Vitamin D and Periodontal Disease

Periodontal disease

Periodontal disease (PD) is a chronic gum condition. Bacteria cause the gums to swell, redden, and bleed. Connective tissue holding the teeth into the jaw bone may become damaged. The gum around the teeth is measured with a thin probe to find out the extent of “attachment loss.” Loss is measured as mild, moderate, or severe. Risk of PD increases with age. For younger people, dental caries are a more important risk for tooth loss, while for older people, PD is the more important risk factor.

Risk factors

• The primary risk factor for PD is lack of adequate dental care. Proper dental care includes regular tooth brushing, flossing, and dental visits.
• Calcium consumption from diet or supplements reduces the risk of PD.
• Alcohol consumption appears to be a risk factor for PD.

Sunlight exposure and risk for periodontal disease

A few studies indicate a direct role of sunlight in reducing the risk of PD:

• A study in Norway found a direct relationship between tooth loss and latitude. Only 11% of people living in the south lost teeth compared to 43% living in the central region and 66% in the northern region. Ultraviolet B (UVB) light and vitamin D production decrease rapidly at higher latitudes.
• A study in Brazil found that people with dark skin had a 50% to 60% greater risk of PD than people with light skin.

Vitamin D and periodontal disease

Vitamin D levels

According to U.S. studies:

• People with lower vitamin D levels had more attachment loss than people with higher vitamin D levels.
• African-Americans had a greater risk of PD than white Americans. African-Americans had average vitamin D blood levels of about 16 ng/mL (40 nmol/L) compared to 26 ng/mL (65 nmol/L) for white Americans. Most vitamin D is obtained from solar UVB exposure. Less UVB reaches the lower layer of dark skin, where vitamin D is produced.
• Pregnant women with PD had lower vitamin D levels and were twice as likely to have vitamin D insufficiency.

PD and a number of diseases are linked to low vitamin D levels: cancer, cardiovascular disease, diabetes, pre-eclampsia, and osteoporosis. In many of the studies, the authors stated that some unknown factor might explain the link.

How vitamin D works

Vitamin D may reduce the risk and severity of PD in several ways:

• Produces cathelicidin and defensins, which have antimicrobial properties. These compounds reduce the number of bacteria in the mouth.
• Reduces matrix metalloproteinases (MMPs). MMPs are enzymes that are associated with PD.

Prevention

Increasing vitamin D blood levels to 40 ng/mL (100 nmol/L) may lower the risk of PD. For most people, it would take 1000–5000 international units (IU) (25–125 mcg)/day of vitamin D3 (cholecalciferol) to reach this level. Vitamin D blood levels should be measured before starting vitamin D. The levels should be tested again after several months. A rule of thumb is that for each 1000 IU (25 mcg)/day of vitamin D3, vitamin D blood levels rise by 6–10 ng/mL (15–25 nmol/L). However, there is considerable variation from person to person. The primary source of vitamin D3 for most people is solar UVB. However, most people do not get enough from the sun.

Vitamin D and calcium

Calcium is also important for dental health and to reduce the risk of PD. The guidelines for calcium intake suggest about 1000 mg/day from food and supplements.

Treatment

Those with PD should consider taking measures to raise their vitamin D blood levels to 40 ng/mL (100 nmol/L). This can be done by moderate UVB exposure (without sunburn) and oral intake of vitamin D and calcium supplements. While doing so may not cure PD, these measures could prevent PD from getting worse.

Acknowledgements

Complete bibliography of research used in this summary

The research we have cited in our summary is listed below, with links to PubMed abstracts and full-text for those who wish to explore further.

References

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