Theories and Techniques of Oral Implantology (vol.1) (published 1970)   Dr. Leonard I. Linkow

Previous Page Next Page

This is an archival HTML version of this book originally hosted here in 2006. The HTML may not display well on modern browsers. Please view the modern PDF Version for a better viewing experience.

 

246 Theories and techniques of oral implantology

only when other and more direct etiologic factors in periodontal disease are present.

Nutritional deficiencies

When the tissues cannot function properly be-cause they lack one or more essential nutrients, the dysfunction may be called a deficiency disease. The dysfunction may be caused by an insufficient amount of a specific nutrient in the diet, by the body's inability to absorb or utilize the nutrient, by increased requirements for it, or by excessive excretion of it. Al-though malnutrition resulting from dietary insufficiency is comparatively rare in the United States, a presenting candidate may be suffering a nutritional deficiency following surgery or a severe injury, during pregnancy and lactation, or as a result of a metabolic disorder. The dentist, by a careful evaluation of the patient's medical history and examination of the periodontia for clinical evidence, should look for signs of a nutritional deficiency. If the patient lacks a specific vitamin or mineral, particularly one involved in bone building and repair, an implantation should be postponed until the condition is alleviated or under control. All suspected nutritional disorders should be referred to an internist.

Vitamin A deficiency. Vitamin A is essential to endochondral bone growth, vision, and the health of the epithelial tissues. Its periodontal symptoms include a slight thickening of the gingiva, buccal mucosa, lips, tongue, and soft palate.

Fig. 6-55. The palatal and mandibular labial gingivae in a patient with a vitamin C deficiency are enlarged and bleed easily. (From Bhaskar, S. N.: Synopsis of oral pathology, ed. 3, St. Louis, 1969, The C. V. Mosby Co.)

Vitamin C (ascorbic acid) deficiency, or scurvy. Ascorbic acid helps maintain intracellular substances, such as those found in bone and the dentin of the teeth. Periodontal symptoms of a deficiency include hemorrhage of the gingiva, enlarged tongue, and petechiae of the buccal mucosa and palate (Fig. 6-55). In the child there is defective dentin formation; in the adult the teeth become loose. As the deficiency becomes more severe, the gingiva develop bags of blood that will rupture at the slightest touch. Trauma to the bone will cause subperiosteal hemorrhages.

Acute scurvy may be cured relatively easily by supplementing the diet with ascorbic acid. However, chronic scurvy with gingivitis should be treated for several months.

Vitamin D deficiency. Vitamin D is critical in maintaining normal bone metabolism. Its chief function seems to be controlling the amount of calcium and phosphorus in the body fluids, which it does by regulating the amounts absorbed from the intestine. In children, a deficiency of vitamin D results in defective calcification of growing bone and ultimately rickets, which may be characterized by delayed tooth eruption, malpositioning of the teeth, and retardation in the growth of the mandible. In adults, osteomalacia—or the demineralization of bone—occurs, particularly in the spine, pelvis, and lower extremities. Some decalcification also occurs in the mouth.

The treatment of a vitamin D deficiency, no matter what its cause, is long, although marked improvement may be seen shortly after treatment is initiated. Implants must be postponed in cases of osteomalacia until the bone returns to normal or until its calcium content is maintained at normal levels by strictly controlled therapy.

Vitamin K deficiency. A deficiency of vitamin K, which is needed for prothrombin formation by the liver, results in hypoprothrombinemia, defective blood coagulation, and a hemorrhagic diatresis. The gums bleed easily, and petechiae of the buccal mucosa and palate are observed.

The most important source of vitamin K is synthesis by intestinal bacteria; a deficiency caused by a poor diet is rare. Nonabsorbable sulfonamide drugs or oral antibiotics sometimes suppress the intestinal bacteria and cause a deficiency, but most vitamin K deficiencies result from the lack of bile salts necessary for the absorption of the bacterially synthesized vitamin. Biliary fistulas, obstructive jaundice, and gastrointestinal conditions can inhibit absorption.

The treatment for this deficiency disease depends

1 Enlarged palatal gingiva in Vit C defeciency, importance in implants



Previous Page Page 246 Next Page
Copyright warning: This information is presented here for free for anyone to study online. We own exclusive internet copyrights on all content presented on this website. We use sophisticated technology to identify and legally close down websites that reproduce copyrighted content without permission - so please don’t do it.