Water soluble vitamins are a heterogeneous group of compounds that differ chemically but share the common characteristic of being soluble in water. They are easily absorbed and not stored in the body except for vitamin B12. The document focuses on various water soluble vitamins including vitamin C, the B vitamins (thiamine, riboflavin, niacin, pantothenic acid, pyridoxine, biotin, folic acid, cyanocobalamin), their roles, dietary sources, requirements and deficiency manifestations.

1. WATER
SOLUBLE
VITAMINS.
BY-
FAHAD AHMAD (2K16)
RN27 MBBS 1ST YEAR
HIMSR, NEW DELHI

2.  They are heterogeneous group of compounds - differ
chemically.
 Common character – solubility in water.
 Easily absorbed.
 Not stored in the body except for Vit B12.
 Readily excreted in urine.
 Form coenzymes – biochemical reactions.
Water Soluble Vitamins

3. Vitamin C (Ascorbic Acid)
 Asscorbic acid is a water soluble vitamin playing an
important role in human health and disease.
Sources:
In plants abundantly seen in citrus fruits, gooseberries,
guava melons, sprouting seeds, leafy vegetables, spinach,
cauliflower, cabbage, tomatoes and drumstick.
RDA:
Infants - 35 mg
Children – 40mg
Adults – 45mg
Pregnant women – 60mg
Lactating Women – 80mg

4. Biochemical functions:
Most important function of vitamin C is its property to
undergo reversible oxidation.
 Vitamin C plays an important role in collagen
formation.
 Acting as a coenzyme.
 Thereby facilitating cross linkage of collagen fibers
and increases its strength.

5.  Helps in bone formation.
 Plays a role in iron and hemoglobin metabolism.
 Takes part in the metabolic reactions of tryptophan,
tyrosine, folic acid and cholesterol.
 Enhances the synthesis of Immunoglobulins and
increases their phagocytic action.
 Also acts as a strong biological antioxidant.

6. BIOSYNTHESIS AND
METABOLISM
Many animals can synthesize ascorbic acid from
glucose via uronic acid pathway. However, man, other
primates, guinea pigs and bats cannot synthesize
ascorbic acid due to the deficiency of a single enzyme
namely L-GULONO-LACTONE OXIDASE
Oxidation of ascorbic acid is rapid in the presence of
copper. Hence vitamin c becomes inactive if the
foods are prepared in copper vessels.
NOTE

7. Deficiency manifestations:
 Leads to scurvy, characterized by spongy and sore gums, loose
teeth, swollen joints, anemia, fragile blood vessels, delayed
wound healing, hemorrhage, osteoporosis etc.
 Defective collagen synthesis.
 “Cork screw” hair pattern with tiny bleeding points around the
orifice of a hair follicle.
 “Woody legs” with large spontaneous bruises in lower
extrimites.
 “Tummer field zone” is the classic histological picture of bone
in scurvy.

8. Oral manifestations:
 Pathognomic sign is the swollen and spongy gums,
particularly the interdental papillae is involved
producing the appearance of scurvy buds.
 In severe cases, hemorrhages to periodontal
membranes followed by loss of bone and loosening of
teeth occurs.

9. Hypervitaminosis C:
* Ascorbic acid, as such, is not toxic. But, dehydroascorbic
acid (oxidized form of ascorbic acid) is toxic. Oxalate is a
major metabolite of vitamin C and oxalates have been
implicated in the formation of kidney stones.
* Mega doses of vitamin C are used in common cold, wound
healing trauma etc. as an antioxidant, ascorbic acid certainly
provides health benefits. However, the potential toxic effects
of mega doses of vitamin C cannot be ignored.

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

11. Components of vitamin B complex are:-
1.Thiamine – Vit B1
2.Riboflavin – Vit B2
3. Niacin – Vit B3
4.Pantothenic acid – Vit B5
5.Pyridoxine – Vit B6
6.Biotin – Vit B7
7.Folic acid group
8.Cyanocobalamin – Vit B12

12. Thiamine (Vitamin B1, anti beriberi, antineuritic
vitamin)
• Free thiamin is basic and heat stable.
• It has a specific coenzyme, thiamine pyrophosphate (TPP),
which is mostly associated with carbohydrate metabolism.
• Readily soluble in water.
• Stable in acid medium.
• Destroyed – autoclaved at 120°C for 30min.
• Destroyed even at room temperature in an alkaline medium.

13. Dietary sources:
Cereals, pulses, oil seeds, nut and yeast are good sources.
Thiamine is mostly concentrated in the outer layer (bran) of cereals.
Also present in animal foods like pork, liver, heart, kidney, milk, etc
RDA:
Infants - 0.3-0.5 mg
Children – 0.7-1.2mg
Adults – Males – 1.2-1.5mg, Females – 1.0-1.1mg
Pregnant women – 1.3-1.5mg
Lactating Women – 1.3-1.5mg

14. Biochemical functions:
The enzyme thiamine pyrophosphate or cocarboxylase
is intimately connected with the energy releasing
reactions in the carbohydrate metabolism.
TPP also plays an important role in the transmission of nerve
impulse. This is because TPP is required for acetylcholine
synthesis and the ion translocation of neural tissue.

15. Deficiency manifestations :
* B1 deficiency is seen in populations consuming polished rice as
staple food.
* The deficiency of vitamin B1 results in a condition called
beriberi.
* The early symptoms of thiamine deficiency are loss of appetite
(anorexia), weakness, constipation, nausea, mental depression,
peripheral neuropathy, irritability etc.

16. In adults, two types of beriberi, namely wet and dry beriberi
occur. Infantile type of beriberi is also seen.
Wet beriberi: is characterized by cardiovascular manifestations
including edema of legs, face, trunk and serous cavities, with
breathlessness and palpitations, along with increase in systolic
and decrease in diastolic blood pressure.
Dry beriberi: is associated with neurological manifestations
resulting in peripheral neuritis, with progressive weakening in
muscles resulting in difficulty to walk.
Infantile beriberi: seen in infants born to mothers suffering from
thiamine deficiency, characterized by sleeplessness, restlessness,
vomiting, convulsions and bouts of screaming, these are due to
cardiac dilatation.

17. Riboflavin (Vitamin B2)
Riboflavin through its coenzymes Flavin mononucleotide (FMN) and
Flavin adenine dinucleotide (FAD) takes part in a variety of cellular
oxidation-reduction reactions. Involved in carbohydrate, lipid, protein
and purine metabolisms, besides electron transport chain.
Enzymes that use flavin coenzymes are called flavoproteins, Many
flavoproteins contain metal atoms and hence known as
metalloflavoproteins.

18. Dietary sources:
Milk and milk products, meat, eggs, liver, kidney are rich sources.
Cereals, fruits, vegetables and fish are moderate sources.
RDA:
Infants - 0.4-0.6 mg
Children – 0.8-1.2mg
Adults – Males – 1.5-1.8mg, Females – 1.1-1.4mg
Pregnant women – 1.4-1.7mg
Lactating Women – 1.6-1.9mg

19. Deficiency manifestations:
* Includes cheilosis, glossitis, and dermatitis.
• Riboflavin deficiency as such is uncommon, it is seen
along with other vitamin deficiencies.
• Chronic alcoholics are more susceptible to this vitamin
deficiency.
• Nasolabial seborrhea.
• Vascularisation of cornea.
• Scrotal dermatitis.

20. Oral manifestations:
• Glossitis – The filliform papillae become atropic while
the fungiform papillae become engorged and
mushroom shaped, resulting in magenta coloured
tongue.
• Cheilosis, ocular lesions.

21. Niacin (Vitamin B3, Nicotinic acid)
 Also known as the pellagra preventive factor of Goldberg.
 The coenzymes of niacin are synthesized by the essential
amino acid, tryptophan.
 These coenzymes NAD+ and NADP+ are involved in a
variety of oxidation-reduction reactions.
 The essential amino acid tryptophan can serve as a
precursor for the synthesis of nicotinamide coenzymes.

22. Dietary sources:
The rich natural sources of niacin include liver, yeast, whole grains,
pulses like beans and peanuts.
Milk, fish, eggs and vegetables are moderate sources.
RDA:
Infants - 0.4-0.6 mg
Children – 0.8-1.2mg
Adults – Males – 1.5-1.8mg, Females – 1.1-1.4mg
Pregnant women – 1.4-1.7mg
Lactating Women – 1.6-1.9mg

23. Deficiency manifestations:
* Niacin deficiency results in a condition called as pellagra.
* The disease pellagra involves skin, gastrointestinal tract and central
nervous system.
* Symptoms are commonly referred to as three D’s. the disease also
progresses in the order Dermatitis, Diarrhea, Dementia, and if not
treated may rarely lead to Death (4th D).
* The symptoms of dementia include anxiety, irritability, poor memory,
insomnia etc.

24. Oral manifestations:
* Bald tongue of sandwith.
* Raw beefy tongue.
* The mucosa becomes fiery red and painful.
* Salivation becomes profuse.

25. Pantothenic acid (Vitamin B5)
Pantothenic acid, also known as chick anti-dermatitis factor or filtrate factor, is
widely distributed in nature.
The functions of pantothenic acid are exerted through coenzyme A or CoA.
CoA is the central molecule involved in all the metabolisms (carbohydrate,
lipid and protein), acting as the carrier of activated acetyl or acyl groups.
Dietary sources:
Widely distributed in plants and animals.
Rich sources are egg, liver, meat, yeast, milk etc.
RDA:
Infants - 0.4-0.6 mg
Children – 0.8-1.2mg
Adults – Males – 1.5-1.8mg, Females – 1.1-1.4mg
Pregnant women – 1.4-1.7mg
Lactating Women – 1.6-1.9mg

26. Deficiency manifestations:
• Burning feet syndrome – pain and numbness in
toes, sleeplessness and fatigue are features.

27. Pyridoxine (Vitamin B6)
Vitamin B6 is used to collectively represent the three compounds
namely pyridoxine, pyridoxal and pyridoxamine.
The active form of vitamin B6 is the coenzyme pyridoxal phosphate
(PLP).
PLP is closely associated with the metabolism of amino acids.
The synthesis of certain specialized products like serotonin,
histamine, niacin coenzymes from amino acids are dependent on
pyridoxine.
PLP participates in reactions like transamination, decarboxylation,
deamination, transsulfuration, condensation etc.

28. Dietary sources:
Animal sources such as egg yolk, fish, milk, meat are rich in
B6.
Wheat, corn, cabbage, roots and tubers are good vegetable
sources.
RDA:
Infants - 0.3 mg
Children – 0.6-1.2mg
Adults – Males – 1.6-2.0mg, Females – 1.6-2.0mg
Pregnant women – 2.5mg
Lactating Women – 2.5mg

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

30. Biotin (Vitamin B7)
Biotin, also called as anti-egg white injury factor, vitamin B7 or
vitamin H, is a sulfur containing B-complex vitamin.
Biotin acts as a carrier of CO2 in carboxylation reactions.
Dietary sources:
Biotin is widely distributed in both animal and plant foods.
The rich sources are liver, kidney, egg yolk, milk, tomatoes, grains,
etc.
Recommended daily requirement:
100-300 mg for adults, but this vitamin is abundantly synthesized by
the intestinal bacteria.

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

32. Folic acid
Folic acid or folacin is abundantly found in green leafy
vegetables.
It is important for one carbon metabolism and is required
for the synthesis of certain amino acids, purines and the
pyrimidine-thymine.
Tetrahydrofolate (THF or FH4), the coenzyme of folic acid
is actively involved in the carbon metabolism.
THF serves as an acceptor or donor of carbon units in a
variety of reactions involving amino acid and nucleotide
metabolism.

33. Dietary sources:
The rich sources are green leafy vegetables, whole grains,
cereals, liver, kidney, yeast and eggs.
RDA:
Infants - 50µg
Children – 100-300µg
Adults – Males – 400 µg, Females – 400 µg
Pregnant women – 800µg
Lactating Women – 600 µg

34. Deficiency manifestations :
* Decreased production of purines and dTMP is observed.
* Which impairs DNA synthesis.
* Due to block in DNA synthesis, the maturation of erythrocytes is
slowed down leading to macrocytic RBC.
* Aminopetrin and methotrexate are structural analogues of folic
acid used in treatment of many cancer including leukemia, these
drugs blocks the formation of THF and hence DNA synthesis is
impaired.

35. Oral manifestation:
* Glossitis
- The filliform papillae disappears first.
- But in advanced cases the fungiform papillae are lost
and the tongue becomes smooth and fiery red in
colour.

36. Cyanocobalamine (Vitamin B12)
Vitamin B12 is also known as anti-pernicious anemia vitamin
and extrinsic factor of Castle.
It has derived the names of cobalamine and cyanocobalamine
due to the presence of cobalt and cyanide groups.
Vit B12 helps in the formation of labile methyl groups, for the
synthesis of thymine and therefore for synthesis of nucleic
acids, and along with folic acid for the normal hemopoisis.
 Synthesis of methionine from homocysteine.
 Isomerization of methymalonyl CoA to succinyl CoA

37. Dietary sources:
Not seen in plant foods.
Animal sources are liver, kidney, eggs, milk, and meat.
RDA:
Infants - 0.3µg
Children – 1-2µg
Adults – Males – 3.0µg, Females – 3.0µg
Pregnant women – 4.0µg
Lactating Women – 4.0µg

38. Deficiency manifestations:
• Most important is pernicious anemia.
• Characterized by low hemoglobin levels.
• Decreased number of erythrocytes.
• Neurological manifestations.
• Degeneration of myelin sheath and peripheral nerves
also occurs.

39. Oral manifestation:
• Beefy red tongue – with glosopyrosis, glossitis and
glossodynia.
• Hunter’s glossitis or Moeller’s glossitis – which is
similar to “bald tongue of sandwith seen in pellagra”.

40.  Thiamine is practically present in all plants and animal
tissues commonly used as food.
 The thiamine contained in these foods is destroyed with
improper cooking.
 Riboflavin is widely distributed throughout the plant
and animal kingdom.
NOTE

41.  The amino acid tryptophan present in the
dietary protein is converted into niacin in the
body.
 60mg of tryptophan produce 1mg of niacin.
 So tryptophan present in the foodstuff also
provides additional niacin.
 Intestinal Bacteria can also produce Vit B6
 Isoniazid – drug used in the treatment of TB is
antagonist to vitamin B6-Pyridoxin.

42.  Biotin deficiency is uncommon since it is well
distributed in food and also supplied by the intestinal
bacteria.
 Vit B12 is present only in the foods of animal origin.
 Bacterial synthesis of cobalamin occurs in the human
colon but it is not absorbed.
 The only source of cobalamin in nature is via synthesis
by micro organisms in soil, water and the animal
intestine.

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

44.  Without vitamin C, collagen formation is disrupted,
causing a wide variety of problems throughout the body.
 The oral manifestations of vitamin C deficiency occur
chiefly in the gingival and periodontal tissues.
 The interdental and marginal gingiva is swollen, bright
red, with a smooth and shiny surface.
 In fully developed scurvy, the gingiva becomes boggy,
ulcerates and bleeds. The color changes to a violaceous
red.

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

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

47. References
1.Essentials of biochemistry – Satyanarayana.
2. Fundamentals of biochemistry – Dr A C Deb.
3. Harper’s biochemistry 30th edition.
4. Graber and Vanarsdall – Orthodontic principles and
practice.