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If vitamin D deficiency is suspected then a test is needed to pro- at rest. This can be quite noticeable during a dental treatment as it
vide a base line before supplementation is recommended. can move the instruments, or fight the suction tube when being
retracted.
VITAMIN C Magnesium plays a vital role in the production of cellular energy,
Vitamin C plays a huge role in the synthesis of collagen and integri- so if you notice a quivering tongue it wouldn’t cause any harm to
ty of the blood vessels. Insufficiency can manifest as small blood ves- recommend magnesium bath flakes, as magnesium is absorbed well
sels in the floor of the mouth due to a lacking of integrity of the transdermally.
blood vessels (Maxfield et al, 2019). Kass et al (2017) in a pilot study found ‘a rise in magnesium
The history of the sailors in the 18th century suffering from serum in the urine of the participants’ after being treated with a
scurvy due to the absence of vitamin C in their diet is well known. transdermal application of magnesium.
Scurvy is a condition that leads to ‘bleeding gums and loss of teeth’ Cuciureanu and Vink (2011) provided a systematic review that
(Maxfield et al, 2019). concluded that ‘high stress levels are highly associated with magne-
The blood blisters may be more noticeable in a patient who is a sium levels’, meaning that when stressed we need more of this min-
smoker as they use up a lot more vitamin C due to the antioxidant eral.
properties it provides (Maxfield et al, 2019) (Figure 2) . Goyal et al (2013) highlighted the link between stress with system
Reactive oxidative species (ROS) from leukocytes lead to destruc- inflammation including periodontal disease. This is due to the phys-
tion of periodontal tissues when in the presence of bacteria (i.e., ical factors and also psychosocial behaviors’ linked with feeling
plaque) and as they are non-specific, they will harm healthy tissues highly stressed for example, poor oral hygiene, fatigue etc.
too. Najeeb and colleagues (2016)concluded in a systemic review of Food sources are numerous and include spinach, kale, broccoli,
nutrition and periodontal health that: ‘Studies suggest that antioxi- avocado, legumes such as kidney beans and chickpeas, banana, rasp-
dants may overcome the ROS-mediated inflammation of periodon- berries, salmon, mackerel, and tuna.
tal tissue’.
With its role in collagen production and antioxidant properties, VITAMIN B COMPLEX
vitamin C is a very important nutrient for periodontal health. B vitamins are sometimes known as ‘the stress vitamin’, as, like mag-
According to the NHS website, an adult needs ‘40 mg of vitamin nesium, we use up a lot more of these vitamins when stressed.
C a day’, which can be easily achieved by eating a varied diet of fruit Young and colleagues (2019) provided a systematic review that
and vegetables. Ideally, advise to your patient to eat 10 or 11 por- found an increase in B vitamins either through diet or supplemen-
tions a day, while making them aware that vitamin C is water solu- tation ‘improved mood’ and helped to ‘decrease anxiety in partici-
ble so is therefore not stored in the body, as a result it needs to be pants’.
replenished daily. If we don’t provide this additional need then the following con-
Vitamin C is found in most fruits and vegetables, and Maxwell et ditions can occur:
al (2019) advise that ‘90% of vitamin C’ is absorbed this way. • Bi lateral sores in the corners of the mouth can appear that don’t
According to the National Institutes for Health (NIH), a smoker heal after a few weeks (Figure 3). This can develop into angular
needs an additional 35mg per day, so may benefit from supplemen- cheilitis in the right environment
tation if they are not prepared to quit. • Cracks in the tongue, red tipped tongue and geographic tongue
can all be a sign that there is a B vitamin deficiency/insufficiency
MAGNESIUM (Figure 4).
Insufficiency can manifest as a tremor, tic or twitching (Di Glossitis also known as ‘red beefy tongue’ was described as ‘a use-
Nicolantinio et al, 2018), which can cause the tongue to quiver when ful tool to diagnosis B12 deficiency’ by Zhoul et al (2018) (Figure 5).

FIG 3: Bi lateral sores and cracked tongue FIG 4: Cracked and fissured tongue FIG 5: Glossitis

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Dental Practice // July-August 2022 // Vol 18 No 4 37