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# Nutritional deficiencies in the mouth

- Mouth and systemic disease

Vitamin C deficiency makes gums swell and bleed. Lack of B vitamins or iron gives a smooth sore tongue and cracked corners of the mouth.

Updated Nov 12, 2026

## Key points

- Swollen bleeding gums with poor diet = think of scurvy.
- Smooth red tongue = iron, B12 or folate.
- Treat B12 before giving folate alone.

## What it is

Deficiencies show early in the mouth because its tissues renew fast. Vitamin C deficiency (scurvy) weakens collagen: gums become swollen, purple, spongy and bleeding, teeth loosen, and there are perifollicular haemorrhages and poor healing. Deficiencies of iron, vitamin B12, folate, riboflavin and niacin cause atrophic glossitis, angular cheilitis, recurrent ulcers and burning. Vitamin D deficiency in childhood (rickets) delays eruption and causes enamel defects. Scurvy still occurs in people with very restricted diets, alcohol use disorder, older adults living alone and children with selective eating.

## Oral findings

- Scurvy: swollen, bleeding gums, loose teeth, perifollicular haemorrhages, corkscrew hairs.
- B12, folate and iron deficiency: smooth red tongue, cheilitis, ulcers.
- Niacin deficiency (pellagra): red swollen tongue with dermatitis, diarrhoea and dementia.
- Rickets: delayed eruption and enamel hypoplasia.
- Coeliac disease can cause enamel defects, aphthous ulcers and deficiencies.

## What the doctor does

- Gum bleeding in a malnourished or isolated person: ask about fruit and vegetables and consider scurvy.
- B12 deficiency can cause neuropathy; giving folate alone may mask the anaemia while nerve damage continues.
- Restrictive diets in children with autism or eating disorders are a modern cause of scurvy.

## Next step / Initial management

- Smooth tongue or cheilitis: full blood count, ferritin, B12 and folate; coeliac serology if indicated.
- Suspected scurvy: dietary history and vitamin C level if available; treat with vitamin C and refer for nutritional support.
- Refer to the dentist for gum and tooth care, and to nutrition or the treating team for the underlying cause.

## Test yourself

Think of the answer, then tap the question to see it.

## Which vitamin deficiency causes swollen, bleeding gums and loose teeth?

Vitamin C deficiency (scurvy).

## Which deficiencies cause atrophic glossitis?

Iron, vitamin B12, folate, riboflavin and niacin, among others.

## Why is folate alone dangerous in B12 deficiency?

It can correct the anaemia while neurological damage from B12 deficiency progresses.

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## Connections

## Related 4

- [The tongue: geographic tongue, glossitis and what to worry about](https://durgical.com/en/dentistry/the-tongue-geographic-tongue-glossitis-and-what-to-worry-about/)
- [Cheilitis: cracked corners and sun-damaged lips](https://durgical.com/en/dentistry/cheilitis-cracked-corners-and-sun-damaged-lips/)
- [Burning mouth syndrome](https://durgical.com/en/dentistry/burning-mouth-syndrome/)
- [The mouth as a mirror: oral signs of systemic disease](https://durgical.com/en/dentistry/the-mouth-as-a-mirror-oral-signs-of-systemic-disease/)

## Related conditions 6

- [Scurvy (vitamin C deficiency)](https://durgical.com/en/conditions/scurvy/)
- [Pernicious anaemia](https://durgical.com/en/conditions/pernicious-anaemia/)
- [Megaloblastic anaemia (B12 or folate deficiency)](https://durgical.com/en/conditions/megaloblastic-anaemia/)
- [Iron deficiency anaemia](https://durgical.com/en/conditions/iron-deficiency-anaemia/)
- [Rickets and osteomalacia](https://durgical.com/en/conditions/rickets-and-osteomalacia/)
- [Coeliac disease](https://durgical.com/en/conditions/coeliac-disease/)

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Educational content; it does not replace assessment by a dentist or doctor and is not a clinical instruction. For facial or neck swelling with difficulty swallowing or breathing, a knocked-out tooth or bleeding that will not stop, go to an emergency department at once.

Sources: [Scurvy](https://medlineplus.gov/ency/article/000355.htm) (MedlinePlus, US National Library of Medicine, 2026); [Vitamin B12 deficiency anemia](https://medlineplus.gov/ency/article/000574.htm) (MedlinePlus, US National Library of Medicine, 2026); [Iron Deficiency and Microcytic Hypochromic Anemia](https://www.ncbi.nlm.nih.gov/books/NBK560876/) (StatPearls Publishing (NCBI Bookshelf), 2024); [Glossitis](https://www.ncbi.nlm.nih.gov/books/NBK560627/) (StatPearls Publishing (NCBI Bookshelf), 2023).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/dentistry/nutritional-deficiencies-in-the-mouth/