Vitamin D and periodontitis; is there an association between vitamin D deficiency and periodontitis severity? A cross-sectional study

Abstract

Background: Periodontitis is an oral disease which is highly prevalent in the adult population worldwide. Periodontitis is characterized by an excessive inflammatory reaction which leads to the destruction of supportive periodontal tissues and potentially tooth loss in the more severe stages of disease. Known risk factors for periodontitis include conditions and lifestyle factors which increase the person’s overall inflammatory risk. Vitamin D has recently been found to play an important role in the immune system and in regulating inflammatory processes. Over the recent decades, there has been an increase in studies investigating the potential influence of vitamin D status on inflammatory diseases and conditions. However, there is still little research to be found on the relationship between vitamin D and periodontitis. The aim of this study was to examine the associations between levels of serum 25(OH)D and periodontitis stage and periodontal pocket depth in Norwegian adults. Methods: The study design was cross-sectional. The data used was obtained from the population-based Tromsø 7 study conducted in 2015 – 2016. From the original Tromsø 7 study sample, only those who had both a valid periodontal diagnosis and data on serum 25(OH)D levels were included in the present study, giving a total study sample of 3 693 participants. Using descriptive statistics and bivariate logistic regression analysis, associations were tested. Periodontitis stage and number of periodontal pockets of ≥ 5 mm were used as dependent variables for their respective separate analyses, and serum 25(OH)D was used as the independent variable for both. An additional analysis of vitamin D and periodontitis stage was performed in which participants were split into two groups according to whether blood samples had been collected between March and September or between October and February. All results were adjusted for selected covariates included in the analyses. Results: Most participants had periodontitis (89.2%) and 19.8% were classified as stage III-IV. 3.8% of the participants were at deficient levels of serum 25(OH)D. The adjusted regression analyses showed that persons with periodontitis stage II-III/IV and persons with periodontal pockets of ≥ 5 mm had higher odds of being vitamin D deficient when adjusting for age, sex, smoking, oral hygiene, and socioeconomic factors. The month when blood samples had been collected was a significant predictor for serum 25(OH)D levels in this sample. Conclusion: The study results suggest that vitamin D status was associated with both periodontitis stage and probing pocket depth. In order to prove causality or direction of the relationship, more prospective research is needed. Nevertheless, these findings would indicate that periodontitis patients might benefit from striving to uphold an intake of vitamin D at the recommended amounts in order to maintain sufficient vitamin D levels throughout the year, even during seasons of restricted sun exposure.