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Serum nutrient deficiencies in the patient with complex temporomandibular joint problems

Posted Sep 11 2009 4:57pm

Research by Pushkar Mehra, DMD and Larry M. Wolford, DMD

" Beta-carotene from green, leafy vegetables is ingested and converted to vitamin A (retinol) in vivo. Vitamin A is required for epithelial integrity and helps in lysosomal stability and glycoprotein synthesis.

Vitamin B1 (thiamine) is involved in neurotransmitter synthesis and energy production, while vitamin B6 (pyridoxine) is essential for the synthesis of many proteins, including neurotransmitters.

Vitamins B6 (cyanoco-balamin) and folate are needed for DNA synthesis, which is essential for cell replication and repair. A deficiency of folate can cause central nervous system irritability, glossitis, diarrhea, depression, weight loss, and anemia.

Vitamin C (ascorbic acid) is important for collagen synthesis and repair of body tissues. It is also known to decrease postexercise stiffness and reduce capillary fragility.

Many dietary minerals, including iron, calcium, and magnesium, are also considered important factors in bodily functions, especially muscle function, and zinc is essential for cell mitosis and proliferation.

Iron is needed for synthesis of hemoglobin, which provides oxygen transport to the tissues. Oxygen is necessary in all four phases of wound healing. Supplemental nutritional support, including zinc and certain vitamins, has been shown to increase the wound healing capacity of patients with diabetes mellitus.

Deficiency of vitamin A causes night blindness, xerophthal-mia, keratomalacia, perifollicular hyperkeratosis of the skin, and increased susceptibility to infection. Deficiency of vitamin B1 can cause beriberi. Early deficiency symptoms include fatigue, irritation, poor memory, sleep disturbances, anorexia, abdominal discomfort, and constipation. Dry beriberi commonly presents with peripheral neuropathic changes, and wet beriberi includes cardiovascular changes. Wernicke's encephalopathy and Korsakof syndrome are forms of cerebral beriberi.

Deficiency of vitamin B6 can cause glossitis, seborrheic dermatitis, lymphopenia, and peripheral neuropathy. Vitamin B12 deficiency can cause peripheral neuropathic changes and megaloblastic (pernicious) anemia. Severe deficiency states of vitamin C (scurvy) can lead to lassitude, fatigue, irritability, vague arthralgias, and myalgias in the initial stages, followed by swollen and bleeding gums, the appearance of splinter hemorrhages, and petechiae. Vitamin B12 deficiency is rare in the general population but was present in 35% of our patients.

Deficiency of iron causes microcytic, hypochromic anemia with symptoms like koilonychia, dysphasia, and tiredness. Zinc deficiency afects cell-mediated immunity and wound healing, with poor growth and appetite. Severe hypo-magnesemia can cause personality changes, anorexia, tetany, vomiting, and lethargy. It also causes hypocalcemia and hypokalemia, which further affect muscle function.

Nutritional inadequacies are considered crucial perpetuating factors in myofascial pain and dysfunction and commonly occur with sources of mechanical stress. Vitamins and minerals are considered micronutrients. They are usually consumed in small amounts ( <1 g/day) and are usually absorbed unchanged. While vitamins A, D, E, and K are fat soluble, vitamins B group and C are water soluble.

It has been established that low normal levels of vitamins B1, B6, B12, and/or folic acid are considered suboptimal and are frequently responsible when only transitory relief is obtained by specific myofascial treatment of involved muscles. Abnormally low values constantly aggravate myofascial trigger points and can cause chronic pain.

Five nutritional elements assayed in this study that have been previously reported to be important in pain syndromes are vitamins B1, B6, B12, folic acid, and vitamin C. Other vitamins and micronutrients are also considered significant but have not yet been investigated in detail."

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