The oral cavity frequently exhibits clinical signs of dietary deficits and systemic sickness initially. Oral cavity is often one of the first locations to exhibit clinical indications., hence a thorough examination of the oral cavity aids in the early identification of nutritional deficiency and systemic illness. Additionally, nutritional deficiencies may be caused by discomfort, agony, and masticatory trouble. Individuals with damaged dentition consume less calcium, iron, protein, fat, carbs, fiber, vitamin B5, and vitamins C and E orally 1. The first indication of an undiagnosed acute or chronic systemic disease can be manifested in the oral cavity. Mucosal alterations, bleeding and inflammation of the periodontal tissue, and the overall health of the teeth should all be assessed during the examination 2, 3, 4.

The chemical molecules known as vitamins are necessary for regular metabolic processes. Some vitamins are created by the gut microbiota, whereas the majority must be received through diet because humans are unable to manufacture them 7. Vitamins can be classified as either water-soluble or fat-soluble (Figure 1).

The B complex vitamins, which include B2 (riboflavin), B3 (niacin), B6 (pyridoxine), B9 (folic acid), and B12 (cobalamin), are the water-soluble vitamins that are most crucial for dental health. Vitamins K (phylloquinone), D (calciferol), E (tocopherol), and A (retinol) are fat-soluble vitamins that significantly impact the oral mucosa 15. Malnutrition seems to affect oral tissues in a number of ways,

Table 1

Nutrient Deficiency	Oral Manifestations	Description/Clinical Signs
Vitamin A Deficiency	- Xerostomia (dry mouth)	Reduced saliva production due to altered mucous membranes.
	- Oral mucosal changes (keratinization)	Dry, thickened, or roughened mucosa due to impaired epithelial growth.
	- Increased susceptibility to oral infections	Higher risk of gingivitis, periodontal disease, and fungal infections.
Vitamin B1 (Thiamine) Deficiency	- Glossitis (inflammation of the tongue)	The tongue appears inflamed, red, and sore, often with papillary atrophy.
	- Oral burning sensation	Burning discomfort, especially in the tongue.
	- Cheilosis (cracks at the corners of the mouth)	Painful fissures or sores at the angles of the mouth, often seen in severe cases.
Vitamin B2 (Riboflavin) Deficiency	- Glossitis (beefy red tongue)	Tongue becomes swollen, inflamed, and bright red with smooth edges.
	- Angular cheilitis	Cracked, sore lesions at the corners of the mouth.
	- Sore throat and difficulty swallowing	Due to inflammation of the mucous membranes.
Vitamin B3 (Niacin) Deficiency	- Glossitis	Red, inflamed tongue.
	- Angular cheilitis	Cracking and soreness at the corners of the mouth.
	- Stomatitis (inflammation of the mouth)	Painful lesions, redness, and ulcers in the oral mucosa.
Vitamin B6 (Pyridoxine) Deficiency	- Glossitis (smooth, sore tongue)	The tongue becomes smooth, red, and sore due to atrophy of the papillae.
	- Angular cheilitis	Cracked corners of the mouth with soreness and irritation.
	- Stomatitis (inflammation of the oral mucosa)	Painful lesions and inflammation on the lips, gums, and mucosal surfaces.
Vitamin B12 Deficiency	- Glossitis (beefy red, smooth tongue)	The tongue appears smooth, shiny, and red due to loss of filiform papillae.
	- Angular cheilitis	Cracking and soreness at the corners of the mouth.
	- Recurrent oral ulcers	Painful sores, often on the tongue or inside the cheeks.
Folate (Vitamin B9) Deficiency	- Glossitis (inflamed, red, and swollen tongue)	Similar to B12 deficiency, the tongue becomes red, smooth, and sore.
	- Recurrent aphthous ulcers	Frequent occurrence of painful, round ulcers in the mouth, especially on the tongue.
Vitamin C Deficiency	- Gingivitis (swollen, bleeding gums)	Red, swollen, and bleeding gums due to impaired collagen synthesis.
	- Periodontal disease	Increased susceptibility to gum disease and loss of gum tissue.
	- Tooth mobility and loss	Due to weakened periodontal ligaments and alveolar bone.
	- Petechiae (small, pinpoint hemorrhages)	Small purple or red spots on the mucous membranes, often associated with bleeding gums.
Iron Deficiency	- Glossitis (smooth, pale tongue)	Tongue appears smooth and pale due to the loss of papillae.
	- Angular cheilitis	Cracks at the corners of the mouth due to skin and mucosal weakening.
	- Pale mucosa (pale oral tissues)	The mucous membranes of the mouth and tongue may appear unusually pale due to anemia.
Zinc Deficiency	- Oral ulcers (recurrent)	Frequent, painful ulcers in the mouth, including the tongue and cheeks.
	- Glossitis (smooth, inflamed tongue)	Inflammation and smoothness of the tongue due to papillary atrophy.
	- Delayed wound healing	Slow healing of oral mucosal injuries or dental extractions.
Calcium Deficiency	- Tooth enamel hypoplasia	Enamel defects, such as pitting, discoloration, and increased risk of tooth decay.
	- Gingival bleeding	Due to the weakened bone structure, gum tissues may bleed easily.
Magnesium Deficiency	- Burning sensation in the tongue and mouth	A feeling of burning in the tongue or soft palate.
	- Oral ulcers	Painful, recurrent oral ulcers may occur, especially on the tongue or lips.
Protein Deficiency	- Muscle wasting around the face	Can lead to atrophy of the muscles of mastication and facial appearance.
	- Cheilitis (inflammation of the lips)	Swelling and inflammation of the lips.
	- Poor wound healing	Delayed healing of oral tissues following dental procedures or injury.
Copper Deficiency	- Pale mucous membranes	Pale oral mucosa due to impaired red blood cell production.
	- Gingival bleeding	Increased bleeding of the gums due to weakened blood vessels.
	- Oral ulcers	Recurrent ulcers may develop in the oral mucosa due to poor tissue repair.

Table 2

Fat-Soluble Vitamins
Vitamin		Age Group 1-3 years		Age Group 4-8 years	Age Group 9-13 years		Adolescents 14-18 years		Key Sources
Vitamin A		300 mcg		400 mcg	600 mcg		900 mcg (M) / 700 mcg (F)		Carrots, sweet potatoes, spinach
Vitamin D		15 mcg (600 IU)		15 mcg (600 IU)	15 mcg (600 IU)		15 mcg (600 IU)		Sunlight, fortified milk, fatty fish
Vitamin E		6 mg		7 mg	11 mg		15 mg		Nuts, seeds, vegetable oils
Vitamin K		30 mcg		55 mcg	60 mcg		75 mcg		Leafy greens, broccoli, soybeans
Water-Soluble Vitamins
Vitamin		Age Group 1-3 years		Age Group 4-8 years	Age Group 9-13 years		Adolescents 14-18 years		Key Sources
Vitamin C		15 mg		25 mg	45 mg		75 mg (M) / 65 mg (F)		Citrus fruits, bell peppers, strawberries
Thiamine (B1)		0.5 mg		0.6 mg	0.9 mg		1.2 mg (M) / 1.0 mg (F)		Whole grains, pork, legumes
Riboflavin (B2)		0.5 mg		0.6 mg	0.9 mg		1.3 mg (M) / 1.0 mg (F)		Dairy, eggs, green leafy vegetables
Niacin (B3)		6 mg		8 mg	12 mg		16 mg (M) / 14 mg (F)		Meat, fish, whole grains
Pantothenic Acid		2 mg		3 mg	4 mg		5 mg		Avocado, eggs, chicken
Vitamin B6		0.5 mg		0.6 mg	1.0 mg		1.3 mg (M) / 1.2 mg (F)		Fish, bananas, chickpeas
Biotin (B7)		8 mcg		12 mcg	20 mcg		25 mcg		Eggs, nuts, seeds
Folate (B9)		150 mcg		200 mcg	300 mcg		400 mcg		Leafy greens, legumes, fortified cereals
Vitamin B12		0.9 mcg		1.2 mcg	1.8 mcg		2.4 mcg		Meat, fish, dairy
Micronutrients
Micronutrient	Age Group 1-3 years		Age Group 4-8 years	Age Group 9-13 years		Adolescents 14-18 years		Key Sources
Calcium	700 mg		1,000 mg	1,300 mg		1,300 mg		Dairy, leafy greens, fortified drinks
Iron	7 mg		10 mg	8 mg		11 mg (M) / 15 mg (F)		Red meat, beans, fortified cereals
Magnesium	80 mg		130 mg	240 mg		410 mg (M) / 360 mg (F)		Nuts, seeds, whole grains
Phosphorus	460 mg		500 mg	1,250 mg		1,250 mg		Meat, fish, dairy
Zinc	3 mg		5 mg	8 mg		11 mg (M) / 9 mg (F)		Meat, shellfish, whole grains
Copper	340 mcg		440 mcg	700 mcg		890 mcg		Shellfish, nuts, seeds

(Ref: Dietary Reference Intakes (DRIs): Recommended Dietary Allowances and Adequate Intakes, ElementsFood and Nutrition Board, National Academies)

which can lead to the development of oral diseases. It impacts the growth of the oral cavity and the advancement of oral illnesses by altering tissue homeostasis, decreasing resistance to microbial biofilms, and decreasing the ability to repair damaged tissue 17.

Inadequate dietary intake, poor nutrient absorption, altered requirements are some of the causes of nutritional deficiencies. Raising awareness, guidance towards screening and proper diet and multi-vitamin supplementation can close nutritional gaps and raise a population's intake of under consumed nutrients 18. Both Under intake and Over intake of the nutrients can affect the overall wellbeing and hence it has to be consumed within in the recommended amount. The recommended dietary allowance (RDA) is the average daily dietary intake level that suffices to meet the nutrient requirements of nearly all healthy persons of a specific sex, age, life stage, or physiological condition (Table 1).

Proper awareness, periodic screening and early diagnosis are important to reduce the severity of nutritional deficiencies, as well as its over intake. As dental practitioners, we should be able to detect the early signs and symptoms of each condition and provide definitive treatment on time. Following a conclusive diagnosis, a customized treatment plan is created, which may involve medication, dental hygiene guidelines, nutritional counselling, or a referral to a specialist for thorough administration. In addition to preventive measures and posttreatment care, patient education is essential in elucidating the nature of the insufficiency, its ramifications, and the suggested course of treatment. In order to track therapy progress and guarantee successful deficit resolution, follow-up meetings are planned. As health care providers, we should have sufficient knowledge in assessing the severity of deficiency, which aids in understanding its potential impact on oral health and overall well-being.