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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 2  |  Page : 43-46

Relationship between Vitamin D status and dental caries in children of Ahmedabad city


1 Senior Lecturer, Department of Pediatric and Preventive Dentistry, College of Dental Sciences and Research Centre, Bopal, Ahmedabad, India
2 Specialist Pediatric and Preventive Dentist, Department of Pediatric and Preventive Dentistry, Ahmedabad Dental College and Hospital, Ahmedabad, Gujarat, India
3 General Dentist, Ahmedabad Dental College and Hospital, Ahmedabad, Gujarat, India
4 General Dentist, AMC Dental College, Ahmedabad, Gujarat, India
5 General Dentist, Centennial College, Toronto, Canada

Date of Submission09-Mar-2021
Date of Acceptance14-Mar-2021
Date of Web Publication04-May-2021

Correspondence Address:
Dr. Himani Shah
Department of Pediatric and Preventive Dentistry, College of Dental Sciences and Research Centre, Bopal, Ahmedabad, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpcdr.ijpcdr_10_21

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  Abstract 


Aim: The aim of the study is to determine the association between Vitamin D status and development of early childhood caries (ECC) in Ahmedabad city.
Materials and Methods: A total of 80 children aged between 3 and 6 years were divided into two groups (case and control, n = 40 each). A structured questionnaire was prepared which included basic information of the child; oral examination was done using decayed, missing, and filled teeth index to record caries status of each child. Blood samples were collected for serum analysis of 25(OH)D levels.
Results: In case group, the mean serum 25(OH)D level was 12.07 ng/ml, and in control group, the mean serum 25(OH)D level was 20.15 ng/ml. Statistically significant difference was found between serum 25(OH)D levels in both the groups.
Conclusion: The results showed that Vitamin D deficiency has been associated with ECC.

Keywords: Children, dental caries, Vitamin D


How to cite this article:
Shah H, Patel D, Patel D, Shah R, Shah H, Shah A. Relationship between Vitamin D status and dental caries in children of Ahmedabad city. Int J Prev Clin Dent Res 2021;8:43-6

How to cite this URL:
Shah H, Patel D, Patel D, Shah R, Shah H, Shah A. Relationship between Vitamin D status and dental caries in children of Ahmedabad city. Int J Prev Clin Dent Res [serial online] 2021 [cited 2021 Jul 29];8:43-6. Available from: https://www.ijpcdr.org/text.asp?2021/8/2/43/315463




  Introduction Top


Dental caries is a major worldwide serious public health problem, especially common among young children. Early childhood caries (ECC) spreads rapidly and can begin in early life.[1] By the American Academy of Pediatric Dentistry, the latest definition of ECC is “The presence of one or more decayed (cavitated or noncavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child 71 months of age or younger.”[2]

ECC can start as soon as the infant's first tooth erupts. Eighty percent of children in India are affected by dental caries.[3] It is the most common prevalent infectious problem caused by bacteria, which does not only affect child's oral health but also the general health.[4]

Vitamin D is a group of fat-soluble vitamins, which is also known as calciferol. It is often referred to as “sunshine vitamin” because it originates from sun exposure. It acts like a prohormone. The most important forms of Vitamin D are Vitamin D2 and D3; Vitamin D2, which is also known as plant-derived ergocalciferol, and Vitamin D3, which is also known as animal-derived cholecalciferol. On exposure of skin to sunlight, Vitamin D is synthesized in skin and 7-dehydrocholesterol converts into cholecalciferol.[5],[6]

Vitamin D plays a significant role in calcium and phosphorus homeostasis. It is very important for the regulation of calcium levels in the blood, which is required to maintain healthy bones and good oral health.[5],[7]

Classification of Vitamin D status (According to US IOM)[8]

  • 25(OH)D levels <5 ng/ml – Severely deficient
  • 25(OH)D levels <15 ng/ml – Deficient
  • 25(OH)D levels >20 ng/ml – Sufficient
  • 25(OH)D levels >50 ng/ml – Risk of toxicity.


In 1928, first association between Vitamin D and teeth cavity was appeared.[9]

The main purpose of this study was to compare the levels of Vitamin D in children with caries and children without caries to evaluate the relationship between Vitamin D and dental caries in Ahmedabad city.


  Materials and Methods Top


This study was carried out in two private schools of Ahmedabad city. Approval was given by the institutional ethics committee, and written consent was obtained from all parents. All procedures performed in the study were conducted in accordance with the ethics standards given in 1964 Declaration of Helsinki, as revised in 2013. This study included 80 children aged between 3 and 6 years. Children were divided into case and control groups depending upon their caries status and both the groups contained 40 children.

Inclusion criteria for case group

  • Age between 3 and 6 years
  • Healthy children
  • No medical history or disorder
  • With decayed, missing, and filled teeth (dmft) score: >4 (considered because scale indicates moderate prevalence in >4).


Inclusion criteria for control group

  • Age between 3 and 6 years
  • Healthy children
  • No medical history or disorder
  • With dmft score: 0.


Exclusion criteria for both case and control groups

  • Any medical illness
  • Children who are taking anticonvulsant drugs because it affects Vitamin D metabolism
  • Children received previous preventive dental treatments.


Oral examination was done to record dental caries status with dmft index which records decayed, missing, and filled teeth. Intraoral examination was done using sterile explorer/probe and dental mouth mirror using proper source of natural light or battery-operated artificial light (torch). Caries status of children was judged using dmft index which is a cumulative score of decayed, missing, and filled primary teeth. Since teeth were not lost because of caries, the missing part was not included. Children having 0 dmft score were considered caries free and allotted to control group, and children with >4 dmft score were considered having caries and allotted to case group.

Serum analysis of 25(OH)D levels was assessed by collecting blood samples to evaluate Vitamin D status of each child. Blood samples were collected by a pathology laboratory technician after the parents had given consent to assess the serum 25(OH) Vitamin D status.

A structured questionnaire with basic information was handed over to the parents to determine child's age, name, gender, any present medical illness, present medication, etc., All the data were collected, compiled, and analyzed using one-way ANOVA test.


  Results Top


A total of 80 children were divided into two groups of 40 children in each group (1 – case group with caries and 2 – control group without caries). A comparison of dmft score and serum 25(OH) Vitamin D levels was done in both the groups along with age and gender.

A comparison of socioeconomic information between the groups was also done. No statistically significant difference was present in terms of age and gender parameter between both the groups [[Table 1] shows P = 0.743 and 0.501, respectively].
Table 1: Differentiation of the statistical data of case and control groups

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In case group, 25 males and 15 females were there, whereas in control group, 22 males and 18 females were there. In case group, the mean age was 4.4 years, and in control group, it was 4.5 years. All forty children had serum 25(OH) Vitamin D levels in the deficiency range (<15 ng/ml) in the case group. In the control group, 21 children had sufficient serum Vitamin D levels of 25(OH) and 13 children had insufficient serum Vitamin D levels of 25(OH).

A comparison of mean value of serum 25(OH) Vitamin D levels was carried out. [Graph 1] shows that the mean value of Vitamin D level in case group was 12.07 ng/ml and in control group was 20.15 ng/ml. Statistically significant difference was found between serum 25(OH) Vitamin D levels of both groups using one-way ANOVA test [[Table 2] shows P < 0.0001].

Table 2: Mean and standard deviation values of case and control group

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In case group, insufficient levels of Vitamin D were positively associated with dental caries status, and in control group, the absence of caries was significantly associated with sufficient levels of Vitamin D.


  Discussion Top


Vitamin D plays a very important role in maintaining good oral health, and it also plays a major role in metabolism and absorption of other minerals in the body.[3] It plays a key role in the formation of enamel, dentin, and normal bone growth. It is also essential for mineralization of calcified tissues such as teeth and bones.[10]

Many studies stated that Vitamin D deficiency has been associated with developmental defect such as enamel. High risk of caries has been associated with enamel hypoplasia. This deformity increases the risk for the adhesion and colonization of cariogenic bacteria, which leads to fast occurrence of ECC. Vitamin D receptors are present on the cells such as ameloblast and odontoblast which forms enamel and dentin, respectively, and it reduces the risk of dental caries.[5],[6],[7]

Chhonkar et al. found that Vitamin D deficiency is a major risk factor for the development of dental caries. These findings are similar to the findings of the present study.[3]

A study conducted by Schroth et al. discovered that maternal 25(OH)D levels are associated with primary dentition and development of ECC.[11]

Singleton et al. stated that, during pregnancy, improved Vitamin D level affects ECC later in their infants.[12]

Kim et al. concluded that children with Vitamin D3 concentration below 20 ng/ml were associated with risk of developing dental caries in the molar teeth among Korean children.[13]

In early life, Vitamin D exposure plays an important role in prevention of the development of dental caries. There are very few researches conducted in India concerning Vitamin D deficiency and its repercussions.


  Conclusion Top


In India, the prevalence of Vitamin D deficiency is between 40% and 99%. Not only for oral health, but also for general health, a sufficient amount of Vitamin D3 is very necessary. Vitamin D3, known as cholecalciferol, is the preferred form of Vitamin D supplement, and it offers additional health benefits.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Colak H, Dülgergil CT, Dalli M, Hamidi MM. Early childhood caries update: A review of causes, diagnoses, and treatments. J Nat Sci Biol Med 2013;4:29-38.  Back to cited text no. 1
    
2.
Misra S, Tahmassebi JF, Brosnan M. Early childhood caries – A review. Dent Update 2007;34:556-8.  Back to cited text no. 2
    
3.
Chhonkar A, Gupta A, Arya V. Comparison of Vitamin D level of children with severe early childhood caries and children with no caries. Int J Clin Pediatr Dent 2018;11:199-204.  Back to cited text no. 3
    
4.
Meyer F, Enax J. Early childhood caries: Epidemiology, aetiology, and prevention. Int J Dent 2018;2018:1-7.  Back to cited text no. 4
    
5.
Preetha P, Vishnu P, Gayathri R. Relationship between Vitamin D and dental caries- review. J Pharm Sci Res 2016;8:459-60.  Back to cited text no. 5
    
6.
Ali N, Rahim A, Ali S, Hatif Iqbal M. Impact of Vitamin D on development of early childhood caries. Pak Armed Forces Med J 2017;67:429-33.  Back to cited text no. 6
    
7.
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;13:174.  Back to cited text no. 7
    
8.
Balasubramanian S, Dhanalakshmi K, Amperayani S. Vitamin D deficiency in childhood-a review of current guidelines on diagnosis and management. Indian Pediatr 2013;50:669-75.  Back to cited text no. 8
    
9.
Mellanby M, Pattison CL. The action of Vitamin D in preventing the spread and promoting the arrest of caries in children. Br Med J 1928;2:1079-82.  Back to cited text no. 9
    
10.
DeLuca HF. The metabolism and functions of Vitamin D. Adv Exp Med Biol 1986;19:361-75.  Back to cited text no. 10
    
11.
Schroth RJ, Lavelle C, Tate R, Bruce S, Billings RJ, Moffatt ME. Prenatal Vitamin D and dental caries in infants. Pediatrics 2014;133:1277-84.  Back to cited text no. 11
    
12.
Singleton R, Day G, Thomas T, Schroth R, Klejka J, Lenaker D, et al. Association of maternal Vitamin D deficiency with early childhood caries. J Dent Res 2019;98:549-55.  Back to cited text no. 12
    
13.
Kim IJ, Lee HS, Ju HJ, Na JY, Oh HW. A cross-sectional study on the association between Vitamin D levels and caries in the permanent dentition of Korean children. BMC Oral Health 2018;18:43-8.  Back to cited text no. 13
    



 
 
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