Low Calcium Intake and Hypovitaminosis D Negatively Affect Oral Health in Young Men

Research Article

Austin J Dent. 2017; 4(7): 1093.

Low Calcium Intake and Hypovitaminosis D Negatively Affect Oral Health in Young Men

Antonenko O¹, Seijo M¹, Brito G², Gualtieri AF³, Pellegrini G1,2 and Zeni SN1,2*

¹Metabolic Bone Diseases Laboratory, Clinical Hospital, Immunology, Genetic and Metabolism Institute (INIGEM), National Council for Scientific and Technologic Research (CONICET), Buenos Aires University (UBA), Argentina

²Department of General and Oral Biochemistry, School of Dentistry, Buenos Aires University (UBA), Argentina

³Department of Biophysics, School of Dentistry, Buenos Aires University (UBA), Argentina

*Corresponding author: Susana N Zeni, General and Oral Biochemistry Department, School of Dentistry, Buenos Aires University (UBA), Av. Córdoba 2351-8vo Piso (1120) Buenos Aires, Argentina

Received: October 06, 2017; Accepted: November 08, 2017; Published: December 07, 2017


Aim: Oral health and nutrition have a synergistic bidirectional relationship. Diet plays an important role in dental caries process, one of the main factors associated with high risk of tooth loss in adults. Conversely, tooth loss, pain and discomfort limit food choices which negatively affect nutritional status. The objective was to evaluate association between oral health and calcium (Ca) and vitamin D nutritional status, several dietary and life-style habits in young men.

Materials and Methods: A total of 241 men (29.4±2.1 years) were studied. Ca intake (CaI) and protein intakes were recorded, and 25hydroxyvitamin D (25OHD) was determined. Dental status and caries risk were assessed by Decayed (D), Missing (M) and Filled (F) Teeth, (DMFT) index, Löe Silness Plaque Index (PI) and sugar intake (SI). Results: Deficient CaI was observed in 48% of men; 71% had 25OHD <30 ng/mL and 65% consumed soft drinks daily. M/T was 2.9%; D/T was 16.2% and F/T was 18.7%; 41% were missing at least one tooth. DMFT score was 11.4±0.9, PI and SI were 1.9±0.2 and 5.3±0.2, respectively. Adjusted-CaI by risk factors was associated with higher caries activity (p<0.01) and missing teeth (p<0.013); 100% presented gingivitis. DMFT of the one third of men with the highest caries scores reached 17.4±0.5; these men had significantly lower CaI (p<0.023) and higher daily consumption of soft drinks and PI values (p<0.05).

Conclusion: CaI and vitamin D inadequacies, together with certain dietary and lifestyle habits observed in the studied men would seemingly be responsible, at least in part, for their high cariogenic activity.

Keywords: Low calcium intake; Hypovitaminosis D; Oral health; Young men


BAP: Bone Alkaline Phosphatase; BMD: Bone Mineral Density; BMI: Body Mass Index; BW: Body Weight; Ca: Calcium; CaI: Ca Intake; CI: Confidence Intervals; Creat: Creatinine; CS: Chemical Score; CTX: Carboxi-Terminal Telopeptide of Type I Collagen; CV: Coefficient of Variation; D: Decayed; DMFT: Decayed, Missing, Filled and Teeth; EAR: Estimated Average Recommendations; ELISA: Enzyme-Linked Immune-Absorbent Assay; ENNyS: National Survey on Nutrition and Health; EPS: Extracellular Polysaccharides; F: Filled; M: Missing; NHANES: National Health and Nutrition Examination Survey; P: Phosphate; PI: Plaque Index; PTH: Parathyroid Hormone; RDA: Recommended Dietary Allowance; SD: Standard Deviation; SI: Sugar Intake; Sic: Significant Caries Index; T: Teeth; UBA: University of Buenos Aires; WHO: World Health Organization; 25OHD: 25hydroxyvitamin D


Diet plays an important role in the dental caries process, one of the main factors associated with high risk of tooth loss in adults. In this regard, several studies have reported an inverse association between the consumption of certain nutrients and progressively impaired oral health [1]. In turn, tooth loss, pain and discomfort impose dietary restrictions because they reduce the ability to masticate, and consequently limit food choices, with negative consequences on nutritional status. Both tooth loss and compromised diet contribute to creating a vicious circle that would seemingly increase dental caries [2-4]. The World Health Organization (WHO) has acknowledged that oral health and nutrition have a synergistic bidirectional relationship, and have included dental disease among the chronic diseases that can be prevented by diet [5].

Certain dietary habits are associated with positive or negative effects on oral health. Milk and dairy product consumption is recognized as one of the factors that decreases caries development [6]. These products are the major source of calcium (Ca) and phosphate (P), both of which have beneficial effects on dental plaque and saliva. In this regard, a high concentration of Ca and P may decrease the adherence of caries-associated bacteria to the enamel [7], whereas high Ca intake may increase enamel remineralization, decrease demineralization, prevent alveolar bone loss, and, hence, promote dental health [8,9]. Vitamin D could also influence oral health, protecting against periodontal disease progression and, consequently, against alveolar bone loss. This is because of the direct effect of vitamin D on bone and phospho-calcium homeostasis and its antiinflammatory and antimicrobial actions [10]. It is important to point out that Ca and vitamin D insufficiency/deficiency is a prevalent condition in the general population, including adolescents and young adults [11-13].

It is now recognized that there has been a displacement of milk intake for soft drinks consumption, especially in adolescents and young adults [14,15]. A high consumption of soft drinks has negative effects on dental health, causing dental caries and enamel erosion [16]. Moreover, lifestyle habits such as poor oral hygiene, smoking or infrequent dental visits could results in an increase in cariogenic activity, which is one of the main risk factors of tooth loss [17]. It is known that men brush their teeth less often, visit the dentist for preventive purposes less frequently, and are less concerned with the preservation of their natural dentition than women [18].

We hypothesized that a poor oral health is associated with a low Ca intake and hypovitaminosis D in young men, and that certain dietary and life-style habits could influence such association. On these bases, the purpose of the present cross-sectional study was to evaluate bone resorption and oral health in relation to Ca and vitamin D nutritional status in a group of young-adult men. The effects of fruits and soft drinks and type and frequency of sugar consumption on caries progression were also explored.

Subjects and Methods

This cross-sectional, observational study was conducted in healthy young men studying or working at the University of Buenos Aires University (UBA) during 2010 and 2014. The study plan was approved by the Ethics Committee and the Teaching and Research Committee of the éJosé San Martín” Clinical Hospital, UBA. All procedures were carried out in keeping with the ethical and legal requirements based on the Nuremberg Code, Declaration of Helsinki and its amendments [19].


Inclusion criteria: Healthy young adult men with no a history of previous bone fractures.

Exclusion criteria: Men that suffer any diseases or disorders that influence bone and phosphocalcium metabolism (i.e. diabetes, malignancies, chronic renal or liver disease, malabsorption syndromes, or hypercalcemia owing to primary hyperparathyroidism) or take dietary supplements or medications known to affect bone homeostasis (i.e., oral corticosteroids, fluoride, vitamin D, calcitonin or bisphosphonates) were excluded. In addition, men who received vitamin D or Ca supplements, oral corticosteroids, fluoride, bisphosphonates, or any other medication that could affect bone metabolism were also excluded.

A total of 524 men were invited to participate; 251 men (30.1±1.9 years) agreed to be interviewed; 10 of them were excluded of the study based on the exclusion criteria. The final studied population comprised 241 men (29.4±2.1 years). All participants were previously informed of the aims of the study, and gave their written informed consent.

Lifestyle questionnaire: All the subjects completed a comprehensive non-validated lifestyle questionnaire based in Short Form 36 (Supplemental Table 1) [20,21]. It included questions about outdoor activities, smoking habits, occupation, and family history of fractures.