Page 36 - Dental Practice August 2022

36-38-Nina article-Q8:18-22-Lanka Mahesh.qxd 8/17/2022 6:25 PM Page 1

oral medicine section

THE MISSING LINK

NINA LORD explores the impact of nutritional insufficiencies on oral health

INTRODUCTION
As dental professionals, we are in a fortunate position to notice
changes in our patients over time. Therefore, as well as benefiting
their oral health we can have a positive effect on their wellbeing.
In this article, the physical manifestations that can be seen in
patients due to nutritional insufficiencies will be discussed so that
you, the clinician, will have the confidence to action this when
assessing and treating patients.
The starting point of this article is in the form of a case study.
VITAMIN D
Figure 1 belongs to patient J.J had been attending the surgery for
routine care for years. At each appointment I would notice the
developmental issues on his thumb nails and suggest a visit to the
GP for appropriate testing. Once it had been pointed out at a few
appointments, the patient started to monitor them. They noticed FIG 1: Issues on thumb nails can signify vitamin D deficiency
that the condition of the thumb nails was declining, so an appoint-
ment was made with the GP.
The patient was referred by the GP for nail scraping and, with
various blood tests, it was detected that they had a very low vitamin
D status.
The patient had a history of skin cancer and after digging a little
deeper it was found that they had avoided sun at all costs due to the
fear of getting skin cancer again. In fact, they were quite frightened
at the prospect.
The doctor advised that the deficiency had manifested this way
due to fact that vitamin D is necessary for the body to absorb calci-
um, which is needed to produce a healthy nail. The patient was told
that this deficiency could have led to osteoporosis, as the same
mechanism is needed for bone health.
Sunyecz (2008) concluded that: ‘Vitamin D deficiency enhances
the mobilization of calcium from the bone’ thus increasing risk of
osteoporosis. This patient took a supplement as recommended by
their doctor and levels are returning to normal. The patient now FIG 2: Blood blisters
reports an increase of energy and feeling of general wellbeing. They
didn’t realise just how tired they were a show they felt had become the two of us – one of empathy from myself and a feeling of really
their ‘normal’. being cared for by the patient.
Vitamin D is well known for its role in general wellbeing, in par- It also highlights the importance vitamin D can have when it
ticular inflammation and immunity. This was highlighted by a study comes to gum health and how deficiency could be a potential risk
by the University of Edinburgh in April 2019, where researchers factor for periodontal disease. Jagelaviciene et al (2018) concluded
found the presence of vitamin D ‘to affect key cells of the immune that: ‘Vitamin D is significant in periodontology’due to the ‘specific
system’. immune response by suppressing the destructive effect of chronic
The reason patient J has been mentioned is because it highlights periodontitis’ alongside the rolein’ jaw bone density homeostasis is
just how important noticing this development issue was for this preventing osteoporosis’.
patient. How far could this deficiency have gone? What potential Najeeb et al (2016) advised: ‘Clinical studies have suggested that
impact would it have had on their health? It also gave me (as the cli- a deficiency of vitamin D leads to periodontal inflammation and a
nician) an insight into what the patient had gone through in the past delay in post-surgical periodontal healing’. Knowing this, could it be
and how they still feel about it. worth routinely liaising with GPs to have patients with periodontal
This helped towards creating a wonderful relationship between disease to have their vitamin D status checked?

36 Dental Practice // July-August 2022 // Vol 18 No 4