Folate and Vitamin B

Forty-one patients with oral lesions and symptoms were enrolled in the study. Their ages ranged from 16 to 79 years with a mean age of 48.5 years. They were divided into two groups. Group I consisted of 25 patients with oral lichen planus and group II consisted of 16 patients with stomatitis or glossitis. Their complete blood counts, hemoglobin typing, serum and red cell folate, and serum vitamin B 12 levels were studied. The results revealed low red cell folate levels in 11 out of 25 patients (44%) in group I and 9 out of 16 patients (56%) in group II. The serum vitamin B 12 levels were within normal range in both groups. They were defined as having folate deficiency ( n = 10), folate deficient erythropoiesis (n = 3) and folate depletion (n = 7). None of them had anemia nor macrocytes. Therefore, folate levels should be investigated in patients with oral lesions and symptoms especially those with risk factors of age, poor nutrition or systemic diseases. When suspected, daily folic acid supplements should be given. PATIENTS AND METHODS Forty-one patients with oral lesions and symptoms referred to the Oral Medicine Department, Faculty of Dentistry, Chulalongkorn University from 1996-1999, were enrolled in the study. The duration of symptoms, type of lesions, medication and systemic diseases were recorded. The patients were divided into two groups. Group I consisted of 25 patients (21 females, 4 males) with erosive or atrophic oral lichen planus who were diagnosed by clinical manifestations and confirmed by histopathological studies (Walsh et al, 1990; Eversole, 1994; Scully et al, 1998). Group II consisted of 16 patients (11 females, 5 males) with stomatitis or glossitis. Their primary complaints included sore mouth, discomfort in the tongue without lesions and erythematous or atrophic lingual mucosa. Candida infection had been excluded. Additionally, 17 healthy volunteers (12 females, 5 males) were included as the control group. They had no oral lesions upon clinical examination or complaints, apart from dental caries or gingivitis. The ages ranged from 16 to 79 years (mean ± SD = 48 ± 17) in group I, 21 to 74 years (mean ± SD = 49 ± 13.5) in group II and 21 to 60 years (mean Correspondence: Prof Kobkan Thongprasom, Department of Oral Medicine, Faculty of Dentistry, Chulalongkorn University, Bangkok 10330, Thailand. Tel: (66-2) 2188935; Fax: (66-2) 2188941 E-mail: [email protected] SOUTHEAST ASIAN J TROP MED PUBLIC HEALTH Vol 32 No. 3 September 2001 644 ± SD = 35.4 ± 11.3) in the control group. Consent was obtained from all patients and control subjects before drawing venous blood. Samples were taken between 10 and 12 am in an attempt to minimized any effects of diurnal variation. Laboratory investigation The laboratory investigation included a complete blood count, hemoglobin typing and determining folate and vitamin B 12 levels. The complete blood count was performed by standard method using Coulter Counter and the hemoglobin typing was analysed by electrophoresis. Serum folate, red cell folate and serum vitamin B 12 levels were determined by competition binding radioassays. Anemia was defined as a hematocrit of less than 39% for males and less than 36% for females. The macrocyte was defined as a mean corpuscular volume (MCV) above 100 fl, normocyte of MCV 80-96 fl and microcyte of MCV less than 80 fl (Dacie and Lewis, 1995). A red cell folate level below 100 ng/ ml was defined as folate deficiency, 100-120 ng/ml as folate deficient erythropoiesis and 120-160 ng/ml as folate depletion (Herbert, 1987). A serum vitamin B 12 level less than 150 pg/ml was defined as low (Herbert, 1994). Statistics The chi-square test or Fisher’s exact test was used to compare the groups. A p value of less than 0.05 was considered significant.