GUIDED BY:

Dr.P.KARUNAKAR
Dr.M.S.RANGA REDDY Presented by:
Dr.B.S.KARTEEK C.L.Charan
(1st Year Pg)
 CONTENTS:

• Introduction
• History
• Nomenclature
• Classification
• Synthesis of vitamins by intestinal bacteria
• Comparison between fat and water soluble vitamins
• Vitamers
• Fat soluble vitamins
 Vitamin A
 Vitamin D
 Vitamin E
 Vitamin K
• Water soluble vitamins
• Vitamin C
• Vitamin B Complex • Thiamine (vit B1)
• Riboflavin (vit B2)
• Niacin (vit B3)
• Pantothenic acid (vit B5)
• Pyridoxine (vit B6)
• Biotin (vit B7)
• Folic acid
• Cyanocobalamin(vit B12)

• Vitamin like compounds

• Antivitamins
• Avitaminosis & dental caries
• Avitaminosis & Pregnancy
• Conclusion
INTRODUCTION:
HISTORY & NOMENCLATURE:

 Hopkins coined the term accessory factors to the unknown and

essential nutrients present in natural foods.
 Funk(1913) isolated an amine from rice polishings and yeast which
cure beri-beri in pigeons.

 He coined the term vitamine(Greek vita-life).

 He believed that all of them were amines but later realised as only
few Of them.
 So the term Vitamin is continued without final letter ‘e’
HISTORY & NOMENCLATURE:

 McCollum and Davis (1915) felt only two vitamins are present –
fat soluble A and water soluble B (anti beri beri factor).

 Soon another water soluble anti scurvy factor named vitamin C

was described.

 Vitamin A was found to possess two components vitamin A

(prevents night blindness) and vitamin D (anti ricket factor).

 Fat soluble vitamin called vitamin E in absence which rats

failed to reproduce properly was discovered.
 Fat soluble vitamin concerned with coagulation was discovered
in 1930’s named vitamin K.

 Regarding water soluble factors vitamin C (ascorbic acid) identified

as pure substance.

 Vitamin B found to be complex mixture and many investigators

between 1920-30 and named them from B1-B12.

 Some of them found to be mixtures of already known vitamins.

 So few members (numbers) disappeared and only B1,B2,B6,B12

names are more commonly used.
CLASSIFICATION
SYNTHESIS OF VITAMINS BY INTESTINAL BACTERIA:

 Normal intestinal bacterial synthesis, and absorption of vitamin K

and Biotin may be sufficient to meet the body requirements.

 For other B complex vitamins, synthesis and absorption are

relatively less.
 Administration of antibiotics often kills vitamin synthesizing
bacteria in gut.

 So additional consumption of vitamins is recommended.

Comparison between fat and water soluble vitamins:
Vitamers:

 Chemically similar substances that possess qualitatively similar

vitamin activity

Vitamin B6
Vitamin A
FAT SOLUBLE VITAMINS
Vitamin A:

• Present in foods of animal origin.

• Carotenes = provitamins ( found in
plants)

Chemistry:

Retinoids = Natural and synthetic forms of vitamin A.

Retinol (vitamin A alocohol)

(oxidation)
Retinal (vitamin A aldehyde)
(oxidation)
Retinoic acid (vitamin A acid)
Absorption , transport & mobilization of vitamin A:
Functions:

• Vision = rhodopsin cycle or walds visual cycle.

• Given by George Wald.
• Retina of eye = rods & cones
• Rods = 10 millions (dim light vision)
• Cones = 5 millions ( bright light &
colour vision)
• Retinol & Retinoic acid = functions like steroid hormones.

• Regulate protein synthesis = cell growth & differentiation.

• Essential to maintain healthy epitheial tissue.

• Carotenoids = antioxidants (reduces risk of cancers & prevent heart

attacks)

Vitamin A = Anti cancer vitamin.

• Histodifferentiation of ameloblasts.
Recommended dietary allowance (RDA):

Adults:
• Man = 1000 retinol equivalents (5000 IU).
• Woman = 800 retinol equivalents (4000 IU).
• Growing children , pregnant women
Lactating mothers. =

Dietary sources:
Deficiency = General manifestations.

Eyes :
Night blindness • Earliest symptom
• Nyctalopia
• Difficult to see in dim light

xerophthalmia

• Severe deficiency
• Dryness in conjunctiva & cornea
 Bitot spots

• Keratinization of epithelial cells

• White triangular plaques

in conjunctiva

keratomalacia

• Ulceration of cornea
• Degeneration & destruction
of cornea
• Total blindness
• Growth retardation due to impairment in skeletal formation

• Degeneration of germinal epithelium leads to sterility in males

• Keratinization of epithelial cells of GIT, Urinary tract, Respiratory tract

leads to increased bacterial infection

• Plasma level of retinol binding protein is decreased

Deficiency = Oral manifestations:

• Keratinising metaplasia = Epithelim results in increased keratin

formation.
• Occlusion of salivary gland ducts with keratin.
• Enamel hypoplasia, atypical dentin formation, epithelial invasion
of pulpal tissue.

• Enamel is more severely affected than dentine.

• Delayed eruption of teeth.
Treatment

 60 mg of retinol as palmitate or acetate to be given orally

immediately following the diagnosis of vit A deficiency

 Single prophylactic oral dose of 60 mg retinol in pre-school

childrens

 Oral administration of periodic high doses is now used to

reduce vit A deficiency in developing countries . Dosing at 4-6
months intervals
 Carotenemia

 Yellowish pigmentation of skin

 Increased beta carotene levels in blood

 Excessive consumption of carotene rich foods

carrots,squash& sweet potatoes

 Harmless and reversible

 Lead to mistaken diagnosis of jaundice

Hypervitaminosis A:

• Dermatitis ( drying &redness of skin).

• Enlargement of liver
• Skeletal decalcification
• Tenderness of long bones
• Loss of weight
• Irritability
• Loss of hair
• Joint pains
Vitamin D:

• Resembles sterols in structure & functions

like hormone
• Anti rachitic vitamin
• Sunshine vitamin

Chemistry:

Cholecalciferol (vit D3) = animals

Provitamins
Ergocalciferol (vit D2) = plants

Calcitriol or 1,25-dihydroxy chole calciferol = Active form

Synthesis & functions of calcitriol:
Vitamin D = Hormone and not vitamin ( justification)

• Vitamin D3 (cholecalciferol) synthesized in skin by sunlight.

• Biologically active form of vit D, calcitriol produced in kidney.

• Calcitriol has target organs – intestine,bone&kidney.

• Calcitriol similar to steroid hormones

• Self-regulated by feedback mechanism = synthesis of calcitriol.

Recommended dietary allowance (RDA) :

• Dialy = 400 IU or 10 micro gram.

• In countries with good sunlight (india) = 200 IU or 5 micro gram.

Dietary sources:
Deficiency = General manifestations:

• Plasma level of calcitriol is decreased.

• Alkaline phosphotase activity
is increased.
• Bones become softer = fractures.

• Chronic renal failure.

• Decreased synthesis of calcitriol
in kidney.
Deficiency = Oral manifestations:

• Delayed eruption of primary and permanent teeth.

• Mal-alignment of the teeth in the jaws.

• Developmental anomalies of enamel and dentin.

• The teeth shows wide predentin zone with much interglobular dentin.

• The pulp horns are elongated & extend high reaching DEJ.
 Treatment

 In persons with vitamin D deficiency, treatment may include oral

ergocalciferol (vitamin D2) at 50,000 IU per week for eight weeks.

 After vitamin D levels normalize, experts recommend maintenance

dosages of cholecalciferol (vitamin D3) at 800 to 1,000 IU per day from
dietary and supplemental sources
Hypervitaminosis D :
Vitamin E:

• Active form = Alpha-tochopherol.

• Natural antioxidant.
• Anti-sterility vitamin.

Chemistry:
Functions :

• Protects the poly unsaturated fatty acids (PUFA) from peroxidation

reactions.

• Protects liver from toxic compounds.

• Preserves and maintains germinal epithelium of gonads.

• Prevents heart disease by preventing oxidation of LDL.

• In association with vit A & C delays onset of cataract.

• Protects RBC from hemolysis by oxidizing agents.

Recommended dietary allowance:

Man = 10 mg (15 IU)

Woman = 8 mg (12 IU)

Dietary sources :
Deficiency = General manifestations.

• Decreased male fertility.

• Impaired foetal-maternal vacular relationships.

• Encephalomalacia

• Nutritional muscular dystrophy.

Vitamin K :

• Only fat soluble vitamin with specific coenzyme function.

• Coagulation vitamin.

Chemistry :

• K1 - phylloquinone ( plants)
• K2 - menaquinone (intestinal bacteria & animals) Naphthoquinone
• K3 - menadione ( synthetic form ) derivatives.
Functions:

• Post translational modification of certain blood clotting factors

( 2,7,9,10 ).

• Acts as coenzyme for carboxylation of glutamic acid

Recommended dietary allowance :

• It can be adequately synthesized in the gut.

• But suggested RDA for adult = 70 – 140 microgram per day.

Dietary sources :
Deficiency – General manifestations :

• Lack of active prothrombin in circulation.

• Individual bleeds profusely even for minor injuries.

Blood Clotting time

 Deficiency – Oral manifestations :

• Prothrombin levels below 35 % results in gingival bleeding after

tooth brushing.

• Spontaneous gingival hemorrhages occur when prothrombin levels

fall below 20 %
 Hypervitaminosis K :

• Hemolytic anemia & jaundice

Particularly in infants.

• Increased break down of RBC.

Water soluble vitamins
 Vitamin C:

• Ascorbic acid

Chemistry :

• Oxidation of ascorbic acid is rapid in presence of copper.

• It becomes inactive if foods prepared in copper vessels.

 Synthesis of vitamin C :

• Man,other primates,guinea
pigs,bats cannot synthesize
ascorbic acid.

• L-gulonolactone oxidase
is absent.
Functions :

• Collagen formation.

• Coenzyme in hydroxylation of proline and lysine,catalysed by lysyl &

prolyl hydroxylase.(protocollagen Collagen)

• Maintainance of normal connective tissue & wound healing process.

• Bone formation
Bone tissues = organic matrix , collagen , inorganic calcium &
phosphate

• Iron & hemoglobin metabolism

Due to its reducing property it enhances

Iron absorption in fe+2 form ( ferrous ).
• Tryptophan & Tyrosine metabolism

• Folic acid metabolism

• Corticosteroid hormones synthesis

• Sparing action of other vitamins

As it is a strong antioxidant,it spares vit A,vit E,and

some B-complex vitamins from oxidation and prevents
free radical injury.
• Immunological function

 Enhances synthesis of
Antibodies (immunoglobulins)

 Increases phagocytic action

of leucocytes

• Preventive action on chronic diseases

Free radicals Damage to proteins, Develops cancer

(Produced in normal Lipids,DNA&cell Heart diseases
metabolism constantly) Membranes. Cellular ageing
Recommended dietary allowance

Adult = 60-70 mg/day

Woman
(pregnancy & = 20-40 % increase
lactation)

Dietary sources
Deficiency – General manifestations

• Scurvy

 Anemia
 Swollen joints
 Delayed wound healing
 Hemorrhage
 osteoporosis

• Defect in collagen synthesis

• Cork screw hair pattern with
tiny bleeding points around
Orifice of a hair follicle

• Woody legs with large spontaneous

bruises in lower extremities
Deficiency – Oral manifestations

• Scurvy buds

 Swollen, spongy gums particularly

inter-dental papilla

 Hemorrhages in periodontal
membrane
 Loss of bone
 Loosening of teeth
Thiamine

 Anti beri-beri vitamin

 Anti neuritic vitamin

Chemistry

Co enzyme = Thiamine pyrophosphate

Carbohydrate metabolism
Functions:

• Conversion of pyruvate to
acetyl coA

• Alpha – ketoglutarate dehydrogenase

(enzyme in krebs cycle)
• Transketolase is dependent on TPP
(enzyme in hexose monophosphate
shunt pathway)

• Required for acetyl choline synthesis &

ion translocation of neural tissue

• Important role in transmission

of nerve impulse
Recommended dietary allowance :

Depends on intake of carbohydrate.

Adults = 1 – 1.5 mg/day

Dietary sources
Deficiency – General manifestations

Beri-beri = seen in populations consuming polished

rice as staple food

 Dry beri-beri or
Periphersl neuritis
• Wet beri-beri

 Cardiac manifestations

• Infantile beri-beri
 Riboflavin

Chemistry

 Flavin mononucleotide (FMN) Coenzymes

 Flavin adenine dinucleotide (FAD)

Flavoproteins
Functions

 Redox reactions
Responsible for
energy production

Recommended dietary allowance

Adult = 1.2 – 1.7 mg/day

Pregnant and lactating woman = (by 0.2 – 0.5 mg/day)

Dietary sources

Deficiency – General manifestations

 Scrotal dermatitis
  Vascularisation of cornea

 Nasolabial seborrhea or dyssabacea

Deficiency – oral manifestations

• Glossitis
 Filiform papillae = atrophic
 Fungiform papillae = enlarged,mushroom shaped
 Magenta coloured
tongue

• Cheilosis , ocular lesions

Treatment

Rapid recovery ususally follows after adiministration of oral

riboflavin 10mg daily
 Niacin

• Nicotinic acid

Chemistry

 Nicotinamide adenine dinucleotide (NAD+) Coenzymes

 Nicotinamide adenine dinucleotide phosphate (NADP+)

Tryptophan

 60 mg of tryptophan = 1 mg of niacin
 Functions

 Oxidation – reduction reactions

Recommended dietary allowance

Adult = 15 – 20 mg/day
Children = 10 – 15 mg/day
Dietary sources

Deficiency symptoms – General manifestations

Dermatitis
Pellagra Diarrhoea
Death
Dementia
Deficiency – Oral manifestations

 Salivation is profuse

 Mucosa = fiery red and painful

 Raw beefy tongue
 Bald tongue of sandwith
Treatment

Oral or parenteral Nicotinamide in a dose of 100mg 8-hourly

Response will be rapid within 24 hrs
Pantothenic acid

 Chick anti – dermatitis factor

Chemistry

Coenzyme A
 Functions

 Coenzyme A = Central molecule for various

biochemical reactions.( carbohydrate,lipid,ptotein )
Regarded as coenzyme of
metabolic integration.
Recommended dietary allowance

 Synthesized in the body

Adult = 5 – 10 mg/day

Dietary sources
 Deficiency symptoms

 Burning feet syndrome

 Pain
 Numbness in toes
 Sleeplessness
 Fatigue
Pyridoxine

Chemistry

Pyridoxal phosphate (PLP) Coenzyme

Functions

 Reactions like transamination,decarboxylation,deamination,

transulfuration.

 Amines like serotonin, serine & catecholamines are synthesized

Recommended dietary allowance

Adult = 2 – 2.2 mg/day

Pregnancy, lactation ,old age = 2.5 mg/day

 Dietary sources

Deficiency – General manifestations

• Peripheral neuropathy
 Decreased synthesis of catecholamines
 Demyelination of neurons
 Biotin

 Vitamin H

 Egg – white injury factor = avidin (glycoprotein)

 Anti – egg white injury factor = biotin

Functions

 Directly participates in carboxylation reactions

 Involved in gluconeogenesis,citric acid cycle,fatty acid synthesis.

Recommended dietary allowance

Synthesized by intestinal bacteria

Adults = 100 – 300 mcg

Dietary sources
Deficiency – General manifestations

 Anemia
 Loss of appetite
 Nausea
 Dermatitis
 Glossitis

 Uncommon – well distributed in foods

supplied by intestinal bacteria
Folic acid

Chemistry

Folic acid

Dihydrofolate reductase

Tetrahydrofolate (active form)

 Functions

 Required for one carbon metabolism

 Amino acids (glycine , serine),purines & pyrimidines synthesized

Recommended dietary allowance

Adult = 200 mcg

Pregnancy = 400 mcg
Lactation = 300 mcg
 Dietary sources

Deficiency – General manifestations

 Most common vitamin deficiency ( primarily in pregnant woman)

  Macrocytic anemia – large RBC

 Megaloblastic changes in
bone marrow

Deficiency – Oral manifestations

• Glossitis

 Filiform papillae disappear first

 In advance cases fungiform also lost
 Tongue – smooth & fiery red in colour
 Cyanocobalamin

 Anti pernicious vitamin

 Extrinsic factor of castle

 Erythrocyte maturation factor

Chemistry

 Methylcobalamin
Coenzymes
 5 – Deoxyadenosyl cobalamin
Absorption, transport & storage
Functions

 Isomerization of methylmalonyl Co A to Succinyl Co A

 Synthesis of methionine from homocysteine

Recommended dietary allowance

Adult = 3 mcg
Children = 0.5 – 1.5 mcg
Pregnancy & lactation = 4 mcg

Dietary sources

 Plants cannot
Synthesize vit B12.

 Animals obtain
by eating foods
derived from
other animals
or
 Intestinal bacterial
Synthesis
Deficiency – General manifestations

 Pernicious anemia

 Neurological manifestations – degenration of posterior &

lateral tracts of spinal cord

 Degeneration of myelin sheath of peripheral nerves occurs

 Deficiency – Oral manifestations

• Beefy red tongue

Glossitis
Glossopyrosis (burning sensation in tongue)
Glossodynia (pain in the tongue)

• Hunters glossitis or Moellers glossitis

Treatment

 Vit B12 is administered in therapeutic doses

(100-1000ug) I.M
 Concurrent admission of VIT B12 & FOLIC
ACID
 Early treatment should be carried out to
prevent neurologic complications which are
usually irreversible.
Interrelation between folic acid & vitamin B12 –
folate trap or methyl trap hypothesis
Vitamin like compounds
 Choline

 Component of phospholipids and involved in membrane

structure and lipid transport

Inositol

 Required for synthesis of lipositol which is component of cell membrane

Lipoic acid

 Involved in decarboxylation reactions with other vitamins like thiamine,

niacin, riboflavin
Para amino benzoic acid

 Structural component of folic acid

 Considered as a vitamin in another vitamin

Bioflavonoids

 Isolated from lemon peels

 Responsible for maintainance of

capillary permeability
 Antivitamins

 Antagonist to action of vitamins

 Structural similarities with vitamins
 Administration causes vitamin deficiencies
Avitaminosis & dental caries
 Vitamin D deficiency results in topical demineralisation of
tooth making it more prone to caries

 Vitamin D supplements reduces dental caries particularly in children

 Vitamin K has been tested as an anticaries agent, due to its enzyme

inhibiting activity in carbohydrate degradation cycle

 Vitamin B6 can be considered as anticaries agent as it promotes the

growth of non cariogenic bacteria thereby reducing the count of
cariogenic ones

 Vitamin C deficiency is known for producing periodontal issues but

studies has also been carried out for its role in dental caries
Avitaminosis & Pregnancy
 Avitaminosis showed their maximum effects in 2nd and 3rd trimester
of pregnancy

 Vitamin A, D & C deficiency showed their maximum effect on oral

tissues

 Vitamin A deficiency leads to defected development of ameloblasts

and leading to enamel hypoplasia

 Vitamin D deficiency as reported by Richards & Co workers

highlights the importance of it in dentin and matrix formation

 Severe defeciency leads to hypoplastic defects and defective dentin

formation

 The children showed altered patterns of tooth development

conclusion

 Influence on various vitamins helps us know the underlying

problem of patient to plan for a prompt treatment which will ensure
proper oral health and successful outcome of the treatment
 On going tremendous research incorporating various components of
diet for the uses in dentistry increases the spectrum of action of
these important substances
References

TEXT BOOK OF BIOCHEMISTRY BY U.SATYANARAYANA-

2ND EDITION
TEXT BOOK OF BIOCHEMISTRY BY DM VASUDEVAN-4th
EDITION
SHAFER’S TEXT BOOK OF ORAL PATHOLOGY- 6th
EDITION
TEXT BOOK OF ORAL PATHOLOGY- SHAFER’S- 7th
EDITION
ESSENTIALS OF MEDICAL PHYSIOLOGY BY PREMA
SEMBULINGAM- 4th EDITION
PRINCIPLES AND PRACTICE OF MEDICINE BY
DAVIDSON 19th EDITION