Title	Hypovitaminosis D is a Risk Factor for Periodontal Disease
Clinical Question	Is periodontal disease (PD) linked to low serum 25-hydroxyvitamin D [25(OH)D]?
Clinical Bottom Line	Evidence shows that there is an association of periodontal disease with low serum 25-hydroxyvitamin D. This is supported by evidence from a cohort study of calcium and vitamin D supplementation and another study that measured periodontal attachment loss as a function of serum 25(OH)D concentrations among different age groups.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 19722793 Miley/2009 Cohort study involving 51 subjects Cohort study Key results The cohort study of 51 subjects, 23 taking vitamin D and calcium supplementation and 28 not taking such supplementation, was evaluated after 18 months. The study provided evidence for the association of periodontal disease (PD) with low serum 25(OH)D concentrations, indicating that subjects who took supplementation had shallower probing depths, fewer bleeding sites, lower gingival index values, fewer furcation involvements, less attachment loss ,and less alveolar crest height loss. Mean values of vitamin D and calcium intake for takers were significantly higher than non-takers for at least 18 months (1,049 IU/d and 1,769 mg/d in takers and 156 IU/d and 642 mg/d in non-takers). Measures of PD were consistently higher in non-takers than in takers (p <0.05) upon receiving periodontal maintenance therapy. 15213036 Dietrich/2004 Survey involving 11,202 subjects Survey Key results Data involving periodontal attachment loss and serum 25(OH)D concentrations were analyzed among subjects of two age groups, 20-49 years and >50 years. There were no significant trends in those 20-49 years old, but for those >50 years standardized b-coefficients varied from 0.39 (in males) and 0.26 (in females) for 25(OH)D <40.2 nmol/L to 1.0 (reference) for 25(OH)D >85.6 nmol/L. These results were adjusted for many factors, such as age, gender, ethnicity, smoking, diabetes, income ratio, body mass index, and gingival bleeding, and results suggested a strong association of PD with poor vitamin D status.
Evidence Search	low[All Fields] AND ("vitamin d"[MeSH Terms] OR "vitamin d"[All Fields] OR "ergocalciferols"[MeSH Terms] OR "ergocalciferols"[All Fields]) AND ("periodontal diseases"[MeSH Terms] OR ("periodontal"[All Fields] AND "diseases"[All Fields]) OR "periodontal diseases"[All Fields] OR ("periodontal"[All Fields] AND "disease"[All Fields]) OR "periodontal disease"[All Fields])
Comments on The Evidence	Validity: Evidence in the first reference was recorded after 18 months. Results over a longer term could add validity to suggest that periodontal maintenance therapy was more efficient in supplement takers. Perspective: The cohort study and survey provides consistent evidence to show that there is an association of periodontal disease with low serum vitamin D, but further evidence, possibly from a long-term cohort study, is needed to support supplementation.
Applicability	Though there are more commonly recognized risk factors for periodontal disease, such as age, diet, and smoking, evidence also supports hypovitaminosis D as a risk factor for PD. In patients with low serum 25(OH)D, supplementation, in addition to other factors, can be suggested to lower risk of PD.
Specialty	(General Dentistry) (Periodontics) (Interprofessional CATs)
Keywords	Periodontal disease, vitamin D
ID#	2884
Date of submission	04/19/2015
E-mail	Nguyenkc@livemail.uthscsa.edu
Author	Kim Chi Nguyen
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Georgiana S. Gross, MPH
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