Scurvy - Vitamin C Deficiency

- Vitamin C is required for the synthesis of collagen in humans.
- The chemical name for vitamin C is Ascorbic Acid.

Causes:
- Scurvy or subclinical scurvy is caused by the lack of vitamin C. In modern Western societies, scurvy is rarely present in adults, although infants and elderly people are affected.
- All Child and Infant Supplements are provided with Vitamin C to avoid Scurvy.
- absence of feeding by the mother breast is one of the most important causes of Scurvy.

Symptoms:
- Early symptoms are malaise and lethargy.
- After 1–3 months, patients develop shortness of breath and bone pain.
- Myalgias may occur because of reduced carnitine production.
- Other symptoms include skin changes with roughness, easy bruising and petechiae, gum disease, loosening of teeth, poor wound healing, and emotional changes.
- Dry mouth and dry eyes similar to Sjögren's syndrome may occur.
- In the late stages, jaundice, generalized edema, oliguria, neuropathy, fever, convulsions, and eventual death are frequently seen.

Prevention:
- Scurvy can be prevented by a diet that includes certain citrus fruits such as oranges or lemons.

- Other sources rich in vitamin C are fruits such as blackcurrants, guava, kiwifruit,papaya, tomatoes, bell peppers, and strawberries.

- It can also be found in some vegetables, such as carrots, broccoli, potatoes, cabbage, spinach and paprika.

Treatment:

Scurvy can be treated by eating food containing vitamin C (such as oranges, papaya, strawberries, lemon), tablets with vitamin C, etc.

Prognosis:

Untreated scurvy is invariably fatal. However, death from scurvy is rare in modern times.

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Lesions of Oral Cavity "Classifications"

Oral Cavity lesions can be seen in different diseases and conditions.
Lesions of the oral cavity may be associated with disease or sometimes hereditary or even normal.
Some lesions even indicate the pre-cancerous condition.
Oral lesions can be broadly classified into four different types.

1. Vesiculo-Bullous lesions
2. Ulcerative lesions
3. White lesions
4. Red lesions

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:: Vesiculo-Bullous lesions ::

These lesions are in the form of superficial blisters of diameter <5mm (vesicle) and >5mm (bulla) usually filled with a clear fluid.

Classification :-

- Hereditary – Epidermolysis bullous dystrophica
- Viral – Small pox, Measles, Chicken pox, Herpes simplex, Herpes zoster, Herpangina, Hand Foot Mouth disease
- Muco cutaneous – Erythema multiforme, Bechet's syndrome , Reiter syndrome, Steven Johnson syndrome
- Immunological – Pemphigus ( vulgaris, vegetans, foliaceous , erythematous),Benign mucous membrane pemphigoid
- Psychosomatic – Bullous lichen planus
- Allergic – Stomatitis medicamatosa, Stomatitis venennata
- Toxicity – Toxic lesions
- Miscellaneous – Submucous fibrosis, Apthous stomatitis, Thermal and Chemical burns.

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:: Ulcerative lesions ::

These lesions are characterized by loss of surface epithelium and frequently some underlying connective tissue. They often appear elevated or depressed.

Classification :-

- Injury - physical, chemical, thermal,radiation, actinic rays
- Infections -
a) Bacterial: Vincent's angina
b) Viral: Herpes simplex ,Herpes zoster, Herpangina
c) Fungal: Candidiasis
- Nutritional deficiencies - protein , B complex
- Allergic - Stomatitis venenata, S.medicamatosa, Fixed drug allergy, Anesthetic reaction during dental extraction.
- Mucocutaneous - Erythema multiforme, Steven-Johnson syndrome, Reiter syndrome, Bechet's disease, Epidermolysis bullosa, Erosive lichen planus
- Immunological - Pemphigus vulgaris, P.vegetans, P.foliaceous
- Idiopathic - major apthous ulcer, minor apthous ulcer, herpetform ulcer
- Systemic - Pyostomatitis vegetans, Uremic stomatitis, Rhinosporidium, Haematological disease
- Neoplastic - Malignant ulcers
- Miscellaneous - Foliate papillitis, Necrotizing sialometaplasia.

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:: White lesions ::

White lesions are described as abnormal areas of the mucosa that appear whiter than the surrounding tissue and are usually raised, roughened or of different texture from adjacent tissue.

Classification :-

- Normal variants - Leukoedema , Fordyces granules, Linea alba
- Heriditary - Leukoedema, White spongy nevus, HBID, Dyskeratosis congenita
- Precancerous -
a) Precancerous Lesions: Leukoplakia, Erythroplakia, Bowen's disease, Actinic keratosis, Actinic chelitis
b) Precancerous Condition: Oral sub mucous fibrosis, Syphilis, Oral lichen planus, Dyskeratosis congenita, Lupus erythematous, Psoriasisis
- Skin diseases - White spongy nevus, HBID, Parakeratosis, Keratosis follicidans, Warty dyskeratosis, Psuedoxanthoma elasticum
- Systemic diseases - Uremic stomatitis, Diabetes stomatitis, Ulcerative stomatitis
- Infections - Oral hairy luekoplakia, Candidiasis, Parulis, Mucous patches
- Traumatic - Cheek biting, Frictional keratosis, Aspirin burn

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:: Red lesions ::

Red lesion is an area of reddened mucosa that may be smooth and atrophic looking or exhibits a granular,velvety texture.

Classification :-

1.Traumatic - Mechanical, Chemical and Thermal injuries
2.Infections -
a) Bacterial: Scarlet fever, Gingivostomatitis
b) Fungal: Erythematous candidiasis
c) Viral: Measles, Lymphonodular pharyngitis
3.Vascular - Haemangioma, Agranulocytosis
4.Dermatological - Pemphigus, Erythema multiforme, Erosive lichen planus, Lupus erythematosus
5.Systemic diseases - Uremic stomatitis, Ulcerative stomatitis, Diabetes, Scurvy, Pernicious anemia
6.Premalignant and malignant condition - Speckled leukoplakia, Erythroplakia, Systemic lupus erythematosus, Kaposi's sarcoma, Carcinoma in situ

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Causes of Impacted Permenant Teeth

- Systemic Factors:

- Heriditary Syndrome such as Cleidocranial dysplasia
- Endocrinal Deficincies such as Hypothyroidism, Hypopitutarism
- Febrile Diseases
- Down Syndrome
- Irradiation

- Local Factors:

- Prolonged Retention of Deciduous Teeth
- Malposed Tooth Germs
- Arch length Defeciency
- Supernumerary Teeth
- Odontogenic Tumors
- Abnormal Eruption Path
- Cleft lip and Palate

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