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Vitamins and their relations to oral health: A review study

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Vitamins and their relations to oral health: A review study

Abstract

oral disease, a relevant public health problem, is considered a common disease of many people. In this respect, vitamins may be a modifying factor in the progression and healing of the oral diseases and promoting oral and dental health. Vitamins have been recommended as nutrients for prevention and treatment of some pathological conditions, such as cardiovascular diseases, cancer and obesity. Thus, an approach to determine how the different vitamin types could improve oral and dental health is necessary to further understanding of the potential benefits and risks of vitamins supplementation use. For this review of English-written literature which included researches on the relationship of each vitamin with oral and dental health, was conducted.
Vitamins and their relations to oral health: A review study
Faehaa Azher Al-Mashhadane 1,*, Amer Abdul Rhman Taqa2,*
1,2 Department of Dental Basic Sciences, University of Mosul, Mosul, Iraq.
* E-mail address: fayhaa6695@gmail.com.
Corresponding author: 2* amertaqa@hotmail.com, mobile; 009647704181543
Abstract: oral disease, a relevant public health problem, is considered a
common disease of many people. In this respect , vitamins may be a
modifying factor in the pro gression an d healing of the oral diseases and
promoting oral and d ental health. Vitamins have bee n recommended as
nutrients for prevention and treatment of some pathological conditions, such
as cardiovascular diseases, cancer and obesity. Thus, an approach t o
determine how the different vitamin types could improve oral and dental
health is necessary to further understanding of the potential benefits and risks
of vitamins supplementation use. For this review of English-written literature
which included researches on the relationship of each vitamin with oral and
dental health, was conducted.
Keywords: vitamin; gingivitis; oral health; periodontitis; caries.
Introduction
Vitamins may be considered as organic compounds required in the diet in
small amounts to perform specific biological functions for normal
maintenance of optimum growth and health of t he organism(1). The Polish
biochemist Casimir Funk in 1912, was isolated a substance (called beri-beri
vitamine) that was present in rice bran which could alleviate the deficiency
disease beriberi, endemic in many Asian countries. At the time, he assumed
that all such essential compounds in the diet contain an amine group, hence,
the t erm vitamine; after that the finalewas dropped to deemphasize the
amine connection(2). Vitamins can basically be classified into the following
two categories: (I) Fat-soluble Vitamins -Include Vitamins A, D, E and K (II)
Water-soluble Vitamins -Include Vitamins B and C (3, 4).
In the past, dental and oral health dietary approaches have mostly focused in
reducing the consumption of “undesirable” dietary components such as
refined sugars. However, promoting the consumption of “healthy and curative
food” has been increased. This perception of “nutrient as a medicament” has
encouraged the search of a growing number of new substances categorized
from dietary supplements with the aim of improving human dental and oral
health.
Available online at www.ijrp.org
International Journal of Research Publications
Volume-22, Issue-1,February 2019
Accepted and Published Manuscript
Vitamins and their relations to oral health: A review study
Amer A. Taqa, Faehaa Azher Al-Mashhadane
PII : Amer A. Taqa.10022122019513
DOI: 10022122019513
Web: http://ijrp.org/paper-detail/514
To appear in: International Journal of Research Publication (IJRP.ORG)
Received date: 07 Feb 2019
Accepted date: 17 Feb 2019
Published date: 03 Mar 2019
Please cite this article as: Amer A. Taqa, Faehaa Azher Al-Mashhadane , Vitamins and their relations to
oral health: A review study , International Journal of Research Publication (Volume: 22, Issue: 1),
http://ijrp.org/paper-detail/514
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Research Publications (IJRP.ORG)
Vitamins and their relations to oral health: A review study
Faehaa Azher Al-Mashhadane 1,*, Amer Abdul Rhman Taqa2,*
1,2 Department of Dental Basic Sciences, University of Mosul, Mosul, Iraq.
* E-mail address: fayhaa6695@gmail.com.
Corresponding author: 2* amertaqa@hotmail.com, mobile; 009647704181543
Abstract: oral disease, a relevant public health problem, is considered a
common disease of many people. In this respect, vitamins may be a
modifying factor in the progression and healing of the oral diseases and
promoting oral and dental health. Vitamins have been recommended as
nutrients for prevention and treatment of some pathological conditions, such
as cardiovascular diseases, cancer and obesity. Thus, an approach to
determine how the different vitamin types could improve oral and dental
health is necessary to further understanding of the potential benefits and risks
of vitamins supplementation use. For this review of English-written literature
which included researches on the relationship of each vitamin with oral and
dental health, was conducted.
Keywords: vitamin; gingivitis; oral health; periodontitis; caries.
Introduction
Vitamins may be considered as organic compounds required in the diet in
small amounts to perform specific biological functions for normal
maintenance of optimum growth and health of the organism(1). The Polish
biochemist Casimir Funk in 1912, was isolated a substance (called beri-beri
vitamine) that was present in rice bran which could alleviate the deficiency
disease beriberi, endemic in many Asian countries. At the time, he assumed
that all such essential compounds in the diet contain an amine group, hence,
the term vitamine; after that the finalewas dropped to deemphasize the
amine connection(2). Vitamins can basically be classified into the following
two categories: (I) Fat-soluble Vitamins -Include Vitamins A, D, E and K (II)
Water-soluble Vitamins -Include Vitamins B and C (3, 4).
In the past, dental and oral health dietary approaches have mostly focused in
reducing the consumption of undesirable” dietary components such as
refined sugars. However, promoting the consumption of “healthy and curative
food” has been increased. This perception of “nutrient as a medicament” has
encouraged the search of a growing number of new substances categorized
from dietary supplements with the aim of improving human dental and oral
health.
Amer A. Taqa / International Journal of Research Publications (IJRP.ORG)
www.ijrp.org
Dental diseases is generally considered a common pathology of population,
they are influenced by many risk factors, such as genetics, systemic diseases ,
stress, smoking, alcohol, and hormonal alteration status, therefore the
maintenance of oral and dental health becomes today a challenge.
Although a link between dietary changes, caries, and dental development has
been observed, the literature provides little insight about this relationship
which need more discussion(1).Undoubtedly, many factors are indispensable
for the pathogenesis of oral and periodontal disease, but, among risk factors,
nutrition represents an aspect that is often neglected . Indeed, nutritional
factors including vitamins have a vital importance for the equilibrium
between those predisposing factors and the host response, from which
depends the onset and progression of oral and dental diseases.
After tooth extraction, for instance, there is resorption often observed in the
alveolar bone which may later interfere with the ideal rehabilitation of the
edentulous site with dental implants and dental prosthesis. Bone adequacy
around dental implants has been well documented as a prerequisite for
implant osseointegration and its survival in long run . Different bone grafting
techniques and bone substitutes have been suggested for bone augmentation.
In this regard, various growth factors, drugs, and nutrients including vitamins
have been evaluated to promote bone formation(5,6,7).The role of vitamins
in dental caries ,which is one of the most public oral disease, has been debated
and mechanisms by which vitamins might influence caries have been
suggested and should be considered. Inadequate intakes of nutrients e.g.,
riboflavin, vitamin D, and vitamin B12 can be associated with increased
caries experience(8,9).
The efficacy of various vitamins on their prevention or treatment is sparse in
literature. A review is warranted to highlight such findings available as
evidence.
CLINICAL RELEVANCE:
In order to improve postoperative management, the level of vitamins over all
patient groups have to be considered in guidelines of treatment.
Vitamin A
Vitamin A is a group of nutritional unsaturated organic compounds. However,
it is known that many carotenoids act as vitamin precursors, being _-carotene
the most important(10). The active form of vitamin A, retinoic acid, is
essential for maintaining the integrity of mucosal tissues and for proper
differentiation of cells, including those of the immune system (11).According
to this, it is expected that an adequate intake of this nutrient prevent oral and
dental diseases onset or progression since it contributed to connective tissue
maintenance. Moreover, its role in immune system could be also important
for maintaining some bacteria in adequate level and for prevention of massive
inflammation(12, 13).Investigators have reported antioxidant activities for
Amer A. Taqa / International Journal of Research Publications (IJRP.ORG)
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retinol and dehydroretinol as well as for many pro-vitamin A compounds,
including b- and a-carotenes (14,15). Antioxidant activities can play an
important role in the periodontal disease and application of antioxidant
vitamin therapy (vitamins A, E and K) normalizes and improves the status of
the parodontium (16,17). Vitamin A deficiency has definite effects on
developing teeth in animals and preferably in human beings, although only a
few reports on dental disturbances in Vitamin A deficiency in humans are
available in literatures.(18)
Vitamin B-Complex
Vitamin B-complex refers to all of the known essential water-soluble vitamins
(except for vitamin C). These include thiamine (vitamin B1), riboflavin
(vitamin B2), niacin (vitamin B3), pantothenic acid (vitamin B5), pyridoxine
(vitamin B6), biotin (vitamin B7 or B8), folic acid (vitamin B9) and
cobalamin (vitamin B12)(19) vitamin B-complex is necessary for cell growth
and metabolism but each member of the B-complex has a unique structure
and performs unique functions. Vitamins B1, B2, B3, and biotin participate in
different aspects of energy production, vitamin B6 is essential for amino acid
metabolism, and vitamin B12 and folic acid facilitate steps required for
cellular division(20) . The relationship between vitamin B12 deficiency and
oral health still remains unclear. The available medical literature does not
show any study performed with such a correlation.
Vitamin B12 is one of the important micronutrients for brain development
and function. Vitamin B12 deficiency is common, and the incidence increases
with age. Studies on the development of cleft lip, alveolus, palate, and velum
and neural tube defects have revealed several shared multifactorial
causes. Vitamin deficiency disorders are one of several factors contributing to
the etiology of these anomalies. A lack of or deficiency in these vitamins thus
has severe consequences for the organism(21, 22).
In a study conducted by Ishimiya M et al it was found that intakes of vitamin
B1correlated significantly with the number of remaining teeth(23). Vitamin
B12 deficiency may cause an increase in prevalence of dental caries and
gingival diseases in children. Studies were found that inadequate intakes vs
low adequate or high adequate intakes of nutrients (e.g., riboflavin, vitamin D,
and vitamin B12) were associated with increased caries experience and low
adequate intakes vs inadequate or high adequate intakes) of nutrients (e.g.,
vitamin B12 and vitamin C) were associated with decreased caries
experience.(9, 24,25)
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Pontes et al also found presence of oral signs and symptoms, including
glossitis, angular cheilitis, recurrent oral ulcer, oral candidiasis, diffuse
erythematous mucositis, and pale oral mucosa in subjects with cobalamin
deficiency offering the dentist an opportunity to participate in the diagnosis of
this condition. Supplementation with vitamin B12 will improve the gingival
health and oral hygiene of children with deficiency(26)
Folic acid is a water-soluble B-complex vitamin. It is required for essential
biochemical reactions for the synthesis of amino acids, purines, and DNA.
Folate deficiency is relatively common, even though the deficiency is easily
corrected by administration of folic acid. Insufficient intake of folic acid
during the pregnancy has been suggested to increase the risk for cleft palate.
Studies have shown the essential role of folate during tissue development and
is required for the integrity of gingival tissues. Orofacial clefts of the lip and
palate are common birth defects of complex genetic and environmental
etiology. There is some suggestive evidence for a possible role of folic acid in
prevention of this defect. (27, 28)
The role of nutrition in periodontology has been studied extensively, and
recent studies on the interactions between nutrition, host defense, and
infection have found a correlation between nutrition and the pathogenesis of
periodontal disease. Vitamin B-complex supplementation has also
demonstrated positive effects on wound healing after periodontal surgery. It
has been reported that one of the B vitamins, thiamine (vitamin B1), may
increase wound repair. Furthermore, niacin (vitamin B3) supplementation
reportedly has a positive effect on the healing of repositioned flaps,
suggesting that the vitamin creates a more balanced collagen structure during
the wound-healing processes(29). Reports have demonstrated that nutrient
supplements, in particular vitamin-B complex, can positively influence wound
healing processes including oral and dental wounds(30).
Vitamin C
For humans vitamin C is an essential vitamin. Its deficiency have largely
been a product of inadequate dietary intake. Vitamin C is naturally found in
fresh fruits and vegetables. Lack of exposure to foods that contain vitamin C
has been the most frequent cause of the deficiency. Additionally, vitamin C is
heat sensitive so, boiling or cooking has removed the nutritional value. There
is very little storage of vitamin C in the body, and therefore, plasma
concentration is largely related to recent intake. Total body storage of vitamin
C is 1500 mg, and clinical features of deficiency occur after that level is
reduced to less than 350 mg (31). Studies showed that consumption of diets
that are rich in vegetables and vitamin C appears to associate positively with
periodontal health and using vitamin C supplementation improves
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postoperative healing following dental implant surgery in patients with
chronic periodontitis and patients treated with Bio-Oss Collagen
grafts(32,33,34).
Dental caries is a complex multifunctional disease. Vitamin C plays an
important role in maintaining the integrity of the teeth and also as an non-
enzymatic antioxidant defense system. It is evident that serum and salivary
vitamin C level decreases with increase in caries activity suggesting the
powerful antioxidant property of vitamin C which is able to scavenge free
radical of both reactive oxygen group and reactive nitrogen group(35)
Deficiency of Vitamin C is well recognized as producing severe changes in
the periodontal tissue and pulps of the teeth. Also it is essential for the
formation and maturation of collagen, and for the integrity of connective and
osteoid tissues, and dentine(4). Also Using vitamin C supplementation could
improves postoperative healing following dental implant surgery in patients
with chronic periodontitis(36)
Vitamin D
Vitamin D deficiency is a frequent health problem worldwide, it regulates
calcium levels and plays a key role in craniofacial development and the
maintenance of good oral health. It has a critical role in enamel, dentin, and oral
bone formation as ameloblasts and odontoblasts are target cells for 1, 25-
dihydroxyvitamin D, the active form of vitamin D. Deficiency in vitamin D
during periods of tooth development may also result in developmental defects
including enamel hypoplasia. In general, higher serum levels of 25-
hydroxyvitamin D (25(OH)D) are associated with improved oral health
outcomes(4,37,38). Vitamin D is associated with the two main oral diseases,
caries and periodontal disease and also linked to several infectious and
inflammatory conditions in oral cavity. It is deficiency may be a potential risk
factor for aggressive periodontitis (39,40). Also is an important modifiable risk
factor for dental caries specially in children. So, vitamin D supplementation can
be used in children for preventing caries in the primary dentition (41,42). A diet
rich in vitamins D, significantly reduced periodontal inflammation in
humans(43). Periodontitis is characterized by alveolar bone loss induced by the
host immune response to bacterial insult. Because vitamin D plays a crucial role
in bone maintenance and immunity, there is biologic rationale to suspect that a
vitamin D deficiency could negatively affect the periodontium. and vitamin D
intake was associated with lower severity of periodontal disease(44,45).
Vitamin E
Vitamin-E is the collective term for a family of chemical substances that are
structurally related to alpha-tocopherol. Vitamin E occurs naturally in eight
different forms: four tocopherols, alpha (α)-, beta (β)-, gamma (γ) - and delta
(δ) tocopherol and four tocotrienols, alpha-, beta-, gamma- and delta-
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tocotrienol. Vitamin-E exhibit antioxidant properties by acting as a lipid-
soluble free radical scavenger in cell membranes. Anticarcinogenic effects of
Vitamin E are its ability to inhibit formation of the carcinogenic chemical
nitrosamine from nitrites in some foods, and its ability to promote immune
system function. Oral cancer is generally preceded by precancerous lesions
which include leukoplakia, lichen planus, oral submucous fibrosis, oral
epithelial dysplasia, erythroplakia. Vitamin-E is an essential nutrient that is
receiving growth attention in the prevention of precancerous lesions because
of its anti oxidant properties(46).also it was found that topical application of
Vitamin E had performed better on oral mucositis induced by Cancer
Chemo/Radiotherapy than Vitamin E systemic administration and the efficacy
of Vitamin A topical treatment also showed reduction in severity of oral
mucositis similar to vitamin E.(47)
Research in animals has allowed to evaluate the use of vitamin E supplements
on periodontal diseases and its possible role on recurrent aphthous stomatitis
and inflammatory processes associated with this conditions. vitamin E
supplements would prevent oxidative stress associated to periodontitis but its
potential for periodontal disease treatment is not clear (48)
Vitamin K
Vitamin K is a fat-soluble substance found primarily in leafy green
vegetables. The dietary requirement is low because the vitamin is naturally
produced by the bacteria in the intestines. Two natural forms exist: vitamins
K1 and K2. Vitamin K1 is found in food(49).
Vitamin K have a role in a wide range of biological activities including cell
growth and proliferation, regulation of calcium metabolism in tissues,
inflammatory reactions, oxidative stress, and plays an essential role in normal
blood clotting, promoting bone strength, and helping to produce proteins for
blood, kidneys, and bones metabolism. So it's a multifunctional vitamin has
been recently deemed appreciable in researches. In bone, vitamin K exerts its
anabolic effect in different ways such as promoting osteoblast differentiation,
upregulating transcription of specific genes in osteoblasts, and activating the
bone-associated vitamin k dependent proteins which play critical roles in
extracellular bone matrix mineralization. A recent study has evaluated the
behavior of dental pulp stem cells after being exposed to Vitamins K2 in an
osteogenic medium. According to the findings, based on ALP activity and
extracellular Ca deposition assay, Vitamins K2 can ameliorate differentiation
of dental pulp stem cells into osteoblast and may enhance bone regenerative
capacity of cell-based bone tissue engineering therapies (50, 51)
Vitamin K has been tested as possible anticaries agent by virtue of its enzyme
inhibiting activity in the carbohydrate degradation cycle. Vitamin K was
found to prevent acid formation in incubated mixtures of glucose and saliva in
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In vitro studies. The traditional theory of dental caries considers only the oral
environment and does not recognize any significant role for the brain. A
healthy tooth is nourished by a centrifugal fluid flow through the dentin. This
is moderated by the hypothalamus/parotid axis which signals the endocrine
portion of the parotid glands. High sugar intake creates an increase in reactive
oxygen species and oxidative stress in the hypothalamus. When this signaling
mechanism halts or reverses the dentinal fluid flow, it renders the tooth
vulnerable to oral bacteria, which attach to the tooth surface. Acid produced
by oral bacteria such as Strep Mutans and lactobacillus de-mineralize the
enamel and irritate the dentin. The acid attack stimulates an inflammatory
response which results in dentin breakdown from the body's own matrix
metalloproteinases. Vitamin K2 has been shown to have an antioxidant
potential in the brain and may prove to be a potent way to preserve the
endocrine controlled centrifugal dentinal fluid flow. Vitamin K2, such as that
found in fermented cheese, improves salivary buffering through its influence
on calcium and inorganic phosphates secreted. Data collected from several
selected primitive cultures on the cusp of civilization demonstrated the
difference in dental health due to diet. The primitive diet group had few
carious lesions compared to the group which consumed a civilized diet high in
sugar and refined carbohydrates. The primitives were able to include the fat
soluble vitamins, specifically K2, in their diet (4 ,52).
CONCLUSION
Vitamins are essential to boost physical well-being, and doubtlessly vitamin
deficiency can have serious health consequences. This review analyzed some of
the published data on the relationship between vitamins and oral health to
understand the potential benefits and risks of supplementation with vitamins on
some oral conditions. the use of supplements with several or certain vitamins for
people under physiological or pathological conditions that increase the risk of
oral and dental diseases could contribute to protect teeth and periodontal tissues.
More studies are needed to confirm this and clarify what vitamins use for each
case, as well as dosages and taking frequency. Problems in obtaining positive
results from experimental studies could be due to used dosages or its
combination with treatment more effective that may occult the effect of this
nutrient. There have been many advances in understanding of dental diseases
and oral health that should be changing the way of dental practice on a daily
basis. It is the responsibility of Dentists, Researchers, and Educators to use the
best available evidence in the detection, assessment, management, and
monitoring of oral health and dental diseases in relation to nutritional factors
including vitamins.
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Abbreviations
Bio-Oss Collagen grafts: Geistlich Bio-Oss Collagen® consists of 90% Geistlich Bio-
Oss® granules with the addition of 10% porcine collagen.
Author contributions statement
All authors reviewed the manuscript.
Competing interests
The author(s) declare no competing interests.
Ethics Approval and consent to participate
'Not applicable'
-Consent for Publication
'Not applicable'
Availability of data materials
'Not applicable'
Funding
'Not applicable'
Competing interests
'Not applicable'
-Authors' contributions
'Not applicable'
-Acknowledgements
'Not applicable'
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Aim To compare the levels of vitamin D in children with severe early childhood caries (SECC) and children without caries and to determine the association of vitamin D deficiency and SECC. Materials and methods A total of 30 children each from case (with caries) and control group (without caries) of age between 3 and 6 years were selected from the Department of Pedo-dontics and Preventive Dentistry, Faculty of Dental Sciences, SGT University, Gurugram. Caries status of the children was recorded using decayed, extracted, and filled teeth (deft) index. Blood samples for serum 25(OH) vitamin D were taken from each child. All the data collected were compiled and subjected to appropriate statistical analysis. Results Case group has mean serum 25(OH) vitamin D level of 12.19 ng/mL [4.37 standard deviation (SD), 95% confidence interval of 10.5-13.8] and control group has mean serum 25(OH) vitamin D level of 20.11 ng/mL (4.12 SD, 95% confidence interval of 18.56-21.65). When the mean levels of serum 25(OH) vitamin D were compared between case and control groups, there was a statistically significant difference (p-value <0.0001). Simple linear regression in case group shows statistically significant inverse correlation between vitamin D levels and SECC (p-value<0.0001). Conclusion Our results showed that vitamin D deficiency is risk factor both for incidence of dental caries and for its severity in children. Clinical significance Vitamin D deficiency is an important modifiable risk factor for dental caries in children. Hence, by supplementing vitamin D in children and preventing the deficiency of vitamin D, dental caries can be prevented. How to cite this article: Chhonkar A, Gupta A, Arya V. Comparison of Vitamin D Level of Children with Severe Early Childhood Caries and Children with No Caries. Int J Clin Pediatr Dent 2018;11(3):199-204.
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