Oral manifestations of Vitamin Deficiency – High yield notes

Oral manifestations of vitamin deficiency illustrated high yield Oral medicine notes

Oral manifestations of Vitamin A deficiency

• 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

• It affects Enamel more seriously than dentin

• Delayed eruption of teeth

Oral manifestations of Vitamin D deficiency

• Delayed eruption of primary and permanent teeth

• Malalignment of the teeth in the Jaws

• Developmental anomalies of dentin and enamel of the teeth shows wide pre dentine zone with much interglobular dentin

• The pulp horns are elongated and extend high, reaching the DE junction

• The enamel does not appear to be weekend but the rough surface may facilitate adherence of dental plaque and food Residue.

Vitamin K deficiency

• Prothrombin level (below 35%) results in gingival bleeding after tooth brushing

• Spontaneous gingival bleeding occurs when the prothrombin levels fall <20%

• Spontaneous bleeding during minor dental, surgical procedure

Vitamin C deficiency

• The pathognomonic sign is swollen and spongy gums, particularly the intendental papilla is involved producing the appearance of scurvy buds

• In severe cases, hemorrhage to periodontal membrane, weakened collagen formation followed by resorption of alveolar bone and loosening of teeth occurs.

• Scurvy occurs in as quickly as 20 days

• Gingival hemorrhage and petechiae are also evident

• Scrobutic changes in the teeth because of changes in ameloblasts and odontoblasts also seen

• Trismus due to hemorrhage in TMJ

 Vitamin B1 (Thiamin) deficiency

• Flabby, red and edematous tongue

• The fungiform papillae enlarge and become hyperemic

• Gingival tissue sometimes present an “old rose” color.

Vitamin B2 (Riboflavin) deficiency

• Glossitis- The filiform papillae become atrophic while the fungiform papillae become engorged and mushroom shaped, resulting in magenta coloured tongue

• Angular cheilosis and ocular lesion

• Non-specific bilateral angular cheilosis may be seen in association with faulty dentures or in patient with reduced vertical dimension due to attrition

• Lips may become extremely red and smooth

Vitamin- B3 (niacin) deficiency

• Bald tongue with Sandwith on Raw beefy tongue due to loss of filliform and fungiform papillae

• Oral mucosa become fiery red and painful

• Painful stomatitis causes diminished food intake

• Pellagrous glossitis begins with swelling of the papillae at the tip of the tongue and lateral borders

• Salivation is profuse

Vitamin -B6 (Pyridoxine) deficiency

• Pyridoxine deficiency induced glossitis is associated with pain, edema and papillary changes

• Initially the tongue has a scalded sensation, followed by reddening and hypertrophy of the filliform papillae at the tip, margins and dorsum.

Folic acid deficiency deficiency

• Glossitis – Tongue becomes fiery red and papillae are absent.

• Initially filliform papilla are involved and in advanced cases fungiform papillae are involved

• Marked chronic periodontitis and loosening of tooth

• Superimposed candidiasis is due to impaired immune response of mucosa.

Ora manifestations of Vitamin B 12 deficiency

• 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.

• An oral examination may reveal stomatitis on a pale or yellowish mucosa, Xerostomia, cheilosis, Hemorrhage gingiva and bone loss.

Biotin deficiency

• Pallor of the tongue and patchy atrophy of the lingual papillae

• Although pattern resembles geographic tongue it is continued to lateral margins is generalised to the entire dorsum.

Reference:

Oral and maxillofacial pathology; Neville; 4th ed

Shafer’s Textbook of Oral Pathology

Burket’s Oral Medicine; 12th ed