Periodontal consideration in vitamins

1. PRESENTED BY-
Dr. SASWATI MOHANTY
MDS 1ST YEAR
DEPARTMENT OF PERIODONTOLOGY

3. Introduction
Definition
General characteristics
General Functions
Classification
Individual Characteristics
Individual Dietary Sources
Individual Function
Individual Deficiency
Individual Oral manifestation
Conclusion
Reference

4.  The word "vitamin" comes from the Latin word “vita”, means
"life”.
 Everybody must eat a certain amount of vitamins to stay healthy.
 Vitamins are chemicals found in very small amounts in many
different foods.

5. vitamins may be regarded as organic compounds required
in the diet in small amounts to perform specific biological
functions for normal maintenance of optimum growth and
health of the organism.

6. Frederick G. Hopkins, reported in
1906 that there was an unknown and
essential nutrients present in natural
foods.
Casimir Funk obtained an anti-
beriberi substance from rice polishing.
He called that substances ‘vital
amines’.
Later its become ‘VITAMINS’

7.  Vitamins are required in small quantities in the diet
 Water soluble vitamins cannot be stored in human tissue
Fat soluble vitamins can be stored in adipose tissue and the
liver
Synthetic vitamins are identical to natural vitamins

8.  They enhance immunity
Prevent and cure diseases caused by
deficiency.
Help the digestion and utilization of
mineral salts and Carbohydrates in the
body.
Give strength to digestive and nervous
system.
Maintain proper health and normal
growth.
FUNCTIONS-

9. VITAMINS
WATER
SOLUBLE
FAT SOLUBLE
NON-B COMPLEX B COMPLEX
RETINOL(A)
CHOLECALCIFEROL(D)
TOCOPHEROL(E)
PHYLLOQUIONONE(K)
FOLIC ACID(B9)
COBALAMINE(B12)
THIAMINE(B1)
RIBOFLAVIN(B2)
NIACIN(B3)
PANTOTHENIC ACID(B5)
PYRIDOXINE(B6)
ASCORBIC ACID(C)
HEMATOPOETIC
ENEGY
RELEASING

10. Fat soluble vitamins:
Vitamins that dissolve in fat. Because fat is easily stored on
our body.
The fat-soluble vitamins are A, D, E and K.

11. Water soluble vitamins
Vitamins that dissolve in
water. Water-soluble vitamins
include the B-complex
vitamins and vitamin C.
There are eight B
vitamins, including vitamin
B1, B2, B3, B5, B6, B7, B9
and B12.

13. Men and women – 600 mcg
Pregnancy and lactation –
950 mcg
Infants – 350mcg
Children – 600mcg
DAILY REQUIRMENT
 Vitamin A is a group of unsaturated nutritional organic compounds, that
includes retinol, retinal, retinoic acid and several provitamin A carotenoids,
among which beta-carotene is the most important. Its active form is present
only in Animal Tissue.
VITAMIN-A

14. DIETARY SOURCES

15. Vision
Gene transcription
Immune function
Embryonic development
Bone metabolism
Hematopoiesis
Skin and cellular health
Antioxidant activity

16.  Night blindness.
 Conjunctival xerosis
 Bitot’s spot
 Corneal xerosis
 Keratomalacia
 Retarded growth
 Skin disorders
 Effect on reproductive
organs
 Effect on bone

17. If the daily dose> 30,000mcg
toxic symptoms:-
 painful joint
 thickening of long bones.
 anorexia
 low grade fever
 rashes
 irregular menstruation
 fatigue.
 loss of hair

18. Deficiency of vitamin A -
Results in mucosal manifestations.
Degenerative changes occur in epithelial tissues,
resulting in a keratinizing metaplasia.
Results in hyperkeratosis and hyperplasia of the gingiva
with a tendency for increased periodontal pocket
formation.( Dreizen , 1962)

19. Vitamin D refers to a group of fat-soluble
secosteroids found in liver and fish oils, or obtained
by irradiating provitamin D with ultraviolet light and
are responsible for enhancing intestinal absorption
of calcium, iron, magnesium, phosphate and zinc. It
is also called SUNSHINE VITAMIN.
It is available in 2 forms-
Cholecalciferol Vitamin D3
Calciferol Vitamin D2

20. Men and women-
0.01 mg
Pregnancy and
lactation – 0.01 mg
Infants & Children
–0.01 mg
DAILY REQUIRMENT

21.  Calcium Balance
 Cell Differentiation
 Immunity
 Blood Pressure Regulation
 Development of Bones &
Teeth

22. Vitamin D - Deficiency
Rickets-
Osteomalacia
Increase the risk of osteoporosis
Rickets
The term is derived from the
old English word for "twist" or
"wrick’’
During growth, human bone is
made and maintained by the
Interaction of calcium,
phosphorus and vitamin D.

23.  it is also known as adult rickets and flat bones and diaphysis of long bones are
affected
 it is most commonly seen in post menopause female with history of low dietary
calcium intake.
 The majority of patient have bone pain &muscle weakness.

24. No studies demonstrate a relationship between
vitamin D deficiency and periodontal disease
Vitamin D deficiency on the periodontal tissues of
young dogs results in osteoporosis of alveolar bone
(Becks H, collins D A, Freytog R M, 1946)

25.  Vitamin E refers to a group of compounds that include
both tocopherols and tocotrienols.
 The word tocopherol is derived from the word toco
meaning child birth and pheros meaning to bear.
 Tocopherol α, β, γ, δ have been obtained from the natural
sources

26.  men- 8 -10mg
 Women- 5- 8mg
 Children - 8.3mg
 Infants - 4- 5mg
DAILY REQUIRMENT

27.  Act as Antioxidant
 Free radical scavenger
 Protects cell membranes
 Protection of double bonds in polyunsaturated fatty acids
 Plays a role in neurological functions, and inhibition of
platelet aggregation.
 Protects lipids and prevents the oxidation of poly unsaturated
fatty acids.

28. Deficiency of vitamin E
 Sterility
 Degenerative changes in muscle
 Megaloblastic anaemia
 Changes in central nervous system
Periodontal consideration
 No relationship has been demonstrated between deficiencies in
vitamin E and oral disease, but systemic vitamin E appears to
accelerate gingival wound healing in the rat. ( Kim J E, Shklar
G , 1983)

29.  It is available in 2 forms
 K1- it is the form occurs in plant origin.
 K2 - it is synthesized by intestinal bacteria.

30.  Men and women – 70 –
140 mcg.Per day
 Children – 35 – 75 mcg
per day
DIETARY SOURCES -
DAILY REQUIRMENT

31.  It is essential for the hepatic synthesis of coagulation factor II,
V,VII, IX, X.
 Clotting – it prevents hemorrhage only in cases when there is
defective production of prothrombin
 Oxidative phosphorylation– it acts as a co- factor in oxidative
phosphorylation associated with lipid

32.  After antibacterial therapy, surgical operations-
Cholecystectomy
 Other Conditions like
• Malabsorption
• Obstructive jaundice
• Increase clotting time
• Prolong bleeding time

33.  It is also called ascorbic acid and antibiotic vitamin.
 it is the most active reducing agent.
 it is powerful antioxidant
 Synthesized by most animals but not by human

34. Men – women – 70-
90mg
Children –40mg
Infant – 25mg
Pregnancy & lactation –
80mg
DAILY REQUIRMENT

35.  Synthesis of collagen.
 Maintenance of bones
& proper functioning
of the adrenal &
thyroid gland
 Antioxidant
 It stimulates immune
function

36.  Scurvy
 Fragility of blood vessels
 Easy bruising, hemorrhage
 Poor healing
 Pain in bones & muscle
 Poor bone formation
 Compromised immunity

37.  Bleeding, swollen gingiva and loosened teeth are common
features of scurvy.
 Ascorbic acid may play a role in periodontal disease
 Low levels of ascorbic acid influence the metabolism of
collagen within the periodontium ( Waerhaug J, 1958)
 Leading to loss of periodontal bone. ( Glickman I,1948 )
 Increases the permeability of the oral mucosa to tritiated
endotoxin and tritiated inulin and of normal human crevicular
epithelium to tritiated dextran. ( Alveres O, Siegl I, 1981)
 May interfere with the ecologic equilibrium of bacteria in
plaque

38.  Sign- Gingivitis with enlarged, hemorrhagic, bluish red
gingiva
 Acute vitamin C deficiency results in edema and hemorrhage
in the periodontal ligament, osteoporosis of the alveolar bone,
and tooth mobility (Waerhaug J, 1958 )
 Also impairs gingival healing

39.  It is also called Anti Beri-Beri factor, Anti Neuritic factor,
and also Aneurin.
 It is colorless basic organic compound composed of a sulfated
pyramiding ring.
 All living organisms use thiamine, but itis synthesized only in
bacteria, fungi, and plants.
 Coenzyme: Thiamin pyrophosphate

40.  Men – 1.3 mg per
day
 women – 1.0mg per
day
 Pregnancy and
lactation-2 mg per
day
 Children –
1.1mg.per day
DAILY REQUIRMENT

41.  Essential for converting carbohydrate into energy.
 Use of thiamine is in the treatment of beriberi
 Helps in maintaining the healthy nervous system.
 Necessary for healthy mucous membranes.
 Helps in the digestion of food.
 Provides strength to muscles.
 Useful for the proper functioning of heart.

42.  Beri beri
• Dry beri beri
• Wet beri beri
• Infantile beri beri
 Other diseases which can be associated with it are wernickes
encephalopathy, peripheral neuritis, korsakoff’spsychosis.
 Beriberi are characterized by paralysis, cardiovascular
symptoms, including edema and loss of appetite.
Periodontal Consideration
 Hypersensitivity of the oral mucosa, minute vesicles on the
buccal mucosa, under the tongue or on the palate and erosion of
the oral mucosa.( Govier W M, Greig M E, 1943)

43.  Hypersensitivity of the oral mucosa, minute vesicles on the
buccal mucosa, under the tongue or on the palate and erosion
of the oral mucosa.( Govier W M, Greig M E,1943)

44.  It is also called as beauty vitamin.
 It is yellowish green fluorescent compound soluble in
water.
 The word riboflavin is derived from 2 sources
Ribose – means many ribose sugar found in several
vitamins
Flavin – yellow

45. Men – 1.5mg
women – 1.2 mg
Pregnancy and
lactation– 2 to 2.3
mg
Children – 1.3mg
DAILY REQUIRMENT

46.  Metabolism of carbohydrates, fat & proteins.
 Helps in digestion
 Helps in proper functioning of nervous system
 Necessary for healthy mucous membranes
 Good for skin, nails and eyes
 Helps in protects the body against cancer

47.  Cheilosis
 Chapping &fissuring of lips
 Glossitis
 Inflammed Red beefy tongue

48.  Glossitis, angular cheilitis, seborrheic dermatitis, and a
superficial vascularizing keratitis.
 The glossitis is characterized by a magenta discoloration
 In mild to moderate- the dorsum exhibits a patchy atrophy of
the lingual papillae and engorged fungiform papillae(Wray D,
Lowe G D O, 1999)
 In severe- the entire dorsum is flat, with a dry and often
fissured surface.
 Changes observed in riboflavin-deficient monkeys include
severe lesions of the gingiva, periodontal tissues, and oral
mucosa, including noma
 Angular cheilitis begins as an inflammation of the
commissure of the lips, followed by erosion, ulceration, and
fissuring ( Chapman O, Harris A E ,1941)

49.  Vitamin B3 is also known as niacin or nicotinic acid.
 Essential for metabolism of carbohydrate, protein & fat.
 It is a colorless, water-soluble solid derivative of pyridine,
with a carboxyl group at the 3-position.
 It is a pyridine derivative and is a precursor of the coenzyme

50. Men – 17mg
Women – 13 mg
Pregnancy and lactation –
12 to15 mg
Children – 15mg
DAILY REQUIRMENT

51.  Helps in releasing energy from carbohydrates, fats and
protiens.
 Essential for the DNA synthesis.
 Essential for production of estrogen progesterone &
testosterone.
 Niacinamide- improve arthritis symptoms
 It helps to detoxify the body.
 Essential for the proper digestion of the food.

52.  Its deficiency results in pellagra.
 It is called disease of 3 ds
Dermatitis
 Diarrhoea
 Dementia
 Skin lesions may produce vesiculation
 Chronic cases – dermatitis occurs as - Roughening & thickening
of skin .
 If not treated may rarely lead to 4th D - Death

53.  Sign- Glossitis, gingivitis, and generalized stomatitis
 This condition is rare but may occasionally result from
malabsorption or alcoholism.
 Glossitis and stomatitis may be the earliest clinical signs of niacin
deficiency. (Manson-Bahr P,1938)
 The gingiva may be involved in aniacinosis with or without tongue
changes.
 The most common finding is NUG, usually in areas of local
irritation.
 In experimental animals include black tongue and gingival
inflammation, with destruction of the gingiva, periodontal ligament,
and alveolar bone.( Denton J, 1928)

54.  Vitamin B5 is also known as Pantothenic Acid, is a water-
soluble vitamin.
 It was discovered by Roger J. Williams in 1919.
 This word derived from greek word pantos meaning
everywhere.
 Part of Coenzyme-A
 Essential for metabolism of fat, protein, carbohydrate

55. Men – 10 mg
women – 10 mg
Children – 5.5mg
DAILY REQUIRMENT

56.  Plays an important role in helping release energy from
sugars, starches, and fats.
 Fatty acids and cholesterol - both require the coa form of b5
for their synthesis.
 They are essential for the cell metabolism.
 They are very helpful in the cholesterol metabolism.
 Accelerates wound healing.
 It is also used as anti-stress factor.

57.  Vitamin B6 is part of the vitamin B complex
group, and its active form, Pyridoxal 5'-
phosphate serves as a cofactor in many enzyme
reactions in amino acid, glucose, and lipid
metabolism.
 It is white crystalline substance soluble in water

58. Men – women – 2
mg
Children – 1.7 mg.
Infant – 0.1-0.4 mg
DAILY REQUIRMENT

59.  Make antibodies and hemoglobin
 Maintain normal nerve function
 Break down proteins. The more protein you eat, the
more vitamin B6 you need.
 Keep blood sugar in normal ranges
 Assists in the balancing of Sodium and Potassium
levels.
 Promotes RBC production
 Production of Serotonin, Dopamine, Noradrenaline
and Adrenaline

60. Neurological symptoms such as-
Depression, irritability, nervousness, mental confusion
 Convulsions and peripheral neuropathy are observed in severe
deficiency
 These symptoms are related to the decreased synthesis of
biogenic amines (GABA, seratonin, epinephrine, norepinephrine)
 Demyelination of neurons

61.  Vitamin B7 or Biotin, also known as vitamin H or
coenzyme R, is a water-solubleB-vitamin.
 Biotin is a coenzyme for carboxylase enzymes, involved in
the synthesis of fatty acids, isoleucine, and valine, and in
gluconeogenesis

62. Men – women –
100- 200 mcg
Children – 50-200
mcg.
Infant – 35 mcg
DAILY REQUIRMENT

63.  It helps the body to- convert food into glucose, which
is used to produce energy produce fatty acids and
aminoacid activate protein/amino acid metabolism in
the hair roots and fingernail cells.
Macronutrient metabolism;
Energy yielding metabolism;
Maintenance of normal skin and mucous membranes;
The normal function of the nervous system;
The maintenance of normal hair;
Normal psychological functions.

64.  Anemia
 Loss of appetite
 Nausea
 Dermatitis
 Glossitis
 Biotin deficiency is uncommon as it is well distributed In foods
and also supplied bythe intestinal bacteria

65. • Folic acid or folacin (folium-leaf) is abundantly found
in green leafy vegetables.
• It is required for synthesis of certain aminoacids, purins
and pyrimidine- thymine

66.  Adult man-400mcg
 Adult women-400-
800mcg
DAILY REQUIRMENT

67.  Helps in formation of RBC
 It is necessary for growth & division of all body cells,
 Essential for the health of skin & hair
 An important nutrient for the pregnant women & her
developing fetus
 Folic acid improves the lactation.
 DNA synthesis-transfer of single carbon units and synthesis of
adenine and guanine
 Homocysteine metabolism
 Neurotransmitter formation

68.  Macrocytic anemia
 Folic acid deficiency in pregnant women may cause
neural defects in the fetus.

69.  Folic acid–deficient animals demonstrate necrosis of the
gingiva, periodontal ligament, and alveolar bone
 The absence of inflammation is the result of deficiency-
induced granulocytopenia.
 In humans with sprue and other folic acid deficiency states,
generalized stomatitis occurs, which may be accompanied by
ulcerated glossitis and cheilitis.
 Vogel et al. (1978) reported a significant reduction of gingival
inflammation after systemic or local use of folic acid
compared with placebo. This reduction occurred with no
change in plaque accumulation.

70.  Vitamin B12 is complex organomatrix compound
called as cobalamin which is cobalt containing
porphyrin. It is freely soluble in water.

71.  Adults :3 mcg per
day
 Children :0.5-1.5
mcg per day
 During pregnancy
and lactation :4 mcg
per day
DAILY REQUIRMENT

72.  Essential for production of RBCs.
 It improves concentration, memory, & balance.
 It is important for metabolism of fat, carbohydrate ,
proteins, folic acid.
 It promotes growth and increases apatite.

73.  Perinicious anemia
 The excretion of methylmalonic acid in urine and estimation of
serum B12levelare used to assess B12 deficiency.
 Common oral effects of vitamin b deficiency are burning
sensations in the mouth and on the tongue, trouble swallowing,
swollen tongue, and pale tissues in the inner cheeks that could
break apart easily and come off

74. •Vitamins do not yield energy but enable the body to use other nutrients.
•Since the body is generally unable to synthesize them (at least in
sufficient amounts) they must be provided by food.
•A well balanced diet supplies in most instances the vitamin needs of a
healthy person.
•The minimum intake for the maintenance of health in respect of many
of the vitamins thus appears to be important.
•Vitamin C and Folic acid plays a major role in many of the important
functions of the oral cavity so it is necessary to take proper amount of
vitamin c to maintain proper function of the body.

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