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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
 Squamous metaplasia in Vitamin A deficiency
Squamous metaplasia in Vitamin A deficiency

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.
Tooth Changes in Vit D deficiency
Changes in Vit D deficiency

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
scorbutic gingivitis
Scorbutic gingivitis

 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.
Beefy red tongue
Beefy red tongue in Vitamin B12 deficiency

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


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