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Online Library: Periodontal Disease

The following pages provide an overview of the most recent research and clinical studies about the health benefits of micronutrients in fighting periodontal disease. This collection of scientific facts proves that anyone who privately or publicly questions the health value of micronutrients does not serve YOUR health, or the health of the people, but rather the multi-billion dollar investment 'business with disease' based on patented pharmaceutical drugs.

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Cross-Sectional Study of Vitamin D and Calcium Supplementation Effects on Chronic Periodontitis

Source: Journal of Periodontology 2009; 80(9): 1433-9

Author: Miley D.D., Garcia M.N., Hildebolt C.F, Shannon W.D., Couture R.A, Anderson Spearie C.L., Dixon D.A., Langenwalter E.M., Mueller C., Civitelli R.

Affiliation: Graduate Periodontics, Saint Louis University Center for Advanced Dental Education, St. Louis, MO 63104, USA.

Abstract: This study examined whether the use of vitamin D and calcium supplements affects periodontal disease status. A cohort of 51 subjects receiving periodontal maintenance therapy was recruited from two dental clinics; 23 were taking vitamin D (>or=400 IU/day) and calcium (>or=1,000 mg/day) supplementation, and 28 were not taking such supplementation. All subjects had at least two interproximal sites with >or=3 mm clinical attachment loss. Daily calcium and vitamin D intake (from food and supplements) were estimated by nutritional analysis. The following clinical parameters of periodontal disease were recorded for the mandibular posterior teeth: gingival index, probing depth, cemento-enamel junction-gingival margin distance (attachment loss), bleeding on probing, and furcation involvement. The study concludes that in subjects receiving periodontal maintenance therapy, there was a trend for better periodontal health with vitamin D and calcium supplementation. More expanded longitudinal studies are required to determine the potential of this relationship.

Calcium and the Risk for Periodontal Disease

Source: Journal of Periodontology 2000; 71(7): 1057-66

Author: Nishida M., Grossi S.G., Dunford R.G., Ho A.W., Trevisan M., Genco R.J.

Affiliation: Sunstar, Inc., Osaka, Japan.

Abstract: This study evaluated the role of dietary calcium intake as a contributing risk factor for periodontal disease utilizing the Third National Health and Nutrition Examination Survey (NHANES III), which is representative of the U.S. civilian non-institutionalized population. Dietary calcium intake was determined from a 24-hour dietary recall. The U.S. Department of Agriculture Nutrient Database was used as a source of nutrient composition data. Periodontal disease was measured by attachment loss. In addition, serum calcium was assessed using venous blood samples. Logistic regression analysis was used to examine the association between periodontal disease and dietary calcium intake or serum calcium levels after adjusting for covariants including age, gender, tobacco consumption, and gingival bleeding. The association of lower dietary calcium intake with periodontal disease was found for young males and females (20 to 39 years of age), and for older males (40 to 59 years of age). These odds ratios were adjusted for gingival bleeding and tobacco consumption. The dose response was also seen in females, where there was 54% greater risk of periodontal disease for the lowest level of dietary calcium intake (2 to 499 mg) and 27% greater risk in females who took moderate levels of dietary calcium (500 to 799 mg) as compared to those who took 800 mg or more dietary calcium per day. The results suggest that low dietary intake of calcium results in more severe periodontal disease. Further studies will be needed to better define the role of calcium in periodontal disease and to determine the extent to which calcium supplementation will modulate periodontal disease and tooth loss.

Coenzyme Q10

Oxidant/Antioxidant Interactions of Nicotine, Coenzyme Q10, Pycnogenol and Phytoestrogens in Oral Periosteal Fibroblasts and MG63 Osteoblasts

Source: Steroids 2006; 71(13-14): 1062-72

Author: Figuero E., Soory M., Cerero R., Bascones A.

Affiliation: Department of Periodontology, Faculty of Dentistry, University Complutense of Madrid, Spain.

Abstract: The aim of this investigation was to evaluate potential oxidant/antioxidant interactions of nicotine with antioxidants: Coenzyme Q10 (CoQ), pycnogenol and phytoestrogens in a cell culture model. Duplicate incubations of human periosteal fibroblasts and osteoblasts were performed with 14C-testosterone as substrate, in the presence or absence of CoQ (20 microgram/ml), pycnogenol (150 microgram/ml), and phytoestrogens (10 and 40 microgram/ml), alone and in combination with nicotine (250 microgram/ml). At the end of a 24-h incubation period, the medium was solvent extracted and testosterone metabolites were separated by thin-layer chromatography and quantified using a radioisotope scanner. This investigation suggests that the catabolic effects of nicotine could be reversed by the addition of antioxidants such as CoQ or pycnogenol and phytoestrogens.

Antioxidant Status (CoQ10 and Vitamin E Levels) and Immunohistochemical Analysis of Soft Tissues in Periodontal Diseases

Source: Biofactors 2005; 25(1-4): 213-7

Author: Battino M., Bompadre S., Politi A., Fioroni M., Rubini C., Bullon P.

Affiliation: Institute of Biochemistry, UniversitÓ Politecnica delle Marche, Ancona, Italy.

Abstract: Reactive oxygen species and antioxidant status in periodontal diseases and periodontal-related pathologies is an item of growing interest. Immunohistochemical approach may be usefully employed in the study of soft tissues affected by periodontal disease, giving valuable information on tissue morphology and vascular proliferation that depends directly on the inflammatory state. In order to study CoQ(10) and vitamin E content in healthy gingiva and in gingivitis a new adaptation to previously published methods for their determination was adopted. During gingivitis tissue displayed a large inflammatory infiltration in the lamina propria and a VEGF positive squamous epithelium. The inflammatory infiltration consisted mainly of lymphocytes, plasma cells and neutrophils. Vitamin E dramatically decreased and CoQ(10) remained unchanged despite the increased amount of cells present in the periodontally affected tissues, indicating that continuous oxidative stress which occurred in these structure affected the antioxidant pattern of the tissue.

Nitric Oxide

Nitric Oxide Synthase Activity in Neutrophils from Patients with Localized Aggressive Periodontitis

Source: Journal of Periodontology 2001; 72(8): 1052-8

Author: Shibata K., Warbington M.L., Gordon B.J., Kurihara H., Van Dyke T.E.

Affiliation: Department of Periodontology and Oral Biology, Boston University Goldman School of Dental Medicine, MA 02118, USA

Abstract: Nitric oxide (NO) and its enzyme, nitric oxide synthase (NOS), have been suggested to be involved in chemotaxis. Some reports, however, were unable to detect either NO or NOS in human neutrophils. This study have focused on NOS activity in Localized Aggressive Periodontitis (LAgP) neutrophils and examined the involvement of NOS in chemotaxis of normal neutrophils and NOS activity in neutrophils from normal subjects and patients with LAgP. Neutrophils from 10 normal subjects and 10 LAgP patients were isolated from peripheral venous blood. Membrane associated-NOS (MA-NOS) and soluble NOS (S-NOS) were extracted from cells with or without FMLP stimulation. NOS activity was measured using the radiolabeled L-arginine to L-citrulline conversion assay. This study suggests that NOS is present in human neutrophils and may be involved in FMLP-induced chemotaxis in normal neutrophils. NOS activity is increased in LAgP and is negatively correlated to chemotaxis response.

Nutrient combinations

Association of Some Specific Nutrient Deficiencies with Periodontal Disease in Elderly People: A Systematic Literature Review

Source: Nutrition 2009; 25(7-8): 717-22

Author: van der Putten G.J., Vanobbergen J., De Visschere L., Schols J., de Baat C.

Affiliation: Zorgaccent Amersfoort Medical Services, Amersfoort, The Netherlands.

Abstract: This article systematically reviews the currently available literature on the feasible association of vitamin B complex, vitamin C, vitamin D, calcium, and magnesium deficiencies with periodontal disease in elderly people. A systematic review of relevant English- and Dutch-language medical literature published from January 1990 to May 2007 was performed, with critical appraisal of those studies evaluating the association of vitamin B complex, vitamin C, vitamin D, calcium, and magnesium deficiencies with periodontal disease in elderly people. None of the studies meeting the selection criteria included institutionalized elderly people. In the studies on non-institutionalized elderly people, no significant or consistent association was found between vitamin B complex, vitamin C, vitamin D, calcium, and magnesium dietary intakes and serum levels and periodontal disease. Although in those studies decreased dietary vitamin C intake was found to be associated with increased risk of periodontal disease, no conclusive evidence could be demonstrated. To produce conclusive evidence on the subject of this systematic literature review, longitudinal cohort studies and follow-up randomized controlled trials are needed.

Effects of Specific Nutrients on Periodontal Disease Onset, Progression, and Treatment

Source: Journal of Clinical Periodontology 2003; 30: 579-588

Author: Neiva R.F., Steigenga J., Al-Shammari K., Wang H-L.


Abstract: The authors studied nutritional elements (e.g., vitamin B-complex, vitamin C, and dietary calcium) that have been strongly associated with the wound healing, periodontal disease status, and response to treatment. Many clinical trials were referenced and reviewed by the authors, and they concluded, "Several studies reported various degrees of association between nutritional elements/supplement and periodontal status, and others have reported possible positive influences of nutritional supplementation on periodontal therapeutic outcomes." They further recommended, "Considering that nutrient supplementation shows minimal or no side effects, controlled clinical trials are able to demonstrate that it could be used to enhance response to therapy and may prove valuable in producing more predictable treatment outcomes."

Effects of a Nutritional Supplement on Periodontal Status

Source: Compendium 2001; 425-438

Author: Munoz C., Kiger R., Stephens J., Kim J., Wilson A.

Affiliation: Loma Linda University, CA

Abstract: Researchers at Loma Linda University studied the impact of an antioxidant-rich oral supplement on 63 patients ranging in age from 20 to 70 years and diagnosed with gingivitis and Type II periodontal disease for a 60-day double-blind clinical trial. The proprietary blend of nutrients contained folate, which is reported to reduce gingival inflammation by binding to the endotoxins from bacterial plaque preventing irritation of the gingival architecture, (9) vitamin B12, vitamin C, an aqueous antioxidant which works synergistically with vitamin E to prevent oxidation of cells, Echinacea, Coenzyme Q10, and Piper Nigrum Extract. The participants were randomly assigned to two groups ?the experimental group, which took two tablets each day of the proprietary blend of antioxidants, and the control group, which took a similar-looking placebo. Results of that study showed significant improvement in the clinical parameters and measurements of gingival inflammation; bleeding on probing, pocket depth, and attachment levels. "At the 60-day evaluation point, all subjects receiving the experimental treatment had significant reduction in the gingival index, pocket depth, and bleeding index," Treatment with this proprietary nutriceutical appeared to offer patients a noninvasive, systemic, adjunctive protocol to potentiate in-office therapies.

Dr. Rath Cellular Nutrient Synergy Program in Peridontosis

Source: Cellular Health Communications, Vol.1, No.1, 2001


Affiliation: Dr. Rath Research Institute, Santa Clara, CA

Abstract: This pilot study has been designed to scientifically document the effects of a specific vitamin treatment in patients with symptoms of periodontosis. Nine patients with typical symptoms of chronic periodontosis took part in the study. All of them were aware of the importance of optimal oral hygiene. The patients took a daily dosage of vitamins and other nutrients for three months. The most important component of these nutrients was vitamin C. As a diagnostic measurement of the progression of periodontosis, the ?Bleeding-on-Probing? method (BoP), which is widely used in the assessment of this disease, was utilized. Before the vitamin therapy, the average BoP value was 60%, which corresponds to a very advanced gum infection. From the sixth week, a clear reduction of gum bleeding was evident and by the eighth week, the average BoP had fallen to 14%. After twelve weeks (the end of the three-month pilot study), the average decrease of gum bleeding was estimated at 85%. In addition, a significant improvement in gum firmness was noted, as was a reduction in visible vascularization, which indicated s a significant reduction of the previously spongy gum tissue fragments of beet-red color. Additional beneficial health effects were spontaneously reported by many patients, including improvement in overall physical condition and vitality.

Vitamin C

Effects of Vitamin C Intake on Gingival Oxidative Stress in Rat Periodontitis

Source: Free Radical Biology and Medicine 2009; 46(2): 163-8

Author: Tomofuji T., Ekuni D., Sanbe T., Irie K., Azuma T., Maruyama T., Tamaki N., Murakami J., Kokeguchi S., Yamamoto T.

Affiliation: Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama 700-8525, Japan.

Abstract: This study hypothesized that increases in plasma vitamin C levels after vitamin C intake might clinically reduce gingival oxidative stress in a rat periodontitis model. A ligature was placed around rat mandibular molars for 4 weeks to induce periodontitis, and the rats were then given drinking water with or without 1 g/L vitamin C for 2 weeks after the ligature was removed. The periodontitis-induced rats showed a 149% increase in 8-hydroxydeoxyguanosine level and a 40% decrease in reduced:oxidized glutathione ratio in gingival tissue. Vitamin C intake induced a 175% increase in plasma vitamin C level, resulting in an improvement in the gingival 8-hydroxydeoxyguanosine level (decreased) and in the reduced:oxidized glutathione ratio (increased). Furthermore, in ligature-induced periodontitis lesions, gene expression encoding inflammation, including interleukin-1 alpha and interleukin-1 beta, was more than twofold down-regulated by vitamin C intake. The results suggest that systemic administration of vitamin C could be clinically beneficial in improving periodontitis-induced oxidative stress by down-regulating inflammatory gene expression.

Java Project on Periodontal Diseases: the Relationship between Vitamin C and the Severity of Periodontitis

Source: Journal of clinical periodontology 2007; 34(4): 299-304

Author: Timmerman M.F., Abbas F., Loos B.G., Van der Weijden G.A., Van Winkelhoff A.J., Winkel E.G., Van der Velden U.

Affiliation: Department of Periodontology, Padjadjaran State University, Bandung, Indonesia.

Abstract: The objective of this study was to investigate the relationship between vitamin C and the severity of periodontitis. The study population consisted of subjects from the Malabar/Purbasari tea estate on West Java, Indonesia. In 2002, clinical measurements were performed in 128 subjects, including evaluation of plaque, bleeding on probing, pocket depth and attachment loss. In 2005, 123 out of 128 subjects could be retrieved who were present at the examination of 2002. Blood samples were taken to measure plasma vitamin C levels. Information about the subject's dietary habit was obtained by means of a personal interview guided by a questionnaire. RESULTS: Plasma levels of vitamin C ranged from 0.02 to 34.45 mg/l with a mean of 7.90 mg/l (+/-5.35). The correlation coefficient between plasma vitamin C level and periodontal attachment loss was -0.199 (p<0.05); stepwise linear regression revealed that vitamin C levels explained 3.9% of the variance in periodontal attachment loss. Subjects with vitamin C deficiency (14.7% of the study population) had more attachment loss compared with those with depletion or normal plasma vitamin C values. The negative association between plasma vitamin C levels and periodontal attachment loss suggests that vitamin C deficiency may contribute to the severity of periodontal breakdown.

The Prevalence of Inflammatory Periodontitis is Negatively Associated with Serum Antioxidant Concentrations

Source: The Journal of Nutrition 2007; 137(3): 657-64

Author: Chapple I.L., Milward M.R., Dietrich T.

Affiliation: Periodontal Research Group, University of Birmingham, School of Dentistry, St. Chads Queensway, Birmingham, B4 6NN, UK.

Abstract: Oxidative stress is reported in periodontitis both locally and peripherally (serum), providing potential mechanistic links between periodontitis and systemic inflammatory diseases. It is therefore important to examine serum antioxidant concentrations in periodontal health/disease, both at an individual species and total antioxidant (TAOC) level. To determine whether serum antioxidant concentrations were associated with altered relative risk for periodontitis, the study used multiple logistic regression for dual case definitions (both mild and severe disease) of periodontitis in an analysis of 11,480 NHANES III adult participants (>20 y of age). Serum concentrations of vitamin C, bilirubin, and TAOC were inversely associated with periodontitis, the association being stronger in severe disease. Vitamin C and TAOC remained protective in never-smokers. Higher serum antioxidant concentrations were associated with lower odds ratios for severe periodontitis of 0.53 (CI, 0.42,0.68) for vitamin C, 0.65 (0.49,0.93) for bilirubin, and 0.63 (0.47,0.85) for TAOC. In the subpopulation of never-smokers, the protective effect was more pronounced: 0.38 (0.26,0.63, vitamin C) and 0.55 (0.33,0.93, TAOC). Increased serum antioxidant concentrations are associated with a reduced relative risk of periodontitis even in never-smokers.

Daytime of Sampling, Tooth-Brushing and Ascorbic Acid Influence Salivary Thiobarbituric Acid Reacting Substances - a Potential Clinical Marker of Gingival Status

Source: Disease Markers 2005; 21(4): 203-7

Author: Hodosy J., Celec P.

Affiliation: Institute of Physiology, Faculty of Medicine, and Department of Animal Physiology and Ethology, Faculty of Natural Sciences, Comenius University, Bratislava, Slovak Republic.

Abstract: The aim of this study was to observe the effects of daily dynamics, tooth-brushing and ascorbic acid administration on salivary TBARS levels. Self-collected samples were obtained from 10 young healthy men collecting samples in the morning, in the afternoon and in the evening during 2 consecutive days. Ascorbic acid (250 mg) was administered orally after the last sampling on day 1 and before every sampling on day 2. Additional sampling was performed before and after tooth-brushing. TBARS levels in saliva specimens were detected spectrofluorometrically. Sialic acid content was measured using a modified method of Warren. The study concludes that TBARS levels in saliva are affected by daytime of sampling, tooth-brushing and ascorbic acid pre-treatment. These results must be considered in clinical research using salivary TBARS levels. Sialic acid seems not to be a major component of TBARS in saliva. Further studies should clarify the molecular compounds of salivary TBARS and uncover the role of oral microbial factors.

Grapefruit Consumption Improves Vitamin C Status in Periodontitis Patients

Source: British Dental Journal 2005; 199(4): 213-7

Author: Staudte H. Sigusch B.W., Glockmann E.

Affiliation: Department of Conservative Dentistry, Friedrich Schiller University, An der alten Post 4, 07750 Jena, Germany.

Abstract: The present study examined the vitamin C plasma levels and inflammatory measures in periodontitis patients before and after the consumption of grapefruit. Fifty-eight patients with chronic periodontitis were assigned to the test group (non-smokers n=21, smokers n=17) and a diseased control group (non-smokers n=11, smokers n=9). Furthermore, 22 healthy subjects were recruited to compare vitamin C plasma levels between periodontally diseased and healthy subjects. Clinical evaluations, including plaque index (PI), sulcus bleeding index (SBI), probing pocket depths (PPD) and plasma vitamin C levels, were performed at baseline, and after two weeks of grapefruit consumption. The present results show that periodontitis patients are characterized by plasma vitamin C levels below the normal range, especially in smokers. The intake of grapefruit leads to an increase in plasma vitamin C levels and improves sulcus bleeding scores. Longer term studies are necessary to determine whether other periodontal outcomes improve with such supplementation especially in smokers.

Serum Vitamin C-Periodontal Relationship in Community-Dwelling Elderly Japanese

Source: Journal of Clinical Periodontology 2005; 32(1): 93-7

Author: Amarasena N., Ogawa H., Yoshihara A., Hanada N., Miyazaki H.

Affiliation: Division of Preventive Dentistry, Department of Oral Health Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.

Abstract: The objective of this study was to determine the relationship between serum vitamin C and periodontitis as estimated by clinical attachment loss (CAL) in community-dwelling elderly Japanese. This analysis was confined to 413 Niigata citizens aged 70 years in whom the data for serum vitamin C and CAL were available. High-pressure liquid chromatography method was used to ascertain the serum vitamin C levels while CAL was assessed on six sites of all teeth present including third molars by means of pressure-sensitive probes. Other variables included gender, smoking, toothbrushing frequency, number of teeth present and random blood sugar levels. The findings suggested that serum vitamin C might have relatively weak but a statistically significant relationship with periodontitis in this elderly population.

Dietary Vitamin C and the Risk for Periodontal Disease

Source: Journal of Periodontology 2000; 71(8): 1215-23

Author: Nishida M., Grossi S.G., Dunford R.G., Ho A.W., Trevisan M., Genco R.J.

Affiliation: Sunstar, Inc., Takatsuki, Osaka, Japan.

Abstract: This study evaluated the role of dietary vitamin C as a contributing risk factor for periodontal disease utilizing the Third National Health and Nutrition Examination Survey (NHANES III) which is representative of the U.S. civilian, non-institutionalized population. A sample of 12,419 adults (20 to 90+ years of age), with dental measurements and assessment of dietary information as well as demographic and medical histories were included in the studies. Dietary vitamin C was estimated by a 24-hour dietary record. Individuals with periodontal disease were arbitrarily defined as those who had mean clinical attachment levels of > or =1.5 mm. Using multiple logistic regression analysis, the study found a relationship between reduced dietary vitamin C and increased risk for periodontal disease for the overall population (odds ratio [OR] = 1.19; 95% CI: 1.05 to 1.33). There was a dose-response relationship between the levels of dietary vitamin C and periodontal disease with an OR of 1.30 for those taking 0 to 29 mg of vitamin C per day, to 1.16 for those taking 100 to 179 mg of vitamin C per day as compared to those taking 180 mg or more of vitamin C per day. The study concludes that dietary intake of vitamin C showed a weak, but statistically significant, relationship to periodontal disease in current and former smokers as measured by clinical attachment. Those taking the lowest levels of vitamin C, and who also smoke, are likely to show the greatest clinical effect on the periodontal tissues.