What are the Relevance and Effects of Vitamins to Our Patients' Oral Health?
Vitamins has been considered as an important nutrients needed by the body. These organic compounds affects the body by performing specific biological functions that help in maintaining and optimizing the body’s health. In 1912, a Polish biochemist named Casimir Funk, isolated an organic substance (called beri-beri vitamin) that was present in rice bran which could alleviate the deficiency disease beriberi, which was a common disease in many Asian countries at that time. The word “vitamine” was coined through that discovered organic substance which was considered “amine” and it was vital or needed for the body. Thus “vital” (because it was needed by the body) + amine coined the word “vitamine”, which was later called vitamin.
Vitamins can basically be classified into the following two categories:
I. Fat-soluble Vitamins Include Vitamins A, D, E and K
II. Water-soluble Vitamins -Include Vitamins B and C.
Diseases of the oral cavity are generally considered a common pathology that is influenced by many risk factors. The factors are genetics, systemic diseases , stress, lifestyle, diet and hormonal alteration status. Thus, the maintenance of oral and dental health becomes today a challenge.
Vitamins play a vital role for the equilibrium between those factors and how the body responds. For instance a tooth extraction, resorption often observed in the alveolar bone. Bone adequacy around dental implants has been well documented as a prerequisite for implant osseointegration and its success in the long run .
In this regard, various growth factors, drugs, and nutrients including vitamins have been evaluated to promote bone formation. On this post, we will be discussing the the roles of vitamins in dental caries , bone formation and maintenance of oral health.
Vitamin A is a group of nutritional unsaturated organic compounds. It is known that many carotenoids act as vitamin precursors, being carotene the most important. The active form of vitamin A, is retinoic acid, which is essential for maintaining the integrity of mucosal tissues and maturation of cells, including those of the immune system.
According to studies, an adequate intake of Vitamin A can prevent oral and dental diseases onset or progression since it contributed to connective tissue maintenance. Moreover, its role in immune system could be also important for maintaining some bacteria in adequate level and for prevention of massive inflammation. Researchers have reported antioxidant activities for retinol and dehydroretinol as well as for many pro-vitamin A compounds, including b- and a-carotenes . Antioxidant plays an important role in the periodontal disease and application of antioxidant vitamin therapy (vitamins A, E and K) which normalizes and improves the status of the periodontium. Vitamin A deficiency has definite effects on developing teeth in human beings.
VITAMIN B COMPLEX
Vitamin B-complex refers collectively to all of the essential water-soluble vitamins (except for vitamin C). These include thiamine (vitamin B1), riboflavin (vitamin B2), niacin (vitamin B3), pantothenic acid (vitamin B5), pyridoxine (vitamin B6), biotin (vitamin B7 or B8), folic acid (vitamin B9) and cobalamin (vitamin B12).
Vitamin B-complex is necessary for cell growth and metabolism, but, each member of the B-complex has a unique structure and performs unique functions. Vitamins B1, B2, B3, and biotin participate in different aspects of energy production, vitamin B6 is essential for amino acid metabolism, and vitamin B12 and folic acid facilitate steps required for cellular division.
Vitamin B12 is one of the important micronutrients for brain development and function. Vitamin B12 deficiency is common, and, the incidence increases with age. Studies on the development of cleft lip, alveolus, palate, and velum and neural tube defects have revealed several shared multifactorial causes. Vitamin deficiency disorders are one of several factors contributing to the etiology of these anomalies. A lack of or deficiency in these vitamins, thus, has severe consequences for the organism.
In a study conducted by Ishimiya M et al it was found that intakes of vitamin B1 correlated significantly with the number of remaining teeth. Vitamin B12 deficiency may cause an increase in prevalence of dental caries and gingival diseases in children. Studies were found that inadequate intakes vs low adequate or high adequate intakes of nutrients (e.g., riboflavin, vitamin D and vitamin B12) were associated with increased caries experience and low adequate intakes VS inadequate or high adequate intakes of nutrients (e.g. vitamin B12 and vitamin C) were associated with decreased caries formation.
Another study by Pontes et al found that the presence of oral signs and symptoms, including glossitis,oral candidiasis , recurrent oral angular cheilitis, ulcer, diffuse erythematous mucositis and pale oral mucosa in subjects with Vitamin B12 deficiency. Thus, it offers the dentist an opportunity to participate in the diagnosis of this condition. Supplementation with vitamin B12 may improve the gingival health and oral hygiene of children with deficiency
Folic acid is a water-soluble B-complex vitamin. It is required for essential biochemical reactions for the synthesis of amino acids, purines, and DNA. Folate deficiency is relatively common, even though the deficiency can be easily addressed by administration of folic acid. Insufficient intake of folic acid during pregnancy has been suggested to increase the risk for cleft palate.
Studies have shown the essential role of folate during tissue development and is required for the integrity of gingival tissues. Orofacial clefts of the lip and palate are common birth defects of complex genetic and environmental etiology. There is some suggestive evidence for a possible role of folic acid in prevention of this defect.
The role of nutrition in periodontology has been studied extensively, and recent studies on the interactions between nutrition, host defense, and infection have found a correlation between nutrition and the pathogenesis of periodontal disease.
It has also been noted that Vitamin B-complex supplementation has also demonstrated positive effects on wound healing after periodontal surgery. It has been reported that one of the B vitamins, thiamine (vitamin B1), may increase wound repair. Furthermore, niacin (vitamin B3) supplementation reportedly has a positive effect on the healing of repositioned flaps, suggesting that the vitamin creates a more balanced collagen structure during the wound healing processes. In a nutshell, Vitamin-B complex, can help in the wound healing process including oral and dental wounds.
Vitamin C is naturally found in fresh fruits and vegetables. Lack of exposure to foods that contain vitamin C has been the most frequent cause of the deficiency. It has been studied that, vitamin C is heat sensitive. Boiling or cooking food with Vitamin C can remove its nutritional value. There is very little storage of vitamin C in the body, and therefore, plasma concentration is largely related to recent intake. Total body storage of vitamin C is 1500 mg, and clinical features of deficiency occur after that level is reduced to less than 350 mg.
Studies showed that consumption of diets that are rich in vegetables and vitamin C appears to associate positively with periodontal health. The use of vitamin C supplementation improves postoperative healing following dental implant surgery in patients with chronic periodontitis and patients treated bone grafts.
Vitamin C also plays an important role in maintaining the integrity of the teeth and also as a non-enzymatic antioxidant defense system. It is evident that serum and salivary vitamin C level decreases with increase in caries activity suggesting the powerful antioxidant property of vitamin C which is able to scavenge free radical.
Deficiency of Vitamin C is well recognized as scurvy. Scurvy produces general weakness, anaemia, severe changes in the periodontal tissue and pulps of the teeth. Vitamin C is also essential for the formation and maturation of collagen, and for the integrity of connective and osteoid tissues, and dentin. Also, using vitamin C supplementation could improves postoperative healing following dental implant surgery in patients with chronic periodontitis
Vitamin D regulates calcium levels and plays a key role in craniofacial development and the maintenance of good oral health. It has a critical role in enamel, dentin, and oral bone formation as ameloblasts and odontoblasts. The 25-dihydroxyvitamin D is the active form of vitamin D.
Deficiency in vitamin D during periods of tooth development may also result in developmental defects including enamel hypoplasia. In general, higher serum levels of 25-hydroxyvitamin D or (25(OH)D) are associated with improved oral health outcomes.
Vitamin D is associated with the two main oral diseases, caries and periodontal disease and also linked to several infectious and inflammatory conditions in oral cavity. Its deficiency may be a potential risk factor for aggressive periodontitis . Vitamin D supplementation can be used in children for preventing caries in the primary dentition . A diet rich in vitamins D, significantly reduced periodontal inflammation in humans. Periodontitis is characterized by alveolar bone loss induced by the host immune response to bacterial insult. Because vitamin D plays a crucial role in bone maintenance and immunity, there is biologic rationale to suspect that a vitamin D deficiency could negatively affect the periodontium and vitamin D intake was associated with lower severity of periodontal disease.
Vitamin-E is the collective term for a family of chemical substances that are structurally related to alpha-tocopherol. Vitamin E occurs naturally in eight different forms: four tocopherols, alpha (α)-, beta (β)-, gamma (γ) - and delta (δ) tocopherol and four tocotrienols, alpha-, beta-, gamma- and delta-tocotrienol.
Vitamin-E exhibit antioxidant properties by acting as a lipid-soluble free radical scavenger in cell membranes. Anti-carcinogenic effects of Vitamin E are its ability to inhibit formation of the carcinogenic chemical nitrosamine from nitrites in some foods, and its ability to promote immune system function.
Oral cancer is generally preceded by precancerous lesions which include leukoplakia, lichen planus, oral submucous fibrosis, oral epithelial dysplasia, erythroplakia. Vitamin-E is an essential nutrient that is receiving growth attention in the prevention of precancerous lesions because of its anti oxidant properties.
It also found that topical application of Vitamin E helps on oral mucositis induced by Cancer Chemo/Radiotherapy, recurrent aphthous stomatitis and inflammatory processes associated with these conditions. Vitamin E supplements would also prevent oxidative stress associated with periodontitis but its potential for periodontal disease treatment.
Vitamin K is a fat-soluble substance found primarily in leafy green vegetables. The dietary requirement is low because the vitamin is naturally produced by the bacteria in the intestines.
Two natural forms exist: vitamins K1 and K2. Vitamin K1 is found in food. Vitamin K have a role in a wide range of biological activities including cell growth and proliferation, regulation of calcium metabolism in tissues, inflammatory reactions, oxidative stress, and plays an essential role in normal blood clotting, promoting bone strength, and helping to produce proteins for blood, kidneys, and bones metabolism.
In bone, Vitamin K exerts its anabolic effect in different ways such as promoting osteoblast differentiation, upregulating transcription of specific genes in osteoblasts, and activating the bone-associated Vitamin K dependent proteins which play critical roles in extracellular bone matrix mineralization. Vitamin K has been tested as a possible anticaries agent by virtue of its enzyme inhibiting activity in the carbohydrate degradation cycle. Vitamin K was found to prevent acid formation in incubated mixtures of glucose and saliva.
To sum it all up, take this information with a grain of salt. Yes, these vitamins may help in the health and the well being of a person. These vital nutrients help decrease the risk of oral and dental diseases and help protect teeth and periodontal tissues. But, more studies are needed to further clarify and confirm these vitamins use for each case, as well its dosages and the frequency of intake.
Dr. Bryan Anduiza - Writer
Dr. M. Jean Villanueva-Galindez - Editor
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