Vitamin D Deficiency and its Effects on Tooth Structure and pulpal changes

Effects on Tooth Structure and pulpal changes
Effects on Tooth Structure and pulpal changes

Scientific Foundation
SPIROSKI, Skopje, Republic of Macedonia
Open Access Macedonian Journal of Medical Sciences. 2021 Feb 24; 9(F):81-87.
eISSN: 1857-9655
Category: F – Review Articles
Section: Narrative Review Article

Lingam Amara Swapna*, Rasheed Abdulsalam
Faculty of Dentistry, Lincoln University College, Kota Bharu, Malaysia


Vitamin D is a steroid hormone that produced primarily by sunlight exposure or obtained from dietary sources, including supplements. The persons who are normally at risk of Vitamin D deficiency are those with scarce of sun exposure and diminished intestinal absorption or limited oral intake. Teeth are nothing but mineralized structure which is enclosed by alveolar bone and are developed by 3 different hard tissues such as dentin, enamel, and cementum. Vitamin D plays a predominant vital part in the tooth and bone mineralization, and it can result in rachitic tooth when the levels get unregulated. Studies suggest that Vitamin D deficiency causes hypocalcified dentin and delayed tooth eruption; thus, representing that Vitamin D has a crucial role in dentin formation as well. The beneficial effects of vitamin D on oral health are not only limited to the direct effects on the tooth mineralization but are also applied through ability to stimulate the production of anti-microbial peptides. In this article, we will briefly discuss the influence on Vitamin D level on the oral and pulpal health.


Vitamin D is a steroid hormone produced primarily by sunlight exposure, but it can also be obtained by dietary and diet supplements [1], [2], [3]. The presence of vitamin D are rare in raw foods and it can be detected in fish oils (including cod liver oil) and oily fish (which includes herring, mackerel, and salmon) [2].

Vitamin D is the collective term for Vitamin D2 and D3. Whereas Vitamin D2 is produced by exposing the ergosterol from yeast to ultraviolet radiation and Vitamin D3 produced by exposing the 7-dehydrocholesterol from lanolin to ultraviolet radiation [4] displaying the biological processes of cholecalciferol (Vitamin D3) and is produced in human bodies. Evaluation of serum 25-hydroxyvitamin D (25[OH]D) is a generally recognized biomarker study of Vitamin D levels [3]. Vitamins are stated as none other than organic compounds that are needed in minute quantities for the purpose of keeping normal health maintained for the organisms [2].

As per the perception of Holick and Chen [2] Vitamin D basically behaves like a hormone; and the endocrine action of it is helpful in promoting the phosphate homeostasis as well as serum calcium with the help of intestinal absorption regulation. According to the statement of Morris and Anderson [5], Vitamin D as well acts alike paracrine and autocrine agent, cell maturation, cell maturation, regulating the process of cell differentiation, and finally innate the process of immune system. On regards to the statement made by Morris and Anderson [5]; Vitamin D’s cellular activities have been mediated through receptor of Vitamin D, that is, (VDR), this is nothing but a receptor molecule which is capable of binding into an active form of Vitamin D. In accordance to the view point of Richard et al. [6], the activities of Vitamin D are based on the VDR regulation for its genomic kind of impacts as well as on the membrane connecting proteins to the non-genomic impacts like signaling pathways. This wide activity is because of the fact or reason that this kind of vitamin tends to modulate the expression of some amount of genes, along with this it is as well analyzed to act so for about 5–10% of the total genome as stated by Morris and Anderson [5].

The public awareness of Vitamin D is seemed to have considerably increased; this is because of the extensive prevalence of Vitamin D defects (VDD) with accordance to the perception of Holick [7], Himmelfarb and Sayegh [8]. This prevalence is surely a matter of concern and worry and it is about the complete significance of common health having special attention on pregnancy, children, prevention of infection, and certain types of cancer as per the statement of Aguiar et al. [9].

Steroid hormone - Vitamin D. Photo credits: AHA Journals

In general, the vital reason of VDD is none other than the absence of exposure toward the sunlight along with sufficient ultraviolet B rays (i.e., exogenous element) as per the statement given by Holick [7], Himmelfarb and Sayegh [8]. Holick [7] stated that the VDD can even get raised from a nutritional deficiency because of insufficient Vitamin D intakes or else hereditary deficiencies or disorders from metabolic conversion and absorption as well. In addition to that, Gröber and Kisters [10] stated VDD relating drug is even possible because of the iatrogenic greater clearance (e.g., with carbamazepine, phenytoin, and oxcarbazepine regimens) comes to periodontal disease or defect, it has not been observed to be completely detected yet. As per the point of view of Chapple et al. [11], when it comes to oral diseases the role played by nutrition has indeed acquired fame and popularity,
furthermore, the researches made in the recent times have greatly unmasked appropriate associations amidst the oral pathologies and nutritional defects. The oral related diseases are quite complicated multifactorial diseases which also keeps the 2 major prevalent diseases all throughout the world Peres et al. [12].

The process through which Vitamin D shows its effect on the oral health is not merely dependent on the system of bone metabolism. Aim of the study is to correlate and enumerate the findings from different studies, the changes noticed in teeth in vit D deficiency patients. The breakthroughs made in the recent times has led us in elaborating a review that focuses on comprehensively summarizing the prevailing evidence of impact due to deficiency of Vitamin D subjected to the oral health. In addition to that, this paper of review will indeed specify the discussion made about the effect of recent researches in which the correction of VDD was applied through supplementation that may result in supporting the
upcoming clinical guidelines.

According to the viewpoint of Dietrich et al. [16], a number of researches has recommended
that the intake involving calcium and/or Vitamin D leads to alleviated gingival inflammation, alveolar bone loss, or/and attachment loss. Nishida et al. [17] stated that most appropriate one are none other than the data on subjects (regarding 12,000) which has been registered in the NHANES III; that is, (Third National Health and Nutrition Examination Survey). It recommends that lesser dietary calcium food has seemed to be increasing the attachment loss in terms of dose-oriented fashion. Taking some other bigger cohort (regarding 6700 subjects), a connection that exists amid gingival inflammation and serum concentrations of D (25OHD), that is, 25-hydroxyvitamin was observed, and this is subsequently associated with the anti-inflammatory effect of Vitamin D as per the examination if [18]. The findings have even supported the capable role played by Vitamin D when it comes to periodontal health. It specifies that the polymorphisms of receptor gene of Vitamin D have connection with the alveolar bone loss, clinical attachment, periodontitis, or/and tooth loss [19].

Therefore, there is proof which points out on the capable part played by the foods such as cod liver oil, salmon fish, egg yolks, and mushrooms relating to calcium and Vitamin D on dental health despite the probable impacts of that kind of dietary supplementation on the parameters of periodontal deficiency. Moreover, the results are yet to be addressed.

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