The Potential Impact of Essential Nutrients Vitamins C and D upon Periodontal Disease Pathogenesis and Therapeutic Outcomes
- 316 Downloads
Diet has powerful effects upon inflammatory status, arguably as strong or stronger than microbial plaque. Despite a relationship between diet and periodontal inflammatory markers being established over 30 years ago, it is only recently that the mechanisms underpinning these effects have begun to be examined in detail. Following an analysis of the evidence base in 2011, this review focuses upon the most contemporaneous evidence relating specifically to the micronutrient vitamins C and D and their potential impact upon periodontal disease pathogenesis and/or therapeutic outcomes. The authors bring together both epidemiological and laboratory data and aim to outline avenues for potential studies given the limited number of larger well-conducted clinical interventional trials completed to date.
KeywordsPeriodontitis Micronutrients Dietary supplements Vitamin C Ascorbic acid Vitamin D
Compliance with Ethical Standards
Conflict of Interest
Gareth R. Brock declares that he has no conflict of interest.
Iain L. C. Chapple reports grants from NSA LLC outside of the submitted work.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 7.Health and Social Care Information Centre. Provisional monthly hospital episode statistics for admitted patient care, outpatients and accident and emergency data. 2015. April 2015 to July 2015; PDF available at: http://www.digital.nhs.uk/seachcatalogue [accessed 16 August 2016].
- 11.Carlo A, Roberto BC, et al. Scientific opinion on dietary reference values for vitamin C. EFSA J. 2013;11:1–2.Google Scholar
- 14.Tu H, Li H, Wang Y, Niyyati M, Wang et al. Low red blood cell vitamin C concentrations induce red blood cell fragility: a link to diabetes via glucose, glucose transporters, and dehydroascorbic acid. 2015; 2:1735-1750.Google Scholar
- 22.Eastwood MA. Interaction of dietary antioxidants in vivo: how fruit and vegetables prevent disease? QJM-Mon J Assoc Phys. 1999;92:527–30.Google Scholar
- 24.Pushparani DS, Nirmala S, Theagarayan P. Low serum vitamin C and zinc is associated with the development of oxidative stress in type 2 diabetes mellitus with periodontitis. Int J Pharm Sci Rev Res. 2013;23:259–64.Google Scholar
- 26.•Dias IHK, Chapple ILC, Milward M, Grant MM, Hill E, Brown J, et al. Sulforaphane restores cellular glutathione levels and reduces chronic periodontitis neutrophil hyperactivity in vitro. PLoS One. 2013;8(6):e66407. This novel research showed a defect in periodontitis patients’ neutrophils in GSH synthetic pathways mediated via NRF2 transcription. This may explain why neutrophils in periodontal disease release excess ROS extracellularly because the authors found that some of the NADPH-oxidase components in oxidatively stressed cells relocate to the outer cell membrane. This would mean that when ROS were produced, some were expelled extracellularly in order to protect the neutrophil, where reduced glutathione to oxidized glutathione ratios were found to be low in periodontitis.CrossRefPubMedPubMedCentralGoogle Scholar
- 36.Report of a WHO Study Group. Diet, nutrition, and the prevention of chronic diseases. World Health Organ Tech Rep Ser. 1990;797:1–204.Google Scholar
- 37.•Dodington DW, Fritz PC, Sullivan PJ, Ward WE. Higher intakes of fruits and vegetables, β-carotene, vitamin C, α-tocopherol, EPA, and DHA are positively associated with periodontal healing after nonsurgical periodontal therapy in nonsmokers but not in smokers. J Nutr. 2015;145:2512–9. This intervention study not only points to the potential benefits of dietary modification to optimize post-periodontal therapy healing, but also makes an interesting analysis on the therapeutic limitations of formulated ‘pure’ compounds in supplements compared with whole foods.CrossRefPubMedGoogle Scholar
- 40.Harpenau LA, Cheema AT, Zingale JA, Chambers DW, Lundergan WP. Effects of nutritional supplementation on periodontal parameters, carotenoid antioxidant levels, and serum C-reactive protein. J Calif Dent Assoc. 2011;39:309-12–314-8.Google Scholar
- 44.Holick MF. Vitamin D and health: evolution, biologic functions, and recommended dietary intakes for vitamin D. In: Holick MF, editor. Vitamin D: physiology, molecular biology, and clinical applications. 2nd ed, Humana; 2010. pp. 3-33.Google Scholar
- 46.Dietary reference intakes for calcium and vitamin D. In: Ross AC, Taylor CL, Yaktine AL, Del Valle HB, editors. Institute of Medicine (US) Committee to review dietary reference intakes for vitamin D and calcium; Washington (DC): National Academies Press (US); 2011.Google Scholar
- 47.Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911–30. Erratum in: J Clin Endocrinol Metab. 2011; 96:3908.Google Scholar
- 48.Bolland MJ, Grey AB, Ames RW, Mason BH, Horne AM, Gamble GD, Reid IR. The effects of seasonal variation of 25-hydroxyvitmain D and fat mass on a diagnosis of vitamin D sufficiency. Am J Clin Nutr. 2007; 86:959–964Google Scholar
- 50.Laine ML, Loos BG, Crielaard W. Gene polymorphisms in chronic periodontitis. Int J Dent. 2010; 324719. doi: 10.1155/2010/324719.
- 54.Newberry SJ, Chung M, Shekelle PG, Booth MS, Liu JL, Maher AR, Motala A, Cui M, Perry T, Shanman R, Balk EM. Vitamin D and calcium: a systematic review of health outcomes (update). Evidence Reports/Technology Assessments, No. 217. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014.Google Scholar
- 62.Millen A, J Evid Base Dent Pract. 2014; 14:197-199; article analysis and evaluation of Zhan Y, Samietz S, Holtfreter B, Hannemann A, Meisel P, Nauck M, Volzke H, Wallaschofski H, Dietrich T, Kocher T. Prospective study of serum 25-hydroxy vitamin D and tooth loss. J Dent Res 2014; 93:639-644Google Scholar
- 71.•Woelber JP, Bremer K, Vach K, König D, Hellwig E, Ratka-Krüger P, et al. An oral health optimized diet can reduce gingival and periodontal inflammation in humans—a randomized controlled pilot study. BMC Oral Health. 2016;17:28. doi: 10.1186/s12903-016-0257-1. This pilot study in conjunction with  presents interventional evidence for the effect of an optimized diet on the reduction of periodontal inflammatory parameters, albeit with a small sample size.CrossRefPubMedPubMedCentralGoogle Scholar