Taking 200 mg Vitamin C Three Times per Day Improved Extraction Socket Wound Healing Parameters: A Randomized Clinical Trial

The effectiveness of vitamin C in dental alveolus healing after dental extraction: A scoping review

BACKGROUND

Dental extraction is a common procedure in dentistry. It is accompanied by postoperative pain and inflammation. In addition, it decreases bone volume and density. Vitamin C is an antioxidant and cofactor that promotes the synthesis and maturation of collagen, the proliferation and migration of fibroblasts and osteoblasts, accelerating the final phase of inflammation, promoting healing. The objective of this scoping review is to evaluate the effectiveness of vitamin c in dental alveolus healing after extraction and synthesize the available evidence and tits clinical implications.

MATERIAL AND METHODS

This review is registered on the Open Science Framework platform (https://osf.io/bstwk/). It was carried out under the PRISMA-ScR protocol, using the question: Is vitamin C effective in alveolar healing in patients undergoing dental extraction? The Pubmed/MEDLINE, Scopus, Web of Science and OPENGREY databases were used. Limiting itself to primary studies.

RESULTS

A total of 287 articles were identified, applying selection criteria, 3 were included. Of a total of 135 patients, 59.8% were administered vitamin C; 46.6% 600 mg, 34.2% 500 mg and 19.2% 1500 mg. A decrease in pain, inflammation, probing depth and mesiodistal length of the socket was observed.

CONCLUSIONS

The role of vitamin C is essential for healing, and therefore, bone regeneration after tooth extraction, reducing adverse effects such as pain and inflammation. Its administration is recommended to promote postoperative recovery. More studies are suggested to observe its effects in oral and maxillofacial surgery.

Impact of vitamin C on the reduction of opioid consumption for acute musculoskeletal pain: A double-blind randomized control pilot study

INTRODUCTION

Recent evidence has shown that vitamin C has analgesic and opioid sparing properties in immediate postoperative context. However, this has never been studied for acute musculoskeletal (MSK) emergency department (ED) injuries. The aim of this pilot study is to evaluate the feasibility of conducting a randomized placebo-controlled study to determine the opioid sparing and analgesic effect of vitamin C compared to placebo, in acute MSK injured ED patients.

METHODS

A double-blind randomized controlled trial (RCT) distributed in two arms, stratified for fractures, was performed in a tertiary care center, one group receiving 1 g of vitamin C twice a day for 14 days and another receiving placebo. Participants were ≥18 years of age, treated in ED for MSK injuries present for ≤2 weeks, and discharged with a standardized opioid prescription of 20 morphine 5 mg tablets (M5T) and, at the clinician discretion, 28 tablets of naproxen 500 mg. Participants completed a 14-day paper diary and were contacted by phone at 14 days, to document their analgesic use, vitamin C consumption, and pain intensity.

RESULTS

Overall, 137 patients were screened; 44(32%) were excluded, 38(40.9%) refused, leaving 55(59.1%) participants, with a consent rate of 9.2/month. Mean age was 53 years (SD = 16) and 55% were men. Fourteen (25%) participants were lost to follow-up and 33(83%) patients complied with treatment. For per-protocol analysis, the median (IQR) M5T consumed was 6.5 (3.3-19.5) for the vitamin C and 9.0 (1.5-16.0) for placebo group. The median (IQR) naproxen 500 mg tablets consumed was 0 (0-9.8) for the vitamin C group and 20 (0-27) for the placebo arm.

CONCLUSION

This pilot study supports the feasibility of a larger RCT on the opioid sparing and analgesic properties of vitamin C for acute MSK injured ED patients. Strategies to reduce the refusal and lost to follow-up rates are discussed.

TRIAL REGISTRATION NUMBER

NCT05555576, ClinicalTrials.Gov PRS.

Therapeutic Impact of Ascorbic Acid on Oral and Periodontal Tissues: A Systematic Literature Review

Background and Objectives: Ascorbic acid (AA), a non-metabolized substance in the human body, is acquired from plant-based foods or supplements and is renowned for its antioxidant and anti-inflammatory properties, widely utilized in medicine, particularly in aesthetic practices. In dentistry, exploring adjunctive therapies like AA has gained traction to complement conventional treatments. This systematic literature review aims to assess the effects of ascorbic acid on oral and periodontal health. Materials and Methods: Following PRISMA guidelines, a systematic review was conducted across three electronic databases-PubMed, The Cochrane Library, and ScienceDirect. The review focused on randomized controlled trials and uncontrolled clinical trials published in English between 2018 and 2023, examining ascorbic acid's impact on oral and periodontal tissues. The search, ending 27 September 2023, identified studies meeting inclusion criteria, assessed using The Cochrane and ROBINS-I bias tools. Results: Seventeen publications, involving 811 patients, met the selection criteria. In the study groups, seven out of nine studies showed better outcomes in indicators such as bleeding on probing, plaque index, gingival index, clinical attachment level, periodontal pocket depth, and/or gingival recession depth (p < 0.05), compared to the control group. Three studies noted reduced VAS scores posttreatment with AA (p < 0.05), while two demonstrated accelerated alveolar healing after tooth extraction. Four publications highlighted ascorbic acid's efficacy in addressing aesthetic concerns. Conclusions: Ascorbic acid emerges as a potentially effective adjunctive therapy for managing oral and periodontal diseases and improving gum aesthetics.

Effect of the use of platelet concentrates on new bone formation in alveolar ridge preservation: a systematic review, meta-analysis, and trial sequential analysis

OBJECTIVES

To investigate the histomorphometric changes occurring in alveolar ridge preservation (ARP) based on the use of different plasma concentrates (PCs) in randomized clinical trials (RCT). There is controversy whether the placement of PCs in ARP is effective in the formation of new bone.

MATERIALS AND METHODS

A systematic review search was conducted in PubMed, Scopus, Web of Science, and Cochrane Database to answer the PICO question: In patients undergoing tooth extraction followed by ARP, do PCs alone in the post-extraction socket in comparison with spontaneous healing improve new vital bone formation percentage in histomorphometric analysis after more than 10 weeks? The risk of bias was assessed and a meta-analysis was conducted.

RESULTS

Of 3809 results, 8 studies were considered suitable for inclusion. A total of 255 teeth were extracted in 250 patients. Regarding the PCs used, ARP was performed with platelet- and leukocyte-rich fibrin (L-PRF) in 120 sockets, and with pure platelet-rich plasma (P-PRP) in 31 sockets and 104 sockets were controlled. PCs improved new bone formation in ARP with respect to the spontaneous healing group (SMD = 1.77, 95%C.I. = 1.47-2.06, p-value < 000.1). There were no differences between the different PCs (L-PRF and P-PRP).

CONCLUSION

The results of this meta-analysis support the efficacy of the use of PCs in new bone formation in ARP. With respect to the different types of PCs studied, no differences were observed.

CLINICAL RELEVANCE

When planning implant surgery after tooth extraction, treatment with PCs should be considered for ARP. Any PC increases new bone formation compared to spontaneous healing.

Impact of vitamin C on the reduction of opioid consumption after an emergency department visit for acute musculoskeletal pain: a double-blind randomised control trial protocol

INTRODUCTION

Recent evidence has shown that vitamin C has some analgesic properties in addition to its antioxidant effect and can, therefore, reduce opioid use during recovery time. Vitamin C analgesic effect has been explored mostly during short-term postoperative context or in disease-specific chronic pain prevention, but never after acute musculoskeletal injuries, which are often seen in the emergency department (ED). The protocol's primary aim is to compare the total morphine 5 mg pills consumed during a 2-week follow-up between patients receiving vitamin C or a placebo after ED discharge for an acute musculoskeletal pain complaint.

METHODS AND ANALYSIS

We will conduct a two-centre double-blind randomised placebo-controlled trial with 464 participants distributed in two arms, one group receiving 1000 mg of vitamin C two times a day for 14 days and another one receiving a placebo. Participants will be ≥18 years of age, treated in ED for acute musculoskeletal pain present for less than 2 weeks and discharged with an opioid prescription for home pain management. Total morphine 5 mg pills consumed during the 2-week follow-up will be assessed via an electronic (or paper) diary. In addition, patients will report their daily pain intensity, pain relief, side effects and other types of pain medication or other non-pharmacological approach used. Three months after the injury, participants will also be contacted to evaluate chronic pain development. We hypothesised that vitamin C, compared with a placebo, will reduce opioid consumption during a 14-day follow-up for ED discharged patients treated for acute musculoskeletal pain.

ETHICS AND DISSEMINATION

This study has received approval from the Ethics Review Committee from the 'Comité d'éthique de la recherche du CIUSSS du Nord-de-l'Île-de-Montréal (No 2023-2442)'. Findings will be disseminated through scientific conferences and peer-reviewed journal publication. The data sets generated during the study will be available from the corresponding author on reasonable request.

TRIAL REGISTRATION NUMBER

NCT05555576 ClinicalTrials.Gov PRS.

A Systematic Review on the Role of Vitamin C in Tissue Healing

Vitamin C is an essential nutrient for humans and animals which are unable to synthesise it themselves. Vitamin C is important for tissue regeneration due to the role it plays in collagen formation, and its antioxidant properties. We reviewed the literature to evaluate potential associations between vitamin C supplementation and healing of an acute or chronic condition. Embase, Medline, PubMed, and the Cochrane Library were searched for studies published prior to April 2022. Studies were eligible if they reported at least one association between vitamin C supplementation and healing outcomes. Eighteen studies met the inclusion criteria and were included in this review. Overall, vitamin C supplementation improved healing outcomes in certain pathologies, predominantly pressure ulcers. However, many of the studies had small sample sizes, combined nutritional treatments, and did not test baseline vitamin C. Future studies should be of larger scale, exclusively using vitamin C to determine its role in tissue healing in other wounds. We recommend consideration of vitamin C supplementation for people with pressure ulcers.