Low vitamin D levels can impair the healing process following periodontal surgery
In patients with periodontitis, lower vitamin D levels compared with healthy controls have been reported. Higher serum 25-hydroxy vitamin D (25OHD) concentrations have been associated with lower rates of gingivitis and less attachment and tooth loss.
One prospective study reported that every 10 μL/L increase in serum 25OHD was associated with a 13% decrease in tooth loss, while another showed that Vitamin D supplementation after nonsurgical periodontal therapy resulted in a slight reduction in probing pocket depth (PPD) and attachment loss compared to placebo controls and improved anti-inflammatory response. Well-designed prospective and intervention studies are needed to define what plasma vitamin D concentration is required prior to the initiation of periodontal treatment to achieve the best therapeutic outcome. (1,2)
Studies have shown that adequate calcium intake is associated with a nearly 20% lower incidence of periodontitis compared to individuals with low calcium intake, as well as a reduced risk of progression of existing disease and loss of attachment (regardless of other significant risk factors such as smoking, blood sugar levels, and BoP) [53]. Furthermore, serum calcium levels have been inversely associated with the progression of periodontal disease in older populations. Lastly, low calcium intake has been shown to increase the risk of tooth loss in both men and women, highlighting the importance of maintaining adequate calcium levels for gum health (3)
Regarding the impact on periodontal treatment, calcium supplements have demonstrated promising results in improving treatment outcomes. Studies have indicated that taking calcium supplements during specific periods and adequate calcium intake may positively affect long-term tooth preservation
Moreover, when examining the effect of vitamin D and calcium supplementation in patients undergoing periodontal maintenance therapy, those who took a vitamin D supplement (≥400 IU) and calcium (≥1000 mg) for an average of 10 years showed improved clinical periodontal parameters compared to their counterparts who did not take dietary supplements (even at a borderline statistical significance). Among these parameters were pocket depth, number of sites with bleeding, gingival index, probing depth, loss of attachment, and loss of radiographic bone support (5,6)
Evidence from both animal and human studies strongly indicates that vitamin D deficiency impairs both new bone formation and BIC. Supplementation, particularly in patients with systemic conditions, may improve implant osseointegration outcomes. Pre-operative screening and correction of vitamin D deficiency are recommended to optimize implant success. (7)
The water-soluble B vitamins are involved in multiple processes, including metabolism, erythrocyte production, and collagen synthesis and they act as coenzymes in several enzymatic processes that support every aspect of cellular physiological functioning. Epidemiological data have demonstrated a higher severity of periodontal disease in individuals with inadequate dietary intake or serum levels of vitamin B9 (folate). Among patients with periodontal disease, smokers had lower serum folic acid concentrations than non-smokers. In a prospective cohort study, an increase in serum vitamin B12 was linked to a decrease in clinical periodontal parameters and tooth loss.
Giving a vitamin B-complex preparation to periodontitis patients after periodontal surgery has improved clinical attachment levels compared with patients receiving placebo. Furthermore, adjunctive systemic folate intake after subgingival instrumentation has resulted in significant additional gain in clinical attachment in patients with stage II-III periodontitis. Nevertheless, further clinical and biochemical data are needed to support these findings.
Studies have shown that a low serum calcium-magnesium ratio is significantly associated with increased attachment loss and the progression of periodontal disease, and that individuals with periodontitis have a significantly lower dietary intake of calcium, magnesium, copper, selenium, and antioxidant nutrients – and respectively lower serum and saliva levels – compared to controls
Case-control studies have revealed significantly lower magnesium, selenium, and zinc levels in diabetic and non-diabetic patients with periodontitis compared to healthy controls. Other studies have shown non-surgical periodontal therapy leading to increased serum zinc levels in Type-2 diabetes mellitus patients with periodontitis, while subjects with magnesium supplementation have lower attachment loss and higher tooth retention compared to non-supplemented control subjects.
Calcium supplements & gastric discomfort.
In a survery conducted in India in 53.12% has encountered some kind of complication while prescribing calcium and most common complication reported from our survey was gastritis (35.15%), 9.37% reported renal stones as a complication. The bioavailability
of calcium citrate is more, than calcium carbonate as the latter requires an acidic environment for absorption. Hence, calcium citrate is preferred in patients with achlorhydria, patients on medication like proton pump inhibitors and H2 blockers to treat gastroesophageal reflux disease (9,10)
CALCIVICTUS- EC has 500 mg of calcium citrate per tablet.
PHYTONUTRIENTS BENEFITS IN DENTISTRY:
Phytomedicine refers to the use of naturally derived products to cure and mitigate human conditions. Natural products have the advantages of causing minimum side effects, being biocompatible, available, and economical, with a wide array of biological activities. Reports have described the use of natural products with antimicrobial and anti-inflammatory properties to treat oral conditions and promote wound healing.
ALO VERA & ORAL SUBMUCOUS FIBROSIS :
Aloe vera can be an effective & safe treatment regime in the management of oral submucous fibrosis IN alleviating symptoms like pain, burining & restricted mouth opening (8). Each tablet of TONGLEN MV has 100 mg of Aloe Vera among other phytonutrients with antioxidant property.
An in vitro study performed by Arévalo-Híjar et al. found that methanolic extracts of M. oleifera leaves suppressed the growth of Enterococcus faecalis with a greater antibacterial effect in comparison to 2% chlorhexidine. These extracts showed minimal cytotoxic effects on cultured Madin–Darby canine kidney (MDCK) cells. This study suggested the possible use of these extracts as antimicrobial agents in root canal therapy.
In a study employing network pharmacology and molecular docking, phenolic compounds derived from M. oleifera leaf were investigated for antiperiodontitis effects both in an in vitro RAW 264.7 macrophage cell culture and in an in vivo ligature-induced periodontitis rat model. Moringa leaf extract achieved antiperiodontitis activity by regulating the p38α/MAPK14-OPG/RANKL pathway. The extract also decreased serum proinflammatory cytokines and increased anti-inflammatory cytokines and reduced alveolar bone resorption within the in vivo model (11)
In vitro & In vivo studies by Dos Santos et al Moringa extracts exhibited antinociceptive and anti-inflammatory effects when administered orally. This potential analgesic effect could be peripherally mediated by action of the heme oxygenase-1 (HO-1) pathway, as well as through inhibition of intercellular adhesion molecule levels while centrally by the activation of opioid receptors (12,13)
REFERENCES :
1) Amano, Y.; Komiyama, K.; Makishima, M. Vitamin D and periodontal disease. J. Oral Sci. 2009, 51, 11–20
2) Bashutski, J.D.; Eber, R.M.; Kinney, J.S.; Benavides, E.; Maitra, S.; Braun, T.M.; Giannobile, W.V.; McCauley, L.K. The impact of vitamin D status on periodontal surgery outcomes. J. Dent. Res. 2011, 90, 1007–1012.
3) Al-Zahrani, M.S. Increased intake of dairy products is related to lower periodontitis prevalence. J. Periodontol. 2006, 77, 289–294.
4) Krall, E.A.; Wehler, C.; Garcia, R.I.; Harris, S.S.; Dawson-Hughes, B. Calcium and vitamin D supplements reduce tooth loss in the elderly. Am. J. Med. 2001, 111, 452–456
5) Hans, M.; Malik, P.K.; Hans, V.M.; Chug, A.; Kumar, M. Serum levels of various vitamins in periodontal health and disease—A cross sectional study. J. Oral Biol. Craniofacial Res. 2023, 13, 471–475
6) Nutrients 2024, 16(22), 3901; https://doi.org/10.3390/nu16223901
7) Miron RJ, Estrin NE, Paz A, Gruber R, Farshidfar N, Zhang Y, Sculean A, Wiedemann TG, Ahmad P. Relationship between vitamin D deficiency and early implant failure and osseointegration. Periodontol 2000. 2025 Oct 30. doi: 10.1111/prd.70017
8) J Oral Pathol Med (2016). Aloe vera for the treatment of OSMF Anuradha et al
9) B. Sheth, S. Akil Prabhakar, P. Pawar et al. Calcium prescription by Indian orthopaedic surgeons: A survey and a review of literature. Journal of Clinical Orthopaedics and Trauma 16 (2021) 292e298
10) Recker RR. Calcium absorption and achlorhydria. N Engl J Med. 1985 Jul 11;313(2):70e73.
11) Wang F., Long S., Zhang J. Moringa oleifera Lam. leaf extract safely inhibits periodontitis by regulating the expression of p38α/MAPK14-OPG/RANKL. Archives of Oral Biology . 2021;132 doi: 10.1016/j.archoralbio.2021.105280.105280
12) Dos Santos A. O., do Val D. R., da Silveira F. D., et al. Antinociceptive, anti-inflammatory and toxicological evaluation of semi-synthetic molecules obtained from a benzyl-isothiocyanate isolated from Moringa oleifera Lam. in a temporomandibular joint inflammatory hypernociception model in rats. Biomedicine & Pharmacotherapy . 2018;98:609–618. doi: 10.1016/j.biopha.2017.12.102.
13) Silveira F. D., Gomes F. I. F., do Val D. R., et al. Biological and molecular docking evaluation of a benzylisothiocyanate semisynthetic derivative from Moringa oleifera in a pre-clinical study of temporomandibular joint pain. Frontiers in Neuroscience . 2022;16 doi: 10.3389/fnins.2022.742239
