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ORIGINAL ARTICLE
Year : 2020  |  Volume : 47  |  Issue : 2  |  Page : 69-73

Evaluation of the relationship between serum level of Vitamin D and decayed, missing, and filled teeth (DMFT) in young women in Semnan, Iran (2018–2019)


1 Department of Oral Medicine, Dental School, Semnan University of Medical Sciences, Semnan, Iran
2 Department of Oral and Maxillofacial Pathology, Dental School, Semnan University of Medical Sciences, Semnan, Iran

Date of Submission05-Mar-2020
Date of Acceptance06-Mar-2020
Date of Web Publication11-Sep-2020

Correspondence Address:
Dr. Shabnam Sohanian
17 Shahrivar Blvd., Oral and Maxillofacial Pathology Department, Dental School, Semnan University of Medical Sciences, Semnan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.JSS_14_20

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  Abstract 


Introduction: Previous studies have shown that Vitamin D has an effect on calcium absorption, mineralization, and dentin formation and also on the maturation and formation of developing teeth, but the aim of this study was to evaluate the relationship between serum level of Vitamin D and Decayed, Missing, and Filled Teeth (DMFT) in adult patients with developed teeth. Materials and Methods: In this descriptive, cross-sectional study, 200 women with the age range of 15–40 years who referred to the Semnan Dental School in 2018–2019 and satisfied the inclusion and exclusion criteria were selected randomly. Then, DMFT, Plaque Index (PI) and SI index, age, the history and recent Vitamin D deficiency, and the history of xerostomia in patients were studied and statistically analyzed. Results: Only 4 (2%) of the women had a DMFT index score of 10 and 78 (39%) had a score of 3 and 4, respectively. Most patients were aged 30 years and younger (64.5%) and most of them (90.5%) had no previous history of Vitamin D deficiency and only eight patients (4%) had xerostomia. More than half of the individuals (54%) had some degree of recent Vitamin D deficiency. More than half of the women had PI grade 3 (54%) and 82 individuals (41%) had high blood sugar levels. According to Spearman's results, there was a moderate and negative correlation between DMFT and Vitamin D levels. Conclusion: Therefore, the lower the level of Vitamin D, the higher the DMFT index by excluding other caries-causing factors. Consequently, it is recommended that this is considered in high-risk groups in order to prevent oral health problems.

Keywords: Decayed, Missing, and Filled Teeth (DMFT), dental caries, serum level of Vitamin D, Vitamin D deficiency


How to cite this article:
Jalili Sadrabad M, Sohanian S. Evaluation of the relationship between serum level of Vitamin D and decayed, missing, and filled teeth (DMFT) in young women in Semnan, Iran (2018–2019). J Sci Soc 2020;47:69-73

How to cite this URL:
Jalili Sadrabad M, Sohanian S. Evaluation of the relationship between serum level of Vitamin D and decayed, missing, and filled teeth (DMFT) in young women in Semnan, Iran (2018–2019). J Sci Soc [serial online] 2020 [cited 2020 Sep 25];47:69-73. Available from: http://www.jscisociety.com/text.asp?2020/47/2/69/294787




  Introduction Top


Vitamins D (1 and 25-hydroxycholecalciferol) is one of the essential vitamins of the body which is fat soluble and made by sun's exposure to the skin and becomes an active form in the kidneys. Vitamin D, accompanying with calcitonin, plays an important role in the deposition of calcium on hard tissues such as bones and teeth and by enhancing the absorption of phosphorus and calcium from the intestines and reducing the excretion of these elements from the kidneys, it contributes to bone metabolism and tooth formation and its toughness.[1]

At least 80% of Iranian children have severe degree and more than 90% have varying degrees of Vitamin D deficiency.[2] Lack of this vitamin in the body causes rickets in children and osteoporosis in adults.[1]

Recent studies have shown that Vitamin D has an important role in the process of tooth formation and development, including in the stages of calcium absorption, mineralization, and dentin formation, as well as in the health of periodontal tissues and especially the supporting bone.[1],[3] Researchers examined the effect of Vitamin D of children's serum and the polymorphism of the receptor gene of Vitamin D on early childhood caries and found conflicting results.[4],[5],[6],[7],[8],[9]

Although the effect of Vitamin D on the development and maturation of developing teeth during childhood and before full maturation of teeth seems reasonable, the question in this study is whether a correlation between the amount of Vitamin D presents in the serum and the Decayed, Missing, and Filled Teeth (DMFT) index in adult patients or not and whether it is scientific and logical or not. Because Vitamin D deficiency is more common in women of reproductive age,[4] they were selected as the target population in this study.

The purpose of this study was to investigate the relationship between the serum level of Vitamin D and DMFT in young women who are in safe reproductive age (15–35 years old)[9] in Semnan, and if there is a relationship, by improving education and information programs about Vitamin D deficiency, we try to reduce DMFT index in the target population to prevent further oral health problems.


  Materials and Methods Top


In this descriptive, cross-sectional study, 200 women of reproductive age with the age range of 15–40 years who referred to the Semnan Dental School in 2018–2019 were randomly selected. All of them had serum Vitamin D test during the last 3 months, and for the patient who did not have, the test was prescribed. Thus, patients younger than 15 and over 35, patients taking medications such as bisphosphonate and alendronate, and patients with congenital dental missing and the teeth that were destroyed by trauma were excluded from the study sample. Patients' examination for DMFT and Plaque Index (PI) was recorded by a trained dentistry student using a mirror and abaisse-langue and Fuchsine tablet sunder the light of the unit and approved by an oral medicine specialist. In this study, a questionnaire including Sugar Index (SI), age, the history of xerostomia, and Vitamin D deficiency was administered to the participants, and the recent serum levels of Vitamin D which were obtained in their blood test were recorded in the checklist [Figure 1] and [Figure 2]. The records and datasheets for each patient were completed in a personal and confidential interview and were never made available to miscellaneous persons. Ethical considerations were licensed by the Ethics Committee (REC.1397.083.IR.SEMUMS) of Semnan University of Medical Sciences. The records of each patient were completed confidentially and were recorded in the Archive of the Dental School and were never accessible to miscellaneous persons.
Figure 1: Frequency distribution of decayed, missing, and filled teeth index in women referred to dental clinic of Semnan University of Medical Sciences in 98–97

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Figure 2: Distribution graph of different levels of Vitamin D based on decayed, missing, and filled teeth index

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  Results Top


Two hundred women (15–35 years old) of safe reproductive age with a mean age of 27.1 ± 5.42 years who referred to the dental clinic of Semnan University of Medical Sciences, participated in this study, with the oldest being 35 and the youngest being 15 years of age.

Decayed, missing, and filled teeth index

They were examined for DMFT index; the mean was found to be 4.7 ± 2.20 that the least level of the index in the patients was 1 and the highest was 10. As shown, only 4 (2%) women had a DMFT index score of 10 and 78 (39%) had a score of 3 and 4, respectively. None of the women referred had a congenital missing tooth as well as a missing tooth due to trauma.

Specifications examined

Other characteristics of the study participants are shown in [Table 1]. As shown in [Table 1], most participants were aged 30 years and younger than 30 years (64.5%) and most of them had no history of Vitamin D deficiency (90.5%) and only eight individuals (4%) had a history of xerostomia. It should be noted that none of the women took bisphosphonate and alendronate medications.
Table 1: Frequency distribution of the characteristics of women referred to the dental clinic of Semnan University of Medical Sciences

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Plaque Index

More than half of the women studied had Grade 3 PI (54%) and only two of them (1%) had Grade 1 PI.

SI index

Eighty-two women (41%) had high levels of sugar consumption during the day and only one woman (0.5%) had zero sugar intake.

Amount of acid consumption during the day

Only one (0.5%) woman had zero acid intake during the day, and most of them (40%) had higher than the average intake.

Recent Vitamin D serum levels

Nearly 46% of the people had adequate Vitamin D levels and more than half (54%) had some level of Vitamin D deficiency.

Correlation between decayed, missing, and filled teeth index and serum Vitamin D level

Spearman's correlation coefficient was used to measure the correlation between DMFT index and serum Vitamin D deficiency (P < 0.001, r = −0.429); as shown by the Spearman's test results, there is a moderate-to-negative correlation between the two parameters, implying that the higher the serum level of Vitamin D, the lower the DMFT index.

Multiple regression analysis

Multiple regression analysis was performed to evaluate the effects of age, history of xerostomia, PI, SI, amount of acid consumption, and serum level of Vitamin D on DMFT index [Table 2].
Table 2: Multiple regression analysis to show the relationship between serum Vitamin D level and decayed, missing, and filled teeth index by adjusting contextual variables

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Results of multiple regression analysis

DMFT indicates a statistically significant relationship with age and history of xerostomia considering that this relationship was significant (P < 0.001) and PI, SI, and acid consumption during the day can have an effect on DMFT. Furthermore, it is found that serum level of Vitamin D is inversely correlated with DMFT index (P < 0.001).


  Discussion Top


DMFT increases in different age groups due to a variety of factors, with one of them being women of safe reproductive age (15–35 years) because this age group is usually deficient in Vitamin D levels. Due to the high prevalence of dental caries and Vitamin D deficiency in this target group and the contradictory results in the correlation studies of these two parameters, this study aimed to evaluate the relationship between serum level of Vitamin D and DMFT index. The rate of DMFT index in pregnant women in the study of Schroth et al. was found to be 10 (54%) of 54 patients. The results showed that only 4 (2%) of the women had a DMFT index score of 10 and 78 (39%) had a score of 3 and 4, respectively. This indicates that the oral health level in this age group is more desirable, as observed in this study, which is in the average range than the study of Schroth et al.[10]

In this study, the findings showed that the PI index in more than half of the women is Grade 3, and the results of the PI index that indicates the amount of plaques present on dental surfaces show that in more than half of the women, oral hygiene was not good enough. According to the study of Schroth et al. which was conducted on 207 pregnant women at the University of Manitoba, only 20 (9%) had a Grade 3 or 4 index, and compared to our study, they had better oral and dental health.[10] In the study of Antonenco et al. which was performed on 200 women, only five individuals had a PI Grade 4 (2.5%), which was more favorable oral health status than that of our study.[11]

According to the analysis and the data obtained, it was found that women at this age use a lot of sugar. Eighty-two (41%) women stated that their sugar intake was high during the day, which increased the activity of anaerobic bacteria in the mouth and increased tooth decay.[11] In the cross-sectional study of Antonenko et al. conducted on 200 women with a mean age of 23.4 years, diet, Vitamin D levels, protein intake, calcium, and PI, SI, and DMFT levels were evaluated. It was found that only 43 individuals (21.5%) had a high sugar intake, which was lower than that of our study.[11] Antoneko et al. assessed the relationship between oral and dental health with Vitamin D levels of women diet and in serum of the people with deficiency. Their result showed that there was no relationship between DMFT index and serum level of Vitamin D. This is contrary to the results of our study.[11]

The results of the present study showed that more than half of the people had some level of Vitamin D deficiency, which indicates that their diets are deficient in the amount of Vitamin D. Finally, the correlation between DMFT index and serum level of Vitamin D according to the results of Spearman's test (P = 0.001, r = −0.429) showed a moderate and negative correlation between these two parameters, which means that the higher the serum level of Vitamin D, the lower the score in DMFT index, which was in contradiction with the results of the study by Herzog et al. (P = 0.223, r = 0.202) that showed weak and nonsignificant correlations.[12]

In the study by Antoneko et al.,[11] there was a significant relationship between DMFT index, age, and the history of xerostomia and the serum level of Vitamin D (P < 0.001). Abreu et al.[13] also concluded that the relationship between DMFT index, age, and PI was statistically significant (P < 0.001). Similarly, in the study by Adegboye et al.[14] in Denmark, there existed a straight and significant relationship between DMFT index and PI (P < 0.001). In the present study, there was a significant and straight relationship between DMFT index, age, and the history of xerostomia. Furthermore, DMFT index had a significant inverse relationship with the serum level of Vitamin D, but there was no significant correlation between DMFT index and PI in our study.

In this study, multiple regression analysis was performed to investigate the concurrent effects of age, the history of xerostomia, PI, SI, amount of acid consumption, and serum levels of Vitamin D on DMFT index, and it was found that serum level of Vitamin D was inversely correlated with DMFT index (P <0.001). Therefore, according to the results, older people with a history of xerostomia have a higher DMFT index, and the higher serum level of Vitamin D in them causes the lower DMFT index. This was a cross-sectional study, which is a limitation. It was difficult to get patients' cooperation through the oral and written explanations which provided in the informed consent and also persuaded them to give us their tim e. There was no predefined standard benchmark for SI, so the research team had to design a grading in this field.

Because there was a significant and inverse relationship between DMFT index and serum level Vitamin D in this study, it is recommended that women in safe reproductive age comply with the hygiene principles by brushing their teeth after eating each meal; reducing the amount of sugar and acid consumption during the day in order to prevent caries; eating diets that contain more Vitamin D, such as fish, egg yolks, shrimp, mushrooms, and cereals; and spending hours of the day sitting under direct sunlight to compensate for their Vitamin D deficiencies so that they can ideally reduce the amount of dental caries.[15] It is also recommended that future studies be designed as a prospective case–control cohort and the sample size be increased in order to obtain a better relevance to examine the involved factors of the study more comprehensively and clearly in the analyses. Furthermore, researchers are advised to investigate the effect of Vitamin D on the density of alveolar bone, which supports the teeth.


  Conclusion Top


Therefore, by excluding other factors affecting caries, it is found that the lower serum levels of Vitamin D lead to the higher DMFT index in individuals. Therefore, it is recommended that this factor needs to be taken into consideration, in high-risk groups, to prevent further problems which are related to oral and dental health.

Acknowledgment

This article is taken from the dissertation of General Doctorate of Dentistry and is approved by Semnan University of Medical Sciences' Research Center No. 1423 and financially supported by the university; therefore, we would like to thank Dr. Parviz Koukhai, Vice-Chancellor for Research, Semnan University of Medical Sciences; Dr. Ali Vali Nezhadi; Dr. Majid MirMohammah Khani; and Dr. Iman Hajizadeh.

Financial support and sponsorship

This study was financially supported by Semnan University of Medical Sciences.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 2004;80:1678S-88S.  Back to cited text no. 1
    
2.
Moradzadeh K, Larijani B, Keshtkar A, Hossein-Nezhad A, Rajabian R, Nabipour I, et al. Normative values of vitamin D among Iranian population: A population based study. Int J Osteoporos Metab Disord 2008;1:8-15.  Back to cited text no. 2
    
3.
Brannon PM, Yetley EA, Bailey RL, Picciano MF. Overview of the conference “Vitamin D and health in the 21st Century: An update”. Am J Clin Nutr 2008;88:483S-490S.  Back to cited text no. 3
    
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Armas LA, Hollis BW, Heaney RP. Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab 2004;89:5387-91.  Back to cited text no. 4
    
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Dye BA, Hsu KL, Afful J. Prevalence and measurement of dental caries in young children. Pediatr Dent 2015;37:200-16.  Back to cited text no. 5
    
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Fischman SL. Design of studies to evaluate plaque control agents. J Dent Res 1979;58:2389-95.  Back to cited text no. 6
    
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Grant WB. Vitamin D, periodontal disease, tooth loss, and cancer risk. Lancet Oncol 2008;9:612-3.  Back to cited text no. 7
    
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Opal S, Garg S, Jain J, Walia I. Genetic factors affecting dental caries risk. Aust Dent J 2015;60:2-11.  Back to cited text no. 8
    
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Shuler CF. Inherited risks for susceptibility to dental caries. J Dent Educ 2001;65:1038-45.  Back to cited text no. 9
    
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Schroth RJ, Lavelle C, Tate R, Bruce S, Billings RJ, Moffatt ME. Prenatal vitamin D and dental caries in infants. Pediatrics 2014;133:e1277-84.  Back to cited text no. 10
    
11.
Antonenko O, Bryk G, Brito G, Pellegrini G, Zeni SN. Oral health in young women having a low calcium and vitamin D nutritional status. Clin Oral Investig 2015;19:1199-206.  Back to cited text no. 11
    
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Herzog K, Scott JM, Hujoel P, Seminario AL. Association of vitamin D and dental caries in children: Findings from the National Health and Nutrition Examination Survey, 2005-2006. J Am Dent Assoc 2016;147:413-20.  Back to cited text no. 12
    
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Abreu OJ, Tatakis DN, Elias-Boneta AR, López Del Valle L, Hernandez R, Pousa MS, et al. Low vitamin D status strongly associated with periodontitis in Puerto Rican adults. BMC Oral Health 2016;16:89.  Back to cited text no. 13
    
14.
Adegboye AR, Christensen LB, Holm-Pedersen P, Avlund K, Boucher BJ, Heitmann BL. Intakes of calcium, vitamin D, and dairy servings and dental plaque in older Danish adults. Nutr J 2013;12:61.  Back to cited text no. 14
    
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Razzaque MS. Sunlight exposure: Do health benefits outweigh harm? J Steroid Biochem Mol Biol 2018;175:44-8.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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