Vitamin D and Dental Caries

Dental Caries

Dental caries, also known as tooth decay, is a tooth infection caused by bacteria that leads to a loss of the hard tissues of your teeth. It is one of the most common diseases in the world. Dental caries are caused by bacteria on the surface of teeth that can turn certain sugars into acids, which can demineralize the hard tissues of your teeth. The bacteria form a sticky layer, which helps protect the bacteria from being removed by your immune system. Frequent snacking, sugary foods, and not enough saliva all increase your risk of developing dental caries. Research shows that vitamin D may help reduce the risk of dental caries in infants and younger children. Studies have shown that children with dental caries have lower levels of vitamin D. More experiments are needed to know for sure if vitamin D can help to treat dental caries.

Doctors and scientists don’t know yet whether taking a vitamin D supplement, or getting more sun exposure, can help to prevent or treat dental caries. If you have dental caries and want to take vitamin D, it is unlikely to make your caries worse or cause you any harm, as long as you take less than 10,000 IU per day. However, it’s not proven that taking vitamin D will help treat dental caries or reduce your risk of developing dental caries. You should not take vitamin D in the place of other medications or treatments for your dental caries. Talk to your doctor for more advice about taking supplements.

What are dental caries?

Dental caries, also known as tooth decay, is a tooth infection caused by bacteria that leads to a loss of the hard tissues of your teeth. There are bacteria that live inside of your mouth that help break down foods and sugars that you eat. When dental caries develop, certain bacteria turn sugars into acids, which demineralize and destroy the hard tissues of the teeth. This results in tooth decay. In children, dental caries are called early childhood caries (ECC). ECC, also known as bottle rot, is the presence of one or more decayed, missing, or filled tooth surfaces in any primary tooth in a child under three years of age¹. Usually, treatment of caries involves removing the decay and then filling the space with restorative materials, such as porcelain or gold. In extreme cases, what is known as a “root canal” is needed if the pulp in your tooth dies from infection by bacteria. A professional cleaning every six months, brushing at least twice a day, and flossing daily can help you to prevent developing dental caries². Brushing your teeth removes plaque, which is a group of bacteria hidden under a protective surface on the teeth. As the amount of plaque increases, the tooth is more vulnerable to dental caries. Eating healthy can help reduce the risk of decay, such as reducing both the amount of and how often you consume sugars that are fermented by bacteria in the mouth. Increasing your intake of calcium is also often recommended to protect against dental caries, because this can strengthen your teeth.

What causes dental caries?

Dental caries are caused by bacteria on the surface of teeth that can turn certain sugars into acids, which can demineralize the hard tissues of your teeth. The bacteria form a sticky layer, which helps protect the bacteria from being removed by your immune system. Caries develop when your tooth enamel starts to demineralize by acids secreted by bacteria. Enamel is the thin, highly mineralized coating that makes up the visible part of teeth. The damage caused by the acids then spreads into the dentin, which is the softer tissue underneath the enamel. At this point, the tooth develops a cavity. Before the cavity forms in the dentin, the process is reversible, but after it spreads to the dentin, it is not. The decay then spreads through the dentin to the layer below, called the pulp. The pulp is the part of the tooth that is made up of living connective tissue and its main purpose is to form dentin.

What are the symptoms of dental caries?

When caries begin to develop in your mouth, you may not be aware that you have the disease. As your tooth decays more and more, the most apparent symptom is pain in your tooth. This pain can be caused by sensitivity to heat and cold or consumption of sweet foods and drinks. When your tooth is severely decayed, a toothache can develop which means the pain will become constant.

How common are dental caries?

About 92% of adults aged 20 to 64 years old have had dental caries in their permanent teeth. In this same group, there is an average of about 3 decayed or missing permanent teeth caused by dental caries³. Medical conditions that reduce the amount of saliva in your mouth, such as Sjögren’s syndrome, diabetes, and sarcoidosis, can increase your risk of developing caries. Certain medications such as antihistamines and antidepressants can also reduce the amount of saliva in your mouth and increase your risk of caries. Saliva contains antimicrobial compounds, as well as minerals that neutralize the acids created by bacteria and help to protect and restore the teeth. There are certain things that can increase your risk for dental caries, such as⁴:

• Tooth location and surface. Caries are most commonly found on incisors, canines, premolars, and fissure sites in molars.
• Foods that cling to the teeth, such as candy or chocolate.
• Frequent snacking and sipping on sugary drinks.
• Bedtime infant feeding.
• Inadequate brushing of teeth.
• Dry mouth.
• Heartburn.

What is the link between vitamin D and dental caries?

Enamel is the most mineralized substance in the human body. It is made up of mostly calcium and phosphate. Vitamin D is important for increasing the absorption of calcium and phosphate from the food you eat. Increasing the absorption of calcium and phosphate can improve the strength of your teeth and their ability to fight demineralization from bacteria. Vitamin D receptors are found on cells in your immune system and in your teeth. Vitamin D can bind to these receptors and increase the amount of good antimicrobial proteins in your body which help to fight the bacteria that cause dental caries⁵. In addition, the cells in the teeth that form dentin and enamel contain vitamin D receptors, meaning that vitamin D may play a role in their functioning.

What does the research say, in general, about dental caries?

Some studies show that dental caries are most common in late winter and early spring, when vitamin D levels are likely to be at their lowest⁶. Many studies have found that geographic location and sun exposure are related to dental caries. People living closer to the equator with greater amounts of sun exposure are less likely to develop dental caries⁷. Most of the research on vitamin D and dental caries has looked at ECC and severe ECC. Children with ECC tend to have lower vitamin D levels than healthy children^8,9. Mothers of children with ECC have lower vitamin D levels during pregnancy than mothers whose children don’t have caries¹⁰. Some experiments have found that giving a mother vitamin D supplements while she is pregnant can reduce the rate of dental enamel defects in their children. Defects in dental enamel increase the risk of a child developing dental caries¹¹. Studies that give people vitamin D supplements to prevent caries have found that vitamin D is effective at preventing the development of caries¹².

What does recent research say about dental caries?

A study published in 2014¹⁰ looked at the vitamin D levels of pregnant Canadian women and whether or not their children developed ECC in their first year of life. They found that:

• Mothers of children who developed ECC had lower vitamin D levels compared to mothers of children who did not develop ECC.
• Children with ECC had more dental caries if their mothers had low vitamin D levels during pregnancy.

The researchers conclude that the vitamin D levels of a mother during pregnancy may relate to their children’s risk of developing ECC. A Canadian study from 2013⁹ looked at preschool children with severe ECC and children of the same age without dental caries. The researchers measured the children’s vitamin D levels and the parents answered questions on their child’s nutritional habits, oral health, and family information. They found that:

• Children with severe ECC had lower vitamin D levels than the healthy children.
• Winter season was also related to low vitamin D levels in children with severe ECC.

A 2013 review from the United States¹² looked at many studies that measured the effects of UV therapy and vitamin D supplementation in preventing dental caries. The main findings were:

• Taking vitamin D supplements resulted in a 47% reduced rate of dental caries.
• Taking vitamin D supplements had no effect on caries in those older than 13 years old, especially in girls.

The researchers concluded that taking vitamin D supplements may help protect against developing dental caries in children younger than 13 years old.

Key points from the research

• Dental caries are more common in late winter and early spring, which is when vitamin D levels tend to be lower.
• Children with severe ECC have lower vitamin D levels compared to children without caries.
• Mothers with low vitamin D levels are more likely to give birth to children who develop dental caries.
• Vitamin D supplementation may help reduce the risk of developing dental caries.

What does this mean for me?

Research has shown that there is a link between vitamin D and dental caries. Vitamin D can help strengthen your teeth’s resistance to bacteria by helping to absorb calcium and phosphate. Vitamin D also increases the amount of good antimicrobial proteins which can destroy the bacteria that causes caries. Research shows that higher vitamin D levels in pregnancy and early life can help to reduce the risk of dental caries. However, more experiments are needed to know for sure if vitamin D is effective in treating dental caries. Doctors and scientists don’t know yet for sure whether or not taking a vitamin D supplement, or getting more sun exposure, can help to prevent or treat dental caries. If you have dental caries and want to take vitamin D, it is unlikely to make your dental caries worse or cause you any harm, as long as you take less than 10,000 IU per day. However, it’s not proven that taking vitamin D will help you prevent or treat dental caries. You shouldn’t take vitamin D in place of the treatment medications for your dental caries. Talk to your doctor for more advice about taking supplements.

References

1. “Statement on Early Childhood Caries.” Statement on Early Childhood Caries. American Dental Association, 22 Sept. 2014. Web. 22 Sept. 2014. https://www.ada.org/resources/ada-library/oral-health-topics/caries-risk-assessment-and-management/
2. “Dental Cavities: MedlinePlus Medical Encyclopedia.” U.S National Library of Medicine. U.S. National Library of Medicine, 8 Sept. 2014. Web. 22 Sept. 2014. https://medlineplus.gov/ency/article/001055.htm
3. “Dental Caries (Tooth Decay) in Adults (Age 20 to 64).” Dental Caries (Tooth Decay) in Adults (Age 20 to 64). National Institute of Dental and Craniofacial Research, 22 Sept. 2014. Web. 22 Sept. 2014. https://www.nidcr.nih.gov/research/data-statistics/dental-caries/adults
4. “Cavities/tooth Decay.” Risk Factors. Mayo Clinic, 22 Sept. 2014. Web. 22 Sept. 2014. https://www.mayoclinic.org/diseases-conditions/cavities/symptoms-causes/syc-20352892
5. Youssef, D., C. Miller, A. El-Abbassi, D. Cutchins, C. Cutchins, W. Grant, and A. Peiris. “Antimicrobial Implications of Vitamin D.” Dermatoendocrinology 3.4 (2011): 220-29.
6. McBeath, E., and T. Zucker. “The Role of Vitamin D in the Control of Dental Caries in Children.” Journal of Nutrition 15.6 (2937): 547-64.
7. Grant, W.B. “A Review of the Role of Solar Ultraviolet-B Irradiance and Vitamin D in Reducing Risk of Dental Caries”. Dermatoendocrinology 3.3 (2011): 193-98.
8. Schroth, R., N. Jean, E. Kliewer, and E. Sellers. “The Relationship between Vitamin D and Severe Early Childhood Caries: A Pilot Study.” International Journal for Vitamin and Nutrition Research 82.1 (2012): 53-62.
9. Schroth, R. et al. “Vitamin D Status of Children with Severe Early Childhood Caries: A Case–control Study.” BMC Pediatrics 13 (2013): 174.
10. Schroth, R. et al. “Prenatal Vitamin D and Dental Caries in Infants.” Pediatrics 133.5 (2014): 1277-284.
11. Cockburn, F. et al. “Maternal vitamin D intake and mineral metabolism in mothers and their newborn infants.” British Medical Journal 281.6332 (1980): 11-14.
12. Hujoel, P. “Vitamin D and dental caries in controlled clinical trials: systematic review and meta-analysis.” Nutrition Reviews 71.2 (2013): 88-97.