Oral Manifestations of Nutritional Status

Chapter 25 Oral Manifestations of Nutritional Status

image Introduction

The structures and lining of the oral cavity offer valuable and easily accessible information on the nutritional status of an individual. Lesions may indicate a nutrient deficiency or may be manifestations of gastrointestinal or other disease.1 Because of the very rapid cell turnover of the oral mucosa, these lesions often may precede other manifestations of nutrient deficiency or systemic disease. Some typical lesions are mucosal ulceration, cheilosis, gingivitis, and glossitis. Between 5% and 10% of the people in the United States are deficient in one or more nutrients, so signs of nutritional deficiency are common.

image Abnormalities of the Oral Membranes

Table 25-1 summarizes the typical oral manifestations associated with a particular nutrient deficiency, and Table 25-2 summarizes common disorders associated with oral manifestations.112

TABLE 25-1 Oral Signs of Nutrient Deficiency

Biotin Geographic tongue, atrophy of lingual papillae
Folic acid Gingivitis, glossitis with atrophy, or hypertrophy of filiform papillae, cheilosis
Niacin Intraoral burning, canker sores, halitosis, glossitis, tongue swollen with red tip and sides, swollen red fungiform papillae, filiform papillae becoming inflamed and losing their epithelial tufts (giving the characteristic slick red appearance)
Pyridoxine Intraoral burning, glossitis, mucosal ulcerations and erosions, cheilosis
Vitamin B12 Intraoral burning, mucosal ulcerations and erosions, painful glossitis with a beefy red or fiery appearance, eventually resulting in an atrophic (smooth and shiny) tongue
Riboflavin Soreness and intraoral burning, cheilosis, angular stomatitis, glossitis with a magenta tongue
Vitamin C Sore and bleeding gums, deep blue-red color to gums, loose teeth, follicular hyperkeratosis
Vitamin D Intraoral burning
Vitamin E Glossitis
Calcium Periodontal disease, tooth decay
Iron Cheilosis, atrophic glossitis, gingivitis, candidiasis, intraoral burning or pain, mucosal ulcerations and erosions, pallor
Zinc Cheilosis, atrophic glossitis, gingivitis, candidiasis, intraoral burning or pain, mucosal ulcerations and erosions, pallor

Data from references 1-12.

TABLE 25-2 Common Disorders Associated with Oral Manifestations

Cheilosis Crohn’s disease, acrodermatitis enteropathica, alcoholism, celiac disease, malabsorption syndrome
Gingivitis Crohn’s disease, anorexia nervosa, celiac disease, scurvy
Erythroplakia Dysplasia or carcinoma
Glossitis Crohn’s disease, diabetes, alcoholism, celiac disease, malabsorption syndrome, pernicious anemia, iron-deficiency anemia, amyloidosis, carcinoid syndrome, cigarette smoking, anemia
Intraoral burning Menopause, diabetes mellitus, esophageal reflux, Sjögren’s syndrome
Leukoplakia Chronic irritation, dysplasia, early invasive squamous cell carcinoma
Ulcerations, erosions Crohn’s disease, ulcerative colitis, celiac erosions disease, corticosteroid use, acrodermatitis enteropathica, anorexia nervosa, pernicious anemia, iron-deficient anemia, mercury poisoning, nicotine withdrawal

Data from references 2-12.

In general, ulceration should be considered a nonspecific expression of a disease state. A search for the etiology will usually result in a specific therapy. Aphthous stomatitis is a common example of a mucosal ulceration and is discussed in detail in Chapter 146.

Similarly, cheilosis is a common expression for acquired nutrient deficiency. Gingivitis is associated with the classic signs of scurvy, but other nutrients have now been shown to play a role in gingival health; this subject is discussed in Chapter 199. Glossitis is associated with numerous vitamin deficiency states, each with a characteristic appearance.

Like glossitis, intraoral burning represents a nonspecific expression of a possible nutrient deficiency or systemic disease.35 Possible causes in addition to those listed in Table 25-2 are as follows:

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Sep 12, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Oral Manifestations of Nutritional Status

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