Re‐evaluating the role of vitamin D in the periodontium

The importance of vitamin D in maintaining skeletal health via the regulation of calcium has long been recognized as a critical function of this secosteroid. An abundance of literature shows an association between oral bone mineral density and some measure of systemic osteoporosis and suggests that osteoporosis/low bone mass may be a risk factor for periodontal disease. Recently, nonskeletal functions of vitamin D have gained notoriety for several reasons. Many cells that are not associated with calcium homeostasis have been demonstrated to possess membrane receptors for vitamin D. These include activated T and B lymphocytes, and skin, placenta, pancreas, prostate and colon cancer cells. In addition, vitamin D “insufficiency” is a worldwide epidemic and epidemiologic evidence has linked this condition to multiple chronic health problems, including cardiovascular and autoimmune diseases, hypertension and a variety of cancers. Interestingly, there is mounting evidence connecting diminished serum levels of vitamin D with increased gingival inflammation and supporting the concept of “continual vitamin D sufficiency” in maintaining periodontal health. The ability of vitamin D to regulate both the innate and the adaptive components of the host response may play an important role in this process. This review will examine the skeletal and nonskeletal functions of vitamin D, and explore its potential role in protecting the periodontium as well as in regulating periodontal wound healing.     

The development of the mouse molar periodontium

The normal development of the tissues of attachment of mouse molar teeth was studied using standard histological techniques. Jaws were taken from mice on the day of birth and each subsequent day, up to and including thirty days after birth, and examined. At birth, the molar teeth were in the late shell stage of development and were enclosed in the dental sac. Subsequent growth of the crown was accompanied by minor changes in the dental sac and alveolar bone. The periodontal ligament began to develop when root formation began. Fibres were laid down in a superior-oblique orientation which was maintained throughout the prefunctional and functional phases of eruption although changes which gave rise to the cervical fibre groups took place in the latter part of the prefunctional phase. Changes in the alveolar bone and cementum were observed as the tooth became functional. It was concluded that the periodontal ligament was preadapted to function and changes in other tissues of attachment, occurring as the teeth attained functional occlusion, were designed to strengthen the attachment of the fibres to bone and tooth.     

The periodontium in experimental bruxism]

Time course of morphologic changes in periodontal tissue was studied in 42 miniature pigs with experimental bruxism. An inflammation has developed in the marginal periodontium. At first the inflammatory infiltrate was situated under the epithelial fixation to the tooth involving destruction of the epithelial fixation and formation of pockets, inflammatory infiltrate, and granulation tissue, these destructive changes involving the lower sections of the periodontium. Signs of resorption were detectable in the dental alveolus osseous wall, cement, and dentin. The changes in the periodontal tissue described above appear to result from a complex of factors developing in experimental animals with simulated bruxism.     

Use of ultrasound imaging for assessment of the periodontium: A systematic review

The objective of this study was to systematically review the literature regarding diagnostic applications of ultrasound imaging for evaluation of the periodontium in humans. The search was conducted on Medline, EMBASE, Web of Science, Scopus, Cochrane, and PubMed up to April 3, 2023. The studies included were exclusively human studies that assessed the periodontium with ultrasound (US) imaging (b-mode). Outcomes measured included alveolar bone level, alveolar bone thickness, gingival thickness, and blood flow quantification. References were imported to Covidence. Two reviewers conducted phases 1 and 2. The JBI risk assessment tool for cross-sectional studies was used. Extracted data included the transducer and measurements used and the study's outcomes. The search yielded 4892 studies after removing duplicates. From these, 25 studies were included and selected for extraction. Included studies retrieved outcomes from US examinations of the periodontal tissues. From the selected studies, 15 used US on natural teeth, 4 used US on implants, 2 used US on edentulous ridges, and 4 used color flow/power in US to evaluate the blood flow. The results of the present systematic review suggest that US might be a feasible and valuable diagnostic tool for the periodontium, with the potential to complement shortfalls of current radiographic technologies.