Some Vitamin Deficiencies - General Manifestations and Oral Manifestations

Vitamin	General Manifestations of deficiency	Oral manifestations of Deficiency
Vitamin A	Night blindness Xerophthalmia characterized by dryness in conjunctiva and cornea Bitot Spots in forms of triangular plaques in conjunctiva if xerophthalmia persists, destruction of cornea occurs, causing total blindness. This condition is known as keratomalacia.	Keratinizing metaplasia of epithelium resulting in increased keratin formation Occlusion of salivary gland ducts with keratin Enamel hypoplasia, atypical dentin formation and epithelial invasion of pulpal tissue are characteristic features. Enamel is more severely affected than dentine Delayed eruption of teeth
Vitamin D (Anti rachitic vitamin)	Rickets in children Osteomalacia in adults Pigeon chest is one of the important features of rickets. Renal rickets or renal osteodystrophy is seen in patients with chronic renal failure. Renal rickets is mainly due to decreased synthesis of calcitriol in kidney. In rickets, the plasma calcitriol is decreased and alkaline phosphatase activity is elevated.	Delayed eruption of primary and permanent teeth Malalignment of the teeth in the jaws Developmental anomalies of dentin and enamel . The teeth shows wide predentin zone with much interglobular dentin. The pulp horns are elongated and extend high , reaching the dentinoenamel junction
Vitamin E (anti -sterility vitamin)	Decreased male fertility Impaired fetal maternal vascular relationships Encephalomalacia Nutritional muscular dystrophy	-------
Vitamin K (Coagulation vitamin)	Deficiency is uncommon Brings about post translational modification of clotting factors II, VII, IX and X, particularly prothrombin. So, deficiency may result in prolonged clotting time.	Prothrombin levels below 35% results in gingival bleeding after toothbrushing Spontaneous gingival hemorrhages occur, when the prothrombin levels fall below 20%.

Vitamin	General Manifestations of deficiency	Oral manifestations of Deficiency
Vitamin C (Ascorbic acid)	Deficiency may result in Scurvy. It is characterized by spongy and sore gums, loose teeth, anemia, swollen joints, delayed wound healing, hemorrhage, osteoporosis, etc. Defective collagen synthesis 'Cork-screw' hair pattern, 'Woody legs' with large spontaneous bruises in lower extremities 'Trummer field zone' is the characteristic histologic picture of bone in Scurvy.	The 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.
Vitamin B1 (anti beri-beri or anti neuritic vitamin)	Vit B1 deficiency is seen in populations consuming polished rice as staple food. Dry beri-beri or peripheral neuritis; Wet berl-beri or cardiac manifestations, and cerebral or Wernickes encephalopathy  with Korsakoff's psychosis are features of vit. B1 deficiency	-------
Vitamin B2 (Riboflavin)	Riboflavin deficiency is common in children who do not drink milk. Nasolabial seborrhea or dyssabacea. Vascularisation of cornea Scrotal dermatitis	Glossitis: The filiform papillae become atrophic while the fungiform papillae become engorged and mushroom shaped, resulting in magenta colored tongue. Cheilosis, ocular lesions. (Non-specific bilateral angular cheilosis may be seen in association with faulty dentures or in patients with reduced vertical dimension due to attrition.)
Niacin	Pellagra (the symptoms of pellagra are referred to as three D's i.e., dermatitis, diarrhoea, dementia and if not treated may lead 4th 'D' i.e, death)	Bald tongue of Sandwith 'Raw beefy tongue'  The mucosa becomes fiery red and painful Salivation is profuse.
Vitamin B5 (pantothenic acid or chick anti dermatitis factor)	Burning feet syndrome : Pain and numbness in the toes, sleeplessness and fatigue are features Pantothenic acid is one of the water-soluble vitamins that is synthesized in the body.	-----
Vitamin B6 (Pyridoxine)	Peripheral neuropathy (due to decreased synthesis of serotonin catecholamines) and demyelination of neurons. Isoniazid (drug used in treatment of TB) is a antagonist of Vitamin B6.	-----
Biotin (Anti egg white injury factor)	Biotin deficiency is uncommon since it is well distributed to foods and also supplied by the intestinal bacteria. also known as Vitamin B7 or Vitamin H	------
Folic acid	Macrocytic anemia, glossitis. Aminopterin and methotrexate are structural analogues of folic acid used in treatment of many cancers including leukemia. These drugs block the formation of THF and hence DNA synthesis is impaired.	GLOSSITIS: The filiform papillae disappear first, but in advanced cases the fungiform papillae are lost and tongue becomes smooth and fiery red in color.
Vitamin B12 (anti pernicious vitamin or extrinsic factor of Castle)	Neurological manifestations due to degeneration of posterior and lateral tracts of spinal cord. Degeneration of myelin sheath and peripheral nerves also occur.	Beefy red tongue with glossopyrosis, glossitis and glossodynia. Hunter's glossitis or Moeller's glossitis, which is similar to 'bald tongue of Sandwith' seen in pellagra