Vitamin D and Health

and tooth wear that spread rapidly through the enamel and underlying thinned dentine to expose the
dental pulp, which results in early pulp death. These changes in the structure of enamel and dentine
occur during tooth development from intra-uterine development up to around 18y of age. Any
change in serum 25(OH)D concentration after the age of 18y will not affect the structure of the teeth.
6.337 In children with rickets, there is also increased susceptibility to periodontal disease or periodontitis, an
inflammatory disease of the attachment apparatus of the tooth to the jaws. The supporting structures
make up the periodontium and comprise the gingiva (or gum), the ligament that attaches the tooth to
the bone and the alveolar bone that supports the tooth (Margvelashvili et al., 2014).
6.338 A bacterial biofilm (dental plaque) forms on the surface of teeth throughout their life. The bacteria in
mature plaque produce metabolites that irritate the gingival tissues around the margin of the tooth
causing a localised inflammatory response or gingivitis. This initial lesion can remain confined to the
gingiva or it can progress to the periodontium resulting in periodontitis. This is characterised by
progressive loss of attachment of the tooth to its supporting bone. The bone destruction is thought to
be a consequence of the host inflammatory response removing bone in an inflamed environment.
The bone does not regrow and loss of support is permanent. The end stage of this pattern of disease
progression is that the tooth becomes detached from the bone and is lost to function. This process is
often accelerated by a dentist extracting the tooth when it becomes loose and sensitive. There is
some evidence suggesting beneficial effects of anti-inflammatory agents in preventing periodontal
bone loss in active teeth (Chapple et al., 2012). It is possible, therefore, that vitamin D could affect
periodontal disease by modifying the rate of progression of bone loss or through anti-inflammatory
effects.
6.339 IOM Report: The IOM did not consider vitamin D in relation to oral health.
Evidence considered
RCTs
6.340 No RCTs on vitamin D and oral health could be identified.
Observational studies
6.341 Cross sectional studies have reported an association between higher serum 25(OH)D concentration
and reduced risk of gingival inflammation (Dietrich et al., 2005), periodontitis (Millen et al., 2013) and
tooth loss (Jimenez et al., 2014). A large cross-sectional analysis of NHANES data (n=11,202; age
≥ 20y) reported a significant and inverse association between serum 25(OH)D concentration and
periodontal tooth loss in men and women aged ≥ 50 y (Dietrich et al., 2004); however no association
was found between BMD of the total femoral region and tooth loss (Dietrich et al., 2004).
6.342 A prospective cohort study in Germany, with 5 years follow-up (n=1904; age, 20-79y), reported that
higher serum 25(OH)D concentration at baseline was associated with a lower risk of tooth loss (Zhan
et al., 2014). Compared with participants in the 1st quintile of serum 25(OH)D concentration (mean,
12.5 nmol/L), those in the 5 th quintile (mean, 67.6 nmol/L) had a 23% lower risk of tooth loss (RR=0.77;
95% CI: 0.60-0.99). Since serum 25(OH)D concentration was only measured once at baseline
information was not available on whether concentrations changed during the follow-up period.
Genetic studies
6.343 It has been suggested that associations between vitamin D and periodontal disease progression may
be independent of it role in terms of bone metabolism and relate more to the role of VDR receptors in
regulating inflammatory disease (Dietrich et al., 2004; Amano et al., 2009). A number of studies have
95