Dr. Al Danenberg ● Nutritional Periodontist
February 21, 2021
Everyone seems to be talking or writing about the importance of Vitamin D for overall health. Much has been published about Vitamin D’s function for healthy bones, a robust immune system, and especially for fighting the SARS-CoV-2 virus. In my Blog on 2/7/21, I described an experiment on myself to determine if high-dose Vitamin D3 in combination with Vitamin K2 could improve my cancer healing.
But the importance of Vitamin D does not start and end with these significant biological roles. Vitamin D plays critical parts in the mouth. If there is a deficiency of Vitamin D levels in the blood, a host of oral problems ensues starting at birth and progressing to those as old as I am and beyond.,
Let’s get into it.
Sources of Vitamin D
Vitamin D (including Vitamin D3 and Vitamin D2) is a steroid hormone.
Our main source of Vitamin D is the Vitamin D3 that is created in the skin from exposure to sunlight. We also get some Vitamin D2 from a few foods in our diet. When we have inadequate blood levels of Vitamin D, we can improve them through dietary supplements. But in order for it to function properly, it requires various “helper” nutrients, which include Vitamin K2, Vitamin A, magnesium, boron, and zinc.
Vitamin D3 and Vitamin D2 enter the circulation and eventually are converted into “25 Hydroxy Vitamin D” (the inactive form of Vitamin D) by the liver. This is basically our “storage pile” of Vitamin D. This inactive form returns to the circulation and reaches the kidneys where it is transformed into “1,25 Dihydroxy Vitamin D” (the active form) as it is needed.
Vitamin D is a very busy hormone in our body. All of its actions are controlled by the Vitamin D Receptor (VDR), which binds to the active form of Vitamin D.
Serum calcium, serum phosphorus, and Vitamin D are intimately and intricately related. The active form of Vitamin D acts on the bones, intestine, and kidney to regulate the level of calcium and phosphorus in our blood. In addition, parathyroid hormone (PTH) is secreted when the serum level of calcium is low. PTH helps stimulate active Vitamin D, which through several pathways causes osteoclasts to release calcium and phosphorus from bone into the serum.
Vitamin D has many other functions in the human body. It regulates cell differentiation, cell maturation and the innate immune system. It also regulates up to 10% of our genetic activity.
In addition, Vitamin D affects our gut microbiome and vice versa.
Vitamin D and the Gut
80 healthy individuals participated in a medical study published in December 2020. At the start of the trial, the participants’ gut bacteria were evaluated. They then were put on Vitamin D supplementation. After 12 weeks of supplementation, their garden of gut bacteria was evaluated again. The results showed that supplementing with Vitamin D improved the subjects’ diversity of microbes in the gut as well as increased the variety of beneficial species. These were all healthy people improving their gut diversity through supplementation.
The diversity of gut bacteria is known as Alpha Diversity, which I described in my article about the 5 Important Tools for a Robust Immune System. A healthy gut made up of numerous different species of bacteria enhances a robust immune system. Both are critical for a healthy mouth.
In another study published in November 2020, researchers showed that the gut bacteria may play a vital role in converting inactive vitamin D into its active, health-promoting form. This paper emphasized that the higher the Alpha Diversity in the gut microbiome, the more active Vitamin D was created. More active Vitamin D results in increased health benefits throughout the body.
Therefore, an adequate store of 25 Hydroxy Vitamin D in circulation and a high Alpha Diversity of the gut microbiome are important factors in the creation of the biologically active form of Vitamin D (1,25 Dihydroxy Vitamin D).
Oral Effects of Vitamin D Deficiency
Teeth are mineralized structures embedded in the jawbone. The human tooth is formed by three hard tissues: enamel, dentin, and cementum. Mineralization of the tooth occurs at the same time as mineralization occurs in the skeleton. In the absence of adequate levels of Vitamin D, teeth become poorly mineralized and structurally weakened.
Once the teeth have mineralized, Vitamin D helps prevent tooth decay by regulating the immune system, which affects the homeostasis of the oral garden of bacteria.
Remarkably, the developing teeth and health of a fetus are influenced by Mom’s inactive Vitamin D levels. All during pregnancy, Mom’s Vitamin D must be maintained at optimum levels. If the mother has deficient levels, then the child will be prone to more tooth decay compared to children whose mothers had adequate levels.
Throughout our growth phases and into our adult years, deficiencies in Vitamin D are associated with a wide variety of mouth disorders.
In children, low levels of Vitamin D will cause defective tooth mineralization, which results in defective tooth development. A consequence of this is the increased risk of tooth decay. Individuals with continuing deficient Vitamin D blood levels become prone to gingival inflammation and periodontitis. Fortunately, Vitamin D3 supplementation can help in the treatment of periodontal disease.
Data has shown that individuals with the highest levels of Vitamin D had less periodontal disease. Vitamin D can promote autophagy of pathogenic periodontal bacteria and can decrease inflammation. Since Vitamin D affects bone metabolism, patients undergoing periodontal surgery may have poorer outcomes if they are deficient in Vitamin D.
Vitamin D may also be linked to specific oral pathology such as oral cancers. Deficient Vitamin D levels were associated with increased risk of esophageal, oral, and pharyngeal squamous cell cancers. Another study revealed that vitamin D supplementation significantly reduced treatment-related side effects in late-stage oral cancers and resulted in better quality of life.
GrassrootsHealth Nutritional Research Institute recommends a blood level of 40-60 ng/mL of inactive Vitamin D. The blood test to determine this range is called, “25 Hydroxy Vitamin D.” The inactive form of Vitamin D is stored in your body ready to be activated as needed.
The following graphic from GrassrootsHealth Nutritional Research Institute suggests how much daily supplementation of Vitamin D3 may be necessary to reach the 40-60 ng/mL level in the blood starting at various levels of existing 25 Hydroxy Vitamin D:
Vitamin D deficiency is implicated in various oral diseases as well as overall health issues. In this article, I reported the effects of Vitamin D deficiency on tooth structure, decay, periodontal diseases, periodontal treatment failure, and oral cancers. Healthy levels of Vitamin D benefit the entire body. But diversity of the gut microbiome appears to be an additional factor in the activation of Vitamin D from its inactive form. A high Alpha Diversity and a healthy blood level of inactive Vitamin D should be goals of proactive health enthusiasts.
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