Introduction

The structures and lining of the oral cavity offer valuable and easily accessible information on the nutritional status of an individual. Lesions may indicate a nutrient deficiency or may be manifestations of gastrointestinal or other disease.¹ Because of the very rapid cell turnover of the oral mucosa, these lesions often may precede other manifestations of nutrient deficiency or systemic disease. Some typical lesions are mucosal ulceration, cheilosis, gingivitis, and glossitis. Between 5% and 10% of the people in the United States are deficient in one or more nutrients, so signs of nutritional deficiency are common.

The Healthy Mouth

The ventral surface of the healthy tongue is covered with a smooth, pink mucous membrane and lymphoid follicles. On the dorsal surface, the filiform, fungiform, and circumvallate papillae (which contain the organs of taste) produce a rough, grayish red appearance. The thick epithelial tufts of the filiform papillae give the tongue its characteristic grayish white coating, whereas the globular, pale red fungiform papillae give it a speckled pink appearance. Furrows are not characteristic of the healthy tongue.

The buccal mucosa has a grayish red color and may be crossed by fine grayish ridges where it touches the closed teeth.

Healthy gums have a light reddish appearance and cover the roots of the teeth completely.

The assessment of oral health, obviously, must include the health and status of the teeth. Patients should be asked about their dental history and encouraged to have regular dental checkups. Here are some key nutritional considerations for examination of the teeth²:

Abnormalities of the Oral Membranes

Table 25-1 summarizes the typical oral manifestations associated with a particular nutrient deficiency, and Table 25-2 summarizes common disorders associated with oral manifestations.^1–12