Application of adjunct vitamin D supplementation in the management of periodontal disease: A three-pronged approach

Abstract

Chronic inflammatory periodontal disease is caused by microbes in the dental plaque and is accompanied by loss of connective tissue and alveolar bone, resulting in tooth loss and diminished oral function. Endotoxins from the lipopolysaccharides (LPS) in Gram-negative bacteria in the dental plaque induce production of several proinflammatory cytokines, such as interleukin 1 (IL-1), Interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-a), matrix metalloproteinases (MMPs) and prostaglandins (PGs). These are the critical biomarkers of periodontal destruction and oral inflammatory burden transmitted via the hematogenous route to the systemic circulation. The management of periodontal disease encompasses two challenges; first is the control of microbial challenge using mechanical plaque control methods, professional scaling and root planing with adjunct chemical plaque control and antimicrobials agents. The second challenge comes from the host-mediated immune response which requires host modulation therapy to counteract pro-inflammatory cytokines and other biologic mediators involved in periodontal destruction. Vitamin D is a fat-soluble vitamin derived from sunlight, diet and nutrition. It is converted to 25hydroxyvitamin D [25(OH)D] in the liver and further to 1,25-dihydroxy vitamin