The effects of a single massive dose of vitamin D 2 (D-stoss therapy) on oral and other tissues of young dogs

Abstract

A DECADE ago European clinicians introduced the vitamin D-Stoss (shock) technique for the prevention of rickets in infants.6 This treatment consisted of the administration of large single doses, of l/s million international units or more, of vitamin D. Since the introduction of this method, large single doses of vitamin D,* or D,t have been employed in this country a1so.18, 22 Administration of as high as 11h2 million international units daily to human beings as a treatment for refractory rickets has been tried.l Warnings have been expressed2’ 9, 10, 12, 13, 22 against too much enthusiasm in biologic therapy because of marked roentgenographic and histologic changes in dental and paradental structures of dogs as the result of overdoses of vitamin D. Complete knowledge on the storage and destruction of excessive amounts of vitamin D is not available as yet; studies along these lines have been conducted in experimental animals** I3 and in human beings.14 Assay of the various body tissues of dogs, sacrificed three days after a large single dose, accounted for less than 10 per cent of the original massive dose.ll Caution was advised against the acceptance of the vitamin D-Stoss therapy for rickets or its prevention until more is known about the possible damaging effects, The hypercalcemia which results from hyperparathyroidism and that from the toxic effect of overdosage of vitamin D are of different physiologic 0rigins.l” The former is from a withdrawal of calcium from the body stores and the latter from an increased absorption from the ihtestines or diminished loss through the feces. Deposition of minerals in bone, dentine, and soft tissue has been observed following the hypercalcemic state of both hyperparathyroidism and hypervitaminosis D.15 Pathologic calcifications have been demonstrated in dogs on the surfaces of bone trabeculae, and tooth roots; connective tissue, as for instance Sharpey’s fibers, and pulp tissue showed amorphous highly calcified depositions.2 Small malformed teeth were also observed in these animals. The establishment of the maximum nontoxic dose of vitamin D is a difficult task, as various species and even individual animals of the same species differ in their tolerance of overdosage of vitamin D. In addition, the vitamin D products used by investigators have varied as to source and method of prepara-