Nutritional Disorders: Clues Are in the Mouth
Nutritional deficiencies can happen for a variety of reasons, and may be difficult to spot. However, a recent report suggests that the oral cavity provides early clues for whether a nutritional disorder is present or perhaps may provide a tip-off to other systemic diseases. The article presented information about oral manifestations and associated findings of nutritional disorders to assist practitioners when evaluating oral changes.
The mouth is a site where there is a rapid rate of epithelial cell turnover in mucous membranes (3-7 days), compared with the skin (up to 28 days). Therefore, the oral cavity is often one of the first places where clinical signs of systemic disease and nutritional deficiency show up. A thorough examination of the mouth may help to formulate early diagnoses. There are certain deficiencies that have hallmark oral changes:
• Iron-deficient anemia: generalized mucosal pallor, atrophic glossitis, angular stomatitis, recurrent aphthous stomatitis, and oral ulcerations.
• B-complex vitamin deficiencies: primarily glossitis, but also changes to the tongue such as surface continuity, and changes to the papillae, color, overall size, and sensation, can all be altered with nutritional insults.
• Vitamin A deficiency: xerostomia, the subjective sensation of a dry mouth.
• Vitamin D deficiency: loss of periodontal attachment and permanent dentition changes, such as enamel pitting and hypoplasia, can be associated with rickets.
• Vitamin K deficiency: Bleeding of the submucosa and gingiva, both spontaneously and after trauma, along with ecchymoses of the buccal mucosa and palate.
• Calcium deficiency: associated with increased risk of periodontal diseases and tooth loss. Patients with calcium deficiency may have the same oral signs of enamel pitting and hypoplasia as those seen with vitamin D deficiency.
The article also notes that two eating disorders, bulimia and anorexia nervosa, can also have oral symptoms that may aid in diagnosis. Patients with eating disorders may have most or none of the previously discussed malnutrition manifestations and in addition may have salivary hypofunction, increased caries, and dental erosions. Also, oral cultures in patients with anorexia and bulimia nervosa have higher oral Candida prevalence. Evaluation for eating disorders in patients with suspected nutritional deficiencies is recommended.
Byline: Martha L. Sikes, MS, RPh, PA-C
Posted: October 30, 2017
Adapted from the original article.