Title Vitamin D and Calcium Supplementation Along with Oral Hygiene Show Positive Affect on Periodontal Health
Clinical Question In patients with periodontal disease does oral supplementation of vitamin D and calcium along with recommended oral hygiene regimens result in improved periodontal health?
Clinical Bottom Line Evidence showed that there is only a slight positive affect on periodontal health when supplementing vitamin D and calcium along with oral hygiene. This is supported by evidence from a randomized clinical trial and an observational clinical trial that measured the periodontal health in two patient groups, one taking supplementation and one that was not.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
26266214Perayil/201582 subjects between the ages of 35-55 with >20 natural teeth, 1 or more teeth with 3-4 mm attachment loss, and bone loss in mandibular molar with a mandibular furcation areaNon-randomized clinical trial
Key results52 patients were divided into two groups. Group A (40 patients) received low-dose vitamin D and calcium supplementation along with a full-mouth oral prophylaxis, subgingival scaling, root planing and curettage for 3 months, while Group B (42 patients) had a full-mouth prophylaxis, subgingival scaling, root planing and curettage. At the end of the study, group A had 36 patients and group B had 41. Five clinical parameters were measured: Oral Hygiene Index-Simplified (OHI-S), Gingival Index (GI), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), and Bone Densities (BD). All parameters showed results that were clinically significant (p=<0.05) except for PPD and CAL, which showed no statistically significant difference. As a result this study concluded that there was a slight positive effect on periodontal parameters in patients who supplement calcium and vitamin D along with scaling and root planing.
20809866Garcia/201151 postmenopausal women and men between the ages of 50-80 years with >2 interproximal sites with >3 mm attachment lossCohort study
Key resultsFifty-one patients were split into two groups, takers (23 patients) and non-takers (28 patients) of supplemental vitamin D and calcium. Throughout the study all patients received periodontal maintenance, which consisted of scaling and root planing, polishing of teeth, reinforcement of oral hygiene procedures, and general dental examinations, every 3 months. The clinical measurements taken into account were attachment loss, gingival index, bleeding, pocket depth, and furcation. When considered collectively, these clinical measurements showed that there were borderline differences between the groups at baseline (p=0.061); at 6 months the differences were significant (p=0.049), but at 12 months there was no significant differences between the groups (p=0.114). Collectively the five clinical measures decreased significantly throughout the study in both takers (p<0.001) and non-takers (p=0.002). This study concluded that there was a modest positive effect in patients taking vitamin D and calcium supplementation along with periodontal maintenance, but following a periodontal maintenance program alone can improve the periodontal health regardless of supplementation.
Evidence Search ("vitamin d"[MeSH Terms] OR "vitamin d"[All Fields] OR "ergocalciferols"[MeSH Terms] OR "ergocalciferols"[All Fields]) AND ("calcium"[MeSH Terms] OR "calcium"[All Fields]) AND periodontal[All Fields] AND ("health"[MeSH Terms] OR "health"[All Fields])
Comments on
The Evidence
Validity: Both these studies show questionable validity in some aspects. In Garcia's study they did not mention the mean serum vitamin D for each patient group, which is important to note since we are trying to tell if this is helping to improve periodontal health. This study also stated that some patients had minimal attachment loss, leading me to believe that improvements are hard to detect if the patients were already in pretty good periodontal health. Perayil's study did not state how patients were assigned to the two groups, and the patient's in Group A started the study with worse OHI-S, PPD, and CAL, which would not make it a fair comparison. It was also a short study and would have benefited from a longer study period. There were not many patients who dropped out of either study, and patients were followed up for an adequate length of time. Perspective: Both studies provide evidence indicating that there is a slight positive effect for taking supplements to help improve periodontal health, but other risk factors such as smoking and systemic diseases should also be taken into account. Perhaps a longitudinal study with increased supplementation could add more validity to the outcome of these studies.
Applicability Adequate nutritional intake should be taken into consideration by dental practitioners. These studies suggest that supplementation may be helpful in the treatment of periodontal disease. Both vitamin D and calcium supplements are readily available over the counter and are a safe and cost-effective way for patients to use to improve their overall periodontal health.
Specialty (General Dentistry) (Periodontics) (Interprofessional CATs)
Keywords Periodontal Health, Vitamin D, Calcium
ID# 3161
Date of submission 04/26/2017
E-mail champion@livemail.uthscsa.edu
Author Samantha Champion
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
None available