Vitamin C testing in an Oral Medicine clinic: A case series

Objective:
Biochemical analysis of serum ascorbic acid is an infrequent investigation in the context of Oral Medicine in the developed world. The most widely documented oral clinical presentations of vitamin C deficiency (Scurvy) include gingival hyperplasia, gingival bleeding, impaired wound healing, and features of associated nutritional deficiency.
Patients presenting to the Glasgow Dental Hospital Oral Medicine department often report alcohol excess and poor diet. The purpose of this study was to analyse a case series of patients for whom vitamin C analysis was requested, despite lack of classic oral signs.

Methods:
We conducted a retrospective review of medical records for 5 patients who were referred to the Oral Medicine department at the Glasgow Dental Hospital, between February 2017 and February 2020.

Results:
Patients had a mean age of 47.4 years and chief presenting complaints varied from tongue discomfort, burning sensation and a neck lump. No patients displayed typical oral signs of scurvy. Vitamin C serum analysis was requested in each case; the mean result was 4.4umol/L (reference range 15 – 90umol/L). Subsequently, dietary advice was provided to all patients and details of their vitamin C levels included in correspondence to medical practitioners, alongside working diagnoses and management plan for the presenting complaints.

Conclusion:
The justification for vitamin C analysis in these 5 cases was primarily alcohol excess and/or poor diet, particularly lacking in fruit intake. None of the patients demonstrated classic oral clinical signs of scurvy. Serum vitamin C is unstable; testing is expensive and time sensitive. The role of vitamin C analysis and correction as a holistic approach to patients with alcohol excess and poor diet remains unclear. Thiamine is often prescribed routinely in this group of patients, is there an argument for empirical ascorbic acid supplementation in addition?