Dr.

Parikshya Shrestha
PG Student
Dept. of Oral Pathology and Microbiology
 Vitamins
Vitamins may be regarded
as organic compounds
required in the diet in
small amounts to
perform specific
biological functions for
normal maintenance of
optimum growth and
health of the organism.
 Vitamins
• Required in small amounts
• Functions
– Regulate metabolism
– Help convert energy in fat, carbohydrate, and protein into
ATP
– Promote growth and reproduction
• Deficiencies can result in potentially serious consequence
Classification of Vitamins
 Vitamin Structure and
Function
• All vitamins contain carbon, hydrogen, and oxygen
– Some vitamins contain nitrogen and sulfur

• Chemical structure of each vitamin is unique

• Each vitamin is a singular unit

• Vitamins are absorbed intact

• Vitamins perform numerous essential functions

 Vitamin Absorption and
Storage
• All absorption takes place in the small intestine

• Fat-soluble vitamins
– Are absorbed in the duodenum
– Storage
• Vitamin A is mainly stored in the liver
• Vitamins K and E are partially stored in the liver
• Vitamin D is mainly stored in the fat and muscle
tissue
– Can build up in body to point of toxicity
 Vitamin Absorption and
Storage
• Water-soluble vitamins
– Absorbed with water and enter directly into the blood
stream
– Most absorbed in the duodenum and jejunum
– Most are not stored in the body
– Excess intake excreted through the urine
– Important to consume adequate amounts daily
– Dietary excesses can be harmful
Digesting and Absorbing Water-
Soluble Vitamins
Digesting and Absorbing
Vitamins
 Water-Soluble Fat-Soluble
Vitamins Vitamins
Absorbed in
Small Intestine Small Intestine
the
Hydrophobic
or Hydrophilic Hydrophobic
Hydrophilic
Absorbed
Blood Lymph
into the
Stored in the
Not Generally Yes
body
Can build up
and become Not Generally Yes
toxic
Need to
consume Yes No
 Bioavailability
• Varies based on
– Amount in food
– Preparation
– Efficiency of digestion and absorption of food
– Individual nutritional status
– Natural or synthetic
• Fat-soluble vitamins are generally less bioavailable than
water-soluble vitamins
• Vitamins from animal foods are generally more
bioavailable than those in plant foods
 Destruction of Vitamins
• Water-soluble vitamins can be destroyed by
– Exposure to air
– Exposure to ultraviolet light
– Water
– Changes in pH
– Heat
– Food preparation techniques
• Fat-soluble vitamins tend to be more stable
 AVITAMINOSeS
• The avitaminoses are due to the absence of minute amounts of
biologically important materials rather than to the presence of
minute amounts of biologically active materials(infectious
agents).

• Another characteristic of the deficiency diseases is that they may

be present in varying degrees.

• Deficiency diseases; however, may occur in partial form, i.e.

they may occur to a mild degree and in their incipient forms the
lesions and symptoms might be difficult to recognize.

• They may also occur in more severe forms, but they are seldom
so serious as to be the immediate cause of death.
 Provitamins and Preformed
Vitamins
• Provitamins
– Substances found in foods that are not in a form
directly usable by the body
– Converted to the active form once absorbed

• Preformed vitamins
– Vitamins found in foods in their active form
FAT-SOLUBLE VITAMINS
• The fat-soluble vitamins are
– Vitamin A,
– Vitamin D,
– Vitamin E, and
– Vitamin K
• Their availability in diet, absorption and transport are
associated with fat.
• They are soluble in fats and oils and also fat solvents (alcohol,
acetone etc.)
• Stored in liver and adipose tissue.
• Not readily excreted in urine so excess consumption
(particularly A and D) leads to their accumulation and toxic
effects.
 VITAMIN A
• Present only in foods of animal origin, however, its provitamin
carotenes are found in plants.

Chemistry
• Term retinoids is often used to include natural and synthetic forms
of vitamin A.
• Retinol, retinal and retinoic acids are regarded as vitamers of
vitamin A
Vitamers : represents chemically similar substances that possess
qualitatively similar vitamin activity.
 VITAMIN A
Biochemical Function
• Vision
• Cell growth and differentiation
• Maintenance of healthy epithelial cells
• Growth and mucus secretion by synthesis of certain glycoprotein
and mucopolysaccharides in presence of retinyl phosphate.
• Reproduction ; acts like a hormone and regulates gene expression
• Maintenance of proper immune system
• Cholestrol synthesis
• As antioxidant
Beneficial effect of β -carotene : due to its antioxidant role, increased
consumption of it is associated with decreased incidence of heart
attacks, skin and lung cancer
Functions of vitamin A
1. Vision:
• Vitamin A is a component of the visual pigments of rod and cone
cells. Rhodopsin, the visual pigment of the rod cells in the retina,
protein that detects and absorbs light in the eye.
• When rhodopsin is exposed to light, a series of photochemical
isomerizations occurs, which results in the bleaching of the visual
pigment and release of all-trans retinal and opsin.
• This process triggers a nerve impulse that is transmitted by the
optic nerve to the brain.
• Similar reactions are responsible for color vision in the cone
cells.
Functions of vitamin A (contd..)
2. Growth: Vitamin A deficiency results in a decreased growth rate
in children. Bone development is also slowed.

3. Reproduction: Retinol and retinal are essential for normal

reproduction, supporting spermatogenesis in the male and
preventing fetal resorption in the female. Retinoic acid promotes
growth and differentiation of epithelial cells.

4. Maintenance of epithelial cells: Vitamin A is essential for

normal differentiation of epithelial tissues and mucus secretion.
 Food Sources

Animal Sources Plant Sources

Liver Yellow and dark
kidney green vegetables
egg yolk and fruits eg :
Milk carrots,
cheese spinach,
Butter pumpkins,
fish liver oil (very mango,
rich) papaya, etc.
 VITAMIN A

RDA (Required Dietary Allowance)

• Male : 1000 retinol equivalents (3500 IU)
• Female : 800 retinol equivalents (2500 IU)
Requirements increases in pregnant and lactating mothers.
 VITAMIN A
Deficiency
• Due to
– Inadequate dietary intake
– Impaired intestinal absorption
– Reduced storage in liver
– Chronic alcoholism
• Deficiency manifestations are related to eyes, skin and growth.
DEFICIENCY
• Deficiency of vitamin A results in dermatologic, mucosal, and
ocular manifestations.

• In experimental animals, vitamin A deficiency results in

hyperkeratosis and hyperplasia of the gingiva with a tendency for
increased periodontal pocket formation.
DEFICIENCY
Eyes –
• Night blindness (nyctalopia) ; difficulty to see in dim light since
dark adaptation time is increased.
• Prolonged deficiency irreversibly damages a no. of visual cells.
• Severe deficiency leads to xerophthalmia; drying in conjunctiva
and cornes and keratinization of epithelial cells. In certain areas of
conjunctiva, white triangular plaques (Bitot’s Spots) are seen.
• Xerophthalmia for long time leads to corneal ulceration and
degeneration resulting in destruction of cornea (Keratomalacia),
causing total blindness.
DEFICIENCY
Skin and epithelial cells –
• degenerative changes occur in epithelial tissues, resulting in
keratinizing metaplasia.
• Skin becomes rough and dry.
• Keratinization of epithelial cells of GIT, Urinary and respiratory
tract leading to increased bacterial infection
• Also associated with formation of urinary stones.

Growth
• Growth retardation due to impairment in skeletal formation

Reproduction
• Degeneration of germinal epithelium leading to sterility in males
 VITAMIN A
Hypervitaminosis A
• Total serum Vitamin A level (normal 20 – 50 μg/dl) is elevated.
• Signs and Symptoms :
– Dermatitis raised intracranial tension
– Enlargement of liver
– Skeletal decalcification
– Tenderness of long bones
– Loss of weight
– Irritability
– Loss of hair
– Joint pains
 VITAMIN D
• Also called anti rachitic vitamin.
• Fat soluble vitamin resembling sterols in function and functions
like a hormone.

Chemistry
• Cholecalciferol (Vitamin D3) is found in animals
• Erocalciferol ( Vitamin D2) is found in plants
• These are souces for vitamin D activity and are referred to as
provitamins.
• Vit D2 and D3 are not biologically active. They are metabolized
identically in the body and converted to active forms of Vitamin D.
• Vitamin D is regarded as sunshine vitamin.
Biochemical function
• The major biologic function of vitamin D is to maintain normal
blood levels of calcium and phosphorus.
• Vitamin D aids in the absorption of calcium, helping to form and
maintain strong bones.
• It promotes bone mineralization in concert with a number of other
vitamins, minerals, and hormones.
• It maintains normal cellular growth and function.
• It maintains healthy immune function and preventng excessive
inflammation.
1. Action of calcitriol on intestine.
– Increases the intestinal absorption of calcium and phosphate
– In intestinal cells, calcitriol binds with a cytosolic receptor to
form a calcitriol- receptor complex which approaches nucleus
and interacts with a specific DNA, leading to synthesis of
specific calcium binding protein which increases the calcium
uptake by intestine.
2. Action of calcitriol on bone.
– In osteoblasts of bone, calcitriol stimulates calcium uptake for
deposition as calcium phosphate, thus essential for bone
formation.
3. Action of calcitriol on kidney.
– Calcitriol is also involved in minimizing excretion of
calciumand phosphate through kidney by decreasing their
excretion and enhancing reabsorption.
 VITAMIN D
Dietary Sources
• Vit D can be provided to body in 3 ways :
1. Exposure of skin to sunlight for synthesis of Vit D
2. Consumption of natural foods; fatty fish, fish liver oils, egg
yolk etc
3. Irradiating food that contains precursors of vit D and
fortification of foods ( milk, butter etc)

RDA (Required Daily allowance)

• 400 IU or 10 mg of cholecalciferol
• 200 IU ir 5 mg cholecalciferol in country with good sunlight like
India.
 VITAMIN D
Deficiency
• Occurs in strict vegetarians, chronic alcoholics, individuals with
liver and kidney disease or fat malabsorption syndromes, in some
individuals who covers entire body for religious customes, if
requirement is not met through diet.

• Consequences : Rickets in children.

Osteomalacia in adults.
 VITAMIN D
Deficiency
• Vitamin D3 has been shown to have an important function as
anticancer, immune modulatory and innate immunity effects
through Vitamin D receptor activation (a transcription factor of
nuclear receptor super family).
• 1,25(OH)2 D3-VDR system plays a role in oral homeostasis and
its dysfunction may lead to periodontal disease.
 VITAMIN D
• Rickets
– Bone deformities due to incomplete mineralization resulting in
soft and pliable bones and delay in teeth formation
– Plasma level of calcitriol is decreased and alkaline phosphate
activity is elevated.
– Clinical manifestations of rickets include irritability, growth
retardation, prominence of costochondral junctions (rachitic
rosary), bowing of long bones
– Oral manifestation : developmental anomalies of dentin and
enamel, delayed eruption, malalignment of teeth in the jaw,
high caries rate, abnormally wide predentin zone, interglobular
dentin.
 VITAMIN D
Deficiency (contd..)
• Osteomalacia : demineralization of bone occurs ( bone becomes
softer), increasing their susceptibility to fracture.
• Unlike juvenile rickets, only the flat bones and diaphysis of the
long bones are affected.
• Most commonly seen in postmenopausal females with a history
of low dietary calcium intake and little exposure to ultraviolet
light.
• Oral manifestation : reported cases of periodontitis in about 50%
women with osteomalacia
Deficiency (contd..)
• Vitamin D-resistant Rickets (Familial hypophosphatemia, refractory
rickets, phosphate diabetes) : X- linked dominant defect in renal
phosphate metabolism. There is inability to reabsorb certain
metabolites such as water, phosphate, calcium and potassium that
may lead to rickets or osteomalacia.
• It is characterized by :
– Hypophosphatemia and hyperphosphaturia
– X-linked dominant trait
– Rickets or osteomalacia which does not respond to the usual doses of vitamin
D
– Normocalcaemia with high-normal parathyroid hormone levels
– Diminished intestinal calcium and phosphate absorption
– Decreases growth with short stature
– Normal vitamin D metabolism
– Absence of other related abnormalities.
Vitamin D-resistant Rickets (contd..)
• Oral manifestations : Characteristically, there is histologic evidence
of widespread formation of globular, hypocalcified dentin, with
clefts and tubular defects occurring in the region of the pulp horns.
• These pulp horns are elongated and extend high, often reaching
nearly to the dentinoenamel junction. Because of these defects,
there is commonly invasion of the pulp by microorganisms without
demonstrable destruction of the tubular matrix.
• Following this, there is often periapical involvement of grossly
normal-appearing deciduous or permanent teeth, followed by the
development of multiple gingival fistulas.
• abnormal cementum seen.
• lamina dura around the teeth is frequently absent or poorly defined
on the radiograph, and the alveolar bone pattern is often abnormal.
 VITAMIN D
Deficiency (contd..)
• Renal rickets (renal osteodystrophy)
– Seen in patient with chronic renal failure
– Mainly due to decreased synthesis of calcitriol in kidney
– Tt : administration of calcitriol
 VITAMIN D
Hypervitaminosos D
• Most toxic in overdoses (10-100 time RDA)
• Toxic effects
– Demineralization of bone (resorption) and increased calcium
absorption from intestine, leading to elevated calcium in
plasma ( hypercalcemia)
– Prolonged hypercalcemia : depostion of calcium in many soft
tissues such as kidney and arteries
– May lead to formation of stones in kidney ( renal calculi)
– Loss of appetite. Nausea, increased thirst, loss of weight etc.
 VITAMIN E
• Naturally occuring antioxidant
• Also called tocopherol
• Essential for normal reproduction hence known as anti-sterility
vitamin.
Chemistry
• Tocopherols contains a substituted aromatic ring and a long
isoprenoid side chain.
• Tocopherols are biological antioxidants. The aromatic ring reacts
with and destroys the most reactive forms of oxygen radicals and
other free radicals, protecting unsaturated fatty acids from
oxidation and preventing oxidative damage to membrane lipids,
which can cause cell fragility.
Biochemical function
1. Membrane antioxidants ; essential for membrane structure and
intregrity
2. Protection of RBC from hemolysis by oxidizing agents.
3. Preserves and maintains germinal epithelium of gonads for
proper reproductive function hence prevents sterility
4. Required for cellular respiration through electron transport chain.
5. Prevents oxidation of vit A and carotenes.
6. Proper storage of creatine in skeletal muscle
7. Optimal absorption of amino acids from intestine.
8. Involved in proper synthesis of nucleic acids
9. Protection of liver from damage from toxic compounds such as
carbon tetrachloride.
10. Delays onset of cataract by working in association with vit A,C
and βcarotene.
 VITAMIN E
RDA (Required Daily allowance)
• Male : 10mg (15 IU) of α- tocopherol
• Female : 8 mg (12 IU) of α- tocopherol
Vit E supplemented diet advised for pregnant and lactating women.

Toxicity
• Least toxic
• No toxic effect even after ingestion of 300 mg/day
 VITAMIN E
Deficiency symptoms
• Dietary deficiency of vitamin E in humans is unknown, although
patients with severe fat malabsorption, cystic fibrosis, and some
forms of chronic liver disease suffer deficiency because they are
unable to absorb the vitamin or transport it, exhibiting nerve and
muscle membrane damage.
• Sterility, degenerative changes in muscle, megaloblastic anaemia,
changes in central nervous system.
• Severe symptoms : increased fragility of erythrocytes and minor
neurological symptoms.
 VITAMIN K
• Only fat soluble vitamin with specific coenzyme function
• Exists in different forms
– Vitamin K1 (phylloquinone) in plants
– Vitamin K2 (menaquinone) produced by intestinal bacteria and
also found in animals
– Vitamin K3 (menadione) synthetic form
• All three are stable to heat but are lost by oxidizing agents,
irradiation, strong acids and alkalies.
 VITAMIN K
Absorption, storage and transport
• Taken in diet or synthesized by intestinal bacteria and absorbed
along with fats and depending on bile salts
• Transported along with LDL and stored mainly in liver.

Biochemical function
• Functions concerned with blood clotting functions : involved in
both the extrinsic and intrinsic systems of coagulation, particularly
with prothrombin (factor II) synthesis and in the regulation of
levels of factors VII, IX, and X (proconvertin, Christmas factor,
and Stuart-Prower factor, respectively).
• Brings about post-translational modification of certain blood
clotting factors
Vegetable oils
 VITAMIN K
RDA (Required Daily allowance)
• No RDA since it can be adequately synthesized in the gut.
• Suggested RDA for an adult is 70 – 140 μg/day

Hypervitaminosis K
• Administration of large doses of vitamin K produces hemolytic
anaemia and jaundice, particularly in infants.
• Toxic effect is due to increased breakdown of RBC
 VITAMIN K
Deficiency
• Deficiency leads to coagulopathy because of inadequate synthesis
of prothrombin and other clotting factors. Profuse bleeding even
for minor injuries. The blood clotting time is increased.

• The most common oral manifestation is gingival bleeding. Pro

thrombin levels below 35% will result in bleeding after
toothbrushing; however, when prothrombin levels fall below 20%,
spontaneous gingival hemorrhages will occur.
WATER-SOLUBLE VITAMINS
 WATER-SOLUBLE VITAMINS
• They are :
– Non B complex : Vitamin C
– B complex : Energy releasing – Vitamin B1, B2, B3, B5, B6, B7
Hematopoietic – Vtiamin B12, Folic acid

• Heterogenous groups of compounds

• Soluble in water
• Most are readily soluble in water and are not toxic to the body
• They should be continuously supplied in the diet.
• They form coenzymes that participates in a variety of biochemical
reactions.
VITAMIN
C
 VITAMIN C
• The active form of vitamin C is ascorbic acid.

• The main function of ascorbate is as a reducing agent in several

different reactions.

• Plays important role in health and disease.

 VITAMIN C
Biochemical Function
1. Collagen formation : plays role of a coenzyme in hydroxylation
of proline and lysine while protocollagen is converted to
collagen.
2. Bone formation
3. Iron and hemoglobin metabolism : enhances iron absorption by
keeping it in ferrous form. Also useful in conversion of
methemoglobin to hemoglobin
4. Tryptophan metabolism
5. Tyrosine metabolism
 VITAMIN C
Biochemical Function
6. Folic acid metabolism : needed for formation of tetrahydrofolate
(FH4), active form of folic acid. Further in association with FH4,
ascorbic acid is involved in the maturation of erythrocytes.
7. Peptide hormone synthesis.
8. Synthesis of corticosteroid hormones : Vit C is necessary for
hydroxylation reaction in synthesis of corticosteroid hormones.
9. Sparing action of other vitamins : Vit C being strong antioxidant,
spares Vit A, E and some B-complex vitamins from oxidation.
10. Immunological functions : enhances synthesis of
immunoglobulins and increases phagocytic action of leucocytes.
11. Preventive action on chronic diseases : being antioxidant, reduces
risk of cancer, cataract and coronary heart disease.
Food Sources
 VITAMIN C
RDA (Required Daily allowance)
• About 60 – 70 mg/day for adult and additional 20- 40 % increase
for females during pregnancy and lactation.

Deficiency
• Severe vitamin C deficiency result in the disease known as scurvy.
• Characterized by spongy and sore gums, loose teeth, anemia,
swollen joints, decreased immunocompetence, delayed wound
healing, haemorrhage, osteoporosis etc.
Oral effects of Scurvy
• occur chiefly in the gingival and periodontal tissues.
• interdental and marginal gingiva is bright red with a swollen,
smooth, shiny surface.
• In fully developed scurvy the gingiva becomes boggy, ulcerates
and bleeds. The color changes to a violaceous red.
• In infants the enlarged tissue may cover the clinical crowns of the
teeth .
• typical foul breath with fusospirochetal stomatitis.
• In the severe chronic cases, hemorrhages into and swelling of the
periodontal membranes occur, followed by loss of bone and
loosening of the teeth, which eventually exfoliate.
 B-COMPLEX VITAMINS
• The B vitamins are widely distributed in foods and their influence
is felt in many parts of the body.

• They function as coenzymes that help the body obtain energy

from food.

• The B vitamins are also important for normal appetite, good

vision, and healthy skin, nervous system, and red blood cell
formation.
 B-COMPLEX VITAMINS
• Eight of the water-soluble vitamins are known as the vitamin B-
complex group:
– thiamin (vitamin B1),
– riboflavin (vitamin B2),
– niacin (vitamin B3),
– vitamin B6 (pyridoxine),
– vitamin B12,
– folate (folic acid),
– biotin and
– pantothenic acid.
 Thiamin: Vitamin B1
• Thiamin, or vitamin B1 has a specific coenzyme, thiamine
pyrophosphate which is mostly associated with carbohydrate
metabolism.

Function
• Thiamin pyrophosphate is required for carbohydrate and branched
chain amino acid metabolism.
• In addition, it acts as coenzyme for transketolase reaction that
mediates the conversion of hexose and pentose phosphates.
• It also plays a role in peripheral nerve conduction but the exact
mechanism is unknown.
 Thiamin: Vitamin B1
RDA (Required Daily allowance)
• Adults : 1 – 1.5 mg/day;
• Infants : 0.3 mg/day
• Pregnant and lactating women should increase their daily intake
by 0.4 mg and 0.5 mg respectively
Deficiency
• Thiamin deficiency leads to beriberi, which is generally insidious
in onset, chronic in course and sudden death may occur.
• Beriberi may be of two types: wet and dry.
• In either form, patients may complain of pain and paresthesia.
• Wet beriberi manifests with cardiovascular symptoms due to
impaired myocardial energy metabolism, dysautonomia,
cardiomegaly, highoutput cardiac failure, peripheral edema, and
peripheral neuritis.
• In dry beriberi, same symptoms occur but for the edema.
Deficiency (contd..)
• Alcoholic patients with chronic thiamin deficiency are having
CNS manifestations known as Wernicke’s encephalopathy, which
consists of horizontal nystagmus, ophthalmoplegia, cerebral
ataxia, and mental impairment.
• If there is loss of memory and confabulatory psychosis also
present, it is known as Wernicke-Korsakoff syndrome.
 RIBOFLAVIN : Vitamin B2
• Riboflavin, or vitamin B2 through its coenzyme takes part in a
variety of cellular oxidation.

• Riboflavin is involved in the energy production for the electron

transport chain, the citric acid cycle, as well as the catabolism of
fatty acids (beta oxidation)
 RIBOFLAVIN : Vitamin B2
Food Sources
• liver, eggs, kidney, meat, dark green vegetables, legumes, whole
and enriched grain products, and milk and milk products.

RDA (Required Daily allowance)

• Adult : 1.2 – 1.7 mg/day
• Increased intake by 0.2 – 0.5 mg/day for pregnant and lactating
women and also in heavy exercise.
Deficiency
• Riboflavin deficiency is particularly common among children who do
not drink milk.
• Deficiency causes ariboflavinosis, symptoms includes cheilosis,
glossitis and dermatitis.
• mild deficiency - glossitis which begins with soreness of the tip and/or
the lateral margins of the tongue. The filiform papillae become
atrophic, while the fungiform papillae remain normal or become
engorged and mushroom shaped, giving the tongue surface a
reddened, coarsely granular appearance. The lesions extend backward
over the dorsum of the tongue.
• severe cases – tongue may become glazed and smooth, owing to
complete atrophy of all papillae. In many cases the tongue has a
magenta color which can be easily distinguished from cyanosis.
Deficiency
• Paleness of the lips, especially at the angles of the mouth, but not
involving the moist areas of the buccal mucosa, is the earliest sign of the
deficiency disease.
• The pallor is followed by cheilosis, which is evidenced by maceration and
fissuring at the angles of the mouth. Later the macerated lesions develop
a dry yellow crust which can be removed without causing bleeding.
• The lips become unusually red and shiny because of a desquamation of
the epithelium.
• As the disease progresses, the angular cheilosis spreads to the cheek. The
fissures become deeper, bleed easily and are painful when secondarily
infected with oral and/or skin microorganisms.
• Deep lesions leave scars on healing.
• The gingival tissues are not involved.
Deficiency
• Riboflavin deficiency also exhibits a scaly, greasy dermatitis of
affects the nasolabial folds and the alae nasi.
• A fine scaly dermatitis may also occur on the hands, vulva, anus,
and perineum.
• Ocular changes, consisting of corneal vascularization,
photophobia, and a superficial and interstitial keratitis, have also
been described.
 NIACIN : Vitamin B3
• Niacin, or vitamin B3, is also known as pellagra preventive (P.P.)
factor of Goldberg.

• Two compounds, nicotinic acid and nicotinamide, have the

biologic activity of niacin; its metabolic function is as the
nicotinamide ring of the coenzymes NAD and NADP in
oxidation/reduction reactions
 NIACIN : Vitamin B3
Food Sources
• Liver, yeast, whole grains, cereals, pulses like beans and peanuts
are rich natural source.
• Milk, fish, eggs and vegetables are moderate sources.

RDA (Required Daily allowance)

• Adults : 15 - 20 mg/day
• Childrens: 10 - 15 mg/day
 NIACIN : Vitamin B3
Deficiency
• occurs with alcoholism, protein malnourishment, low calorie
diets, and diets high in refined carbohydrates.
• Pellagra (italian : rough skin ) is the disease state that occurs as a
result of severe niacin deficiency.
• Symptoms commonly referred as 3 Ds : dermatitis, diarrhoea,
dementia and if not treated may rarely lead to death.
 NIACIN : Vitamin B3
Pellegra
• The mucous membrane lesions affecting the tongue, oral cavity,
and vagina are usually the earliest lesions diagnostic of the
disease. Other lesions being the typical dermal lesions of
bilaterally symmetric, sharply outlined, roughened, keratotic
areas.
• prodromal stage :
– loss of appetite and vague gastrointestinal symptoms, general
weakness, lassitude, mental confusion, forgetfulness, and other
ill-defined symptoms develop.
– burning sensation in the tongue, which becomes swollen and
presses against the teeth, causing indentations.
– tip and lateral margins of the tongue become red.
 NIACIN : Vitamin B3
Pellegra
Acute stage :
• entire oral mucosa becomes fiery red and painful.
• profuse salivation.
• epithelium of the entire tongue desquamates.
• Tenderness, pain, redness, and ulcerations begin at the interdental
gingival papillae and spread rapidly.
• Superimposed necrotizing ulcerative gingivostomatitis or Vincent’s
infection involving the gingiva, tongue, and oral mucosa is a common
sequel.

Epithelial changes followed by the characteristic skin rash particularly in

the areas exposed to sunlight especially in the neck region are called
Casal’s necklace.
 NIACIN : Vitamin B3
Niacin toxicity
• Consuming large doses of niacin supplements may cause flushed
skin, rashes, or liver damage.
• Over consumption of niacin is not a problem if it is obtained
through food.
Pantothenic Acid is involved in
energy production.

Coenzyme A, which can be

synthesised from panothenic
acid, is involved in the
synthesis of amino acids,
fatty acids, ketones,
cholesterol, phospholipids,
steroid hormones,
neurotransmitters (such as
acetylcholine) and antibodies.
 PANTOTHENIC ACID
Food Sources
• Sources include liver, kidney, meats, egg, whole grains, yeast,
milk etc.

RDA (Required Daily allowance)

• since no evidence of human pantothenic acid deficiency has been
recorded, human requirement of this vitamin is unknown
• 5 mg/day is considered adequate for children and adults.
 Pyridoxine : Vitamin B6
• Vitamin B6, otherwise known as pyridoxine, pyridoxal or
pyridoxamine, aids in protein metabolism.

Food Sources
• Animal sources : egg yolk, fish, milk, meat
• Vegetable source : wheat, corn, cabbage, roots and tubers.

RDA (Required Daily allowance)

• 2 – 2.2 mg/day for adult
• 2.5 mg/day during pregnancy, lactation and old age.
 Pyridoxine : Vitamin B6
Deficiency
• Depression, mental confusion, albuminuria, and leukopenia
occurred in normal people placed on a pyridoxine-deficient diet.
• The oral lesions of experimentally induced pyridoxine deficiency
bear a striking resemblance to pellagrous stomatitis.

Toxicity
• Pyridoxine is the only water-soluble vitamin with significant
toxicity.
• Over consumption is rare, but neurologic symptoms (sensory
neuropathy) occur at intakes above 200 mg/day, an amount more
than 100 times the RDA.
 BIOTIN
• formerly known as anti-egg white injury factor, vitamin B7 or
vitamin H
• helps release energy from carbohydrates and aids in the
metabolism of fats, proteins and carbohydrates from food.

Food Sources
• Sources of Biotin include liver, kidney, egg yolk, milk, tomatoes,
grains etc
• Biotin is also made by intestinal bacteria.

RDA (Required Daily allowance)

• 100 - 300 mg/day for adult males and females
Biotin Deficiency
• Biotin deficiency does not occur naturally because the vitamin is
widely distributed in food. Also, a large percentage of the biotin
requirement in humans is supplied by intestinal bacteria.

• However, the addition of raw egg white (20 eggs/day) to the diet
as a source of protein induces symptoms of biotin deficiency,
namely, dermatitis, glossitis, loss of appetite, and nausea.

• Raw egg white contains a glycoprotein, avidin, which tightly

binds biotin and prevents its absorption from the intestine.
 FOLic acid
• Folate, also known as folic acid or folacin is abundantly found in
green leafy vegetables.

• It is important for one carbon metabolism and is required for the

synthesis of certain amino acids, purines and the pyrimidine-
thymine.
 FOLic acid
Function
• Folic acid is essential for the growth of many animal species and
is also essential in man.
• Folic acid acts as a co-enzyme in the form of tetrahydrofolate
(THF), which is involved in the transfer of single-carbon units in
the metabolism of nucleic acids and amino acids.
• THF is involved in pyrimidine nucleotide synthesis, so is needed
for normal cells division, especially during pregnancy and infancy,
which are times of rapid growth.
• Folate also aids in erythropoiesis, the production of red blood
cells.
• The synthesis of DNA is impossible in the absence of folic acid.
 FOLic acid
Food Sources
• liver, kidney, dark green leafy vegetables, meats, fish, whole
grains, fortified grains and cereals, legumes, and citrus fruits.

RDA (Required Daily allowance)

• 200 μg/day for adult males and females.
• Pregnancy will increase the RDA for folate to 400 μg/day and
lactation to 300μg/day.
Deficiency
• Folic acid deficiency is probably the most common vitamin
deficiency among pregnant women.
• Also lactating mothers, women on oral contraceptives and
alcoholics are susceptible.
• Deficiency may occur due to indequate dietary intake, defective
absorption, use of anticonvulsant drugs ( phenobarbitone, dilantin,
phenyltoin) and increased demand.
Deficiency
• Folic acid deficiency is characterized by
glossitis, diarrhea, and macrocytic
anemia.
• The glossitis appears initially as a
swelling and redness of the tip and
lateral margins of the dorsum.
• The filiform papillae are the first to
disappear, the fungiform papillae remain
as prominent spots.
• In advanced cases, the fungiform
papillae are lost and the tongue becomes
slick, smooth, and either pallid or fiery
red in color.
Deficiency
• The macrocytic anaemia associated with megaloblastic changes in
bone marrow is a characteristic feature of folate deficiency.

Decreased production of purines

impairs DNA synthesis.

slowing down of maturation of erythrocytes

macrocytic RBC.

• In pregnancy, deficiency may cause neural defects in the fetus.

 Vitamin B12 : COBALAMIN
• Vitamin B12, also known as anti-pernicious anemia vitamin.
• Vitamin B12 is involved in the cellular metabolism of
carbohydrates, proteins and lipids.
• It is essential in the production of blood cells in bone marrow,
nerve sheaths and proteins.

Chemistry
• Complex structure
• Empirical formula (cyanocobalamin) : C63H90N14O14PCo
 Vitamin B12 : COBALAMIN
Biochemical Function
• aids in the building of genetic material, production of normal red
blood cells, and maintenance of the nervous system.
• When the vitamin is deficient, unusual fatty acids accumulate and
become incorporated into cell membranes, including those of the
nervous system.
• This may account for some of the neurologic manifestations of
vitamin B12 deficiency.
Food sources
 Vitamin B12 : COBALAMIN

RDA (Required Daily allowance)

• 3 μg/day for adult males and females
• 0.5 – 1.5 μg/day for childrens
• 4 μg/day for pregnant and lactating women
Vitamin B12 Deficiency
• Vitamin B12 deficiency most commonly affects strict vegetarians
(those who eat no animal products), infants of vegan mothers, and
the elderly.
• Symptoms of deficiency include anemia, fatigue, neurological
disorders, and degeneration of nerves resulting in numbness and
tingling.
• Most common disease associated is Pernicious anemia,
characterized by low hemoglobin levels, decreased number of
erythrocytes and neurological manifestations.
• In order to prevent vitamin B12 deficiency, a dietary supplement
should be taken. Some people develop a B12 deficiency because
they cannot absorb the vitamin through their stomach lining.
• This can be treated through vitamin B12 injections.
Vitamin B12 Deficiency
• Treatment : Vitamin B12 is administered in therapeutic doses
( 100 – 1000 μg) intramuscualrly.
• Folic acid administration can also reverse hematological
abnormalities observed in vit B12.
• Combined supplemntation of B12 and folate given to treat
megaloblastic anaemia.

.
SUMMARY
 REFERENCE
• U. Satyanarayan. Essentials of Biochemistry, 4th edition
• Lippincott’s Illustrated Reviews: Biochemistry; Fifth Edition
• Harper's Illustrated Biochemistry, 28th edition
• Shafer’s Textbook of Oral pathology, 8th edition
• Role of Vitamins in Oral Health & Disease: an Overview.
Indian Journal of Applied Research ; December 2015
• Pavithra R.S., Ramaprabha G , Rajasekar S , Lakshmi sree S
Vitamin Deficiency And Periodontal Disease – A Tie- in
Relationship.; Sch. J. App. Med. Sci., 2017; 5(1A):74-81