A study to assess anti Inflammatory Effect of Vitamin D on Gingivitis A Dose Dependent Randomised Controlled Trial

Abstract

Purpose: ix Decreased serum vitamin D levels have been linked with gingivitis. Also studies have shown that vitamin D has anti inflammatory effect at higher dose. The objective of this study was to determine the optimum level of vitamin D that could initiate an anti inflammatory effect on gingivitis after oral supplementation. Materials and methods: After collecting the baseline serum vitamin D and gingival status in the 96 subjects of the 451 screened, a double blind randomized controlled trial was conducted in Maratha Mandal Dental College, Belgaum. The subjects were randomised into four groups and later given a daily oral vitamin D3 supplementation in dose of 2000 IU for Group A, 1000 IU for Group B , 500 IU for Group C and placebo for Group D over three months period. The changes in gingival scores were measured at the period of 1 st , 2nd and 3 rd month to assess the anti inflammatory effect. The change in serum vitamin D levels were also analyzed for the association with gingivitis. Results: Group A which had mean baseline serum vitamin D of 22.46+ 6.97 had a final visit scores of 52.20+10.17. An average increase of 9.91 was seen per month. The mean baseline gingival scores in this group of 2.4 got reduced to 1.7 at end of first month and later to 0.8 at end of two months and 0.3 at the end of third month. When ANCOVA was applied to compare mean gingival score between the groups with baseline as co-variate showed significant changes at the 3 rd and final visit. When the group A, B and C were compared with placebo group D using Student Neuman Keul Post hoc test, showed significant reduction in gingivitis compared with the placebo group showing the anti inflammatory effect of vitamin D on gingivitis. When baseline scores were compared with subsequent visit scores by Wilcoxon paired test, Group A showed significant anti inflammatory effect at end of first month itself with Plt0.0001. The group B with baseline serum vitamin D levels of 26.50+3.68 had an average increase of 5.62 per month with final visit scores of 43.67+8.80. The mean baseline gingival scores in this group from 2.3 got reduced to 2.0 at end of first month and later to 1.1 at end of two months and 0.5 at the end of third month. This group showed significant anti inflammatory effect at the end of 2 month with Plt0.0001. Group C had significant anti inflammatory effect at the end of the 3 rd month with Plt0.0001 having baseline gingival scores as 2.2 after one month as 1.9, after two months as 1.4 and 0.8 at the last visit. Also baseline vitamin D scores was 23.98+ 5.65 and final visit score of 36.8 1+ 6.13 respectively, a monthly increase of.4.27.However Group D did not show significant anti inflammatory effect. The above finding demonstrates dose dependent anti inflammatory effect of vitamin D on gingivitis. When repeated test of ANOVA was applied for comparing gingival scores at various visits we got Eta square effect of 90 % in group A, 81% in group B and 66% in group C and 39% in group D indicating dose dependent effect. The serum vitamin D levels were inversely associated with gingival score after vitamin D supplementation in the groups. Also the optimum serum vitamin D to initiate anti inflammatory effect was proposed to be 32-37ng/ml x nd Conclusion: Vitamin D is a safe and effective anti inflammatory agent in dose ranging from 500 IU to 2000 IU; however results are appreciated early with higher dose of 2000 IU. It was also found that the optimum level of 30-35 ng/ml of serum vitamin D can initiate an anti inflammatory effect on gingivitis after oral vitamin D supplementation. newline