nutritional+disorders

=The Influence of Nutritional Disorders on the Periodontium =

Past studies conducted on animals have shown little relationship between periodontal and nutritional deficiencies. More research must be done to correlate the professional opinions of many that there is a link between periodontal disease and nutrition.

//"There are no nutritional deficiencies that by themselves can cause gingivitis or periodontitis." – Fermin Carranza//


 * Nutritional disorders**

__Vitamin A__: Deficiency in this vitamin can cause degenerative changes in the epithelial cells of the skin and mucous membranes in the oral cavity. Keratinizing metaplasia can result from this deficiency. Vitamin A helps to maintain epithelial integrity and may play an important role in protecting against against microbial invasion. __Vitamin B complex__: Includes thiamin, riboflavin, niacin, pyridoxine (B6), biotin, folic acid, ascorbic acid and cobalamin (B12). Deficiency may involve an array of combinations and is rarely caused by one deficiency but multiple. A major change in the oral cavity associated with vitamin B complex is glossitis. Angular cheilitis may also occur when these vitamins are depleted. __Thiamin__: manifestations include paralysis, cardio symptoms, edema, loss of appetite, hypersensitivity to oral mucosa, minute vesicles on buccal mucosa, under the tongue or on the palate, and erosion of oral mucosa. __Riboflavin:__ glossitis (magenta color), angular cheilitis, dermatitis, loss of papilla on tongue that can range from patchy atrophy, pebble elevations or a flat, dry fissured tongue. __Niacin:__ rare condition that may result from malabsorption or alcoholism; dermatitis, gastrointestinal, neurologic and mental disturbances, glossitis, gingivitis, stomatitis and NUG. __Folic acid:__ GI lesions, diarrhea, intestinal malabsorption. In animals, necrosis of gingiva, PDL, and alveolar bone was noted. __Vitamin C__: Lack of vitamin C can increase bleeding times. In patients already suffering from gingivitis, vitamin C deficiency can actually increase those symptoms, more edema, more inflammation, more bleeding. Vitamin C is an antioxidant that will reduce periodontal inflammation. Lack of vitamin c can result in scurvy (disease that's symptoms include hemorrhagic diathesis and delayed wound healing)- although rare in USA. __Ascorbic acid:__ effects ability of tissue to repair and regenerate, interferes with bone formation, permeability of oral mucosa for endotoxins, regulates vascular response and wound healing. __Vitamin D__: Vitamin D is essential for calcium absorption from the gastrointestinal tract. Deficiency in vitamin D increases the chance of osteoporosis and reduces bone density. Lamina dura may disappear as well. Reduction in the width of the periodontal ligament space, decalcification and some cementum resorption. __Vitamin E__: With this deficiency the oral cavity may not heal as well or as fast if any trauma occurs. Vitamin E is needed for wound healing. __Iron deficiency__: Decrease function of lymphocyte proliferation, neutrophil cytotoxic activity, and antibody response. Iron- deficiency anemia may lead to Plummer-Vinson syndrome consisting of glossitis and ulceration of the oral mucosa and oropharynx, including dysphasia. __Zinc deficiency__: Decrease of antibody response, Phagocytic function of macrophages, B-cell and T- cell proliferation.
 * Vitamin deficiencies**:


 * Protein deficiency**: protein is essential for the oral cavity, when protein is lacking (seen in animals) the gingiva, connective tissue and the periodontal ligament begin to degenerate, impaired cementum deposits, atrophy of tongue epithelium & osteoporosis (including alveolar bone) may also occur. A deficiency could result in muscular atrophy, weakness, weight loss, anemia, leukopenia, edema, poor wound healing, low lactation, poor resistance to infection & lymphoid depletion. Protein deficiency also accentuates the destructive effects of bacterial plaque and occlusal trauma on the periodontal tissues, but the initiation of gingival inflammation and it's severity depend on the bacterial plaque. As a result, when protein deprived periodontal tissues are more vulnerable to breakdown when challenged by bacteria.