Vitamin D is a group of fat soluble secosteroids. It is a prohormone which means it is converted into a hormone by our body. To make things more confusing is that it isn’t just one substance but five different substances but 2 you are familiar with. D2 and D3. Vitamin D is fundamental for good health and in dentistry having adequate D is essential for dental patients. Vitamin D deficiencies have been related to tooth decay in children and gum disease in adults. Vitamin D is a key participant in bone growth and metabolism because it helps promote the absorption of calcium, magnesium and phosphorus. In fact, if you ate foods high in calcium but your body doesn't have enough vitamin D it would only absorb 10 to 15% of the calcium you took in. Studies abound show just how vitamin D is essential for brain, cardiovascular and endocrine health. Vitamin D also helps our respiratory track, our skin and most importantly our immune system.  D plays a critical role in managing the immune system and controls how in which immune cells are formed. For instance, vitamin D can produce immune cells that make specific antibodies, B cells, but can also slow the release of immune cells that can cause inflammation if they build up too much. Low levels of vitamin D can make autoimmune diseases worse and is associated with frequent infections.

Vitamin D deficiency is not just in the elderly population. Data retrieved from The National Health and Nutrition Examination survey 2005 to 2006 discovered that the overall prevalence of vitamin D deficiency was 41.6% in adults with the highest rates seen in blacks at 82.1%. As expected, during the winter months levels of vitamin D decreased.

Deficient levels are less than or equal to 10ng/ml and more than 20ng/ml is what we are really looking for. One of the biggest problems with elevating levels is you only get about 10% of D from food. The rest is made by our bodies when our skin is exposed to sunlight. All forms of vitamin D2 and D3 obtained from our diet or supplements require conversion in our liver and kidneys before being active in our body. Vitamin D3 is more potent than D2 and binds to vitamin D receptors more effectively. D2 is also better absorbed and more easily converted into active D.

Sources of D2 are:

• Mushrooms
• Vitamin D2 supplements (made from irradiated mushrooms and plant material)
• Fortified foods containing D2 (eg, breakfast cereal, infant formula, margarine, orange juice, milk)

Sources of D3 are:

• Exposing our skin to sunlight
• Butter
• Cheese
• Egg yolk
• Liver
• Oily fish (eg, mackerel, salmon, tuna) and fish oil
• Vitamin D3 supplements made using lanolin from sheep’s wool
• Vitamin D3 supplements made using lichen (vegan/vegetarian friendly)
• Fortified foods containing D3 (eg, breakfast cereal, infant formula, margarines, orange juice, milk)

In clinical practice:

When reviewing health histories, a rule of thumb to help pursue more thorough questioning looking for D deficiencies is to look at patient’s risk factors. These would include chronic liver disease, chronic kidney disease, eating disorders, medical conditions such as celiac or pancreatic insufficiency that affect absorption of vitamin D from the diet, obesity due to the fact that stores of vitamin D get locked up in adipose tissue. Patients that take medications that affect vitamin D synthesis are carbamazepine, efavirenz, phenobarbital, phenytoin, primidone, and rifampin.

Dental treatment and optimal patient care can be affected by vitamin D deficiency. Vitamin D takes part in a specific immune response that suppresses the destructive effects of chronic periodontitis. Vitamin D deficiency can impair the immune response to infections.  For implantologists, Vitamin D is especially important for patients who are healing from not only implant placement surgeries but the extraction appointment as well.  Vitamin D plays a role in the metabolism of bone. D stimulates the activity of osteoclasts and increases the production of extracellular matrix proteins by osteoblasts. There has also been a correlation with failure of bone grafts and regenerative materials with vitamin D deficiencies.¹ The relationship between low vitamin D levels and osseointegration is controversial but most studies suggest that the proper level of D can help the healing of peri-implant bone tissue. A retrospective study of 885 patients that had a deficiency of <10ng/ML showed an early implant failure rate of 11.1% compared to a 2.9% failure rate in patients with normal levels of D (>30mg/ML)²

The benefits of proper vitamin D in dentistry are something clinicians should pay attention to. Whether it is reducing the risk of gingivitis or chronic periodontitis, or the positive effects for  wound healing and the promotion of bone formation around implants. Coordinating with patients’ medical doctors regarding a patient’s D levels could be another avenue to help with implant success.

1. Choukroun J, Khoury G, Khoury F, et al. Two neglected biologic risk factors in bone grafting and implantology: high low-density lipoprotein cholesterol and low serum vitamin D. J Oral Implantol. 2014;40)1)110-114.
2. Mangano FG, Oskouei SG, Paz A, Mangano N, Mangano C. Low serum vitamin D and early dental implant failure: is there a connection? A retrospective clinical study on 1740 implants placed in 885 patients. J Dent Res Dent Clin Dent Prospects. 2018;12(3):174-182.