Background: A previous study reported by this group found that patients in periodontal maintenance programs taking vitamin D and calcium supplementation had a trend for better periodontal health compared to patients not taking supplementation. The objective of the present study is to determine, for the same cohort of subjects, whether such differences persist over a 1-year period.Methods: Fifty-one patients enrolled in maintenance programs from two dental clinics were recruited. Of these, 23 were taking vitamin D (≥400 IU/day) and calcium (≥1,000 mg/day) supplementation, and 28 were not. All subjects had at least two interproximal sites with ≥3 mm clinical attachment loss. For mandibular-posterior teeth, gingival index, plaque index, probing depth, attachment loss, bleeding on probing, calculus index, and furcation involvement were evaluated. Photostimulable-phosphor, posterior bitewing radiographs were taken to assess alveolar bone. Daily vitamin D and calcium intakes were estimated by nutritional analys...

/pdf/one-year-effects-of-vitamin-d-and-calcium-supplementation-on-xuakl9wdm5.pdf

One-year effects of vitamin D and calcium supplementation on chronic periodontitis.

Objective: To study the relationship between vitamin C and the severity of periodontitis. Material and Methods: The study population consisted of subjects from the Malabar/Purbasari tea estate on West Java, Indonesia. In 2002, clinical measurements were performed in 128 subjects, including evaluation of plaque, bleeding on probing, pocket depth and attachment loss. In 2005, 123 out of 128 subjects could be retrieved who were present at the examination of 2002. Blood samples were taken to measure plasma vitamin C levels. Information about the subject's dietary habit was obtained by means of a personal interview guided by a questionnaire. Results: Plasma levels of vitamin C ranged from 0.02 to 34.45 mg/l with a mean of 7.90 mg/l (+/- 5.35). The correlation coefficient between plasma vitamin C level and periodontal attachment loss was -0.199 (p <0.05); stepwise linear regression revealed that vitamin C levels explained 3.9% of the variance in periodontal attachment loss. Subjects with vitamin C deficiency (14.7% of the study population) had more attachment loss compared with those with depletion or normal plasma vitamin C values. Conclusion: The negative association between plasma vitamin C levels and periodontal attachment loss suggests that vitamin C deficiency may contribute to the severity of periodontal breakdown.

Java project on periodontal diseases: the relationship between vitamin C and the severity of periodontitis.

Periodontitis is a complex chronic inflammatory noncommunicable disease, initiated by the development of a dysbiotic microbial plaque biofilm below the gingival margin. Whilst the pathogenic biofilm is a "necessary cause" of periodontitis, it is insufficient on its own to cause the disease, and a destructive immune-inflammatory response is a key to the translation of risk to destructive events. Other exposures or "component causes" include individual genetic predisposition, lifestyle (including smoking and nutrition), and environmental factors. Dietary nutrients are essential for life as they provide crucial energy sources in the form of macronutrients, as well as important cofactors in the form of micronutrients, which regulate the functionality of enzymes during the regulation of anabolic and catabolic processes in human cells. Moreover, micronutrients can regulate gene transcription factors, such as the proinflammatory nuclear factor kappa B and the anti-inflammatory nuclear factor (erythroid-derived 2)-like 2. This review focuses on the role of vitamins (vitamin A, carotenoids, the vitamin B complex, vitamins C, D, and E, and coenzyme Q10) and minerals (calcium, magnesium, iron, zinc, potassium, copper, manganese, and selenium) in human physiology and the impact of their deficiencies upon periodontal health and disease.

Effect of micronutrient malnutrition on periodontal disease and periodontal therapy.

Background In 2009, the Institute of Medicine/Food and Nutrition Board constituted a Dietary Reference Intakes (DRI) committee to undertake a review of the evidence that had emerged (since the 1997 DRI report) on the relationship of vitamin D and calcium, both individually and combined, to a wide range of health outcomes, and potential revision of the DRI values for these nutrients. To support that review, several United States and Canadian Federal Government agencies commissioned a systematic review of the scientific literature for use during the deliberations by the committee. The intent was to support a transparent literature review process and provide a foundation for subsequent reviews of the nutrients. The committee used the resulting literature review in their revision of the DRIs. In 2013, in preparation for a project the National Institutes of Health Office of Dietary Supplements (NIH/ODS) was undertaking related to evidence-based decisionmaking for vitamin D in primary care, based on the updated DRI report, the ODS and AHRQ requested an update to the 2009 systematic review to incorporate the findings of studies conducted since the 2009 evidence review on the relationship between vitamin D alone or vitamin D plus calcium to selected health outcomes and to report on the methods used to assay vitamin D in the included trials. Purpose To systematically summarize the evidence on the relationship between vitamin D alone or in combination with calcium on selected health outcomes included in the earlier review: primarily those related to bone health, cardiovascular health, cancer, immune function, pregnancy, all-cause mortality, and vitamin D status; and to identify the vitamin D assay methods and procedures used for the interventional studies that aimed to assess the effect of vitamin D administration on serum 25(OH)D concentrations, and to stratify key outcomes by methods used to assay serum 25(OH)D concentrations. Data sources MEDLINE; Cochrane Central; Cochrane Database of Systematic Reviews; and the Health Technology Assessments; search limited to English-language articles on humans. Study selection Primary interventional or prospective observational studies that reported outcomes of interest in human subjects in relation to vitamin D alone or in combination with calcium, as well as systematic reviews that met the inclusion and exclusion criteria. Data extraction A standardized protocol with predefined criteria was used to extract details on study design, interventions, outcomes, and study quality. Data synthesis We summarized 154 newly identified primary articles and two new systematic reviews that incorporated more than 93 additional primary articles. Available evidence focused mainly on bone health, cardiovascular diseases, or cancer outcomes. Findings were inconsistent across studies for bone health; breast, colorectal, and prostate cancer; cardiovascular disease and mortality; immune function; and pregnancy-related outcomes. Few studies assessed pancreatic cancer and birth outcomes. One new systematic review of observational studies found that circulating 25(OH)D was generally inversely associated with risk for cardiovascular disease. Methods used to assay serum 25(OH)D in studies reporting on key outcomes diverged widely. The current report also identified one new systematic review published since the original report that addressed whether a dose response relationship exists between dietary and supplemental vitamin D intake and serum 25(OH)D concentrations. The systematic review, based on 76 RCTs, reported widely varying increases in serum concentrations of 25(OH)D for similar doses of vitamin D, with a general increase in serum concentration with dietary intake. The RCTs identified for the current report found increases in serum 25(OH)D with supplementation; however, the findings varied by age group and health status of participants, baseline vitamin D status, dose, duration, and assay used to assess serum 25(OH)D. Limitations Studies on vitamin D and calcium were not specifically targeted at life stages (except for pregnant and postmenopausal women) specified for the determination of DRI and were often underpowered for their intended outcomes. Studies vary widely in methodological quality and in the assays used to measure vitamin D status. Conclusions In solid agreement with the findings of the original report, the majority of the findings concerning vitamin D, alone or in combination with calcium, on the health outcomes of interest were inconsistent. Associations observed in prospective cohort and nested case-control studies were inconsistent, or when consistent, were rarely supported by the results of randomized controlled trials. Clear dose-response relationships between intakes of vitamin D and health outcomes were rarely observed. Although a large number of new studies (and longer followups to older studies) were identified, particularly for cardiovascular outcomes, all-cause mortality, several types of cancer, and intermediate outcomes for bone health, no firm conclusions can be drawn. Studies identified for the current report suggest a possible U-shaped association between serum 25(OH)D concentrations and both all-cause mortality and hypertension and also suggest that the level of supplemental vitamin D and calcium administered in the Women's Health Initiative Calcium-Vitamin D Trial are not associated with an increased risk for cardiovascular disease or cancer among postmenopausal women who are not taking additional supplemental vitamin D and calcium. Studies suggest the method used to assay 25(OH)D may influence the outcomes of dose-response assessments. Beyond these observations, it is difficult to make any substantive statements on the basis of the available evidence concerning the association of either serum 25(OH)D concentration, vitamin D supplementation, calcium intake, or the combination of both nutrients, with the various health outcomes because most of the findings were inconsistent.

Vitamin D and Calcium: A Systematic Review of Health Outcomes (Update).

Titanium implants are widely used on an increasing number of patients in orthopedic and dental medicine. Despite the good survival rates of these implants, failures that lead to important socio-economic consequences still exist. Recently, research aimed at improving implant fixation, a process called osseointegration, has focused on a new, innovative field: systemic delivery of drugs. Following implant fixation, patients receive systemic drugs that could either impair or enhance osseointegration; these drugs include anabolic and anti-catabolic bone-acting agents in addition to new treatments. Anabolic bone-acting agents include parathyroid hormone (PTH) peptides, simvastatin, prostaglandin EP4 receptor antagonist, vitamin D and strontium ranelate; anti-catabolic bone-acting agents include compounds like calcitonin, biphosphonates, RANK/RANKL/OPG system and selective estrogen receptor modulators (SERM). Examples of the new therapies include DKK1- and anti-sclerostin antibodies. All classes of treatments have proven to possess positive impacts such as an increase in bone mineral density and on osseointegration. In order to prevent complications from occurring after surgery, some post-operative systemic drugs are administered; these can show an impairment in the osseointegration process. These include nonsteroidal anti-inflammatory drugs, proton pump inhibitors and selective serotonin reuptake inhibitors. The effects of aspirin, acetaminophen, opioids, adjuvants, anticoagulants and antibiotics in implant fixations are not fully understood, but studies are being carried out to investigate potential ramifications. It is currently accepted that systemic pharmacological agents can either enhance or impair implant osseointegration; therefore, proper drug selection is essential. This review aims to discuss the varying effects of three different classes of treatments on improving this process.

Systemic drugs that influence titanium implant osseointegration

Background: Vitamin D is associated with a number of inflammatory diseases and plays a significant role in regulating bone metabolism. Serum calcifediol was demonstrated to be potentially associated with periodontal disease. The purpose of this study was to evaluate whether an association exists between plasma calcifediol concentrations and aggressive periodontitis (AgP) and whether plasma levels of bone-related biomarkers (osteocalcin, alkaline phosphatase, calcium, and phosphorus) regulated by vitamin D are related to AgP.Methods: Sixty-six patients with generalized AgP, 52 patients with chronic periodontitis, and 60 healthy controls were included in this study. Periodontal examination consisted of probing depth, attachment loss, and bleeding index measurements. Hematic calcifediol and bone-related biomarker levels were detected using radioimmunity assay kits or a biochemical analyzer.Results: Plasma calcifediol levels in patients with AgP were higher than those of healthy controls (29.28 versus 21.60 n...

Elevated Plasma Calcifediol Is Associated With Aggressive Periodontitis

Background and objective Estrogen has been shown to up-regulate the expression of osteoblastic phenotypes of human periodontal ligament cells via binding to estrogen receptors and may also help periodontal tissue regeneration. However, which subtype of estrogen receptor (alpha or beta) is predominately expressed in human periodontal ligament cells, and how estrogen receptor expression is regulated during the osteogenic differentiation of human periodontal ligament cells, is still unclear. This study aimed to explore the expression and regulation of estrogen receptor subtypes in human periodontal ligament cells and during their osteogenic differentiation. Material and methods Human periodontal ligament cells derived from 10 individual age-matched donors (five male and five female donors) were cultured. Human periodontal ligament cells under osteogenic induction (group M) and the corresponding controls (group C) were harvested on days 7, 14 and 21 for estrogen receptor detection. Results Both estrogen receptor-alpha and estrogen receptor-beta mRNAs were expressed in human periodontal ligament cells from all of the 10 donors. Protein only of estrogen receptor-beta (not of estrogen receptor-alpha) was detected and was shown to be located in the nuclei of human periodontal ligament cells. The expression levels of estrogen receptor-beta mRNA and protein from both male and female donors in group M were significantly higher compared with group C during the 21-d study period. In comparison, the expression level of estrogen receptor-alpha mRNA of the donors was not significantly different from that of the controls during osteogenic differentiation and no estrogen receptor-alpha protein was detected. Conclusion The results suggest that estrogen receptor-beta may be the predominant subtype expressed in human periodontal ligament cells and may actively participate in the osteogenic differentiation process of human periodontal ligament cells, both in male and in female subjects.

Up-regulation of estrogen receptor-β expression during osteogenic differentiation of human periodontal ligament cells

OBJECTIVE This study was to longitudinally evaluate the change of prevalence of five periodontal putative pathogens in the subgingival plaque of artificial class III furcation defects at the three time-points, including before the establishment of furcation defects, before and 6 months after periodontal surgery. METHODS Eighteen chronic infected class III FI defects were created at the mandibular first molars, second molars and second premolars of three adult male Macaca fascicularis. The samples of subgingival plaque were obtained from the subgingival area of furcation defects in buccal and lingual sites before the establishment of furcation defects, before and 6 months after periodontal surgery. 36 samples were obtained at one time-points. Five periodontal putative pathogens, including Porphyromonas gingivalis (Pg), Tannerella forsythensis (Tf), Treponema dinticola (Td), Actinobacillus actinomycetemcomitans (Aa) and Fusobacterium nucleatum (Fn), were detected with 16SrRNA based PCR. RESULTS 1. The prevalence of Pg, Tf, Td and Fn was gradually increased, from 58.3% to 69.4% to 88.9%, 47,2% to 69.4% to 83.3%, 13.9% to 36.1% to 61.1% (P<0.01), and 69.4% to 91.7% to 91.7% (P<0.05), respectively during the experimental period. The prevalence of Fn was higher than Pg, Tf and Td. The prevalence of Aa was the lowest and no obvious difference among the three samplings(from 25.9% to 13.9% to 33.3%)was detected. 2. The prevalence of more than 3 species simultaneously detected was increased from 38.9% to 61.1% to 83.3% (P <0.01). The red complex (Pg + Tf + Td) was detected from 8.3% to 27.8% to 44.4% (P<0.01) at the different time point. 3. The combined detection frequency of red complex in the inflammatory sites (87.5%), which were histologically defined as inflammatory cells infiltrated in furcation area 6 months post-surgery, and the same sites pre-surgery (62.5%) was more than that in pre-creation of furcation defects (P<0.01). But there were no significant differences compared to that in non inflammatory area (60.0%, 40.0%), respectively. CONCLUSION The prevalence of periodontal pathogenic bacteria correlated with the severity of local inflammation. The increase of coexistent rate of red complex at the second and third sampling times suggests that the red complex play important role in the pathogenesis of periodontitis. Fn may be a resident bacteria in the subgingival plaque, play a bridge role on the biofilm formation and maturation. Aa may not be a major causative bacteria in the clinical periodontitis.

Effect of periodontal surgery on the subgingival periodontal microbiota in artificial class III furcation defects: an experimental study in monkeys

OBJECTIVE To explore the relationship between plasmatic 25-hydroxy vitamin D3 (25OHD3) level and plasmatic osteocalcin level in patients with aggressive periodontitis (AgP). METHODS Thirty four AgP patients and 29 healthy controls were included in this study. 25OHD3 and osteocalcin levels in plasma were measured using commercially available radioimmunoassay kits. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were measured using a standard hospital analytical technique. RESULTS Plasmatic 25OHD3 level was significantly higher in AgP patients than that in healthy controls (8.65 microg/L vs 3.10 microg/L; P<0.01). Osteocalcin level was also significantly higher in AgP patients than that in healthy subjects (1.0 microg/L vs 0.8 microg/L; P=0.028). AST level was significantly lower in AgP patients than that in healthy controls(20.0 U/L vs 23.0 U/L). No correlations between the plasmatic levels of 25OHD3 and osteocalcin were detected in AgP patients or in healthy controls (r=0.271, P=0.12; r=-0.356, P=0.58). CONCLUSION Plasmatic 25OHD3 and osteocalcin concentrations were not correlated but might be influenced by AgP.

[Correlation analysis between plasma levels of 25-hydroxy vitamin D3 and osteocalcin in patients with aggressive periodontitis].

Objective To study the effects of 1,25-dihydroxyvitamin D3(VD3)on the expression of vitamin D receptor(VDR),receptor activator of nuclear factor-kappa B ligand(RANKL)and osteoprotegerin(OPG)in human periodontal ligament cells(hPDLC)populations and to analyze the potential mechanisms.Methods Twelve hPDLC populations were primarily established from 12 donors individually.Two samples of each hPDLC population of passage three were treated respectively with 10-8 mol/L VD3(V D3 group)or 0.1% absolute ethyl alcohol as controls(control group).Six days later,the mRNA expression Ievels of VDR.RANKL and OPG in the samples were determined with real-time quantitative RT-PCR.The DNA base sequences upstream to the transcription start site of RANKL gene were also analyzed.Results Compared with the control group.the mRNA expression level of VDR increased significantly in the VD3 group(P=0.003),averagely(3.04±1.06)times of that in the control group;the mRNA expression level of RANKL was also up-regulated by VD3(P=0.001),9.82(0.75-119.18)times of that in the control group;the OPG expression level was(94.48±39.15)% of the controls(P=0.136);OPG/RANKL ratio was down-regulated in the VD3 group to averagely 10.36%(1.01%-138.00%)of the controls(P=0.003).No mutation wes found in the DNA fragments upstream to the transcription start site in the RANKL gene and the genotypes of the polymorphism at-1832(rs7984870,C/G)were not shown to be significantly related to the RANKL mRNA expression leveL Conclusions In hPDLC,VD3 can significantly increase the mRNA expression level of VDR:VD3 can increase RANKL mRNA expression level to decrease OPG/RANKL ratio,but it has little effect on OPG mRNA expression.The big differences of the RANKL mRNA regulation in response to VD3 treatment among hPDLC populations may not be associated with the DNA sequences upstream to the transcription start site in the RANKL gene.

Key words: 
Calcitriol;  Receptor activator of nuclear factor-kappa B;  Osteoprotegerin;  Human periodontal ligament cells

[Effects of calcitriol on the expression of vitamin D receptor, RANKL and osteoprotegerin in human periodontal ligament cells].

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