Vitamin C or ascorbic acid is one of the most critical and essential nutrients that act as a reducing agent and produces anti-oxidant effects in our body. The free radicals are scavenged, and thus vitamin C plays a vital role as an enzyme co-factor 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 the 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 our body:
A. Collagen synthesis.
B. Responsible for neuromodulation activities.
C. Responsible for immune responses such as chemotaxis.
D. Controls oxidative metabolism.
E. Helps in the decay or scavenging of damaging free radicals, also known as ROS (reactive oxygen species).
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:
A. Scurvy Siderosis - Clinically, a general discoloration may be caused in gingiva that results from bleeding and blood breakdown. This condition occurs as a result of further progression of scurvy.
B. 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.
C. 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 diggers 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 our tooth structure and eventually leads to a natural loss of tooth and, in turn, bone resorption.
How Is It Associated With Systemic Diseases?
The oxidative stress phenomenon as a result of these PMNs and ROS may be attributed as primary reasons in traditional medical and dental literature as the key causative factor for localized damage of periodontal tissue in periodontal disease, which if left untreated by the dentist and ignored by the patient 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 will be advised by your dental surgeon or physician 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.
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, and good oral hygiene are key factors and vitamin C supplements. In addition, it demonstrates its preventive action regarding maintaining and preserving gingival, periodontal health, and dentition in periodontally diseased patients.