14.  Metabolic disorders

Q. 2. What are the oral manifestations of hypovitaminosis?


Discuss the oral manifestations of avitaminosis.


Vitamins are essential for growth and normal body functions and deficiency of vitamins causes various clinical manifestations as follows:

i. Thiamine

Cardiac beriberi—high output cardiac failure

Dry beriberi—polyneuropathy

Wernicke’s encephalopathy—confusion, nystagmus, ophthalmoplegia, ataxia and polyneuropathy

Korsakoff’s psychosis—amnesia with confabulation

ii. Riboflavin

Angular stomatitis, glossitis and cheilosis

Seborrhoeic dermatitis

Photophobia, lacrimation and visual fatigue

iii. Niacin (Pellagra)




iv. Pyridoxine

Angular stomatitis, glossitis and cheilosis

Convulsions, peripheral neuropathy

Hypochromic, microcytic anaemia

v. Pantothenic acid

Apathy, depression, paraesthesia, muscle weakness, burning feet and personality changes

vi. Biotin

Periorofacial dermatitis, conjunctivitis, alopecia, ataxia, deafness, optic atrophy

vii. Cyanocobalamin

Megaloblastic anaemia, peripheral neuropathy, subacute degeneration of spinal cord and megaloblastic madness

viii. Folic acid

Megaloblastic anaemia

Psychosis and neural tube defects

ix. Ascorbic acid (scurvy)

Bleeding gums, petechiae, ecchymosis, purpura, arthralgia and joint effusions

Depression, hysteria, and postural hypotension

x. Vitamin A

Night blindness, Bitot’s spots, corneal ulceration, blindness and follicular keratosis

Recurrent respiratory tract infections

xi. Vitamin D

Rickets and osteomalacia

xii. Vitamin E

Haemolytic anaemia , macrocytic anaemia, spinocerebellar syndrome, myopathy and peripheral neuropathy

xiii. Vitamin K

Ecchymosis, mucosal bleeding and internal haemorrhage.

Q. 3. Describe in detail about rickets.

Ans. Vitamin D deficiency—rickets occurs generally in growing children.

Clinical features

In first 6 months of life tetany and convulsions are common, these manifestations are due to hypocalcaemia.

The wrist and ankles are swollen and the changes in bone are found in epiphyseal plates, metaphysis and shaft.

Localized area of thinning are sometime present in skull so that a finger can produce indentation. This condition is called as craniotabes.

Pigeon breast.

Developmental abnormalities of dentine, hypoplasia of enamel and delayed eruption.

Higher caries index.

Malocclusion of teeth is present.


Dietary enrichment of vitamin D in form of milk.

If tetany is present give IV calcium gluconate. Daily dose is 1000–2000 IU of vitamin D combined with 500–1000 mg of calcium.

Curative treatment includes 2000–4000 IU of calcium daily for 6–12 weeks followed by daily maintenance dose of 2000–4000 IU for long period.

Q. 4. Scurvy.


i. Scurvy is caused due to deficiency of vitamin C, which results in defective collagen formation in connective tissue.

ii. It is of two types:

a. Adult scurvy

b. Infantile scurvy

iii. In adult scurvy:

Swollen spongy gums–scurvy buds

Scorbutic gingivitis

Perifollicular haemorrhages

Petechial haemorrhages, ecchymoses, epistaxis and GI bleeding

Nail beds: splinter haemorrhages

Haemorrhages into muscles and joints

Poor wound healing

iv. Infantile scurvy:

Scorbic child usually assumes a frog-like position and this may reflect as subperiosteal haemorrhage in to shafts of long bone

Scorbutic rosary—i.e., enlargement of costochondral joints

Lassitude and anorexia

Painful limbs giving rise to pseudoparalysis

v. Management:

Consumption of citrus fruits and vegetables

Vitamin C 500 mg daily initially.

Q. 5. Dental considerations in asthmatic patients.


The major goal for the dentist in the management of the patient with asthma is to minimize the likelihood of the precipitating an asthmatic attack.

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Apr 11, 2016 | Posted by in Orthodontics | Comments Off on 14.  Metabolic disorders
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