Vitamins and Dentistry

As references of interest to the dentist in affording a more up-to-date picture of the relationships of Vitamins A, B, C and D to dental disease we offer the following extracts from

1. Vitamins: A Survey of Present Knowledge (British Medical Research Council), 1932.
2. The Vitamins and Their Clinical Application, Stepp, Kuhnaus and Schroeder, Germany, 1936.

(1) Pages 90-91.

“VITAMIN D IN RELATION TO THE TEETH. The investigations carried out by M. Mellanby (1918-30) have included animal experiments and clinical investigations on man. The former have demonstrated the importance of specific dietetic factors in controlling the development of the teeth, and in determining their reaction to harmful stimuli…

“Young puppies fed on diets deficient in Vitamin D exhibit obvious defects in the development of their teeth and jaws, the most important of which are the following:

1. Delay in the eruption of the permanent teeth, affecting particularly those teeth which normally erupt at a late period.
2. Thickening of the jaw bones and irregularity in the arrangement of the teeth, most noticeable in the lower incisors.
3. Irregularly formed and poorly calcified enamel, the surface of which is pitted and grooved and frequently pigmented.
4. Defective development and irregular calcification of the dentine, which can be satisfactorily studied only by microscopic examination of ground sections of the teeth.
5. Abnormal development of the calcified tissues at the gingival margin and hence irregularity of the periodontal membrane.”

Page 93.

“EFFECT OF THE MINERAL SUPPLY ON THE STRUCTURE OF THE TEETH. The absolute or relative amounts of calcium and phosphorus in an experimental diet were found to influence the degree and character of the calcification of the teeth. When there was little or no vitamin D in the diet, extra supplies of calcium in the form of carbonate resulted in a slight but distinct improvement in the structure of the teeth. The effect of adding phosphates under these conditions was variable, but the beneficial effect sometimes observed was only slight. The addition of calcium salts, the carbonate, phosphate, or hydrogen phosphate, to diets containing butter resulted usually in great improvement in the calcification of the teeth. When liberal quantities of vitamin D were given, the addition of calcium salts to a diet otherwise containing very little of this element sometimes resulted in the production of an increased amount of dentine, though the structure was always perfect or nearly perfect even when the diet contained only small amounts of calcium. In the presence of sufficient quantities of vitamin D the ratio of calcium to phosphorus could also be varied within considerable limits without producing any effect on the development of the teeth. It therefore appears safe to conclude that an adequate supply of vitamin D is of greater importance in determining the perfect development of the teeth than an abundant or carefully balanced supply of calcium and phosphorus (M. Mellanby, 1923, 1929).”

Pages 100-102.

“PERIODONTAL DISEASE. Dogs, especially pet dogs, are, like man, very susceptible to periodontal disease. These animals were therefore chosen by M. Mellanby for an extensive study of the etiology of this disease of the tissues surrounding the teeth. It was found that dogs could be kept under laboratory conditions for periods up to 8 years and, so long as the diet was complete from birth onwards, they remained free from periodontal disease. If, however, the diet was deficient In vitamins A and D and rich in cereals, especially during the period of growth in the early months of life, this disease ultimately developed. These dietetic defects acted in two ways, by allowing the abnormal development of periodontal tissues, and by allowing these abnormally formed tissues to change their anatomical relations to the teeth and become subject to invasion by micro-organisms.

“VITAMINS A AND D IN RELATION TO THE STRUCTURE OF PERIODONTAL TISSUES. Experiments on puppies brought up on diets rich and poor respectively in both vitamins A and D, or deficient in either vitamin A or D only, showed that Vitamin A primarily controls the normal development of the soft periodontal tissues, including the sub-gingival epithelium and the underlying connective tissues, while, as might be expected, vitamin D is largely responsible for the normal calcification of the alveolar bone and the other hard tissues.

“Thus, if the diet is deficient in both fat-soluble vitamins A and D, as for instance when olive oil replaces cod-liver oil, the following abnormalities develop:

1. Thickening of the gingival region.
2. Imperfect development of the alveolar bone, particularly of the alveolar crest, and of the laminae durae, with the inclusion of osteoid tissue and poorly calcified bone.
3. Imperfection of the epithelial attachment to the hypoplastic enamel.
4. Poor calcification of the laminae durae.
5. Hypertrophy of the sub-gingival epithelium, with the development of finger-like processes.
6. Abnormal arrangement of the connective tissue of the corium, with connective tissue reaction and cell infiltration.
7. Irregular thickness of the periodontal membrane.

“Irregular alignment of some of the teeth and tilting of the teeth in relation to the jaw are also sometimes found when the diets are deficient in vitamins A and D.

“VITAMINS A AND D IN RELATION TO PERIODONTAL DISEASE. The term ‘periodontal disease’, which is susceptible of various meanings, is here used in its widest sense, that is to say, to denote any morbid condition affecting the tissues surrounding the teeth, ranging from simple gingivitis to ‘pyorrhoea alveolaris’ with extensive absorption of bone.

“McCollum, Simmonds, Kinney and Grieves (1922) found what they term ‘attaching-tissue’ lesions after death in some rats fed on experimental diets, especially when these were low in calcium, phosphorus and fat-soluble vitamins.

“In M. Mellanby’s experiments (1930) the majority of the dogs used were about 2 months old when the experiments were begun, and in some cases were born in the laboratory from mothers whose diets were controlled throughout pregnancy and lactation. In a few experiments in which curative, rather than prophylactic measures, were tested, the animals were several years old when brought to the laboratory suffering from periodontal disease.

“The periodontal tissues of dogs kept in kennels in a laboratory and fed from the time of weaning for 8 years on a diet containing among other ingredients white bread and a liberal supply of vitamins A and D are rendered very resistant to periodontal disease. On the other hand, the periodontal tissues of animals kept under similar conditions of diet and environment, but receiving comparatively little vitamins A and D for the first 6½ years, are very susceptible to the disease.

“These experiments stress the fundamental importance of including vitamins A and D in the diet during the early developmental period if the periodontal tissues are to resist disease. A large supply of these vitamins given later, even from the fifth month onwards, does not entirely compensate for a deficiency during the early period of life, although vitamin A given in large doses may then prevent the spread of the pathological condition. Conversely, the addition of a liberal supply of vitamins A and D to a diet composed largely of white bread, for nearly a year after weaning (i.e. for the full developmental period), renders the periodontal tissues resistant to disease in later life, even when the diet of the adult animal is deficient in these vitamins for long periods.

“It will be noted that hyperplasia of the squamous epithelium adjoining the teeth produced by vitamin A deficiency in the developing period of growth is a special instance of the general effect of this deficiency. The susceptibility to bacterial infection of this hyperplastic epithelium of the gums or gingival margin is a condition which would also be expected from other known instances, in which infective foci and epithelial overgrowth are commonly associated with a deficient intake of this vitamin. Just as the administration of vitamin A in such conditions tends to correct the pathological changes of the epithelium and to heal the septic foci, so also in pyorrhoea alveolaris in dogs massive Vitamin A therapy seems to increase the resistance of the gum tissues to microorganisms to the extent that the exudate of pus is greatly diminished and may even be suppressed.

“VITAMIN C AND DENTAL TISSUES. One of the earliest investigations on the influence of the diet on the teeth was that of Zilva and Wells (1919), who fed guinea-pigs on a scorbutic diet of oats, bran, and autoclaved milk. Ground and decalcified sections of the teeth showed defects in the pulp, odontoblasts and dentine. In the pulp various degrees of degeneration of a type designated as ‘fibroid’ were found, and in the dentine an irregular ‘osteoid’ condition. Changes in the teeth were observed even in the mildest degree of scurvy, but never when a sufficiency of vitamin C was added to the basal diet.

“Howe (1919, 1921, 1923) has also carried out much experimental work on guinea-pigs–and monkeys, primarily, however, with a view to establishing the relation of diet, and in particular of vitamin C, to caries. He concludes that a deficiency of this vitamin leads to decalcification of the teeth. Toverud (1923, 1926) made a histological and chemical examination of some of the teeth of Howe’s guinea-pigs and found the defects described by Zilvn and Wells. Robb and collaborators (1921) found similar changes in the teeth of guinea-pigs on a scorbutic diet.

“Extensive investigations by Höjer (1924, 1926, Höjer and Westin 1925) and others have also emphasized the importance of vitamin C in determining the structure of the teeth in guinea-pigs. They summarize the defects that follow vitamin C deficiency as follows:

1. The gradual change and disappearance of the odontoblastic layer.
2. The amorphous calcification of the ‘predentine’ and the absence of canals in this layer.
3. The previously calcified dentine becomes porous.
4. The dilatation of the vessels in the pulp.
5. The production of nerve lesions and oedema of the pulp tissues.

“As a result of these investigations a method was devised for the estimation of the antiscorbutic value of foods.”

(2) Page 44.

“…In rats dental caries is produced by withdrawal of Vitamin B1. Food rich in Vitamin B1 prevents acid reaction upon enamel. Upon regeneration of bone and formation of callus Vitamin B has favorable effect, the nature of which is still unknown. An essential anti-infectious activity is not possessed by Vitamin B1…”

Sajous has stated that Vitamin C deficiency results in a loss of bactericidal power of the mouth fluids, as Vitamin B and Vitamin C are cooperative in most of their functions, a deficiency of either causing an aggravation of symptoms due to a deficiency of the other. We can, thereby, see why orange juice is only partly effective in the control of caries. The deficiencies of Vitamin C and Vitamin A seem to be the basic factors in setting the stage for pyorrhea, deficiency of Vitamin A causing a degeneration and overgrowth of periodontal epithelial structures, while Vitamin C deficiency is responsible for capillary fragility and consequent tendency to hemorrhage, to say nothing of the decalcification of supporting bone resulting from the same cause. Loose teeth can usually be restored to usefulness by administration of Vitamin C concentrate alone.