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Do you have bleeding gums?

You may be deficient in VITAMIN C 

What is vitamin C?

Vitamin C (ascorbic acid) is essential for collagen formation and helps to maintain the integrity of connective tissue, bone and dentine. It is essential for wound healing and facilitates recovery from burns. Vitamin C also facilitates the absorption of iron. Severe deficiency results in scurvy, which is characterised by haemorrhages and abnormal bone and dentin formation. The adverse effects of more mild degrees of vitamin C deficiency are not known. Vitamin C is an anti-oxidant but the benefit of vitamin C supplements is a subject of many claims but very little evidence.

Vitamin C is found in a wide variety of fruit and vegetables. Good sources include:

Fruits: especially grapefruits, lemons, blackcurrants, oranges and kiwi fruit
Vegetables: e.g. broccoli, green peppers, tomatoes, cabbage, sprouts, and sweet potatoes
Fresh milk

The incidence of vitamin C deficiency peaks in children aged 6-12 months who are fed a diet deficient in citrus fruits or vegetables. Incidence also peaks in the elderly.

Risk factors include the following:
Alcoholism and conforming to food fads
Low income families tend not to buy foods high in vitamin C
Vitamin C deficiency has been noted in refugees1
Increased need due to increased utilisation in pregnant and lactating women, thyrotoxicosis, surgery, and burns
Chronic diarrhoea increases faecal loss

Symptoms Early symptoms of scurvy are malaise, lethargy, myalgia and arthralgia . Other symptoms include skin changes with easy bruising, gum disease , loosening of teeth and poor wound healing.

Signs The gums become swollen, purple, spongy, and friable. The skin shows papules and haemorrhages around hair follicles, petechiae and multiple bruises. Nail splinter haemorrhages may occur. In the later stages, jaundice, generalised oedema, oliguria, neuropathy, fever, and convulsions may occur.

Differential Diagnosis
Clotting factor deficiencies
Platelet dysfunction
Senile purpura


Plasma ascorbic acid levels are reduced. Ascorbic acid levels in the white blood cell-platelet layer of centrifuged blood are more significant. A positive capillary fragility test is an almost constant finding, and anaemia is common. Bleeding, coagulation, and prothrombin times are all normal.


Ascorbic acid replacement therapy.


Scurvy is fatal if untreated. Patients respond quickly to oral therapy.

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