Systemic effect of micronutrients
Teeth are protected from chemical or mechanical attacks by the hard tooth tissue, consisting of dental enamel, dentin and the root cementum. Nutrients can only influence the hard tooth tissue systemically during its original formation, i.e. before eruption of the teeth. As the teeth develop in the organism, an organic matrix is generated, which is subsequently mineralized with calcium and phosphate. During matrix generation, extreme mineral deficits can cause structural changes in the dental enamel, e.g. pits or indentations. Insufficient nutrient supplies during mineralization of the enamel can lead to opaque whitish spots on the upper part of the tooth, although not to deformations.
Only a vitamin D deficiency in pregnant women can have a systemically negative effect on the quality of the dental germs in the fetus. Deficient nutrition of an expectant mother does not otherwise affect tooth development in the fetus, as the mineral requirement of the dental germs is relatively low (1). Studies have shown that, unlike bones, teeth that were formed in the fetus during situations of calcium and phosphate deficiency present a normal mineral composition. Conversely, with a deficiency in childhood and adulthood, calcium and phosphates can no longer be mobilized from teeth (2).
Teeth can only anchor themselves securely in a stable, healthy jawbone and only a healthy, intact periodontal attachment apparatus can guarantee such a secure anchorage. A good vitamin D supply is essential for preserving the health of the whole musculoskeletal system, including the jawbone and gums. An insufficient vitamin D supply can contribute both to the loss and softening of bony substance (osteoporosis, osteopenia), as well as to the development of chronic inflammatory disorders caused by a disturbance of the mineral balance (e.g. of calcium absorption). Recent studies have investigated the connections between the density of jawbones (alveolar bones), osteoporosis and tooth loss. They showed that the health of the periodontal attachment apparatus depends on a sufficiently high concentration of vitamin D in the blood (3-5). In addition, vitamin D status also seems to be crucial for healing successfully after receiving an operation because of inflammatory changes in the gums (periodontitis) (6). Patients with chronic periodontitis seem to benefit from the administration of additional vitamin D in combination with calcium (7). Essentially, however, a good supply of vitamin D is recommended for the prevention of disorders of the jawbone and periodontal attachment apparatus.
Apart from vitamin D’s basic immune-strengthening, anti-inflammatory properties, the immune defense of the gum tissue against inflammatory germs seems to be connected with certain gene variants (polymorphisms) of the vitamin D receptor (VDR) as well. Thus, researchers discovered that it was principally people with a particular VDR polymorphism who suffered from chronic, aggressive periodontitis (8). The conjecture is that vitamin D induces the synthesis of an antimicrobial peptide via the bond with VDRs.
Pregnant women in particular often suffer from bleeding gums or even an inflammation of the gums or periodontium. Studies suggest that aside from diligent oral hygiene and dental checkups, a good supply of vitamin D can also help prevent this (9). An optimal vitamin D status appears to benefit not only the pregnant woman, but the dental health of her future offspring as well. Study results indicate that children from ages 9 to 23 months who have mothers with good blood levels of vitamin D have considerably less caries (10, 11).
The antioxidant vitamins E and C as well as carotenoids (e.g. beta-carotene) neutralize oxidative stress in all cells and tissues of the organism. Thus, they appear to strengthen the immune resistance of the gums via antioxidants, and in particular to act against invading germs in the mucous membrane of the mouth. Studies found a connection between low levels of antioxidants in serum and an increased occurrence of periodontitis (12, 13). Insufficient levels of vitamin C appear to promote the risk of disorders of the gums and periodontal attachment apparatus. Conversely, a good supply of vitamin C could prevent these disorders (14, 15). One disorder typical of severe vitamin C deficiency is scurvy; a less severe vitamin C deficiency may cause gingivitis (the bleeding of receded gums).
A disturbed DNA synthesis as a result of vitamin B12 and folate deficiency can lead to an alteration of the rapidly dividing (epithelial) cells in the mucous membrane of the mouth. Typical vitamin B deficiency can cause a red, swollen and burning tongue, cracked lips and corners of the mouth, as well as alter the sensation of taste (16, 17).