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B complex avitaminosis with oral aureomycin
B COMPLEX AVITAMINOSIS CAPTAIN WILLIAM
WITH ORAL
C. SCHULTE, DEXTAL
AUBEOMYCIN
CORPS, ITNITED STATES
AIR FOR(~G
T
HE systemic and oral manifestations associated with a deficient intake or utilization of the members of the B complex are varied, and symptoms due to a lack of any single factor are uncommon. In clinical practice it is extremely difficult to identify lesions resulting from a deficiency of any one component of the B complex inasmuch as such deficiencies are usually multiple. The vitamin B complex is composed of at least twelve factors, and the exact’ chemical structure and physiologic function of some of these is not yet definitrly known. Thiamine, nicotinic acid, and riboflavin are all involved basically with cellular respiration and nutrition, and function in part as activators which are constantly being regenerated; however, they also function as portions of cuzymatic systems which are utilized and require replacement. Experimental studies’ by various research laboratories upon deficiency diseases have brought to light evidence that vitamin B romplex was elaborated by the organisms of the normal intestinal flora. In these studies, it was found that in such experimental animals as the.rat, it was exceedingly difficult to produce symptoms of vitamin B deficiency even when the animals were placed upon a vitamin-deficient diet, except in instances where the gastrointestinal tract had been partially sterilized prior to the institut,ion of the vitamin-deficient diet, by such ant,ibacterial agents as were available at that time. The presumption was that the vitamin B deficiency failed to supervene due to the elaboration of vitamin B by the bacteria normally resident in the intestinal t,ract of the animals. Later studies upon the chick, whic,h eventually led to discoveries in connection wibh the animal protein factor, revealed some twenty or more organisms, each capable of elaborating vitamin B in the intestine of the chick by their natural biologic processes. It has long been known t,hat, the yeasts are a fruit,ful source of thiamine ; Monilia likewise can be identified as an organism which produces some vitamin B. Many bact,eria vary greatly in the amount and type of activit,y, and from strain to strain in this regard. The exact mechanism of action is a subject presently requiring further research; however, in general the bacteria elaborate these substances as by-products of their vital metabcllic processes. A clinical illustration3 of these phenomena is observed in the following case. Case Report A 7-year-old boy was admitted t,o the hospital for treatment myelitis of the right femur. Prior to admission he had been treated at hospital for one week with a total of two million units of penicillin, milligrams of oral aureomycin every six hours during this period. biotics were continued upon transfer to this hospital, with the same
279
of osteo a civilian and 250 The antidosage of
280
CAPTAIN
WILLIAM
C. SCHULTE
aureomycin. After two weeks, a total of three weeks from the initiation of therapy, the patient began to complain of soreness of the tongue and gingival Thorough tissues, and was referred to the dental clinic for further examination. examination of the oral cavity revealed that the gingivae were rose-pink in color, satiny in texture, and somewhat edematous. The tongue exhibited a mild redness, and appeared smooth, glossy, and slightly edematous. A tentative diagnosis of vitamin B complex deficiency was made, and the patient’s diet was supplemented with oral administration of vitamin B complex in the form of triasyn, two tablets three times a day, and also hexavita,mins, one tablet twice a day. The patient was examined for oral manifestations every other day. Within five days, marked improvement was noted in the condition of the gingival tissues, and at the end of ten days all oral tissues appeared normal. During t,his period the patient continued to receive oral aureomycin with no recurrence of symptoms. Patients do not usually seek dental advice first in instances of vitamin B complex deficiences because t,he associated oral lesions and symptoms are not always sufficiently prominent or serious enough to require such consultat.ion. However, clinical evidence and laboratory tests indicate that the administration Conseof oral aureomycin inhibits the normal growth of intestinal bacteria. quently it is advisable to replace factors of the vitamin B complex produced by these bacteria with an oral B complex supplement in all patients receiving oral aureomycin for periods longer than seven days.
References Oral Medicine, Philadelphia, 1946, J. B. Lippincott Company, p. Lester W.: 388-400. Comroe, Bernard I., Collins, Leon H., and Crane, Martin P.: Internal Medicine in Dental Practice, Philadelphia, 1949, Lea & Febiger. Laboratories Division, New York, Correspondence, American Cyanamid Co., Lederle N. Y., 1950. on the Bacterial Flora Dearing, W. H., and Hellman, F. R.: The Effect of Aureomycin of the Intestinal Tract of Man: A Contribution to Preoperative Medication, Proc. Staff Meet., Mayo Clin. 25: 87-89, 1950. of Periodontia, Philadelphia, 1948, The Blakiston Company. Miller, Samuel C.: Textbook Philadelphia, 1949, W. B. Saunders ComThoma, Kurt H.: Oral and Dental Diagnosis, pany.
1. Burket, 2. 3. 4. 5. 6.
WITH ORAL
C. SCHULTE, DEXTAL
AUBEOMYCIN
CORPS, ITNITED STATES
AIR FOR(~G
T
HE systemic and oral manifestations associated with a deficient intake or utilization of the members of the B complex are varied, and symptoms due to a lack of any single factor are uncommon. In clinical practice it is extremely difficult to identify lesions resulting from a deficiency of any one component of the B complex inasmuch as such deficiencies are usually multiple. The vitamin B complex is composed of at least twelve factors, and the exact’ chemical structure and physiologic function of some of these is not yet definitrly known. Thiamine, nicotinic acid, and riboflavin are all involved basically with cellular respiration and nutrition, and function in part as activators which are constantly being regenerated; however, they also function as portions of cuzymatic systems which are utilized and require replacement. Experimental studies’ by various research laboratories upon deficiency diseases have brought to light evidence that vitamin B romplex was elaborated by the organisms of the normal intestinal flora. In these studies, it was found that in such experimental animals as the.rat, it was exceedingly difficult to produce symptoms of vitamin B deficiency even when the animals were placed upon a vitamin-deficient diet, except in instances where the gastrointestinal tract had been partially sterilized prior to the institut,ion of the vitamin-deficient diet, by such ant,ibacterial agents as were available at that time. The presumption was that the vitamin B deficiency failed to supervene due to the elaboration of vitamin B by the bacteria normally resident in the intestinal t,ract of the animals. Later studies upon the chick, whic,h eventually led to discoveries in connection wibh the animal protein factor, revealed some twenty or more organisms, each capable of elaborating vitamin B in the intestine of the chick by their natural biologic processes. It has long been known t,hat, the yeasts are a fruit,ful source of thiamine ; Monilia likewise can be identified as an organism which produces some vitamin B. Many bact,eria vary greatly in the amount and type of activit,y, and from strain to strain in this regard. The exact mechanism of action is a subject presently requiring further research; however, in general the bacteria elaborate these substances as by-products of their vital metabcllic processes. A clinical illustration3 of these phenomena is observed in the following case. Case Report A 7-year-old boy was admitted t,o the hospital for treatment myelitis of the right femur. Prior to admission he had been treated at hospital for one week with a total of two million units of penicillin, milligrams of oral aureomycin every six hours during this period. biotics were continued upon transfer to this hospital, with the same
279
of osteo a civilian and 250 The antidosage of
280
CAPTAIN
WILLIAM
C. SCHULTE
aureomycin. After two weeks, a total of three weeks from the initiation of therapy, the patient began to complain of soreness of the tongue and gingival Thorough tissues, and was referred to the dental clinic for further examination. examination of the oral cavity revealed that the gingivae were rose-pink in color, satiny in texture, and somewhat edematous. The tongue exhibited a mild redness, and appeared smooth, glossy, and slightly edematous. A tentative diagnosis of vitamin B complex deficiency was made, and the patient’s diet was supplemented with oral administration of vitamin B complex in the form of triasyn, two tablets three times a day, and also hexavita,mins, one tablet twice a day. The patient was examined for oral manifestations every other day. Within five days, marked improvement was noted in the condition of the gingival tissues, and at the end of ten days all oral tissues appeared normal. During t,his period the patient continued to receive oral aureomycin with no recurrence of symptoms. Patients do not usually seek dental advice first in instances of vitamin B complex deficiences because t,he associated oral lesions and symptoms are not always sufficiently prominent or serious enough to require such consultat.ion. However, clinical evidence and laboratory tests indicate that the administration Conseof oral aureomycin inhibits the normal growth of intestinal bacteria. quently it is advisable to replace factors of the vitamin B complex produced by these bacteria with an oral B complex supplement in all patients receiving oral aureomycin for periods longer than seven days.
References Oral Medicine, Philadelphia, 1946, J. B. Lippincott Company, p. Lester W.: 388-400. Comroe, Bernard I., Collins, Leon H., and Crane, Martin P.: Internal Medicine in Dental Practice, Philadelphia, 1949, Lea & Febiger. Laboratories Division, New York, Correspondence, American Cyanamid Co., Lederle N. Y., 1950. on the Bacterial Flora Dearing, W. H., and Hellman, F. R.: The Effect of Aureomycin of the Intestinal Tract of Man: A Contribution to Preoperative Medication, Proc. Staff Meet., Mayo Clin. 25: 87-89, 1950. of Periodontia, Philadelphia, 1948, The Blakiston Company. Miller, Samuel C.: Textbook Philadelphia, 1949, W. B. Saunders ComThoma, Kurt H.: Oral and Dental Diagnosis, pany.
1. Burket, 2. 3. 4. 5. 6.