidal anti-inflammatory drugs have also been shown to reduce bone inflammatory drugs have also been shown to reduce bone resorption. Long-term administration of these drugs may resorption. Long-term administration of these drugs may therefore delay the necessary bone response to respective tooth-therefore delay the necessary bone response to respective tooth-borne pressure and should not be administered for long borne pressure and should not be administered for long periods of time to patients undergoing orthodontic tooth periods of time to patients undergoing orthodontic tooth movement. Attention has also been focused on the effects of movement. Attention has also been focused on the effects of prostaglandins and leukotrienes in orthodontic tooth prostaglandins and leukotrienes in orthodontic tooth movement. It seems that they might have future clinical movement. It seems that they might have future clinical applications that could result in enhanced tooth movement. applications that could result in enhanced tooth movement. The use of the above drugs should be considered by every The use of the above drugs should be considered by every dentist in evaluating the treatment time and in planning dentist in evaluating the treatment time and in planning treatment when tooth movement is attempted.treatment when tooth movement is attempted.


ASDC J Dent Child. 1997

Orthodontic treatment of a patient with hypophosphatemic vitamin D-resistant rickets.

Kawakami M, Takano-Yamamoto T.

Hypophosphatemic vitamin D-resistant rickets, when developed later in life, is less severe and may not be characterized by rickets or other osseous deformities. A Japanese girl, age nine years and one month, was first seen in the Dental Hospital of Osaka University, complaining of the crowding of the maxillary teeth. At one year of age, the patient was admitted to Osaka University Hospital for her leg deformities. Although the patient has been administered 4 micrograms 1 alpha/-hydroxyvitamin D3 and 1.0 g phosphorous daily, the serum phosphate has been low and never reached normal level. This case was a Class II division 2 malocclusion with severe anterior crowding and retarded mandibular growth. We treated her with a functional appliance (elastic open activator), followed by the extraction of four premolars and the use of an edgewise appliance. No unfavorable root resorption or bone defect occurred. Good occlusion was achieved and the facial features were pleasing.


ConclusionConclusion

Although vitamins are required in minute quantities, they are Although vitamins are required in minute quantities, they are indispensable for maintaining the integrity and proper indispensable for maintaining the integrity and proper functioning of various body systems.functioning of various body systems.Though the clinical applications of vitamins, as far as the Though the clinical applications of vitamins, as far as the branch of orthodontics is concerned, is limited in the present branch of orthodontics is concerned, is limited in the present day situation, there may be a time when injection or day situation, there may be a time when injection or application of vitamin solutions may itself help in faster tooth application of vitamin solutions may itself help in faster tooth movement, helps faster bone formation after the desired movement, helps faster bone formation after the desired movement is achieved.movement is achieved.Research is yet to take place in this area.Research is yet to take place in this area.


References References

1.Essentials of biochemistry – Harper.1.Essentials of biochemistry – Harper.

2.R.W.Strang – Text book of Orthodontics2.R.W.Strang – Text book of Orthodontics

3.Graber and vanarsdall – Orthodontic principles 3.Graber and vanarsdall – Orthodontic principles and practice,and practice,

4. 4. Quintessence Int. 2001 Quintessence Int. 2001

5. Journal of Bone and Mineral Metabolism, 20045. Journal of Bone and Mineral Metabolism, 2004

6. Oper Dent. 2003 6. Oper Dent. 2003

7.Textbook of medical physiology by Guyton and Hall.7.Textbook of medical physiology by Guyton and Hall.

8.J.A.Salzmann – orthodontic practice and techniques8.J.A.Salzmann – orthodontic practice and techniques


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