chapter 10 vitamins required for oral soft tissues and salivary glands copyright © 2010, 2005, 1998...

CHAPTER 10CHAPTER 10

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

GLANDSGLANDS

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

2204/18/2304/18/23 Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.Copyright © 2010, 2005, 1998 by Saunders, an imprint of Elsevier Inc.

Vitamins Required for Oral Soft Vitamins Required for Oral Soft Tissues and Salivary GlandsTissues and Salivary Glands

Oral cavity site of systemic disease Oral cavity site of systemic disease manifestations for several reasons manifestations for several reasons 1.1. Rapid cellular turnover rateRapid cellular turnover rate

2.2. The constant assault by microorganismsThe constant assault by microorganisms

3.3. Trauma-intense environmentTrauma-intense environment

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

From Darby ML, Walsh MM: Dental From Darby ML, Walsh MM: Dental Hygiene: Theory and Practice, ed 2, Hygiene: Theory and Practice, ed 2, St. Louis, 2003, Saunders/Elsevier.St. Louis, 2003, Saunders/Elsevier.


Vitamins Required for Oral Soft Vitamins Required for Oral Soft Tissues and Salivary GlandsTissues and Salivary Glands

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

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

From Ibsen OAC, Phelan JA: Oral From Ibsen OAC, Phelan JA: Oral Pathology for the Dental Hygienist, ed 5, Pathology for the Dental Hygienist, ed 5,

St. Louis, 2009, Saunders/Elsevier.St. Louis, 2009, Saunders/Elsevier.


Physiological Roles and Physiological Roles and Requirements: Thiamin (BRequirements: Thiamin (B11))

First B-vitamin identifiedFirst B-vitamin identifiedFunctionsFunctions

Coenzyme for Coenzyme for metabolism of CHO and metabolism of CHO and amino acidsamino acids

Energy transformationEnergy transformationMembrane and nerve Membrane and nerve

conductionconductionCoenzyme in synthesis of Coenzyme in synthesis of

niacinniacin

RDARDAMen: 1.2 mg/dayMen: 1.2 mg/dayWomen: 1.1 mg/dayWomen: 1.1 mg/day

No UL set at this timeNo UL set at this time


Sources: Thiamin (BSources: Thiamin (B11))

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


Hypostates: Thiamin (BHypostates: Thiamin (B11))Seldom seen in US because of enriched grains Seldom seen in US because of enriched grains

in foods, except in alcoholicsin foods, except in alcoholicsSeen predominantly in countries using refined, Seen predominantly in countries using refined,

polished rice as major dietary staplepolished rice as major dietary staple

Early symptomsEarly symptomsAnorexia, indigestion, constipationAnorexia, indigestion, constipationMalaiseMalaiseHeaviness and weakness of legsHeaviness and weakness of legs

Calf muscle tendernessCalf muscle tenderness Increased pulse rate and palpitationsIncreased pulse rate and palpitations


Hypostates: Thiamin (BHypostates: Thiamin (B11))BeriberiBeriberi

Peripheral neuropathy and muscle wastingPeripheral neuropathy and muscle wastingCardiovascular symptoms include tachycardia and Cardiovascular symptoms include tachycardia and

enlarged heartenlarged heartWernicke-Korsakoff syndromeWernicke-Korsakoff syndrome

Mental confusionMental confusion 3rd leading cause of dementia in US3rd leading cause of dementia in US

Nystagmus (involuntary rapidNystagmus (involuntary rapidmovement of the eyeball)movement of the eyeball)

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

alcoholicsalcoholics

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

Europe Ltd, 1992.Europe Ltd, 1992.


Physiological Role and Requirement:Physiological Role and Requirement:Riboflavin (BRiboflavin (B22))

Physiological rolePhysiological roleInvolved in energy metabolismInvolved in energy metabolismConversion of tryptophan to niacinConversion of tryptophan to niacin

RDARDA Men: 1.3 mg/dayMen: 1.3 mg/day Women: 1.1 mg/dayWomen: 1.1 mg/day

Median intakeMedian intake Men: 2 mg/dayMen: 2 mg/day Women: 1.5 mg/dayWomen: 1.5 mg/day


Sources: Riboflavin (BSources: Riboflavin (B22))

SourcesSourcesMilk, cheddar cheese, and cottage cheeseMilk, cheddar cheese, and cottage cheeseFortified breads and cerealsFortified breads and cerealsLean meat, poultry, and fishLean meat, poultry, and fishLeafy green vegetablesLeafy green vegetables


Hypostates: RiboflavinHypostates: Riboflavin

Deficiency is rare and usually involves Deficiency is rare and usually involves secondary deficiencies of other B-vitaminssecondary deficiencies of other B-vitamins

SymptomsSymptomsBurning and itching of the eyesBurning and itching of the eyesLoss of visual acuityLoss of visual acuityDermatitisDermatitisAnemiaAnemiaGlossitis: progressive papillaryGlossitis: progressive papillary

atrophy and patchy, irregular denudationatrophy and patchy, irregular denudationAngular cheilosis (fissuring of corners of the mouth)Angular cheilosis (fissuring of corners of the mouth)

From Ibsen OAC, Phelan JA: Oral From Ibsen OAC, Phelan JA: Oral Pathology for the Dental Hygienist, ed 5. St. Pathology for the Dental Hygienist, ed 5. St.

Louis: Saunders, 2009.Louis: Saunders, 2009.


Physiological Roles and Physiological Roles and Requirements: Niacin (BRequirements: Niacin (B33))

Physiological rolePhysiological roleCoenzyme in energy metabolism from CHOsCoenzyme in energy metabolism from CHOsFats, protein metabolismFats, protein metabolism

RequirementsRequirementsRDARDA

14-16 mg/day for adults14-16 mg/day for adultsULUL

35 mg/day 35 mg/day

From Thibodeau GA, Patton KT: Anatomy & From Thibodeau GA, Patton KT: Anatomy & Physiology, ed 6. St. Louis: Mosby, 2007.Physiology, ed 6. St. Louis: Mosby, 2007.


Sources: Niacin (BSources: Niacin (B33))

SourcesSourcesLean meats, poultry, fishLean meats, poultry, fishPeanuts and peanut butterPeanuts and peanut butterBrewer’s yeastBrewer’s yeastFortified breads and cerealsFortified breads and cerealsLegumesLegumesSeeds and nutsSeeds and nuts


Hyperstates: Niacin (BHyperstates: Niacin (B33))

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

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

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

Extended-release forms of niacin produce fewer Extended-release forms of niacin produce fewer adverse effectsadverse effects


Hypostates: NiacinHypostates: Niacin

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

dietdietClassic symptoms include “3 Ds”Classic symptoms include “3 Ds”

1.1. DementiaDementia2.2. DiarrheaDiarrhea3.3. DermatitisDermatitis

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

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

and buccal mucosaand buccal mucosa Gingival inflammation may resemble ulcerative gingivitisGingival inflammation may resemble ulcerative gingivitis

From Ibsen OAC, Phelan JA: Oral From Ibsen OAC, Phelan JA: Oral Pathology for the Dental Hygienist, ed 5. St. Pathology for the Dental Hygienist, ed 5. St.

Louis: Elsevier, 2009.Louis: Elsevier, 2009.


Physiological Roles: Physiological Roles: Vitamin BVitamin B66 (Pyridoxine) (Pyridoxine)

Coenzyme in protein metabolismCoenzyme in protein metabolismConversion of tryptophan to niacinConversion of tryptophan to niacinHemoglobin synthesisHemoglobin synthesisSynthesis of unsaturated fatty acidsSynthesis of unsaturated fatty acids

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

synthesis of neurotransmitters synthesis of neurotransmitters

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.


Requirements: Requirements: Vitamin BVitamin B66 (Pyridoxine) (Pyridoxine)

RDARDA1.3-1.7 mg/day for adults1.3-1.7 mg/day for adults

ULUL100 mg/day100 mg/day

Groups at risk for deficiencyGroups at risk for deficiencyWomen of reproductive age, especially current and Women of reproductive age, especially current and

former users of oral contraceptivesformer users of oral contraceptivesMale smokersMale smokersAfrican-American menAfrican-American menIndividuals older than 65 yearsIndividuals older than 65 years


Sources:Sources:Vitamin BVitamin B66 (Pyridoxine) (Pyridoxine)

Meat, poultry, and fishMeat, poultry, and fishNon-citrus fruitsNon-citrus fruitsWhole grainsWhole grainsDark green leafy vegetablesDark green leafy vegetablesLegumesLegumesNutsNuts


Hyperstates and Hypostates:Hyperstates and Hypostates:Vitamin BVitamin B66 (Pyridoxine (Pyridoxine))

DeficiencyDeficiencyGlossitis, atrophy of Glossitis, atrophy of

filiform papillae, filiform papillae, magenta tonguemagenta tongue

Angular cheilosisAngular cheilosisPeripheral neuropathyPeripheral neuropathyImpaired immune Impaired immune

responseresponse

Toxicity symptoms Toxicity symptoms from megadosesfrom megadosesAtaxia Ataxia Severe sensory Severe sensory

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

Bone pain and muscle Bone pain and muscle weaknessweakness


Physiological Roles and Physiological Roles and Requirements: Folate (Folic Acid)Requirements: Folate (Folic Acid)

Physiological rolePhysiological roleCoenzyme for Coenzyme for

approximately 20 approximately 20 enzymesenzymes

Synthesis of DNA, RNASynthesis of DNA, RNAInvolved in maturation Involved in maturation

of RBCsof RBCsProper formation of Proper formation of

neural tubes during neural tubes during fetal development fetal development

RDARDA400 mcg/day400 mcg/day

ULUL1000 mcg/day from 1000 mcg/day from

supplementssupplements



Sources: Sources: Folate (Folic Acid)Folate (Folic Acid)

LiverLiverKidney and lima beansKidney and lima beansDark green leafy Dark green leafy

vegetablesvegetablesLean beefLean beefFortified breads and Fortified breads and

cerealscereals


Hyperstates: Folate (Folic Acid)Hyperstates: Folate (Folic Acid)

ToxicityToxicityExcess intakes may Excess intakes may

mask vitamin Bmask vitamin B1212 deficiencydeficiency

Kidney damageKidney damageIncreased risk of Increased risk of

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

Physiology Learning System, ed 3. Physiology Learning System, ed 3. Philadelphia: Saunders, 2006.Philadelphia: Saunders, 2006.


Hypostates: Folate (Folic Acid)Hypostates: Folate (Folic Acid)DeficiencyDeficiency

Neural tube defectsNeural tube defectsMegaloblastic anemiaMegaloblastic anemiaElevated blood Elevated blood

homocysteine levelshomocysteine levelsGlossitis (fiery red; Glossitis (fiery red;

denuded of papillae)denuded of papillae)Impairs immune Impairs immune

responseresponse

At risk if:At risk if:Secondary to alcohol Secondary to alcohol

abuseabusePregnancy/lactationPregnancy/lactationKidney dialysisKidney dialysisInadequate dietary Inadequate dietary

intakeintakeLiver diseaseLiver diseaseGastrointestinal Gastrointestinal

diseasediseaseMedicationsMedications



Physiological Roles/Requirements: Physiological Roles/Requirements: Vitamin BVitamin B1212 (Cobalamin) (Cobalamin)

Physiological rolesPhysiological rolesSynthesis of nucleic Synthesis of nucleic

acidsacidsMetabolism of certain Metabolism of certain

amino acids, fatty amino acids, fatty acids, carbohydrates, acids, carbohydrates, folatefolate

Formation and Formation and regeneration of red regeneration of red blood cells and for blood cells and for myelinmyelin synthesis synthesis

RDARDA2.4 µg/day2.4 µg/day

10%-30% of elderly may 10%-30% of elderly may be unable to absorb be unable to absorb naturally occurring Bnaturally occurring B1212 because of because of stomach stomach acidity/lack of intrinsic acidity/lack of intrinsic factor and may need factor and may need supplementationsupplementation

From Thibodeau GA, Patton KT: Anatomy & Physiology, From Thibodeau GA, Patton KT: Anatomy & Physiology, ed 6. St. Louis: Mosby, 2007.ed 6. St. Louis: Mosby, 2007.


Absorption:Absorption:Vitamin BVitamin B1212 (Cobalamin) (Cobalamin)

Vitamin BVitamin B12 12 in food released from protein bond in food released from protein bond

by hydrochloric acid and enzymes in stomach by hydrochloric acid and enzymes in stomach and intestine and intestine

Free vitamin BFree vitamin B1212 combines with salivary R- combines with salivary R-

binder (protein produced by the salivary binder (protein produced by the salivary glands) in stomach glands) in stomach

In the small intestine, trypsin (pancreatic In the small intestine, trypsin (pancreatic enzyme) removes R-binder and vitamin Benzyme) removes R-binder and vitamin B1212

combines with intrinsic factorcombines with intrinsic factorAbsorption of BAbsorption of B12 12 occurs at specific receptor occurs at specific receptor

sites in ileum sites in ileum onlyonly if bound to intrinsic factor if bound to intrinsic factorFrom Thibodeau GA, Patton From Thibodeau GA, Patton

KT: Anatomy & Physiology, ed KT: Anatomy & Physiology, ed 6. St. Louis: Mosby, 2007.6. St. Louis: Mosby, 2007.


Sources:Sources:Vitamin BVitamin B1212 (Cobalamin) (Cobalamin)

Animal proteinAnimal proteinOrgan meatsOrgan meatsMilk, cheeseMilk, cheeseEggsEggsFishFish

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


Hypostates:Hypostates:Vitamin BVitamin B1212 (Cobalamin) (Cobalamin)

Pernicious anemiaPernicious anemiaMacrocytic (large), Macrocytic (large),

immature red blood cellsimmature red blood cells

Glossopyrosis Glossopyrosis (unexplained pain of the (unexplained pain of the tongue)tongue)

Altered taste sensationAltered taste sensationGlossitis (smooth, Glossitis (smooth,

beefy-red tongue)beefy-red tongue)CheilosisCheilosis

Stomatitis or a pale or Stomatitis or a pale or yellowish mucosayellowish mucosa

Hemorrhagic gingiva Hemorrhagic gingiva and bone lossand bone loss

Gastrointestinal Gastrointestinal disturbancesdisturbances

Neurologic Neurologic manifestations, manifestations, numbness and tinglingnumbness and tingling

Stunted growthStunted growth


Overview: Pantothenic AcidOverview: Pantothenic AcidPhysiological rolesPhysiological roles

Metabolism of carbohydrate, fat, and protein Metabolism of carbohydrate, fat, and protein Synthesis and degradation of triglycerides, Synthesis and degradation of triglycerides,

phospholipids, and sterolsphospholipids, and sterolsFormation of certain hormones and nerve-regulating Formation of certain hormones and nerve-regulating

substancessubstances

RequirementsRequirementsAI = 5 mg/day for adultsAI = 5 mg/day for adults

SourcesSourcesAbundant in foods from animal sources, whole grainsAbundant in foods from animal sources, whole grains

Dietary deficiency has not been documentedDietary deficiency has not been documented


Overview: BiotinOverview: BiotinPhysiological rolesPhysiological roles

Coenzyme in metabolism of proteins, Coenzyme in metabolism of proteins, carbohydrates, and fatscarbohydrates, and fats

Regulating gene transcriptionRegulating gene transcriptionAids in utilization of protein, folic acid, Aids in utilization of protein, folic acid,

pantothenic acid, vitamin Bpantothenic acid, vitamin B1212

RequirementsRequirementsAI = 25-30 mcg/day for adultsAI = 25-30 mcg/day for adults

SourcesSourcesRich sources: egg yolk, liver, cerealsRich sources: egg yolk, liver, cereals



Hypostates: BiotinHypostates: BiotinDeficiency can be produced by ingestion of Deficiency can be produced by ingestion of

avidin, the protein found in raw egg whitesavidin, the protein found in raw egg whitesAvidin is denatured with cookingAvidin is denatured with cooking12 to 24 egg whites per day can produce anorexia, 12 to 24 egg whites per day can produce anorexia,

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

atrophy of lingual papillae along the lateral borders of the atrophy of lingual papillae along the lateral borders of the tonguetongue


Important Functions in Soft Oral Important Functions in Soft Oral Tissues: Other VitaminsTissues: Other Vitamins

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

Vitamin AVitamin AMaintaining integrity of epithelial tissuesMaintaining integrity of epithelial tissues

Vitamin EVitamin EAntioxidant to neutralize free radicals and promote Antioxidant to neutralize free radicals and promote

integrity of cell membranes of the mucosaintegrity of cell membranes of the mucosa


Nutrition DirectionsNutrition DirectionsA careful medical, social and dietary history, A careful medical, social and dietary history,

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

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

MyPyramid guidelinesMyPyramid guidelines

chapter 10 vitamins required for oral soft tissues and salivary glands copyright © 2010, 2005, 1998...

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