Evaluation and comparison of serum vitamin D and calcium levels in periodontally healthy, chronic gingivitis and chronic periodontitis in patients with and without diabetes mellitus - a cross-sectional study

The Associations of Cardiometabolic and Dietary Variables with Clinical Periodontitis in Adults with and without Type 2 Diabetes: A Cross-Sectional Study

Periodontitis is a commonly occurring inflammatory oral disease affecting a large proportion of global and US adults and is characterized by the destruction of the tooth-supporting apparatus. Its etiology is multifactorial, and type 2 diabetes and diet play critical roles in its remission and progression. However, few studies have addressed nutritional and serum vitamin D status in adults with periodontitis in the presence of diabetes. A cross-sectional study (n = 78), and a sub-set of age- and BMI-matched case-control studies (n = 50), were conducted to examine differences in dietary and cardiometabolic variables, and serum vitamin D in adults with periodontitis with or without diabetes. Participants provided fasting blood samples and 24-h diet recalls on at least two different days. Data on health history, body weight, height, nutritional habits, and clinical features of periodontitis were also collected. The Mann-Whitney U Test (with exact p-value estimation by Monte Carlo simulation) was used to examine differences by diabetes status in continuous and ordinal variables. Results revealed significantly lower serum vitamin D, and dietary intake of fruits, vegetables, dairy, vitamins A and C in adults with periodontitis with vs. without diabetes in the sub-study (all p < 0.05). In the overall sample, adults with diabetes presented with higher caries risk measures and lower numbers of teeth than those without diabetes; plaque and bleeding scores did not differ by diabetes status. Finally, a significant associations of food habits was observed, especially consuming protein-rich foods twice a day with a lower bleeding score, and daily consumption of fried or fast foods with a fewer number of teeth present (all p < 0.05). The present findings show significant dietary and serum vitamin D inadequacies among adults with periodontitis, and diabetes further aggravates the observed malnourishment and oral health.

Association between Periodontitis and HbA1c Levels in Non-Diabetic Patients: A Systematic Review and Meta-Analysis

BACKGROUND

A high detection rate of diabetes among dental visitors has been reported recently. This systematic review aimed to evaluate the association between periodontitis and glycated hemoglobin (HbA1c) levels among non-diabetic individuals.

METHODS

The EMBASE, MEDLINE, Web of Science, Cochrane Library, PubMed, and Open GREY databases were searched, and observational studies published until 1st June 2023 were identified. A methodological quality assessment was conducted based on the original and modified versions of the Newcastle-Ottawa scale. Cohort, case-control, and cross-sectional studies that performed clinical periodontal examinations and measured HbA1c levels in non-diabetic adults were included. A meta-analysis was conducted to estimate the weighted mean difference (WMD) between individuals with and without periodontitis.

RESULTS

In total, 29 case-control and 5 cross-sectional studies were selected from 2583 potentially eligible articles. Among them, sixteen case-control and three cross-sectional studies with moderate to high quality were selected for the meta-analyses. The HbA1c levels in periodontitis patients were significantly higher than those in individuals with healthy periodontal conditions (WMD = 0.16; p < 0.001) among the non-diabetic populations.

CONCLUSIONS

This study reveals a significant association between periodontitis and HbA1c levels in non-diabetic populations. Thus, HbA1c screening may be recommended to detect potential hyperglycemia in non-diabetic periodontitis patients.

Estimation of Vitamin D Levels Using a Chairside Diagnostic Test Kit in Patients with Gingivitis and Periodontitis: A Cross-Sectional Study

Aim

Periodontitis is an inflammatory condition of the periodontium that is instigated by microbial biofilms developed on the teeth. The purpose of the study was to ascertain the vitamin D status of gingivitis and periodontitis patients while maintaining a healthy group as the control using simple low-cost chairside pre-coated with 25-OH Vitamin D antigen rapid test kits.

Materials and Methods

From outpatients visiting the college's periodontics clinics, a total of 101 patients were screened. The study sample includes 38 patients in the periodontitis group, 32 in the gingivitis group, and 31 in the healthy group. A middle-digit needle was used to collect blood samples, which were put into a test cassette with membrane that had been coated with 25-OH Vitamin D antigen on the test line area of the strip. Vitamin D Quick Test (Natejah) Semi-quantitatively detects 25-hydroxyvitamin D (25 (OH) D) in human finger-stick complete blood at a cutoff convergence of 30 ± 4 ng/mL. Vitamin D blood levels below 80 nmol/L are considered to have deficient vitamin 25(OH)D levels. Clinical parameters between healthy, gingivitis, and different stages of periodontitis subjects were compared using one-way ANOVA and Tukey's multiple comparison. Fisher's exact test was done to compare vitamin D levels in the three groups.

Results

Fisher's exact test revealed that there was a statistically significant increase in the number of subjects with stages 4 and stage 3 periodontitis who lacked vitamin D levels (less than 80 nmol/L). Whereas least deficient in Vit D were noticed among Healthy and Gingivitis subjects. When compared to healthy individuals, gingivitis, and various stages of periodontitis had significantly higher mean PI values in a Tukey's multiple comparison. Vitamin D deficiency was found to be 27.5% in subjects with gingivitis and 71.5% in subjects with periodontitis.

Conclusion

Periodontitis is associated with vitamin D deficiency, in contrast to gingivitis and healthy subjects. The severity of periodontitis was likewise linked to the amount of vitamin D in the individual's blood. When compared to expensive, time-consuming, and laborious laboratory methods, the findings of this study suggest that a simple inexpensive chairside pre-coated with 25-OH Vitamin D antigen rapid test kits can be considered a viable alternative for determining vitamin D levels.

Association of vitamin D in individuals with periodontitis: an updated systematic review and meta-analysis

BACKGROUND

There are differences in vitamin D levels between periodontitis and healthy individuals, but the effect of vitamin D on periodontitis is controversial. The purpose of this Meta-analysis is twofold: (1) compare vitamin D levels in individuals with or without periodontitis; (2) assess the effects of vitamin D supplementation during scaling and root planing (SRP) on periodontal clinical parameters in individuals with periodontitis.

METHODS

A systematic search was conducted in five databases (PubMed, Web of Science, MEDLINE, EMBASE, and Cochrane library), published from the database inception to 12 September 2022. The Cochrane Collaboration Risk of bias (ROB) assessment tool, the risk of bias in non-randomized studies of intervention (ROBINS-I) tool, the Newcastle-Ottawa Quality Assessment Scale (NOS), and Agency for Healthcare Quality and Research (AHRQ) were used to evaluate randomized controlled trial (RCT), non-RCT, case-control study, and cross-sectional study, respectively. Statistical analysis was performed using RevMan 5.3 and Stata 14.0 software, with weighted mean difference (WMD), standardized mean difference (SMD) and 95% confidence intervals (CI) as the effect measures, and heterogeneity was tested by subgroup analysis, sensitivity analysis, Meta-regression.

RESULTS

A total of 16 articles were included. The results of Meta-analysis showed that periodontitis was associated with lower serum vitamin D levels compared to normal population (SMD = -0.88, 95%CI -1.75 ~ -0.01, P = 0.048), while there was no significant difference in serum or saliva 25(OH)D levels between periodontitis and normal population. Additionally, the Meta-analysis showed that SRP + vitamin D and SRP alone had a statistically significant effect on serum vitamin D levels in individuals with periodontitis (SMD = 23.67, 95%CI 8.05 ~ 32.29, P = 0.003; SMD = 1.57, 95%CI 1.08 ~ 2.06, P < 0.01). And SRP + vitamin D could significantly reduce clinical attachment level compared to SRP alone (WMD = -0.13, 95%CI -0.19 ~ -0.06, P < 0.01), but had no meaningful effect on probing depth, gingival index, bleeding index, respectively.

CONCLUSION

The evidence from this Meta-analysis suggests that the serum vitamin D concentration of individuals with periodontitis is lower than that of normal people, and SRP along with vitamin D supplementation has been shown to play a significant role in improving periodontal clinical parameters. Therefore, vitamin D supplementation as an adjuvant to nonsurgical periodontal therapy has a positive impact on the prevention and treatment of periodontal disease in clinical practice.

Periodontal disease in pregnancy and adverse pregnancy outcomes: Progress in related mechanisms and management strategies

Periodontal disease is an inflammatory and destructive disease of tissues supporting the tooth. A large number of studies have confirmed that periodontal pathogens and their metabolites can lead to adverse pregnancy outcomes in direct or indirect ways. Adverse pregnancy outcomes, such as preterm birth, low birth weight, and pre-eclampsia, have a serious impact on human reproductive health. In recent years, although the level of global medical technology has gradually improved, the incidence of adverse pregnancy outcomes has not declined and is still a global public health problem. The purpose of this review is to summarize the current data on periodontal disease in pregnancy and adverse pregnancy outcomes, including the association between periodontal disease and adverse pregnancy outcomes, the pathogenic mechanism related to this association, the efficacy of different nutrition supplements for both periodontal disease and adverse pregnancy outcomes and the effect of providing periodontal treatment on the occurrence of adverse pregnancy outcomes, to provide guidance for the prevention and treatment of adverse pregnancy outcomes in clinical practice.

Vitamin D3 Serum Levels in Periodontitis Patients: A Case–Control Study

Background: Periodontitis is a multifactorial disease characterized by bacterial-dysbiosis-associated, host-mediated inflammation, which results in the loss of the tooth-supporting tissues. Vitamin D3 plays an important role in the tissue homeostasis and its deficiency might have a negative effect on the periodontitis progression and treatment outcomes. Objectives: The aim of the study was to evaluate the vitamin D3 serum levels among patients with periodontitis and healthy subjects. Materials and Methods: A total of 100 generally healthy adult participants (50 diagnosed with periodontitis, 50 with healthy periodontium) were enrolled in the study. The periodontal clinical parameters were measured, radiographs were performed and the 25-hydroxy vitamin D (25(OH)D) test was used to assess vitamin D3 levels. Results: Vitamin D3 levels were found to be statistically significantly lower among periodontitis patients (31.34; SD = 5.62) compared with healthy controls (39.64; SD = 8.77). Vitamin D3 deficiency was corresponding to the stage and grade of the disease as well as the clinical attachment and bone loss. Conclusion: Adequate monitoring of the vitamin D3 serum levels and supplementation could be of benefit in periodontitis treatment.

Vitamin D and Its Role in Oral Diseases Development. Scoping Review

Vitamin D is a fat-soluble secosteroid that plays a significant role in the whole body, including the maxillofacial region. The discovery of its receptors in many cells and organs made it possible to reveal the participation of vitamin D not only in the regulation of calcium phosphate metabolism, but also in immune processes, in providing anti-inflammatory and antimicrobial effects, slowing down cell proliferation and stimulating differentiation. In this literature review, we demonstrate the association between low vitamin D levels and the development of recurrent aphthous stomatitis, the course and response to treatment of squamous cell carcinoma of the oral cavity, the severity of periodontal diseases, and the processes of osseointegration and bone remodeling during dental implantation and guided tissue regeneration. The aim of our article was to demonstate a possible connection between vitamin D level and the oral diseases that can be presented at an oral surgery appointment, which will help clinicians to reduce the risk of early dental implant failure, ensure favorable outcomes of augmentative operations, as well as decrease the destructive effects of severe periodontitis and other conditions throug knowledge and timely lab tests and endocrinologist prescriptions.

Evaluation and association of periodontal status with levels of Porphyromonas gingivalis in chronic periodontitis with and without Type 2 diabetes mellitus following nonsurgical periodontal therapy using quantitative polymerase chain reaction: An interventional study

Background:

The aim of the present study was to detect and correlate the levels of Porphyromonas gingivalis with clinical parameters after nonsurgical periodontal therapy (NSPT) in chronic periodontitis patients with or without Type 2 diabetes mellitus (T2DM), using quantitative polymerase chain reaction (Q-PCR) method.

Materials and Methods:

Sixty patients equally divided into three groups, i.e., periodontally healthy (Group I), chronic periodontitis (CP) (Group II), and CP with T2DM patients (Group III) were assessed through clinical parameters of probing pocket depth (PPD) and clinical attachment level (CAL) and were correlated for the presence of P. gingivalis in the respective groups. PPD, CAL, and saliva samples for microbiological evaluation were assessed at baseline, 1-, and 3-month post-NSPT.

Results:

Significant reduction of PPD was found 1.26 ± 0.22 versus 0.43 ± 0.33 mm in Group I, 4.62 ± 0.78 versus 2.58 ± 0.60 mm in Group II, and 6.28 ± 1.52 versus 4.01 ± 1.38 mm in Group III post-NSPT at 3 months. Similarly, a notable reduction of CAL was exhibited in both Group II (5.28 ± 0.80 vs. 3.12 ± 0.77 mm) and Group III (7.14 ± 1.59 vs. 4.51 ± 1.38 mm) patients after NSPT at 3 months. A greater reduction of P. gingivalis concentrations was observed in both Group II and Group III at 3-month post-NSPT.

Conclusion:

The substantial improvement of clinical parameters was found to be in correlation with the load of P. gingivalis, which was reduced more in Group II than in Group III, emphasizing the applicability and sensitivity of Q-PCR method for its assessment.

Serum 25-hydroxyvitamin D is negatively associated with severe periodontitis: a cross-sectional study

BACKGROUND

Periodontitis can lead to the destruction of periodontium and adversely influence the overall health, wellbeing, and quality of life. However, studies on the relationship between severe periodontitis and serum 25-hydroxyvitamin D [25(OH)D] are limited. This study is designed to explore the relationship between 25(OH)D and severe periodontitis.

METHODS

A cross-section study of 2928 participants enrolled from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2014 was conducted. The periodontal examination was performed using a total oral periodontal examination program, and probe measurements were collected at six sites per tooth in NHANES. Severe periodontitis was characterized as: ≥ 2 interproximal sites with attachment loss (AL) ≥ 6 mm (not on the same tooth) and ≥ 1 interproximal site with probing depth (PD) ≥ 5 mm. Severe periodontitis and serum 25(OH)D were the dependent and independent variables, respectively. Univariate, multivariate, and subgroup analyses were performed to explore the relationship between severe periodontitis and serum 25(OH)D.

RESULTS

Among the 2928 participants, the average age of the population was 50 ± 13.71 years old, with 1425 (48.67%) males, 316 (10.79%) exhibited severe periodontitis. Serum 25(OH)D showed a significantly negative association with severe periodontitis after adjusting all variables (OR 0.75, 95% CI 0.63-0.89). In addition, severe periodontitis has a nonlinear relationship with serum 25(OH)D, whoes inflection point was 102 (nmol/L). On the left side of the inflection point (25(OH)D ≤ 102 nmol/L), the effect size was 0.98 and 95%CI was 0.98-0.99 (25(OH)D per 1 nmol/L increments). On the right side of the inflection point (25(OH)D > 102 nmol/L), the effect size was 0.99 and 95% CI was 0.98-1.01. The subgroup analysis showed pronounced changes in non-Hispanic white, alcohol consumption, diabetes, and health insurance.

CONCLUSION

Serum 25 (OH) D in relation to severe periodontitis is nonlinear in our study.When serum 25 (OH) D is less than 102 nmol/L, serum 25 (OH) D is negatively associated with severe periodontitis.

Exploratory Efficacy of Calcium-Vitamin D Milk Fortification and Periodontal Therapy on Maternal Oral Health and Metabolic and Inflammatory Profile

In this 2 × 2 factorial, outcome-assessor blinded, feasibility randomised trial we explored the effect of a non-pharmaceutical multi-component intervention on periodontal health and metabolic and inflammatory profiles among pregnant women with periodontitis receiving prenatal care in a Brazilian public health centre. 69 pregnant women (gestational age ≤20 weeks, T0) were randomly allocated into four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus periodontal therapy during pregnancy (early PT) (n = 17); (2) placebo sachet and powdered milk plus early PT (n = 15); (3) fortified sachet and powdered milk plus late PT (after delivery) (n = 19); (4) placebo sachet and powdered milk plus late PT (n = 18). Third trimester (T1) and 6-8 weeks postpartum (T2) exploratory outcomes included periodontal health (% sites with bleeding on probing (BOP)), glucose, insulin, C-Reactive Protein, serum calcium and vitamin D. The mean BOP was significantly reduced in the early PT groups, while BOP worsened in the late PT groups. No significant effect of fortification on BOP was observed. Changes in glucose levels and variation on birthweight did not differ among groups This feasibility trial provides preliminary evidence for estimating the minimum clinically important differences for selected maternal outcomes. A large-scale trial to evaluate the interventions' clinical benefits and cost-effectiveness is warranted.

Association between low bone mineral density and periodontitis in generally healthy perimenopausal women

BACKGROUND

The association between low bone mineral density (BMD) and periodontitis in perimenopausal women is controversial. The purpose of this study was to determine whether osteoporosis or osteopenia is associated with periodontal disease in a population of adult women.

METHODS

A sample of over-45-year-old women with or without low BMD underwent lumbar spine and hip bone densitometry and a complete periodontal examination. The extent/severity or absence of periodontal disease was noted using two different case definitions. Data were gathered on socio-economic status, medication history, systemic co-morbidities, alcohol or tobacco use as well as serum levels of calcium and vitamin D.

RESULTS

One hundred seventy three women aged between 45 and 72 years old were recruited with a mean age of 57.8 years. One hundred and three had decreased BMD (61 with osteoporosis and 42 with osteopenia) and 70 were healthy. Moderate or severe periodontitis was present in 52.6% of the women. Multivariate analysis showed a clear association between low BMD and periodontitis, but only in women above 58 years old and independent of tobacco consumption or oral hygiene.

CONCLUSION

In this sample of generally healthy perimenopausal women, low BMD was associated with clinical attachment level (CAL). Women over 58 years old with decreased BMD presented with a higher mean percentage of sites with CAL ≥ 4 mm as well as CAL ≥ 6 mm when compared to controls, independent of active smoking status or poor oral hygiene.

Relationship between Blood and Standard Biochemistry Levels with Periodontitis in Parkinson's Disease Patients: Data from the NHANES 2011-2012

People with Parkinson's Disease (PD) are associated with the presence of periodontitis. We aimed to compare blood and standard biochemical surrogates of PD patients diagnosed with periodontitis with PD individuals without periodontitis. This retrospective cohort study used a sample from the National Health and Nutrition Examination Survey (NHANES) 2011-2012 that underwent periodontal diagnosis (n = 3669). PD participants were identified through specific PD reported medications. Periodontitis was defined according to the 2012 case definition, using periodontal examination data provided. Then, we compared blood levels and standard chemical laboratory profiles of PD patients according to the presence of periodontitis. Multivariable regression was used to explore this dataset and identify relevant variables towards the presence of periodontitis. According to the medication report, 37 participants were eligible, 29 were secure and 8 were unsecure PD medications regimens. Overall, PD cases with periodontitis presented increased levels of White Blood Cells (WBC) (p = 0.002), Basophils (p = 0.045) and Segmented neutrophils (p = 0.009), and also, lower levels of Total Bilirubin (p = 0.018). In the PD secure medication group, a significant difference was found for WBC (p = 0.002) and Segmented neutrophils (p = 0.002) for the periodontitis group. Further, WBC might be a discriminating factor towards periodontitis in the global sample. In the secure PD medication, we found gender, segmented neutrophils and Vitamin D2 to be potential discriminative variables towards periodontitis. Thus, periodontitis showed association with leukocyte levels alterations in PD patients, and therefore with potential systemic changes and predictive value. Furthermore, Vitamin D2 and gender showed to be associated with periodontitis in with secure medication for PD. Future studies should assess in more detail the potential systemic repercussion of the presence of periodontitis in PD patients.

Vitamin D and Periodontitis: A Systematic Review and Meta-Analysis

To explore the vitamin D levels of periodontitis patients in comparison with periodontally healthy ones, and to assess the influence of vitamin D supplementation as an adjunctive during nonsurgical periodontal treatment (NSPT). Five databases (Pubmed, Embase, Scholar, Web of Sciences, and Cochrane Library) were searched until May 2020. Mean difference (MD) meta-analysis with corresponding 95% confidence interval (95% CI) and sensitivity tests via meta-regression were used. We followed Strength of Recommendation Taxonomy (SORT) to appraise the strength and quality of the evidence. Sixteen articles were included, fourteen case-control and two intervention studies, all reporting 25-hydroxyvitamin D (25(OH)D) levels. Compared with the healthy controls, the circulating 25(OH)D levels were significantly lower in chronic periodontitis patients (pooled MD = −6.80, 95% CI: −10.59 to −3.02). Subgroup analysis revealed differences among 25(OH)D measurements, with liquid chromatography-mass spectrometry being the most homogeneous method (pooled MD = −2.05, 95% CI: −3.40 to −0.71). Salivary levels of 25(OH)D showed no differences between groups. Due to the low number of studies, conclusions on aggressive periodontitis and in the effect of vitamin D supplementation after NSPT were not possible to ascribe. Compared with healthy controls, 25(OH)D serum levels are significantly lower in chronic periodontitis patients, with an overall SORT A recommendation. Future studies are needed to clarify the effect of vitamin D supplementation and the biological mechanisms linking vitamin D to the periodontium.

Vitamin D Deficiency and Oral Health: A Comprehensive Review

Vitamin D (VD) levels have been gaining growing attention in Oral Health. During growth and adulthood, VD deficiency (VDD) is associated with a wide variety of oral health disorders, and impaired VD synthesis may expedite some of these conditions. In children, severe VDD can induce defective tooth mineralization, resulting in dentin and enamel defects. As a consequence, these defects may increase the risk of the onset and progression of dental caries. Further, VDD has been associated with higher prevalence of periodontitis and gingival inflammation, and several recent preclinical and clinical studies have unveiled potential pathways through which Vitamin D may interact with the periodontium. VDD correction through supplementation may contribute to a successful treatment of periodontitis; however, alveolar bone regeneration procedures performed in baseline VDD patients seem more prone to failure. Vitamin D may also be linked with some oral pathology entities such as certain oral cancers and events of osteonecrosis of the jaw. This review aims to provide comprehensive evidence of how VD levels should be considered to promote good oral health, and to summarize how VDD may hamper oral development and its role in certain oral conditions.

Evaluation of Salivary Cytokines and Vitamin D Levels in Periodontopathic Patients

Periodontal disease (PD) is an inflammatory condition of the tissues supporting the teeth, which is widespread among the adult population. Evidence shows a relationship between PD and vitamin D levels, which is involved in the regulation of bone metabolism, mineral homeostasis, and inflammatory response. This study aimed to perform a simultaneous evaluation of inflammatory mediators and vitamin D levels in saliva in periodontopathic patients to better understand their role in periodontal disease. In this observational study, clinical periodontal parameter examination was performed for each patient. Moreover, the saliva levels of 25(OH)D₃, TGFβ, IL-35, IL-17A, and MMP9 were evaluated using an ELISA assay. An increase in TGFβ, IL-35, MMP9, and IL-17A salivary levels and a reduction in 25(OH)D₃ levels were observed in periodontopathic patients with respect to the healthy controls. The present study revealed significant positive correlation between cytokines and highly negative correlation between 25(OH)D₃ and salivary cytokine levels. Further studies are needed to better understand if salivary cytokines and vitamin D evaluation may represent a new approach for detection and prevention of progressive diseases, such as PD.

Effectiveness of vitamin D for adult patients with gingivitis

BACKGROUND

This study aims to explore the effectiveness of vitamin D for the management of adult patients with gingivitis.

METHODS

We will perform a comprehensive search from the following electronic databases: Cochrane Library, PUBMED, EMBASE, AMED, CINAHL, WANGFANG, VIP, CBM, and China National Knowledge Infrastructure. All databases will be searched from their inceptions to the present without language limitation. We will also search for unpublished data to avoid missing more potential studies. Two authors will carry out study selection, data extraction, and methodological quality evaluation, respectively. RevMan 5.3 software will be utilized for statistical analysis.

RESULTS

This study will summarize the up-to-date evidence about the anti-inflammatory effect of vitamin D for the management of adult patients with gingivitis through assessing modified gingival, gingival bleeding indices, inflammatory factors, plaque, quality of life, and any adverse events.

CONCLUSION

This study may provide helpful evidence of vitamin D for the management of adult patients with gingivitis for clinical practice.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019156561.