This document provides information on various vitamins. It begins with an introduction that defines vitamins and their classification. It then discusses individual vitamins - Vitamins A, D, E, K, B, and C. For each vitamin, it describes chemistry, biochemical functions, deficiency symptoms, recommended dietary allowances, and implications for dental and periodontal health. The document concludes with references. It serves as a comprehensive yet concise review of the essential roles and impacts of different vitamins.

2. CONTENTS
 Introduction
 Terminologies
 Classification
 Vitamin A
 Vitamin D
 Vitamin E
 Vitamin K
 Vitamin B
 Vitamin C
 Conclusion
 References

3. INTRODUCTION
Definition:
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
-Harper’s Illustrated Biochemistry.26th
edition.

4. Terminologies

5. • Vitamins = 'vital' and 'amine'.
Cashmir Funk 1911- ‘Vitamine’
 Other names: accessory food factors, food hormones
 Vitamers

6. Classification

8. Vitamin A

9. VITAMIN A
 2 groups: McCollum,Davis;Osborne and Mendel.(1913)
 Fat soluble vitamin- present only in foods
of animal origin.
 Pigmented carotenoids - plants

10. Chemistry
 Retinol→ß-ionone ring and the side chain
contains two isoprenoid rings,four double bonds(oxidation)
 ß carotenes- cleaved in the intestine to produce 2 mol.of
retinal, hence called provitamins. Antioxidant property.
Carotenes

11. Biochemical functions:
 Normal function of the retina
 Growth and differentiation of epithelial tissues
 Bone growth
 Gene transcription
 Immune function
 Embryonic development and reproduction

12.  Haematopoiesis
 Skin and cellular health:Isotretinoin
 Antioxidant activity

13. RDA:
5000 IU (1000 retinol equivalents*)
4000 IU (800 retinol equivalents*)
* 1 IU = 0.3 µg of retinol
Serum retinol = 30-65mg/dl

14. Vitamin AVitamin A

15. Deficiency:
 Night blindness (nyctalopia)
 Xeropthalmia
 Bitot’s spots
 Corneal ulceration – Keratomalacia
 Degenerative changes-keratinizing metaplasia-bacterial inf
 General defense mechanism of the body-impaired
 Growth retardation:impairment of skeletal formation
 Degeneration of germinal epithelium leads to sterility in
males and termination of pregnancy (fetal death) also seen

16.  In developing tooth, odontogenic epithelium fail to
undergo differentiationinc rate of cell proliferation
epithelial invasion of pulpal tissue
 Mothers (5 months before birth)distortion of shape of
incisors and molars.
Poor calcification of enamel matrixenamel
hypoplasia
 Atypical dentin cellular and vascular inclusions
 Alveolar bone  retarded rate of formation.
 Eruption rate retarded
Dental Manifestations

17. Hypervitaminosis
 Symptoms: include dermatitis, enlargement of liver,
skeletal decalcifications, tenderness of long bones, loss of
weight, irritability, loss of hair, joint pains.
 Constant headache
 pregnant women
 Total serum vitamin level is elevated.
retinol + lipoproteins =harmful to the body.
retinol binding protein exceeds=toxicosis.
Higher retinol =increases the synthesis of lysosomal
hydrolasesdestructive action of hydrolases, particularly
on the cell membranes

18. Vitamin A and periodontal diseases
 Avitaminosis has been shown to produce localized gingival
recession, epithelial hypertrophy, and hyperplasia in
monkeys, guinea pigs and dogs.
(Mellanby and King 1934; King 1935, 1937, Topping and
Fraser 1939; Mellanby 1941; Glickman and Stoller 1948;
Miglani 1959)

19.  The following periodontal changes have been reported in
vitamin A deficient rats:
– Hyperplasia and hyperkeratinization of the gingival
epithelium.
– Proliferation of junctional epithelium.
– Retardation of gingival wound healing.
– Deep periodontal pockets

20.  Transient inflammation ,gingivitis and pocket formation
have been reported in dogs
( Mellanby and King,1934)
 However later it was indicated that local irritation was
necessary before an inflammatory response is observed.
( Boyle 1941; Glickman and Stoller 1948; Frandsen 1963)
Vitamin A is controversial in its antioxidant property
At the low partial oxygen pressures- antioxidant and vice-
versa and can cause detrimental effects on the tissues
(Iain L.C. Chapple and John B. Matthews,2007)

21. Contradictory findings i.r.t bone:
 Replacement of bony trabeculae with fibrous connective
tissue ( Marshall 1927, King 1935)
 Reduced bone formation ( Boyle 1941; Miglani 1959)
 Increased thickness of bone and greater deposition on the
labial cortical plates. (Irving 1949,1956; Schour et al
1941).

22.  Frandsen (1963) put forth a theory that the
main effect of Vitamin A deficiency is to suppress
resorption by inhibiting osteoclast function.
Osteoblast function may also be reduced (Frandsen and
Becks 1962), although if the magnitude of suppression is
greater in favour of the resorbing cells, then bone
deposition will continue but at a slower rate. The time
interval-significant factor

23.  In a case report, a 20- year old woman presented with
gingival erosions, ulcerations, bleeding, swelling and a
loss of keratinization.
 Headache, dry mouth and loss of hair were also noted.
 History of taking 200,000 IU of vitamin A daily for 6
months was given.
 When the vitamin supplementation was stopped, gingival
improvement was noted in 1 week. At 2 months, the
appearance of the oral tissues was found to be normal.
A. C. de Menzes et al,1984

24. Vitamin D

25.  Vitamin D can be considered as a conditional vitamin
 Cholecalciferol (vitamin D3) :animals.
 Ergocalciferol (vitamin D2) :plants.
 RDA: 400 IU or 10µg of cholecalciferol.
In countries with good sunlight (like India), the RDA is
200 IU or 5 µg.
Serum Vit. D = 24-65 pg/ml

26. Vitamin DVitamin D

27. Biosynthesis
skin
1-hydroxylase

28.  Biological functions

29. Deficiency
 Less common (synthesized in the body).
 Occurs in strict vegetarians, chronic alcoholics,
individuals with liver and kidney diseases or fat
malabsorption syndrome.
 Leads to demineralization of bone.
 Rickets- children
osteomalacia - adults.

30. Rickets
 Derived from an old English word
wricken = twist.
 Antirachitic vitamin.
 Rickets in children is characterized by :
 bone deformities due to incomplete
mineralization, resulting in soft and
pliable bones
 delay in teeth formation.
 calcitriol
alkaline phosphatase

31.  Osteomalacia:
 Osteomalacia is derived from Greek (osteon - bone;
malakia - softness).
 Demineralization of the bones occurs increased
susceptibility to fractures.
Taylor and Day :50 % incidence of severe periodontitis in a
series of 22 indian women with osteomalacia
 Renal Rickets (renal osteodystrophy):
 It is seen in patients with chronic renal failure.
decreased synthesis of calcitriol in kidney.
 It can be treated by administration of calcitriol

32. Dental Manifestations
Mellanby:
 Developmental abnormalities of dentin and enamel
 Delayed erption
 Malaligned teeth
 Human rachitic teeth:
abnormally wide predentin zone and interglobular dentin

33. Hypervitaminosis D
 Vitamin D is mostly stored in liver and slowly
metabolized.
 Most toxic in overdoses (10-100 times RDA).
 Bone resorption and hypercalcemia
 Renal calculi
 Loss of appetite, nausea, increased thirst and loss of
weight.

34. Periodontal Implications
 Oliver et al studied that deficiency of calcium + vitamin
D there was a reduction of alveolar bone mass and greater
areas of unmineralized osteoid.
 In the periodontal ligament, the number and diameter of
the dentoalveolar fibres were reduced alteration in the
masticatory activity due to loss of the mineralized
tissue

35.  The periodontal effects of overdosing with vitamin D in
dogs have also been described (Becks 1942).
 Increased osteoblastic activity, included :
 pathological calcification of the periodontal membrane
and gingiva
 Osteosclerosis of the alveolar bone,
 Marked hypercementosis.

36.  The effect of vitamin D deficiency or imbalance on the
periodontal tissues of young dogs results in :
 osteoporosis of alveolar bone; osteoid that forms at a
normal rate but remains uncalcified; failure of osteoid to
resorb, which leads to excessive accumulation
 reduction in the width of the periodontal ligament space
 a normal rate of cementum formation, but defective
calcification and some cementum resorption
 and distortion of the growth pattern of alveolar bone.

37.  Data from the NHANES III :
 Low serum levels of vitamin D have been linked with a
loss of periodontal attachment. (immunomodulatory
effect-50 years of age.)
 The association between serum conc. of 25-
hydroxyvitamin-D and gingival inflammation were
evaluated .
 It was concluded that the anti-inflammatory effects of
vitamin D might reduce the susceptibility to gingivitis

38. Vitamin E

39. VITAMIN E
 Herbert Evans and Katherine Bishop in green leafy
vegetables (1922)
 “Antisterility vitamin.”
 Fat soluble
 Naturally occurring antioxidant.
 Tocopherols

40. Biochemical functions:
 Antioxidant property
 Membrane antioxidant- membrane integrity.
 prevents the oxidation of Vitamin A and carotenes.
 Prevents peroxidation of PUFA. Aging.

41.  nitric oxide production by vascular endothelium.
 synthesis of heme- ALA synthase and dehydratase
 cellular respiration through ETC
 Synthesis of nucleic acids.
 Protects liver –(carbon tetrachloride)
 Inhibition of protein kinase C -platelet aggregation.

42.  Storage of creatine in skeletal muscles.
 Absorption of amino acids from the intestine.
 in association with vitamins A, C and β carotene, to delay
the onset of cataract.
 Recent studies have shown that high intake of vitamin E
(about 200 – 300 mg/day) protects against the
development of heart diseases.

43.  Protects RBC from hemolysis by oxidizing
agents.
 Associated with reproductive functions and prevents
sterility (anti-sterility vitamin).
 RDA
10 mg (15 IU*)
8 mg (12 IU*)
*1 mg of alpha tocopherol = 1.5 IU
Serum level =
5-20 mcg/ml

44. Vitamin
E
Vitamin
E

45. Deficiency:
 Neurological problems due to poor nerve
conduction.
 Erythrocyte membrane fragility results as the erythrocytes
are oxidized.
 Degenerative changes in muscles
 Megaloblastic anaemia
 Depresses immunological responses to antigens,
lymphocytic proliferative responses, delayed dermal
hypersensitivity and general resistance.

46. Vitamin E and periodontal tissues:
 Ability to interfere with the production of prostaglandins.
 Goodson and Bowles(1973) used vitamin E to treat 14
patients with periodontal disease and found a reduction in
inflammation after 21 days, as determined by crevicular
fluid flow.
 Cerna et al showed that long term (12 weeks)
administration of 300 mg of Vitamin E significantly
reduced inflammation of the periodontal tissues

47.  In contrast, a cross-sectional study showed that no
significant difference existed in the serum level of
vitamin E in patients with periodontal disease when
compared to healthy controls (Slade et al. 1976).
 Schafer et al – toothpaste containing Vit E and F
maintained the bio-availabilty of zinc and triclosan and
provided with anti plaque and anti-gingivitis properties

48. Vitamin K

49. VITAMIN K
 In 1934, Dam discovered that a nutritional disease of
chicks, characterized by severe bleeding, could be cured
by alfalafa and fish meal.
 On isolation of the active principle they named it
Koagulations vitamin or Vitamin K.
 Almquist and Stokstad
 Quick and co-workers (1935) :coagulation defect in
jaundiced individualsdecrease in the concentration of
prothrombin in the blood.

50. Chemistry

51. Physiology:
 Carboxylation of certain glutamate residues in proteins
to form γ-carboxyglutamate residues.(Gla)
 The Gla-residues play key roles in the regulation of three
physiological processes:
1. Blood Coagulation
2. Bone metabolism
3. Vascular biology.
ETC and oxidative phosphorylation

52.  Blood clotting : It brings about the post-translational
modification of certain blood clotting factors. (Factor II,VII,
IX, and X )
RDA
• No RDA
120 µg
80 µg
Serum level= 1-2 mcg/kg

53. Vitamin
K
Vitamin
K

54. Deficiency
 Uncommon
 It may occur in newborn infants and in patients on
antibiotics which suppress the gut flora.
 Prolonged clotting time
 Increased risk of fractures or reduced bone density-
production of osteocalcin affected

55. Antagonists to Vitamin K
 Heparin and Coumarin derivatives
 Warfarin
 Salicylates

56. Vit K and Periodontal tissues:
 The most common oral manifestation is gingival bleeding and
post extraction hemorrhage.
Prothrombin level < 35% - bleeding on brushing.
< 20% - spontaneous bleeding occurs
 Diagnosis made on :
 Elevated prothrombin time or reduced clotting factors
 Rx: parental dose of 10 mg
 Some studies indicated an association between vitamin K and
osteoporosis; however, the relationship between vitamin K
and bone health remains unclear (
Hendler 1983)

57. THANK YOU!!!!

59. Vitamin B

60. VITAMIN B
 Eijkman (1897) polyneuritis in fowlscured by feeding
extracts of polished rice
 Jansen And Donalto (1926 )

62. THIAMINE
Admiral Takaki (1880)
Jansen and Donath(1926)
 Anti beri beri or anti neurotic vitamin.
 Chemistry:

63. Vitamin
B1
Vitamin
B1
1.4mg/day
1mg/day

64. Biological functions:
 carbohydrate metabolism as a coenzyme in the
decarboxylation of :
pyruvate
α-ketoglutarate
 Utilization of pentose in the HMP shunt;enzyme
transketolase.
 Transmission of nerve impulse , acetylcholine synthesis

65. Dry Beriberi :symmetrical ascending
peripheral neuritis.
 Initially: weakness, stiffness, and
cramps in the legs, can walk only
short distance.
 numbness of the dorsum of the feet
and ankles, vibration sense dec.
 Hyperesthetic (stocking and glove
distribution)
Anesthesia.
 Terminal stages:patient-bedridden

66. Wet Beriberi
 Heart: dilatation of arterioles, rapid blood flow, inc pulse
rate and pressure, inc JVP RHF & edema.
 The signs of CHF may be seen without peripheral
neuritis.
 lactate and pyruvate
pyruvate dehydrogenase

67. Wernicke-Korsakoff Syndrome
 Chronic alcoholics.
 The body needs of thiamine increases + Insufficient
intake or impaired intestinal absorption
 Korsakoff’s psychosis:confusion, loss of recent memory
 Wernicke’s encephalopathy: nystagmus and extraocular
palsy

68. Oral Manifestations
 Hypersensitivity of the oral mucosa
 Minute vesicles (simulating herpes) on the buccal
mucosa, under the tongue, or on the palate
 Erosion of the oral mucosa

69. RIBOFLAVIN
 Warburg and Christian (1932) identified a yellow enzyme
which contained riboflavin.

70. Physiological Functions:
 FMN and FAD- coenzymes for a wide variety of
respiratory flavoproteins.
 Redox reactions energy production.
 Carbohydrate, lipid, protein and purine metabolism
 Glutathione reductase in erythrocytes-assess deficiency

71. Vitamin
B2
Vitamin
B2
1.7mg/day
1.3mg/day

72. Deficiency: (ariboflavinosis)
 Cheilosis, glossitis and seborrhic
dermatitis, superficial
vascularizing keratitis
 Mild to moderate cases : dorsum
→ magenta, patchy atrophy of
the filiform papillae and
engorged fungiform papilla
(pebble-like elevations)
 Severe deficiency : dorsum is
flat, with a dry and fissured
surface.

73.  Angular cheilitis begins as an inflammation of the
commissure of the lipserosion, ulceration and fissuring.
 Candidiasis may develop in the commissures of
debilitated personsperleche
 Riboflavin deficient monkeys include severe lesions of
the gingiva, periodontal tissues and oral mucosa,
including noma.

74. NIACIN
 Also known as “Pellagra preventive factor of Goldberg.”
Coenzymes synthesized by tryptophan
Redox reaction

75. Vitamin
B3
Vitamin
B3
18mg/day
12-16mg/day

76. Deficiency
 Pellagra- 3 D’s
 Photosensitive dermatitis, like
severe sunburn (butterfly-like
pattern)
 Physiological conditions (e.g.
Hartnup disease and
malignant carcinoid
syndrome)
 Drug therapies (e.g. isoniazid)
can lead to niacin deficiency
(Carpenter 1983)

77.  Glossitis and stomatitis .
Tongue is “beefy red”,
glossodynia and
glossopyrosis.
(Bald tongue of Sandwith)
 Profuse salivation.
 The most common finding
is NUG usually in areas of
local irritation.
 Necrosis of gingiva and
leukopenia-terminal
features

78.  Dreizen et al(1977) stomatitis was highlighted by a
necrotizing gingivitis and periodontitis and an ulcerative
and atrophic glossitis.
 These results showed a possible predisposition of the
periodontium to aggressive forms of periodontal disease
due to a deficiency of vitamin B3intake.

79. Taguchi, S. Nippon Shishubyo
 The effects of a vitamin B3-supplemented toothpaste
(1% nicotinate ethyl ester paste )
gingival blood circulation of plaque induced gingivitis
were evaluated in a nonhuman primate model.
 gingival inflammation

80. PANTOTHENIC ACID
Derived from a Greek word Pantos - everywhere.
RDA
Adults: 5-10 mg/day
Synthesis of CoA in fatty acid synthesis.

81. Deficiency Symptoms:
 Rare
Dr. Gopalan:burning feet syndrome (pain and numbness
in the toes, sleeplessness, fatigue)
Anemia, fatty liver, decreased steroid synthesis
 Oral changes seen in animals but not in humans

82. PYRIDOXINE
The active form of Vit B6 is the coenzyme- pyridoxal
phosphate.

83. Vitamin
B6
Vitamin
B6
RDA:
Adult- 2-2.2 mg/day

84.
Biochemical Functions:
 PLP- coenzyme amino acid metabolism
(transamination and decarboxylation)
 Cofactor of glycogen phosphorylase
 steroid hormone action where it removes the
hormone-receptor complex from DNA binding

85. Deficiency:
 Rare. Foods,intestinal flora
 Depression, nervousness,
convulsions, peripheral
neuropathy.
Demyelination of neurons
 associated with a poor
prognosis in women with
breast cancer.

86.  skin lesions (e.g., acrodynia in the rat) and fissures or
ulceration at the corners of the mouth and over the tongue
 Patchy atrophy of the tongue, angular cheilitis and
glossitits. Magenta discoloration of the tongue.
 hypochromic microcytic anemia (the first step of heme
biosynthesis is PLP dependent)
 changes in leukocyte count and activity

87.  impairment of immune responses
 endocrine abnormalities
 defects in the metabolism of tryptophan, methionine, and
other amino acids
Drug Induced B6 Deficiency:
Isoniazid and penicillamine should be accompanied by
pyridoxine supplementation to avoid B6deficiency

88. BIOTIN
 Anti-egg white injury factor or vitamin H
 It plays a role in gluconeogenesis and fatty acid synthesis.
RDA:
Adults- 100-300 µg/day.
Sources: liver, kidney, egg, milk, tomatoes, grains etc.

89. Deficiency Symptoms:
 Large amounts of uncooked eggs .
High intake of avidin, +biotinunavailable.
 Major resection of the gut.
 Alopecia and a scaly erythematous dermatitis, especially
around the body orifices.
 Histology : absence of sebaceous glands and atrophy of
the hair follicles.
Oral Manifestations:
 Glossitis and atrophy of the lingual papillae

90. CYANOCOBALAMIN
 Anti-pernicious anaemia vitamin.
 Unique vitamin.(microorganisms)
RDA
 Adults- 3 µg/day
 Pernicious anemia is the megaloblastic anemia
specifically due to vitamin B12 deficiency

91. Vitamin
B12
Vitamin
B12
Extrinsic factor of Castle

92. Biochemical Functions:
1) 3 vitaminB12-dependent enzymes:
 methionine synthetase,
 methylmalonyl CoA mutase
 leucine aminomutase.
2) metabolism of cyanidecyanocobalamin.
Estimation of Methylmalonic acid and serum B12
levelsassess Vit.B12 deficiency

93. Deficiency Symptoms:
 spinal cord degeneration and
peripheral neuropathy. (Seen in
2/3rd
of the cases)
 gait ataxia and loss of position
& vibratory sense. cutaneous
sensation and tendon reflexes
 synthesis of TNF-α
epidermal growth factor in
the spinal cord

94. Oral Manifestations:
Glossitis:50-60% .(Moeller’s glossitis or Hunter’s
glossitis)
 stomatitis and mucosal ulcerations.
 Epithelial cell abnormalities.
More susceptible to epithelial dysplasia or malignant
transformation
 Treatment: Vit B12 (100-1000µg)-IM

95. FOLIC ACID
 Lucy Wills in 1931 identified folate as the
nutrient needed to prevent anemia during pregnancy.
 Derived from Latin word Folium-leaf
RDA
 Adults- 400 µg/day

96. Folic
acid
Folic
acid

97. Biochemical Functions:
 Tetrahydrofolate (THF), the coenzyme of folic acid is
actively involved in this one-carbon metabolism.
 Synthesis of purines, pyramidines, glycine, serine and
choline

98. Deficiency Symptoms:
 macrocytic anemia with megaloblastic erythropoiesis,
 Glossitis – swelling of lateral borders and tip of the
tongue.
 depression, cognitive impairment and dementia

99. Periodontal Implications:
 Animals: necrosis of the gingiva, periodontal ligament,
and alveolar bone without inflammation
(granulocytopenia). (Shaw JH, 1962)
 humans :generalized stomatitis,ulcerated glossitis and
cheilitis.
 Ulcerative stomatitis is an early indication of the toxic
effect of folic acid antagonists (e.g., methotrexate)-Rx of
leukemia

100. B-Complex Supplements

101. Studies
 Vogel(1976) evaluated the effects of vitamin Bc
supplementation in humans. (2 mg ,twice daily,30 days)
 resistance of the gingiva to local irritants
 gingival inflammation

102.  Pack A.R. (1980) The effect of systemic and topical Vit.
Bc on gingival inflammation during pregnancy
 Improvement in GI despite no significant changes in PI.
Vitamin Bc can improve the resistance of the
periodontium to bacterial plaque
 Pack (1984) effects of a vitamin Bc mouthwash (5 mg/5
ml, twice daily for 4 weeks) on established gingivitis .
 Influence on gingival health through local rather than
systemic influence

103.  Drew(1987) effects of both systemic and topical
administration of vitamin Bc
 Topical vitamin Bc significantly inhibited gingival
overgrowth to a greater extent than either the systemic
vitamin Bc or placebo groups
 A similar finding was also reported by Backman(1989)
who suggested that folate levels should be checked and
supplementation with vitamin Bc considered in patients
on long term anticonvulsive diphenylhydantoin therapy

104.  On the contrary, Brown et al.(1991) found a single daily
oral 3 mg capsule of vitamin Bc did not show efficacy as
the sole therapeutic agent in the reduction of PIGO
 Poppel et al(1979) examined the effect of vitamin Bc on
the recurrence of PIGO following gingivectomy and
observed less recurrence in these patients.

105. Vitamin C

106. VITAMIN C
 In 1747, the Scottish surgeon James Lind discovered
that citrus foods helped to prevent scurvy.
 First vitamin to be artificially synthesized in 1935.
 Seen among: elderly living alone,alcoholics,dietary
faddists,and infants only on sterilized milk and foods.

107.  Chemistry:
 Ascorbic acid is a six carbon ketolactone
 Structurally related to glucose and other hexoses.
 Reversibly oxidizeddehydroascorbic acid. (possesses
full vitamin C activity). Copper.
 Man cannot synthesize it due to the deficiency of a L-
gulonolactone oxidase.
 Threshold substance-degree of saturation

108. Vitamin
C
Vitamin
C
Males:90 mg/day
Females:75 mg/day

109. Physiological functions:
1) Collagen formation:
proline lysine
hydroxyproline hydroxylysine
2) Intercellular ground substance, dentin, bone and CT
3) Iron and Haemoglobin metabolism
4) Tryptophan,tyrosine, folic acid metabolism

110. 5) Synthesis of corticosteroid hormones by hydroxylation
6) Sparing effect on Vit A,Vit E, Vit B complex
7) Immunological function: Igs and phagocytic action of
leucocytes
8) Antioxidant property: prevents damage to cellular
structures and implicated in dev. of cancer,heart diseases
and ageing
9) Carnitine biosynthesis
10) DopamineNorepinephrine

111. Dentin: Hojer and Crampton
 Atrophy and disorganization of the odontoblasts
Irregularly laid down dentin with irregular tubules
Dentin formation ceases & predentin becomes
hypercalcified
Producing heavy basophilic line between the dentin and
the pulp
Odontoblasts become indistinguishable from pulpal cells

112. Gingiva:
 Classic sign: Gingivitis with enlarged,
hemorrhagic, bluish red gingiva
 But gingivitis is not caused by
vitamin C deficiency.
(Woolfe et al 1980)
 Gingivitisbacterial plaque.
 Aggravate the gingival response to plaque and worsen the
edema, enlargement, and bleeding.

113.  Goldman: Hypertrophy of the gingiva covering the entire
crowns
 Subperiosteal hemorrhage lifted the gingiva from
underlying bone
 Focal areas of necrosis of free margin of the gingiva
 Interdental and marginal gingiva-bright red with
swollen,smooth,shiny surface.
 Fully developed scurvy: gingiva becomes boggy,ulcerates
and bleeds easily on slight stimulation like chewing
(Stolman 1961)

114.  Long standing case: Purple swellings and gingival
bleeding (capillaries fragile and susceptible to rupture)
(Thomas 1997) . petechiaechymoses
 Gingival epithelium undergoes thinning-spongiosis
When severe atrophy occurs, blood exudes through the
breaks in the epithelial layer.
Tritated inulin and endotoxin-oral mucosa
Tritated dextran-human crevicular epithelium

115.  Periodontal Ligament:
 Formed collagen-unaffected by deficiency.
 Thus alteration in the fibres of the periodontal
ligament—due to inability of the host to synthesize
and repair rather than inability to maintain mature
fibres.(Waerhaug 1958)
 Doesnot reduce the no: of fibroblasts present in the
CT(Gersh and Catchpole 1949; Chen and Postlewait
1961)

116.  The periodontal fibers that are least affected :just below
the junctional epithelium and above the alveolar crest
 infrequent apical down growth of the epithelium.
 Chronic cases: Hemorrhages into and swelling of the
periodontal ligament
 High conc. of alkaline phosphatase in vicinity of collagen
(Jenkins, 1978).

117.  Alveolar bone
 Alveolar bone resorption with increased tooth mobility
(Shaw 1978)
 although true loss of attachment and pocket formation do
not occur as a result of ascorbic acid deficiency alone
(
(Boyle 1937; Waerhaug 1958)
 Shows atrophic changes; marrow space replaced with
fibroblasts
 Histologic changes:
Trummerfeld zone
Gerustmark

118. Vitamin C and PMNs
 Conc. of Vit C in PMNs = 16 mg/ dl
in plasma = 0.5-1 mg/ dl
 Plasma level sensitive to diet change,stress, nicotine
intake, use of oral contraceptives.within 3 weeks it is
depleted.
 Invitro (Nugester, Ames,1948)-Impaired phagocytic
activity
 Invivo- bactericidal activity of leucocytes impaired when
daily intake of ascorbate increased to 2g
(Shilotri,Bhat,1977)
 But inc. chemotactic and migratory action of leukocytes.
 Mungster and Ames (1948)

119. Long bones and hair
 If haemorrhage in the subperiosteal region of the long
bones-severe pain and tenderness occurs
 Petechiae, ecchymoses and spontaneous bruising of the
extremities.
 Vascular congestion of the hair follicles leads to
enlargement, keratosis and localized reddening of the
skin.

120. Studies
Animal Studies:
 The effects of vitamin C deficiency in periodontal tissues
were first studied by Glickman (1948)
 Guinea pigs were placed on a vitamin C free diet and
sacrificed after 35 days.
 Histological examination revealed :
Deeper periodontal pockets in animals fed on vitamin C
free diet.
Gingival edema and hemorrhage were also seen in the
test group

121.  Boyle (1937,1938) believed that the deficiency
produced atrophic changes in the gingiva and
underlying bone in guinea pigs .
 There is bleeding, osteoporosis and resorption of
alveolar bone, rupture of periodontal ligament fibers,
widening of periodontal ligament space and increased
tooth mobility. (Topping and Fraser 1939;Turseky and
Gilckman 1954;Dunphy et al 1956; Waerhaug 1958)

122. Human studies
 Studies have shown that low levels of plasma Vit C are
associated with some degree of gingivitis and
periodontitis. (Blockley and Baenziger 1942 ;
Stuhl1943; Kyhos et al 1944).
 Crandon et al. (1940).He consumed a vitamin C-
deficient diet for six months and after the fifth month a
slightly boggy gingival appearance was noticed.

123.  Cohen (1955) showed that, in absence of local
periodontal treatment, a 500 mg oral tablet of ascorbic
acid improved the gingival condition in teenagers after
90 days.
Over a similar trial period, daily doses of ascorbic acid
(1-3 g) have reduced irregularities in the lamina dura of
young adults.
It is due to the consolidation of collagen at the alveolar
bone/cementum interface. (Cowan,1976)

124.  Nishida et al. in the NHANES III, evaluated the effect of
dietary intake of vitamin C and the presence of
periodontal disease.
 There was a weak, but statistically significant,
relationship with periodontal disease in current and
former smokers, as measured by clinical attachment.
 Those taking the lowest doses of vitamin C, and who also
smoked, had the greatest negative clinical effect on their
periodontal tissues
J Periodontol 2000; 71: 1215-1223

125.  Vogel et al.(1986) evaluated the role of mega doses of
vitamin C on PMN chemotaxis and on the progression of
experimental gingivitis.
 Four months of daily vitamin C (500 mg, three times
daily) supplementation
 resulted in a significant increase in plasma ascorbate
levels, but did not increase host resistance to
experimental gingivitis

126.  In a later analysis, Chapple et al.(2007) reviewed the data
of 11,480 adult participants (> 20 years of age) in the
NHANES III.
 They demonstrated that increased serum concentrations
of vitamin C, billirubin and total antioxidant levels were
associated with reduced relative risk of periodontitis in
both smokers and nonsmokers

127.  Yasuko Shimada et al ascorbic acid significantly inhibited
tyrosinase activity and melanin formation in B16mouse
melanoma cells.
 concluded that ascorbic acid has potential for the
treatment of gingival melanin pigmentation
J Periodontol 2009; 80: 317-323

128. Rx
Drug name Dosage Vitamins present
Tab Limcee 500 mg Vit C
Inj Vitcofol 10 ml Folic acid, B12,B3
Tab Nurokind -OD 150µg Vit B12
Cap Becosules –Z Vit B-complex, Vit C and
Zinc
Tab A to Z Vit C, Vit B-complex, Vit
A, Vit D3, Vit E,
Inj, Tab Zincovit Vit C, Vit B-complex, Vit
A, Vit D3, Vit E,

129. CONCLUSION
Nutritional deficiencies and imbalances have a
significant impact on the periodontal tissues.
Hence, a sound understanding of the various vitamins
and their effects on the periodontium is crucial for
every clinician.

130. REFERENCES
 Essentials of Biochemistry- Satyanarayanan. 2nd
edition
 Biochemistry and Oral Biology – A.S Cole, J.E. Eastole. 2nd
edition
 Drugs, Diseases and Periodontium – Robin Seymour
 Clinical Periodontology, Carranza. 10th
edition
 Shafer’s Textbook of Oral pathology. 5th
edition
 Schafer et al. In vivo evaluation of an oral health toothpaste with 0.1%
Vitamin E acetate and 0.5% sunflower (with vitamin F). International
Dental Journal (2007); 87: 119-123.
 Essentials of medical pharmacology, KD Tripathi. 5th
edition
 Drug update, July-Oct 2008 Vol 5, Issue IV

131.  A. C. de Menzes et al. Clinical manifestations of Hypervitaminosis A in
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 Iain L.C. Chapple and John B. Matthews. The role of reactive oxygen
and antioxidant species in periodontal tissue destruction. Perio 2000 Vol
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nutritional modulation of periodontal inflammation. JADA 2009, Vol
140; 178-184.
 Robert K. Murray, Daryl K. Granner, Peter A. Mayes, Victor W.
Rodwell. Harper’s Illustrated Biochemistry. 26th
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132.  Yasuko Shimada et al. Effects of ascorbic acid on gingival melanin
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