Periodontal disease, a chronic inflammatory disease, is the primary cause of tooth loss among adults. This widespread disease is characterized by the loss of periodontal attachment, that is, periodontal ligament and alveolar bone. Periodontal disease and potential tooth loss can greatly impact an individual's quality of life, dietary quality, and nutritional intake. Additionally, recent reports found associations between periodontal disease and increased risks of cardiovascular diseases. Scientists believe the mechanisms involved in these associations are decreased dietary quality and chronic inflammation. There are also positive associations between osteoporosis or low bone density and alveolar bone and tooth loss, which indicates poor bone quality may be a risk factor for periodontal disease.
Vitamin D status may impact periodontal disease both through an effect on bone mineral density (BMD) and through immunomodulatory effects. The active metabolite of 25-hydorxyvitamin D, 1,25-dihydroxyvitamin D, has been found to inhibit cytokine production and cell proliferation. Whether vitamin D, calcium, or both are beneficial in the prevention of periodontal disease is unclear. Furthermore, it is not clear whether the effect is mediated by the BMD or the BMD-independent effects of vitamin D.
A study was conducted to determine whether serum 25(OH)D3 concentrations are associated with periodontal disease in a large, representative sample of the US population [third National Health and Nutrition Examination Survey (NHANES III)] and, if so, whether this association is mediated by total hip BMD. NHANES III is a complex, multistage, stratified, clustered sample survey. Interviews were conducted at participants' homes. The examination included extensive dental examinations with periodontal assessments. Blood samples were taken and analyzed for serum 25(OH)D3 concentrations. Smoking status and diabetes mellitus were assessed during the household interview. The poverty income ratio was computed. Body mass index (BMI) was also calculated.
It was found that 25(OH)D3 concentrations were significantly and inversely associated with periodontal attachment loss (AL) in men and women aged >50 years. Compared with men in the highest 25(OH)D3 quintile, those in the lowest quintile had a mean AL that was 0.39 mm (95% CI: 0.17, 0.60 mm) higher; in women, the difference in AL between the lowest and highest quintiles was 0.26 mm (0.09, 0.43 mm). In men and women younger than 50 years, there was no significant association between 25(OH)D3 and AL. The BMD of the total femoral region was not associated with AL and did not mediate the association between 25(OH)D3 and AL.
It appears that low serum 25(OH)D3 concentrations may be associated with periodontal disease independently of BMD. Because of the high prevalence of both periodontal disease and vitamin D deficiency, the findings of this study may have influential public health consequences.
T. Dietrich, K. Joshipura, B. Dawson-Hughes, et al. Association between serum concentrations of 25-hydroxyvitamin D3 and periodontal disease in the US population. Am J Clin Nutr;80:108-113 (July, 2004). [Correspondence: T Dietrich, Department of Health Policy and Health Services Research, Goldman School of Dental Medicine, Boston University, 715 Albany Street, 560 3rd floor, Boston, MA 02118. E-mail: tdietric@bu.edu].
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