What are the treatment options for oral issues caused by vitamin deficiencies, such as vitamin B12 (cobalamin) or iron deficiency (hypoferritinemia)?

From the Guidelines

Treatment for oral issues caused by vitamin deficiencies, such as vitamin B12 or iron deficiency, should prioritize addressing the underlying nutritional deficiency with supplementation and symptomatic relief. For vitamin B12 deficiency, treatment typically includes hydroxocobalamin 1 mg intramuscularly three times a week for 2 weeks, followed by maintenance treatment with 1 mg intramuscularly every 2–3 months lifelong, as recommended by NICE 1. Iron deficiency is treated with oral iron supplements, with a once daily dose of 50–100 mg of elemental iron (eg, one ferrous sulfate 200 mg tablet a day) taken in the fasting state being a reasonable initial treatment option 1. Key considerations include:

• Monitoring the initial haematological response and modifying treatment as necessary
• Providing symptomatic relief for oral symptoms with topical corticosteroids, antifungal medications, and oral lubricants or artificial saliva
• Implementing dietary modifications to consume B12-rich and iron-rich foods for long-term management
• Considering parenteral iron for patients with significant intolerance to oral iron therapy or those with chronic disease, continuing blood loss, impaired absorption, or GI inflammatory pathology 1. It is essential to correct the underlying metabolic pathways disrupted by these deficiencies, as B12 is crucial for DNA synthesis and neurological function, while iron is essential for hemoglobin production and oxygen transport to oral tissues.

From the FDA Drug Label

Directions Adults 18 years or older: 1,000 mcg (1 tablet) daily preferably with a meal or as directed by your doctor. CONTAINS: Each tablet contains 324 mg of ferrous sulfate, equivalent to 65 mg of elemental iron, providing 362% of the U.S. recommended daily intake (RDI) of iron for adults and children 4 and older.

The treatment options for oral issues caused by vitamin B12 (cobalamin) deficiency include taking 1,000 mcg of cyanocobalamin daily, preferably with a meal or as directed by a doctor 2. For iron deficiency (hypoferritinemia), treatment options include taking ferrous sulfate tablets, which contain 65 mg of elemental iron 3.

• The daily recommended intake of these supplements should be followed as directed by a doctor.
• It is essential to consult a doctor before taking any supplements, especially for persons under 18 years of age.

From the Research

Vitamin Deficiency and Oral Issues

• Vitamin deficiencies can cause various oral health issues, including periodontitis, gingivitis, and tooth development problems 4.
• A lower intake of vitamin A has been associated with decreased oral epithelial development, impaired tooth formation, enamel hypoplasia, and periodontitis 4.
• Vitamin D deficiency during tooth development may result in non-syndromic amelogenesis and dentinogenesis imperfecta, enamel and dentin hypoplasia, and dysplasia 4.
• Vitamin B deficiencies are associated with recurrent aphthous stomatitis, enamel hypomineralization, cheilosis, cheilitis, halitosis, gingivitis, glossitis, atrophy of the lingual papillae, stomatitis, rashes around the nose, dysphagia, and pallor 4.

Treatment Options for Oral Issues Caused by Vitamin Deficiencies

• Correction of vitamin D deficiency through supplementation may contribute to a successful treatment of periodontitis 5.
• Oral administration of high-dose vitamin B12 (1 to 2 mg daily) is as effective as intramuscular administration for correcting anemia and neurologic symptoms 6.
• Intramuscular therapy leads to more rapid improvement and should be considered in patients with severe deficiency or severe neurologic symptoms 6.
• Patients who have had bariatric surgery should receive 1 mg of oral vitamin B12 per day indefinitely 6.
• Vitamin B12 supplementation, either via high-dose oral routes or via parenteral administration, is used to manage vitamin B12 deficiency 7.

Association Between Vitamin Deficiencies and Oral Health

• Vitamin D deficiency has been associated with higher prevalence of periodontitis and gingival inflammation 5.
• Clinical studies have demonstrated an association between vitamin D's endocrine effects and periodontitis 4.
• No significant association has been found between cariogenic activity and vitamin D deficiency 4.
• The role of nutrition in oral health and its effects on the immune system and inflammatory pathways has attracted a recent increase in research 8.