Effectiveness of Vitamin C Supplementation in Periodontal Therapy

Authors

  • Anggun Rafisa Physiology, Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Indonesia
  • Gita Dwi Jiwanda Sovira Anatomy, Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Indonesia

Keywords:

Vitamin C, ascorbic acid, gingivitis, periodontitis, supplementation

Abstract

Periodontal disease is a chronic inflammatory condition initiated by microbial dysbiosis and driven by host immune responses, notably the overproduction of reactive oxygen species (ROS), which contribute to tissue damage. Vitamin C (ascorbic acid), a potent antioxidant, plays a role in collagen synthesis and immune regulation. Several studies have proposed vitamin C as an adjunct in periodontal therapy, yet its effectiveness remains unclear. This systematic review aims to evaluate the effect of vitamin C supplementation on clinical periodontal parameters in patients with periodontal disease. A comprehensive literature search was conducted in PubMed and Scopus for randomized controlled trials (RCTs) published between January 2015 and June 2025. Included studies investigated vitamin C supplementation in patients with periodontal disease without systemic conditions, pregnancy, lactation, or medication use. Studies involving vitamin C in combination with other nutrients without a separate vitamin C-only group were excluded. Data extraction and analysis followed the PRISMA guidelines. Four RCTs met the inclusion criteria. Significant clinical improvements were observed in periodontal parameters following non-surgical periodontal therapy (NSPT). However, the addition of vitamin C supplementation alone did not consistently provide significant improvements beyond NSPT alone. One study showed greater improvements when vitamin C was combined with melatonin, and another suggested potential benefits from guava—a natural source of vitamin C and polyphenols—over synthetic vitamin C. Current evidence suggests that while vitamin C supplementation may offer modest anti-inflammatory and antioxidant benefits, it does not consistently enhance clinical outcomes in periodontal therapy when used alone.

References

P. M. Bartold and T. E. Van Dyke, "Periodontitis: a host-mediated disruption of microbial homeostasis. Unlearning learned concepts," (in eng), Periodontol 2000, vol. 62, no. 1, pp. 203-17, Jun 2013.

N. S. Gasner and R. S. Schure, Periodontal Disease. Treasure Island (FL): StatPearls Publishing, 2025.

M. A. Nazir, "Prevalence of periodontal disease, its association with systemic diseases and prevention," (in eng), Int J Health Sci (Qassim), vol. 11, no. 2, pp. 72-80, Apr-Jun 2017.

M. Sanz, F. D'Aiuto, J. Deanfield, and F. Fernandez-Avilés, "European workshop in periodontal health and cardiovascular disease—scientific evidence on the association between periodontal and cardiovascular diseases: a review of the literature," European Heart Journal Supplements, vol. 12, no. suppl_B, pp. B3-B12, 2010.

A. A. Abdulkareem, F. B. Al-Taweel, A. J. B. Al-Sharqi, S. S. Gul, A. Sha, and I. L. C. Chapple, "Current concepts in the pathogenesis of periodontitis: from symbiosis to dysbiosis," (in eng), J Oral Microbiol, vol. 15, no. 1, p. 2197779, 2023.

E. Könönen, M. Gursoy, and U. K. Gursoy, "Periodontitis: A Multifaceted Disease of Tooth-Supporting Tissues," vol. 8, no. 8, p. 1135, 2019.

G. T. Nguyen, E. R. Green, and J. Mecsas, "Neutrophils to the ROScue: Mechanisms of NADPH Oxidase Activation and Bacterial Resistance," (in eng), Front Cell Infect Microbiol, vol. 7, p. 373, 2017.

C. Galli, G. Passeri, and G. M. Macaluso, "FoxOs, Wnts and oxidative stress-induced bone loss: new players in the periodontitis arena?," (in eng), J Periodontal Res, vol. 46, no. 4, pp. 397-406, Aug 2011.

R. J. Waddington, R. Moseley, and G. Embery, "Reactive oxygen species: a potential role in the pathogenesis of periodontal diseases," (in eng), Oral Dis, vol. 6, no. 3, pp. 138-51, May 2000.

D. V. Sculley and S. C. Langley-Evans, "Periodontal disease is associated with lower antioxidant capacity in whole saliva and evidence of increased protein oxidation," (in eng), Clin Sci (Lond), vol. 105, no. 2, pp. 167-72, Aug 2003.

P. De Angelis et al., "The Effect of an Optimized Diet as an Adjunct to Non-Surgical Periodontal Therapy in Subjects with Periodontitis: A Prospective Study," (in eng), Healthcare (Basel), vol. 10, no. 3, Mar 21 2022.

M. G. Traber and J. F. Stevens, "Vitamins C and E: beneficial effects from a mechanistic perspective," (in eng), Free Radic Biol Med, vol. 51, no. 5, pp. 1000-13, Sep 1 2011.

L. Maxfield, S. F. Daley, and J. S. Crane, Vitamin C Deficiency. Treasure Island (FL): StatPearls Publishing, 2023.

P. J. Pussinen, T. Laatikainen, G. Alfthan, S. Asikainen, and P. Jousilahti, "Periodontitis is associated with a low concentration of vitamin C in plasma," (in eng), Clin Diagn Lab Immunol, vol. 10, no. 5, pp. 897-902, Sep 2003.

A. Tada and H. Miura, "The Relationship between Vitamin C and Periodontal Diseases: A Systematic Review," (in eng), Int J Environ Res Public Health, vol. 16, no. 14, Jul 11 2019.

M. Nishida, S. G. Grossi, R. G. Dunford, A. W. Ho, M. Trevisan, and R. J. Genco, "Dietary vitamin C and the risk for periodontal disease," (in eng), J Periodontol, vol. 71, no. 8, pp. 1215-23, Aug 2000.

D. W. Dodington, P. C. Fritz, P. J. Sullivan, and W. E. Ward, "Higher Intakes of Fruits and Vegetables, β-Carotene, Vitamin C, α-Tocopherol, EPA, and DHA Are Positively Associated with Periodontal Healing after Nonsurgical Periodontal Therapy in Nonsmokers but Not in Smokers," (in eng), J Nutr, vol. 145, no. 11, pp. 2512-9, Nov 2015.

S. Nisha, A. Bettahalli Shivamallu, A. Prashant, P. Shashikumar, A. Ganganna, and D. Das, "Effect of non surgical periodontal therapy and vitamin C supplementation on total antioxidant capacity in patients with chronic generalised periodontitis - A randomised controlled trial," (in eng), J Oral Biol Craniofac Res, vol. 13, no. 4, pp. 511-516, Jul-Aug 2023.

U. Raghavendra et al., "Vitamin C Supplementation as an Adjunct to Nonsurgical Therapy in the Treatment of Chronic Periodontitis: A Clinical and Biochemical Study," vol. 10, no. 5, pp. 256-261, 2018.

A. Amaliya, A. S. Risdiana, and U. Van der Velden, "Effect of guava and vitamin C supplementation on experimental gingivitis: A randomized clinical trial," (in eng), J Clin Periodontol, vol. 45, no. 8, pp. 959-967, Aug 2018.

M. Chitsazi, M. Faramarzie, M. Sadighi, A. Shirmohammadi, and A. Hashemzadeh, "Effects of adjective use of melatonin and vitamin C in the treatment of chronic periodontitis: A randomized clinical trial," (in eng), J Dent Res Dent Clin Dent Prospects, vol. 11, no. 4, pp. 236-240, Fall 2017.

H. N. Fageeh, H. I. Fageeh, A. Prabhu, S. Bhandi, S. Khan, and S. Patil, "Efficacy of vitamin C supplementation as an adjunct in the non-surgical management of periodontitis: a systematic review," (in eng), Syst Rev, vol. 10, no. 1, p. 5, Jan 4 2021.

S.-A. Kim, H. Joung, and S. Shin, "Dietary pattern, dietary total antioxidant capacity, and dyslipidemia in Korean adults," Nutrition Journal, vol. 18, no. 1, p. 37, 2019/07/13 2019.

K. Ravi and P. Divyashree, "Psidium guajava: A review on its potential as an adjunct in treating periodontal disease," (in eng), Pharmacogn Rev, vol. 8, no. 16, pp. 96-100, Jul 2014.

K. M. Mohamad Rauf, A. F. Alzubaidee, and N. H. Hamonari, "Evaluation of the Effect of Topically Applied Melatonin and Vitamin C in the Non-surgical Treatment of Chronic Periodontitis: A Triple-Blind Randomized Clinical Trial," (in eng), Cureus, vol. 16, no. 12, p. e76676, Dec 2024.

Downloads

Published

2025-07-04

How to Cite

Rafisa, A., & Sovira, G. D. J. (2025). Effectiveness of Vitamin C Supplementation in Periodontal Therapy. Jurnal EduHealth, 16(03), 1041–1049. Retrieved from https://ejournal.seaninstitute.or.id/index.php/healt/article/view/6854

Most read articles by the same author(s)

<< < 1 2