& Joannie Dobbs Tuesday, September 10, 2013
Oral and facial signs offer clues to vitamin deficiency
As part of a physical exam, doctors often ask patients to say "ah" so they can get a good view of the gums, teeth, tongue and back of the oral cavity.
This provides a peek into the inside of the body that can indicate health problems well beyond the mouth itself. Some of these problems can be linked to diet and nutrition.
QUESTION: Why does the mouth serve as a good indicator of overall health and nutritional adequacy?
ANSWER: The mouth has rather delicate tissues that can change rapidly. Most of the cells lining the inside of the mouth last only three to seven days, being replaced by new cells. This allows for rapid healing of damage to the tissues if all the nutrients needed for repair are available.
The availability of all essential nutrients maintains a healthful balanced state in the body that is called homeostasis. When homeostasis is maintained, it results in a consistent healthy appearance of the oral cavity despite the constant change as new cells replace old cells. A nutrient deficiency, however, can throw everything out of balance, reduce the capacity for repair, and alter the appearance of mouth parts rather rapidly.
Q: What oral signs are indicators of nutrient deficiency?
A: There are many possible signs of nutrient deficiency. Keep in mind that these easily observed signs can serve as indicators of nutritional problems, but further evaluation is usually needed to confirm a nutrient deficiency.
Even before you say "ah," the appearance of the skin on your face and around your mouth can provide clues to problems. Darkened skin under the eyes and over the cheeks can indicate poor B vitamin status. Pale skin in general on the face may indicate iron deficiency. Lips that are red, irritated and swollen may indicate niacin and/or vitamin B2 are in short supply. Cracks in the corners of the mouth typically indicate vitamin B2 or iron deficiency.
Inside the mouth, soft and abnormally red gums that bleed easily are a classic sign of vitamin C deficiency. If vitamin C deficiency progresses too far, teeth can even become loose in their sockets and lead to tooth loss.
Of course, the appearance of the tongue can provide clues that indicate nutrient deficiencies. When one or more key nutrients are too low in the diet for too long, the surface of the tongue gets smoother as the taste buds flatten out. This usually is accompanied by a red, raw, irritated appearance. The general medical term for this is glossitis. It can be caused by several B vitamin deficiencies as well as iron deficiency.
Q: What health problems develop from these nutrient deficiencies?
A: The list of health problems is long and complex. They range from the well-established classic conditions like scurvy (vitamin C deficiency), beriberi (B1 deficiency) and pellagra (niacin deficiency) to less obviously linked conditions such as cardiovascular disease, diabetes and various gastrointestinal conditions.
Q: What habits help to maintain good oral health?
A: Of course, step 1 is to follow your dentist's advice for oral hygiene and avoid sugary and acidic foods that stay in your mouth too long. Step 2 is meeting nutrient needs.
All cells in the body, especially those in the mouth, require an adequate supply of each essential nutrient for normal function.
Consequently, eating a diet that meets nutrient needs is basic. This requires eating foods from all the major food groups and eating a variety of foods from within each food group. Consuming a variety of foods also provides food components that promote good health even though they are not strictly required by the body.
Alan Titchenal, PhD, CNS and Joannie Dobbs, PhD, CNS
are nutritionists in the Department of Human Nutrition, Food and Animal Sciences,
College of Tropical Agriculture and Human Resources, UH-Manoa. Dr. Dobbs also works with the University Health Services.
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