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Periodontal disease

Posted on: July 23, 2012   by  Vitamin D Council


Periodontal disease (PD) is a chronic gum condition. Bacteria cause the gums to swell, redden, and bleed. Connective tissue holding the teeth into the jaw bone may become damaged. The gum around the teeth is measured with a thin probe to find out the extent of “attachment loss.” Loss is measured as mild, moderate, or severe.

Risk of PD increases with age. For younger people, dental caries are a more important risk for tooth loss, while for older people, PD is the more important risk factor.

Risk factors

  • The primary risk factor for PD is lack of adequate dental care. Proper dental care includes regular tooth brushing, flossing, and dental visits.
  • Calcium consumption from diet or supplements reduces the risk of PD.
  • Alcohol consumption appears to be a risk factor for PD.

Sunlight exposure and risk for periodontal disease

A few studies indicate a direct role of sunlight in reducing the risk of PD:

  • A study in Norway found a direct relationship between tooth loss and latitude. Only 11% of people living in the south lost teeth compared to 43% living in the central region and 66% in the northern region. Ultraviolet B (UVB) light and vitamin D production decrease rapidly at higher latitudes.
  • A study in Brazil found that people with dark skin had a 50% to 60% greater risk of PD than people with light skin.

Vitamin D and periodontal disease

Vitamin D levels

According to U.S. studies:

  • People with lower vitamin D levels had more attachment loss than people with higher vitamin D levels.
  • African-Americans had a greater risk of PD than white Americans. African-Americans had average vitamin D blood levels of about 16 ng/mL (40 nmol/L) compared to 26 ng/mL (65 nmol/L) for white Americans. Most vitamin D is obtained from solar UVB exposure. Less UVB reaches the lower layer of dark skin, where vitamin D is produced.
  • Pregnant women with PD had lower vitamin D levels and were twice as likely to have vitamin D insufficiency.

PD and a number of diseases are linked to low vitamin D levels: cancer, cardiovascular disease, diabetes, pre-eclampsia, and osteoporosis. In many of the studies, the authors stated that some unknown factor might explain the link.

How vitamin D works

Vitamin D may reduce the risk and severity of PD in several ways:

  • Produces cathelicidin and defensins, which have antimicrobial properties. These compounds reduce the number of bacteria in the mouth.
  • Reduces matrix metalloproteinases (MMPs). MMPs are enzymes that are associated with PD.


Increasing vitamin D blood levels to 40 ng/mL (100 nmol/L) may lower the risk of PD. For most people, it would take 1000–5000 international units (IU) (25–125 mcg)/day of vitamin D3 (cholecalciferol) to reach this level. Vitamin D blood levels should be measured before starting vitamin D. The levels should be tested again after several months. A rule of thumb is that for each 1000 IU (25 mcg)/day of vitamin D3, vitamin D blood levels rise by 6–10 ng/mL (15–25 nmol/L). However, there is considerable variation from person to person. The primary source of vitamin D3 for most people is solar UVB. However, most people do not get enough from the sun.

Vitamin D and calcium

Calcium is also important for dental health and to reduce the risk of PD. The guidelines for calcium intake suggest about 1000 mg/day from food and supplements.


Those with PD should consider taking measures to raise their vitamin D blood levels to 40 ng/mL (100 nmol/L). This can be done by moderate UVB exposure (without sunburn) and oral intake of vitamin D and calcium supplements. While doing so may not cure PD, these measures could prevent PD from getting worse.


This evidence summary was written by:

William B. Grant, Ph.D.
Sunlight, Nutrition, and Health Research Center (SUNARC)
P.O. Box 641603
San Francisco, CA 94164-1603, USA
[email protected]

Complete bibliography of research used in this summary

The research we have cited in our summary is listed below, with links to PubMed abstracts and full-text for those who wish to explore further.


  1. Adams, J. S. Ren, S. Liu, P. T. Chun, R. F. Lagishetty, V. Gombart, A. F. Borregaard, N. Modlin, R. L. Hewison, M. Vitamin d-directed rheostatic regulation of monocyte antibacterial responses. J Immunol. 2009 Apr 1; 182 (7): 4289-95.
  2. Amano, Y. Komiyama, K. Makishima, M. Vitamin D and periodontal disease. J Oral Sci. 2009 Mar; 51 (1): 11-20.
  3. Awano, S. Ansai, T. Takata, Y. Soh, I. Akifusa, S. Hamasaki, T. Yoshida, A. Sonoki, K. Fujisawa, K. Takehara, T. Oral health and mortality risk from pneumonia in the elderly. J Dent Res. 2008 Apr; 87 (4): 334-9.
  4. Blaizot, A. Vergnes, J. N. Nuwwareh, S. Amar, J. Sixou, M. Periodontal diseases and cardiovascular events: meta-analysis of observational studies. Int Dent J. 2009 Aug; 59 (4): 197-209.
  5. Boggess, K. A. Espinola, J. A. Moss, K. Beck, J. Offenbacher, S. Camargo, C. A. Vitamin D Status and Periodontal Disease Among Pregnant Women. J Periodontol. 2010 Sep 1;
  6. Cronin, A. Periodontal disease is a risk marker for coronary heart disease?. Evid Based Dent. 2009; 10 (1): 22.
  7. de Brito Junior, R. B. Scarel-Caminaga, R. M. Trevilatto, P. C. de Souza, A. P. Barros, S. P. Polymorphisms in the vitamin D receptor gene are associated with periodontal disease. J Periodontol. 2004 Aug; 75 (8): 1090-5.
  8. Dietrich, T. Joshipura, K. J. Dawson-Hughes, B. Bischoff-Ferrari, H. A. Association between serum concentrations of 25-hydroxyvitamin D3 and periodontal disease in the US population. Am J Clin Nutr. 2004 Jul; 80 (1): 108-13.
  9. Dietrich, T. Nunn, M. Dawson-Hughes, B. Bischoff-Ferrari, H. A. Association between serum concentrations of 25-hydroxyvitamin D and gingival inflammation. Am J Clin Nutr. 2005 Sep; 82 (3): 575-80.
  10. Dunning, T. Periodontal disease–the overlooked diabetes complication. Nephrol Nurs J. 2009 Sep-Oct; 36 (5): 489-95; quiz 496.
  11. Fitzpatrick, S. G. Katz, J. The association between periodontal disease and cancer: a review of the literature. J Dent. 2010 Feb; 38 (2): 83-95.
  12. Kurtzke, J.F. Epidemiologic evidence for multiple sclerosis as an infection. Clin Microbiol Rev. 1993 Oct; 6 (4): 382-427.
  13. Gombart, A. F. The vitamin D-antimicrobial peptide pathway and its role in protection against infection. Future Microbiol. 2009 Nov; 41151-65.
  14. Grant, W. B. Boucher, B. J. Are Hill’s criteria for causality satisfied for vitamin D and periodontal disease?. Dermatoendocrinol. 2010 January/February/March; 2 (1): 30-36.
  15. Graves, D. Cytokines that promote periodontal tissue destruction. J Periodontol. 2008 Aug; 79 (8 Suppl): 1585-91.
  16. Gutner, M. Chaushu, S. Balter, D. Bachrach, G. Saliva enables the antimicrobial activity of LL-37 in the presence of proteases of Porphyromonas gingivalis. Infect Immun. 2009 Dec; 77 (12): 5558-63.
  17. Holick, M. F. Vitamin D deficiency. N Engl J Med. 2007 Jul 19; 357 (3): 266-81.
  18. Humphrey, L. L. Fu, R. Buckley, D. I. Freeman, M. Helfand, M. Periodontal disease and coronary heart disease incidence: a systematic review and meta-analysis. J Gen Intern Med. 2008 Dec; 23 (12): 2079-86.
  19. Inagaki, K. Krall, E. A. Fleet, J. C. Garcia, R. I. Vitamin D receptor alleles, periodontal disease progression, and tooth loss in the VA dental longitudinal study. J Periodontol. 2003 Feb; 74 (2): 161-7.
  20. Jabbar, S. Drury, J. Fordham, J. Datta, H. K. Francis, R. M. Tuck, S. P. Plasma vitamin D and cytokines in periodontal disease and postmenopausal osteoporosis. J Periodontal Res. 2010 Aug 20;
  21. Kebschull, M. Demmer, R. T. Papapanou, P. N. “Gum bug, leave my heart alone!”–epidemiologic and mechanistic evidence linking periodontal infections and atherosclerosis. J Dent Res. 2010 Sep; 89 (9): 879-902.
  22. Kinane, D. Bouchard, P. Periodontal diseases and health: Consensus Report of the Sixth European Workshop on Periodontology. J Clin Periodontol. 2008 Sep; 35 (8 Suppl): 333-7.
  23. Krall, E. A. Wehler, C. Garcia, R. I. Harris, S. S. Dawson-Hughes, B. Calcium and vitamin D supplements reduce tooth loss in the elderly. Am J Med. 2001 Oct 15; 111 (6): 452-6.
  24. Law, V. Seow, W. K. Townsend, G. Factors influencing oral colonization of mutans streptococci in young children. Aust Dent J. 2007 Jun; 52 (2): 93-100; quiz 159.
  25. Lieff, S. Boggess, K. A. Murtha, A. P. Jared, H. Madianos, P. N. Moss, K. Beck, J. Offenbacher, S. The oral conditions and pregnancy study: periodontal status of a cohort of pregnant women. J Periodontol. 2004 Jan; 75 (1): 116-26.
  26. Lorencini, M. Silva, J. A. de la Hoz, C. L. Carvalho, H. F. Stach-Machado, D. R. Changes in MMPs and inflammatory cells in experimental gingivitis. Histol Histopathol. 2009 Feb; 24 (2): 157-66.
  27. Marcaccini, A. M. Novaes, A. B., Jr. Meschiari, C. A. Souza, S. L. Palioto, D. B. Sorgi, C. A. Faccioli, L. H. Tanus-Santos, J. E. Gerlach, R. F. Circulating matrix metalloproteinase-8 (MMP-8) and MMP-9 are increased in chronic periodontal disease and decrease after non-surgical periodontal therapy. Clin Chim Acta. 2009 Nov; 409 (1-2): 117-22.
  28. Michaud, D. S. Liu, Y. Meyer, M. Giovannucci, E. Joshipura, K. Periodontal disease, tooth loss, and cancer risk in male health professionals: a prospective cohort study. Lancet Oncol. 2008 Jun; 9 (6): 550-8.
  29. 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. Cross-sectional study of vitamin D and calcium supplementation effects on chronic periodontitis. J Periodontol. 2009 Sep; 80 (9): 1433-9.
  30. Nibali, L. Parkar, M. D’Aiuto, F. Suvan, J. E. Brett, P. M. Griffiths, G. S. Rosin, M. Schwahn, C. Tonetti, M. S. Vitamin D receptor polymorphism (-1056 Taq-I) interacts with smoking for the presence and progression of periodontitis. J Clin Periodontol. 2008 Jul; 35 (7): 561-7.
  31. Park, K. S. Nam, J. H. Choi, J. The short vitamin D receptor is associated with increased risk for generalized aggressive periodontitis. J Clin Periodontol. 2006 Aug; 33 (8): 524-8.
  32. Powell, R. N. Geographic effects on dental caries prevalence and tooth loss in Australia. Community Dent Oral Epidemiol. 1983 Aug; 11 (4): 242-5.
  33. Ramagopalan, S.V. Heger, A. Berlanga, A.J. et al A ChIP-seq defined genome-wide map of vitamin D receptor binding: associations with disease and evolution. Genome Res. 2010; 20 (10): 1352-60.
  34. Santacroce, L. Carlaio, R. G. Bottalico, L. Does it make sense that diabetes is reciprocally associated with periodontal disease?. Endocr Metab Immune Disord Drug Targets. 2010 Mar 1; 10 (1): 57-70.
  35. Timms, P. M. Mannan, N. Hitman, G. A. Noonan, K. Mills, P. G. Syndercombe-Court, D. Aganna, E. Price, C. P. Boucher, B. J. Circulating MMP9, vitamin D and variation in the TIMP-1 response with VDR genotype: mechanisms for inflammatory damage in chronic disorders?. QJM. 2002 Dec; 95 (12): 787-96.
  36. Wang, C. Zhao, H. Xiao, L. Xie, C. Fan, W. Sun, S. Xie, B. Zhang, J. Association between vitamin D receptor gene polymorphisms and severe chronic periodontitis in a Chinese population. J Periodontol. 2009 Apr; 80 (4): 603-8.
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