Vitamin D is essential for bone growth and metabolism because it promotes calcium and phosphorus absorption in the intestine. Vitamin D is also essential for the health of the brain, cardiovascular system, respiratory tract, skin, immune and endocrine systems.
It is also important in the dental field for tooth development, immune response to oral microbial infections, and healing after periodontal, oral, and implant surgery. Vitamin D deficiency and insufficiency are estimated to have a prevalence of 50%-75% in the United States alone (especially during the winter) and have been linked to various dental treatment complications. This article will review the causes of vitamin D deficiency and how they affect dental treatment.
Vitamin D is considered deficient when serum 25(OH) levels are less than ten ng/mL, insufficient when serum levels are between 10 and 30 ng/mL, and optimal when serum levels are greater than 30 ng/mL. Vitamin D levels can be measured using a variety of commercially available tests.
Causes of Vitamin D deficiency
Causes of Vitamin D deficiency
Vitamin D deficiency is caused primarily by three factors:
Diet—The majority of natural sources of vitamin D are derived from animals. This vitamin is abundant in fatty fish (salmon and mackerel), fish oil, egg yolks, fortified milk/orange juice, and beef liver. Daily, approximately 90 IU of vitamin D can be absorbed from food without supplements. 2 People who are strict vegans or who do not consume these foods must find alternative sources of this vitamin.
Sun exposure—The human body produces approximately 10,000 IU of vitamin D from tanning in natural sunlight until the skin turns light red. Vitamin D can be absorbed by exposing the face, hands, and palms to sunlight twice weekly. The medical community believes that one only needs to be in the sun for half the time it takes for the skin to turn pink. In other words, if it takes 30 minutes for the skin to turn red, only 15 minutes of sun exposure is required to get enough vitamin D. Individuals who live in areas with little sunlight, have insufficient sun exposure, have darkly pigmented skin, or use high SPF sunscreen in the sun may need to supplement to achieve adequate vitamin D levels.
Medical history— Because vitamin D is converted to its active form in the kidneys, people with kidney disease may be at risk for deficiency. Furthermore, certain intestinal diseases, such as celiac disease, cystic fibrosis, and Crohn's disease, reduce vitamin D absorption, resulting in a deficiency. Finally, individuals with a BMI greater than 30 may have low vitamin D levels because adipose cells extract vitamin D from the blood.
The Impact on Dental Treatment
The Impact on Dental Treatment
Infection— Vitamin D deficiency is known to impair the immune response to oral microbial infections, increasing the risk of oral infections and periodontitis. Vitamin D stimulates the synthesis of antimicrobial proteins by immune and epithelial cells and nonspecific immune responses. 4 Vitamin D also participates in the specific immune response and reduces the damaging effects of chronic periodontitis.
Bone metabolism—Vitamin D is essential for bone metabolism. Vitamin D stimulates osteoclast activity and increases osteoblast production of extracellular matrix proteins in the bone. Vitamin D deficiency has been linked to low bone density, pathologic fractures, and poor bone healing after dental surgery. 5 Furthermore, case studies have suggested that low vitamin D levels are linked to the failure of bone grafts and regenerative materials.
Periodontium—Because vitamin D has antimicrobial and anti-inflammatory properties, low-risk patients are more susceptible to gingival and periodontal disease. Periodontal patients with low vitamin D levels have poor responses to periodontal surgery due to the vitamin's positive influence on bone metabolism. According to research, patients with a vitamin D deficiency in their blood plasma have poorer outcomes (lower tissue attachment level and probing depth change) after periodontal surgery. The authors of these studies recommend testing vitamin D levels in the patient's blood before treatment and, if necessary, administering supplements to improve postsurgical results in cases where periodontal treatment has failed.
Dental implants—Because osseointegration depends on bone metabolism, low vitamin D levels in the blood may impair healing processes and new bone formation on the implant surface. The relationship between serum vitamin D levels and osseointegration of dental implants is debatable and has only been investigated in a few case reports and animal studies. Most studies indicate adequate serum vitamin D levels can improve peri-implant bone tissue healing.
A recent retrospective clinical study examined the relationship between low serum vitamin D levels and early dental implant failure. This study looked at 885 patients who had received 1,740 fixtures. Patients with vitamin D deficiency (serum vitamin D levels ten ng/mL) had an early implant failure rate of 11.1%, compared to 2.9% in patients with normal vitamin D levels (>30 ng/mL). 8 The authors concluded that serum vitamin D levels should be checked in cases of unknown failure, and the operator may be advised to administer vitamin D weeks to months before implant surgery.
Treatment
Treatment
When treating patients who are vitamin D deficient, dental care providers must first determine whether the patient is deficient, insufficient, or normal. According to the National Academy of Medicine's 2011 vitamin D dietary intake recommendations, an intake of 600-800 IU of vitamin D would meet the nutritional needs of most of the population. Some practitioners previously advocated for upper limits of 4,000-10,000 IU per day for vitamin D-deficient individuals, but those recommendations have recently been challenged. According to the most recent research, people who took 10,000 IU daily had lower bone mineral densities and increased bone resorption.
These studies conclude that taking excess doses has no negative effects once a certain vitamin D level is reached. With specific serum testing, treatment should be tailored to the patient and coordinated with their medical doctor.
Conclusion
Vitamin D deficiency can result in decreased bone mineral density, osteoporosis, bone fracture, periodontal disease progression, and possible dental implant failure. Vitamin D, which has antibacterial, anti-inflammatory, and wound-healing properties, has been shown to reduce the risk of gingivitis and chronic periodontitis.
Furthermore, vitamin D is necessary for bone metabolism, alveolar bone resorption, tooth preservation, and bone formation around dental implants. Patients with a poor wound healing response after dental treatment, including oral, periodontal, and implant surgery, should have their vitamin D serum levels checked and, if necessary, treated.
