Title	Ascorbic Acid Supplementation Ineffective as Therapy for Periodontal Disease
Clinical Question	Does ascorbic acid supplementation provide therapeutic effects in treating periodontal disease?
Clinical Bottom Line	Ascorbic acid supplementation does not prove promising as an antioxidant therapy in treating periodontal disease, but it does play a role in inhibiting alveolar bone resorption and could play a role in developing medicines that promote differentiation of periodontal ligament progenitor cells into bone cells.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 20569170 Abou/2010 Patients with Chronic Periodontitis Randomized Controlled Trial Key results While other methods of periodontal therapy enhanced antioxidant therapy (TAOC), the supplemental dose of ascorbic acid did not prove to provide any further therapeutic benefit to patients in the trial. 22702517 Akman/2012 Rats Laboratory study Key results Alpha lipoic acid and ascorbic acid played a part in inhibiting alveolar bone resorption and destruction of periodontal tissue, thereby providing therapeutic benefit. 23836152 Yan/2013 Progenitor Cells Laboratory study Key results Ascorbic acid activates the differentiation of periodontal ligament progenitor cells leading to ossteogenesis through the PELP1-ERK axis. For this reason, ascorbic acid may play a role in developing medicines which promote regeneration as treatment for periodontitis.
Evidence Search	ascorbic acid and periodontitis
Comments on The Evidence	Validity: The Abou (2010) study contained a randomized controlled trial with groups that were similar at the start and treated the same with adequate follow-up. The study was not double blind but eliminated the need to evaluate adequacy of compliance and recall bias through the design of the study. The Akman (2012) laboratory study involved rats and started with similar groups that were treated the same through the trial. The experiment was not double blind but it demonstrated adequate follow-up. The Yan (2013) laboratory study exposed periodontal ligament progenitor cells to ascorbic acid. Because of the nature of the study, the groups were similar at the start and demonstrated an adequate completion rate without recall bias. Perspective: Although ascorbic acid has been shown to be an integral component of connective tissue development and used in the prevention of soft issue and bone breakdown, the use of ascorbic acid in the actual treatment of periodontitis has not be evaluated thoroughly. These studies could provide the information needed to determine how a natural and abundant substance such as ascorbic acid could be used to promote regeneration of soft and hard tissues of the oral cavity after destruction from periodontal disease.
Applicability	At the current time, the use of ascorbic acid supplementation does not present as a therapy for patients with any form of periodontal disease.
Specialty	(General Dentistry) (Periodontics) (Interprofessional CATs)
Keywords	ascorbic acid periodontal disease
ID#	3088
Date of submission	04/15/2016
E-mail	JosephM3@livemail.uthscsa.edu
Author	Maria Joseph
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Georgiana S. Gross, MPH, RD, LD
Faculty mentor 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?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available