Scurvy diagnosis due to gingival alterations
Case report
DOI:
https://doi.org/10.5935/2525-5711.20230218Keywords:
Scurvy, Gingivitis, Ascorbic acid Deficiency, Avitaminosis, Oral ManifestationsAbstract
Introduction: Scurvy is a disease resulting from a severe vitamin C deficiency, and its diagnosis is often challenging owing to nonspecific symptoms. Objective: encouraging dentists to reflect on systemic causes that may influence the oral manifestations of diseases. Emphasize that despite a disease from the last century, today you can still find vitamin deficiencies, and report of a case of Scurvy with gingival alterations. Case Report: A 30-year-old female patient sought dental care because she experienced sensitivity in her gums and bleeding. Intraoral examination revealed a slightly swollen gingiva which was erythematous, with friable consistency, and bled upon probing. Diseases such as anemia, hypovitaminosis, and AIDS, were considered within the diagnostic hypothesis of gingivitis. After hematological investigation, a very low level of vitamin C was detected, and scurvy was diagnosed. Vitamin C supplementation was then initiated in addition to the control of oral hygiene. After four months, clinical improvement was observed. Conclusion: Althou-gh there are few cases in the literature, oral surgeons must be aware of oral alterations associated with scurvy. The search for local and systemic etiological factors is important because changes in general health have a direct impact on oral tissues.
References
Lehninger TM, Nelson DL, Cox MM. Lehninger's principles of biochemistry. 7th ed. Porto Alegre: Artmed; 2018.
Stegeman CA, Davis JR. The dental hygienist's guide to nutritional care. St. Louis: Elsevier Saunders; 2015.
Manela-Azulay M, Mandarim-de-Lacerda CA, Perez MA, Filgueira AL, Cuzzi T. Vitamina C. An Bras Dermatol. 2003 Jun;78(3):265-72.
Padayatty SJ, Levine M. New insights into the physiology and pharmacology of vitamin C. CMAJ. 2001 Feb;164(3):353-5.
Khonsari H, Grandière-Perez L, Caumes E. Scurvy, a re-emerging disease. Rev Med Interne. 2005;26(11):885-90.
Magiorkinis E, Beloukas A, Diamantis A. Scurvy: past, present and future. Eur J Intern Med. 2011;22:147-52.
Schleicher RL, Carroll MD, Ford ES, Lacher DS. Serum vitamin C and the prevalence of vitamin C deficiency in the United States: 2003-2004 national health and nutrition examination survey (nhanes). Am J Clin Nutr. 2009 Nov;90(5):1252-63.
Hagel AF, Albrecht H, Dauth W, Hagel W, Vitali F, Ganzleben I, et al. Plasma concentrations of ascorbic acid in a cross section of the German population. J Int Med Res. 2018 Jan;46(1):168-74.
Souza PRM, Dupont L, Rodrigues FE. Scurvy: hard to remember, easy to diagnose and treat. An Bras Dermatol. 2021 Mar/Apr;96(2):257-8.
Alagl AS, Bhat SG. Ascorbic acid: new role of an age-old micronutrient in the management of periodontal disease in older adults. Geriatr Gerontol Int. 2015 Mar;15(3):241-54.
Hasegawa T, Watase H. Multiple risk factors of periodontal disease: a study of 9260 Japanese non-smokers. Ger Geront Int. 2004 Mar;4(1):37-43.
Ebersole JL. Systemic humoral immune responses in periodontal disease. Crit Rev Oral Biol Med. 1990;1(4):283-331.
Loe H, Theilade E, Jensen SB. Experimental gingivitis in man. J Periodontol. 1965 May/Jun;36:177-87.
Lang NP, Schätzle MA, Löe H. Gingivitis as a risk factor in periodontal disease. J Clin Periodontol. 2009 Jul;36(Suppl 1):S3-S8.
Mosdøl A, Erens B, Brunner EJ. Estimated prevalence and predictors of vitamin c deficiency within UK's low-income population. J Public Health (Oxf). 2008 Dec;30(4):456-60.
Bede F, Cumber SN, Nkfusai CN, Venyuy MA, Ijang YP, Wepngong EN, et al. Dietary habits and nutritional status of medical school students: the case of three state universities in cameroon. Pan Afr Med J. 2020 Jan;35:15.
Demaeyer E. Preventing and controlling iron deficiency anaemia trough primary health care. A guide for health administrators and programme managers. Geneva: WHO; 1989.
Lopes SMP, Gonzaga HFS, Lopes MA, Vargas PA. Oral manifestations associated with acquired immunodeficiency syndrome. J Bras Med. 2004;96:11-5
Leggott PJ. Oral manifestations of HIV infection in children. Oral Surg Oral Med Oral Pathol. 1992 Feb;73(2):187-92.
Willmott NS, Bryan RA. Case report: scurvy in an epileptic child on a ketogenic diet with oral complications. Eur Arch Paediatr Dent. 2008 Sep;9(3):148-52.
Maltos AL, Silva LL, Bernardes Junior AG, Portari GV, Cunha DF. Scurvy in a patient with aids: case report. Rev Soc Bras Med Trop. 2011 Feb;44(1):122-3.
Hodges RE, Baker EM, Hood J, Sauberlich HE, March SC. Experimental scurvy in man. Am J Clin Nutr. 1969 May;22(5):535-48.
Hodges RE, Hood J, Canham JE, Sauberlich HE, Baker EM. Clinical manifestations of ascorbic acid deficiency in man. Am J Clin Nutr. 1971 Apr;24(4):432-43.
Nakamoto T, McCroskey M, Mallek HM. The role of ascorbic acid deficiency in human gingivitis-a new hypothesis. J Theor Biol. 1984 May;108(2):163-71.
Lindhe J, Thorkild Karring, Araujo M. Anatomy of periodontal tissues. In: Lindhe J, Lang NP, Karring T, eds. Textbook of clinical periodontics and oral implantology. 5th ed. Rio de Janeiro: Guanabara Koogan; 2011.
Padayatty SJ, Levine M. Vitamin C: the known and the unknown and goldilocks. Oral Dis. 2016 Sep;22(6):463-93.
Touyz LZG. Vitamin C, oral scurvy and periodontal disease. S Afr Med J. 1984 May;65(21):838-42.
Keller SE, Ringsdorf WM, Cheraskin E. Interplay of local and systemic influences in the periodontal diseases: 1. Effect of prophylaxis and multivitamin therapy on gingivitis score. J Periodontol. 1963;34(3):259-80.
Shannon I, Gibson WA. Intravenous ascorbic acid loading in subjects classified as to periodontal status. J Dent Res. 1965 Mar/Apr;44:355-61.
Shannon IL. Correlations between gingival scores and ascorbic acid status. J Dent Res. 1973 Mar/Apr;52(2):394-6.
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Bruna Ferreira de Lima, Thais Oliveira da Luz, João Roig Martins, Natália Batista Daroit
This work is licensed under a Creative Commons Attribution 4.0 International License.
