The rachitic tooth: Refining the use of interglobular dentine in diagnosing vitamin D deficiency

Hypervitaminosis D is correlated with adverse dental implant outcomes: A retrospective case-control study

OBJECTIVES

To investigate vitamin-D levels effect on the survival/success and on marginal bone levels of dental implants.

METHODS

Patients with peri-implant disease and healthy control patients with functionally loaded dental implants were included in this retrospective case-control study. Forty patients with 201 implants were in the diseased-cohort, while thirty-three patients with 90 implants were in the control-cohort. Patient blood 25(OH)D levels were assessed through quantitative blood test. The correlation between abnormal 25(OH)D levels and disease status of each patient was assessed using Fisher's exact tests. The correlation of each implant's outcomes with vitamin-D status was assessed using Kaplan-Meier survival analysis and Mann-Whitney U tests.

RESULTS

Patients with blood 25(OH)D levels >70 ng/mL (hypervitaminosis-D) had a 21.1-fold increase in the risk of implant failure or severe peri-implant bone loss regarding patients with intermediate (>30, ≤70 ng/mL) levels. Kaplan-Meier survival analysis revealed that implants in the hypervitaminosis-D cohort had a survival probability of 73.7 % (95 % CI:56.5-84.5 %) at 19-years after surgery, compared to 95 % for implants in patients with intermediate 25(OH)D levels (95 % CI:88.3-97.9 %). Additionally, implants in the hypervitaminosis-D cohort lost bone faster than implants in the intermediate cohort. These results were specific to the patient cohort with elevated blood 25(OH)D levels and not observed in patients taking vitamin-D supplementation. The impact of hypervitaminosis-D was enriched for implants in the maxilla, and not as apparent for implants in the mandible.

CONCLUSIONS

Blood 25(OH)D levels >70 ng/mL were correlated with adverse implant outcomes, including implant failure and peri-implant bone loss, especially in the maxilla.

CLINICAL RELEVANCE

These results suggest that hypervitaminosis D may be a previously unidentified risk factor for dental implant complications and should be further investigated to elucidate the underlying mechanism.

Association between prenatal vitamin D deficiency with dental caries in infants and children: a systematic review and meta-analysis

Prenatal vitamin D (PVD) is a vital micronutrient for dental caries (DCs). The association between prenatal vitamin D deficiencies (PVDD) and DCs in children has been conflicting in different reports. This meta-analysis aimed to investigate the association between PVDD and DCs in children for the first time. We searched PubMed, Scopus, Web of Sciences, Embase, and Scholar databases to find relevant studies based on mesh terms from 2000 to October 2023. This study was conducted based on the 2020 version of the PRISMA checklist. Cochran's Q and I2 tests were used to evaluate heterogeneity between studies. Egger's test was used to evaluate publication bias. The effect size of the association between PVDD and DCs was reported by the odds ratio (OR) at the 95% confidence interval (95% CI).Twelve studies, including 11,021 participants, were reviewed. The pooled prevalence of PVDD was estimated at 4353 (32%). The prevalence of DCs in children of mothers with and without PVDD was 44% and 25%, respectively. PVDD was significantly associated with an increased risk of DCs in children (OR: 1.35, 95% CI (1.22, 1.47), I2 = 86.6%). The association of DCs with PVDD was different based on gestational age groups, children's age groups, and vitamin D levels. This meta-analysis showed PVDD can be associated with an increased risk of DCs in children, especially in mothers with prenatal vitamin D levels ≤ 35 nmol/L. Adequate vitamin D levels throughout pregnancy can help prevent DCs in children.

Vitamin D status in post-medieval Northern England: Insights from dental histology and enamel peptide analysis at Coach Lane, North Shields (AD 1711-1857)

OBJECTIVES

The post-medieval period in Europe saw a dramatic increase in metabolic bone disease related to vitamin D deficiency (VDD). Recent paleopathological work has utilized interglobular dentin (IGD) as a proxy for poor vitamin D status during development, while enamel peptide analysis allows the identification of chromosomal sex in non-adult remains. Here we explore the relationship between sex, the presence of IGD, and macroscopic markers of VDD in an industrial era assemblage from Northeast England.

MATERIALS AND METHODS

25 individuals (9 females, 9 males, 9 unknown sex) from the cemetery site at Coach Lane, North Shields (1711-1857) were selected for paleopathological analysis, histological assessment of IGD, and enamel peptide determination of chromosomal sex.

RESULTS

Ground tooth sections from 21 individuals were of suitable quality for detection of IGD, and enamel peptide analysis confirmed the chromosomal sex of ten individuals. Sixteen individuals (76.1%) exhibited ≥1 episode of IGD. Nine of these (42.8%) exhibited >1 episode and four (19%) exhibited ≥4 episodes in regular intervals. Male sex was significantly associated with the presence of IGD (p = 0.0351; 100% males vs. 54.5% females). Females were more likely to exhibit macroscopic evidence of VDD (45.5% females vs 30% males) but this was not statistically significant.

DISCUSSION AND CONCLUSIONS

Periods of poor mineral metabolism during childhood appear much more prevalent at Coach Lane than macroscopic evidence suggests. Evidence of seasonal IGD episodes indicates that northern latitude played a major role in poor VD status in the Northeast of England. The significant association of IGD with male sex may be due to sex-related differences in dentinal mineralization or a higher risk of poor VD status in males aged <5 years. More work is needed to establish an evidence-based threshold for pathological levels of IGD before the presence of this feature can confidently be used as a biomarker for poor VD status.

Correlation between vitamin D levels in serum and the risk of dental caries in children: a systematic review and meta-analysis

BACKGROUND

Vitamin D plays a crucial role in oral health, and its deficiency is associated to significant changes in oral health diseases. We aimed to explore the relationship between levels of 25-hydroxyvitamin D (25(OH) D) and dental caries in children.

METHODS

Four electronic databases were searched by two investigators including PubMed, Embase, Web of Science, and Cochrane Library. Dental caries results were presented as either prevalence or based on the index of primary and permanent teeth/surfaces with decaying, missing, and filled areas, while vitamin D levels were determined through laboratory testing. Two researchers independently selected studies, collected information, assessed risk of bias, and evaluated the study quality. Any disagreements were resolved through discussion.

RESULTS

A total of 13 studies were included, comprising 5 cross-sectional studies, 5 cohort studies, 3 case-control studies, all of which had high methodological quality. Our meta-analysis showed that children with vitamin D deficiency had a 22% higher risk of dental caries than those with normal vitamin D levels, with a relative risk (RR) of 1.22 and a 95% confidence interval (CI) of 1.18 to 1. 25. Further subgroup analysis according to the three types of studies showed that the risk of dental caries in children with vitamin D deficiency was higher than that in normal vitamin D level group (cohort studies: 62%; cross-sectional studies, 19%; and case-control studies, 5%). Additionally, according to age, subgroup analysis also showed that the risk of dental caries in children with vitamin D deficiency was higher than that in normal vitamin D level group (permanent teeth studies, 28%; deciduous teeth studies, 68%; and mixed dentition studies 8%).

CONCLUSIONS

Levels of 25 (OH) D have been found negatively associated with dental caries in children, indicating that low vitamin D levels may be considered a potential risk factor to this dental disease.

A certain protective effect of vitamin D against dental caries in US children and youth: A cross-sectional study

OBJECTIVES

Recent studies reported that evidence of the association between caries and vitamin D was inconclusive. We investigated the relationship between dental caries and serum vitamin D levels in US children and youth aged 5-19 years through the National Health and Nutrition Examination Survey (NHANES). The purpose of this study was to analyze the relations between serum 25-hydroxyvitamin-D [25(OH)D] level and dental caries in children and youth.

METHODS

Data were collected from the NHANES dataset performed in 2011-2018. A total of 8896 subjects completed the examination was enrolled. Serum 25(OH)D was determined by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). All teeth examined and caries assessment was conducted by licensed dentists. Statistical analyses included complex samples Chi-square tests, analysis of variance, logistic regression analyses, and restricted cubic splines conducted by R software.

RESULTS

There was a nonlinear relation between dental caries and age in youth. Vitamin D showed a relatively stable protective effect when the concentration exceeded 60 nmol/L. There was a dose-effect relation that a 10 nmol/L increase in serum 25(OH)D concentrations was associated with a decreased caries odd by 10%.

CONCLUSIONS

Our findings suggested that vitamin D sufficiency may be a protective factor for dental caries.

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.

Precarious adolescence: Adolescent rickets and anterior sacral angulation in two Dutch skeletal collections from the 18th-19th centuries

OBJECTIVE

This project aims to provide an objective approach to suggesting cases of adolescent rickets using the presence of anterior sacral angulation and interglobular dentine.

MATERIALS

Sacra from 49 individuals from Hattem and 150 individuals from Middenbeemster, and second and third molars from five individuals from Hattem were analyzed. Both sites date to the 17th to 19th centuries.

METHODS

The sacra were visually assessed for sacral angulation and measured to quantify anterior sacral angulation. The sampled molars were thin sectioned to look for the presence of interglobular dentine.

RESULTS

Metric analysis determined that seven individuals had significantly anteriorly angled sacra. Three of the five individuals with sampled molars had interglobular dentine formed during adolescence.

CONCLUSIONS

Adolescent rickets may be associated with anterior sacral angulation.

SIGNIFICANCE

Anterior sacral angulation may help identify possible cases of adolescent rickets in archaeological human remains.

LIMITATIONS

The small sample size for the molars prevented the identification of more individuals with interglobular dentine present during adolescence. Several individuals with visibly angled sacra were unmeasurable due to post-mortem damage and lacked molars.

SUGGESTIONS FOR FURTHER RESEARCH

Research on a larger sample would allow us to understand better the association between anterior sacral angulation and adolescent rickets.

Forgotten and found: A case of childhood rickets in the 19th-century settler village of Heuvelton, New York

OBJECTIVE

To evaluate pathological lesions suggesting the presence of rickets and to place the diagnosis into bioarchaeological and historical context.

MATERIALS

The remains of a 3-year ± 12-month-old child discovered during a rescue excavation in Heuvelton, New York.

METHODS

We examined the individual macroscopically and conducted a differential diagnosis following established protocols in the palaeopathological literature.

RESULTS

Bony change on the orbits, mandible, ribs, clavicles, left scapula, humerii, radii, ulnae, femora, tibiae, fibulae (e.g., porosity, diaphyseal thickening, flaring, bowing), and dental lesions were recorded.

CONCLUSIONS

We demonstrate that the child likely presented with vitamin D deficiency rickets during crawling and as they learned to walk.

SIGNIFICANCE

This example offers an important contribution to the bioarchaeological literature, as few cases of rickets have been recorded in rural North America using updated diagnostic criteria and little is known of the health and lifeways of early settlers in 19th-century upstate New York.

LIMITATIONS

It is not possible to ascertain the precise aetiology of this child's rachitic state and to compare this individual with others in the population.

SUGGESTIONS FOR FURTHER RESEARCH

Examination (and re-assessment) of other North and South American skeletal assemblages for signs of vitamin D deficiency rickets following current bioarchaeological standards.

Can the palaeoepidemiology of rickets during the industrialisation period in France be studied through bioarchaeological grey literature and French medico-historical literature of the 18th-early 20th centuries? Preliminary examination of a complex topic

OBJECTIVE

This study explores whether data relating to rickets from the French medico-historical literature (FMHL) and bioarchaeological grey literature are useful in evaluating its epidemiology during the industrialisation of France. Unlike other European countries such as England, industrialisation in France was a slow and continuous process with two phases: the first in 1830-1870 and the second in 1870-1914.

MATERIALS AND METHODS

A bibliographical analysis of 2800 FMHL sources from the 18th to the early 20th centuries and 50 archaeological excavation reports from the last 21 years was undertaken.

RESULTS

The FMHL data is very heterogeneous and predominantly dates to the second phase of industrialisation. The bioarchaeological data is very incomplete and predominantly relates to the period before industrialisation. At the same time, knowledge improvement and institutional changes to protect children could explain more systematic registration of cases of rickets.

CONCLUSIONS

No solid conclusions can be made regarding the prevalence of rickets at present, however these data hold great potential.

SIGNIFICANCE

In comparison to England, no systematic investigation of rickets prevalence during the period of industrialisation in France has been undertaken to date.

LIMITATIONS

The lack of archaeological excavations from this period and the limited paleopathological analysis of the sites excavated have contributed to our current lack of understanding regarding the impact of industrialization on the prevalence of rickets on the French population.

SUGGESTIONS FOR FURTHER WORK

The FMHL data needs to be homogenized and osteoarchaeological collections need to be restudied with a common protocol focusing on signs of vitamin D deficiency.

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.

Using teeth as tools: Investigating the mother-infant dyad and developmental origins of health and disease hypothesis using vitamin D deficiency

OBJECTIVES

With a growing interest in the mother-infant dyad and the Developmental Origins of Health and Disease hypothesis among biological and medical anthropologists, this study set out to provide all the information required to evaluate if mineralization defects in dentine might be caused by vitamin D deficiency in the critical first 1000 days of life.

MATERIALS AND METHODS

Information was compiled on dentine formation in utero to approximately 18 years, and a method for determining the location of the neonatal line in dentine was devised, allowing the assessment of the prenatal and early life period. Re-evaluation of previously analyzed teeth (n = 61) was undertaken with detailed examination of n = 5/22 first permanent molars forming in the prenatal and critical early life periods.

RESULTS

First permanent molars and all deciduous teeth give information on intrauterine development and on the first 1000 days postnatally providing a direct window on maternal and fetal health. Three archaeological individuals had interglobular dentine that formed prenatally suggesting that their mothers experienced vitamin D deficiency at the time dentine was forming and all other individuals had a deficiency during the first 1000 days of life. Conditions that could cause systemic mineralization defects were determined, and in each, case they were found to be consistent with vitamin D deficiency.

DISCUSSION

The neonatal line serves as a clear baseline for determining prenatal and postnatal events, particularly those related to vitamin D, calcium, and phosphate metabolism, and can be used to investigate the maternal-infant dyad for both past and present communities.

Micro-CT assessment of dental mineralization defects indicative of vitamin D deficiency in two 17th-19th century Dutch communities

OBJECTIVES

This study investigates vitamin D deficiency patterns in individuals from birth to the beginning of adolescence. Microscopic computed tomography (micro-CT) evaluation of interglobular dentine (IGD) in teeth provides information on the age of disease onset and the number of deficient periods per individual, which will increase our understanding of factors influencing vitamin D deficiency prevalence, including sociocultural practices and latitude.

MATERIALS AND METHODS

Beemster and Hattem, two Dutch 17th-19th century communities, yielded relatively high prevalences of rickets (15-24%) and residual rickets (15-24%). From the affected individuals, a subsample of 20 teeth were selected for micro-CT scanning. Thin sections were made of 17 teeth, consisting of 6 teeth with and 11 teeth without observable IGD on micro-CT that were included for method comparison.

RESULTS

About 19 out of 29 (65.5%) individuals (one tooth was deemed unobservable) presented with IGD on micro-CT. Eight of the 11 (72.7%) individuals without IGD on micro-CT demonstrated histologically visible IGD. In 40.7% (11/27) of the affected individuals (combined micro-CT and histology results), vitamin D deficiency was recurrent, and in four individuals, some episodes occurred at approximately annual intervals suggesting vitamin D deficiency was seasonal. In three individuals, IGD occurred in the dentine formed around birth, suggesting maternal vitamin D deficiency.

DISCUSSION

Micro-CT analysis of IGD is found to be a valuable non-destructive method that can improve our understanding of the influence of sociocultural practices and latitude on disease development within age and sex groups in past communities.