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Title There Is Insufficient Evidence To Attribute Periodontal Disease To Low Serum Ascorbic Acid
Clinical Question Is there a correlation between a deficiency of ascorbic acid and periodontal disease?
Clinical Bottom Line A low serum level of ascorbic acid tends to have a strong association with periodontal disease.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22166583Iwasaki/2012224 Japanese individuals age 71 yrs. Prospective case Series
Key resultsThe multivariate adjusted relative risks for number of teeth with loss of clinical attachment level in the highest, middle, and lowest tertiles of serum ascorbic acid were 1.00 (reference), 1.12 (95% CI 1.01-1.26), and 1.30 (1.16-1.47).
#2) 20569170Abou Sulaiman/201060 subjects in Syria: 30 with chronic periodontitis and 30 matched controlsCase-Control
Key resultsTotal antioxidant capacity was lower in cases than in controls (p<0.001). Non-surgical periodontal therapy resulted in increased plasma total antioxidant capacity (p<0.001) but the addition of an adjunctive dose of vitamin C did not further alter antioxidant capacity.
#3) 17378886Amaliya/2007128 subjects on a tea estate in IndonesiaProspective case Series
Key resultsLinear regression indicated that 3.9% of the variance in periodontal attachment loss was explained by vitamin C levels. Vitamin C-deficient individuals had more attachment loss than those with vitamin C depletion or normal levels of vitamin C.
Evidence Search "Ascorbic Acid Deficiency"[Mesh] AND "Periodontal Diseases"[Mesh] AND "humans"[MeSH Terms] ...view in PubMed
Comments on
The Evidence
These case-control and prospective case series study designs suggest, but cannot confirm, that the risk for periodontal disease is partially explained by serum ascorbic acid.
Applicability This study can be applied to patients who have low serum levels of vitamin C or periodontitis.
Specialty/Discipline (Public Health) (General Dentistry) (Periodontics)
Keywords Ascorbic Acid, Chronic Periodontitis, Vitamin C, Oxidative Stress, Periodontal Index, Total Antioxidant Capacity
ID# 2205
Date of submission: 04/13/2012spacer
E-mail orsatti@livemail.accd.edu
Author Matt Orsatti
Co-author(s) e-mail
Faculty mentor/Co-author Georgiana S. Gross, MPH
Faculty mentor/Co-author e-mail grossg@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Kristina Orquiz, Kaylee Denton (San Antonio, TX) on 11/28/2017
Via a November 2017 PubMed search, Amaliya 2015 (PMID: 25683157), a follow-up investigation of the cohort study provided as above CAT evidence, found no relation between fasting plasma vitamin C values and the amount of alveolar bone loss, in contrast to findings of Amaliya 2007. Prior studies by Amaliya utilized non-fasting plasma vitamin C (in contrast to the fasting plasma vitamin C measured in the follow up) while studies from other authors do not always distinguish between fasting and non-fasting vitamin C, which Amaliya mentions may contribute to contradictory findings. In contrast, a cross-sectional study of 120 individuals by Gokhale (PMID: 23725523) in 2013 found that ascorbic acid levels were significantly lower in individuals with chronic gingivitis (p = .0004) and chronic periodontitis (p = .0003) compared to patients without periodontal disease. Supporting Gokhale, in a 42 patient cross-sectional study, Kuzmanova 2012 (PMID: 22845498) demonstrated that plasma vitamin C was lower in periodontitis patients (8.3 mg/L) than controls (11.3 mg/L, p = 0.03). With the recent contradictory findings of Amaliya 2015, further cohort studies and systematic review including different populations are needed to elaborate the association between periodontal disease and ascorbic acid deficiency

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