Nutrition and Oral Medicine (Nutrition and Health)

266 Part IV / Select Diseases and ConditionsTable 2Adult Dietary Reference Intake Values of Calciumand Vitamin D in the United States (49)Age Calcium (mg/d) Vitamin D (IU [µg]/d)0–6 mo 210 200 [5]6–12 mo 270 200 [5]1–3 yr 500 200 [5]4–8 yr 800 200 [5]9–13 yr 1300 200 [5]14–18 yr 1300 200 [5]19–30 yr 1000 200 [5]31–50 yr 1000 200 [5]51–70 yr 1200 400 [10]70 yr and older 1200 600 [15]an inverse association between calcium intake level (from diet only) and the odds ofhaving periodontal disease (defined as mean periodontal attachment loss 1.5 mm)among younger adults. The odds were nearly double in both men and women whosecalcium intake was below 800 mg/d relative to a higher intake. Although these findingssupport an association between low dietary calcium and increased risk of periodontaldisease, the study was limited by its cross-sectional design and lack of data on calciumsupplement use.Calcium intake was associated with a reduction in the risk of tooth loss in a 5-yr studyof elderly men and women (46). During the first 3 yr of the study, when placebos andsupplements containing 500 mg calcium and 700 IU vitamin D per day were randomlyassigned, the odds of losing any teeth were reduced by more than half in the supplementedgroup. In a 2-yr follow-up of the same individuals, the odds of tooth loss were again about50% lower in subjects whose total calcium intake was at least 1000 mg/d compared tothose who consumed less than 1000 mg.Calcium and vitamin D intakes have been associated with erosion of edentate regionsof the alveolar ridge. In several small cross-sectional studies, subjects with low calciumor vitamin D intake tended to have more severe erosion (22,47). Initiation of supplementscontaining 750 mg of calcium and 375 IU of vitamin D shortly after tooth extractionresulted in less alveolar bone loss 1 yr later (48). Recommended intake levels for calciumand vitamin D in the United States (49) are shown in Table 2.6. PROFESSIONAL AND PRACTICE ISSUESThe elderly are at increased risk of osteoporosis and osteopenia as well as tooth lossand periodontal disease. The available evidence supports the hypothesis that poor systemicbone status contributes to tooth loss and periodontal disease but is not conclusive.If such a relationship exists, the impact to an individual elderly patient is likely to besmall. Good oral hygiene, professional prophylaxis, and avoidance of smoking playimportant roles in the preservation of alveolar bone and teeth. However, given the