Vitamin D Deficiency and its Effects on Tooth Structure and pulpal changes


  • Lingam Amara Swapna Faculty of Dentistry, Lincoln University College, Kota Bharu, Malaysia
  • Rasheed Abdulsalam Faculty of Dentistry, Lincoln University College, Kota Bharu, Malaysia



Vitamin D, Tooth mineralization, Dental Pulp


Vitamin D is a steroid hormone that produced primarily by sunlight exposure or obtained from dietary sources, including supplements. The persons who are normally at risk of Vitamin D deficiency are those with scarce of sun exposure and diminished intestinal absorption or limited oral intake. Teeth are nothing but mineralized structure which is enclosed by alveolar bone and are developed by 3 different hard tissues such as dentin, enamel, and cementum. Vitamin D plays a predominant vital part in the tooth and bone mineralization, and it can result in rachitic tooth when the levels get unregulated. Studies suggest that Vitamin D deficiency causes hypocalcified dentin and delayed tooth eruption; thus, representing that Vitamin D has a crucial role in dentin formation as well. The beneficial effects of vitamin D on oral health are not only limited to the direct effects on the tooth mineralization but are also applied through ability to stimulate the production of anti-microbial peptides. In this article, we will briefly discuss the influence on Vitamin D level on the oral and pulpal health.


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Borel P, Caillaud D, Cano NJ. Vitamin D bioavailability: State of the art. Crit Rev Food Sci Nutr. 2015;55(9):1193-205. PMid:24915331

Holick MF, Chen TC. Vitamin D deficiency: A worldwide problem with health consequences. Am J Clin Nutr. 2008;87(4):1080S-6. PMid:18400738

Turck D, Bresson J, Burlingame B, Dean T, Fairweather-Tait S, Heinonen M, et al. Update of the tolerable upper intake level for vitamin D for infants. EFSA J. 2018;16(8):e05365.

Lanham-New SA, Wilson LR. Vitamin D - has the new dawn for dietary recommendations arrived? Nutr Bull. 2016;41:2-5.

Morris HA, Anderson PH. Autocrine and paracrine actions of Vitamin D. Clin Biochem Rev. 2010;31(4):129-38. PMid:21170259

Richard CL, Farach-Carson MC, Rohe B, Nemere I, Meckling KA. Involvement of 1,25D3-MARRS (membrane associated, rapid response steroid-binding), a novel Vitamin D receptor, in growth inhibition of breast cancer cells. Exp Cell Res. 2010;316(5):695- 703. PMid:20036234

Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266-81. PMid:17634462

Himmelfarb J, Sayegh MH. Chronic Kidney Disease, Dialysis, and Transplantation. Amsterdam: Elsevier; 2010. p. 721-37.

Aguiar M, Andronis L, Pallan M, Högler W, Frew E. The economic case for prevention of population Vitamin D deficiency: A modelling study using data from England and Wales. Eur J Clin Nutr. 2020;74(5):825-33.

Gröber U, Kisters K. Influence of drugs on Vitamin D and calcium metabolism. Dermatoendocrinology. 2012;4(2):158-66. PMid:22928072

Chapple IL, Bouchard P, Cagetti MG, Campus G, Carra MC, Cocco F, et al. Interaction of lifestyle, behaviour or systemic diseases with dental caries and periodontal diseases: Consensus report of group 2 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol. 2017;44 Suppl 18:S39-51. PMid:28266114

Peres MA, Macpherson LM, Weyant RJ, Daly B, Venturelli R, Mathur MR, et al. Oral diseases: A global public health challenge. Lancet. 2019;394(10194):249-60. PMid:31327369

Moore C, Murphy MM, Keast DR, Holick MF. Vitamin D intake in the United States. J Am Diet Assoc. 2004;104(6):980-3. PMid:15175600

Holick MF. Resurrection of Vitamin D deficiency and rickets. J Clin Invest. 2006;116(8):2062-72. PMid:16886050

National Osteoporosis Foundation. Calcium and Vitamin D. Arlington, VA: National Osteoporosis Foundation; 2018.

Dietrich T, Joshipura KJ, Dawson-Hughes B, Bischoff Ferrari HA. Association between serum concentrations of 25-hydroxyvitamin D3 and periodontal disease in the US population. Am J Clin Nutr. 2004;80(1):108-13. PMid:15213036

Nishida M, Grossi SG, Dunford RG, Ho AW, Trevisan M, Genco RJ. Calcium and the risk for periodontal disease. J Periodontol. 2000;71(7):1057-66. PMid:10960010

Dietrich T, Nunn M, Dawson-Hughes B, Bischoff-Ferrari HA. Association between serum concentrations of 25-hydroxyvitamin D and gingival inflammation. Am J Clin Nutr. 2005;82(3):575-80. PMid:16155270

Inagaki K, Krall EA, Fleet JC, Garcia RI. Vitamin D receptor alleles, periodontal disease progression, and tooth loss in the VA dental longitudinal study. J Periodontol. 2003;74(2):161-7. PMid:12666703

Alshouibi EN, Kaye EK, Cabral HJ, Leone CW, Garcia RI. Vitamin D and periodontal health in older men. J Dent Res. 2013;92(8):689-93. PMid:23788610

Bashutski JD, Eber RM, Kinney JS, Benavides E, Maitra S, Braun TM, et al. Teriparatide and osseous regeneration in the oral cavity. N Engl J Med. 2010;363(25):2396-405.

Scardina GA, Messina P. Good oral health and diet. J Biomed Biotechnol. 2012;2012:720692. PMid:22363174

Schroth RJ, Levi JA, Sellers EA, Friel J, Kliewer E, Moffatt ME. Vitamin D status of children with severe early childhood caries: A case-control study. BMC Pediatr. 2013;13(1):174. PMid:24160554

Kingsley K, O’Malley S, Ditmyer M, Chino M. Analysis of oral cancer epidemiology in the US reveals state-specific trends: Implications for oral cancer prevention. BMC Public Health. 2008;8(1):87. PMid:18331638

Grimm M, Cetindis M, Biegner T, Lehman M, Munz A, Teriete P, et al. Serum Vitamin D levels of patients with oral squamous cell carcinoma (OSCC) and expression of vitamin D receptor in oral precancerous lesions and OSCC. Med Oral Patol Oral Cir Bucal. 2015;20(2):e188-95. PMid:25662556

Osafi J, Hejazi A, Stutz DD, Keiserman MA, Bergman CJ, Kingsley K. Differential effects of 1,25-dihydroxyvitamin D3 on oral squamous cell carcinomas in vitro. J Diet Suppl. 2014;11(2):145- 54. PMid:24670118

Miley DD, Garcia MN, Hildebolt CF, Shannon WD, Couture RA, Anderson Spearie CL, et al. Cross-sectional study of Vitamin D and calcium supplementation effects on chronic periodontitis. J Periodontol. 2009;80(9):1433-9. PMid:19722793

Garcia MN, Hildebolt CF, Miley DD, Dixon DA, Couture RA, Anderson Spearie CL, et al. One-year effects of Vitamin D and calcium supplementation on chronic periodontitis. J Periodontol. 2011;82(1):25-32. PMid:20809866

Souza AP, Kobayashi TY, Lourenço Neto N, Silva SM, Machado MA, Oliveira TM. Dental manifestations of patient with Vitamin D-resistant rickets. J Appl Oral Sci. 2013;21(6):601-6. PMid:24473729

Ozkan S, Ucok Z, Alagöl F. Dental manifestations of familial hypophosphatemic vitamin-D-resistant rickets: Report of case. ASDC J Dent Child. 1984;51:448-50.

D’Ortenzio L, Kahlon B, Peacock T, Salahuddin H, Brickley M. The rachitic tooth: Refining the use of interglobular dentine in diagnosing vitamin D deficiency. Int J Paleopathol. 2018;22:101- 8. PMid:30048808

Bergwitz C, Jüppner H. Regulation of phosphate homeostasis by PTH, Vitamin D, and FGF23. Annu Rev Med. 2010;61(1):91-104. PMid:20059333

Foster BL, Nociti FH, Somerman MJ. The rachitic tooth. Endocr Rev. 2014;35(1):1-34. PMid:23939820

Pike JW, Meyer MB. The Vitamin D receptor: New paradigms for the regulation of gene expression by 1,25-dihydroxyvitamin D3. Rheum Dis Clin North Am. 2012;38(1):13-27. PMid:22525840

Girgis CM, Clifton-Bligh RJ, Hamrick MW, Holick MF, Gunton JE. The roles of vitamin d in skeletal muscle: Form, function, and metabolism. Endocr Rev. 2013;34(1):33-83. PMid:23169676

Schroth RJ, Lavelle C, Tate R, Bruce S, Billings RJ, Moffatt MEK. Prenatal Vitamin D and dental caries in infants. Pediatrics. 2014;133(5):e1277-84. PMid:24753535

Hollist BW, Pittardm W. Evaluation of the total fetomaternal Vitamin D relationships at term: Evidence for racial differences. J Clin Endocrinol Metab. 1984;59(4):652-7. PMid:6090493

Karras SN, Fakhoury H, Muscogiuri G, Grant WB, van den Ouweland JM, Colao AM, et al. Maternal Vitamin D levels during pregnancy and neonatal health: Evidence to date and clinical implications. Ther Adv Musculoskelet Dis. 2016;8(4):124-35. PMid:27493691

Reed SG, Voronca D, Wingate JS, Murali M, Lawson AB, Hulsey TC, et al. Prenatal Vitamin D and enamel hypoplasia in human primary maxillary central incisors: A pilot study. Pediatr Dent J. 2017;27(1):21-8. PMid:30100673

Nørrisgaard PE, Haubek D, Kühnisch J, Chawes BL, Stokholm J, Bønnelykke K, et al. Association of high-dose Vitamin D supplementation during pregnancy with the risk of enamel defects in offspring: A 6-year follow-up of a randomized clinical trial. JAMA Pediatr. 2019;173(10):924-30. PMid:31381020

Tanaka K, Hitsumoto S, Miyake Y, Okubo H, Sasaki S, Miyatake N, et al. Higher Vitamin D intake during pregnancy is associated with reduced risk of dental caries in young Japanese children. Ann Epidemiol. 2015;25(8):620-5. PMid:25956333

Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global burden of untreated caries: A systematic review and metaregression. J Dent Res. 2015;94(5):650-8. PMid:25740856

Petersen PE. World Health Organization global policy for improvement of oral health--World Health Assembly 2007. Int Dent J. 2008;58(3):115-21. PMid:18630105

Selwitz RH, Ismail AI, Pitts NB. Dental caries. Lancet. 2007;369(9555):51-9. PMid:17208642

Rosier BT, Marsh PD, Mira A. Resilience of the oral microbiota in health: Mechanisms that prevent dysbiosis. J Dent Res. 2018;97(4):371-80. PMid:29195050

Zhou F, Zhou Y, Shi J. The association between serum 25-hydroxyvitamin D levels and dental caries in US adults. Oral Dis. 2020;26(7):1537-47. PMid:32304260

Herzog K, Scott JM, Hujoel P, Seminario AL. Association of Vitamin D and dental caries in children: Findings from the National Health and Nutrition Examination Survey, 2005-2006. J Am Dent Assoc. 2016;147(6):413-20. PMid:26827077

Wójcik D, Krzewska A, Szalewski L, Pietryka-Michałowska E, Szalewska M, Krzewski S, et al. Dental caries and Vitamin D3 in children with growth hormone deficiency. Medicine (Baltimore). 2018;97(8):e9811. PMid:29465564

Gyll J, Ridell K, Öhlund I, Karlsland Åkeson P, Johansson I, Lif Holgerson P. Vitamin D status and dental caries in healthy Swedish children. Nutr J. 2018;17(1):11. PMid:29338758

Hujoel PP. Vitamin D and dental caries in controlled clinical trials: Systematic review and meta-analysis. Nutr Rev. 2013;71(2):88- 97. PMid:23356636

Kühnisch J, Thiering E, Heinrich-Weltzien R, Hellwig E, Hickel R, Heinrich J. Fluoride/vitamin D tablet supplementation in infants-effects on dental health after 10 years. Clin Oral Investig. 2017;21(7):2283-90. PMid:27928689

Altman H. In vitro assessment of antimicrobial peptides as potential agents against several oral bacteria. J Antimicrob Chemother. 2006;58(1):198-201. dkl181 PMid:16687459

Wong J, Ye X, Ng T. Cathelicidins: Peptides with antimicrobial, immunomodulatory, anti-inflammatory, angiogenic, anticancer and procancer activities. Curr Protein Pept Sci. 2013;14(6):504- 14. PMid:23968350

Grant WB. A review of the role of solar ultraviolet-B irradiance and vitamin D in reducing risk of dental caries. Dermatoendocrinology. 2011;3(3):193-8. PMid:22110779

Colombo NH, Ribas LF, Pereira JA, Kreling PF, Kressirer CA, Tanner AC, et al. Antimicrobial peptides in saliva of children with severe early childhood caries. Arch Oral Biol. 2016;69:40-6. PMid:27232359

Chen Z, Yang G, Lu S, Chen D, Fan S, Xu J, et al. Design and antimicrobial activities of LL-37 derivatives inhibiting the formation of Streptococcus mutans biofilm. Chem Biol Drug Des. 2019;93(6):1175-85. PMid:30635992




How to Cite

Swapna LA, Abdulsalam R. Vitamin D Deficiency and its Effects on Tooth Structure and pulpal changes. Open Access Maced J Med Sci [Internet]. 2021 Feb. 24 [cited 2022 Aug. 15];9(F):81-7. Available from:



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