VITAMIN D

By: Paige Dye

• Fat soluble nutrient (sometimes referred to as a
hormone)

• Vitamin D has acquired the nickname of the “sunshine

vitamin”.
WHAT IS
• Ultraviolet rays from the sun reach the skin and trigger
VITAMIN D?
vitamin D syntheses.

• Vitamin D aids the human body in many of its functions.

 VITAMIN D FUNCTIONS

• Promotes calcium and phosphate absorption in the stomach

• Maintains serum calcium and phosphate concentrations
• Aids in the formation, strengthening, and mineralization of bones.
• Supports cell growth
• Nerve and muscle function
• Supports the immune system
• Reduces inflammation
• Aids in odontogenesis
IMPORTANT FUNCTIONS
 EFFECTS OF VITAMIN D DEFICIENCY: BONES

• Without adequate vitamin D there may be a lack of calcium and phosphate regulation.
• Due to this, severe vitamin D deficiency can lead to softened, brittle, and weak bones.

• Severe vitamin D deficiency seen in adults that affects the bones  Osteomalacia
• Painful, weakened bones

• Severe vitamin D deficiency seen in children that affects the bones  Rickets
• Alters growth and development of bones
• Underdeveloped skeletal system
 BO N Y
E F F E CT S

Notice that with rickets the bone is more porous and bowed, making it weaker.
EFFECTS OF VITAMIN D DEFICIENCY: IMMUNE
SYSTEM

Deficiency of vitamin D may lead to a compromised immune system.

Compromised immune system is a major risk factor for other systemic diseases and
conditions.

Effects are dependent on the degree of the deficiency and the hosts susceptibility

NOTE: Compromised immune system is a risk factor for oral health complications and
dental diseases.
 EFFECTS OF VITAMIN D
DEFICIENCY: ORAL
IMPLICATIONS

• Inadequate tooth mineralization

• Underdeveloped dentition

• Delayed eruption

• Increased risk of gingivitis,

periodontitis, and caries
 VITAMIN D DEFICIENCY: TOOTH
MINERALIZATION & DEVELOPMENT

Vitamin D deficiency causes:

• Defective tooth mineralization, causing abnormal enamel and dentin formation.
• Interference with the mineralization process
• Leading to hypomineralized tooth structures
• Inadequate ameloblast function  affects the formation of enamel
• Due to the odontogenic effects, delayed tooth eruption may occur.
 VITAMIN D DEFICIENCY: DENTAL CARIES &
PERIODONTAL DISEASE

• Hypomineralized tooth structures are weaker and more susceptible to decay and disease.

• Dental caries – The hypomineralized/ weakened structure is more susceptible to the acid produced by bacterial
residents when the metabolism of sugars and fermentable carbohydrates occurs.
• The acid acts on the tooth to produce decay.

• Periodontal disease – Maxillary and mandibular bone are affected by vitamin D deficiency.
• Deficiency affects the alveolar bone porosity, trabecular patters, and produces more rapid alveolar bone
resorption.
• Alveolar bone loss is associated with periodontal disease.
 VITAMIN D &
PERIODONTITIS
 EXCESSIVE VITAMIN D

Not only does vitamin D deficiency have an impact on health, but excessive
vitamin D levels do as well.

Excessive vitamin D levels cause:

Toxicity  renal failure and even death

Hypercalcemia & hypercalciuria

• Hypercalcemia may cause nausea, vomiting, muscle weakness, pain, loss of appetite, and
dehydration.
 UNDERSTANDING BARRIERS TO CARE

• Osteoporosis, rickets, and other bony effects of vitamin D deficiency on the body may
make it challenging for the patient to:
• Attend dental hygiene treatment
• Perform adequate personal oral hygiene tasks
• Support themselves financially – making dental care a low priority

• Depending on the severity of the condition, the patient may be dependent on a caregiver
for transportation, oral hygiene, and even financially.
 DENTAL HYGIENE TREATMENT CONSIDERATIONS:
OSTEOPOROSIS & RICKETS

• Some individuals show no signs and symptoms.

When osteoporosis or rickets are present:

• Modify treatment and appointments depending on the patient’s needs
• Flexibility and adaptation are key
• Provide communication before having the patient change positions, adjusting the operatory chair, and
having the patient standing.
• Make appointment comfortable and tolerable for the patient.

• Be mindful of symptoms of vitamin D deficiency: Fatigue, bone pain, mood changes, muscle aches, and
weakness
 D E N TA L H Y G I E N E T R E AT ME N T
C O N S I D E RAT I O N S : O R A L H Y G I E N E
MO D I F I C AT I O N S

• Patient with bony and oral effects of vitamin D deficiency may benefit
from:
• Electrical toothbrushes
• Different grips/ devices to make grasping easier
• Interproximal brushes may be best with limited hand strength
(flossing may be too challenging).
• Automatic flossers
• Adequate oral hygiene instruction tailored to the patients needs.
• Fluoride varnish in office and daily use of fluoride containing
toothpaste
• Diet modification / nutritional counseling: To help minimize dental
caries
• Referrals to a physician when deficiency is suspected
ORAL HYGIENE TOOLS
 MEDICAL MANAGEMENT

• Patient may need to be referred to their physician

• Deficiency can be determined through blood work/ labs

• Deficiency can stem from factors such as:

• Lack of sunlight
• Genetic variations
• Issues preventing vitamin D absorption

• A doctor/physician may prescribe vitamin D supplements or

recommend OTC supplementation.
 NUTRITION COUNSELING
• Most of America is deficient in vitamin D- some symptomatic and others not.
• Foods containing vitamin D:
• Fatty fish, beef liver, egg yolks, fortified foods, some dairy products

• Often adequate vitamin D levels will NOT be met through food consumption alone.
• Usually, other methods such as supplements are necessary to obtain adequate levels of vitamin D.
VITAMIN D
OVERVIEW
 CONTENT RELATED CITATIONS

• Botelho, J., Machado, V., Proença, L., Delgado, A. S., & Mendes, J. J. (2020, May 19). Vitamin D deficiency and Oral
Health: A Comprehensive Review. Nutrients. Retrieved April 22, 2023, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7285165/

• Mungai, L. N. W., Mohammed, Z., Maina, M., & Anjumanara, O. (2021). Vitamin D Review: The Low Hanging Fruit
for Human Health. Journal of Nutrition & Metabolism, 1–6. https://doi-org.lanecc.idm.oclc.org/10.1155/2021/6335681

• The truth about nutrient deficiencies. (2022). Harvard Women’s Health Watch, 29(10), 4–5.

• U.S. Department of Health and Human Services. (n.d.). Office of dietary supplements - vitamin D. NIH Office of
Dietary Supplements. Retrieved April 22, 2023, from https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

• “Vitamin D.” Funk & Wagnalls New World Encyclopedia, Jan. 2018, p. 1; EBSCOhost, lanecc.idm.oclc.org/login?
url=https://https://search.ebscohost.com/login.aspx?direct=true&db=funk&AN=vi034060&site=ehost-
live&scope=site.
 IMAGE CITATIONS: PT1

• Botelho, J., Machado, V., Proença, L., Delgado, A. S., & Mendes, J. J. (2020, May 19). Vitamin D deficiency and Oral
Health: A Comprehensive Review. MDPI. https://www.mdpi.com/2072-6643/12/5/1471

• Boulin, T. (2022, November 2). Vitamin D: Benefits, foods, how much & more. tiphandnutrition.
https://www.tiphandnutrition.com/nutrition-lifestyle/vitamind

• Diamondclean sonic electric toothbrush HX9354/21 Sonic Electric Toothbrush. Philips. (2018, July 8).
https://www.usa.philips.com/c-p/HX9354_21/sonicare-diamondclean-sonic-electric-toothbrush

• Figure 2. pathogenesis of periodontal disease and a possible... (n.d.-a).

https://www.researchgate.net/figure/Pathogenesis-of-periodontal-disease-and-a-possible-relationship-with-vitamin-D-
deficiency_fig2_361715272

• Nebraska Medicine. (2022, October 7). 9 vitamin D deficiency symptoms (and 11 high vitamin D Foods). Nebraska
Medicine. https://www.nebraskamed.com/primary-care/9-vitamin-d-deficiency-symptoms-and-11-high-vitamin-d-foods
 IMAGE CITATIONS: PT 2

• Rickets: All you wanted to know. Apollo Hospitals Blog. (2022, December 6).
https://healthlibrary.askapollo.com/rickets-all-you-wanted-to-know/

• Tepe extra grip toothbrush holder. KleenTeeth. (n.d.). https://www.kleenteeth.com/tepe-extra-grip-toothbrush-

holder/

• The effectiveness of interdental brushes - registered dental hygienists. (n.d.-d). https://www.rdhmag.com/patient-

care/prosthodontics/article/16404305/the-effectiveness-of-interdental-brushes

• Vitamin D Deficiency. Eremedium. (n.d.). https://eremedium.in/tag/vitamin-d-deficiency/