Vitamin C or Ascorbic Acid Deficiency

Introduction:

Scurvy is a clinical condition brought on by a lack of vitamin C. Pirate and British sailor stories made the disease renowned. The first mention of this illness dates back to 1550 BC when people used onions and vegetables to precisely explain the diagnosis and treatment. James Lind of the British Royal Navy discovered in the 1700s that lemon and orange intake resulted in a remission of the illness. In 1927, the ascorbic factor's structural details were revealed, and shortly thereafter, ascorbic acid, also known as vitamin C, was synthesized. If vitamin C intake is stopped, the body's store of the vitamin typically runs out in four to twelve weeks. Numerous variables that can harm ascorbic acid's functions and absorption have an impact on it. Consuming fruits and vegetables frequently is the best method to avoid vitamin C deficiency.

What Is Vitamin C?

Vitamin C (ascorbic acid) is a water-soluble vitamin, a potent reducing antioxidant agent that wards off and protects the body from bacterial infections and toxicants. It is also known as ascorbic acid and is a potent inhibitor of ROS (reactive oxygen species). Apart from detoxification, it is attributed to collagen formation within the connective tissues, bone, capillaries, fibrous tissues, and even the skin. It is not produced within the body and hence can be obtained only through diet.

Dietary supplements of ascorbic acid are commonly recommended by some physicians for patients:

• To improve their antioxidant functions.

• To rectify tissue repair or damage.

• For improving enzymatic sufficiency of neurotransmitters.

Lack of vitamin C has several negative impacts and is linked to diseases of the oral cavity and general health. Ascorbic acid's enzymatic function is essential for a strong defensive system. Although conflicting research findings regarding the role of vitamin C in the prevention of cardiovascular diseases and various neurovascular diseases, such as Alzheimer's disease and dementia, are documented, ascorbic acid (vitamin C) continues to be a potent inhibitor of microbial activity and promotes lymphocyte proliferation, regulating and boosting the individual's immunity to a significant extent.

What Is the Pathogenesis of Vitamin C Deficiency or Scurvy?

In ascorbic acid deficiency, the fibroblasts that proliferate and synthesize collagen molecules are affected. Immature fibroblasts in this deficiency lead to delayed wound healing because of weak or somewhat affected collagen tissue. Similarly, the bone gets compressed or brittle as osteoblasts or bone-forming cell movement is restricted or non-migratory. Instead, the cartilage pools up and gets calcified in between the rows at the end of long bones. Thus, impaired collagen synthesis and brittle bone formation are significant impediments to wound healing in patients suffering from scurvy.

As per the ultrastructure study, cell organelles like the ER (endoplasmic reticulum) and ribosomal granules are dilated and lost, with fibrillar material spilling into the extracellular matrix. The cellular structures are vital for maintaining the integrity of all the supporting tissues that arise from the mesenchymal origin, such as bone, connective tissue, or dentine. As per research, the clinical manifestations of scurvy are fully established in the individual only after four to six months, approximately after the pool of ascorbic acid undergoes complete or partial depletion.

What Causes Vitamin C Deficiency?

Vitamin C is an essential nutrient for humans. Since L-gluconolactone oxidase is not produced by humans, it must be consumed. Therefore, a lack of dietary consumption has been a major contributor to vitamin C deficiency and its symptoms. Fresh fruits and veggies such as potatoes, spinach, broccoli, red peppers, and tomatoes, as well as grapefruits, oranges, lemons, and limes, naturally contain vitamin C. Fruits and vegetables account for up to 90 percent of vitamin C consumption.

The most common cause of the deficiency has been a lack of exposure to these foods. Furthermore, because vitamin C is heat-sensitive, cooking or boiling traditionally removes the nutritious value. Leukocytes, endocrine glands, and other tissues contain only trace amounts of vitamin C. Although vitamin C is found in trace levels in leukocytes, adrenal glands, and the pituitary, the body fails to store much of it, therefore plasma concentration is mostly influenced by recent dietary intake. Overall, the body accumulates 1500 milligrams of vitamin C, and clinical signs of deficiency develop when that amount falls to fewer than 350 milligrams.

Vitamin C insufficiency risk factors include:

• Alcoholism.

• Infants who are only given cow's milk.

• Seniors who only eat bread and tea.

• People with limited incomes cannot buy fruits and vegetables.

• Smokers.

• People suffering from eating problems.

• People with type 1 diabetes need a lot of vitamin C.

• Individuals with disorders of the GI (gastrointestinal) system like inflammatory bowel disease.

• People with iron excess, which causes the kidneys to waste vitamin C.

• People who follow strict diets or have dietary allergies.

What Are the Clinical Features of Vitamin C Deficiency?

The signs and symptoms of scurvy are as follows:

• Malaise or fatigue.

• Inflammation of bone or joints accompanied by pain or generalized edema (swelling) can be present.

• Mood swings or depression.

• Anxiety and irritability.

• Tooth mobility.

• Anemia (low hemoglobin).

• Purpuras (can be spontaneous with bleeding lesions occurring on the skin and oral mucosal membranes).

• Petechiae (red or brown spots on the skin).

• Ecchymosis (skin discoloration brought on by blood artery rupture).

• Blurred vision.

• Headaches.

• Photosensitivity or light sensitivity.

• Pathologic fracture of bones (ascorbic acid deficiency in the bone matrix).

• Neuropathies and convulsions may be common features in severe cases of scurvy.

Oral and dental manifestations due to vitamin C deficiency are as follows:

• Attachment loss around the tooth.

• Bleeding gums.

• Probing depth clinically.

• Radiographic bone loss and eventual mobility of the teeth.

• Tooth loss.

How Is Vitamin C Deficiency Diagnosed?

• The assessment of risk factors and a physical examination are the first steps in the diagnosis.

• Low plasma vitamin C levels (less than 0.2 mg/dL) detected by serum testing are typically indicative of scurvy; however, recent intake or supplementation may raise plasma levels and not be indicative of a prior prolonged deficit.

• Since leukocytes are less susceptible to abrupt dietary shifts, their vitamin C levels are more reliable when measuring the limited vitamin C stores.

• Latent scurvy is indicated by a leukocyte vitamin C content of 0 mg/dL. Greater than 15 mg/dL (milligrams per deciliter) is sufficient, and between zero and seven mg/dL is compatible with deficiency.

• It is important to check for concurrent deficits in other vitamins in addition to vitamin C levels. Since deficiency is mainly caused by inadequate intake, those who are affected may also have inadequate intakes of other crucial vitamins and minerals. In this patient group, levels of vitamin B12, folate, calcium, zinc, and iron have been noticeably low. Furthermore, because vitamin C aids iron intake, those with scurvy are more susceptible to bleeding, and iron deficiency in particular should be evaluated.

What Is the Management for Vitamin C Deficiency?

1. Vitamin C is typically replaced directly, with toddlers receiving up to 300 mg daily and adults receiving 500 to 1000 mg daily. The final stage of replacement is to be completed after a month or when clinical effects have disappeared. Adults can also receive one to two grams for up to three days, 500 milligrams every day for a week, and then 100 milligrams every day for up to three months as alternative therapy regimens. In addition to immediate supplementation, educate the patient on lifestyle changes to ensure sufficient intake and suggest abstaining from alcohol and tobacco use.

2. However, since attachment loss may ultimately lead to tooth loss, dental management will also include scaling, root planing, and periodontal or gingival surgery, followed by prosthetic protocols if patients require them.

3. Also, severe periodontal disease leading to tooth mobility cannot be reversed.

Conclusion:

In conclusion, even though vitamin C supplementation may greatly enhance the quality of life for those who are vitamin C deficient, the adverse effects of this deficit on periodontal health and irreversible effects on oral health require stringent dental management by the dental surgeon.