ch 11 - Vitamins Required for Oral Soft Tissues and Salivary Glands

Physiology of Soft Tissues

• Rapid turnover, constant challenge, and a rich saliva supply

• The oral cavity can reflect systemic disease before other signs and symptoms become evident, has a rapid cellular turnover rate, and is under constant assault by microorganisms

• Healthy adults produce approximately 1 to 1.5 L/day of saliva; unstimulated saliva pH is ~6.1, rising to 7.8 at high flow rates

• Filiform papillae are smooth, threadlike structures on the tongue dorsum; fungiform papillae are red, mushroom -shaped structures; taste buds are located on the foliate papillae

• Mucosal cells have a very rapid turnover rate; atrophy of fungiform and foliate papillae leads to loss of taste buds and chan ges in taste acuity

Thiamin (Vitamin B1)

• A coenzyme in carbohydrate and amino acid metabolism

• Energy transformation

• membrane and nerve conduction

• coenzyme in niacin synthesis

Thiamin (Vitamin B1) RDA

• 1.2 mg/day (men)

• 1.1 mg/day (women)

Thiamin (Vitamin B1) UL

• No UL established

• Rigorous physical activity increases the requirement

Thiamin (Vitamin B1) sources

• Lean meat & poultry

• Whole grain or enriched breads & cereals

• Egg yolk

• Nuts

• Legumes (~40% of thiamin intake comes from enriched breads, cereals & pasta)

Thiamin (B1): Hypo States

• EARLY DEFICIENCY — “THE MORALE VITAMIN”

  • Short-term deficiency causes patients to become depressed, irritable, anorexic, fatigued, and unable to concentrate

• BERIBERI

  • Peripheral neuropathy and muscle wasting; cardiovascular symptoms include tachycardia and enlarged heart

• WERNICKE-KORSAKOFF SYNDROME

  • Typically associated with alcoholism; characterized by mental confusion, nystagmus, and ataxia. Early diagnosis is essential.

Riboflavin (Vitamin B2): Role

Involved in energy metabolism and the conversion of tryptophan to niacin

Riboflavin (Vitamin B2) RDA

• 1.3 mg to men

• 1.1mg women

Riboflavin (Vitamin B2) RDA

• Milk

• cheddar cheese & cottage cheese

• Fortified breads & cereals

• Lean meat, poultry & fish

• Leafy green vegetables

Riboflavin (B2): Hypo States

• Deficiency is rare and usually involves secondary deficiencies of other B vitamins

• burning and itching eyes

• loss of visual acuity

• dermatitis

• anemia

• glossitis (papillary atrophy)

• angular cheilosis

• body carefully guards its limited riboflavin stores

Niacin (Vitamin B3) RDA

14-16 mg

Niacin (Vitamin B3) UL

35 mg

Niacin (Vitamin B3) sources

• Lean meats, poultry & fish

• Peanuts & peanut butter

• Brewer’s yeast

• Fortified breads & cereals

• Legumes

• Seeds & nuts

Niacin (Vitamin B3) hyper states

• Pharmacological doses of nicotinic acid (3 to 6 g/day) reduce cholesterol and triglycerides while increasing HDL cholesterol

• Doses of 50 mg or more act as vasodilators, causing flushing, nausea, tachycardia, itching, fainting, and blurred vision

• The body can store some niacin, so larger supplement doses may lead to abnormal liver function and gout

• Extended-release forms of niacin produce fewer adverse effects

Niacin (Vitamin B3) hypo states - pellagra

• Dermatitis

• Diarrhea

• Depression or Dementia

• Death

• mucous membrane symptoms

  • Scarlet glossitis — the entire tongue turns bright scarlet and sore; edema develops

  • Ulcerations may appear under the tongue, on the mucosa of the lower lip, and buccal mucosa

  • Gingival inflammation may resemble ulcerative gingivitis

Pantothenic Acid (Vitamin B5) ROLES & REQUIREMENTS

• Metabolism of carbohydrate, fat, and protein

• Synthesis and degradation of triglycerides, phospholipids, and sterols

• Formation of certain hormones and nerve-regulating substances

• Requirement: AI of 5 mg/day for adults

Pantothenic Acid (Vitamin B5) sources

Abundant in animal sources and whole grains; also produced by digestive tract bacteria

Pantothenic Acid (Vitamin B5) hypo states

• Deficiency results in dysfunctional lipid synthesis and energy production

• Symptoms: burning sensations in the feet, depression, fatigue, insomnia, and weakness

Pyridoxine (Vitamin B6)

• Coenzyme in protein metabolism

• tryptophan-to-niacin conversion

• hemoglobin synthesis

• unsaturated fatty acid synthesis

• energy production from glycogen

• proper nervous system function, including neurotransmitter synthesis

Pyridoxine (Vitamin B6) RDA

1.1–1.7 mg/day

Pyridoxine (Vitamin B6) UL

100 mg/day

Pyridoxine (Vitamin B6) sources

• Meat, poultry & fish

• Non-citrus fruits

• Whole grains

• Dark green, leafy vegetables

• Legumes

• Nuts

Pyridoxine (B6): Hyper state (Megadoses)

• Ataxia - severe sensory neuropathy (impaired sensing of touch, vibration, temperature, pinprick)

• bone pain and muscle weakness

Pyridoxine (B6): Hypo state (deficiency)

• Glossitis - atrophy of filiform papillae

• magenta tongue

• angular cheilosis

• peripheral neuropathy

• impaired immune response

Folate / Folic Acid (Vitamin B9)

• Coenzyme for approximately 20 enzymes

• Synthesis of DNA and RNA

• involved in maturation of red blood cells

• proper formation of neural tubes during fetal development

Folate / Folic Acid (Vitamin B9) RDA

400 mcg/day

Folate / Folic Acid (Vitamin B9) UL

1,000 mcg/day from supplements

Folate / Folic Acid (Vitamin B9) sources

• Liver

• Kidney & lima beans

• Dark green, leafy vegetables

• Lean beef

• Fortified breads & cereals

Folate (B9): Absorption

• Dietary folate must undergo changes to be absorbed

• The intestinal enzyme responsible requires a slightly acidic pH and is activated by zinc

• Individuals needing larger amounts may need a supplement

Folate (B9): Hyper States

• Excess intake may mask vitamin B12 deficiency and cause kidney damage

• Increased risk of cognitive decline has been reported in elderly persons taking folic acid supplements

Folate (B9): Hypo States

• Neural tube defects

• megaloblastic anemia

• elevated blood homocysteine

• glossitis (fiery red, denuded of papillae)

• impaired immune response

Folate (B9): risk groups

• Secondary to alcohol abuse; pregnancy/lactation

• kidney dialysis

• inadequate dietary intake or certain medications

• liver and GI disease

Cobalamin (Vitamin B12)

• synthesis of nucleic acids

• metabolism of certain amino acids, fatty acids, carbohydrates, and folate

• formation and regeneration of red blood cells and myelin synthesis

• Bacterial synthesis in humans occurs in the colon and is not absorbed

• Microorganisms can synthesize vitamin B12, which is why vegans need a fortified source or supplement

Cobalamin (Vitamin B12) Requirement and UL

• 2.4 µg/day

• no established UL

Cobalamin (Vitamin B12) sources

• Animal protein (organ meats)

• Milk

• Cheese

• Eggs

• Fish

Cobalamin (Vitamin B12) absorption and excretion

• Stomach

  • Vitamin B12 in food is released from its protein bond by hydrochloric acid and enzymes, then combines with salivary R-binder

• Small Intestine

  • Trypsin removes R-binder; vitamin B12 combines with intrinsic factor

• Ileum

  • Absorption occurs at specific receptor sites only if bound to intrinsic factor

Cobalamin (Vitamin B12) hyper and hypo states

• Macrocytic (large), immature red blood cells; glossopyrosis (unexplained tongue pain) and altered taste sensation

• Glossitis (smooth, beefy-red tongue) and cheilosis

• Stomatitis, pale or yellowish mucosa, hemorrhagic gingiva and bone loss

• Gastrointestinal disturbances; neurologic manifestations including numbness, tingling, and stunted growth

Biotin (Vitamin B7)

• Deficiency can be produced by ingestion of raw egg whites

• Coenzyme in metabolism of proteins, carbohydrates & fats; regulates gene transcription

• Aids utilization of protein, folic acid, pantothenic acid & vitamin B12

Biotin (Vitamin B7) RDA and UL

Intakes of 10–200 µg/day are considered safe/adequate; no established UL

Biotin (Vitamin B7) Sources

• egg yolk,

• liver

• cereals

• dietary supplements

• infant formula

• baby foods

Biotin (Vitamin B7) hypo state

• Avidin, the protein in raw egg whites, produces deficiency

• cooking denatures avidin

• Consuming 12 to 24 raw egg whites/day can produce anorexia, nausea, vomiting, glossitis, pallor, depression, and dry scaly dermatitis

• Oral signs: pallor of the tongue and patchy atrophy of lingual papillae along the

• lateral borders of the tongue

Vitamin C

Improves the host defense mechanism; plays a role in collagen formation and optimal wound healing

Vitamin A

Maintains the integrity of epithelial tissues. Deficiency produces squamous metaplasia in salivary duct cells, decreasing salivary secretion and causing xerostomia; associated with oral/oropharyngeal cancer risk

Vitamin E

Acts as an antioxidant, neutralizing free radicals and promoting integrity of mucosal cell membranes