How to manage oral issues caused by nutritional deficiencies, specifically vitamin C and vitamin B12 deficiencies?

From the Guidelines

To manage oral issues caused by nutritional deficiencies, specifically vitamin C and vitamin B12 deficiencies, you should prioritize supplementation with vitamin C and vitamin B12, alongside proper oral care, as the most effective approach to address morbidity, mortality, and quality of life. When considering the management of oral issues due to nutritional deficiencies, it's crucial to address both the deficiency and the oral symptoms. For vitamin C deficiency, supplementation is key, but there isn't a recent, high-quality study directly linking vitamin C supplementation dosage to oral health outcomes in the provided evidence. However, general medical knowledge suggests that vitamin C is essential for collagen production and can help resolve symptoms like bleeding gums and loose teeth 1. For vitamin B12 deficiency, similar to vitamin C, while there's no direct evidence in the provided studies, vitamin B12 plays a critical role in cell reproduction and nerve health, which can help address oral issues like glossitis and mouth ulcers. In terms of oral care, rinsing the mouth with an alcohol-free mouthwash upon awakening and at least four times a day after brushing, for ∼1 min with 15 ml mouthwash, gargling, and then spitting out, as recommended by the ESMO clinical practice guidelines 1, is a crucial step in managing oral mucosal injury and can be applied to managing oral issues caused by nutritional deficiencies. Maintaining good oral hygiene through brushing twice daily with a soft-bristled toothbrush and flossing daily, alongside a balanced diet rich in fruits, vegetables, lean proteins, and fortified foods, is also vital. If symptoms persist after 2-3 weeks of supplementation and proper oral care, consulting a healthcare provider is necessary, as severe deficiencies may require professional intervention or indicate underlying conditions.

From the FDA Drug Label

Patients with pernicious anemia should be informed that they will require monthly injections of vitamin B12 for the remainder of their lives. A vegetarian diet which contains no animal products (including milk products or eggs) does not supply any vitamin B12. Patients following such a diet, should be advised to take oral vitamin B12 regularly

The management of oral issues caused by vitamin B12 deficiency involves addressing the underlying deficiency. Since the provided drug labels do not directly discuss oral issues, the focus is on managing the deficiency.

• Vitamin B12 supplementation is essential for individuals with pernicious anemia or those following a vegetarian diet.
• Monthly injections of vitamin B12 are recommended for patients with pernicious anemia.
• Oral vitamin B12 preparations can be used for chronic treatment in patients with normal intestinal absorption.

However, the provided drug labels do not directly address vitamin C deficiency or its management. Therefore, no conclusion can be drawn regarding the management of oral issues caused by vitamin C deficiency based on the provided information 2 2.

From the Research

Nutritional Deficiencies and Oral Issues

• Nutritional deficiencies, including vitamin C and vitamin B12 deficiencies, can cause oral issues due to the essential role of vitamins and minerals in maintaining oral health 3, 4.
• Vitamin C deficiency can result in changes in the gingivae and bone, as well as xerostomia, while vitamin B deficiencies are associated with recurrent aphthous stomatitis, enamel hypomineralization, and other oral conditions 5.
• A diet lacking essential nutrients can lead to disease progression of the oral cavity, altered tissue homeostasis, and reduced resistance to microbial biofilm 6.

Management of Oral Issues Caused by Nutritional Deficiencies

• Health professionals should be aware of the effects of vitamins on oral health to provide the best available care for their patients 5.
• Screening for vitamin B12 deficiency may be warranted in patients with risk factors, such as gastric or small intestine resections, inflammatory bowel disease, or use of certain medications 7.
• Oral administration of high-dose vitamin B12 (1 to 2 mg daily) is as effective as intramuscular administration for correcting anemia and neurologic symptoms, while intramuscular therapy leads to more rapid improvement 7.
• Patients with vitamin B12 deficiency should consume foods fortified with vitamin B12 or take vitamin B12 supplements, especially those older than 50 years, vegans, or strict vegetarians 7.

Prevention and Treatment

• A systematic approach to examination of the mouth and perioral skin, along with a detailed medical and social history, can help identify patients at risk for nutritional disorders and initiate appropriate therapy 3.
• Health care professionals should consider poor nutritional status in patients with periodontitis, poor healing response to surgical procedures, or recurrent oral disease, particularly amongst elderly patients and patients in long-stay care 6.