Interaction between vitamin D insufficiency and periodontitis, GCF vitamin D and LL-37 levels in well-controlled diabetes patients with periodontitis

Purpose To determine whether low serum vitamin D levels are inversely correlated with clinical parameters and positively correlated with gingival crevicular fluid (GCF) 25(OH)D3, 1,25(OH)2D3, LL-37 and tumor necrosis factor-alpha (TNF-alpha) levels in periodontitis patients with well-controlled type-2 diabetes (T2DM). Materials and Methods Twenty-six well-controlled T2DM patients with periodontitis and Vitamin D insufficiency (Vit.D-IS group), and 15 well-controlled T2DM patients with periodontitis and Vitamin D sufficiency (Vit.D-S group) were included. Papilla bleeding index, bleeding on probing (BOP), supragingival plaque, clinical attachment level (CAL) and probing depth (PD) were evaluated. GCF total amounts of 25(OH)D,1,25(OH)2D3, LL-37 and TNF-alpha were analyzed by ELISA. Serum 25(OH)D3 levels were determined using liquid chromatography tandem-mass spectrometry. Results Whole mouth CAL and BOP scores were higher in the Vit.D-IS group than those of Vit.D-S group (P=0.038, P=0.048, respectively). Whole mouth PD and plaque values were comparable in both groups. Differences were not detected in GCF 25(OH)D3, 1,25(OH)2D3, LL-37 and TNF-alpha levels between Vit.D-IS and Vit.D-S groups. Serum 25(OH)D3 levels were adversely associated with CAL and BOP scores (P=0.018, P=0.049, respectively). Also, GCF 1,25(OH)2D3 total amounts were positively related with GCF LL-37 total amounts (P=0.0001). Conclusion Serum 25(OH)D3 insufficiency was related to periodontal inflammation and destruction in periodontitis patients with well-controlled T2DM. However, GCF 25(OH)D3, 1,25(OH)2D3, TNF-alpha and LL-37 total amounts were not correlated with serum vitamin D levels. We have opinion that obtaining and maintenance of periodontal health should be included in the diabetic treatment protocol in Vitamin D deficient patients with periodontitis and well-controlled T2DM.