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Published in: Systematic Reviews 1/2021

Open Access 01-12-2021 | Gingival Diseases | Systematic review update

Efficacy of vitamin C supplementation as an adjunct in the non-surgical management of periodontitis: a systematic review

Authors: Hytham N. Fageeh, Hammam I. Fageeh, Ashwin Prabhu, Shilpa Bhandi, Shahrukh Khan, Shankargouda Patil

Published in: Systematic Reviews | Issue 1/2021

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Abstract

Background and objective

The antioxidant potential of vitamin C is useful in reducing oxidative stress, free radicals, and reactive oxygen species, which may assist in the improved outcomes of periodontal therapy. This systematic review was aimed to evaluate the effectiveness of vitamin C supplementation as an adjunct to non-surgical periodontal therapy, in the management of periodontitis.

Data sources

PubMed, EMBASE, Cochrane Library, and Web of Science.

Study eligibility criteria

Randomized controlled trials published between January 1990 and March 2020.

Participants

People 18 years and older with periodontitis.

Study appraisal and synthesis methods

The Critical Appraisal Skills Programme (CASP) quality appraisal tool.

Results

The initial search yielded 441 articles out of which six studies fulfilled the inclusion criteria. Vitamin C supplementation helped improve bleeding indices in gingivitis but did not significantly lead to reduction of probing depths or clinical attachment gain for periodontitis.

Conclusion

Administration of vitamin C as an adjunct to non-surgical periodontal therapy did not result in clinically significant improvements in pocket probing depths at 3 months in periodontitis patients. With the limited evidence available, no recommendation can be made for supplementation of vitamin C in conjunction with initial periodontal therapy for subjects with periodontitis to improve primary treatment outcome measures.
Literature
2.
go back to reference Van Dyke TE, Van Winkelhoff AJ. Infection and inflammatory mechanisms. Journal of clinical periodontology. 2013;40:S1–7.CrossRef Van Dyke TE, Van Winkelhoff AJ. Infection and inflammatory mechanisms. Journal of clinical periodontology. 2013;40:S1–7.CrossRef
3.
go back to reference Nguyen GT, Green ER, Mecsas J. Neutrophils to the ROScue: mechanisms of NADPH oxidase activation and bacterial resistance. Front Cell Infect Microbiol. 2017;7:373.CrossRef Nguyen GT, Green ER, Mecsas J. Neutrophils to the ROScue: mechanisms of NADPH oxidase activation and bacterial resistance. Front Cell Infect Microbiol. 2017;7:373.CrossRef
4.
go back to reference Waddington RJ, Moseley R, Embery G. Periodontal disease mechanisms: reactive oxygen species: a potential role in the pathogenesis of periodontal diseases. Oral diseases. 2000;6:138–51.CrossRef Waddington RJ, Moseley R, Embery G. Periodontal disease mechanisms: reactive oxygen species: a potential role in the pathogenesis of periodontal diseases. Oral diseases. 2000;6:138–51.CrossRef
5.
go back to reference Chapple IL, Matthews JB. The role of reactive oxygen and antioxidant species in periodontal tissue destruction. Periodontology. 2007;43:160–232.CrossRef Chapple IL, Matthews JB. The role of reactive oxygen and antioxidant species in periodontal tissue destruction. Periodontology. 2007;43:160–232.CrossRef
6.
go back to reference Wang Y, Andrukhov O, Rausch-Fan X. Oxidative stress and antioxidant system in periodontitis. Front Physiol. 2017;8:910.CrossRef Wang Y, Andrukhov O, Rausch-Fan X. Oxidative stress and antioxidant system in periodontitis. Front Physiol. 2017;8:910.CrossRef
7.
go back to reference Liang XP, Li Y, Hou YM, et al. Effect of dietary vitamin C on the growth performance, antioxidant ability and innate immunity of juvenile yellow catfish (Pelteobagrus fulvidraco Richardson). Aquacult Res. 2017;48:149–60.CrossRef Liang XP, Li Y, Hou YM, et al. Effect of dietary vitamin C on the growth performance, antioxidant ability and innate immunity of juvenile yellow catfish (Pelteobagrus fulvidraco Richardson). Aquacult Res. 2017;48:149–60.CrossRef
8.
go back to reference Kurutas EB. The importance of antioxidants which play the role in cellular response against oxidative/nitrosative stress: current state. Nutrition journal. 2015;15:71.CrossRef Kurutas EB. The importance of antioxidants which play the role in cellular response against oxidative/nitrosative stress: current state. Nutrition journal. 2015;15:71.CrossRef
9.
go back to reference Yan Y, Zeng W, Song S, et al. Vitamin C induces periodontal ligament progenitor cell differentiation via activation of ERK pathway mediated by PELP1. Protein & cell. 2013;4:620–7.CrossRef Yan Y, Zeng W, Song S, et al. Vitamin C induces periodontal ligament progenitor cell differentiation via activation of ERK pathway mediated by PELP1. Protein & cell. 2013;4:620–7.CrossRef
10.
go back to reference Varela-López A, Navarro-Hortal MD, Giampieri F, et al. Nutraceuticals in periodontal health: a systematic review on the role of vitamins in periodontal health maintenance. Molecules. 2018;23:1226.CrossRef Varela-López A, Navarro-Hortal MD, Giampieri F, et al. Nutraceuticals in periodontal health: a systematic review on the role of vitamins in periodontal health maintenance. Molecules. 2018;23:1226.CrossRef
11.
go back to reference Lykkesfeldt J, Poulsen HE. Is vitamin C supplementation beneficial? Lessons learned from randomised controlled trials. British journal of nutrition. 2010;103:1251–9.CrossRef Lykkesfeldt J, Poulsen HE. Is vitamin C supplementation beneficial? Lessons learned from randomised controlled trials. British journal of nutrition. 2010;103:1251–9.CrossRef
12.
go back to reference Amaliya TM, Abbas F, et al. Java project on periodontal diseases: the relationship between vitamin C and the severity of periodontitis. J Clin Periodontol. 2007;34:299–304.CrossRef Amaliya TM, Abbas F, et al. Java project on periodontal diseases: the relationship between vitamin C and the severity of periodontitis. J Clin Periodontol. 2007;34:299–304.CrossRef
13.
go back to reference Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Int Med. 2009;151:264–9.CrossRef Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Int Med. 2009;151:264–9.CrossRef
14.
go back to reference Higgins J, Green S. Cochrane handbook for systematic reviews of interventions Version 5.1. 0 [updated March 2011]. London: The Cochrane Collaboration; 2011; 2016. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions Version 5.1. 0 [updated March 2011]. London: The Cochrane Collaboration; 2011; 2016.
16.
go back to reference Kunsongkeit P, Okuma N, Rassameemasmaung S, et al. Effect of vitamin C as an adjunct in nonsurgical periodontal therapy in uncontrolled type 2 diabetes mellitus patients. European journal of dentistry. 2019;13:444–9.CrossRef Kunsongkeit P, Okuma N, Rassameemasmaung S, et al. Effect of vitamin C as an adjunct in nonsurgical periodontal therapy in uncontrolled type 2 diabetes mellitus patients. European journal of dentistry. 2019;13:444–9.CrossRef
17.
go back to reference Chitsazi M, Faramarzie M, Sadighi M, et al. Effects of adjective use of melatonin and vitamin C in the treatment of chronic periodontitis: a randomized clinical trial. J Dental Res Dental Clin Dental Prospect. 2017;11:236. Chitsazi M, Faramarzie M, Sadighi M, et al. Effects of adjective use of melatonin and vitamin C in the treatment of chronic periodontitis: a randomized clinical trial. J Dental Res Dental Clin Dental Prospect. 2017;11:236.
18.
go back to reference Dodington DW, Fritz PC, Sullivan PJ, et al. Higher intakes of fruits and vegetables, β-carotene, vitamin C, α-tocopherol, EPA, and DHA are positively associated with periodontal healing after nonsurgical periodontal therapy in nonsmokers but not in smokers. The Journal of nutrition. 2015;145:2512–9.CrossRef Dodington DW, Fritz PC, Sullivan PJ, et al. Higher intakes of fruits and vegetables, β-carotene, vitamin C, α-tocopherol, EPA, and DHA are positively associated with periodontal healing after nonsurgical periodontal therapy in nonsmokers but not in smokers. The Journal of nutrition. 2015;145:2512–9.CrossRef
19.
go back to reference Abou Sulaiman AE, Shehadeh RM. Assessment of total antioxidant capacity and the use of vitamin C in the treatment of non-smokers with chronic periodontitis. J Periodontol. 2010;81:1547–54.CrossRef Abou Sulaiman AE, Shehadeh RM. Assessment of total antioxidant capacity and the use of vitamin C in the treatment of non-smokers with chronic periodontitis. J Periodontol. 2010;81:1547–54.CrossRef
20.
go back to reference Gokhale NH, Acharya AB, Patil VS, et al. A short-term evaluation of the relationship between plasma ascorbic acid levels and periodontal disease in systemically healthy and type 2 diabetes mellitus subjects. Journal of dietary supplements. 2013;10:93–104.CrossRef Gokhale NH, Acharya AB, Patil VS, et al. A short-term evaluation of the relationship between plasma ascorbic acid levels and periodontal disease in systemically healthy and type 2 diabetes mellitus subjects. Journal of dietary supplements. 2013;10:93–104.CrossRef
21.
go back to reference Shimabukuro Y, Nakayama Y, Ogata Y, et al. Effects of an ascorbic acid–derivative dentifrice in patients with gingivitis: a double-masked, randomized, controlled clinical trial. Journal of periodontology. 2015;86:27–35.CrossRef Shimabukuro Y, Nakayama Y, Ogata Y, et al. Effects of an ascorbic acid–derivative dentifrice in patients with gingivitis: a double-masked, randomized, controlled clinical trial. Journal of periodontology. 2015;86:27–35.CrossRef
22.
go back to reference Bujang MA, Baharum N. Guidelines of the minimum sample size requirements for Cohen’s Kappa. Epidemiol Biostat Public Health. 2017;14(2):e12267-1-10. Bujang MA, Baharum N. Guidelines of the minimum sample size requirements for Cohen’s Kappa. Epidemiol Biostat Public Health. 2017;14(2):e12267-1-10.
23.
go back to reference Ishikawa I, Baehni P. Nonsurgical periodontal therapy--where do we stand now? Periodontol. 2004;36:9–13.CrossRef Ishikawa I, Baehni P. Nonsurgical periodontal therapy--where do we stand now? Periodontol. 2004;36:9–13.CrossRef
24.
go back to reference Palwankar P, Rana M, Arora K, Deepthy C. Evaluation of non-surgical therapy on glutathione levels in chronic periodontitis. Eur J Dent. 2015;9:415–22.CrossRef Palwankar P, Rana M, Arora K, Deepthy C. Evaluation of non-surgical therapy on glutathione levels in chronic periodontitis. Eur J Dent. 2015;9:415–22.CrossRef
25.
go back to reference Muniz FW, Nogueira SB, Mendes FL, Rösing CK, Moreira MM, de Andrade GM, Carvalho RS. The impact of antioxidant agents complimentary to periodontal therapy on oxidative stress and periodontal outcomes: a systematic review. Arch Oral Biol. 2015;60:1203–14.CrossRef Muniz FW, Nogueira SB, Mendes FL, Rösing CK, Moreira MM, de Andrade GM, Carvalho RS. The impact of antioxidant agents complimentary to periodontal therapy on oxidative stress and periodontal outcomes: a systematic review. Arch Oral Biol. 2015;60:1203–14.CrossRef
26.
go back to reference Buettner GR. The pecking order of free radicals and antioxidants: lipid peroxidation, alpha-tocopherol, and ascorbate. Arch Biochem Biophys. 1993;300:535–43.CrossRef Buettner GR. The pecking order of free radicals and antioxidants: lipid peroxidation, alpha-tocopherol, and ascorbate. Arch Biochem Biophys. 1993;300:535–43.CrossRef
27.
go back to reference Frei B, Birlouez-Aragon I, Lykkesfeldt J. Authors’ perspective: what is the optimum intake of vitamin C in humans? Crit Rev Food Sci Nutr. 2012;52:815–29.CrossRef Frei B, Birlouez-Aragon I, Lykkesfeldt J. Authors’ perspective: what is the optimum intake of vitamin C in humans? Crit Rev Food Sci Nutr. 2012;52:815–29.CrossRef
28.
go back to reference Murakami HN, Kim H, Kong JM, et al. Vitamin C down-regulates VEGF production in B16F10 murine melanoma cells via the suppression of p42/44 MAPK activation. J Cell Biochem. 2011;112(3):894–901.CrossRef Murakami HN, Kim H, Kong JM, et al. Vitamin C down-regulates VEGF production in B16F10 murine melanoma cells via the suppression of p42/44 MAPK activation. J Cell Biochem. 2011;112(3):894–901.CrossRef
29.
go back to reference Amaliya A, Risdiana AS, Van der Velden U. Effect of guava and vitamin C supplementation on experimental gingivitis: a randomized clinical trial. J Clin Periodontol. 2018;45:959–67.CrossRef Amaliya A, Risdiana AS, Van der Velden U. Effect of guava and vitamin C supplementation on experimental gingivitis: a randomized clinical trial. J Clin Periodontol. 2018;45:959–67.CrossRef
30.
go back to reference Vogel RI, Lamster IB, Wechsler SA, Macedo B, Hartley LJ, Macedo JA. The effects of megadoses of ascorbic acid on PMN chemotaxis and experimental gingivitis. J Periodontol. 1986;57:472–9.CrossRef Vogel RI, Lamster IB, Wechsler SA, Macedo B, Hartley LJ, Macedo JA. The effects of megadoses of ascorbic acid on PMN chemotaxis and experimental gingivitis. J Periodontol. 1986;57:472–9.CrossRef
31.
go back to reference Field CJ, Johnson IR, Schley PPD. Nutrients and their role in host resistance to infection. J Leukoc Biol. 2002;71(1):16–32.PubMed Field CJ, Johnson IR, Schley PPD. Nutrients and their role in host resistance to infection. J Leukoc Biol. 2002;71(1):16–32.PubMed
32.
go back to reference Brock G, Chapple IL. The potential impact of essential nutrients vitamins C and D upon periodontal disease pathogenesis and therapeutic outcomes. Curr Oral Health Rep. 2016;3:337–46.CrossRef Brock G, Chapple IL. The potential impact of essential nutrients vitamins C and D upon periodontal disease pathogenesis and therapeutic outcomes. Curr Oral Health Rep. 2016;3:337–46.CrossRef
33.
go back to reference Sánchez-Moreno C, Cano MP, de Ancos B, Plaza L, Olmedilla B, Granado F, Martín A. Effect of orange juice intake on vitamin C concentrations and biomarkers of antioxidant status in humans. Am J Clin Nutr. 2003;78:454–60.CrossRef Sánchez-Moreno C, Cano MP, de Ancos B, Plaza L, Olmedilla B, Granado F, Martín A. Effect of orange juice intake on vitamin C concentrations and biomarkers of antioxidant status in humans. Am J Clin Nutr. 2003;78:454–60.CrossRef
34.
go back to reference Staudte H, Sigusch BW, Glockmann E. Grapefruit consumption improves vitamin C status in periodontitis patients. Br Dent J. 2005;199:213–7.CrossRef Staudte H, Sigusch BW, Glockmann E. Grapefruit consumption improves vitamin C status in periodontitis patients. Br Dent J. 2005;199:213–7.CrossRef
35.
go back to reference Graziani F, Discepoli N, Gennai S, Karapetsa D, Nisi M, Bianchi L, et al. The effect of twice daily kiwifruit consumption on periodontal and systemicconditions before and after treatment: A randomized clinical trial. J Periodontol. 2018;89:285–93.CrossRef Graziani F, Discepoli N, Gennai S, Karapetsa D, Nisi M, Bianchi L, et al. The effect of twice daily kiwifruit consumption on periodontal and systemicconditions before and after treatment: A randomized clinical trial. J Periodontol. 2018;89:285–93.CrossRef
Metadata
Title
Efficacy of vitamin C supplementation as an adjunct in the non-surgical management of periodontitis: a systematic review
Authors
Hytham N. Fageeh
Hammam I. Fageeh
Ashwin Prabhu
Shilpa Bhandi
Shahrukh Khan
Shankargouda Patil
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Systematic Reviews / Issue 1/2021
Electronic ISSN: 2046-4053
DOI
https://doi.org/10.1186/s13643-020-01554-9

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