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Vitamin C Deficiency Linked to Periodontal Disease

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Ascorbic acid or vitamin C plays a key role in maintaining oral health. Read the article to know the impact of vitamin C deficiency on periodontal disease.

Medically reviewed by

Dr. Sowmiya D

Published At June 1, 2022
Reviewed AtFebruary 19, 2024

Introduction:

Vitamin C, or ascorbic acid, is one of the most critical and essential nutrients that act as a reducing agent and produce antioxidant effects in the body. The free radicals are scavenged, and thus, vitamin C plays a vital role as an enzyme cofactor in cell functions. Research indicates that the dietary intake of vitamin C plays a crucial role in preventing or potentially slowing down the progression of periodontal disease. However, this supplementation is only efficient in controlling periodontal disease as research alongside proper oral hygiene and dental management can induce the differentiation of progenitor cells in the periodontal ligament.

The highest concentration of ascorbic acid in the human tissues is located within the pituitary and the adrenal glands. Vitamin C is an essential cofactor in diverse biological processes and has numerous functions in the body:

  • Collagen synthesis.

  • Responsible for neuromodulation activities.

  • Responsible for immune responses such as chemotaxis.

  • Controls oxidative metabolism.

  • Helps in the decay or scavenging of damaging free radicals, also known as ROS (reactive oxygen species).

Vitamin C needs vary depending on the individual and are varied for men, women, babies, teenagers, breastfeeding mothers, and pregnant women. The daily recommended quantity of vitamin C is 75 milligrams per day for adult women and 90 milligrams per day for adult males.

Vitamin C is present in a wide range of fruits and vegetables. Fresh vegetables like broccoli, cauliflower, tomatoes, green leafy vegetables, and cabbage are rich sources of vitamin C. Oranges, pineapples, papayas, raspberries, grapefruits, and watermelon are among the fruits high in vitamin C. Vitamin C's transport and metabolism are crucial mechanisms of regulation that may assist in concentrating vitamin C within the cells to boost its effectiveness as an antioxidant and cofactor.

What Are the Clinical Observations of Vitamin C Deficiency?

The hydroxylation process is affected by scurvy or vitamin C deficiencies, leading to inadequate collagen synthesis. This failure in the connective tissue support leads to the capillary walls getting vascularly fragile. In addition, it results in bleeding tendencies like petechiae and ecchymoses in the tissues.

Oral scurvy is mainly characterized by intense red or altered physiologic responses invoking a painful swollen gingival tissue. This onset may be acute or chronic, and the gingiva bleeds spontaneously, even on the slightest provocation like brushing or eating. This may be a source of great oral discomfiture or even esthetic concern in many patients because of the recurrent hemorrhages, purpuras, or bruising observed on gingival tissues. The oral manifestations include:

  • Scurvy Siderosis - Clinically, a general discoloration may be caused in the gingiva that results from bleeding and blood breakdown. This condition occurs as a result of further progression of scurvy.

  • Acute Necrotising Ulcerative Gingivitis (ANUG) - Ascorbic acid deficiency has also been implicated in the development of ANUG. The pathologic link established by research is that due to an increase in the gingival sulcus permeability of the epithelial cells present, there would be an impairment of polymorpho-nuclear leukocytes, and this damaged functionality is responsible for the oral manifestation of periodontal lesions.

  • Scorbutic Gingivitis - Severe vitamin C deficiency can also induce periodontal syndromes associated with scurvy like “scorbutic gingivitis.” This condition is like ulcerative gingivitis, but with rapid periodontal pocket development and eventual mobility or tooth exfoliation, the patient suffers from severe halitosis (fetid odor), which is severe with poor oral hygiene.

What Is the Mechanism of Scurvy in Progressive Periodontitis?

Periodontal disease is not just an inflammatory disease. Still, because its origin is nearly always bacterial, the progression of this disease is via an aberrant response invoked in the human body (host tissue). Inflammatory polymorphonuclear leukocytes (PMNs) are the primary cells involved against the periodontal invasive pathogens or bacteria in biophylaxis processes. These processes invoke an antimicrobial response at the injection site with the help of various intracellular signaling pathways that would be triggered, including reactive oxygen species (ROS) that are mainly responsible for causing cytotoxic effects on periodontal tissues at higher-level circulating concentrations. Progressive periodontitis, an untreated, periodontal disease, destroys the alveolar bone supporting and surrounding the tooth structure and eventually leads to a natural loss of the tooth and, in turn, bone resorption.

How Is It Associated With Systemic Diseases?

The oxidative stress (imbalance in the body between antioxidants and free radicals) phenomenon due to PMNs and ROS is considered the key causative factor for localized damage of periodontal tissue in periodontal disease. If left untreated, it leads to chronic systemic inflammation, such as cardiovascular and immune-evoking responses. In addition, evidential research indicates that periodontitis possibly increases the risk of various other diseases, such as diabetes mellitus type 2 and cardiovascular diseases, and may be associated with complicated pregnancy outcomes like preterm birth or low birth weight infants. This may be because patients with periodontitis have also demonstrated higher tissue biomarkers that significantly indicate ROS-induced tissue damage.

How Is Periodontal Disease Treated?

To prevent the complications of periodontal disease in scurvy patients, it is not only the supplementation of vitamin C daily that the dental surgeon or physician will advise but an overall effective dental prophylactic restorative and functional approach. The periodontist should focus on improving the pocket depth and clinical attachment levels (CAL) through local or systemic antibiotic therapy and regular follow-ups to observe the attachment gain post-treatment. A reduction of the pocket depth indicates successful periodontal treatment by the dental surgeon, and alternate approaches may also be suggested to regenerate the alveolar bone-like bone grafting materials, barrier membranes, and guided tissue regenerating material.

What Happens If One Consumes an Excessive Amount of Vitamin C?

Consumption of excessive amounts of vitamin C leads to the formation of calcium oxalate stones, particularly in individuals with kidney dysfunction. The most frequent side effects of high vitamin C dosages include digestive issues, including bloating and pain in the stomach, nausea, and diarrhea. The negative effects will go away in two weeks if the consumption of vitamin C is reduced. To avoid these side effects, adults should not take more than 0.070 ounces of vitamin C daily.

Conclusion:

According to recent dental evidence and research, supplementation or vitamin C administration has been linked with improved long-term periodontal outcomes. However, frequent dental visits, regular follow-ups, oral prophylaxis regimens, chemical or mechanical plaque control, good oral hygiene, and vitamin C supplements are key factors. In addition, it demonstrates its preventive action regarding maintaining and preserving gingival, periodontal health, and dentition in periodontally diseased patients.

Frequently Asked Questions

1.

Can Periodontal Disease Be Treated With Vitamin C?

Scurvy occurs due to a lack of vitamin C, resulting in symptoms such as gum bleeding and more mobile teeth. Moreover, vitamin C is essential for lowering the severity of periodontal illnesses such as advanced gingivitis (inflammation of gingiva) and periodontitis (inflammation of gums and supporting tissues). 

2.

Does a Lack of Vitamin C Lead To Gum Issues?

A lack of vitamin C can cause scurvy, which has symptoms such as bleeding gums and increased mobility of the teeth due to reduced collagen in the periodontal ligament and alterations in the cells present in the teeth, like odontoblasts.

3.

Which Conditions Are Associated With a Lack of Vitamin C?

Vitamin C insufficiency symptoms begin to show in eight to 12 weeks such as:
- Poor wound healing.
- Swelling of the gingiva with tooth loss.
- Mucocutaneous petechiae (tiny blood spots that appear suddenly and spread throughout the body).
- Ecchymosis (discoloration of the skin).
- Hyperkeratosis (increased thickness of the outer layer of skin).

4.

Can Gums Repair With Vitamin C?

It has been found in various studies that a daily dose of vitamin C can aid in treating gingivitis and gingival hemorrhage. However, this may not be true for periodontitis but vitamin C does help to lower the risk of periodontal disease.

5.

Which Vitamin Is Beneficial for Gum Disease?

Vitamin C helps to keep the connective fibers in the gums that hold the teeth in place robust and healthy. Although bleeding gums are commonly associated with gingivitis, an early stage of periodontal disease, they can also indicate a lack of vitamin C.

6.

How Do Teeth Respond to Vitamin C?

Scurvy, which can manifest as gum bleeding and more mobile teeth, can be caused by a vitamin C deficit. Moreover, vitamin C is essential for lowering the severity of periodontal illnesses such as advanced gingivitis and periodontitis.

7.

Who Suffers From a Vitamin C Shortage the Most?

The most frequent risk factors for vitamin C insufficiency are as follows:
- Poor food.
- Alcoholism.
- Anorexia (eating disorder).
- Severe mental illness.
- Smoking.
- Dialysis.
- Poor lifestyle choices.

8.

Do Teeth Heal With Vitamin C?

Various research has shown that Vitamin C may help hasten healing after tooth extraction and lower the risk of dry sockets.

9.

Which Mineral Help to Regenerate Gums and Teeth?

Calcium -
Calcium is an excellent vitamin for the teeth. Calcium aids in the formation of bones and offers structural support throughout the body. This mineral strengthens the jawbone and assists in hardening the tooth enamel.

10.

How Much Vitamin C Is Needed for Healthy Gums?

The specialists advise supplementing with 100 to 200 mg of vitamin C daily or increasing the intake of vegetables like kale, peppers, oranges, and kiwis.

11.

How To Treat Gum Disease?

- Scaling - It helps to remove tartar and bacteria from the surfaces of the teeth and underneath the gumline.
- Planing the roots - Root planing smoothes out the root surfaces.
- Antibiotics - Bacterial infection can be controlled with topical or oral medicines.

12.

Which Mineral Shortage Has a Significant Role in Periodontal Disease?

Periodontal disease has been linked to vitamin deficiencies such as:
- B complex.
- Vitamin C.
- Vitamin D.
- Magnesium.
- Calcium.

13.

Which Element Combats Gum Disease?

Omega-3 -
Pistachios, almonds, fish, and sesame seeds are sources of omega-3s. They are essential components of a healthy and nutrient-dense diet. They are very helpful for treating gum problems since they contain anti-inflammatory qualities. 
Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop

Dentistry

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periodontal gum diseasevitamin deficiency
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