GOOD MORNING

Water Soluble Vitamins – Vitamin B & C complex

DR.V.VASUNDHARADEPT OF CONSERVATIVE DENTISTRY AND ENDODONTICSKVG DENTAL COLLEGE & HOSPITAL, SULLIA.

VITAMINS

Definition:

Vitamins may be regarded as organic compounds required in the diet in small amounts to perfom specific biological functions for normal maintenance of optimum growth and health of the organism.

Classification:

Based on the nature of solubility vitamins were classified into two groups.

vitaminsFat soluble water solubleVitamin A Non B-complex vitamin B-complexVitamin D Vitamin C Energy releasing HematopoiticVitamin E Thiamin B1 Folic acidVitamin K Riboflavin B2 Cyanocobalamin Niacin B3 (vitaminB12) Pantothenic acid B5 Pyridoxine B6 Biotin B7

They are heterogeneous group of compounds - differ chemically.

Common character – solubility in water. Easily absorbed. Not stored in the body except for Vit B12. Readily excreted in urine. Form coenzymes – biochemical reactions.

Water Soluble Vitamins

Vitamin C (Ascorbic Acid)

The isolation of vitamin C was carried out by Zilva during 1917-1927. He obtained the highly potent substance and noted its reducing properties.

In 1928, Szent-Gyorgi isolated an acid with strong reducing properties from cabbages, adrenal glands and oranges. He called it Hexuronic acid.

In 1933, Waugh and King isolated vitamin C in cryatalline form, from lemon juice.

In 1933, Vitamin C was named ascorbic acid owing its antiscorbutic properties.

Asscorbic acid is a water soluble vitamin playing an important role in human health and disease.

Sources: In plants abundantly seen in citrus fruits, gooseberries, guava

melons, sprouting seeds, leafy vegetables, spinach, cauliflower, cabbage, tomatoes and drumstick.

RDA:Infants - 35 mgChildren – 40mgAdults – 45mgPregnant women – 60mgLactating Women – 80mg

Biochemical functions:

Most important function of vitamin C is its property to undergo reversible oxidation.

Vitamin C plays an important role in collagen formation.

Acting as a coenzyme. Thereby facilitating cross linkage of collagen fibers

and increases its strength.

Helps in bone formation. Plays a role in iron and hemoglobin metabolism. Takes part in the metabolic reactions of

tryptophan, tyrosine, folic acid and cholesterol. Enhances the synthesis of Immunoglobulins and

increases their phagocytic action. Also acts as a strong biological antioxidant.

BIOSYNTHESIS AND METABOLISMMany animals can synthesize ascorbic acid from glucose via uronic acid pathway. However, man, other primates, guinea pigs and bats cannot synthesize ascorbic acid due to the deficiency of a single enzyme namely L-GULONO-LACTONE OXIDASE

Oxidation of ascorbic acid is rapid in the presence of copper. Hence vitamin c becomes inactive if the foods are prepared in copper vessels.

NOTE

Deficiency manifestations:

Leads to scurvy, characterized by spongy and sore gums, loose teeth, swollen joints, anemia, fragile blood vessels, delayed wound healing, hemorrhage, osteoporosis etc.

Defective collagen synthesis. “Cork screw” hair pattern with tiny bleeding points around the

orifice of a hair follicle. “Woody legs” with large spontaneous bruises in lower

extrimites. “Tummer field zone” is the classic histological picture of bone

in scurvy.

Oral manifestations:

Pathognomic sign is the swollen and spongy gums, particularly the interdental papillae is involved producing the appearance of scurvy buds.

In severe cases, hemorrhages to periodontal membranes followed by loss of bone and loosening of teeth occurs.

Hypervitaminosis C:

* Ascorbic acid, as such, is not toxic. But, dehydroascorbic acid (oxidized form of ascorbic acid) is toxic. Oxalate is a major metabolite of vitamin C and oxalates have been implicated in the formation of kidney stones.

* Mega doses of vitamin C are used in common cold, wound healing trauma etc. as an antioxidant, ascorbic acid certainly provides health benefits. However, the potential toxic effects of mega doses of vitamin C cannot be ignored.

Vitamin B-complexB-complex group of vitamins comprise a large number of water soluble vitamins which are nutritional essentials forall forms of life, from the lowest form of yeast and bacteria to the highest form, the man.

Apart from being important nutritionally, they form essential co enzymes to certain important intracellular enzyme systems. There are about individual components, most of them are synthesized by the microbial flora.

Components of vitamin B complex are:-

1.Thiamine – Vit B12.Riboflavin – Vit B23. Niacin – Vit B34.Pantothenic acid – Vit B55.Pyridoxine – Vit B66.Biotin – Vit B77.Folic acid group8.Cyanocobalamin – Vit B12

Thiamine (Vitamin B1, anti beriberi, antineuritic vitamin)

• Free thiamin is basic and heat stable.

• It has a specific coenzyme, thiamine pyrophosphate (TPP), which is mostly associated with carbohydrate metabolism.

• Readily soluble in water.

• Stable in acid medium.

• Destroyed – autoclaved at 120°C for 30min.

• Destroyed even at room temperature in an alkaline medium.

Dietary sources:Cereals, pulses, oil seeds, nut and yeast are good sources.Thiamine is mostly concentrated in the outer layer (bran) of cereals. Also present in animal foods like pork, liver, heart, kidney, milk,

etc

RDA:Infants - 0.3-0.5 mgChildren – 0.7-1.2mgAdults – Males – 1.2-1.5mg, Females – 1.0-1.1mgPregnant women – 1.3-1.5mgLactating Women – 1.3-1.5mg

Biochemical functions:

The enzyme thiamine pyrophosphate or cocarboxylase is intimately connected with the energy releasing reactions in the carbohydrate metabolism.

TPP also plays an important role in the transmission of nerve impulse. This is because TPP is required for acetylcholine synthesis and the ion translocation of neural tissue.

Deficiency manifestations :

* B1 deficiency is seen in populations consuming polished rice as staple food.

* The deficiency of vitamin B1 results in a condition called beriberi.

* The early symptoms of thiamine deficiency are loss of appetite (anorexia), weakness, constipation, nausea, mental depression, peripheral neuropathy, irritability etc.

In adults, two types of beriberi, namely wet and dry beriberi occur. Infantile type of beriberi is also seen.

Wet beriberi: is characterized by cardiovascular manifestations including edema of legs, face, trunk and serous cavities, with breathlessness and palpitations, along with increase in systolic and decrease in diastolic blood pressure.

Dry beriberi: is associated with neurological manifestations resulting in peripheral neuritis, with progressive weakening in muscles resulting in difficulty to walk.

Infantile beriberi: seen in infants born to mothers suffering from thiamine deficiency, characterized by sleeplessness, restlessness, vomiting, convulsions and bouts of screaming, these are due to cardiac dilatation.

Riboflavin (Vitamin B2)

Riboflavin through its coenzymes Flavin mononucleotide (FMN) and Flavin adenine dinucleotide (FAD) takes part in a variety of cellular oxidation-reduction reactions. Involved in carbohydrate, lipid, protein and purine metabolisms, besides electron transport chain.

Enzymes that use flavin coenzymes are called flavoproteins, Many flavoproteins contain metal atoms and hence known asmetalloflavoproteins.

Dietary sources:

Milk and milk products, meat, eggs, liver, kidney are rich sources. Cereals, fruits, vegetables and fish are moderate sources.

RDA: Infants - 0.4-0.6 mgChildren – 0.8-1.2mgAdults – Males – 1.5-1.8mg, Females – 1.1-1.4mgPregnant women – 1.4-1.7mgLactating Women – 1.6-1.9mg

Deficiency manifestations:

* Includes cheilosis, glossitis, and dermatitis. • Riboflavin deficiency as such is uncommon, it is seen

along with other vitamin deficiencies. • Chronic alcoholics are more susceptible to this vitamin

deficiency.• Nasolabial seborrhea.• Vascularisation of cornea.• Scrotal dermatitis.

Oral manifestations:

• Glossitis – The filliform papillae become atropic while the fungiform papillae become engorged and mushroom shaped, resulting in magenta coloured tongue.

• Cheilosis, ocular lesions.

Niacin (Vitamin B3, Nicotinic acid) Also known as the pellagra preventive factor of Goldberg.

The coenzymes of niacin are synthesized by the essential amino acid, tryptophan.

These coenzymes NAD+ and NADP+ are involved in a variety of oxidation-reduction reactions.

The essential amino acid tryptophan can serve as a precursor for the synthesis of nicotinamide coenzymes.

Dietary sources: The rich natural sources of niacin include liver, yeast, whole grains, pulses like beans and peanuts. Milk, fish, eggs and vegetables are moderate sources.

RDA: Infants - 0.4-0.6 mgChildren – 0.8-1.2mgAdults – Males – 1.5-1.8mg, Females – 1.1-1.4mgPregnant women – 1.4-1.7mgLactating Women – 1.6-1.9mg

Deficiency manifestations:

* Niacin deficiency results in a condition called as pellagra.

* The disease pellagra involves skin, gastrointestinal tract and central nervous system.

* Symptoms are commonly referred to as three D’s. the disease also progresses in the order Dermatitis, Diarrhea, Dementia, and if not treated may rarely lead to Death (4th D).

* The symptoms of dementia include anxiety, irritability, poor memory, insomnia etc.

Oral manifestations: * Bald tongue of sandwith.

* Raw beefy tongue.

* The mucosa becomes fiery red and painful.

* Salivation becomes profuse.

Pantothenic acid (Vitamin B5) Pantothenic acid, also known as chick anti-dermatitis factor or filtrate factor, is widely distributed in nature. The functions of pantothenic acid are exerted through coenzyme A or CoA. CoA is the central molecule involved in all the metabolisms (carbohydrate, lipid and protein), acting as the carrier of activated acetyl or acyl groups.

Dietary sources: Widely distributed in plants and animals. Rich sources are egg, liver, meat, yeast, milk etc.

RDA: Infants - 0.4-0.6 mgChildren – 0.8-1.2mgAdults – Males – 1.5-1.8mg, Females – 1.1-1.4mgPregnant women – 1.4-1.7mgLactating Women – 1.6-1.9mg

Deficiency manifestations:

• Burning feet syndrome – pain and numbness in toes, sleeplessness and fatigue are features.

Pyridoxine (Vitamin B6)

Vitamin B6 is used to collectively represent the three compounds namely pyridoxine, pyridoxal and pyridoxamine.

The active form of vitamin B6 is the coenzyme pyridoxal phosphate (PLP).

PLP is closely associated with the metabolism of amino acids.

The synthesis of certain specialized products like serotonin, histamine, niacin coenzymes from amino acids are dependent on pyridoxine.

PLP participates in reactions like transamination, decarboxylation, deamination, transsulfuration, condensation etc.

Dietary sources: Animal sources such as egg yolk, fish, milk, meat are rich in

B6. Wheat, corn, cabbage, roots and tubers are good vegetable

sources.

RDA: Infants - 0.3 mgChildren – 0.6-1.2mgAdults – Males – 1.6-2.0mg, Females – 1.6-2.0mgPregnant women – 2.5mgLactating Women – 2.5mg

Deficiency manifestations:

* Pyridoxine deficiency is associated with neurological symptoms such as depression, irritability, nervousness and mental confusion.

* Convulsions and peripheral neuropathy are observed in severe deficiency.

* These symptoms are related to the decrease in the synthesis of biogenic amines like serotonin, nor epinephrine and epinephrine.

* Demyelination of neurons is also observed.

* Decrease in hemoglobin levels, associated with hypochromic microcytic anemia, is seen in B6 deficiency, this is due to the decrease in heme production.

Biotin (Vitamin B7) Biotin, also called as anti-egg white injury factor, vitamin B7 or

vitamin H, is a sulfur containing B-complex vitamin.

Biotin acts as a carrier of CO2 in carboxylation reactions.

Dietary sources: Biotin is widely distributed in both animal and plant foods.The rich sources are liver, kidney, egg yolk, milk, tomatoes, grains,

etc.

Recommended daily requirement: 100-300 mg for adults, but this vitamin is abundantly synthesized by

the intestinal bacteria.

Deficiency manifestations:

symptoms include anemia, loss of appetite, nausea, dermatitis, glossitis etc.

Biotin deficiency is not common, since it is well distributed in foods and also supplied by the intestinal bacteria.

Folic acid

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.

Tetrahydrofolate (THF or FH4), the coenzyme of folic acid is actively involved in the carbon metabolism.

THF serves as an acceptor or donor of carbon units in a variety of reactions involving amino acid and nucleotide metabolism.

Dietary sources:

The rich sources are green leafy vegetables, whole grains, cereals, liver, kidney, yeast and eggs.

RDA: Infants - 50µgChildren – 100-300µgAdults – Males – 400 µg, Females – 400 µgPregnant women – 800µgLactating Women – 600 µg

Deficiency manifestations :

* Decreased production of purines and dTMP is observed.

* Which impairs DNA synthesis.

* Due to block in DNA synthesis, the maturation of erythrocytes is slowed down leading to macrocytic RBC.

* Aminopetrin and methotrexate are structural analogues of folic acid used in treatment of many cancer including leukemia, these drugs blocks the formation of THF and hence DNA synthesis is impaired.

Oral manifestation:

* Glossitis

- The filliform papillae disappears first.

- But in advanced cases the fungiform papillae are lost and the tongue becomes smooth and fiery red in colour.

Cyanocobalamine (Vitamin B12)

Vitamin B12 is also known as anti-pernicious anemia vitamin and extrinsic factor of Castle.

It has derived the names of cobalamine and cyanocobalamine due to the presence of cobalt and cyanide groups.

Vit B12 helps in the formation of labile methyl groups, for the synthesis of thymine and therefore for synthesis of nucleic acids, and along with folic acid for the normal hemopoisis.

Synthesis of methionine from homocysteine. Isomerization of methymalonyl CoA to succinyl CoA

Dietary sources:

Not seen in plant foods. Animal sources are liver, kidney, eggs, milk, and meat.

RDA: Infants - 0.3µgChildren – 1-2µgAdults – Males – 3.0µg, Females – 3.0µgPregnant women – 4.0µgLactating Women – 4.0µg

Deficiency manifestations:

• Most important is pernicious anemia.

• Characterized by low hemoglobin levels.

• Decreased number of erythrocytes.

• Neurological manifestations.

• Degeneration of myelin sheath and peripheral nerves also occurs.

Oral manifestation:

• Beefy red tongue – with glosopyrosis, glossitis and glossodynia.

• Hunter’s glossitis or Moeller’s glossitis – which is similar to “bald tongue of sandwith seen in pellagra”.

Thiamine is practically present in all plants and animal tissues commonly used as food.

The thiamine contained in these foods is destroyed with improper cooking.

Riboflavin is widely distributed throughout the plant and animal kingdom.

NOTE

The amino acid tryptophan present in the dietary protein is converted into niacin in the body.

60mg of tryptophan produce 1mg of niacin.So tryptophan present in the foodstuff also

provides additional niacin. Intestinal Bacteria can also produce Vit B6 Isoniazid – drug used in the treatment of TB is

antagonist to vitamin B6-Pyridoxin.

Biotin deficiency is uncommon since it is well distributed in food and also supplied by the intestinal bacteria.

Vit B12 is present only in the foods of animal origin. Bacterial synthesis of cobalamin occurs in the human

colon but it is not absorbed. The only source of cobalamin in nature is via synthesis

by micro organisms in soil, water and the animal intestine.

ROLE OF VITAMINS

* The very structure of the body - the skin, bones, teeth, blood vessels, cartilage, tendons and ligaments - depends on collagen. And the integrity of collagen, in turn, depends on vitamin C.

* In a report on ascorbic acid in Vitamin Intake and Health, S.K. Gaby and V.N. Singh explain that collagen protein requires vitamin C for "hydroxylation," a process that allows the molecule to achieve the best configuration and prevents collagen from becoming weak and susceptible to damage. Beyond that, they say, recent evidence indicates that vitamin C increases the level of procollagen messenger RNA. "Collagen subunits are formed within fibroblasts as procollagen, which is excreted into extra cellular spaces. Vitamin C is required to export the procollagen molecules out of the cell. The final structure of the collagen is formed after pieces of the procollagen are enzymatically cleaved," state Gaby and Singh.

Without vitamin C, collagen formation is disrupted, causing a wide variety of problems throughout the body.The oral manifestations of vitamin C deficiency occur chiefly in the gingival and periodontal tissues. The interdental and marginal gingiva is swollen, bright red, with a smooth and shiny surface. In fully developed scurvy, the gingiva becomes boggy, ulcerates and bleeds. The color changes to a violaceous red.

* The B-complex vitamins, such as niacin, thiamin, riboflavin, folic acid, and B12, are co-factors in energy metabolism and needed in DNA and RNA synthesis. 

* This makes them indispensable for tissue maintenance and the production of new cells during development and healing.

* Descriptions of vitamin B deficiencies appear as early as 2600 BC, but a majority of the reports of B vitamin deficiencies originate in the early 1900's when these conditions reached nearly epidemic proportions. 

* Epidemiologic and experimental studies conducted in the early 1900's identified the most common symptom of B vitamin deficiencies to be the loss of the integrity of the oral mucosa.

* The oral manifestations of the loss of integrity include stomatitis, angular cheilitis, and glossitis.

Conclusion Although vitamins are required in minute quantities, they are

indispensable for maintaining the integrity and proper functioning of various body systems.

The clinical applications of vitamins, as far as Dentistry is concerned, is limited in the present day situation, there may be a time when injection or application of vitamin solutions may itself help in faster tooth movement, helps faster bone formation after the desired movement is achieved.

Research is yet to take place in this area.

References 1.Essentials of biochemistry – Satyanarayana.2. Fundamentals of biochemistry – Dr A C Deb.3. Harper’s biochemistry 25th edition.4. Graber and Vanarsdall – Orthodontic principles and

practice.

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