Role of vitamins in orthodontics final /certified fixed orthodontic courses by Indian dental academy

ROLE OF VITAMINS IN
ORTHODONTICS

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

Nutrition
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Nutrition is the science of food and its relationship to health.
The nutritional sciences deal with the nature and distribution
of nutrients in food, their metabolic effects, and the
consequences of inadequate food intake.
Nutrients are chemical compounds in foods that are absorbed
and used to promote health. Some nutrients are essential
because they cannot be synthesized by the body and thus must
be derived from the diet.
Essential nutrients include vitamins, minerals, amino acids,
fatty acids, and some carbohydrates as a source of energy.
Nonessential nutrients are those that the body can synthesize
from other compounds, although they may also be derived
from the diet.
Nutrients are generally divided into macronutrients and
micronutrients.

Macronutrients :They constitute the bulk of the diet and supply
energy as well as essential nutrients needed for growth,
maintenance, and activity. Carbohydrates, fats (including
essential fatty acids), proteins, and water are macronutrients.
Vitamins, which are classified as water-or fat-soluble, and
trace minerals are micronutrients
Essential trace minerals include iron, iodine, fluorine, zinc,
chromium, selenium, manganese, molybdenum, and copper.
Except for fluorine and chromium, each of these minerals is
incorporated into enzymes or hormones required in
metabolism.
Nutritional Requirements
The objective of a proper diet is to achieve and maintain a
desirable body composition and a high potential for physical
and mental work. The daily dietary requirements for essential
nutrients, including energy sources, depend on age, sex, height,
weight, and metabolic and physical activity.

VITAMINS
Vitamins are organic nutrients that are required in
small quantities for a variety of biochemical
functions and which generally cannot be
synthesized by the body and therefore be supplied
by the diet.
Vitamins are not related chemically, but are
considered as a group because of the similarity in
their functions.
Vitamins being accessory food factors, are essential
for metabolic reactions and form coenzymes to
many enzyme systems.

The vitamins are named one after another as they were discovered
as A,B,C,D and so on, and each one of them has a different
chemical nature. The nature of solubility was made use of, in
classifying them into two groups. They are as follows

vitamins
Fat soluble
Vitamin A
Vitamin D
Vitamin E
Vitamin K

non B-complex
Vitamin C

water soluble

vitamin B-complex
energy releasing

Thiamin B1
Riboflavin B2
Niacin B3
Pyridoxine B6
Biotin B7
Pantothenic acid

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hematopoitic

Folic acid
Cyanocobalamin
(vitamin B12)

Vitamin A
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The fat soluble vitamin A is present only in foods of animal
origin, however its provitamins carotenes are found in plants.
Dietary sources: animal sources contain preformed vitamin A,
like liver, kidney, egg yolk, milk, cheese, butter, fish (cod or
shark) liver oils.
Vegetable sources contain provitamin A-carotenes. Yellow and
dark green vegetables and fruits are good sources e.g. carrots,
spinach, amaranthus, pumpkins, papaya, mango etc
Biochemical functions:
Vitamin A is necessary for a variety of functions like vision,
proper growth and differentiation,
reproduction and
maintenance of epithelial cells.
Carotenoids function as antioxidants and reduce the risk of
cancers initiated by the free radicals and strong oxidants.

Recommended dietary requirement
Adults-750ug,
 Infants and young children- 300ug,
 Women during pregnancy and lactation- 1200ug
Deficiency manifestations: they are mainly related to the eyes, skin
and growth
 Effect on eyes: night blindness (nyctalopia), xeropthalmia,
keratomalacia
 On growth: retardation due to impairment in skeletal formation
 On reproduction: degeneration of germinal epithelium leads to :
sterility in males, termination of pregnancy due to fetal death
 On skin and epithelial cells: keratinization of epithelial cells.
Hypervitaminosis A: Excessive consumption of vitamin A leads to
toxicity. Symptoms include dermatitis, hepatomegaly, skeletal
decalcification, tenderness of long bones and joints, loss of weight
etc. ingestion of high quantities of vitamin A by pregnant women
induces risk of congenital malformations in the developing fetus
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Vitamin D

Vitamin D is a fat soluble vitamin resembling sterols in structure
and functions like a hormone
Sources : include fatty fish, fish liver oils, egg yolk etc, by irradiating
foods (yeast) that contains precursors of vitamin D, and natural
sunlight.
 Recommended daily requirement:
 Vitamin D is required for proper growth of the skeleton,
recommended doses are
 Infants: 400 to 800 IU daily
 Children and adolescents: 400 IU daily
 During pregnancy and lactation: 400 to 800 IU daily
Biochemical functions: ergocalciferol and cholecalciferol are the
sources of vitamin D activity and are referred to as provitamins.
The biologically active form is calcitriol.
Calcitriol regulates the plasma calcium levels of calcium and
phosphate. It acts on intestine, bone and kidney to maintain
calcium levels.
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Deficiency manifestations:
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Results in demineralization of bone . The result is rickets in
children and osteomalacia in adults.
Rickets in children is characterized by bone deformities due to
incomplete mineralization resulting in soft and pliable bones and
delay in teeth formation. In osteomalacia demineralization of
bone occurs making them susceptible to fracture.

Hypervitaminosis D: toxic effects of hypervitaminosis include
demineralization of bone (resorption) and increased calcium
absorption from the intestine, leading to hypercalcemia.
Prolonged hypercalcemia leads to deposition of calcium in the
soft tissues such as kidneys, blood vessels, forming renal calculi
(stones). High consumption of vitamin D is associated with loss
of appetite, nausea, increased thirst, loss of weight etc.

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Vitamin E (Tocopherols)
This is a naturally occurring antioxidant essential for normal
reproduction and hence known s ‘anti sterility vitamin’.
Sources : occur abundantly in plants.
All green plants, especially lettuce and Alfa alfa are rich sources.
vegetable oils like wheat germ oil and seed germ oil,
milk, eggs and meat are also good sources.
Biochemical functions: vitamin E prevents the non enzymatic
oxidation of various cell components by molecular oxygen and
free radicals such as super oxide (O2-) and hydrogen peroxide
(H2O2).
Recommended requirement: 20-25mg .
Deficiency manifestations: associated with sterility,
degenerative changes in the muscle, megaloblastic anemia and
changes in the central nervous system.

Vitamin K
This is the only fat soluble vitamin with a specific coenzyme
function. It is required for the production of blood clotting
factors, hence essential in coagulation.
Sources: cabbage, cauliflower, tomatoes, Alfa alfa, spinach and
other green vegetables are good sources. It is also present in egg
yolk, meat, liver, cheese and dairy products.
Biochemical functions: concerned with the blood clotting process.
It brings about post-translational modification of certain blood
clotting factors.
Deficiency manifestations: leads to the lack of active prothrombin
in the circulation, adversely affecting the blood coagulation. The
blood clotting time is increased.
Hypervitaminosis K: administration of large doses produces
hemolytic anemia and jaundice particularly in infants. The toxic
effect is due to increased breakdown of RBC.
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Vitamin C (Ascorbic acid)
This is a water soluble vitamin playing an important role in
human health and disease.
Sources: in plants abundantly seen in citrus fruits, berries, melons,
sprouting seeds, leafy vegetables, spinach, cauliflower, cabbage,
tomatoes, drumstick and guava. In animals present in liver,
kidneys and adrenal cortex.
Recommended requirement: 75-100 mg per day.
Biochemical functions: most important function of vitamin C is its
property to undergo reversible oxidation.
 Vitamin C plays an important role in collagen formation, acting
as a coenzyme, thereby facilitating cross linkage of collagen
fibers and increases its strength.
 Helps in bone formation, plays a role in iron and hemoglobin
metabolism, takes part in the metabolic reactions of tryptophan,
tyrosine, folic acid and cholesterol, enhances the synthesis of
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Immunoglobulins and increases their phagocytic action and
also acts as a strong biological antioxidant.
Deficiency manifestations.: leads to scurvy, characterized by
spongy and sore gums, loose teeth, swollen joints, anemia,
fragile blood vessels, delayed wound healing, hemorrhage,
osteoporosis etc.
Hypervitaminosis C : mega doses of vitamin C are used in
common cold, wound healing trauma etc. as an antioxidant,
ascorbic acid certainly provides health benefits. However, the
potential toxic effects of mega doses of vitamin C cannot be
ignored.
Ascorbic acid, as such, is not toxic. But, dehydroascorbic acid
(oxidized form of ascorbic acid) is toxic. Further, oxalate is a
major metabolite of vitamin C. oxalates have been implicated
in the formation of kidney stones.

Vitamin B-complex
B-complex group of vitamins comprise a large number of water
soluble vitamins which are nutritional essentials for all forms of
life, from the lowest form of yeast and bacteria to the highest
form, the man. Apart from being important nutritionally, they
form essential co enzymes to certain important intracellular
enzyme systems. There are about individual components, most
of them are synthesized by the microbial flora.
Components of vitamin B complex are:1.Thiamine
2.Riboflavin
3. Niacin
4.Pyridoxine
5.Pantothenic acid
6.Biotin
7.Folic acid group
8.cyanocobalamin

Vitamin B1- Thiamin (anti beriberi, antineuritic
vitamin)
Free thiamin is basic and is heat stable. It has a specific
coenzyme, thiamine pyrophosphate (TPP), which is mostly
associated with carbohydrate metabolism.
Dietary sources: cereals, pulses, oil seeds, nut and yeast are
good sources. Thiamine is mostly concentrated in the outer
layer (bran) of cereals. Also present in animal foods like pork,
liver heart, kidney, milk, etc
Biochemical functions: The enzyme thiamine pyrophosphate or
cocarboxylase is intimately connected with the energy
releasing reactions in the carbohydrate metabolism.
TPP also plays an important role in the transmission of nerve
impulse. This is because TPP is required for acetylcholine
synthesis and the ion translocation of neural tissue.
Recommended requirements: for an average man who takes
3000 calories of food 1.5mg of thiamine is recommended.

Deficiency manifestations : The deficiency of vitamin B1 results
in a condition called beriberi. The early symptoms of thiamine
deficiency are loss of appetite (anorexia), weakness, constipation,
nausea, mental depression, peripheral neuropathy, irritability etc.
In adults, two types of beriberi, namely wet and dry beriberi occur.
Infantile type of beriberi is also seen.
Wet beriberi is characterized by cardiovascular manifestations
including edema of legs, face, trunk and serous cavities, with
breathlessness and palpitations, along with increase in systolic and
decrease in diastolic blood pressure.
Dry beriberi is associated with neurological manifestations
resulting in peripheral neuritis, with progressive weakening in
muscles resulting in difficulty to walk.
Infantile beriberi: seen in infants born to mothers suffering from
thiamine deficiency, characterized by sleeplessness, restlessness,
vomiting, convulsions and bouts of screaming, these are due to
cardiac dilatation.

Riboflavin (vitamin B2)
Riboflavin through its coenzymes Flavin mononucleotide (FMN)
and Flavin adenine dinucleotide (FAD) takes part in a variety of
cellular oxidation-reduction reactions. Enzymes that use flavin
coenzymes are called flavoproteins, many flavoproteins contain
metal atoms and hence known as metalloflavoproteins.
Recommended requirement: for adults- 1.5-1.8 mg. Pregnant and
lactating women and children require 2.0-2.5 mg daily.
Dietary sources: milk and milk products, meat, eggs, liver, kidney
are rich sources. Cereals, fruits, vegetables and fish are moderate
sources.
Deficiency symptoms: includes cheilosis, glossitis, and dermatitis.
Riboflavin deficiency as such is uncommon, it is seen along with
other vitamin deficiencies. Chronic alcoholics are more
susceptible to this vitamin deficiency.

Niacin ( nicotinic acid)
Also known as the pellagra preventive factor of
Goldberg.
The coenzymes of niacin are synthesized by the essential
amino acid, tryptophan. These coenzymes NAD+ and
NADP+ are involved in a variety of oxidation-reduction
reactions.
Recommended daily requirement: for adults it is 17 to
21 mg. Increased amounts are required during
adolescence, pregnancy and lactation.
Dietary sources: the rich natural sources of niacin
include liver, yeast, whole grains, pulses like beans and
peanuts. Milk, fish, eggs and vegetables are moderate
sources. The essential amino acid tryptophan can serve
as a precursor for the synthesis of nicotinamide
coenzymes.

Deficiency manifestations: niacin deficiency results in a
condition called as pellagra. The disease pellagra involves
skin, gastrointestinal tract and central nervous system.
Symptoms are commonly referred to as three D’s. the
disease also progresses in the order dermatitis, diarrhea,
dementia, and if not treated may rarely lead to death (4th D).
The symptoms of dementia include anxiety, irritability, poor
memory, insomnia etc.
Therapeutic uses: administration of niacin in
pharmacological doses results in a number of biochemical
effects in the body. These are believed to be due to the
influence of niacin on cyclic AMP levels.

Pyridoxine (vitamin B6)
Vitamin B6 is sued to collectively represent the three compounds
namely pyridoxine, pyridoxal and pyridoxamine.
The active form of vitamin B6 is the coenzyme pyridoxal phosphate
(PLP). PLP is closely associated with the metabolism of amino
acids. The synthesis of certain specialized products like serotonin,
histamine, niacin coenzymes from amino acids are dependent on
pyridoxine. PLP participates in reactions like transamination,
decarboxylation, deamination, transsulfuration, condensation etc.
Recommended daily requirement: for an adult 2-2.2 mg/day. During
pregnancy, lactation and old age an intake of 2.5mg/day is
recommended.
Dietary sources: animal sources such as egg yolk, fish, milk, meat are
rich in B6. wheat, corn, cabbage, roots and tubers are good
vegetable sources.

Deficiency symptoms: pyridoxine deficiency is associated with
neurological symptoms such as depression, irritability, nervousness
and mental confusion. Convulsions and peripheral neuropathy are
observed in severe deficiency. These symptoms are related to the
decrease in the synthesis of biogenic amines like serotonin, nor
epinephrine and epinephrine. Demyelination of neurons is also
observed. Decrease in hemoglobin levels, associated with
hypochromic microcytic anemia, is seen in B6 deficiency, this is due
to the decrease in heme production.


Biotin
Biotin, also called as anti-egg white injury factor, vitamin
B7 or vitamin H, is a sulfur containing B-complex
vitamin.
Biotin acts as a carrier of CO2 in carboxylation reactions.
Dietary sources: biotin is widely distributed in both
animal and plant foods. The rich sources are liver,
kidney, egg yolk, milk, tomatoes, grains, etc.
Recommended daily requirement: 100-300 mg for
adults, but this vitamin is abundantly synthesized by the
intestinal bacteria.
Deficiency symptoms: symptoms include anemia, loss of
appetite, nausea, dermatitis, glossitis etc. biotin
deficiency is not common since it is well distributed in
foods and also supplied by the intestinal bacteria.

Pantothenic acid
Pantothenic acid, also known as chick anti-dermatitis
factor or filtrate factor, is widely distributed in nature.
The functions of pantothenic acid are exerted through
coenzyme A or CoA. CoA is the central molecule
involved in all the metabolisms (carbohydrate, lipid
and protein), acting as the carrier of activated acetyl or
acyl groups.
Recommended dietary requirement: 5-10 mg for
adults.
Dietary sources: widely distributed in plants and
animals, rich sources are egg, liver, meat, yeast, milk
etc.
Deficiency symptoms: no deficiency manifestations in
man

Folic acid
Folic acid or folacin is abundantly found in green leafy
vegetables. It is important for one carbon metabolism and
is required for the synthesis of certain amino acids,
purines and the pyrimidine-thymine.
Tetrahydrofolate (THF or FH4), the coenzyme of folic acid
is actively involved in the one carbon metabolism. THF
serves as an acceptor or donor of carbon units in a variety
of reactions involving amino acid and nucleotide
metabolism.
Recommended daily requirement: around 100ug. In the
women, higher intakes are recommended during
pregnancy (300ug/day) and lactation (150ug/day).
Dietary sources: the rich sources are green leafy
vegetables, whole grains, cereals, liver, kidney, yeast and
eggs.

Deficiency symptoms :decreased production of purines
and dTMP is observed which impairs DNA synthesis.
Due to block in DNA synthesis, the maturation of
erythrocytes is slowed down leading to macrocytic RBC
leading to macrocytic anemia


Vitamin B12
Vitamin B12 is also known as anti-pernicious anemia
vitamin and extrinsic factor of Castle. It has derived the
names of cobalamine and cyanocobalamine due to the
presence of cobalt and cyanide groups.
B12 helps in the formation of labile methyl groups, for the
synthesis of thymine and therefore for synthesis of
nucleic acids, and along with folic acid for the normal
hemopoisis.
Dietary sources: not seen in plant foods. Animal sources
are liver, kidney, eggs, milk, and meat.
Deficiency symptoms: most important is pernicious
anemia characterized by low hemoglobin levels,
decreased number of erythrocytes and neurological
manifestations.

Vitamin like compounds
These are components present in food and act as
accessory factors. They are
Choline : it is trimethylhydroxy ethylammonium
hydroxide. It is a component of phospholipids, acts as
a lipotropic factor, takes part in one carbon
metabolism and in transmission of nerve impulse.
Inositol: is hexahydroxy-cyclohexane. Acts as a second
messenger for the release of Ca2+ ions, as a lipotropic
factor and in synthesis of phosphotidylinositol- a
constituent of cell membrane

Bone metabolism

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Orthodontists and dentofacial orthopedists manipulate bone.
The biomechanical response to altered function and applied
loads depends on the metabolic status of the patient.

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The skeletal system is composed of highly specialized
mineralized tissues that have both structural and metabolic
functions. Bone modeling and remodeling are distinct
physiologic responses to integrated metabolic and mechanical
demands. Biomechanical manipulation of bone is the
physiologic basis of orthodontics and dentofacial orthopedics.

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Bone is the primary reservoir of calcium in the body.
Approximately 99% of the calcium in the body is stored on the
skeleton. The continual flux of bone mineral responds to a
complex interaction of endocrine, biomechanical and cell-level
control factors that maintain the serum calcium level at about
10 mg/dl.

Maintaining zero calcium balance requires optimal function of
the gut, parathyroid glands, bone, liver and kidney. PTH and
the active metabolite of vitamin D, 1,25 dihydroxycholecalciferol
(DHCC), are the major hormones involved


Calcium homeostasis
Calcium homeostasis is the process by which mineral
equilibrium is maintained. Maintenance of serum calcium
levels at about 10 mg/dl is an essential life support
function. When substantial calcium is needed to maintain
the critical serum calcium level, bone structure is sacrifice.
The alveolar processes and basilar bone of the jaws also
are subject to metabolic bone loss.
Calcium homeostasis is supported by three temporally related
mechanisms:
1.
Rapid flux of calcium from the bone fluid (occurs in
seconds)
2.
Short-term response by osteoclasts and osteoblasts
(extends from minutes to days) and
3.
Long term control of bone turnover (over weeks to
months).

Instantaneous regulation of calcium homeostasis is
accomplished in seconds by selective transfer of calcium ions
into and out of bone fluid.
Bone fluid is separated from extracellular fluid by osteoblasts
or relatively thin bone-lining cells.
A decrease in the serum calcium level stimulates secretion of
PTH, which enhances transport of calcium ions from bone
fluid into osteocytes and bone-lining cells.
The active metabolite of vitamin D (1,25-DHCC) enhances
pumping of calcium ions from bone-lining calls into the
extracellular fluid.
Within physiologic limits it is possible to support calcium
homeostasis without resorbing bone. However, a sustained
negative balance can be compensated for only by removing
calcium from bone surfaces.

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Short term control of serum calcium levels affects rate of bone
resorption and formation within minutes through the action of
three calcific hormones, PTH, 1,25-DHCC and calcitonin.
Calcitonin, a hormone produced by the interstitial cells of the
thyroid gland, is believed to help control hypercalcemia by
transiently suppressing bone resorption.
PTH, acting in concert with 1,25-DHCC, accomplishes three
important tasks:
1. it enhances osteoclast recruitment from promonocyte
precursors,
2. it enhances the resorption rate of existing osteoclasts, and
3. it may suppress the rate at which osteoblasts form bone.
Long term regulation has profound effects on the skeleton.
Biomechanical factors, noncalcific hormones, and the
metabolite mechanisms dictate mass, geometric distribution
and the mean age of the bone.

Flowchart of calcium homeostasis showing the roles of
PTH, vitamin D, the kidneys, gut and bone.


Dietary calcium recommendations
Group

Age

mg/day

Infants

0-6 months

400

6-12 months

600

1-5 years

800

6-10 years

800-1200

Adolescents and young adults

11-24 years

1200-1500

Men

25-65 years

1000

Women

25-50 years

1000

Children

pregnant or lactating

1200-1500

Post menopausal
Receiving estrogen
replacement

1000

therapy
Not receiving
Men and women

1500
>65 years


1500

ROLE OF VITAMINS
Vitamin A has a hormonal effect in the regulation of
epithelial differentiation. One of the basic changes is
a keratinizing metaplasia of the epithelial cells,
occurring throughout the body including the oral
mucous membrane and salivary glands. The teeth of
animals on a vitamin A deficient diet contains less
ash than the teeth of normal animals. Absence of this
vitamin during the period when dental structures are
formed results in disturbance in the calcification of
enamel and dentin, retards tooth eruption. The
alveolar bone is retarded in its rate of formation.

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A nutrient seldom discussed in terms of bone health is vitamin
K. There is, however, an association between vitamin K
insufficiency and reductions in bone density and possibly bone
strength. This may be of particular concern among people
taking vitamin K antagonists such as oral anticoagulants as a
significant decrease in bone mineral density has been
observed.
The most common oral manifestation of vitamin K deficiency
is gingival bleeding. Prothrombin levels below 35% will result
in bleeding following tooth brushing, however, when
prothrombin level fall below 20%, spontaneous gingival
hemorrhages will occur.


The very structure of the body - the skin, bones, teeth, blood vessels,
cartilage, tendons and ligaments - depends on collagen. And the integrity
of collagen, in turn, depends on vitamin C.
In a report on ascorbic acid in Vitamin Intake and Health, S.K. Gaby
and V.N. Singh explain that collagen protein requires vitamin C for
"hydroxylation," a process that allows the molecule to achieve the best
configuration and prevents collagen from becoming weak and
susceptible to damage. Beyond that, they say, recent evidence indicates
that vitamin C increases the level of procollagen messenger RNA.
"Collagen subunits are formed within fibroblasts as procollagen, which
is excreted into extra cellular spaces. Vitamin C is required to export the
procollagen molecules out of the cell. The final...structure of the
collagen is formed after pieces of the procollagen are enzymatically
cleaved," state Gaby and Singh.

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Type 1 - Connective tissue of skin, bone, teeth, tendons,
ligaments, fascia, organ capsules
Type 2 - Cartilage
Without vitamin C, collagen formation is disrupted,
causing a wide variety of problems throughout the body.
The oral manifestations of vitamin C deficiency occur
chiefly in the gingival and periodontal tissues. The
interdental and marginal gingiva is swollen, bright red,
with a smooth and shiny surface. In fully developed
scurvy, the gingiva becomes boggy, ulcerates and
bleeds. The color changes to a violaceous red.


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In severe chronic cases, hemorrhages and swelling of the
periodontal membranes occur, followed by the loss of bone
and loosening of teeth, which eventually exfoliate.
Formation of intercellular cement substances in connective
tissues, bones, and dentin is defective, resulting in weakened
capillaries with subsequent hemorrhage and defects in bone
and related structures. Hemorrhagic areas are organized
avascularly, so that wounds heal poorly and break open easily.
Endochondral growth ceases because osteoblasts fail to form
osteoid tissue, resulting in bone lesions. Instead, a fibrous
union forms between the diaphysis and the epiphysis, and
costochondral junctions enlarge. Densely calcified fragments
of cartilage are embedded in this fibrous tissue.
Small ecchymotic hemorrhages within or along the bone or
large subperiosteal hemorrhages due to small fractures just
shaftward of the white line complicate these lesions.

Oper Dent. 2003 Nov-Dec;28
Kaya.AD, Turkun.M
Reversal of dentin bonding to bleached teeth.
Many studies have shown a considerable reduction in enamel bond
strength of resin composite restorations when the bonding procedure
is carried out immediately after bleaching. These studies claim that
a certain waiting period is needed prior to restoration to reach the
original bond strength values prior to bleaching. This study
determined the effect of anti-oxidant applications on the bond
strength values of resin composites to bleached dentin. Ninety
human teeth extracted for orthodontic purposes were used in this
study.
The labial surface of each tooth was ground and flattened until dentin
appeared. The polished surfaces were subjected to nine different
treatments: 1) bleaching with gel (35% Rembrandt Virtuoso); 2)
bleaching with gel + 10% sodium ascorbate (SA); 3) bleaching with
gel + 10% butylhydroxyanisole (BHA); 4) bleaching with sol (35%
hydrogen peroxide); 5) bleaching with sol + 10% sodium ascorbate;
6) bleaching with sol + 10% BHA; 7) bleaching with gel +
immersed in artificial saliva for seven days; 8) bleaching with sol +
immersed in artificial saliva for seven days; 9) no treatment.

After bonding application, the resin composite in standard
dimensions was applied to all specimens. The teeth were stored in
distilled water at 37 degrees C for 24 hours and a universal testing
machine determined their resistance to shear bond strength. The
data was evaluated using ANOVA and Duncan tests. Bond strength
in the bleached dentin group significantly decreased compared to
the control group. On the other hand, the antioxidant treatment had
a reversal effect on the bond strength to dentin. After the bleaching
treatment, the 10% sodium ascorbate application was effective in
reversing bond strength. In the samples where antioxidant was
applied after the bleaching process, bonding strength in dentin
tissue was at the same level as those teeth kept in artificial saliva
for seven days


•The B-complex vitamins, such as niacin, thiamin, riboflavin,
folic acid, and B12, are co-factors in energy metabolism and
needed in DNA and RNA synthesis. This makes them
indispensable for tissue maintenance and the production of
new cells during development and healing.
Descriptions of vitamin B deficiencies appear as early as 2600
BC, but a majority of the reports of B vitamin deficiencies
originate in the early 1900's when these conditions reached
nearly epidemic proportions.
Epidemiologic and experimental studies conducted in the early
1900's identified the most common symptom of B vitamin
deficiencies to be the loss of the integrity of the oral mucosa.
The oral manifestations of the loss of integrity include
stomatitis, angular cheilitis, and glossitis.

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Bone growth and the quality of osseous structures are
very much dependent vitamin D. In deficiency states
enamel and dentin are poorly formed an eruption of
teeth is delayed leading to misalignment of teeth in
the jaws. In human rachitic teeth there is an
abnormally wide predentin zone with much
interglobular dentin. Jaw growth is retarded and the
alveolar processes are bulky and poorly calcified. In
addition to abnormal cementum, the lamina dura
around the teeth is frequently absent or poorly
defined.

Journal of Bone and Mineral Metabolism, 2004
Masayoshi Kawakami and Teruko Takano-Yamamoto
Local injection of 1,25-dihydroxyvitamin D3 enhanced bone formation for
tooth stabilization after experimental tooth movement in rats
The present investigation evaluated the effect of 1,25-dihydroxyvitamin D3
(1,25(OH)2D3) on alveolar bone formation during tooth movement in rats.
Orthodontic elastics were inserted between the maxillary first and second
molars on bilateral sides in male rats. 1,25(OH) 2D3 was injected locally, at
the concentration of 10–10 M, once every 3 days in the sub mucosal palatal
area of the root bifurcation of the molar on the right side.
Histomorphometric analysis revealed that tooth movement without
application of 1,25(OH)2D3 decreased the mineral appositional rate (MAR)
on the compression area at 7 days. Repeated injections of 1,25(OH) 2D3 in
the orthodontically treated animals distinctly stimulated alveolar bone
formation on the mesial side at 14 days. There was a significant increase in
MAR associated with elevated osteoblast surface value on the tension
surface.
These findings suggest that local application of 1,25(OH) 2D3 enhances the
reestablishment of supporting tissue, especially alveolar bone of teeth, after
orthodontic treatment. www.indiandentalacademy.com

Department of Orthodontics, Gazi University
Faculty of Dentistry, Ankara, Turkey.
Kale S, Kocadereli I, Atilla P, Asan E.
Comparison of the effects of 1,25, DHCC and prostaglandin E2
on orthodontic tooth movement.
This study compared the effects of local administrations of
prostaglandin E2 (PGE2) and 1,25-dihydroxycholecalciferol
(1,25-DHCC) on orthodontic tooth movement in rats.
Thirty-seven 6-week-old male Sprague-Dawley rats, weighing 160
+/- 10 g were used. Five rats served as the baseline control
group.
A fixed appliance system exerting 20 g of distally directed force
was applied on the maxillary incisors of 32 animals for 9 days.
Eight rats served as the appliance control group; 8 received a 20microL injection of dimethyl sulfoxide (solvent for 1,25-DHCC)
on days 0, 3, and 6; 8 received 20 microL of 10(-10) mol/L 1,25DHCC on days 0, 3, and 6; 8 received a single injection of 0.1
mL of 0.1 microgm PGE2 only on day 0.

There was no significant difference in tooth movement between
the PGE2 and the 1,25-DHCC groups. Both PGE2 and 1,25DHCC enhanced the amount of tooth movement significantly
when compared with the control group. The numbers of Howship's
lacunae and capillaries on the pressure side were significantly
greater in the PGE2 group than in the 1,25-DHCC group. On the
other hand, the number of osteoblasts on the external surface of
the alveolar bone on the pressure side was significantly greater in
the 1,25-DHCC group than in the PGE2 group. Thus, 1,25-DHCC
was found to be more effective in modulating bone turnover
during orthodontic tooth movement, because its effects on bone
formation and bone resorption were well balanced.


Quintessence Int. 2001 May;32
Tyrovola JB, Spyropoulos MN
Effects of drugs and systemic factors on orthodontic treatment.
Orthodontic tooth movement and bone remodeling activity are
dependent on systemic factors such as nutritional factors,
metabolic bone diseases, age, and use of drugs. Therefore, a
comprehensive review of the effects of these factors on
orthodontic tooth movement is attempted in this article.
Systemic hormones such as estrogen, androgen, and calcitonin
are associated with an increase in bone mineral content, bone
mass, and a decrease in the rate of bone resorption.
Consequently, they could delay orthodontic tooth movement.
On the contrary, thyroid hormones and corticosteroids might
be involved in a more rapid orthodontic tooth movement
during orthodontic therapy and have a less stable orthodontic
result.

Drugs such as bisphosphonates, vitamin D metabolites, and
fluorides can probably cause a reduction of tooth movement
after the orthodontic force is applied. Nonsteroidal antiinflammatory drugs have also been shown to reduce bone
resorption. Long-term administration of these drugs may
therefore delay the necessary bone response to respective toothborne pressure and should not be administered for long
periods of time to patients undergoing orthodontic tooth
movement. Attention has also been focused on the effects of
prostaglandins and leukotrienes in orthodontic tooth
movement. It seems that they might have future clinical
applications that could result in enhanced tooth movement.
The use of the above drugs should be considered by every
dentist in evaluating the treatment time and in planning
treatment when tooth movement is attempted.

ASDC J Dent Child. 1997
Orthodontic treatment of a patient with hypophosphatemic vitamin D-resistant rickets.

Kawakami M, Takano-Yamamoto T.
Hypophosphatemic vitamin D-resistant rickets, when developed later in life, is
less severe and may not be characterized by rickets or other osseous
deformities. A Japanese girl, age nine years and one month, was first seen in the
Dental Hospital of Osaka University, complaining of the crowding of the maxillary
teeth. At one year of age, the patient was admitted to Osaka University Hospital
for her leg deformities. Although the patient has been administered 4 micrograms
1 alpha/-hydroxyvitamin D3 and 1.0 g phosphorous daily, the serum phosphate
has been low and never reached normal level. This case was a Class II division 2
malocclusion with severe anterior crowding and retarded mandibular growth. We
treated her with a functional appliance (elastic open activator), followed by the
extraction of four premolars and the use of an edgewise appliance. No
unfavorable root resorption or bone defect occurred. Good occlusion was
achieved and the facial features were pleasing.

Conclusion


Although vitamins are required in minute quantities, they are
indispensable for maintaining the integrity and proper
functioning of various body systems.
Though the clinical applications of vitamins, as far as the
branch of orthodontics is concerned, is limited in the present
day situation, there may be a time when injection or
application of vitamin solutions may itself help in faster tooth
movement, helps faster bone formation after the desired
movement is achieved.
Research is yet to take place in this area.


References
1.Essentials of biochemistry – Harper.
2.R.W.Strang – Text book of Orthodontics
3.Graber and vanarsdall – Orthodontic principles and
practice,
4. Quintessence Int. 2001
5. Journal of Bone and Mineral Metabolism, 2004
6. Oper Dent. 2003
7.Textbook of medical physiology by Guyton and Hall.
8.J.A.Salzmann – orthodontic practice and techniques


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