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Dental problems if low Vitamin D (Hill's, Global Rec.) - Grant June 2023

Periodontal Disease and Other Adverse Health Outcomes Share Risk Factors, including Dietary Factors and Vitamin D Status

Nutrients . 2023 Jun 17;15(12):2787. doi: 10.3390/nu15122787.
William B Grant 1, Barbara M van Amerongen 2, Barbara J Boucher 3

Chart: More D less PD

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For nearly a century, researchers have associated periodontal disease (PD) with risks of other adverse health outcomes such as cardiovascular disease, diabetes mellitus, and respiratory diseases, as well as adverse pregnancy outcomes. Those findings have led to the hypothesis that PD causes those adverse health outcomes either by increasing systemic inflammation or by the action of periodontopathic bacteria. However, experiments largely failed to support that hypothesis. Instead, the association is casual, not causal, and is due to shared underlying modifiable risk factors, including smoking, diet, obesity, low levels of physical activity, and low vitamin D status. Diabetes mellitus is also considered a risk factor for PD, whereas red and processed meat are the most important dietary risk factors for diabetes. Because PD generally develops before other adverse health outcomes, a diagnosis of PD can alert patients that they could reduce the risk of adverse health outcomes with lifestyle changes. In addition, type 2 diabetes mellitus can often be reversed rapidly by adopting an anti-inflammatory, nonhyperinsulinemic diet that emphasizes healthful, whole plant-based foods. This review describes the evidence that proinflammatory and prohyperinsulinemia diets and low vitamin D status are important risk factors for PD and other adverse health outcomes. We also make recommendations regarding dietary patterns, food groups, and serum 25-hydroxyvitamin D concentrations. Oral health professionals should routinely inform patients with PD that they could reduce their risk of severe PD as well as the risks of many other adverse health outcomes by making appropriate lifestyle changes.

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Hills Criterion
CriterionMeaning
Strength of associationOR or RR between 1 and 2 is considered weak, whereas >2.0 is considered strong.
ConsistencySimilar findings in different situations.
SpecificityA factor influences specifically a particular outcome or population.
TemporalityThe causal agent should precede the incidence of an expected outcome.
Biological gradientA monotonically changing dose-response relationship.
PlausibilityMechanisms exist to explain the effect.
CoherenceThe interpretation should not seriously conflict with generally known facts of the natural history and biology of the disease.
ExperimentRCTs are generally the strongest type of evidence. They should be for disease outcomes, not merely biological parameters related to diseases. In the absence of RCTs, prospective studies may be used.
Analogy . . . . . . . . . . . . . . . . . . . . Analogous exposures for demonstrated outcomes.

OR—odds ratio; RCT—randomized controlled trial; RR—relative risk.

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