The Role of Vitamin D for Periodontal Diseases and Osteoporosis

Article Information

Egle Jagelaviciene

Department of Dental and Oral Pathology, Lithuanian University of Health Sciences, Lithuania

*Correspondence to: Egle Jagelaviciene, Department of Dental and Oral Pathology, Lithuanian University of Health Sciences. Eiveni? str, Kaunas, Lithuania. Email: egle.

Received: April 04, 2020; Accepted: May 19, 2020; Published: May 22, 2020

Copyright: ©2020 Jagelaviciene E. 

Citation: Jagelaviciene E. The Role of Vitamin D for Periodontal Diseases and Osteoporosis. J Dietetics Food Technol. 2020; 1(1):004.

View / Download Pdf
Article Details

Opinion, advocating important role of vitamin D and its deficiency in significant number of individuals, prevails within the society, mass of information is available regarding its use, doses, sources, etc. One billion people on the planet were diagnosed with vitamin D deficiency during the last decade [1]. There are four forms of vitamin D (calciferol) - lamisterol (vitamin D1), ergocalciferol (vitamin D2), cholecalciferol (vitamin D3) and dihydrotachysterol (vitamin D4), two of which being the most important - D2 and D3. There are many reasons of vitamin D deficiency, which is finally diagnosed if serum level of 25OHD3 is less than 20 ng/mL [2,3]. This determines pathogenesis of many diseases, including ones of periodontal, resulting in loss of masticatory function.

Periodontium consist of four structures: gingiva, periodontal ligament, cementum and alveolar bone. This is functional unit, maintaining homeostasis - the connection between tooth and gingiva makes up a unified whole, preventing penetration of pathogenic microorganisms or chemical substances, capable to induce inflammation of periodontal tissue (PTs). PTs keep tooth inside the alveolar socket, distribute mechanical load of mastication, and have their own blood supply, neural regulation and defensive mechanisms. Formation of bacterial biofilm and its adhesion to tooth surface induces diseases and response of PTs. Soft and mineralized tooth plaque is initiative risk factor of these diseases, but in general, diseases are caused by many predisposing factors. Periodontal diseases initially manifest as gingivitis, inflammation of the gingiva, which, if untreated, spreads deeper within periodontal tissue: causing destruction of periodontal ligament, formation of pathological periodontal pocket and resorption of the alveolar bone, causing tooth loss over time [4].

For some time already, clinical studies strive to link vitamin D with periodontal diseases and prove its therapeutic and preventive role in Periodontology. Vitamin D is secosteroidal hormone, playing important role in the treatment of periodontal diseases because of its anti-inflammatory and antibacterial effect on PTs as well as its immunomodulatory, differentiating, anti-proliferative and regulative effect on autoimmune processes and cellular apoptosis and participation in bone metabolism [2,5,6,7,8]. One of the main functions of vitamin D is maintaining the proper blood levels of calcium and phosphorus by regulating absorption of these substances inside the bowels and reabsorption in kidneys and by enhancing processes of resorption and regeneration, which are generally called remodulation [9]. Bony tissue is like a living and continuously changing organ and due to this process, the old bony tissue is not accumulating and bone adaptation to changing mechanical forces develops. Disintegration and renewal processes of bony tissue depend on metabolism, as constant interchange of mineral substances between bone and blood plasma, where an active form of vitamin D is circulating, takes place [10]. Besides, bone performs supportive function (e.g. keeps teeth in alveolar sockets), skeletal bones protect internal organs, acts as depot of mineral substances (especially calcium), which is necessary for normal muscle function [11].

Osteoporotic changes of skeletal bones occur because of impaired mineralization of the bones due to long term decreased uptake of vitamin D and calcium, increasing risk of bone fractures, what concerns jaws – accelerated resorption of bone tissue causes adentia [12]. Osteoporosis (OP) is common metabolic disease, characterized by loss of bone’s organic and non-organic structure. Gender, age, early menopause, petty physique, race and heredity are uncontrollable risk factors, whereas calcium and vitamin D levels are controllable ones. OP and periodontal diseases are closely related, having many common risk factors. In OP, bone mineral density (BMD) loss takes place in whole skeleton, including jaws. From dental point of view, the whole chain of processes starts developing with this disease: radiographic picture of jaw bone is changing, the height of alveolar process diminishes due to resorption, loss of bone tissue of alveolar process influences prosthetics and denture retention, tooth mobility increases, individuals lose teeth faster, reduced number of teeth changes functional load on jaws, leading to reduced BMD, mastication load is distributed unevenly – remaining teeth carry an extra load, changes take place in periodontal ligament, gingival soft tissue support is lost, lower facial third reduces in height, thus causing esthetic problems, also lacunar resorption takes place in cortical bone of mandibular base, changing its dimensions and reducing success rate of implantation procedures [13,14,15]. But tendency of developing moderate-severe chronic periodontitis and the extent of bone resorption (height of alveolar ridge) might be reduced up to 46% with of 800 IU vitamin D supplements per day [16]. It is worth noting that BMD in healthy individuals is not associated with chronic periodontitis and 25-hydroxyvitamin blood levels, it is more common for young and middle-aged individuals [17]. Individuals with low systemic BMD exhibited increased systemic cytokine levels, enhancing bone resorption throughout the body. Jaws are part of bony skeletal system, with the same processes taking place there. Bacterial infection of PTs also enhances local increase of cytokine levels, osteoclast activity and resorption. Hence, systemic factors act together with local ones in PTs [18].

Chronic periodontitis is one of the causes, responsible for tooth loss. Periodontal ligament degrades, periodontal pocket forms and deepens and tooth becomes mobile as disease progresses and inflammation spreads deeper. Several factors, including poor life quality and low socioeconomic status and various systemic diseases may play role in etiopathogenesis of periodontitis, influencing the number of teeth inside the oral cavity [19,20]. Tooth loss may be reduced by optimal serum 25(OH)D level, which is inversely proportional to risk of tooth loss: increase of 25(OH)D level by 10 μg/L reduces tooth loss risk from 13% to 23% [21,22]. In conclusion it should be noted, that vitamin D is very unique substance due to its abilities, functions and participation in various processes. Its optimal serum levels could prevent occurrence of numerous diseases, including such common diseases throughout the world as chronic periodontal diseases and osteoporosis, which are social problems, compromising individual’s quality of life.


1. Holick MF. Vitamin D deficiency. New England Journal of Medicine. 2007 Jul 19;357(3):266-81.

2. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: An endocrine society clinical practice guideline (Journal of Clinical Endocrinology and Metabolism (2011) 96,(1911-1930)). Journal of Clinical Endocrinology and Metabolism. 2011 Dec;96(12):3908.

3. Glade MJ. Vitamin D: health panacea or false prophet?. Nutrition. 2013 Jan 1;29(1):37- 41.

4. Trombelli L, Farina R, Silva CO, Tatakis DN. Plaque-induced gingivitis: Case definition and diagnostic considerations. Journal of clinical periodontology. 2018 Jun;45:S44-67.

5. Schwalfenberg GK. A review of the critical role of vitamin D in the functioning of the immune system and the clinical implications of vitamin D deficiency. Molecular nutrition & food research. 2011 Jan;55(1):96-108.

6. Heaney RP. Vitamin D in health and disease. Clin J Am Soc Nephrol. 2008;3(5):1535-41.

7. Krishnan AV, Feldman D. Mechanisms of the anti-cancer and anti-inflammatory actions of vitamin D. Annual review of pharmacology and toxicology. 2011 Feb 10;5: 311-36.

8. Muszkat P, Camargo MB, Griz LH, Lazaretti-Castro M. Evidence-based non-skeletal actions of vitamin D. Arquivos Brasileiros de Endocrinologia & Metabologia. 2010 Mar; 54(2):110-7.

9. Amano Y, Komiyama K, Makishima M. Vitamin D and periodontal disease. Journal of oral science. 2009;51(1):11-20.

10. Praškevi?ius A, Burneckien? J. Biochemistry of bones, teeth and saliva. Kaunas: KMU Press; 2000. p. 44.

11. Berchtold MW, Brinkmeier H, Muntener M. Calcium ion in skeletal muscle: its crucial role for muscle function, plasticity, and disease. Physiological reviews. 2000 Jul 1;80(3):1215-65.

12. Stein SH, Tipton DA. Vitamin D and its impact on oral health—an update. Journal of the Tennessee Dental Association. 2011;91(2):30.

13. Bandela V, Munagapati B, Karnati RK, Venkata GR, Nidudhur SR. Osteoporosis: its prosthodontic considerations-a review. Journal of clinical and diagnostic research: JCDR. 2015 Dec;9(12):ZE01.

14. Bhatnagar S, Krishnamurthy V, Pagare SS. Diagnostic efficacy of panoramic radiography in detection of osteoporosis in post-menopausal women with low bone mineral density. Journal of clinical imaging science. 2013;3.

15. Glowacki J, Christoph K. Gender differences in the growing, abnormal, and aging jaw. Dental Clinics. 2013 Apr 1;57(2):263-80.

16. Alshouibi EN, Kaye EK, Cabral HJ, Leone CW, Garcia RI. Vitamin D and periodontal health in older men. Journal of dental research. 2013 Aug;92(8):689-93.

17. Dietrich T, Joshipura KJ, Dawson-Hughes B, Bischoff-Ferrari HA. Association between serum concentrations of 25-hydroxyvitamin D3 and periodontal disease in the US population. The American journal of clinical nutrition. 2004 Jul 1;80(1):108-13.

18. Wactawski-Wende J, Hausmann E, Hovey K, Trevisan M, Grossi S, et al. The association between osteoporosis and alveolar crestal height in postmenopausal women. Journal of periodontology. 2005 Nov;76:2116-24.

19. Al-Harthi LS, Cullinan MP, Leichter JW, Thomson WM. The impact of periodontitis on oral health-related quality of life: A review of the evidence from observational studies. Australian dental journal. 2013 Sep;58(3):274-7.

20. Navarro MD, Saavedra P, Jódar E, Gómez de Tejada MJ, Mirallave A, et al. Osteoporosis and metabolic syndrome according to socio-economic status, contribution of PTH, vitamin D and body weight: The Canarian Osteoporosis Poverty Study (COPS). Clinical endocrinology. 2013 May;78(5):681-6.

21. Jimenez M, Giovannucci E, Kaye EK, Joshipura KJ, Dietrich T. Predicted vitamin D status and incidence of tooth loss and periodontitis. Public health nutrition. 2014 Apr;17(4):844-52.

22. Zhan Y, Samietz S, Holtfreter B, Hannemann A, Meisel P, et al. Prospective study of serum 25-hydroxy vitamin D and tooth loss. Journal of dental research. 2014 Jul;93(7):639-44.