The Relationship between Vitamin D and Periodontal Pathology

Vitamin D deficiency and oral health: a systematic review of literature

BACKGROUND

Vitamin D (VD) levels are gaining increasing interest in dentistry due to their association with several oral diseases.

OBJECTIVE

This study aimed to evaluate the relationship between vitamin D deficiency and various oral disorders.

MATERIALS AND METHODS

A broad search on the MEDLINE database via the PubMed interface and on the Spring Link platform was carried out using keywords related to the subject. An additional electronic search of gray literature was conducted via Google Scholar. Inclusion criteria were listed for the selection of articles and a reading grid was designed for the extraction of data relating to the research question. The quality of included studies was assessed using JBI's critical appraisal tools.

RESULTS

A total of 57 studies were identified. After reading the full text, 16 studies were included and selected for qualitative analysis. There is an association between vitamin D deficiency and different oral disorders. Indeed, ten publications assessed the association between vitamin deficiency and periodontal disease, three examined the relationship between vitamin D deficit and dental caries, and one examined the intriguing relationship between vitamin D deficiency and tooth mineralization and two articles interested in vitamin D deficiency and stomatitis.

CONCLUSION

The analysis of these selected articles shows that Vitamin D deficiency can lead to various oral health disorders during growth and adulthood. Indeed, it can be linked to tooth mineralization defects and increasing the risk of dental caries. Severe Vitamin D deficiency also increases the prevalence of periodontitis and gingival inflammation. It may also be linked to certain oral pathology entities, such as oral cancers and jaw osteonecrosis.

Correlation of serum vitamin D and IL-8 to stages of periodontitis: a case-control analysis

OBJECTIVES

The current literature lacks the correlation between serum levels of vitamin D and interleukin-8 (IL-8) to the stages of periodontitis. The present research objectives are to evaluate the serum levels of vitamin D and IL-8 in periodontitis participants and healthy controls and to measure their correlation with the stages of periodontitis.

METHODS

The current case-control study was conducted on patients with periodontitis and healthy controls. After obtaining a questionnaire from the participants, the following clinical parameters were measured; periodontal probing depth (PPD), clinical attachment loss (CAL), plaque index (PI), gingival index (GI), bleeding on probing (BOP), and tooth count. The serum levels of vitamin D and IL-8 were measured using ELISA kits. Then, we measured the correlation of the stages of periodontitis with the serum levels of vitamin D and IL-8.

RESULTS

Ninety-eight participants; 52 with periodontitis and 46 healthy controls were included. The patients with periodontitis showed a significantly lower level of vitamin D, higher PPD, CAL, BOP, and lower number of teeth than the controls. In addition, serum vitamin D significantly correlated with the stages of periodontitis. Serum IL-8 showed no significant difference between the study and control groups while it does not significantly correlate with the stages of periodontitis.

CONCLUSION

The current study's findings suggest a potential association between serum level of vitamin D with severity of periodontitis which necessitates screening vitamin D status in patients with periodontitis and investigating the possibility of vitamin D supplementation in decreasing the progression of periodontitis.

The Impact of Nutritional Components on Periodontal Health: A Literature Review

Periodontitis is a chronic inflammatory disease driven by the accumulation of bacterial plaque and the host's immune response, leading to the destruction of periodontal tissues. Nutrition, particularly the intake of micronutrients with anti-inflammatory and antioxidant properties, plays a crucial role in maintaining periodontal health. This review explores the impact of various micronutrients-vitamins (A, B, C, D, E), minerals (calcium, iron, zinc, potassium, copper, manganese, selenium), and omega-3 fatty acids-on periodontal disease prevention and management. Deficiencies in these nutrients can exacerbate periodontal tissue damage by impairing immune responses, promoting oxidative stress, and reducing bone and tissue regeneration capabilities. While certain populations may be more vulnerable to these deficiencies, such as those following Western diets or living in low- and middle-income countries, even in developed nations, suboptimal nutrient intake is associated with worse periodontal outcomes. Although some studies suggest that supplementation of specific micronutrients may benefit periodontal therapy, the evidence remains inconclusive, necessitating further randomized clinical trials. This review underscores the importance of considering nutritional guidance in periodontal treatment protocols and highlights the need for tailored recommendations based on recent findings.

Jamil F, M. AL-Anee A, Jassim Muhsen S. Relationship Between the Level of Vitamin D3 Deficiency and Successful Osseointegration: A Prospective Clinical Study

Purpose: This study aimed to evaluate the influence of vitamin D3 levels on bone density, primary dental implant stability, and successful osseointegration. Materials and Methods: Clinical and radiological examination with a standardized cone-beam computed tomography (CBCT) machine and laboratory investigation for serum levels of vitamin D3 were performed for all patients. Only patients in need of single or multiple straightforward dental implant surgery in either jaw with no history of systemic disease or condition that may interfere with bone healing were included in this study to receive the dental implant by the same oral and maxillofacial surgeon, which re-opened 4 months later to assess the osseointegration and to complete the prosthetic part. Results: One hundred twenty-eight dental implants were inserted into 108 patients. Most of the patients in the study had insufficient vitamin D3 levels. The prognosis of dental implants regarding successful osseointegration 4 months after implant placement had a weak positive association with the insertion torque and bone mineral density and a statistically significant positive correlation with the serum vitamin D3 level. Conclusion: Preoperatively, it is advisable to request the serum vitamin D3 level of the patients along with the standard clinical and radiological examination. Severe vitamin D3 deficiency could be associated with early dental implant failure despite the favorable bone density and primary dental implant stability achieved. Trial Registration: ClinicalTrials.gov identifier: TCTR20200304001.

The Association of Vitamin D Levels and Dental Caries in Older Adults: A Cross-Sectional Study

INTRODUCTION

Most research examining vitamin D and dental caries focuses on children and younger adults. This study investigated the association between vitamin D levels and dental caries in older adults using data from the United States National Health and Nutrition Examination Survey from 2011 to 2016.

METHODS

Data were analyzed from 2723 participants aged 65 years and older who completed both dental examinations and serum 25(OH)D tests. Dental caries assessments included the decayed, missing, and filled teeth (DMFT) index and the presence of untreated dental caries. Vitamin D levels were measured as serum 25(OH)D concentrations and categorized as severely deficient (<25 nmol/L), deficient (25-49.9 nmol/L), insufficient (50-74.9 nmol/L), and normal (≥75 nmol/L). Logistic regression and Poisson regression models were used to assess the association between vitamin D levels and dental caries, adjusting for demographic factors.

RESULTS

The mean DMFT score was 17.73 ± 8.34, with 35.1% of participants having untreated dental caries. Vitamin D deficiency was associated with a 1.44 times higher likelihood of untreated caries (95% CI: 1.15, 1.81), which weakened after adjustment for demographic factors (adjusted OR: 1.23, 95% CI: 0.97, 1.55). Severe vitamin D deficiency correlated with a 1.13 times higher DMFT score (95% CI: 1.06, 1.20), with the association remaining similar after adjustment (adjusted RR: 1.12, 95% CI: 1.05, 1.20). Significant differences in vitamin D levels were observed across gender, race/ethnicity, and country of birth.

CONCLUSIONS

This study suggests the potential importance of adequate vitamin D levels for maintaining dental health among older adults. Vitamin D deficiency is associated with a higher risk of poorer DMFT scores. Public health strategies that include vitamin D screening and supplementation, particularly for high-risk groups, may improve oral health outcomes in the older adult population. Further research is needed to elucidate the mechanisms by which vitamin D influences dental health and the potential for vitamin D supplementation to reduce the burden of dental caries in older adults.

Associations of Serum Vitamin D With Dental Caries and Periodontitis: The HUNT Study

OBJECTIVE

To study the relationships of serum 25-hydroxyvitamin D [25(OH)D] with dental caries and periodontitis in a general Norwegian adult population.

METHODS

We analysed a subsample of 1605 participants from the Trøndelag Health Study (HUNT) in Norway that had serum 25(OH)D levels measured in HUNT3 (2006-08) and oral health assessed in the HUNT4 Oral Health Study (2017-19). Negative binomial and Poisson regression models were used to estimate the ratios of means (RMs; for count oral outcomes) and prevalence ratios (PRs; for dichotomous oral outcomes).

RESULTS

Serum 25(OH)D was inversely associated with the number of decayed teeth in a dose-response gradient (<30.0 nmol/L: RM 1.41, 95% CI 1.07-1.85; 30.0-49.9 nmol/L: 1.14, 0.98-1.32 and ≥75.0 nmol/L: 0.84, 0.67-1.04, as compared to the 50.0-74.9 nmol/L group, P for trend <.001). Each 25 nmol/L decrease in 25(OH)D level was associated with a 15% (RM 1.15, 95% CI 1.05-1.26) increase in the mean number of decayed teeth. Serum 25(OH)D <30.0 nmol/L was associated with a 35% higher prevalence of severe periodontitis (PR 1.35, 95% CI 1.00-1.83). No association was observed between 25(OH)D and the number of natural teeth.

CONCLUSION

The present study suggested that serum 25(OH)D level had an inverse and dose-response association with the number of decayed teeth, and serum 25(OH)D <30 nmol/L was associated with a higher prevalence of severe periodontitis in this Norwegian adult population.

The Impact of Vitamin Deficiencies on Oral Manifestations in Children

Vitamins play a vital role in human health, particularly in the development and maintenance of oral health in children. These nutrients are broadly categorized into fat-soluble and water-soluble types, crucial for children's well-being. The objective of this study is to investigate the impact of vitamin deficiencies on the oral health of children, focusing on how these deficiencies contribute to various oral health issues and determining the relationship between specific vitamin shortages and oral diseases. Findings indicate that shortages in vitamins A and D lead to enamel issues and a higher susceptibility to dental diseases, vitamin E assists in treating oral mucositis, and vitamin K is essential for blood clotting in dental surgeries. Deficits in B-complex and vitamin C result in enamel hypomineralization and soft tissue ailments, including aphthous stomatitis and gingival petechiae. Additionally, a lack of vitamin B7 compromises the immune response, increasing oral candidiasis risk. Therefore, vitamin deficiencies markedly affect children's oral health, highlighting the need for joint efforts between dental professionals and caregivers for effective pediatric care. Addressing vitamin deficiencies through supplementation and tailored dental care emphasizes the significance of nutritional health in children's overall and dental well-being, advocating for a collaborative approach to achieve optimal health outcomes.

Assessment of nutritional status in chronic periodontitis patients: A cross-sectional study

Background

This cross-sectional study compared the nutritional status of chronic periodontitis (CP) patients who presented with various degrees of severity with systemically healthy individuals using the Mini Nutritional Assessment (MNA®) tool along with laboratory analysis of macro- and micronutrients.

Materials and Methods

This research enrolled a total of 84 participants, of which 63 belonged to the CP group while 21 served as healthy controls. The CP patients were divided into three groups of 21 each, based on severity as mild, moderate, and severe. Clinical periodontal parameters (plaque index, bleeding on probing, probing depth, clinical attachment level/loss, total number of teeth present [NOT-P], furcation involvement, pathological migration, and tooth mobility), biochemical parameters (lipid, protein, iron profiles, and Vitamin D3 and B12), and the MNA® tool were used to assess the nutritional status of all the participants. The results were analyzed statistically.

Results

NOT-P, MNA score, lipid profile (except very-low-density lipoprotein), iron profile (except total iron-binding capacity), and Vitamin D3 showed high significant differences (P < 0.001) among the groups. However, Vitamin B12 and protein profile except for total protein revealed significant differences (P < 0.05).

Conclusion

CP can be a contributing risk factor for the development of malnutrition. MNA® tool can be used for assessing the nutritional status of CP patients.

Can vitamins improve periodontal wound healing/regeneration?

Periodontitis is a complex inflammatory disorder of the tooth supporting structures, associated with microbial dysbiosis, and linked to a number if systemic conditions. Untreated it can result in an irreversible damage to the periodontal structures and eventually teeth loss. Regeneration of the lost periodontium requires an orchestration of a number of biological events on cellular and molecular level. In this context, a set of vitamins have been advocated, relying their beneficial physiological effects, to endorse the biological regenerative events of the periodontium on cellular and molecular levels. The aim of the present article is to elaborate on the question whether or not vitamins improve wound healing/regeneration, summarizing the current evidence from in vitro, animal and clinical studies, thereby shedding light on the knowledge gap in this field and highlighting future research needs. Although the present review demonstrates the current heterogeneity in the available evidence and knowledge gaps, findings suggest that vitamins, especially A, B, E, and CoQ10, as well as vitamin combinations, could exert positive attributes on the periodontal outcomes in adjunct to surgical or nonsurgical periodontal therapy.

Vitamin D and Periodontal Health: A Systematic Review

The role of vitamin D in maintaining gum well-being is crucial. However, scientific research reported that the connotations of cholecalciferol and periodontal health have been divested in the present literature. However, there is enormous heterogeneity in the data available. The current review aims to systematically review and appraise the available literature investigating the role of vitamin D in maintaining periodontal health. Studies included randomized controlled trials and clinical trials following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and cohort studies reporting associations between vitamin D and oral health in systemically healthy patients. Databases such as PubMed, Google Scholar, Scopus, Embase, and other sources, including hand search, were searched until May 2023 using together-equipped search sequences. Altogether, scientific articles that conform to the inclusion principles underwent a thorough eminence evaluation. All papers meeting inclusion criteria were subject to quality assessment, and the method used to assess the risk of bias was the Cochrane risk of bias tool. The search identified 1883 papers, among which 1435 were excluded after title evaluation. After abstract and title screening, 455 were excluded, and six full texts were assessed. After full-text evaluation, two articles were excluded, and only four were included. The data shows vitamin D's association with oral health maintenance. Along with its action on bone metabolism, it has extended function, which provides for its action as an anti-inflammatory agent and production of anti-microbial peptides, which help maintain oral health. Although the literature available is immense, there is enormous heterogenicity in the papers conducted to appraise the association between vitamin D and oral health. This systematic review has filtered all the data to review a few essential aspects of the role of vitamin D in maintaining oral physiology. Vitamin D has a linear relationship with periodontal health; however, the evidence is insufficient, and further studies must be done.

Human β-defensins are correlated with the immune infiltration and regulated by vitamin D3 in periodontitis

OBJECTIVE

Exploring the correlation between human β-defensins (HBDs) and immune infiltration in periodontitis, and whether it is regulated by vitamin D3 .

BACKGROUND

The human body produces essential antimicrobial peptides called HBDs, which are associated with periodontitis. There is a strong link between periodontal tissue destruction and the immune cell infiltration. Moreover, vitamin D3 has been reported to regulate the expression of immune cell chemokines. However, the relationship between vitamin D3 , HBDs, and immune infiltration in periodontitis remains to be investigated.

METHODS

The Gene Expression Omnibus database was accessed to obtain transcriptomic information of gingival samples taken from periodontitis patients. The expression value of HBD-2 and HBD-3 was calculated. Additionally, using the online program ImmuCellAl, 10 immune cells were scored for immune infiltration in the high-HBDs-expression group and the low-HBDs-expression group, separately. After that, transcriptome sequencing was done based on human gingival fibroblasts that had received vitamin D3 treatment. Furthermore, hGFs were treated by vitamin D3 , tumor necrosis factor-α (TNF-α), and Porphyromonas gingivalis lipopolysaccharide (Pg-LPS). The expressions of HBD-2, HBD-3, interleukin-8 (IL-8), and monocyte chemoattractant protein-1 (MCP-1) were detected. To seek the potential mechanism, CYP27A1 siRNA was employed to reduce the expression of CYP27A1, and nuclear factor-gene binding protein 65 (NF-κB p65) was examined.

RESULTS

In GSE10334, the expressions of HBD-2 and HBD-3 were down-regulated in periodontitis group. Meanwhile, monocyte, macrophage, and CD4_T cell were less infiltrated in low-HBD-2-expression group, while less Gamma-delta T-cell infiltration was found in low-HBD-3-expression group. Transcriptome sequencing found that 21 genes were significantly expressed, of which the function was enriched in response to bacterial origin and TNF signal pathway. Vitamin D3 could significantly up-regulate the expression of HBD-2 and HBD-3, which could be controlled by knocking down CYP27A1 mRNA expression. With prolonged vitamin D3 stimulation, the expression of HBD-2 and HBD-3 increased. TNF-α/Pg-LPS could significantly increase the expression of HBD-2, HBD-3, IL-8, MCP-1, and p65, all of which were reduced by vitamin D3 .

CONCLUSION

HBDs are correlated with immune infiltration in periodontitis. Vitamin D3 inhibits the expression of HBDs and chemokines induced by TNF-α/Pg-LPS, possibly through NF-κB pathway, in human gingival fibroblasts.

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.

Associations between vitamin D levels and periodontal attachment loss

OBJECTIVES

Periodontitis is accompanied by attachment loss and alveolar bone resorption. Vitamin D (VD) deficiency was closely associated with bone loss or osteoporosis. The study aims to investigate the potential relationship between different VD levels and severe periodontal attachment loss in American adults.

METHODS

A cross-sectional analysis was conducted including 5749 participants in the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2014. The association of periodontal attachment loss progression with total VD, vitamin D3 (VD3), and vitamin D2 (VD2) levels was assessed using multivariable linear regression models, hierarchical regression, fitted smoothing curves, and generalized additive models.

RESULTS

Based on the indicators of 5749 subjects, we found that severe attachment loss tended to occur in the elderly or males and was accompanied by less total VD levels, or VD3 levels, as well as a lower poverty-income ratio (PIR). Total VD (below the inflection point: 111 nmol/L) or VD3 were negatively associated with the progression of attachment loss in each multivariable regression model. In threshold analysis, VD3 is linearly correlated with the progression of attachment loss (β =  - 0.0183, 95% CI: - 0.0230 to - 0.0136). The relationship between VD2 and attachment loss progression was an S-shaped curve (inflection point: 5.07 nmol/L).

CONCLUSION

Increasing total VD (below 111 nmol/L) and VD3 levels may be beneficial to periodontal health. VD2 levels above 5.07 nmol/L were a risk factor for severe periodontitis.

CLINICAL RELEVANCE

The present study reports that different vitamin D levels may serve as different associations with periodontal attachment loss progression.

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.

Association between Malnutrition and Dental Caries in Iraqi Kurdish Children

BACKGROUND

This paper aimed to study the association of serum Vitamin D level and Body Mass Index (BMI) as representatives of malnutrition at micro and macro levels, respectively, on dental caries.

METHOD AND PARTICIPANTS

A total of 333 randomly selected children aged 6-12 years in Sulaimani, Kurdistan, Iraq were examined for three variables of the Decayed Missed Filled Tooth (DMFT) index, BMI, and Vitamin D serum levels in a single-time cross-sectional snapshot.

RESULTS

The majority of the population studied (70%) were Vitamin D deficient. In the linear regression analysis, both Vitamin D and BMI had insignificant effects on DMFT, with p-values of 0.22 and 0.55, respectively. After the categorization of the data, the risk estimate between normal (≥20 ng/mL) and deficient (<20 ng/mL) Vitamin D groups with regards to the caries and caries-free categories was 1.97 (95% CI: 0.91-4.24). According to the mean and median of the DMFT, which were both 4, the sample is categorized into the low-caries group (DMFT < 4) and high-caries group (DMFT > 4). When these groups are compared to Vitamin D levels and taking 20 and 15 as thresholds, the odds ratios were 1.19 (CI: 0.74-1.92) and 1.88 (CI: 1.20-2.94), respectively. Regarding the BMI, a normal BMI increases the chances of having a lower caries index (OR = 1.83, CI: 1.10-3.03).

CONCLUSIONS

Our results show that having a serum Vitamin D level ≥15 ng/mL and having a normal BMI are associated with a lower caries index in children.

The Role of Vitamin C and Vitamin D in the Pathogenesis and Therapy of Periodontitis-Narrative Review

Periodontitis is a common disorder affecting the bone and soft tissues of the periodontal complex. When untreated, it may lead to severe mobility or even loss of teeth. The pathogenesis of periodontitis is complex, with crucial factors being chronic inflammation in gingival and periodontal tissues and oral microbiome alterations. However, recent studies highlight the alleged role of vitamins, such as vitamin C (VitC) and vitamin D (VitD), in the development of the disease. VitC regulates numerous biochemical reactions, but foremost, it is involved in synthesizing collagen. It was reported that VitC deficiency could lead to damage to the periodontal ligaments. VitC supplementation improves postoperative outcomes in patients with periodontitis. VitD is a steroid derivative that can be produced in the skin under ultraviolet radiation and later transformed into an active form in other tissues, such as the kidneys. VitD was established to decrease the expression of proinflammatory cytokines in gingiva and regulate the proper mineral density of teeth. Moreover, the supplementation of VitD was associated with better results in the nonsurgical treatment of periodontitis. In this review, we summarize recent knowledge on the role of vitamins C and D in the pathogenesis and treatment of periodontitis.

Association between circulating 25-hydroxyvitamin D metabolites and periodontitis: Results from the NHANES 2009-2012 and Mendelian randomization study

AIM

This study sought to investigate associations of 25-hydroxyvitamin D (25(OH)D) metabolites with periodontitis and to assess causality using Mendelian randomization (MR).

MATERIALS AND METHODS

This study included 7246 participants of the National Health and Nutrition Examination Survey, 2009-2012. The association of periodontitis with 25(OH)D metabolites was assessed using multivariable logistic regression analysis. Two-sample MR for 25(OH)D, 25(OH)D₃ , and C3-epi-25(OH)D₃ with periodontitis (n = 17,353 cases/28,210 controls) was conducted. The principal analysis employed the inverse-variance-weighted (IVW) approach. We controlled for horizontal pleiotropy using five additional methods.

RESULTS

Based on the observational study, each 1-point increase in standard deviation of 25(OH)D lowered the risk of periodontitis by 15% (OR = 0.85, 95% confidence interval [CI]: 0.78-0.93, p = .006) after multivariable adjustment. A similar relationship was observed between 25(OH)D₃ and periodontitis (OR = 0.88, 95% CI: 0.80-0.97, p = .031). Furthermore, a potential non-linear association was found between periodontitis and both 25(OH)D and 25(OH)D₃ . However, C3-epi-25(OH)D₃ was not found to be associated with periodontitis risk. IVW-MR showed that periodontitis risk was not significantly associated with genetically increased levels of 25(OH)D (OR = 1.02, 95% CI: 0.90-1.16, p = .732), 25(OH)D₃ (OR = 1.04, 95% CI: 0.93-1.17, p = .472), or C3-epi-25(OH)D₃ (OR = 1.11, 95% CI: 0.87-1.41, p = .400). The pleiotropy-robust MR approaches yielded similar results after we had eliminated the variants with horizontal pleiotropy risk.

CONCLUSIONS

Cross-sectional observational analysis identified significant relationships between periodontitis with 25(OH)D metabolites, while findings based on MR study did not support a causal role.

Total, free, and bioavailable 25-hydroxyvitamin D levels in patients with periodontitis (stage III): a case-control study

OBJECTIVE

The aim of this study was to investigate the relationship between total, free and bioavailable 25-hydroxyvitamin D levels, and periodontitis.

MATERIALS AND METHODS

Thirty-nine patients with periodontitis diagnosis and 44 healthy participants were included in this study. 25-Hydroxyvitamin D, vitamin D-binding protein, procalcitonin, and albumin levels were measured from the serum samples obtained. Free and bioavailable 25-hydroxyvitamin D levels were calculated. Total, free, and bioavailable 25-hydroxyvitamin D levels were compared between the healthy control and periodontitis groups. The association of total 25 (OH)D levels with periodontitis was tested through univariate analysis and multivariate logistic regression.

RESULTS

Total 25-hydroxyvitamin D, bioavailable 25-hydroxyvitamin D, and free 25-hydroxyvitamin D levels were significantly lower in the periodontitis group than in the healthy control group (p < 0.001). In the logistic regression analysis, a significant correlation was observed between total 25-hydroxyvitamin D and periodontitis (p<0.001).

CONCLUSION

Our study shows that there is a relationship between total, free and bioavailable 25-hydroxyvitamin D levels and periodontitis. In addition, it has been shown that the determination of free and bioavailable 25-hydroxyvitamin D levels does not provide additional advantages in terms of the relationship between periodontitis and vitamin D.

CLINICAL RELEVANCE

In this case-control study, we examined the relationship between total, free and bioavailable 25-hydroxyvitamin D and periodontitis. We found lower total, free, and bioavailable 25-hydroxyvitamin D levels in periodontitis patients. It was also found that vitamin D-binding protein may be an important biomarker in the identification of various forms of periodontal disease.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT05343273.

The effect of the "Oral-Gut" axis on periodontitis in inflammatory bowel disease: A review of microbe and immune mechanism associations

Periodontitis and inflammatory bowel diseases (IBD) are inflammatory diseases of the gastrointestinal tract that share common features of microbial-induced ecological dysregulation and host immune inflammatory response. The close relationship between periodontitis and IBD is characterized by a higher prevalence of IBD in patients with periodontitis and a higher prevalence and severity of periodontitis in patients with IBD, indicating that periodontitis and IBD are different from the traditional independent diseases and form an "Oral-Gut" axis between the two, which affect each other and thus form a vicious circle. However, the specific mechanisms leading to the association between the two are not fully understood. In this article, we describe the interconnection between periodontitis and IBD in terms of microbial pathogenesis and immune dysregulation, including the ectopic colonization of the gut by pathogenic bacteria associated with periodontitis that promotes inflammation in the gut by activating the host immune response, and the alteration of the oral microbiota due to IBD that affects the periodontal inflammatory response. Among the microbial factors, pathogenic bacteria such as Klebsiella, Porphyromonas gingivalis and Fusobacterium nucleatum may act as the microbial bridge between periodontitis and IBD, while among the immune mechanisms, Th17 cell responses and the secreted pro-inflammatory factors IL-1β, IL-6 and TNF-α play a key role in the development of both diseases. This suggests that in future studies, we can look for targets in the "Oral-Gut" axis to control and intervene in periodontal inflammation by regulating periodontal or intestinal flora through immunological methods.

Dietary vitamin D and calcium and periodontitis: A population-based study

Aim

This study aimed to explore the relationship between dietary vitamin D and calcium intake and periodontitis among adults and whether it differs from males to females.

Methods

Cross-sectional analysis of a population-based cohort study with adults aged 20 to 60 from Southern Brazil. Intake of vitamin D and calcium were gathered in 2012 using two 24h-dietary recalls. Clinical examination assessed the clinical attachment level and bleeding on probing. Confounders included sex, age, family income, smoking, and obesity. The controlled direct effect of vitamin D and calcium on periodontitis was examined using marginal structural modeling. Analyses were also stratified by sex.

Results

Of the 1,066 investigated adults (mean age 35 ± 11.7 years; 49% females), 12.3% (95%CI 10.2;14.7) had periodontitis. Calcium intake had a direct protective effect on periodontitis (risk ratio (RR) 0.61; 95%CI 0.45;0.83), whereas no association between vitamin D and periodontitis was observed (RR 1.13; 95%CI 0.82;1.56). Stratified analyses revealed a null association between both vitamin D and calcium intake and periodontitis among men, but a protective association between calcium and intake and periodontitis among women (RR 0.56; 95%CI 0.38;0.79), while vitamin D remained without any association (RR 1.07; 95%CI 0.72;1.61).

Conclusion

Our findings suggest a protective association between dietary calcium intake and periodontitis among women.

Severe, Treatment-Refractory Periodontitis and Vitamin D Deficiency: A Multidisciplinary Case Report

Introduction

Vitamin D deficiency and periodontitis are common diseases among people. These conditions interact with each other and worsen the patient's health. Modern dentistry aims to rehabilitate oral health and bring it back to the original state or even improve aesthetics. Without analysing the general health conditions of patients and without a multidisciplinary approach, it is sometimes not possible to solve a case such as we describe. This study shows how a vitamin D deficit can influence the choice of dental treatment. The patient, a 40-year-old woman, in generally good health, came to our observation complaining about pain during mastication, and profuse bleeding during home hygiene maneuvers. She wished to solve this situation.

Materials and Methods

Since the patient did not respond well to the initial periodontal therapy, we carried out some accurate research concerning the patient's previous clinical history, and as we suspected that a vitamin D deficit might be involved, a chemical test for vitamin D was carried out and the results confirmed our suspicions. The team programmed the following therapeutical plan: Phase 1—rehabilitation of normal values of vitamin D with the support of an endocrinologist; Phase 2—full mouth disinfection; Phase 3—periodontal surgical restorative therapy; and Phase 4—orthodontic therapy and fixed prosthetics rehabilitation.

Results

The results for this clinical case were extremely satisfying; we were able to bring the periodontal illness under control; resolve the orthodontic problems; and rehabilitate the patient both functionally and aesthetically.

Conclusion

Thanks to the collaboration and communication between specialists from different sectors of medicine and dentistry, the clinical case was solved with absolutely satisfactory results.

Periodontal damage after thermal inhalation injury - The impact of high temperature inhalation injury on long term periodontal health

PURPOSE

Thermal inhalation injury is a common, life-threatening problem in burned patients. Whether or not this single event of damage to the oral integrity causes long term health problems is yet to be examined.

MATERIAL AND METHODS

All consecutive burn patients between 2014 and 2017 of Marienhospital Stuttgart (MHS), Germany, with at least 10% of burned skin surface were included and compared. The Periodontal Screening Index as well as Vitamin D levels were examined. Vitamin D has been suspected to contribute to the genesis of periodontitis. Risk factors and subjective oral life quality were prompted.

RESULTS

We included a total of 32 patients, 15 of which had an inhalation injury in their medical history. Risk factors were examined via Renatus' questionnaire. While risk factors were equally distributed in both groups we saw a remarkable difference in periodontal integrity, with the Periodontal Screening Index (PSI) per sextant differing drastically (with inhalation injury: 2.40, without inhalation injury: 1.10, p < 0.001). Patients with an inhalation injury had a mean of 5.2 out of 6 possible sextants with a pathologic PSI (with the median being 6/6), while patients without an inhalation injury had a mean of 1.83 out of 6 (median: 1/6), p < 0.001. The oral health impact profile showed a difference as well, albeit without statistical significance (with inhalation injury: median = 11, without: median = 3.5, p = 0.414). A correlation between Serum Vitamin D levels and periodontal integrity could not be seen in this group.

CONCLUSION

Inhalation injury is a possible cause for periodontitis and hence impacts the quality of life of burned patients.

Cathelicidin LL-37 in Health and Diseases of the Oral Cavity

The mechanisms for maintaining oral cavity homeostasis are subject to the constant influence of many environmental factors, including various chemicals and microorganisms. Most of them act directly on the oral mucosa, which is the mechanical and immune barrier of the oral cavity, and such interaction might lead to the development of various oral pathologies and systemic diseases. Two important players in maintaining oral health or developing oral pathology are the oral microbiota and various immune molecules that are involved in controlling its quantitative and qualitative composition. The LL-37 peptide is an important molecule that upon release from human cathelicidin (hCAP-18) can directly perform antimicrobial action after insertion into surface structures of microorganisms and immunomodulatory function as an agonist of different cell membrane receptors. Oral LL-37 expression is an important factor in oral homeostasis that maintains the physiological microbiota but is also involved in the development of oral dysbiosis, infectious diseases (including viral, bacterial, and fungal infections), autoimmune diseases, and oral carcinomas. This peptide has also been proposed as a marker of inflammation severity and treatment outcome.

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.

Association between Maternal Periodontitis and Development of Systematic Diseases in Offspring

Periodontal disease (PD) is one of the most common oral conditions affecting both youths and adults. There are some research works suggesting a high incidence of PD in pregnant women. As an inflammatory disease of bacterial origin, PD may result in the activation of the pathways affecting the course and the pregnancy outcome. The authors, based on the literature review, try to answer the PICO question: Does maternal periodontitis (exposure) influence the incidence of complications rates in pregnancy and the development of systemic diseases in childhood and adult offspring (outcome) in the humans of any race (population) compared to the offspring of mothers with healthy periodontium (comparison)? The authors try to describe the molecular pathways and mechanisms of these interdependencies. There is some evidence that maternal periodontitis may affect the pregnancy course and outcome, resulting in preeclampsia, preterm delivery, vulvovaginitis and low birth weight. It can be suggested that maternal periodontitis may affect offspring epigenome and result in some health consequences in their adult life.

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.

The association between vitamin D level and periodontal disease in Saudi population, a preliminary study

OBJECTIVE

Among other regulatory functions, vitamin D has a role in modulating the inflammatory process of periodontal disease. Therefore, this retrospective study aimed to assess the relationship between vitamin D levels and periodontal health in dental patients from the Eastern Province of Saudi Arabia.

METHODS

Radiographs and serum vitamin D levels of patients seeking dental treatment were collected. Exclusion criteria were systemic disease, smoking, recent vitamin D supplementation, and previous periodontal surgery. Gender, age, and alveolar crest height (ACH) were recorded. A total of 67 patients were categorized into three groups according to their serum vitamin D level (<10, <20, and > 20 ng/mL) and their bone loss compared.

RESULTS

Differences in means were compared by t-test. ANOVA was used to compare vitamin D groups and the corresponding ACH, as well as the correlation (p < .05). Patients with vitamin D levels > 20 ng/mL demonstrated a mean ACH of 1.6 mm. The mean ACH was 3.1 mm for those with vitamin D levels < 20 ng/mL, and 4.6 mm for vitamin D levels < 10 ng/mL. A weak negative correlation was found between vitamin D and ACH in all groups (r = -0.055, p = .7).

CONCLUSION

Serum vitamin D level seems to be an important factor that influences oral health, especially the periodontal condition, of both male and female patients.

Association between periodontitis and vitamin D status: A case-control study

Vitamin D deficiency and periodontitis are commonly prevalent among Saudi adults. However, the association between periodontitis and vitamin D status has not been well documented. This study aims to examine the association between periodontitis and vitamin D status among adults in the Albaha region of Saudi Arabia. A case-control study of 123 Saudi adults was conducted; 60 had severe or moderate periodontitis, and 63 were periodontally healthy. Data was collected by an online self-reported sociodemographic questionnaire. All participants then underwent a full periodontal examination. Blood samples were also provided to assess participants' vitamin D statuses through serum levels of 25-hydroxyvitamin D (25(OH)D). A total of 60 cases and 63 controls matched for BMI (30.2 ± 4.86 kg/m²), age (40.01 ± 7.73 years), and sex (46.3% and 53.7% male and female, respectively) participated in the study. Mean levels of 25(OH)D were significantly lower in periodontitis participants than in controls (25.03 ± 8.55 ng/ml, 29.19 ± 12.82 ng/ml, p = 0.037, respectively). Lower odds of periodontitis were detected per unit of 25(OH)D level (OR 0.964, 95% CI; 0.931-0.999, p = 0.043). In conclusion, periodontitis is significantly associated with deficient and insufficient levels of vitamin D among Saudi adults in the Albaha region. Future longitudinal research with a larger sample size may be suggested to confirm these results.

The relevance of vitamin D in the oral health of HIV infected patients

HIV infection affects 36.9 million people globally, and vitamin D deficiency is a global public health concern for HIV patients. Approximately 70 %-80 % of HIV-infected patients have vitamin D deficiency. The deficiency is associated with many pathologies such as immune disorders, infectious diseases, chronic inflammation, oral diseases, as well as the fast progression of HIV. The causes of vitamin D deficiency in HIV infections include HIV itself, traditional factors such as less sun exposure, mal-absorption, hypercholesterolemia, seasonal variation, poor nutrition as well as some HAART drugs like efavirenz. Vitamin D has an immunomodulatory, anti-inflammatory, and anti-proliferative function. In the oral cavity, it plays a significant role in preventing oral infections such as periodontal and gum diseases, dental caries, and oral candidiasis. The consequences of vitamin D deficiency are bone resorption, increased productions of pro-inflammatory cytokines, T-lymphocytes, increased T-helper-1 functions, and decreased T-helper-2 functions. Consequently, this leads to increased infections, chronic inflammation, and the occurrence of oral diseases such as oral candidiasis, periodontal and gum diseases, and dental caries. The majority of these oral diseases are encountered in HIV patients. Vitamin D deficiency is significantly found in HIV patients. There is a lack of studies that directly link vitamin D to most oral diseases in HIV patients; however, the role of vitamin D in immunoregulation, prevention of oral diseases, and HIV infection is substantiated.

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.

Investigating the relationship between the severity of periodontitis and rheumatoid arthritis: a cross-sectional study

OBJECTIVES

This paper evaluates the prevalence and severity of periodontitis (PD) in patients with rheumatoid arthritis (RA), focusing on the link between the severity of PD with RA disease activity/disability scores, the influence of RA treatment on PD, and levels of vitamin D.

METHODS

A total of 93 RA patients were enrolled in the cross-sectional study and analyzed accordingly as RA-PD (N = 63, 67.8%) and RA-only (N = 30, 32.2%) groups. A number of associations between rheumatological clinical data, i.e., Disease Activity Score (DAS28 CRP), health assessment questionnaires, and PD severity (measured by periodontal outcome parameters) with regard to serum levels of vitamin D were assessed. The outcome variables were compared by parametric and non-parametric tests.

RESULTS

A total of 29% of RA patients were diagnosed with severe PD. The RA-PD group presented a higher mean DAS28 CRP score in moderate-severe PD compared to periodontally healthy-initial stage PD subjects (4.49 ± 1.22 vs. 3.86 ± 1.58, p = 0.033). RA patients treated with biologic disease-modifying antirheumatic drugs (bDMARDs) were less likely to be diagnosed with PD (p = 0.022) and revealed significantly lower PD outcome parameters, i.e., bleeding on probing (%) and bone loss (%) (p < 0.05). Vitamin D concentration was significantly lower in RA-PD group with diagnosed advanced severe PD (IV stage) compared to moderate PD (II stage) (39.61 ± 17.12 vs. 52.07 ± 18.23 nmol/l, p = 0.031).

CONCLUSIONS

The study revealed a high prevalence of severe PD in RA patients, being significantly associated with higher RA disease activity and lower vitamin D level in RA-PD group, while bDMARD treatment was related to lower PD outcome parameters. Key Points • Severe PD is prevalent amongst RA patients and is associated with RA disease activity. The higher RA DAS28 CRP score is associated with moderate-severe PD compared to periodontally healthy-initial stage PD in RA patients. • Biologic DMARDs treatment used for RA is linked to lower PD rates and PD outcome parameters. • Significantly lower vitamin D level is found in advanced severe PD compared to moderate PD stage in RA-PD subjects.

Serum Vitamin Profile in Oral Lichen Planus Patients in Southwest of Iran

Introduction

Oral lichen planus (OLP) is a chronic mucocutaneous disease. It is mainly an immune system-related disorder. Vitamins can modulate immune system functions, and thus, vitamin deficiency might have roles in exacerbating OLP. We aim to determine the serum levels of vitamins A, B12, C, D3, and E in OLP patients.

Methods and Materials

34 OLP patients referred to Shiraz Dental School entered the study. Blood samples were collected and levels of A, B12, C, D3, and E vitamins were measured in serum. 43 healthy people were also included as the control group. Serum levels of vitamins were measured by HPLC (A, B12, D3, and E) and Kiazist analyzing kit (vitamin C).

Results

Most of the patients were female (62.3%), and the mean age of patients was 48.03 ± 11.57. Serum levels of vitamins A, C, and E were lower in OLP patients in comparison with the healthy group; however, the difference was not significant. Vitamins B12 and D3 were higher in the OLP group but the difference was not significant.

Conclusion

Serum levels of vitamins A, B12, C, D3, and E do not have a significant difference in OLP patients and healthy groups. These vitamins may not have a considerable role in OLP pathogenesis in the southwest of Iran.

Medication-Related Osteonecrosis of the Jaw (MRONJ): Are Antiresorptive Drugs the Main Culprits or Only Accomplices? The Triggering Role of Vitamin D Deficiency

Osteonecrosis of the jaw (ONJ) is a severe clinical condition characterized mostly but not exclusively by an area of exposed bone in the mandible and/or maxilla that typically does not heal over a period of 6-8 weeks. The diagnosis is first of all clinical, but an imaging feedback such as Magnetic Resonance is essential to confirm clinical suspicions. In the last few decades, medication-related osteonecrosis of the jaw (MRONJ) has been widely discussed. From the first case reported in 2003, many case series and reviews have appeared in the scientific literature. Almost all papers concerning this topic conclude that bisphosphonates (BPs) can induce this severe clinical condition, particularly in cancer patients. Nevertheless, the exact mechanism by which amino-BPs would be responsible for ONJ is still debatable. Recent findings suggest a possible alternative explanation for BPs role in this pattern. In the present work we discuss how a condition of osteomalacia and low vitamin D levels might be determinant factors.

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.

The Polycomb Protein Bmi1 Plays a Crucial Role in the Prevention of 1,25(OH)2 D Deficiency-Induced Bone Loss

We analyzed the skeletal phenotypes of heterozygous null Cyp27b1 (Cyp27b1^+/- ) mice and their wild-type (WT) littermates to determine whether haploinsufficiency of Cyp27b1 accelerated bone loss, and to examine potential mechanisms of such loss. We found that serum 1,25-dihydroxyvitamin D [1,25(OH)₂ D] levels were significantly decreased in aging Cyp27b1^+/- mice, which displayed an osteoporotic phenotype. This was accompanied by a reduction of expression of the B lymphoma Moloney murine leukemia virus (Mo-MLV) insertion region 1 (Bmi1) at both gene and protein levels. Using chromatin immunoprecipitation (ChIP)-PCR, electrophoretic mobility shift assay (EMSA) and a luciferase reporter assay, we then showed that 1,25(OH)₂ D₃ upregulated Bmi1 expression at a transcriptional level via the vitamin D receptor (VDR). To determine whether Bmi1 overexpression in mesenchymal stem cells (MSCs) could correct bone loss induced by 1,25(OH)₂ D deficiency, we overexpressed Bmi1 in MSCs using Prx1-driven Bmi1 transgenic mice (Bmi1^Tg ) mice. We then compared the bone phenotypes of Bmi1^Tg mice on a Cyp27b1^+/- background, with those of Cyp27b1^+/- mice and with those of WT mice, all at 8 months of age. We found that overexpression of Bmi1 in MSCs corrected the bone phenotype of Cyp27b1^+/- mice by increasing osteoblastic bone formation, reducing osteoclastic bone resorption, increasing bone volume, and increasing bone mineral density. Bmi1 overexpression in MSCs also corrected 1,25(OH)₂ D deficiency-induced oxidative stress and DNA damage, and cellular senescence of Cyp27b1^+/- mice by reducing levels of reactive oxygen species (ROS), elevating serum total superoxide dismutase levels, reducing the percentage of γH₂ A.X, p16, IL-1β, and TNF-α-positive cells and decreasing γH2A.X, p16, p19, p53, p21, IL-1β, and IL-6 expression levels. Furthermore, 1,25(OH)₂ D stimulated the osteogenic differentiation of MSCs, both ex vivo and in vitro, from WT mice but not from Bmi1^-/- mice and 1,25(OH)₂ D administration in vivo increased osteoblastic bone formation in WT, but not in Bmi1 ^-/- mice. Our results indicate that Bmi1, a key downstream target of 1,25(OH)₂ D, plays a crucial role in preventing bone loss induced by 1,25(OH)₂ D deficiency. © 2019 American Society for Bone and Mineral Research.

1,25-Dihydroxyvitamin D insufficiency accelerates age-related bone loss by increasing oxidative stress and cell senescence

We investigated the role of insufficiency of the active form of vitamin D, 1,25-dihydroxyvitamin D [1,25(OH)₂D] in age-related bone loss. We employed mice with heterozygous deletion of Cyp27b1, the gene encoding the enzyme that synthesizes 1,25(OH)₂D, as a model for 1,25(OH)₂D insufficiency and compared the phenotype of lumber vertebrae from 3-, 9- and 18-month-old Cyp27b1^+/- mice and their wild-type littermates. We found that in wild-type mice, bone mineral density, bone volume, and Cyp27b1 protein expression levels decreased progressively with age, accompanied by declining osteoblastic bone formation and increasing osteoclastic bone resorption, however these age-related skeletal alterations were more severe in Cyp27b1^+/- mice which had significantly lower serum 1,25(OH)₂D levels. We then assessed the effect of 1,25(OH)₂D haploinsufficiency on oxidative stress and DNA damage, cell senescence and senescence-associated secretory phenotype (SASP) in 9-month-old wild-type and Cyp27b1^+/- mice. Our results demonstrated that, in Cyp27b1^+/- mice compared with their wild-type littermates, the parameters of oxidative stress and DNA damage were significantly increased, whereas the expression levels of antioxidant enzymes were significantly down-regulated; the percentage of senescent osteocytes and bone marrow mesenchymal stem cells, and the expression levels of SASP molecules and p16, p19 and p53 proteins were all significantly increased in bone tissues. Taken together, the results of this study indicate that 1,25(OH)₂D insufficiency accelerates age-related bone loss by increasing oxidative stress and DNA damage, inducing bone cell senescence and SASP, and subsequently inhibiting osteoblastic bone formation while stimulating osteoclastic bone resorption.

The Role of Vitamins in Oral Health. A Systematic Review and Meta-Analysis

The association between vitamins and oral health have recently been discussed, yielding increased attention from medical and dental perspectives. The present review aimed to systematically evaluate and appraise the most recently scientific papers investigating the role of vitamins in the prevention and treatment of the main oral diseases as hard dental pathological processes and gum/periodontal disease. Randomized controlled trials, cross-sectional studies, cohort studies, comparative studies, validation studies and evaluation studies, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, reporting associations between vitamins and oral diseases or the use of vitamins to prevent or treat oral diseases in patients of any age were included. PubMed, Embase and Scopus were searched to November 2019 using an ad hoc prepared search string. All the papers meeting the inclusion criteria were subjected to a quality assessment. The search identified 1597 papers; 741 were selected after removing duplicates. A total of 334 articles were excluded after title and abstract evaluation; 407 were assessed and 73 papers were full-text assessed; other 14 papers were discharged after full text evaluation, leaving finally 58 papers included. In general, there is weak evidence supporting the association between vitamins and both gingival/periodontal disease and hard dental pathological processes.

A Review of the Potential Benefits of Increasing Vitamin D Status in Mongolian Adults through Food Fortification and Vitamin D Supplementation

Serum 25-hydroxyvitamin D (25(OH)D) concentrations are low in Mongolia, averaging 22 ng/mL in summer and only 8 ng/mL in winter. Mongolians have high incidence and/or prevalence of several diseases linked to low 25(OH)D concentrations, including ischemic heart disease, malignant neoplasms, cirrhosis of the liver, ischemic stroke, lower respiratory tract infections, preterm birth complications, and diabetes mellitus. Fortifying regularly consumed foods such as flour, milk, and edible oils with vitamin D₃ could raise 25(OH)D concentrations by about 10 ng/mL. However, to achieve 25(OH)D concentrations of 30–40 ng/mL in adults, vitamin D intakes of 1000 to 4000 IU/day would be required, making personal supplement use necessary. On the basis of prospective observational studies and clinical trials of disease incidence or known mortality rates and adverse pregnancy and birth outcomes, raising mean serum 25(OH)D concentrations to 40 ng/mL would likely reduce incidence and mortality rates for those and other diseases, reduce the rate of adverse pregnancy and birth outcomes, and increase mean life expectancy by one year or more.

Associations between vitamin D receptor genetic variants and periodontitis: a meta-analysis

Objective: Numerous studies already investigated potential associations between vitamin D receptor (VDR) genetic variants and periodontitis. However, the results of these studies were not consistent. Previous studies failed to reach a consensus regarding associations between VDR variants and periodontitis partially because of their relatively small sample sizes. Thus, we performed the present meta-analysis to explore the relationship between VDR variants and periodontitis in a larger pooled sample size. Material and methods: Systematic literature research was conducted in PubMed, Web of Science, Embase and CNKI to identify eligible case-control studies on associations between VDR variants and periodontitis. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) to estimate the strength of associations in all possible genetic models, and p values ≤.05 were considered to be statistically significant. Results: Totally 30 studies were enrolled for analyses. Pooled analyses suggested that VDR rs2228570 variant was significantly associated with the susceptibility to periodontitis under dominant genetic model in the overall population (p = .03, OR = 0.82, 95%CI: 0.69-0.98, I² = 0). Further subgroup analyses yielded similar positive results for rs2228570 variant in East Asians and patients with chronic periodontitis. Nevertheless, no any other positive findings were observed in overall and subgroup analyses. Conclusions: Our meta-analysis supported that VDR rs2228570 variant might serve as a genetic biomarker of periodontitis. However, further well-designed studies are still warranted to confirm our findings.

Evaluation of FGF-23 and 25(OH)D3 levels in peri-implant sulcus fluid in peri-implant health and diseases

BACKGROUND

There are limited studies to date investigating vitamin D and fibroblast growth factor (FGF)-23 in different peri-implant conditions.

PURPOSE

To evaluate the peri-implant sulcus fluid (PISF) FGF-23 and 25-hydroxy-vitamin D₃ (25(OH)D₃ ) levels in peri-implant health and diseases.

MATERIALS AND METHODS

A total of 90 dental implant sites (peri-implant healthy group [n = 30], peri-implant mucositis group [n = 30], and peri-implantitis group [n = 30]) in 53 participants were included in the study. Probing depth (PD), clinical attachment level (CAL), suppuration (S), modified plaque index (mPI), gingival index (GI), modified sulcus bleeding index (mSBI), and keratinized mucosa width (KMW) were recorded as clinical parameters, and PISF samples were obtained. FGF-23 and 25(OH)D₃ levels were analyzed by enzyme-linked immunosorbent assay.

RESULTS

There were no statistically significant differences in FGF-23 concentrations among the groups (P > .05). The 25(OH)D₃ concentration was significantly lower in peri-implantitis group compared with the other two groups (P < .05). The mean total amount of FGF-23 in the peri-implantitis group was significantly higher than the peri-implant healthy group whereas 25(OH)D₃ total amount was significantly lower in the peri-implantitis group than the peri-implant healthy group. The 25(OH)D₃ concentration was significantly negatively correlated with CAL, PD, mPI, S, GI, and mSBI and statistically significant relationship was found between FGF-23 total amount and these clinical parameters (P < .05). There was a negligible positive correlation between 25(OH)D₃ and FGF-23 concentrations (τ = 0.169; P = .018).

CONCLUSION

Within the limitations of this study, it can be concluded that FGF-23 and vitamin D seems to affect peri-implant bone health, and further studies are needed to explain the association between FGF-23 and 25(OH)D₃ in peri-implant conditions.

Relationship between Clinical Indicators of Periodontal Disease and Serum Level of Vitamin D

Background: Vitamin D is obtained through food and nutritional supplements, or is synthesized in the skin by sunshine. It is then transferred to the liver and kidney through the bloodstream and hydroxylated by a specific enzyme (cytochrome P450 family 27 subfamilies A member 1, cytochrome P450 family 27 subfamily B member 1) to form 25-hydroxyvitamin D and 1,25-dihydroxy vitamin D. The vitamin D synthesis facilitates calcium and phosphorus absorption from the intestines. The parathyroid hormone helps to synthesize 1,25-dihydroxy vitamin D to aid calcium absorption. Objectives: Many researchers have investigated the relationship between serum vitamin D levels and periodontal disease. And periodontal disease indicators such as bleeding on probing, pocket depth, clinical attachment level, gingival index, and cementoenamel junction-alveolar cresthave been used to identify the effects of vitamin D on periodontal disease. The effects of vitamin D on bacteria or cytokines have also been investigated. In this review article, vitamin D levels according to the status of periodontal disease were summarized. Data sources: PubMed was searched electronically, and randomized clinical trials, cross-sectional studies, and case-control studies were included in the review. Study appraisal and synthesis methods: Articles that the classification of periodontitis was accurately described, indicators for identifying periodontitis was clearly marked, and the form of vitamin D measured in the study was accurately described were selected. Only highly relevant journals were selected and summarized. Results: Most of the research has found positive associations between the serum 25-hydroxyvitamin D level and periodontal health, and the clinical parameters of periodontal disease were reduced by vitamin D. Limitations: Detailed categorization of the characteristics associated with the 25-hydroxyvitamin D level should be needed in future studies. Conclusions: This review article can be used as a guide by clinicians and as a reference book for patients’ education.