Contributing authors
Annelise Collins, MBA, RD US
Ellen R Guritzky, MJS, RDH, FADHA
Alpa Shah, MS, RDN US
B complex vitamins are water-soluble and are important for many daily bodily functions, such as energy, metabolism, and DNA synthesis. People obtain essential vitamins only through their food or supplements as the body is unable to make them. Therefore, it's imperative to include the B vitamins in our daily diet.
Insufficient B vitamins in the body can limit ATP (adenosine triphosphate) production and result in fatigue, mood changes, cognitive difficulties, or changes to the skin. B vitamins play a role in the nervous and cardiovascular systems, inflammatory processes, and DNA replication and synthesis. Many signs of vitamin B deficiency are present in the oral cavity, though deficiency is rare in the US. Observational studies have shown a link between some B vitamins and periodontal risk.1
Vitamin B1 (thiamine)
Thiamine, vitamin B1, is a coenzyme that occurs during the Krebs, or citric acid, cycle to produce energy for the cell.2 It contributes to the synthesis of nucleic acids, myelin, and other neurotransmitters. Deficiencies can be caused by low intake or impaired intestinal absorption, which can be a problem for people who consume a lot of alcohol or have AIDS.2
A thiamine deficiency can manifest as beriberi, which brings on weakness, numbness, confusion, and nystagmus, and can cause cardiovascular symptoms such as shortness of breath and fluid retention.2 Thiamine is in foods such as whole grains, legumes, nuts, and pork products. Some cereals have also been fortified with B1.
Vitamin B2 (riboflavin)
Riboflavin, vitamin B2, has antioxidant properties and is an important part of metabolism and energy production as it participates in electron transfers in redox reactions.2 Pregnant and lactating women, women on birth control, and people who abuse alcohol may be at high risk for vitamin B2 deficiency.
Athletes require greater B2 uptake due to their need for energy production. B2 deficiencies can present as angular cheilitis and glossitis or a purple or swollen tongue.2-3 Riboflavin intake has shown a negative correlation with periodontal disease risk.1 Riboflavin is found in dairy products, eggs, leafy greens, organ and red meats, salmon, chicken, and some fortified cereals.
Vitamin B3 (niacin)
Niacin, vitamin B3, plays a vital role in the aerobic respiration pathway in the Krebs cycle and the synthesis of many molecules in the body, including cholesterols.2 Niacin is a precursor of nicotinamide adenine dinucleotide (NAD+), the coenzyme needed for more than 400 enzymes to catalyze reactions in the body, including those involved in repairing damaged DNA.2
Patients with Crohn’s disease, dermatitis, or who abuse alcohol may be at greater risk for deficiency.2 One study in Korean adults suggests inadequate intake of vitamin B3 is associated with an increased risk of developing periodontitis, particularly among women and 40- to 59-year-old people.4 Vitamin B3 is found in most animal products, beans, nuts, and seeds.
Vitamin B5 (pantothenic acid)
Pantothenic acid, vitamin B5, is vital in the synthesis of coenzyme A, a cofactor used in the Krebs cycle, and it contributes to brain cell structure and function through the synthesis of metabolites and neurotransmitters.5 Vitamin B5 is available in a wide variety of foods such as fruits, vegetables, fortified cereals, and most animal products. Patients who suffer from eating disorders are at risk for deficiency, as are those who have a genetic anomaly of the pantothenate kinase gene 2, which affects the conversion of vitamin B5 to coenzyme A2.
Vitamin B6 (pyridoxine)
Pyridoxine, vitamin B6, is used during the metabolism of carbohydrates, fats, and proteins.2 An observational study showed high B6 intake is associated with a decreased risk of periodontal disease.1 Patients who are malnourished or abuse alcohol are at risk for deficiency. Vitamin B6 is found in an abundance of foods such as pork, poultry, fish, whole wheat, nuts, and beans.2
Vitamin B7 (biotin)
Biotin, vitamin B7, aids in gene signaling and replication.3 Biotin is used in the metabolism of carbohydrates, fats, and proteins, but is commonly associated with hair, skin, and nail health. Deficiency can result in skin rashes, hair loss, and brittle nails. Deficiency is rare but can present itself with certain genetic anomalies. Biotin can be acquired through diet and is found in egg yolks, dairy products, soybeans, and leafy vegetables.
Vitamin B9 (folate)
Folate, vitamin B9, participates in the synthesis and replication of DNA. Deficiency is often due to alcohol abuse, malabsorption disorders, or increased requirements for folate during pregnancy.2 Inadequate intake during pregnancy can result in neural tube defects such as spina bifida or cleft palate.
Women of childbearing age and pregnant women should obtain adequate folate intake through diet and supplementation. High B9 daily intake is associated with a lower risk of periodontal disease.1 Folate can be acquired through green leafy vegetables, beans, nuts, eggs, and other animal products.
Vitamin B12 (cobalamin)
Cobalamin, vitamin B12, is required for red blood cell formation and DNA synthesis and aids in nervous system function. Patients with Crohn’s or celiac disease or older adults may be at a greater risk for developing a deficiency due to impaired absorption.3
Prolonged deficiency can cause megaloblastic anemia or a change in red blood cells, as well as neurological changes such as cognitive impairment and neuropathy.3 Since B12 is primarily found in animal products, supplementation may be appropriate for vegetarians and vegans.
The B complex vitamins provide daily energy, synthesize and repair DNA, and work to support various systems throughout the body. These vitamins are not able to be made or stored by the body and need to be consumed daily and are found in many whole foods. Adequate daily consumption of B vitamins may correspond with oral health, as a meta-analysis of observational studies showed a lower risk of periodontal disease associated with higher intake of certain B vitamins.
It's important to know patients’ medical histories and diets to learn if they’re at risk for a vitamin B deficiency. This is especially true if you see physiological signs of deficiency such as fatigue or oral manifestations like cheilitis and glossitis. While we don’t diagnose a deficiency, we can provide patients with valuable knowledge about the vitamin B complex and refer to their primary care physician if we suspect a deficiency.
Editor's note: This article appeared in the January/February 2025 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.
References
1. Mi N, Zhang M, Ying Z, Lin X, Jin Y. Vitamin intake and periodontal disease: a meta-analysis of observational studies. BMC Oral Health. 2024;24(1):117. doi:10.1186/s12903-024-03850-5
2. Bayram-Weston Z, Knight J, Andrade M. Vitamin B complex: B group vitamins and their role in the body. Nursing Times. February 26, 2024. Accessed September 26, 2024. https://www.nursingtimes.net/nutrition-and-hydration/vitamin-b-complex-b-group-vitamins-and-their-role-in-the-body-26-02-2024/
3. Edited by LeBlanc JG. B-Complex Vitamins. Sources, Intakes, and Novel Applications. Published in London, United Kingdom. February 23, 2022.
4. Lee JH, Lee SA, Kim HD. Periodontitis and intake of thiamine, riboflavin and niacin among Korean adults. Community Dent Oral Epidemiol. 2020;48(1):21-31. doi:10.1111/cdoe.12496
5. Kennedy DO. B vitamins and the brain: mechanisms, dose and efficacy–a review. Nutrients. 2016;8(2):68. doi:10.3390/nu8020068
