Table 1.
Observational studies on vitamin D association with periodontal disease.
| Study Type | Sample | Sex; Age; N | Dietary Intake Assessment | Nutritional Status Assessment | Periodonta Status | Analysis Results (p-Value) | Main Results/Conclusions | Ref. |
|---|---|---|---|---|---|---|---|---|
| CS | DANHES 2007–2008 participants (Denmark) | Both; ≥18 y; N = 3287 | Vitamin D intake by FFQ | - | Severe periodontitis 1 | N.S. (mult. logistic reg.) | No association | [30] |
| CAL | N.S. (mult. linear reg.) | |||||||
| CS | DLS participants (USA) | Male; 62.9 ± 7.6 y; N = 562 | Daily dietary intake (≥400 IU, 400–800 IU or ≥800 IU) by FFQ | - | Severe periodontal disease 1 | OR 1 = 0.67 (95%CI: 0.55–0.81); p < 0.05 for trend (mult. logistic reg.) | Inverse associations | [28] |
| Moderate to severe ABL 2 | OR 1 = 0.54 (95%CI: 0.30–0.96); p < 0.05 for trend (mult. logistic reg.) | |||||||
| CS | NHANES III participants (USA) | Both; ≥20 y; N = 11,202 | - | Serum levels of 25(OH)D (quintile) | Mean CAL | N.S. (mult. linerar reg.) in men <50 y old | Negative association with CAL, only in subjects ≥50 years | [27] |
| CAL 2 = +0.39 mm (95%CI: 0.17–0.60); p = 0.001 (mult. linerar reg.) in men ≥50 y old | ||||||||
| N.S. (mult. linerar reg.) in women <50 y old | ||||||||
| CAL 2 = +0.26 mm (95%CI: 0.09–0.43); p = 0.008 (mult. linerar reg.) in women ≥50 y old | ||||||||
| % BOP | N.S. (mult. linerar reg.) in all subsets | |||||||
| CS | 4th KNHANES Participants (South Korea) | Both; ≥19 y; N = 6011 | - | Serum levels of 25(OH)D (>20, <20 ng/mL) deficiency | CPI ≥ 3 | N.S. (mult. logistic reg.) in non-restricted model | Inverse association only in current smokers | [31] |
| OR 2 = 1.53 (95%CI: 1.07–2.18) (mult. logistic reg.) in model resticted to current smokers | ||||||||
| N.S. (mult. logistic reg.) in model restricted to non-current smokers | ||||||||
| CS | Paticipants in OsteoPerio Study (USA) | Female, Postmenopause; N = 920 | - | Plasma levels of 25(OH)D (Adequate or inadequate nutritional status) | 50% BOP | OR = 0.42% (95%CI: 21–58%); p < 0.05 for trend | Inverse association with % BOP & periodontal disease according to CDC/AAP criteria 5 | [33] |
| periodontal disease based on ACH measures 3 | N.S. | |||||||
| periodontal disease based on CDC/AAP criteria 1 | OR = 33% (95%CI: 5–53%) p < 0.05 for trend | |||||||
| tooth loss | N.S. | |||||||
| CC | Subjects from an University Health Center (China) | Both; 16–64 y; N = 178 | - | Plasma levels of 25(OH)D | Aggressive periodontitis 4 vs. chronic periodontitis-affected 4 vs. healthy (Staff) | 29.28 in aggressive periodontitis patients >21.60 nmol/L in controls; p < 0.05 (ANCOVA) | Plasma 25(OH)D levels in patients with aggressive periodontitis were higher than those of healthy controls | [35] |
| CC | Women with a singleton pregnancy taking vitamin D supplements (USA) | 27 ± 6 for cases/31 ± 6 y for controls; N = 235 | - | Serum levels of 25(OH)D | Clinical moderate to severe periodontal disease-affected 5 vs. healthy | 59 > 100 nmol/L; p < 0.001 (Wilcoxon Mann-Whitney U) | Subject with periodontal disease had lower serum levels of 25(OH)D | [34] |
| Women with vitamin D deficiency (<75 nmol/L) | 65 > 29%; p < 0.001) (x2 Test). Moreover, multivariable analysis showed an adjusted OR of 2.1 between periodontal disease and vitamin D insufficiency (95%CI. 0.99–4.5) | |||||||
| CC | Cases of moderate/severe periodontitis & periodontally healthy controls aged. (Puerto Rico, USA) | Both; 35–64 y; N = 38 | - | Serum levels of 25 (OH) D levels | periodontal disease | 18.5 (± 4.6) ng/mL < 24.2 (± 7.1) ng/mL; p = 0.006. | Inverse association | [29] |
| Serum levels of 25 (OH) D levels | OR = 0.885 (95%CI: 0.785–0.997) p < 0.05 for trend | |||||||
| C (5 y) | Postmenopausal paticipants in OsteoPerio Study (USA) | Female; Postmenopause; N = 665 | - | Plasma levels of 25(OH)D | Mean ACH increase (1 mm) | N.S. (mult. linear reg.) | No association | [32] |
| Mean CAL increase (1 mm) | N.S. (mult. linear reg.) | |||||||
| Mean PD increase (1 mm) | N.S. (mult. linear reg.) | |||||||
| Mean % BOP increase (1%) | N.S. (mult. linear reg.). | |||||||
| C (20 y) | Health Professionals Follow-Up Study participants (USA) | Both; 40–75 y; N = 42,730 | Semi-quantitative FFQ | Predicted 25(OH)D score 6 (quintiles) | Tooth loss incidence | HR = 0.90 (95%CI: 0.88–0.92); p < 0.001 for trend (COX model) | Inverse dose-dependent associations | [26] |
| Self-reported periodontitis | HR = 0.91 (95%CI: 0.86–0.95); p < 0.001 for trend (COX model) |
1 values compared highest vs. lowest percentile, 2 values compared lowest vs. highest percentile, 1 AAP/CDC criteria: PPD ≥ 5 mm on at least 1 tooth and CAL ≥ 6 mm at 2 or more sites (not on same tooth), 2 ABL ≥ 40% at 3 or more sites. 3 ABL ≥ 40% or ≥1 tooth lost, 4 IWCPDC criteria: 3 BOP & PPD ≥ 3 mm at ≥1 sites. AL > 2 mm or ≥1 tooth lost, 5 ≥15 sites with PPD ≥4 mm. Abbreviations: 95%CI: 95% confidence interval, 25(OH)D: 25-hydroxyvitamin D, AAP: American Academy of Periodontology, ABL: alveolar bone loss, ACH: alveolar crestal height, BOP: bleeding on probing, CAL: clinical attachment loss, CC: case-control study, CDC: Center for Disease Control and Prevention, CS: cross-sectional study, DLS: Department of Veteran Affairs Dental Longitudinal Study, HR: hazard ratio, IWCPDC: International Workshop for the Classification of Periodontal Diseases & Conditions in 1999, NHANES III: Third National Health and Nutrition Examination Survey, OR: odds ratio, PPD: periodontal probing pocket, US: United States, vs.: versus, w: weeks.