VITAMINS IN ODONTOSTOMATOLOGY.
I°/DEFINITION:
Vitamins = Organic substances essential to humans, active at low doses and which are not synthesized in the body (unlike hormones).
They are provided by food or by the bacterial flora of the digestive tract (capable of synthesizing certain products in sufficient quantity (vitamin K).
The absence of one or more vitamins leads to deficiency diseases called acute avitaminosis. This deficiency can have various origins:
Vitamin deficiency: the diet does not provide all the vitamins.
Absorption deficiency: due to the impermeability of the digestive tract due to a lack of a protein necessary for normal absorption (case of B12 and stomach protein).
Deficiency of use: during degenerative disorders of the hepatic parenchyma.
Iatrogenic deficiency: during drug treatments (antibiotics, sulfonamides), which destroy the bacterial flora necessary for the synthesis of certain vitamins.
The major acute syndromes of historical avitaminosis (scurvy, beriberi) have almost disappeared, however there is frequently a mild avitaminosis due to alcoholism and unbalanced diets.
In dentistry, chronic deficiency of certain vitamins is a causative agent of gingivitis and stomatitis.
Vitamins are classified according to their solubility: we will speak of water-soluble vitamins and fat-soluble vitamins. They also have a letter (A, B, C, etc.) which allows us to name them instead of their often very complex chemical name.
II°/ FAT-SOLUBLE VITAMINS:
1- Vitamin A:
- Found naturally in foods of animal origin and in particular in the liver of fish (cod, herring, tuna) but also in milk and its derivatives, in eggs, etc.
- It exists in certain plants in the form of provitamins (carotene) which can be easily broken down into vitamin A by the body.
- Vitamin A deficiency is characterized by decreased twilight vision (night blindness) and keratinization of corneal tissues (xerophthalmia), which is common in the Orient among populations that eat rice.
- In dentistry, vitamin A deficiency can contribute to the development of hyperkeratinized lesions of the mouth.
Vitamin A is prescribed to remedy these phenomena in the form of an oral solution.
(Hydrosol polyvitaminé®, Quotivit®, Alvityl®) or in ointment to promote healing in wounds and burns (Avibon®) and in children in the form of drops.
Daily requirements = 2000 IU for children and double that for adults 1 IU = 0.3 µg of vit A
Hypervitaminosis (overdose) causes in children: fatigue, sad face, anorexia; long bones are sensitive and painful.
In severe forms, the condition is sometimes comatose with seizures and cranial hypertension syndromes. In newborns, hypervitaminosis A causes acute hydrocephalus.
Vitamin A is contraindicated in pregnant women.
2-Vitamin D:
These are sterols; natural vitamin D is cholecalciferol or vit D 3. The others are skin sterols which, when exposed to the UV rays of the sun, become products with vitamin D action.
The sources of vit. D are identical to those of vit. A
Vit D is necessary for Ca metabolism and therefore for ossification.
Vitamin D deficiency leads to serious diseases in children such as RICKETS, characterized by stunted bone growth, skeletal deformities (lower limbs and thorax)
Signs of rickets are marked by the absence of calcification in the cartilage, the absence of fontanelle closure and dental disorders. Sometimes, slight hypocalcemia, normal phosphoremia and increased alkaline phosphatases.
Hypervitaminosis D of iatrogenic origin exists in children and causes renal disorders (polyuria), anorexia, apathy, vomiting and increased BP and hypercalcemia.
The risk of overdose has led to vitamin D being included in table C. It is used in solution for the prophylaxis of dental caries, dental decalcification during pregnancy, during breastfeeding in the form of cod liver oils.
Daily requirements are low and depend on the season (sunshine) and latitude. Vit D is generally prescribed in combination with vit C (calcium fructose) or alone (sterogyl):
1 drop = 800 IU; 1 IU = 0.0025 mcg.
Dosage: 10 to 20 drops/day up to 10 years and 20 to 30 g/day > 10 years.
The prescription is carried out as a course of 1 to 2 weeks/month.
VITAMINS IN ODONTOSTOMATOLOGY.
3- Vitamin K:
Natural vitamin K is present in the leaves of plants and in fruits. It is synthesized in the intestine of mammals and humans by the microbial flora.
Its deficiency occurs after long-term antibiotic therapy or due to malabsorption in cases of obstructive jaundice, bleeding (hemorrhages).
Vit K is essential for the synthesis by the liver of various factors involved in blood coagulation, and in particular prothrombin.
It is administered in drops (NN)*, in tablets, in IM or IV injection at a dose of 10 to 100 mg/day in cases of vitamin deficiency, in hypocoagulability, before surgical intervention.
III°/ WATER-SOLUBLE VITAMINS:
1- The vitamin B complex:
1.1/ Vitamin B1 (Thiamine):
The main source is provided by cereal germs, brewer’s yeast, milk and egg yolk.
Vitamin B1 deficiency results in a disease historically known as “beriberi” which is a polyneuritis with psychological and cardiac disorders and the presence of secondary edema.
Chronic deficiency can often be noted in alcoholics because vit B1 is the coenzyme of decarboxylases involved in the metabolism of alcohol.
It is used in combination or alone in tablets to treat polyneuritis, neuralgia and alcoholism crises.
There is no risk of overdose with this vitamin or with all water-soluble vitamins.
1.2/ Vitamin B2 (Riboflavin):
Widely distributed in foods (milk, vegetables, eggs, etc.)
Its deficiency leads to skin lesions, stomatitis, cracks at the corners of the lips and increased vascularization of the cornea.
It is used in high doses in various skin and mucosal conditions (glossitis, stomatitis, cheilitis) and ocular conditions (conjunctivitis) and in muscle cramps of various etiologies.
The dose is 15 to 30 mg/day in tablet or IM form and in combination with other B vitamins (B1-B12).
1.3/ Vitamin B 6 (Piridoxine):
Found in all foods along with vitamins B1 and B2.
Pyridoxine is a coenzyme of many metabolic reactions (transamination of amino acids, various decarboxylations). It plays an important role in the metabolism of Tryptophan, which leads to the synthesis of serotonin.
Vitamin B6 deficiency causes skin, nervous and digestive disorders
It is administered in tablet form; dosage: 250 to 500 mg/day and combined with vitamin B1.
It is indicated in polyneuritis, neurological disorders, pregnancy vomiting, oral and dental lesions (mouth ulcers, stomatitis, gingivitis, herpes).
VITAMINS IN ODONTOSTOMATOLOGY.
1.4- Vitamin PP (B3):
This vitamin from group B owes its name to the fact that it prevents pellagra which is a disease due to its deficiency ( Pellagra Preventive Factor ).
It is present in brewer’s yeast, liver, fish flesh and barley. It plays a role in dehydrogenases: enzymes of cellular respiration.
Its acute deficiency leads to pellagra characterized by digestive disorders (stomatitis, depapillated tongue, diarrhea), skin disorders and psychological disorders (dementia in severe cases 🡪 death). It is used in tablet form at a dose of 0.10 to 0.50 g / day in dermatological disorders (seborrhea).
1.5-Vitamin B 12 (Cobalamin):
Present in liver and meat.
Its deficiency leads to megaloblastic anemia (BIERMER’S ANEMIA)
It is used outside of Biermer’s anemia in glossitis, asthenia, polyneuritis: in drinkable ampoule 1 to 3 amp. / day for 3 weeks or in IM associated with B1 – B6.
2-Vitamin P:
Present in natural products extracted from horse chestnut bark or flowers
Acute vitamin deficiency does not occur in humans.
It is administered to increase the resistance of capillary walls and venules, either alone or in combination with vitamin C; dosage 4 tablets/day.
3-Vitamin C (ascorbic acid):
Vitamin C is found in many fruits (kiwi, orange, lemon, red currant, strawberry) and in many vegetables.
Daily requirements are 100 mg/day for adults and around 3 mg/kg/day for infants.
Its acute deficiency is responsible for scurvy, a hemorrhagic syndrome associated with gingivostomatitis and very significant apathy.
Vitamin C is a hydrogen transporter in the body and participates in cellular oxidation-reduction reactions.
It is also necessary for the synthesis of adrenal sterols and plays a role in ossification and tooth formation.
It is used in tablet form in the treatment of caries, alveolo-dental pyorrhea, for a stimulating effect in flu syndromes associated with aspirin.
Dose: 0.5 to 3 g/day. Sometimes prescribed for hemorrhagic purpura (IM or IV).
VITAMINS IN ODONTOSTOMATOLOGY.
Cracked teeth can be healed with modern techniques.
Gum disease can be prevented with proper brushing.
Dental implants integrate with the bone for a long-lasting solution.
Yellowed teeth can be brightened with professional whitening.
Dental X-rays reveal problems that are invisible to the naked eye.
Sensitive teeth benefit from specific toothpastes.
A diet low in sugar protects against cavities.