Periodontal disease is one of the world’s commonest diseases with approximately 800 million people worldwide suffering with severe periodontal disease. Vitamin D is a lipid-soluble vitamin which plays an important role in many biochemical functions in the body. Some studies have suggested that periodontitis is associated with lower vitamin D levels with other finding no correlation.
The aim of this review was to compare vitamin D levels in individuals with or without periodontitis, and to evaluate the effects of scaling and root planing (SRP) +vitamin D on periodontal clinical parameters in patients with periodontitis.
Methods
Searches were conducted in the Cochrane Library, Medline/PubMed, Embase and Web of Science databases. Human experimental studies (randomised controlled trial (RCT)/ non-RCT/observational studies) in people with periodontitis where intervention or exposure to vitamin D was measure were considered. Two reviewers independently screened studies and extracted data. 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 assess study quality. Categorical data were combined as relative risk (RR) or odds ratio (OR), and quantitative data as weighted mean difference (WMD) or standardised mean difference (SMD) with 95% confidence intervals (CI).
Results
- 16 studies involving 1455 patients were included.
- 5 studies were interventional (2 RCTs, 3 non-RCTs), 9 case-controlled and 2 cross-sectional.
- 6 studies compared the difference in serum 25(OH)D levels between periodontitis and healthy individuals finding no significant difference SMD =-0.30 (95%CI; -0.73 to 0.13).
- 4 studies compared the difference in serum vitamin D level showing lower serum vitamin D levels in periodontal patients SMD = -0.88 (95%CI; -1.75 to -0.01).
- 2 studies compared in saliva 25(OH)D levels between periodontitis and healthy individuals demonstrating no difference SMD = 1.05 (95%CI; 1.98 to 4.07).
- 2 RCTs and 1 non-RCT assessed the effect of SRP+ vitamin D versus SRP on serum vitamin D levels in individuals with periodontitis showing and increase in serum vitamin D concentration in the SRP + vitamin D group SMD = 23.67 (95%CI; 8.05 to 32.29).
- 2 non-RCTs studied the effects of SRP on serum vitamin D levels in individuals with periodontitis, showing a statistically significant difference in serum vitamin D levels of individuals with periodontitis between before and after SRP SMD = 1.57 (95%CI; 1.07 to 2.06).
- A small number of studies were included in meta-analyses of the effects of SRP + Vitamin D on periodontal clinical parameters. With the exception of CAL no benefits were demonstrated (see table below).
| Clinical parameter | No. of studies | WMD (95%CI) |
| Probing Depth (PD) | 3 | -0.11 ( -0.23 to 0.01) |
| Clinical Attachment level (CAL) | 3 | -0.13 ( -0.19 to -0.06) |
| Gingival index (GI) | 2 | -0.55 ( -1.11 to 0.01) |
| Bleeding index (BI) | 1 | -0.05 ( -0.15 to 0.05) |
Conclusions
The authors concluded: –
…vitamin D plays a positive role in the adjuvant treatment of individuals with periodontitis. Therefore, vitamin D in combination with nonsurgical periodontal therapy such as SRP has a practical application of value on the prevention and treatment of periodontitis in clinical practice. However, Due to the small number of included studies, high heterogeneity, and lack of clear explanation of the source of heterogeneity, the actual effect of vitamin D combined with SRP in periodontitis in this study needs to be carefully interpreted……
Comments
The authors have searched a number of major databases for including 16 studies only 5 of which were interventional. The research question is similar to an earlier review by Pinto et al (Dental Elf – 27th Mar 2018) which included 27 studies and provided inconclusive evidence of an association with the authors calling for studies using more rigorous designs. This new review includes 10 studies which have been published since the Pinto review with a majority being of an observational design. The included studies are heterogenous with periodontal disease diagnostic criteria varying as well as outcome measure across the included studies confounding factors across the studies also vary. While a few outcomes suggest a positive outcome with adjunctive vitamins D the lack of high-quality interventions studies means that the findings should be interpreted very cautiously. High quality well conducted and reported prospective studies reported using common outcome measures are needed to clarify the evidence in relation to vitamin D and periodontitis.
Links
Primary Paper
Liang F, Zhou Y, Zhang Z, Zhang Z, Shen J. Association of vitamin D in individuals with periodontitis: an updated systematic review and meta-analysis. BMC Oral Health. 2023 Jun 13;23(1):387. doi: 10.1186/s12903-023-03120-w. PMID: 37312090; PMCID: PMC10265775.
Other references
Dental Elf – 27th Mar 2018
