Dental Management in Anemic Patients PDF

Oral manifestations of Vitamin Deficiency Prof. Nahed Attia Oral medicine, Periodontology, Diagnosis and Oral Radiology, Department.  Objectives of the lectures List and explain vitamins essential for healthy functioning of human body and oral healt...

Oral manifestations of Vitamin Deficiency Prof. Nahed Attia Oral medicine, Periodontology, Diagnosis and Oral Radiology, Department.  Objectives of the lectures List and explain vitamins essential for healthy functioning of human body and oral health. Identify daily requirements. Identify the effect of vitamin deficiency on oral tissues. To monitor the hypervitaminosis toxicity.  Water Soluble B-complex Non B-complex Thiamine (Vit.B1) Ascorbic acid Riboflavin (Vit.B2) vit c Niacin (Vit.B3) Pantothenic acid (Vit. B5) Fat Soluble: Pyridoxine (Vit.B6) Vit.A Biotin (Vit. B7) Vit.D Folic acid (Vit B9) Vit.E Cobalamin (Vit.B12) Vit.K  Vitamins are essential for sustaining life, maintaining the health and functions of the body, including the oral cavity. Manifestations of vitamin deficiencies are observable in both the hard and soft tissues. Deficiencies in vitamins such as A, D, and K prominently affect the hard tissues within the oral cavity, such as teeth and the jawbone.  Deficiencies in water-soluble vitamins, notably the B-complex and vitamin C, have symptoms primarily in the soft tissues, including the tongue, gingiva, buccal mucosa, and lips. While some deficiencies lead to identifiable anomalies in teeth or the alveolar ridge, others might not exhibit specific signs yet play a significant role in treating various conditions and complications.  An overdose of vitamins might lead to hypervitaminosis, a condition associated with various health issues, a lack of vitamins, or avitaminosis also produce oral manifestations. Insufficient vitamin intake can impair several bodily functions, resulting in conditions such as night blindness, clotting problems, and bone diseases like rickets and osteomalacia, as well as deterioration of nerve and muscle health.  Vitamin Deficiency due to Defective digestion / Defective intake absorption Defective utilization Increased requirement Water Soluble Vitamins  Vitamin B1 (Thiamin) Daily requirements 1.2mg/day for men 1 mg /day for women Increases in pregnancy& lactation. Function - Normal Growth - Normal Function of heart Nerves & muscles - Coenzyme in CHO metabolism Legumes, Whole grains eggs, fish liver oil, liver  Vitamin B1 Deficiency General Features Beriberi - Muscular weakness. - Mental changes. - Numbness/tingling - Congestive heart failure. - Growth retardation. - Dry skin & irritability. Oral Manifestations - Oral mucosa satiny appearance, old rose color. - Hypersensitive oral mucosa. - Angular cheilitis - Identation markings of tongue. - Cracks in vermillion border of lips.  Vitamin B2 (Riboflavin) Daily requirements 1.3mg/day for adult men 1.1 mg/day for adult women Increases in pregnancy & lactation Function - Normal growth - Coenzyme in protein & energy metabolism Milk, eggs, meat, Fish, poultry, Green vegetables, yeast  Vitamin B2 Deficiency General Features Ariboflavinosis - Eyes: photophobia, diminished vision, cloudiness, corneal ulceration Itching, burning eyes Skin: scaly greasy dermatitis (seborrheic dermatitis) + erythematous base In nasolabial folds, post-auricular area Anemia may develop. Seborrheic dermatitis  Oral Manifestations Tongue: - Magenta red, smooth & glazed. Glossitis (atrophy of filiform papillae) Angular cheilitis. Lip & buccal mucosa: - Desquamation. - Oral ulceration.  Vitamin B3 (Niacin) Daily requirements 16 mg/day for adult men 14 mg/ day for women Increases in pregnancy & lactation. Function - Coenzymes in energy production. - Normal growth. - Skin health. - Normal activity of stomach, Meat, liver, poultry, fish, brown rice, Fotified cereals and breads, nuts, seeds, intestine & Nervous system legumes, bananas.  Vitamin B3 Deficiency General Features Pellagra: “4 Ds” - Dermatitis: red scaly (glove and Hyperpigmentation in sun exposed areas stocking area) aggravated by sun. - Diarrhea, stools fatty & frothy. - Dementia (impaired memory). - Death. Necklace  Vitamin B3 Deficiency General Features Systemic Dermatitis -Areas exposed to light & friction. - Sharply outlined erythema + scaling Dermatitis - Surface of lesions dry & rough. - Vesiculobullous lesion may occur. - Skin becomes pigmented.  Oral Manifestations Tongue: - Beefy red, burning sensation - Painful ulcers may occur. - ANUG - Dry fissured lips. - Angular cheilitis. - Dysphagia.  Vitamin B5 (PantothenicAcid) Daily requirements 5mg/day for men 5 mg/ day for women. Increases for pregnancy and lactation Function - Deficiency is rare as it is widespread distribution in whole grain cereals legumes & meat. Beef, poultry, sea food, eggs, milk, - Has a role in managing vegetables as mashroom, avocado, dry mucosal conditions, including potatoes, broccoli, whole grains as whole xerosis and cheilitis. wheat, rice and brown and oats  Vitamin B5 (Pantothenic acid) Deficiency General Features Headaches Fatigue, muscle cramps Paresthesia, and nausea - Symptoms are similar to vitamin B deficiency.  Vitamin B6 (Pyridoxine) Daily requirements 1.6mg/day for men 1.2mg/day for women Increased in pregnancy & lactation Function - Contributes to hemoglobin synthesis, amino acid metabolism, and protein synthesis. Egg yolk, milk, liver, - Deficiency rare. meat, grains & vegetables  Vitamin B6 (Pyridoxine) Deficiency General Features - Anemia, irritability. - Convulsions & neuritis. - Generalized dermatitis.  Oral Manifestations - Angular cheilitis (bilateral) - Glossitis, burning sensation. - Recurrent aphthous stomatitis. - Halitosis. - Fungal infections. Exfoliative glossitis and angular cheilitis due to hypovitaminosis of B2 and B6 vitamins  Vitamin B7 (Biotin) Daily requirements 25mcg/day for both men & women Increases for lactation. Function - Vital coenzyme for the metabolism of fats, carbohydrates & amino acids. - Supports cellular proliferation & health of hair and nails.  Vitamin B7 (Biotin) Deficiency General Features - Anemia - Vomiting - Hair loss - Nail inflammation - Dermatitis  Oral Manifestations - Oral candidiasis, caused by Candida albicans as white patches within the oral cavity that affects swallowing Oral Candidiasis  Vitamin B9 (Folic Acid) Daily requirements 400 mcg/day for both men & women Increases in pregnancy and lactation. Function -Important in diet of pregnant females DNA synthesis and fetal development - Normal function for the red cell production. Green leafy vegetables, liver, - Normal metabolism of whole grains, legumes & yeast growing cells & tissues  Vitamin B9 Folate Deficiency General Features - Megaloblastic anemia. - Intestinal malabsorption - Diarrhea, stools are fatty.  Oral Manifestations Tongue: - swollen, enlarged and painful. - Atrophy of tongue coating filiform papillae - Angular cheilitis. - Gingivitis. - Sialorrhea  Vitamin B12 (Cobalamine) Daily requirements 2.4mcg/day for both men & women Increased in pregnancy & lactation Function - Nerve cell function - DNA replication - Maturation of RBCs in B.M. Fish, red meat, poultry, eggs, sea - Fatty acid metabolism. food, beans, peas, lentils, nuts, - Affects folic acid metabolism. soya products  Vitamin B12 (Cobalamin) Deficiency General Features - Pernicious anemia - General weakness. - Neurologic manifestations (due to progressive demyelination of nerve cells) - Numbness & tingling extremities  Oral Manifestations - Atrophy of tongue coating. - Glossitis & stomatitis. Inflammation and complete loss of filiform papillae - Recurrent Aphthous ulcers without angular cheilitis. - Pallor of oral mucosa  Vitamin C Daily requirements 75 mg/day for men 65 mg/day for women Function - Biological oxidation-reduction reactions. Collagen synthesis, osteoid tissue of bone & dentin - Wound healing - Protects folic acid from oxidation. - Regulates iron distribution & storage. Citrous fruits, leafy vegetable, - Firm capillary walls form cementing tomato, cabbage, melons substances between cells  Vitamin C Deficiency General Features Scurvy - Weakness, easily fatigued. - Follicular hyperkeratosis. - Petechiae & ecchymosis of skin. - Delayed wound healing. - Susceptibility to infections.  Oral Manifestations - Gingival enlargement - Gingiva swollen, tender, bleeds easily. - Tooth loss & secondary infection due to poor healing wounds. Oral Manifestations - ANUG. - Bleeding gingiva - Delayed wound healing. - Teeth loose (periodontal ligament involvement). Fat Soluble Vitamins  Vitamin A (Retinol) Daily requirements 900mcg/day for men 700mcg/day for women Vit A level N range:: 20-65 (mcg/dL) Function - Formation of retinal pigments (rhodopsin) for vision in dim light. - Bone & teeth development. - Formation & maturation of epithelium Fish liver oil, egg yolk, fortified milk, of skin, eyes, digestive, respiratory & urinary tract green plants (contain carotene)  Vitamin A Deficiency General Features - Skin: Dry, fissured, & hyperkeratotic. - Degeneration of sebaceous, sweat glands & hair follicles. Bone: Retarded bone growth.  Vitamin A Deficiency General Features - Night blindness, photophobia, xerophthalmia & conjunctivitis. - Bitot spots, on conjunctiva. - Increased susceptibility to infection. - Nail fragility.  Oral Manifestations Teeth: - Enamel hypoplasia - Increased caries susceptibility. - Dentin defects Salivary glands: - Atrophy of salivary acini xerostomia Increased liability to infection (fungal infection)  Oral Manifestations - Oral keratotic changes. - Disorders of mucosal keratinization. - White lesions cannot be scrapped off. - Periodontitis. White keratotic lesion along sublingual mucosa, lateral edge and ventral part of tongue.  Vitamin D (Cholecalciferol) Daily requirements 15 mcg (600) IU Function - Increased intestinal calcium & phosphorous absorption. - Increased deposition of calcium in bone mineralization). - Has immunosuppressive and anti- inflammatory properties. Fish liver oil, (Fortified milk)  Vitamin D Levels Vitamin D sufficiency if 25(OH)D was >30ng/ml. Vitamin D insufficiency if 25(OH)D was between 20 and 30ng/ml. Vitamin D deficiency if 25(OH)D was