Vitamins & minerals are essential for the development and functioning of the organism. Maintaining a healthy life will help in maintaining a healthy mouth since poor health is a link to diseases.

1. Vitamins & Minerals
-Dr.Shraddha Kode

2. VITAMINS

3. INTRODUCTION
3
o Vitamins have been
defined as the organic
compounds which are
required in minute
amounts to maintain
normal health of the
organisms

4. 4
Vitamins
Fat-soluble Water-soluble
Vitamins
A,D,E,K
B-complex Non B-complex
Vitamins B1, B2, B3,
B5, B6, B7, B9,B12
Vitamin C

5. VITAMIN A
5
o Source – yellow, red,
green vegetables and
fruits, meat, liver and
dairy products
o RDA – 600mcg per day
o Animal – pre-formed –
retinol; plants – pro-
formed - carotene

6. 6
o Physiological functions
 Vision (rod and cone cells)
 Epithelial cell integrity
 Growth & reproduction
 Resistance to infectious
diseases

7. Deficiency
7
o OCULAR:
 Night blindness
 Conjunctival xerosis
 Bitot’s spots
 Keratomalacia
1
2
3
4

8. Deficiency
8
o EXTRA-OCULAR:
 Retarded growth &
reproduction
 Dry skin
 Poor wound healing

9. Increased production
9
o Hypervitaminosis (Daily
dose > 30,000mcg) – toxic
symptoms
o Painful joints
o Anorexia
o Thickening of long bones
o Rashes
o Fatigue

10. Oral manifestations
10
o Defective formation of enamel –
hypoplasia
o Dentin lacks the normal
tubular structure
o Increased risk for caries
o Delayed eruption of teeth
o Hyperplastic and increased
keratinisation of gingival
epithelium

11. Treatment
11
o Treat urgently
o Dose of 7500 to 15000mcg
per day for 1 month
o Hypervitaminosis –
restriction of diet

12. VITAMIN D
12
o “Sunshine Vitamin”
o 2 forms – cholecalciferol(D3)
& calciferol (D2)
o Source – Exposure to
sunlight synthesizes Vitmin
D; fatty fish, liver oils, egg
yolk
o RDA – 400IU of
cholecalciferol

13. Origin & Synthesis
13
o precursor – 7-dehydrocholesterol converted
to pre-vitamin D2 – then to vitamin D3
o Vitamin D2 & D3 – converted to calcitriol
in liver and kidney

14. 14

15. Deficiency
15
 Children – Rickets
 Adults – Osteomalacia
 Increased risk of osteoporosis

16. Oral manifestations
16
o Developmental anomalies of
dentin & enamel
o High risk of caries
o High pulp horns, large pulp
chamber

17. Treatment
17
o Fortified fruit juices
o 2000 to 4000 IU daily for 6 to 12 weeks

18. VITAMIN E
18
o Naturally occurring
antioxidant
o Essential for reproduction
in animals – anti
sterility vitamin
o Sources – vegetable oils,
meat, butter and eggs
o RDA – men – 10mg;
women – 8mg

19. Functions
19
 Membrane structure and
integrity – called
membrane antioxidant
 Prevents peroxidation of
polyunsaturated fatty
acids in tissues and
membranes
 Protects RBCs from
hemolysis

20. 20
 Preserves and maintains
proper reproductive
function – prevents
sterility
 Prevents oxidation of LDL
– protects from heart
diseases

21. Deficiency
21
 Sterility
 Degenerative changes
 Megaloblastic anemia

22. Oral manifestations
22
o Loss of pigmentation
o Atrophic degenerative
changes in enamel

23. 23
o Available in 2 forms: K1 – plant
origin
K2 – synthesised by intestinal
bacteria
o RDA – 70 to 140 mcg/day
o Source – milk, meat, fish,
spinach, cabbage, cauliflower,
soyabean, wheat germ, carrots,
potatoes, tomatoes
VITAMIN K

24. 24
o Hepatic synthesis of coagulation
factors – II, V, VII, IX, X
Functions
Deficiency
o Increased clotting time –
prolonged bleeding –
hemorrhagic conditions

25. VITAMIN C
25
o Ascorbic acid
o Powerful antioxidant
o Source – citrus fruits,
green vegetables,
gooseberry, guava,
tomatoes, potatoes
o RDA – 60-70mg/day

26. Functions
26
 Collagen formation
 Iron and hemoglobin
metabolism
 Tryptophan, tyrosine and
folic acid metabolism
 Immunological function
 Sparing action on other
vitamins

27. Deficiency
27
o SCURVY – spongy and
sore gums, loose teeth,
anemia, swollen joints,
delayed wound healing,
hemorrhage

28. Oral manifestations
28
o SCORBUTIC
GINGIVITIS – ulcerative
gingivitis, rapid
periodontal involvement,
tooth exfoliation

29. VITAMIN B COMPLEX
29
o Most of the B-complex vitamins in
the nature are in the bound form
within the cells of vegetables or
animal tissues
o Breakdown of cellular structures
in the gut –digestion for the
liberation of vitamins and
absorption
o Excretion - kidney

30. Thiamine (Vitamin B1)
30
oAnti Beri-Beri factor, Anti neurotic factor,
Aneurin
oSpecific coenzyme – thiamine pyrophosphate
(TTP) – associated with carbohydrate metabolism
oSource – cereals, pulses, oil seeds, nuts, yeasts,
meat, milk
oRDA – 1 to 1.3 mg/day
oFunction – TPP – transmission of nerve impulse.
Energy releasing in carbohydrate metabolism

31. 31
oDeficiency – Beri-beri (Dry, wet and infantile)
oOther diseases – Wernicke’s encephalopathy,
Peripheral neuritis, Korsakoff’s psychosis
oOral manifestations – hypersensitivity of oral
mucosa, pain in tongue, teeth, jaw and face
oTreatment – Thiamine 50mg IM for 3 days then
10mg TDS by oral route

32. 32
Riboflavin (Vitamin B2)
oTakes part in cellular oxidation reduction reactions
oCoenzymes – Flavin mononucleotide (FMN) and
Flavin adenine dinucleotide (FAD)
oSources – milk and milk products, meat, eggs,
liver, kidney, cereals, fruits, vegetables
oRDA – 1.2-1.7mg/day
oFunctions – Redox reactions responsible for energy
production
oDeficiency – cheilosis (chapping and fissuring of
lips), glossitis (inflamed, red beefy tongue)

33. 33
Niacin (Vitamin B3)
oNiacin or nicotinic acid – known as Pellagra
preventive factor of Goldberg
oCoenzymes – NAD and NADP – synthesised by
essential amino acid – tryptophan
oSources – wholegrain, cereals, pulses, liver, milk,
fish, eggs, vegetables
oRDA – 15-20mg/day

34. 34
oFunctions – oxidation reduction
reactions
oDeficiency – Pellagra – 3Ds –
Dermatitis, Diarrhoea, Dementia – if
not treated 4th D – death
oOral manifestations – oral mucosa –
fiery red, painful and profuse
salivation, desquamated epithelium of
tongue, red swollen and beefy tongue,
tongue loses all papillae and intense
reddening

35. Pyridoxine (Vitamin B6)
35
oCollectively represents 3 compounds – pyridoxine,
pyridoxol and pyridoxamine
oSource – wheat, corn, cabbage, egg yolk, fish,
milk, meat
oRDA – 2.2mg/day
oFunctions – pyridoxal phosphate, coenzyme,
partipates in reactions – transamination,
decarboxylation, deamination, transsulfuration,
condensation

36. 36
oDeficiency – depression, irritability, nervousness,
mental confusion, convulsions, peripheral
neuropathy

37. Biotin (Vitamin B7)
37
oAnti-egg white injury factor, vitamin B7, vitamin H
oSulfur containing B-complex vitamin
oCoenzyme in carboxylation reactions
oSources- liver, kidney, egg yolk, milk, tomatoes, grains
oRDA – 100-300mcg/day
oFunctions – carrier for CO2 in carboxylation reactions,
metabolic reactions – gluconeogenesis, citric acid cycle,
fatty acid synthesis

38. 38
oDeficiency – anemia,
loss of apetite, nausea,
dermatitis, glossitis
oBiotin deficiency is
uncommon as it is well
distributed in food and
supplied by intestinal
bacteria

39. Pantothenic acid (Vitamin B5)
39
oChick anti-dermatitis factor
oMetabolic role as coenzyme A or CoA (A for
acetylation) is widespread
oRDA – 5-10mg
oSources – egg, liver, meat, yeast, milk (most widely
distributed vitamins found in plants and animals)
oFunctions – CoA – carrier for activated acetyl or acyl
groups
oDeficiency – burning feet syndrome – pain and
numbness in toes, sleeplessness, fatigue

40. Folic acid (Vitamin B9)
40
oLatin – folium – abundantly found in green leafy
vegetables
oSynthesis of amino acids, purines and pyrimadines –
thymine
oSources – green leafy vegetables, whole grains, cereals,
liver, kidney, yeast and eggs (milk is a poor source)
oRDA – 200mcg
oFunctions – tetra hydrofolate – coenzyme of folic acid –
involved in the one carbon metabolism

41. 41
oDeficiency – Macrocytic anemia
ofolic acid deficiency in pregnant women lead to
neural defects in foetus

42. Cyanocobalamin (Vitamin B12)
42
oMost of the therapeutic preparations contain
cyanocobalamin. It is sensitive to light and heat labile
oSources – liver, kidney, brain, meat, fish, eggs
oAbsent in plant foods – vegetarians are likely to develop vit
B12 deficiency
oRDA – 3mcg/day
oFunctions – synthesis of methionine from homocysteine
and isomerisation of methylmalonyl CoA

43. 43
oDeficiency – Pernicious anemia – low Hb levels,
decreased no of erythrocytes, neurological
manifestations
oOral manifestations – burning sensation in the
mouth, trouble swallowing, swollen tongue, pale tissues
in the inner cheeks

44. “Importance of understanding vitamin
deficiencies:
Act as exacerbating factors in infectious
diseases, chronic diseases thus impacting
the morbidity, mortality and quality of
life. Understand the pathophysiology and
implement successful methods of prevention
44

45. MINERALS

46. INTRODUCTION
46
o Minerals are those elements that our bodies
need to develop and function normally

47. 47
Minerals
Macrominerals/
Principal elements
(60-80%; required in amounts
> 100mg/day)
Microminerals/
Trace elements
(Required in amounts <
100mg/day)
Ca, Mg, Na, K,
Cl, S
Essential trace elements
Possibly essential trace elements
Non essential trace elements

48. CALCIUM
48
o Most abundant
o Total content – 1-1.5kg
(about 99% present in
bones & teeth)
o RDA – 800mg/day
o Absorption of Ca takes
place in the duodenum

49. Functions
49
 Development of bones & teeth – bone formation
 Ca ions interact with troponin C to trigger
muscle contraction
 Several reactions in the blood clotting process
depend on Ca ions
 Ca ions are necessary for nerve transmission

50. 50
 Membrane integrity &
permeability
 Ca ions are required for direct
activation of enzymes –pancreatic
lipase and ATPase
 Release of hormones from
endocrine glands is facilitated by
insulin, PTH and calcitonin

51. Factors promoting Ca absorption
51
o Vitamin D (through its active form
– calcitriol)
o PTH
o Low pH of intestinal lumen
o Lactose
o Lysine & arginine

52. Factors inhibiting Ca absorption
52
o Phytates & oxalates
o Dietary phosphate
o Free fatty acids
o High pH in intestinal lumen
o High content of dietary fibre

53. Hormonal regulation of plama Ca levels
53
o Calcitriol – absorption of Ca from
intestines – increased blood calcium
level - increased Ca uptake by
osteoblasts – promotes mineralisation
and remodelling of bone
o PTH – increased blood calcium level -
decalcification or demineralisation of
bone & increased Ca reabsorption by
renal tubules

54. 54
o Calcitonin – secreted by
parafollicular cells of thyroid
gland – opposite action of PTH –
decreased blood calcium level -
promotes calcification

55. Hypercalcemia
55
o Increased serum Ca levels
o Associated with hyperparathyroidism – caused
by increased activity of parathyroid glands
o Symptoms – lethargy, muscle weakness, loss of
appetite, constipation, nausea, increased
myocardial contractility

56. Hypocalcemia
56
o < 7mg/dl – fall of serum Ca level
– tetany
o Symptoms – neuromuscular
irritability, spasms, convulsions
o Mostly due to hypoparathyroidism
– surgical removal of parathyroid
gland or due to autoimmune
disease

57. Treatment
57
o Estrogen administration with calcium
supplementation in combination with
Vitamin D to postmenopausal women –
reduce the risk of fracture
o Higher dietary intake of Ca (1.5mg/day) –
recommended for elderly

58. SODIUM
58
o Chief cation of extracellular fluid
o RDA - 5-10gm/day
o Absorption – mainly in GI tract & excreted
through kidney
o Functions
 acid-base balance regulated
 Maintain osmotic pressure & fluid balance
 Normal muscle irritability & cell
permeability

59. Hypernatremia
59
o Elevation in serum sodium level
o Symptoms – increased blood volume & blood
pressure
o Occurs due to hyperactivity of adrenal cortex –
Cushing’s syndrome, prolonged use of cortisone,
ACTH, sex hormones & loss of water from the body -
dehydration

60. Hyponatremia
60
o Serum sodium levels fall
below the normal level
o Occurs due to – diarrhoea,
prolonged vomitting,
chronic renal disease and
adrenocortical
insufficiency (Addison’s
disease)

61. IRON
61
o Contains about 3-5gm in an adult individual
o 70% present in erythrocytes of blood – Hb; 5%
present in myoglobin of muscles
o RDA – 19.3–20.5mg/day in men; 17-
18.9mg/day in women
o Heme is the most predominant iron containing
substance
o Constituents of several proteins& enzymes –
hemoglobin, myoglobin, cytochrome, xanthine
oxidase

62. 62
o Non - heme iron is present in transferrin,
ferritin & hemosiderin
o Dietary iron is mainly absorbed in
stomach & duodenum
o Storage of iron – ferritin & hemosiderin
o Function – Hb & myoglobin require iron
for transport of O2 & CO2, electron
transport chain & effective
immunocompetence

63. Diseased state
63
o Iron deficiency anemia – most common
nutritional deficiency in growing children,
adolescent girls, pregnant and lactating
mothers
o Microcytic hypochromic anemia with reduced
Hb levels (<12g/dl)
o Retarded growth
o Loss of appetite
o Sluggish metabolic activity

64. 64
o Hemosiderosis – excessive iron in the body
deposited as ferritin and hemosiderin
o High intake of iron or repeated blood
transfusions in patients of hemolytic
anemia and hemophilia
o Hemochromatosis – iron is deposited in
tissues like liver, spleen, pancreas and skin
o Bronze pigmentation of skin (Bronze
diabetes), cirrhosis and pancreatic fibrosis

65. Phosphorus
65
o Adult male person contains 1kg of phosphorus
o Mostly combined with Ca to deposit in teeth and
bones (80%) whereas 10% is found in muscles &
blood in association with protein, carbohydrate
and lipids and remaining 10% in various
chemical compounds
o RDA – 700mg/day
o Absorption from jejunum
o Excretion from kidney

66. 66
o Functions – development of bones & teeth,
formation & utilistion of ATPs, formation of
phospholipids, phosphoprotein and nucleic
acids and maintenance of pH of blood

67. Magnesium
67
o Body contains 20gm of Mg
o 70% in combination with Ca and P; 30% in
soft tissues and body fluids
o RDA – 350mg/day
o Functions – Formation of bones and teeth,
cofactor for several enzymes requiring ATP –
Hexokinase and glucokinase and for proper
neuromuscular function

68. Diseased state
68
o Deficiency leads to neuromuscular irritation,
weakness and convulsions
o Low level of Mg leads to uremia, rickets and
abnormal pregnancy

69. Potassium
69
o Principal intracellular cation
o Absorption in GI tract
o RDA – 3500-4500mg/day
o Functions – maintains intracellular osmotic
pressure, regulation of acid base balance and
water balance in the cell, transmission of
nerve impulse, influence cardiac muscle
activities

70. Diseased state
70
o Hyperkalemia – increased serum
potassium levels; seen in renal
failure, addison’s disease
(adrenocortical insufficiency),
diabetic coma, severe dehydration
o Hypokalemia – decreased serum
potassium levels; overactivity of
adrenal cortex (Cushing’s
syndrome), prolonged cortisone
therapy, prolonged diarrhoea and
vomitting

71. Copper
71
o Body contains 100mg of copper
o RDA – 2-3mg/day
o Functions – essential component of several
enzymes – cytochrome oxidase and catalase,
important component of ALA synthase –
needed for heme synthesis, synthesis of
melanin and phospholipids, development of
bone & nervous system

72. Diseased state
72
o Deficiency leads to demineralisation of bone,
demyelination of nervous sytem, anemia,
fragility of arteries, hypopigmentation of
skin, graying of hair
o Menke’s disease – defect in the intestinal
absorption of copper - decreased copper in
plasma and urine, anemia, depigmentation
of hair

73. 73
o Wilson’s disease – abnormal copper
metabolism – copper deposited in liver and
brain leads to hepatic cirrhosis and brain
necrosis, low level of copper and
ceruloplasmin in plasma, increased excretion
of copper in urine, copper deposition in
kidney causes renal damage

74. Iodine
74
o Body contains 20mg of iodine
o 80% present in the thyroid gland as
iodothyroglobulin – contains thyroxin and
triiodothyronine
o RDA – 150ug/day
o Absorption in the small intestine
o Excretion through kidney
o Function – required for synthesis of T3 and T4
o Disorders – simple & toxic goitre

75. Zinc
75
o Total content in the body – 2gm
o Majority of content in the prostate gland
o RDA – 8-11mg/day
o Zn is mainly an intracellular element
o Zn deficiency – growth retardation, poor
wound healing, loss of taste sensation, loss
of appetite, depression
o Zinc toxicity – nausea, gastric ulcers,
pancreatitis, anemia, excessive salivation

76. Fluorine
76
o Mainly found in bones & teeth
o RDA < 2ppm; drinking water is the main
source
o Functions – prevents development of caries,
necessary for proper development of bones,
o Diseased states – dental caries, dental
fluorosis

77. CONCLUSION
Maintain a healthy life by
making sure your body is
receiving all the proper
vitamins and minerals it
needs to function correctly
Maintain a healthy mouth
since poor health may be a
link to health issues
including heart disease,
obesity, stroke, cancer
77

78. THANK YOU
78