SAS 18: NUTRITIONAL DEFICIENCIES & DENTAL TREATMENT

vitamins

are organic compounds that serve as cofactors for enzymes prosthetic groups needed for a functional molecule (catalyst)

two types of vitamins

fat soluble vitamins (A, D, E, K)

water soluble vitamins (B, C)

risk factors for vitamin & mineral deficiencies

alcoholics

food faddists

chronically ill patients

malnourished patients

bulimia nervosa patients

anorexia nervosa patients

primary deficiency

occurs when an individual does not get enough of the vitamin in its food

secondary deficiency

due to an underlying disorder that prevents or limits the absorption or use of the vitamin

due to a “lifestyle factor” such as smoking, excessive alcohol consumption, or the use of medications that interfere with the absorption or use of the vitamin

examples of fat soluble vitamins

vitamin E — tocopherol, tocotrienols

vitamin K —phylloquinone, menaquinone

vitamin D — ergocalciferol, cholecalciferol

vitamin A — retinol, carotenoids, retinoic acid

A — retinoic acid retinol, carotenoids

deficiency can cause:

• alopecia

• headaches

• papilledema

• night blindness

• corneal ulceration

• hepatosplenomegaly

• increased intracerebral pressure

vitamin D — cholecalciferol, ergocalciferol

deficiency can cause:

• osteomalacia

• hypocalcemia

• hypercalcemia

• rickets hypocalcification of teeth (severe)

E — tocopherol & tocotrienols

deficiency can cause:

• ataxia

• ophthalmoplegia

• loss of proprioception

• congestive heart failure

• cancer prevention unproven

• antioxidant benefit in coronary artery disease

• predisposition to bleeding in patients on warfarin

K — phylloquinone, menaquinone

deficiency can cause:

• bleeding disorder

• abnormal bleeding tendencies

• increases coagulation in patients on warfarin

examples of water soluble vitamins

C — ascorbic acid

B1 — thiamine

B2 — riboflavin

B3 — niacin

B5 — pantothenic acid

B6 — pyridoxine, pyridoxamine, pyridoxal

B7 — biotin

B9 — folic acid, folinic acid

B12 — cyanocobalamin, hydroxycobalamin, methylcobalamin

B1 — thiamine

deficiency can cause:

• beriberi

• drowsiness

• wernicke-korsakoff syndrome

• rare hypersensitive reaction shock

B2 — riboflavin

deficiency can cause:

• glossitis

• dermatitis

• cracked lips

• angular stomatitis

B3 — niacin

deficiency can cause:

• liver damage

• hyperuricemia

• flushin, pruritus

• GI disturbances

• pellagra — diarrhea, dementia, dermatitis

B5 — pantothenic acid

deficiency can cause paresthesia

B6 — pyridoxine, pyridoxamine, pyridoxal

deficiency can cause:

• glossitis

• dermatitis

• stomatitis

• sensory neuropathy

• peripheral neuropathy

B7 — biotin

deficiency can cause:

• enteritis

• dermititis

• hair loss

• brittle nails

B9 — folic acid, folinic acid

deficiency can cause:

• megaloblastic anemia

• neural tube defect of fetus in pregnancy

B12 — cyanocobalamin, hydroxycobalamin, methylcobalamin

deficiency can cause:

• anemia

• megaloblastic

• posterior column neuropathy

C — ascorbic acid

deficiency can cause:

• purpura

• easy bruising

• GI discomfort

• predisposition to form oxalate stones

• scurvy (bleeding gums, periodontal disease, poor wound healing)

antibiotics — penicillin, amoxicillin

consider taking probiotics to help restore the balance

can destroy both the good & bad bacteria in the stomach, which influences digestion like diarrhea

cholesterol-lowering statin drugs

can decrease the amount of coenzyme Q10 (CoQ10) — an important antioxidant that aids in the production of energy

diuretics — meds for heart failure, hypertension (e.g amiloride, triamterene, bumetanide)

taking potassium supplements can be helpful

this rid the body of excess fluid, which can lower blood pressure

eating bananas, which are potassium-rich, is a natural alternative

this process can lead to the depletion of potassium, which can cause abnormal heart rhythms

anticonvulsants — phenytoin

consider taking vitamin D & serum 25-hydroxyvitamin

can cause vitamin D deficiency in epilepsy patients under antiepileptic drug treatment

acid reflux medications — proton pump inhibitors, esomeprazole

can reduce the level of vitamin C plasma in some people

take vitamin C prior to the course of medication

you won’t be able to get enough via dietary intake

NSAIDS (e.g., aspirin, ibuprofen)

can cause calcium loss through the urine & can interfere with nutrient metabolism

check your vitamin D levels with your doctor as it helps improve your calcium absorption

fruits that are rich in vitamin C

apple, orange

banana, mango

lychee, pineapple

strawberry, durian

watermelon, kiwi, guava