Vitamin C, Scurvy in Oral Medicine: A Review of Biochemistry Clinical insights, Case Reports and Advisories

   

Louis ZG Touyz*

McGill University School of Dental Medicine and Related Sciences
*Corresponding author: Touyz LZG, McGill University School of Dental Medicine and Related Sciences.
 
Citation: Touyz LZG. Vitamin C, Scurvy in Oral Medicine” A review of Biochemistry Clinical insights, Case Reports and Advisories. J Clin Pract Med Case Rep. 1(2):1-11.

Received: December 08, 2024 | Published: December 18, 2024.

Copyright© 2024 genesis pub by Touyz LZG. CC BY-NC-ND 4.0 DEED. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives 4.0  International License. This allows others distribute, remix, tweak, and build upon the work, even commercially, as long as they credit the authors for the original creation.

DOI: https://doi.org/10.52793/JCPMCR.2024.1(2)-14

Abstract

Vitamin C as a water-soluble Vitamin, is an essential dietary requirement for human health, Avitaminosis-C results in scurvy which causes capillary fragility manifesting clinically as bruising, joint, musculoskeletal pain, oro-dental breakdown and compromised immunity.

Aim: Presented here is an overview of Vit-C physiology, listing clinical symptoms, and indicates sources of Vit-C in a North American Diet. Directions for successful dosages of Vit-C to optimize therapeutic benefit are discussed. A sound rationale with relevant clinical safe use of Vit-C is provided.

Conclusion: Vit-C stores in human physiology can be depleted and scurvy results.  Fruits and vegetables are the main source of Vit-C and should be consumed regularly to avoid scurvy.

Keywords

Acid; Capillary-fragility; Collagen; Cancer; Gingivitis; Immunity; Scurvy; Vit-C

Abbreviations

Vit-C = Vitamin-C; DHCW =Dental Health Care Workers; FF&V = Fresh Fruit and Vegetables; MHCW =Medical Health Care Workers; RDA = Recommended Daily Allowances; GIT = Gastro Intestinal Tract.

Introduction

Vitamin C was known as an anti-scurvy factor for centuries. Sailors who were at sea for months were notorious for developing scurvy, and scurvy prevention was procured by eating citrus. Vitamin-C was first chemically produced in 1933. Vitamin-C as a water-soluble vitamin, is known as ascorbic acid and ascorbate, and is active as L-ascorbate. Most animals, like dogs, are capable of synthesizing their own Vit-C.  Anthropoid apes, including humans, some rodents, most fish and fruit-eating bats, all must obtain Vit-C  from exogenous dietary sources as the gene(s) for its’ enzyme  is lacking in these organisms. Clinical presentations of Scurvy in the 20th Century had become rare, but is again manifesting in select communities due to ignorance, socio-economic factors and changes driven by industrialization to consumption of traditional foods. This includes The United States of America, as well as regions in Canada [1,2,3]. Although the chemistry of Vit-C is well known, as are the symptoms of scurvy and its cure, appraisals with readily available information for Medical Health Care Workers (MHCW), specifically Dental Health care Workers (DCHW), are rare and clinically targeted articles on this topic in the current 21st century are scant.

Aim: Presented here is an overview of Vit-C biochemistry, physiology, and metabolism, with emphasis listing clinical signs and symptoms with examples of Scurvy, as well a therapeutic dosing, while indicating reliable sources of Vit-C in a health-promoting diet. Recommended Daily Allowances (RDA) and directions for successful prescription dosages of Vit-C to optimize treatment and prophylaxis are discussed. A sound rationale with relevant clinically safe use of Vit-C is indicated.

Vit-C Biochemistry, Physiology and Metabolism

The biochemistry of Vit-C in plants​

Vit-C Biochemistry, Physiology and Metabolism/ The biochemistry of Vit-C in plants Biochemistry of sugars, like glucose, transforms with enzymes to Vit-C, as ascorbic acid. Mankind, apes and some animals, do not have the genes and consequent enzymes, to synthesize Vit-C [4,5,6].

Physiology and Metabolism

Vit-C is an essential  metabolic requirement for  the growth and  repair of tissues; it is a prime component in forming collagen, and the enzymatic synthesis of neurotransmission catecholamines and tyrosine to DOPA. Consequently, every tissue and organ that has a cytostructural reliant of a collagen matrix can be affected by inadequate Vit-C. All blood vessels, especially capillaries sustain their integrity with replenishment of collagen and reticulin fibers. Micro-trauma to bulging areas of limbs or organs will allow easy rupture of the capillaries with hematoma formation. Figures 1-A, 1-B. Deficient formation of collagen induces weakening with a physical malfunction, and a combination of these properties facilitates periodontal breakdown with consequent loosening and loss of teeth.  Humans do store small amounts of Vit-C in the adrenal glands, which store can be depleted without regular replacement. Vit-C is involved in the formation of steroids (Gluco-corticoids, Mineralo-corticoids and Sex Hormones) and Vit-C is intrinsic to the functioning of enzymes for the immune system to function. Vit-C functions as an antioxidant and consequently is important in all leucocyte enzymatic activity. Vit-C facilitates the growth of intercellular substances, changes Proline to Hydroxy-proline, Lysine to Hydroxy-lysine (in muscle), Folic acid to active folinic acid, and is intrinsic to most microsomal metabolism of many drugs. Vit-C is important in sustaining immunity for optimal function and this has been claimed to be an optimizing factor in therapy for cancer [7].

Aetiology of Scurvy

Scurvy develops in individuals who are deprived of Vit-C intake. Adult scurvy takes a month or two for symptoms to manifest as reserves of Vit-C become depleted. Scurvy develops more rapidly in infants who are fed Vit-C deficient milk or formulae. Childhood Scurvy is labeled Barlow or Cheadle disease for non-breast-fed babies.  Cow’s milk is notorious for its’ high protein, low glucose and absent Vit-C content. Human breast-milk is best, with over 200 defined factors needed for babies to thrive. Accordingly, when children have to be fed cow’s milk, the cows-milk should be diluted by half, have about one teaspoonful of glucose per pint of milk (or sugar as second choice if necessary), and extra Vit-C supplement added. The addition of Vit-C is vital. This is not ideal but often resorted to when mothers don’t produce lactation, or if proper infant-formula is not available, and starvation is to be eschewed. Poor diets relying on cheap processed foods often contribute to avitaminosis-C and scurvy may be part of general malnutrition. Alcohol consumption, smoking tobacco or marijuana makes extra demands on Vit-C usage and often contributes to scurvy developing. The cost, access to, and/or availability of foods with Vit-C are all confounding factors contributing to the prevalence of scurvy developing in 21st century living. Vit-C sources, minimum requirements and RDA’s and doses needed are enumerated below [6,7,1,20].

Clinical Manifestations of Scurvy

Babies show cachexia, pallor, have fetid breath, bacterially coated tongue, swollen gums, peri-labial bleeding, sub-periosteal haemorrhages, defective collagen formation, capillary fragility, sub-ungual hematomata, skin bruises, and infections. Of major importance to DMHCW’s is Adult Scurvy, because it affects the gums and threatens survival of the whole dentition. There is some confusion between infective periodontal disease and scurvy. Both are associated with gingival bleeding but are different conditions and demand different therapy and management [8-10]. Also, a whole group of conditions known as Haemorrhagic Diatheses should be born in mind when encountering spontaneous bleeding in the mouth [12]. Hereditary bleeding disorders occur due to the absence or deficiency of specific clotting proteins. The commonest three inherited bleeding diatheses are: von Willebrand disease, hemophilia from factor VIII deficiency, hemophilia from factor IX deficiency. Differential diagnosis may include other haemorrhagic diatheses [12]. An accurate diagnosis is essential to ensure successful therapy.  Scurvy will allow for rapid progressive destruction of the periodontally affected teeth, often resulting in bleeding with eventual tooth loss. But periodontal disease developing after a Herpes infection, is not the result of avitaminosis Vit-C, but rather to Immunosuppression combined with stagnant invasive oral biofilm ecosystems.8-10 In Scurvy oral manifestations derives from capillary fragility that allows spontaneous gingival bleeding and swelling with scurvy, and presents with oral malodor, marked lymphadenopathy, and other signs of hematomata on the body (Figures 1-A, 1-B).

                                        Figure 1-A:                                                                                              Figure 1-B:

Figure 1-A: Oral Presentation of Scurvy in a 30-year-old male, who was a cadet in training, and for months traded his daily fresh fruit portion, for tradable cigarettes; this shows his teeth and gums. There is spontaneous bleeding, swollen gums and fetid oral malodor. Figure 1-B The same case as in Figure 1-A, after one week, treated with one gram a day of Vit-C. The bleeding has stopped.