Low vitamin D status strongly associated with periodontitis in Puerto Rican adults

Effect of sleeve gastrectomy on the levels of oral volatile sulfur compounds and halitosis-related bacteria

Background

The association between sleeve gastrectomy and halitosis remains relatively unknown. Therefore, this study aimed to evaluate the effect of sleeve gastrectomy on halitosis and the oral bacterial species associated with halitosis in patients with obesity.

Methods

This was a prospective longitudinal cohort study that examined patients before and after sleeve gastrectomy and followed the patients at three time intervals (1, 3, and 6 months) after sleeve gastrectomy. Clinical periodontal measurements (plaque index [PI], gingival index [GI], and probing depth [PD]) were obtained. In addition, plaque samples were collected for quantification of the periodontopathogenic bacteria: Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Fusobacterium nucleatum using real-time quantitative polymerase chain reaction (qPCR). In addition, breath samples were collected to analyze the concentration of volatile sulfur compounds (VSCs), namely hydrogen sulfide (H2S), methyl mercaptan (CH3SH), and dimethyl sulfide (CH3SCH3), via portable gas chromatography (Oral Chroma™).

Results

Of the 43 patients initially included, 39 completed the study, with a mean age of 32.2 ± 10.4 years. For PI and GI repeated measurements one way analysis of variance showed a significant increase (p-value < 0.001 for both) one month after surgery, with mean values of 1.3 and 1.59, respectively, compared to the baseline. During the same period, the number of P. gingivalis increased, with a p-value = 0.04. Similarly, the levels of hydrogen sulfide (H2S) and methyl mercaptan (CH3SH) increased significantly in the first month after surgery (p-value = 0.02 and 0.01, respectively).

Conclusion

This study demonstrated that sleeve gastrectomy may lead to increased halitosis one month post-surgery, attributed to elevated and P. gingivalis counts, contributing to the development of gingivitis in obese patients who underwent sleeve gastrectomy. This emphasizes the importance of including oral health professionals in the multidisciplinary team for the management of patients undergoing bariatric surgery.

Vitamin intake and periodontal disease: a meta-analysis of observational studies

OBJECTIVE

A meta-analysis was performed to assess the epidemiological correlation between dietary intake of various types of vitamin intake and the risk of periodontal disease.

METHODS

A comprehensive computerized search was conducted in eight databases, namely PubMed, Web of Science, Embase, Cochrane Library, China Biology Medicine Disc, CNKI, VIP, and WanFang Database, and a random effect model was applied to combine pooled odds ratio (ORs) with corresponding 95% confidence intervals (CIs) of the included studies, and the sensitivity analysis was performed to explore the impact of a single study on the comprehensive results.

RESULTS

We finally included 45 effect groups from 23 observational studies, with a total number of study participants of 74,488. The results showed that higher levels of vitamin A (OR: 0.788, 95% CI: 0.640-0.971), vitamin B complex (OR: 0.884, 95% CI: 0.824-0.948), vitamin C (OR: 0.875, 95% CI: 0.775-0.988), vitamin D (OR: 0.964, 95% CI: 0.948-0.981), and vitamin E (OR: 0.868, 95% CI: 0.776-0.971) intake all were negatively correlated with periodontal disease. After removing each study, leave-one-out sensitivity analysis indicated no significant change in the overall results of any of the five meta-analyses.

CONCLUSIONS

The results from this meta-analysis demonstrated a negative association between high-dose vitamin A, vitamin B complex, vitamin C, vitamin D, and vitamin E consumption and the likelihood of developing periodontal disease, revealing the significant role of vitamins in preventing periodontal disease.

Nutritional Modulation of Periodontal Diseases: A Narrative Review of Recent Evidence

The role of nutrition in managing periodontal diseases is a dynamic and evolving area of study. This review presents an in-depth analysis of various nutritional elements, including essential fatty acids, proteins, vitamins (D, E, and C), coenzyme Q10, melatonin, and probiotics, and their impact on periodontal health. It synthesizes findings from randomized clinical trials and observational studies to highlight the multifaceted influence of these nutrients on periodontal disease management. Key areas of focus include their role in reducing inflammation, altering the composition of the oral microbiota, and enhancing tissue repair and bone health. The review consistently points to the potential benefits of these nutrients, either as standalone agents or in conjunction with standard periodontal treatments, offering valuable insights for both clinicians and researchers. It advocates for a more nutritionally informed approach to periodontal disease management, emphasizing the importance of a well-rounded, preventive, and therapeutic strategy in dental health.

Serum levels of vitamin D and periodontal inflammation in community-dwelling older Japanese adults: The Otassha Study

AIM

To evaluate the association between vitamin D status and periodontal inflammation as determined by the periodontal inflamed surface area (PISA) in community-dwelling older adults.

MATERIALS AND METHODS

This cross-sectional study included 467 Japanese adults (mean age = 73.1 years) who underwent full-mouth periodontal examinations and measurements of serum levels of 25-hydroxyvitamin D (25(OH)D). We used linear regression and restricted cubic spline models to analyse the association between exposure (serum 25(OH)D) and outcome (PISA).

RESULTS

The linear regression model showed that, after adjusting for potential confounders, participants in the lowest quartile of serum 25(OH)D had 41.0 mm2 more PISA (95% confidence interval [CI]: 4.6-77.5) than the reference group (the highest quartile of serum 25(OH)D). The spline model showed that the association between serum 25(OH)D and PISA was non-linear and restricted to the low 25(OH)D range. PISA initially sharply decreased as serum 25(OH)D increased, and then the decreasing trend slowed and plateaued. The inflection point with the minimum PISA value was a serum 25(OH)D level of 27.1 ng/mL, above which there was no decreasing trend in PISA with increasing serum 25(OH)D levels.

CONCLUSIONS

Low vitamin D status had an L-shaped association with periodontal inflammation in this cohort of Japanese adults.

Periodontal Disease and Other Adverse Health Outcomes Share Risk Factors, including Dietary Factors and Vitamin D Status

For nearly a century, researchers have associated periodontal disease (PD) with risks of other adverse health outcomes such as cardiovascular disease, diabetes mellitus, and respiratory diseases, as well as adverse pregnancy outcomes. Those findings have led to the hypothesis that PD causes those adverse health outcomes either by increasing systemic inflammation or by the action of periodontopathic bacteria. However, experiments largely failed to support that hypothesis. Instead, the association is casual, not causal, and is due to shared underlying modifiable risk factors, including smoking, diet, obesity, low levels of physical activity, and low vitamin D status. Diabetes mellitus is also considered a risk factor for PD, whereas red and processed meat are the most important dietary risk factors for diabetes. Because PD generally develops before other adverse health outcomes, a diagnosis of PD can alert patients that they could reduce the risk of adverse health outcomes with lifestyle changes. In addition, type 2 diabetes mellitus can often be reversed rapidly by adopting an anti-inflammatory, nonhyperinsulinemic diet that emphasizes healthful, whole plant-based foods. This review describes the evidence that proinflammatory and prohyperinsulinemia diets and low vitamin D status are important risk factors for PD and other adverse health outcomes. We also make recommendations regarding dietary patterns, food groups, and serum 25-hydroxyvitamin D concentrations. Oral health professionals should routinely inform patients with PD that they could reduce their risk of severe PD as well as the risks of many other adverse health outcomes by making appropriate lifestyle changes.

Association of vitamin D in individuals with periodontitis: an updated systematic review and meta-analysis

BACKGROUND

There are differences in vitamin D levels between periodontitis and healthy individuals, but the effect of vitamin D on periodontitis is controversial. The purpose of this Meta-analysis is twofold: (1) compare vitamin D levels in individuals with or without periodontitis; (2) assess the effects of vitamin D supplementation during scaling and root planing (SRP) on periodontal clinical parameters in individuals with periodontitis.

METHODS

A systematic search was conducted in five databases (PubMed, Web of Science, MEDLINE, EMBASE, and Cochrane library), published from the database inception to 12 September 2022. The Cochrane Collaboration Risk of bias (ROB) assessment tool, the risk of bias in non-randomized studies of intervention (ROBINS-I) tool, the Newcastle-Ottawa Quality Assessment Scale (NOS), and Agency for Healthcare Quality and Research (AHRQ) were used to evaluate randomized controlled trial (RCT), non-RCT, case-control study, and cross-sectional study, respectively. Statistical analysis was performed using RevMan 5.3 and Stata 14.0 software, with weighted mean difference (WMD), standardized mean difference (SMD) and 95% confidence intervals (CI) as the effect measures, and heterogeneity was tested by subgroup analysis, sensitivity analysis, Meta-regression.

RESULTS

A total of 16 articles were included. The results of Meta-analysis showed that periodontitis was associated with lower serum vitamin D levels compared to normal population (SMD = -0.88, 95%CI -1.75 ~ -0.01, P = 0.048), while there was no significant difference in serum or saliva 25(OH)D levels between periodontitis and normal population. Additionally, the Meta-analysis showed that SRP + vitamin D and SRP alone had a statistically significant effect on serum vitamin D levels in individuals with periodontitis (SMD = 23.67, 95%CI 8.05 ~ 32.29, P = 0.003; SMD = 1.57, 95%CI 1.08 ~ 2.06, P < 0.01). And SRP + vitamin D could significantly reduce clinical attachment level compared to SRP alone (WMD = -0.13, 95%CI -0.19 ~ -0.06, P < 0.01), but had no meaningful effect on probing depth, gingival index, bleeding index, respectively.

CONCLUSION

The evidence from this Meta-analysis suggests that the serum vitamin D concentration of individuals with periodontitis is lower than that of normal people, and SRP along with vitamin D supplementation has been shown to play a significant role in improving periodontal clinical parameters. Therefore, vitamin D supplementation as an adjuvant to nonsurgical periodontal therapy has a positive impact on the prevention and treatment of periodontal disease in clinical practice.

The role of vitamin D in periodontal health and disease

Vitamin D plays an essential role in calcium and bone metabolism, immune regulation and possesses profound anti-inflammatory effects. Evidence suggests that low serum vitamin D is associated with increased severity of periodontitis, a chronic inflammatory condition characterised by destruction of the supporting tissues surrounding the tooth, which has several shared risk factors with other chronic non-communicable diseases. The biological functions of vitamin D are mediated by its strong anti-microbial, anti-inflammatory, and host modulatory properties. Experimental periodontitis models involving targeted deletion of 1α-hydroxylase, the enzyme responsible for the conversion of inactive substrate to active 1,25(OH)₂ D₃ (calcitriol), showed augmented alveolar bone loss and gingival inflammation. Vitamin D receptor (VDR) gene polymorphisms have also been associated with increased severity of periodontitis. Thus, the involvement of vitamin D in the pathogenesis of periodontitis is biological plausible. Clinical studies have consistently demonstrated an inverse relationship between serum 25OHD₃ and periodontal disease inflammation. However, due to the paucity of well-designed longitudinal studies, there is less support for the impact of vitamin D status on periodontal disease progression and tooth loss. The evidence emphasises the importance of maintaining vitamin D sufficiency in supporting periodontal health. This review aims to first examine the biological mechanisms by which vitamin D might influence the pathogenesis of periodontal disease and second, discuss the clinical evidence which implicate the role of vitamin D in periodontal disease.

Comparison of serum levels of vitamin D in periodontitis patients with and without type 2 diabetes and healthy subjects

OBJECTIVE

The purpose of this study is to find out the levels of serum vitamin D in periodontitis patients with and without type 2 diabetes and to compare them with healthy subjects.

METHODS

In this study, 48 periodontitis patients with type 2 diabetes mellitus (PDM), 53 periodontitis patients (P), and 42 controls who were in the age ranges of 30-50 years and had the entry requirements were selected. Plaque index, calculus index, modified gingival index, pocket depth, clinical attachment loss (CAL), and tooth loss were measured. Serum 25(OH)D level was estimated by electrochemiluminescence immunoassay, and fasting blood sugar and glycosylated hemoglobin were estimated by biochemical colorimetric assays.

RESULTS

The mean serum 25(OH)D level was 17.06 ± 10.73, 15.12 ± 7.74, and 14.17 ± 11.04 ηg/ml for PDM, P, and control groups, respectively, showing no statistical difference. The mean CAL was significantly high in diabetic patients as compared to other groups. Prediabetes prevalence was significantly high in periodontitis patients as compared to controls.

CONCLUSIONS

The prevalence of vitamin D insufficiency was high in the population studied. Serum levels of 25(OH)D showed no significant difference between groups. Periodontitis patients showed an elevated risk for diabetes.

Periodontal damage after thermal inhalation injury - The impact of high temperature inhalation injury on long term periodontal health

PURPOSE

Thermal inhalation injury is a common, life-threatening problem in burned patients. Whether or not this single event of damage to the oral integrity causes long term health problems is yet to be examined.

MATERIAL AND METHODS

All consecutive burn patients between 2014 and 2017 of Marienhospital Stuttgart (MHS), Germany, with at least 10% of burned skin surface were included and compared. The Periodontal Screening Index as well as Vitamin D levels were examined. Vitamin D has been suspected to contribute to the genesis of periodontitis. Risk factors and subjective oral life quality were prompted.

RESULTS

We included a total of 32 patients, 15 of which had an inhalation injury in their medical history. Risk factors were examined via Renatus' questionnaire. While risk factors were equally distributed in both groups we saw a remarkable difference in periodontal integrity, with the Periodontal Screening Index (PSI) per sextant differing drastically (with inhalation injury: 2.40, without inhalation injury: 1.10, p < 0.001). Patients with an inhalation injury had a mean of 5.2 out of 6 possible sextants with a pathologic PSI (with the median being 6/6), while patients without an inhalation injury had a mean of 1.83 out of 6 (median: 1/6), p < 0.001. The oral health impact profile showed a difference as well, albeit without statistical significance (with inhalation injury: median = 11, without: median = 3.5, p = 0.414). A correlation between Serum Vitamin D levels and periodontal integrity could not be seen in this group.

CONCLUSION

Inhalation injury is a possible cause for periodontitis and hence impacts the quality of life of burned patients.

The Relationship Between Low Serum Vitamin D Level and Early Dental Implant Failure: A Systematic Review

The variety in shape and type of dental implants in the present time is considered one of the most successful evolutions in dentistry. This facilitates dental treatment options to restore patient function and appearance. However, numerous significant factors influence the predictability of survival or the success rates of dental implants, some of which, such as vitamin D levels, have not been included in many studies. The main purpose of this systematic review was to investigate whether there is a relationship between low serum levels of vitamin D and early dental implant failures (EDIFs). Our literature search involved international databases including PubMed, Directory of Open Access Journals (DOAJ), and Web of Science. Initially, according to our search criteria, 1200 studies were found. After excluding duplicates, incomplete studies, and studies not meeting our inclusion criteria, only six human studies were included in this research and analyzed. Finally, upon meticulous analysis of included studies, this systematic review revealed inconsistent results in articles with respect to the association between vitamin D deficiency and implant failures. Large-scale studies, especially clinically relevant studies, on this subject is recommended.

Tropical Oral Disease: Analysing Barriers, Burden, Nutrition, Economic Impact, and Inequalities

Traditionally, a healthy mouth is a good indicator of good general health. Poor oral hygiene reflects the health of the oral cavity and is a risk factor for overall health. Although oral diseases like dental decay and periodontitis are prevalent, awareness of oral diseases is still limited. Oral disorders include a wide range of diseases that may not be confined to the oral anatomical structures but may be manifestations of systemic diseases. Identification of the risk factors of dental and oral diseases, including socio-economic determinants, plays a major role in the type of oral health care, and in the promotion of dental health awareness. This article reviews oral diseases in the Caribbean and aims to raise awareness of this subject while suggesting a research agenda for the region.

The association between vitamin D level and periodontal disease in Saudi population, a preliminary study

OBJECTIVE

Among other regulatory functions, vitamin D has a role in modulating the inflammatory process of periodontal disease. Therefore, this retrospective study aimed to assess the relationship between vitamin D levels and periodontal health in dental patients from the Eastern Province of Saudi Arabia.

METHODS

Radiographs and serum vitamin D levels of patients seeking dental treatment were collected. Exclusion criteria were systemic disease, smoking, recent vitamin D supplementation, and previous periodontal surgery. Gender, age, and alveolar crest height (ACH) were recorded. A total of 67 patients were categorized into three groups according to their serum vitamin D level (<10, <20, and > 20 ng/mL) and their bone loss compared.

RESULTS

Differences in means were compared by t-test. ANOVA was used to compare vitamin D groups and the corresponding ACH, as well as the correlation (p < .05). Patients with vitamin D levels > 20 ng/mL demonstrated a mean ACH of 1.6 mm. The mean ACH was 3.1 mm for those with vitamin D levels < 20 ng/mL, and 4.6 mm for vitamin D levels < 10 ng/mL. A weak negative correlation was found between vitamin D and ACH in all groups (r = -0.055, p = .7).

CONCLUSION

Serum vitamin D level seems to be an important factor that influences oral health, especially the periodontal condition, of both male and female patients.

Association between periodontitis and vitamin D status: A case-control study

Vitamin D deficiency and periodontitis are commonly prevalent among Saudi adults. However, the association between periodontitis and vitamin D status has not been well documented. This study aims to examine the association between periodontitis and vitamin D status among adults in the Albaha region of Saudi Arabia. A case-control study of 123 Saudi adults was conducted; 60 had severe or moderate periodontitis, and 63 were periodontally healthy. Data was collected by an online self-reported sociodemographic questionnaire. All participants then underwent a full periodontal examination. Blood samples were also provided to assess participants' vitamin D statuses through serum levels of 25-hydroxyvitamin D (25(OH)D). A total of 60 cases and 63 controls matched for BMI (30.2 ± 4.86 kg/m²), age (40.01 ± 7.73 years), and sex (46.3% and 53.7% male and female, respectively) participated in the study. Mean levels of 25(OH)D were significantly lower in periodontitis participants than in controls (25.03 ± 8.55 ng/ml, 29.19 ± 12.82 ng/ml, p = 0.037, respectively). Lower odds of periodontitis were detected per unit of 25(OH)D level (OR 0.964, 95% CI; 0.931-0.999, p = 0.043). In conclusion, periodontitis is significantly associated with deficient and insufficient levels of vitamin D among Saudi adults in the Albaha region. Future longitudinal research with a larger sample size may be suggested to confirm these results.

Expanding the Capabilities of Nutrition Research and Health Promotion Through Mobile-Based Applications

Mobile-based applications are popular and prevalently used in the US population. Applications focusing on nutrition offer platforms for quantifying and changing behaviors to improve dietary intake. Such behavior changes can intervene in the relation of diet to promote health and prevent disease. Mobile applications offer a safe and convenient way to collect user data and share it back to users, researchers, and to health care providers. Other lifestyle factors like activity, sleep, and sedentary behavior, can also be quantified and included in investigations of how lifestyle is related to health. Yet, challenges in the assessment offered through mobile applications and effectiveness to change behavior still remain, including rigorous evaluation, demonstration of successful health improvement, and participant engagement. The data mobile applications generate, however, expands opportunities for discovery of the integrated and time-based nature of various daily activities in relation to health. This article is a summary of a symposium at Nutrition 2020 Live Online on the role of mobile applications as a tool for nutrition research and health promotion. The types and capabilities of mobile applications, challenges in their evaluation and use in research, and opportunities for the data they generate along with a specific example, are reviewed.

1α,25-dihydroxyvitamin D3 promotes early osteogenic differentiation of PDLSCs and a 12-year follow-up case of early-onset vitamin D deficiency periodontitis

Periodontitis is a chronic periodontal disease that contributes to tooth loss. In recent years, many animal studies have reported that vitamin D (VitD) deficiency results in chronic periodontitis. However, no studies have reported cases of early-onset periodontitis with VitD deficiency. This study reports a 5-year-old male patient with early-onset periodontitis, VitD deficiency and VitD receptor (VDR) mutation. The patient was treated with VitD and calcium, and received systematic periodontal treatment. During the 12-year treatment, the periodontal conditions of this patient were stable. Our in vitro study found that VitD could promote the expression of alkaline phosphatase (ALP), runt-related transcription factor 2 (Runx2), bone morphogenetic protein 2 (BMP2), bone gamma-carboxyglutamate protein (BGLAP), and VDR in the early osteogenic differentiation of periodontal ligament stem cells (PDLSCs). Meanwhile, VitD could downregulate mRNA expression levels of Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interleukin-1β (IL-1β) and protein levels of IL-6 in the tumor necrosis factor-α (TNF-α) -induced inflammation of PDLSCs. Therefore, sufficient VitD supply can be a potential treatment for VitD deficiency induced early-onset periodontitis.

Low serum 25-hydroxyvitamin D levels, tooth loss, and the prevalence of severe periodontitis in Koreans aged 50 years and older

PURPOSE

Vitamin D deficiency may cause bone loss and increased inflammation, which are well-known symptoms of periodontal disease. This study investigated whether serum 25-hydroxyvitamin D (25(OH)D) levels are associated with periodontal disease status and tooth loss.

METHODS

Cross-sectional data from 5,405 individuals aged ≥50 years (2,253 males and 3,152 females) were obtained from the 2008-2010 Dong-gu study, a prospective cohort study of risk factors for chronic diseases. Periodontal examinations were conducted to evaluate the number of remaining teeth, the periodontal probing depth (PPD), the clinical attachment level (CAL), and bleeding on probing. The percentages of sites with PPD ≥4 mm and CAL ≥4 mm were recorded for each participant. The severity of periodontitis was classified using the Centers for Disease Control and Prevention and the American Academy of Periodontology case definitions. Serum 25(OH)D levels were classified as reflecting severe deficiency, deficiency, insufficiency, or sufficiency. Multivariate linear regression analysis was performed to assess the associations of serum 25(OH)D levels with periodontal parameters and the number of remaining teeth after adjusting for confounders including age, smoking status, alcohol consumption status, month of blood collection, and physical activity. Multivariate logistic regression was used to evaluate the association between serum vitamin D levels and severe periodontitis. An overall statistical analysis and a stratified analysis by sex were performed.

RESULTS

Overall, the rates of severe deficiency, deficiency, insufficiency, and sufficiency were 6.5%, 67.9%, 22.4%, and 3.2%, respectively. After adjustment for confounders, vitamin D levels were directly associated with the number of remaining teeth, an association that was significant in males, but not in females. Sufficient serum 25(OH)D was associated with a low frequency of severe periodontitis.

CONCLUSIONS

This population-based cross-sectional study indicates that low serum 25(OH)D is significantly associated with tooth loss and severe periodontitis in Koreans aged 50 years and older.

Relationship between risk markers for cardiovascular disease and peri-implant diseases

Background

The aim of this paper is to explore the serum biochemical parameters also known as risk markers for cardiovascular system, in individuals who have received dental implant treatment, and to reveal risk factors for peri-implant diseases.

Methods

The study included 58 subjects with peri-implantitis, 49 subjects with peri-implant mucositis, and 49 healthy subjects. All the subjects were assessed in terms of both peri-implant clinical parameters—probing depth (PD), bleeding on probing (BOP), the type of prosthesis, gingival index (GI), keratinized mucosa width (KMW), and plaque index (PI)—and serum biochemical parameters (e.g., LDL cholesterol, HDL cholesterol, triglyceride, total cholesterol, vitamin D, uric acid, white blood cell (WBC), neutrophil, hemoglobin (Hb), and platelet counts).

Results

KMW was the lowest in the peri-implantitis group. Compared with the other groups, the peri-implantitis group showed significantly higher levels of triglyceride, uric acid, and WBC. The peri-implantitis group had the lowest level of vitamin D. Triglyceride and uric acid levels had positive correlations with peri-implant clinical parameters.

Conclusion

High levels of triglyceride and uric acid may pose a risk for both peri-implant diseases and cardiovascular diseases. Prior to dental implant surgery, patients’ serum biochemical parameters should be checked.

Vitamin D and Periodontitis: A Systematic Review and Meta-Analysis

To explore the vitamin D levels of periodontitis patients in comparison with periodontally healthy ones, and to assess the influence of vitamin D supplementation as an adjunctive during nonsurgical periodontal treatment (NSPT). Five databases (Pubmed, Embase, Scholar, Web of Sciences, and Cochrane Library) were searched until May 2020. Mean difference (MD) meta-analysis with corresponding 95% confidence interval (95% CI) and sensitivity tests via meta-regression were used. We followed Strength of Recommendation Taxonomy (SORT) to appraise the strength and quality of the evidence. Sixteen articles were included, fourteen case-control and two intervention studies, all reporting 25-hydroxyvitamin D (25(OH)D) levels. Compared with the healthy controls, the circulating 25(OH)D levels were significantly lower in chronic periodontitis patients (pooled MD = -6.80, 95% CI: -10.59 to -3.02). Subgroup analysis revealed differences among 25(OH)D measurements, with liquid chromatography-mass spectrometry being the most homogeneous method (pooled MD = -2.05, 95% CI: -3.40 to -0.71). Salivary levels of 25(OH)D showed no differences between groups. Due to the low number of studies, conclusions on aggressive periodontitis and in the effect of vitamin D supplementation after NSPT were not possible to ascribe. Compared with healthy controls, 25(OH)D serum levels are significantly lower in chronic periodontitis patients, with an overall SORT A recommendation. Future studies are needed to clarify the effect of vitamin D supplementation and the biological mechanisms linking vitamin D to the periodontium.

Limited Evidence Suggests That Vitamin D May Help Prevent and Treat Periodontal Disease in Adults

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Serum vitamin D levels and chronic periodontitis in adult, Caucasian population-a systematic review. Peric M, Cavallier E, Toma S, Lasserre JF. J Periodontal Res 2018; 53:645-56.

SOURCE OF FUNDING

Information not available/none declared.

TYPE OF STUDY/DESIGN

Systematic review.

Could Vitamin D influence risk for Periodontal Disease - to "D" or not to "D"?

PURPOSE OF REVIEW

The purpose of this review is to discuss the literature on associations between vitamin D and periodontal disease, including its strengths and weaknesses. Future direction for continued work in this area is provided.

RECENT FINDINGS

Research in cross-sectional cohorts, surveys, and case-control studies provide support for a role of vitamin D in periodontal disease, especially using clinical indicators such as bleeding on probing and clinical attachment loss. However, these studies have a number of limitations. They cannot establish temporality of these associations. Most case-control studies have been limited in sample size and have inconsistent findings. A number of cross-sectional studies are restricted to select populations (e.g., persons with HIV, diabetes, rheumatoid arthritis) limiting extrapolation of findings to the general aging population.Fewer prospective studies have been conducted, and only three have examined associations using a biomarker for vitamin D that reflects exposure from all its sources (sunlight, diet and supplements). One study is limited by using self-reported measures of disease outcomes, and only two used measures of alveolar crestal height. However, of the prospective studies published, there is a suggestion that vitamin D might prevent against tooth loss. Only two randomized controlled trials have examined these associations, and they support the effects of vitamin D supplementation on prevention of tooth loss and gingival bleeding.

SUMMARY

We strongly suggest that new research should focus on prospective study designs with followup of participants longer than a decade and long-term clinical trials. Such studies should incorporate measures of alveolar bone loss and tooth loss with indication for reason for tooth loss. Such clinical trials should be designed to examine both the influence of vitamin D supplementation alone as well as with other nutrients (e.g., calcium) or therapeutic medications (e.g., bisphosphonates). Currently, there is no strong evidence to suggest that vitamin D protects against development of periodontal disease.

The Role of Vitamins in Oral Health. A Systematic Review and Meta-Analysis

The association between vitamins and oral health have recently been discussed, yielding increased attention from medical and dental perspectives. The present review aimed to systematically evaluate and appraise the most recently scientific papers investigating the role of vitamins in the prevention and treatment of the main oral diseases as hard dental pathological processes and gum/periodontal disease. Randomized controlled trials, cross-sectional studies, cohort studies, comparative studies, validation studies and evaluation studies, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, reporting associations between vitamins and oral diseases or the use of vitamins to prevent or treat oral diseases in patients of any age were included. PubMed, Embase and Scopus were searched to November 2019 using an ad hoc prepared search string. All the papers meeting the inclusion criteria were subjected to a quality assessment. The search identified 1597 papers; 741 were selected after removing duplicates. A total of 334 articles were excluded after title and abstract evaluation; 407 were assessed and 73 papers were full-text assessed; other 14 papers were discharged after full text evaluation, leaving finally 58 papers included. In general, there is weak evidence supporting the association between vitamins and both gingival/periodontal disease and hard dental pathological processes.

1,25-dihydroxyvitamin D3 suppresses lipopolysaccharide-induced interleukin-6 production through aryl hydrocarbon receptor/nuclear factor-κB signaling in oral epithelial cells

Background

Antiinflammatory effect of 1,25-dihydroxyvitamin D₃ (1,25D3) has been reported in periodontitis, but the exact mechanisms remain unclear. Oral epithelial cells are recently highlighted as an important regulator of inflammation in this disease. This in vitro study was established to investigate the effect of 1,25D3 on key proinflammatory cytokine IL-6 production and aryl hydrocarbon receptor (AhR)/nuclear factor-κB (NF-κB) signaling in oral epithelial cells upon the stimulation of lipopolysaccharide (LPS) from periodontal pathogens.

Methods

OKF6/TERT-2 oral keratinocytes were incubated with LPS and different concentrations of 1,25D3, and levels of IL-6 production were determined using enzyme-linked immunosorbent assay (ELISA). Expression of vitamin D receptor (VDR), and activation of AhR was examined using western blot analysis, and phosphorylation of NF-κB was detected using cell-based protein phosphorylation ELISA.

Results

1,25D3 inhibited LPS-induced IL-6 overexpression in OKF6/TERT-2 cells. Additionally, 1,25D3 increased VDR expression and AhR activation, and repressed NF-κB phosphorylation. Furthermore, 1,25D3 suppressed IL-6 expression and enhanced VDR expression and regulated AhR/NF-κB signaling activation in a dose-dependent manner after 48 h treatment.

Conclusions

These results suggest that 1,25D3 may inhibit LPS-induced IL-6 overexpression in human oral epithelial cells through AhR/NF-κB signaling. Our findings may provide an explanation for the antiinflammatory effect and therapeutic benefit of 1,25D3 in periodontitis.

Effects of 1,25-dihydroxyvitamin D3 on experimental periodontitis and AhR/NF-κB/NLRP3 inflammasome pathway in a mouse model

Vitamin D has been known to have important regulatory functions in inflammation and immune response and shows inhibitory effects on experimental periodontitis in animal models. However, the potential mechanism has yet to be clarified. Recent studies have highlighted Aryl hydrocarbon receptor (AhR) and its downstream signaling as a crucial regulator of immune homeostasis and inflammatory regulation.

OBJECTIVE

This study aimed to clarify the effect of 1,25-dihydroxyvitamin D3 (VD3) on experimental periodontitis and AhR/nuclear factor-κB (NF-κB)/NLR pyrin domain-containing 3 (NLRP3) inflammasome pathway in the gingival epithelium in a murine model.

METHODOLOGY

We induced periodontitis in male C57BL/6 wild-type mice by oral inoculation of Porphyromonas gingivalis (P. gingivalis), and subsequently gave intraperitoneal VD3 injection to the mice every other day for 8 weeks. Afterwards, we examined the alveolar bone using scanning electron microscopy (SEM) and detected the gingival epithelial protein using western blot analysis and immunohistochemical staining.

RESULTS

SEM images demonstrated that alveolar bone loss was reduced in the periodontitis mouse model after VD3 supplementation. Western blot analyses and immunohistochemical staining of the gingival epithelium showed that the expression of vitamin D receptor, AhR and its downstream cytochrome P450 1A1 were enhanced upon VD3 application. Additionally, VD3 decreased NF-κB p65 phosphorylation, and NLRP3, apoptosis-associated speck-like protein, caspase-1, interleukin-1β (IL-1β) and IL-6 protein expression.

CONCLUSIONS

These results implicate the alleviation of periodontitis and the alteration of AhR/NF-κB/NLRP3 inflammasome pathway by VD3 in the mouse model. The attenuation of this periodontal disease may correlate with the regulation of AhR/NF-κB/NLRP3 inflammasome pathway by VD3.

Epidemiologic evaluation of Nhanes for environmental Factors and periodontal disease

Periodontitis is a chronic inflammation that destroys periodontal tissues caused by the accumulation of bacterial biofilms that can be affected by environmental factors. This report describes an association study to evaluate the relationship of environmental factors to the expression of periodontitis using the National Health and Nutrition Examination Study (NHANES) from 1999-2004. A wide range of environmental variables (156) were assessed in patients categorized for periodontitis (n = 8884). Multiple statistical approaches were used to explore this dataset and identify environmental variable patterns that enhanced or lowered the prevalence of periodontitis. Our findings indicate an array of environmental variables were different in periodontitis in smokers, former smokers, or non-smokers, with a subset of specific environmental variables identified in each population subset. Discriminating environmental factors included blood levels of lead, phthalates, selected nutrients, and PCBs. Importantly, these factors were found to be coupled with more classical risk factors (i.e. age, gender, race/ethnicity) to create a model that indicated an increased disease prevalence of 2-4 fold across the sample population. Targeted environmental factors are statistically associated with the prevalence of periodontitis. Existing evidence suggests that these may contribute to altered gene expression and biologic processes that enhance inflammatory tissue destruction.

Relationship between Clinical Indicators of Periodontal Disease and Serum Level of Vitamin D

Background: Vitamin D is obtained through food and nutritional supplements, or is synthesized in the skin by sunshine. It is then transferred to the liver and kidney through the bloodstream and hydroxylated by a specific enzyme (cytochrome P450 family 27 subfamilies A member 1, cytochrome P450 family 27 subfamily B member 1) to form 25-hydroxyvitamin D and 1,25-dihydroxy vitamin D. The vitamin D synthesis facilitates calcium and phosphorus absorption from the intestines. The parathyroid hormone helps to synthesize 1,25-dihydroxy vitamin D to aid calcium absorption. Objectives: Many researchers have investigated the relationship between serum vitamin D levels and periodontal disease. And periodontal disease indicators such as bleeding on probing, pocket depth, clinical attachment level, gingival index, and cementoenamel junction-alveolar cresthave been used to identify the effects of vitamin D on periodontal disease. The effects of vitamin D on bacteria or cytokines have also been investigated. In this review article, vitamin D levels according to the status of periodontal disease were summarized. Data sources: PubMed was searched electronically, and randomized clinical trials, cross-sectional studies, and case-control studies were included in the review. Study appraisal and synthesis methods: Articles that the classification of periodontitis was accurately described, indicators for identifying periodontitis was clearly marked, and the form of vitamin D measured in the study was accurately described were selected. Only highly relevant journals were selected and summarized. Results: Most of the research has found positive associations between the serum 25-hydroxyvitamin D level and periodontal health, and the clinical parameters of periodontal disease were reduced by vitamin D. Limitations: Detailed categorization of the characteristics associated with the 25-hydroxyvitamin D level should be needed in future studies. Conclusions: This review article can be used as a guide by clinicians and as a reference book for patients’ education.

Evaluation and comparison of Vitamin D receptors in periodontal ligament tissue of Vitamin D-deficient chronic periodontitis patients before and after supplementation of Vitamin D3

Background:

Vitamin D, an important hormone required by the body, exerts its biological effects through Vitamin D receptors (VDRs) present on target cells. Vitamin D is ineffective in tissues which lack VDR. Various tissues show the presence of VDRs. However, evidence for the presence of VDRs in human periodontal ligament tissue in fully erupted teeth in adults is lacking. The present study intends to evaluate the presence of VDRs in periodontal ligament (PDL) tissue and assess their response to serum Vitamin D3 levels in chronic periodontic patients.

Materials and Methods:

A total of 19 chronic periodontitis patients were enrolled in the study and tested for serum 25(OH)D3 levels. Deficient patients were supplemented with Vitamin D3. PDL tissue of these patients was isolated after tooth extraction before and after supplementation of Vitamin D3 and analyzed for the presence of VDR in PDL tissue by using enzyme-linked immunosorbent assay.

Results:

All the chronic periodontitis patients were found to be deficient in Vitamin D3. The mean serum 25(OH)D3 level before supplementation was 13.96 ng/mL which significantly increased to 35.12 ng/mL after supplementation of Vitamin D3 for 6 weeks. VDR analysis determined mean VDR conc. in PDL tissue to be -1.443 ng/mL, which increased to 2.38 ng/mL after supplementation. A concentration dependent correlation was seen between serum 25(OH)D3 levels and VDR conc. in PDL tissue after supplementation.

Conclusions:

The study determined Vitamin D Receptors (VDR) in PDL tissue after supplementation of Vitamin D. Thus in addition to the standard treatment modalities, Vitamin D3 supplementation would be an important factor for generation of adequate immune response.

Serum Nutrient Levels and Aging Effects on Periodontitis

Periodontal disease damages tissues as a result of dysregulated host responses against the chronic bacterial biofilm insult and approximately 50% of US adults >30 years old exhibit periodontitis. The association of five blood nutrients and periodontitis were evaluated due to our previous findings regarding a potential protective effect for these nutrients in periodontal disease derived from the US population sampled as part of the National Health and Nutrition Examination Survey (1999⁻2004). Data from over 15,000 subjects was analyzed for blood levels of cis-β-carotene, β-cryptoxanthin, folate, vitamin D, and vitamin E, linked with analysis of the presence and severity of periodontitis. Moderate/severe disease patients had lower cis-β-carotene levels across all racial/ethnic groups and these decreased levels in moderate/severe periodontitis were exacerbated with age. β-cryptoxanthin demonstrated lower levels in severe disease patients across the entire age range in all racial/ethnic groups. Folate differences were evident across the various age groups with consistently lower levels in periodontitis patients >30 years and most pronounced in females. Lower levels of vitamin D were consistently noted across the entire age range of patients with a greater difference seen in females with periodontitis. Finally, an analytical approach to identify interactions among these nutrients related to age and periodontitis showed interactions of vitamin D in females, and folate with race in the population. These findings suggest that improving specific nutrient intake leading to elevated blood levels of a combination of these protective factors may provide a novel strategy to affect the significant increase in periodontitis that occurs with aging.

Age and Periodontal Health - Immunological View

PURPOSE OF THE REVIEW

Aging clearly impacts a wide array of systems, in particular the breadth of the immune system leading to immunosenescence, altered immunoactivation, and coincident inflammaging processes. The net result of these changes leads to increased susceptibility to infections, increased neoplastic occurrences, and elevated frequency of autoimmune diseases with aging. However, as the bacteria in the oral microbiome that contribute to the chronic infection of periodontitis is acquired earlier in life, the characteristics of the innate and adaptive immune systems to regulate these members of the autochthonous microbiota across the lifespan remains ill defined.

RECENT FINDINGS

Clear data demonstrate that both cells and molecules of the innate and adaptive immune response are adversely impacted by aging, including in the oral cavity, yielding a reasonable tenet that the increased periodontitis noted in aging populations is reflective of the age-associated immune dysregulation. Additionally, this facet of host-microbe interactions and disease needs to accommodate the population variation in disease onset and progression, which may also reflect an accumulation of environmental stressors and/or decreased protective nutrients that could function at the gene level (ie. epigenetic) or translational level for production and secretion of immune system molecules.

SUMMARY

Finally, the majority of studies of aging and periodontitis have emphasized the increased prevalence/severity of disease with aging, all based upon chronological age. However, evolving areas of study focusing on "biological aging" to help account for population variation in disease expression, may suggest that chronic periodontitis represents a co-morbidity that contributes to "gerovulnerability" within the population.

Apolipoprotein E, periodontal disease and the risk for atherosclerosis: a review

The association between cardiovascular and periodontal diseases is characterized by chronic inflammatory processes, with a high prevalence worldwide and complex genetic-environment interactions. Although apolipoprotein E4 (ApoE4), one of the isoforms coded by a polymorphic APOE gene, has been widely recognized as a risk factor for cardiovascular diseases and as an immunoinflammatory factor, less is known regarding how ApoE4 affects atherosclerosis in periodontitis patients. The aim of this review was to investigate the potential underlying mechanisms related to APOE4 that could increase the risk of periodontal disease and, ultimately, of atherosclerosis. There have only been a few studies addressing apoE polymorphisms in patients with chronic periodontitis. To date, no studies have been performed that have assessed how ApoE4 affects atherosclerotic disease in chronic periodontitis patients. Although clinical studies are warranted, experimental studies have consistently documented the presence of periodontal pathogens, which are usually found in the oral cavity and saliva, in the atherosclerotic plaques of ApoE-deficient mice. In addition, in this review, the potential role of the APOE4 allele as an example of antagonistic pleiotropy during human evolution and its relation to oral health is discussed.

Vitamin D deficiency in patients with aggressive periodontitis

OBJECTIVES

Vitamin D deficiency is a frequent health problem worldwide, especially as fewer people spend much time in the sun. Vitamin D deficiency is linked to several infectious and inflammatory conditions, including periodontal disease. However, its role in aggressive periodontitis (AgP) has not been well studied. We evaluated the association between vitamin D concentration and periodontal disease, both AgP and chronic (CP) periodontitis.

METHOD AND MATERIALS

Forty-seven AgP 55 CP and 27 control subjects participated. All patients were tested for serum vitamin D concentration (25(OH)D), parathyroid hormone, and serum bone-related biomarkers (alkaline phosphatases, calcium, and phosphorus) regulated by vitamin D.

RESULTS

The patients with AgP had lower serum 25(OH)D concentration (11.22 ± 4.8 ng/ml) than controls (16.9 ± 6.4 ng/ml) and patients with CP (16.13 ± 8.3 ng/ml; overall p value 0.0002). These associations remained significant after adjustment for age and gender (p = 0.002). No significant differences were observed in any bone-related biomarker among the three groups, and no association was observed with periodontal disease indices.

CONCLUSIONS

Our results suggest that vitamin D deficiency may be a potential risk factor for AgP. Given the high prevalence of vitamin D deficiency in AgP patients, routine screening for vitamin D status may be advisable in these subjects.

Low serum vitamin D and early dental implant failure: Is there a connection? A retrospective clinical study on 1740 implants placed in 885 patients

Background. Since osseointegration depends on bone metabolism, low levels of vitamin D in the blood may negatively affect bone formation around dental implants. To date, only a few studies have investigated the possible connection between serum levels of vitamin D and early dental implant failure (EDIF), i.e. failure that occurs within 4 months after placement, before the connection of the prosthetic abutment. The aim of this study was to investigate whether there is a relationship between low serum levels of vitamin D and EDIF.

Methods. Data used for this retrospective study were derived from the records of a private dental clinic. Inclusion criteria were patients who had been treated with dental implants, inserted with a submerged technique from January 2003 to December 2017. EDIF was the outcome of this study. Chi-squared test was used to investigate the effect of patient-related variables (age, gender, smoking habit, history of periodontal disease and serum levels of vitamin D) on EDIF.

Results. Originally, 885 patients treated with 1,740 fixtures were enrolled in this study. Overall, 35 EDIFs (3.9%) were reported. No correlation was found between EDIF and the patients' gender (P=0.998), age (P=0.832), smoking habit (P=0.473) or history of periodontal disease (P=0.386). Three EDIFs (11.1%) were reported in 27 patients with serum levels of vitamin D <10 ng/mL, 20 EDIFs (4.4%) in 448 patients with levels between 10 and 30 ng/mL, and 12 EDIFs (2.9%) in 410 patients with levels >30 ng/mL. Although there was a clear trend toward an increased incidence of EDIF with lowering of serum vitamin D levels, no statistically significant difference (P=0.105) was found among these three groups.

Conclusion. Within its limitations (retrospective design, low number of patients with severe blood levels of vitamin D enrolled), this study failed to demonstrate a significant relationship between low serum levels of vitamin D and increased risk of EDIF. However, since a dramatic increase in EDIFs with lowering of vitamin D levels in the blood has been reported, further clinical studies with appropriate design (prospective or randomized controlled studies on a larger sample of severely deficient patients) are needed to better investigate this topic

Relationship between VITAMIN D and chronic periodontitis

Introduction

Chronic periodontitis is a multifactorial disease primarily caused by plaque microorganisms, modified from the immune inflammatory response to chronic infection, which leads to the destruction of periodontal tissues in a susceptible host. It is very well known that vitamin D plays a vital role in bone homeostasis and immunity. There can be a biologic rationale to suspect that Vitamin D deficiency could negatively affect the periodontium. Present study was conducted to investigate any relationship between periodontitis and vitamin D.

Material and method

The clinico-biochemical relationship study was carried out in 168 subjects with Chronic Periodontitis. Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL) are correlated with serum level of Vitamin D.

Results

Statistically significant relationship between serum 25(OH) D level and periodontal parameters namely GI, PPD and CAL were observed.No relationship between 25(OH) D levels and PI was observed.This study also revealed overall low levels of serum Vitamin D in patients with chronic periodontitis but the levels of Vitamin D did not decrease with the increase in the severity of periodontitis.

Conclusion

A statistically significant relationship between serum 25(OH) D level and periodontal parameters namely GI, PPD and CAL were observed. No relationship between 25(OH) D levels and PI was observed.

Serum vitamin D levels and chronic periodontitis in adult, Caucasian population-a systematic review

The aim of this systematic review was to explore the relationship between serum vitamin D levels and periodontal disease. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The focused PICO question was: Are serum vitamin D levels (I) associated with gingivitis or periodontitis (C) in healthy humans (P)? PubMed (Medline), Embase, Science Direct, the Cochrane library, and grey literature were searched up to 31 July 2017. Two reviewers independently selected studies and extracted data. Quality, risk of bias, and heterogeneity of the studies were assessed using the Newcastle-Ottawa Scale. In total, 365 studies were identified and 24 were analyzed. Seven studies fulfilled the inclusion criteria. Four case-control studies showed an influence of vitamin D and its metabolites on periodontal health status/disease. One interventional study suggested the proposed anti-inflammatory role of vitamin D. Two cross-sectional studies failed to show a relationship between vitamin D and periodontal condition. The literature on the effect of serum vitamin D levels on periodontal status remains scarce and controversial. Some data, however, support a "perio-protective" role for vitamin D. There is a need for well-designed randomized clinical trials to explore the possible anti-inflammatory effect of vitamin D on periodontal health.

Nutraceuticals in Periodontal Health: A Systematic Review on the Role of Vitamins in Periodontal Health Maintenance

Periodontal disease, a relevant public health problem worldwide, is generally considered a common pathology of elderly people. In this respect, there is agreement about that nutritional status may be a modifying factor in the progression and healing of the periodontal tissues. Vitamins have been recommended as nutraceuticals for prevention and treatment of some pathological conditions, such as cardiovascular diseases, obesity or cancer. Thus, a systematic approach to determining how the different vitamin type could ameliorate periodontal risks or improve periodontal health is necessary to further the understanding of the potential benefits and risks of vitamins supplementation use. For this, a systematic review of English-written literature in PubMed until February 2018, which included both human and animal research on the relationship of each vitamin with periodontal disease, was conducted. Among all the analyzed vitamins those with antioxidant capacity and effects on immune system seem to be useful for prevention or improvement of periodontal disease, as well as those implicated in bone metabolism. In the first case, there are quite information in favor of various vitamins, mainly vitamin C, that is the most studied. In the second case, vitamin D seems to have the most relevant role.

Vitamin D levels and risk for periodontal disease: A systematic review

OBJECTIVE

To evaluate the existing evidence supporting or refuting the following questions: (i) Do patients with lower vitamin D levels have higher risk for periodontal disease? (ii) Are periodontal treatment outcomes improved by the adjuvant supplementation of vitamin D or by elevated serum vitamin D levels?

MATERIAL AND METHODS

MEDLINE, SCOPUS, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched up to September 2017. Studies were included if they had measured serum vitamin D levels or vitamin D intake and any periodontal parameter.

RESULTS

Overall, 27 studies were included (13 cross-sectional studies, 6 case-control studies, 5 cohort studies, 2 randomized clinical trials and 1 case series study). Sixty-five percent of the cross-sectional studies reported significant associations between low vitamin D levels and poor periodontal parameters. None of the observational longitudinal studies found that periodontal disease progression could be attributed to lower vitamin D levels. No interventional studies that evaluated the use of vitamin D supplementation as a solely adjuvant to periodontal treatment was found. No meta-analysis was performed due to high variability across studies.

CONCLUSION

The data to support or refute the association between vitamin D levels and periodontal disease are inconclusive at the moment. More rigorously designed longitudinal studies with standardized definitions of periodontal disease and vitamin D are necessary.

Factors associated with the risk of gingival disease in patients with rheumatoid arthritis

Gingival disase and rheumatoid arthritis (RA) are linked at both the epidemiologic and pathogenesis levels. In this study, we aimed to identify environmental factors associated with RA and gingival disease and to investigate factors that protect the gingival tissue in RA patients. This retrospective study analyzed 754 RA patients with gingival disease selected from the NHANES database who completed the mobile examination center interview/examination between 1999 and 2004. Data collected included demographics, lifestyle, dietary intake, and biomarkers. The study included 173 RA patients with gingival disease. Multivariate logistic regression analysis showed that the odds of gingival disease were significantly increased with male gender. However, the odds of gingival disease was significantly decreased with increased vitamin C intake (OR = 0.996, p = 0.041), and higher serum vitamin D levels (OR = 0.979, p = 0.011). Given the significant association between the prevalence of gingival disease and RA, identification of risk factors of gingival disease will be useful as a screening tool in national health surveys to improve the management of periodontal disease in patients with RA.