Grossman 1

Jesse Grossman
Michelle Cummins
DH 120
15 May 2015
Vitamin A
Vitamin A is a fat soluble vitamin that is found naturally in either preformed vitamin A retinoids
or pro-vitamin A carotenoids. Retinoids are found in animal products like beef liver, egg yolks, fish liver
oils, fortified milk, cream, and cheeses. Carotenoids are found in plants like green leafy vegetables and
orange, red and yellow colored fruits and vegetables. Some of these colored vegetables sources are carrots,
melons, squash, and sweet potato. Beta-carotene has the highest vitamin A of any carotenoid. Vitamin A
can also be consumed through dietary supplements, either in a preformed vitamin A, a pro-vitamin A, or a
combination of the two.
Vitamin A is an important component of normal body growth, development and functioning.
Vitamin A is important for tooth development. It promotes normal growth of dentin enamel. Vitamin A
is essential for the development and maintenance of epithelial mucosa in the oral cavity. It also promotes
normal growth and function of salivary glands. Vitamin A is also important for normal vision, especially
in dim light. Its often known as retinol because it produces the pigments in the retina of the eye. Vitamin
A also promotes a healthy immune system, and is essential for reproduction because it supports normal
cell differentiation. Vitamin A is important for many of these reasons, including healthy bone and tooth
development, healthy skin and eyes, normal vision, immune system integrity, and reproduction.
Because vitamin A has so many benefits, there can also be many problems associated with a
vitamin A deficiency. One of the early symptoms of a deficiency in vitamin A in children and pregnant
women is xerophthalmia. According to Merriam-Webster online dictionary xerophthalmia (or xeroma) is

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a dry thickened lusterless condition of the eyeball resulting especially from a severe systemic deficiency
of vitamin A (Merriam-Webster, n.d.). Night blindness, which is often associated with a vitamin A
deficiency, is one of the first signs of xerophthalmia. Being deficient in vitamin A is one of the leading
causes of preventable blindness in children. People that are vitamin A deficient are often also iron
deficient, which can cause anemia. Infections like measles or diarrhea can have a higher mortality risk if
there is also a vitamin A deficiency. Another condition associated with a vitamin A deficiency is the
impairment of cell differentiation. This can cause impaired healing and defective tissue formation.
Deficiency to vitamin A can also affect the immune system, resulting in the impairment of specific and
non-specific immuno-protective mechanisms (Harris, Garcia-Godoy and Nathe, 2009, p. 298). Vitamin A
deficiency can also lead to many other conditions like poor growth, keratinization of epithelium, skin
disorders, infections (like measles), diarrhea, and lung disorders.
Although vitamin A deficiency results in many health problems, vitamin A deficiency is very rare
in the United States and other developed countries. Vitamin A deficiency is still a problem, however, in
developing countries where poor nutrition is more common. Developing countries may not have as much
access to animal food products which contain preformed vitamin A (retinoids) or fresh fruits and
vegetables that contain pro-vitamin A (carotenoids or beta-carotene). In countries where nutrition is a
problem, vitamin A deficiency is most common during times when nutrition is most important, like
infancy, childhood, pregnancy, and lactation. Low vitamin A intake often starts during the infant stage,
because infants may not consume enough colostrum and breast milk. In young children, chronic diarrhea
can also cause vitamin A deficiency; and vitamin A deficiency can cause diarrhea (NIH, 2005).
In the United States where vitamin A deficiency isnt very common, there are a couple groups
that have an increased risk of vitamin A deficiency. One of these groups is premature infants. The
National Institutes of Health website (NIH, 2005) explains that premature infants do not have enough
vitamin A stored in their liver at birth and their plasma concentrations of retinol can be low, and often
stay low throughout their first year. Preterm infants that have had a vitamin A deficiency can have eye,

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lung, or gastrointestinal problems. The other group at risk for vitamin A deficiency in the United States
are those with cystic fibrosis. People with cystic fibrosis can have pancreatic problems, which makes it
difficult for them to absorb fat, which can cause vitamin A deficiency because it is fat soluble. According
to the NIH website, studies have shown that between 15% and 40% of people with cystic fibrosis are
deficient in vitamin A. People with cystic fibrosis that are vitamin A deficient can often become sufficient
by pancreatic replacement treatment, better nutrition, or caloric supplements (NIH, 2005).
Along with the many medical concerns of a vitamin A deficiency, there are also some dental
implications associated with a vitamin A deficiency. Vitamin A deficiency can cause defective dentin
formation, atrophy of oral mucosa, xerostomia, and oral leukoplakia. When someone has a severe vitamin
deficiency (of vitamins A, C, or D) during the period of tooth formation, a form of enamel hypoplasia can
occur. As defined in Oral Pathology for the Dental Hygienist, Sixth Edition (Ibsen and Phelan, 2014)
enamel hypoplasia is the incomplete or defective formation of enamel, resulting in alteration of tooth
form or color. The type of enamel hypoplasia that can be caused by vitamin deficiency is characterized
by the pitting of the enamel. This type of enamel hypoplasia mostly affects the teeth that are forming
during the first year of life, and only the crowns that are developing during the deficiency. This type of
enamel hypoplasia can also be cause by a febrile illness, like measles or chickenpox. This may also be
related to vitamin A deficiency, as measles can be associated with a vitamin A deficiency (Ibsen and
Phelan, 2014, pg. 171).
While there are many medical concerns with vitamin A deficiency, there are also concerns around
vitamin A excess. Vitamin A excess can affect oral health and overall health. Toxicity to vitamin A can
have some reactions that are similar to a deficiency. Impaired healing is one response to toxicity, and this
can have the most direct affect in the mouth. The Primary Preventive Dentistry, Seventh Edition textbook
(Harris, Garcia-Godoy and Nathe, 2009, p. 298) lists several more oral complications associated with
vitamin A excess including proliferation of oral epithelium, reduction of keratin layer, thickening of basal
membrane, and increase in granular layer. The same textbook also refers to a case report where someone

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took 200,000 IU (which is much higher than the recommended intake) of vitamin A for 6 months. This
patient had many symptoms, including painful gingival lesions, nausea, vomiting, xerostomia, and
headaches. This patient had clinical examinations that revealed gingival ulcerations, erosions, bleeding,
and swelling amongst other symptoms. The patient kept the same oral hygiene habits but quit taking
vitamin A, and within two months all pathologic manifestations disappeared. Besides the oral
implications from an excess of vitamin A, there are also studies that suggest too much vitamin A can
increase the chance of a hip fracture. Vitamin A excess can cause headaches and vomiting like in the
patient described, along with severe liver damage and defect in long bone formation. According the NIH
website (NIH, 2005), vitamin A excess can even cause coma or death. Too much vitamin A during
pregnancy can also cause congenital birth defects, like malformations of the eyes, skull, lungs, or heart.
These side effects associated with vitamin A excess are associated with preformed vitamin A retinoids,
not pro-vitamin A carotenoids (NIH, 2005).
Because foods that contain vitamin A are readily available in the United States, people can often
get enough vitamin A from a healthy diet. Foods like sweet potato, beef liver, carrots, and spinach have a
very high content of vitamin A. If you include some of these high vitamin A foods into your regular diet
you should not need any vitamin A supplements because these foods contain more than the recommended
daily value of vitamin A in just one serving. However, if you do not get enough vitamin A through your
diet, you can take a dietary supplement containing vitamin A. According to the NIH website (NIH, 2005)
the RDA (recommended dietary allowance) for vitamin A is given in RAE (retinol activity equivalents),
but food and supplement labels list vitamin A in IUs (international units). A vitamin A RAE cannot be
directly converted to IUs without knowing the source of vitamin A, but there are conversion methods
available. For newborns up to 6 months old, the RDA is 400 mcg RAE. For children 7 months to 12
months, RDA is 500 mcg RAE. For children 1 year to eight years old the RDA is between 300-400 mcg
RAE. The RDA is 600 mcg RAE for children 9-13 years of age. Males 14 years and older should
consume 900 mcg RAE. Women 14 years and older are recommended 700 mcg RAE, unless they are

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pregnant or nursing. If women are pregnant the RDA is 750-770 mcg RAE and if they are nursing they
should consume between 1,200-1,300 mcg RAE (NIH, 2005).
According to NIH website (NIH, 2005) vitamin A intake can be related to some other diseases.
Studies have been done that suggest people that have a high intake of vitamin A rich foods containing
beta-carotene may have a lower risk of getting certain types of cancer. There have also been studies that
suggest that certain types of carotenoids that contain antioxidants may be used to prevent age-related
macular degeneration. The NIH doesnt list these studies as definitive, but just suggests that vitamin A
may be beneficial for treating or prevention of these conditions (NIH, 2005).
It is important to consider reactions that vitamin A may have with medications. Vitamin A
absorption can decrease when taken with a weight loss drug called Orlistat, according to NIH (NIH,
2005). The manufacturers of this drug recommend that patients take a supplement. Synthetic retinoids,
which are derived from vitamin A and are used to treat psoriasis can cause an excess of vitamin A if taken
with a supplement (NIH, 2008).
Because vitamin A has so many health implications, including many oral health concerns, it is
important to be aware of how much vitamin you are consuming. Vitamin A is found in many foods that
are readily available in the United States, and with a balanced and healthy diet there should not be
concern for deficiency. Patients should be counseled about the importance of adequate nutrition,
including food choices that are high in vitamin A. If a patient is in a risk category, there should be an
extra emphasis on nutritional counseling. Its not just important to talk about deficiencies, but also excess,
because both can have oral implications. As stated, vitamin A deficiency is rare in the United States, but
because it is such an important part of development, immunity, and reproduction it is important to be
educated about all the health benefits and concerns relating to vitamin A.

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Works Cited
Harris, N. Nutrition, Diet and Associated Oral Conditions. Primary Preventive Dentistry. By F. GarciaGodoy,, C. Nathe. 7th ed. Upper Saddle River: Pearson Education, 2009. 298. Print.
Phelan, J. Developmental Disorders. Oral Pathology of the Dental Hygienist. By O. Ibsen. 6 th ed. St.
Louis: Saunders Elsevier, 2014. 171. Print
"Vitamin A." National Institutes of Health Office of Dietary Supplements. N.p., 5 June 2005. Web. 12
May 2015. <http://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/>.
Walsh, M. "Nutritional Counseling." Dental Hygiene Theory and Practice. By A. Darby. 3 rd ed. St. Louis:
Saunders Elsevier, 2010. 625. Print.
Wilkins, E. Diet and Dietary Analysis. Clinical Practice of the Dental Hygienist10th ed. Baltimore:
Wolters Kluwer, 2009. 529. Print.
"Xerophthalmia." Merriam-Webster Dictionary. N.p., n.d. Web. 12 May 2015. <http://www.merriamwebster.com/dictionary/xerophthalmia>.