Oral manifestations of nutritional deficiencies

1. Oral Manifestations of
Nutritional Deficiencies
Dr. Arsalan Wahid Malik
M. Phil (Oral Pathology) Dip.(Orthodontics)
ِ‫ح‬َّ‫ر‬‫ال‬ ِ‫من‬ْ‫ح‬َّ‫ر‬‫ال‬ ِ‫هللا‬ ِ‫م‬ْ‫س‬ِ‫ب‬ِ‫ميم‬

2. Cause/Reasons:
• Reduced intake
• Faulty absorption or metabolism
• Increased excretion

3. Deficiency Systemic effects Oral effects
Vitamin A Xerophthalmia Leukoplakia,
Hyperkeratosis of oral
epithelium
Thiamin B1 Neuritis, Cardiac failure,
Beriberi
None
Riboflavin B2 Dermatitis Angular stomatitis,
Glossitis
Nicotinamide
(Niacin B3)
Pellagra, CNS, Diarrhoea,
Dementia
Glossitis, Stomatitis,
Gingivitis
Vitamin B12 Pernicious anemia Glossitis, Aphthae
Vitamin C Scurvy Gingival swelling, Bleeding
Folic acid Macrocytic anemia Glossitis, Aphthae, Atrophy
of lingual papillae
Vitamin D Rickets, Osteomalacia Hypocalcification of teeth,
Malformation

4. Pregnancy:
• During pregnancy the hormonal changes effects a
previously existing chronic gingivitis which have been
symptom free and unrecognized
Causes:
 Elevated estrogen and progesterone levels
 Birth control pills

5. Pregnancy:
Oral manifestations:
• Gingiva hyperplasic with purple color
• Bleeding from pockets
• Food stagnation
• Secondary infections
• Halitosis
• “pregnancy tumor”
Treatment:
• Maintenance of oral hygiene
• Excision of Epulis

6. Gingival hyperplasia in pregnancy

7. Management consideration during
pregnancy:
• Hypotension if laid in supine position so dental
treatment in sitting position
• Nausea and vomiting
• Pregnancy hypertension
• Iron/folic acid deficiency

8. Hazards to fetus from dental
treatment:
• X-ray
• Respiratory depression due to sedatives, diazepam
and opioids all these cross placenta
• Aspirin causes neonatal hemorrhage
• NSAID in high dosages causes pulmonary
hypertension
• Steroids causes fetal adrenosuppresion

9. Safe drugs:
• Paracetamol
• Metronidazole

10. Diabetes Mellitus:
• Hyperglycemia due to deficiency of insulin
• Type-1
• Type-11
• Glucose concentration in blood ( mg/100ml)
Normal Diabetic
• Fasting 100 120
• 2-hr after glucose 120 180
Complications:
• Diabetic nephropathy
• Diabetic retinopathy
• Diabetic neuropathy

11. Diabetes Mellitus:
General signs/symptoms:
• Polyuria
• Polydipsia
• Loss of weight
• Tiredness

12. Diabetes Mellitus:
Oral manifestations:
• Dry mouth
• Increased susceptibility to infections
• Periodontal diseases
• Glossodynia
• Burning mouth syndrome
• Sialosis
• Lichen planus

13. Diabetes gingivitis

14. Scurvy:
• Ascorbic acid deficiency
• Old aged patients
• Vitamin C - synthesis of collagen

15. Scurvy:
Clinical features in scurvy:
• Hyperplasic gums
• Swollen gingival false pocketing
• Tiredness
• Malaise
• Bleeding gums

16. Scurvy:
Investigations:
• Blood examinations
Treatment:
Ascorbic acid