The skinny on fat-soluble vitamins and their relationship to oral health

Contributing authors:
Annelise Collins, MBA, RD
Ellen R Guritzky, MJS, RDH, FADHA
Alpa Shah, MS, RDN

Fat-soluble vitamins are required for proper cellular function, growth, and repair. They’re typically found in various dietary products, such as meat, dairy, fruits, and vegetables. Vitamin D is the only vitamin produced in the body, so it’s important to consume vitamins in one’s diet. Vitamins A, D, E, and K are fat-soluble vitamins that are soluble in organic substances and stored in the liver and fatty tissues. These vitamins are stored and transported in the body in a similar way to fats.

Fat-soluble vitamins play an essential role in cellular maintenance and immune function,¹ and many chronic diseases are related to deficiencies in these vitamins. For example, a prolonged lack of vitamins D and K may worsen osteoporosis. Fat-soluble vitamins also play significant roles in optimal oral health. As we treat the whole patient, understand how fat-soluble vitamins function in the body.

Vitamin A

Vitamin A plays a vital role in regulating the body’s immune response and inflammation, and in epithelial proliferation and maintenance.¹ It maintains the health of epithelial cells on the skin surface and mucous membranes by increasing collagen and extracellular matrix formation and inhibiting the inflammatory effects on cell membranes.¹ Vitamin A regulates inflammation by controlling immune cell development and influencing monocyte and macrophage function in inflamed tissues.¹

A vitamin A deficiency is thought to disrupt the metabolic pathways involved in β cell function, obesity, and lipid metabolism.2 Vitamin A is vital for the maintenance of β cells and insulin production.² While there is a link between vitamin A deficiency and diabetes, it’s unclear and requires further research.

Inflammatory oral mucositis can be painful for patients undergoing chemotherapy or radiation. Due to the role of vitamin A in growth, differentiation of epithelial tissues, and modulating inflammatory response functions, it has been examined as a potential topical ingredient to treat oral mucositis.³ However, the data is limited, and further research is required.

The body does not produce vitamin A; therefore, it must be obtained through diet. Vitamin A is in green leafy vegetables such as spinach, kale, and broccoli, as well as orange and yellow vegetables and some fruits. It is also high in liver, fish, and egg products.

Vitamin D

Vitamin D plays many important roles in the body. Calcium reuptake and bone homeostasis are heavily influenced by Vitamin D as it directly and indirectly regulates the functions of osteoblasts and osteoclasts for bone remodeling.⁴ This vitamin helps modulate inflammation, reduce the proliferation of cells, promote cell differentiation, and modulate mechanisms associated with cancer.⁴ Low vitamin D has been associated with cardiovascular risk,4 and increased risk for depression and anxiety⁵; however, more research is needed to better understand the relationship.

Vitamin D helps maintain the integrity of the oral epithelium and immune functions.⁴ Through its anti-inflammatory and antimicrobial effects, vitamin D protects the oral tissues from pathogens in biofilm. Deficiencies in vitamin D have been associated with periodontal disease and chronic periodontitis.⁴

The body can synthesize vitamin D with exposure to sunlight; however, it can also be obtained through diet.⁴ Daily sun exposure can help obtain vitamin D but can be challenging in the winter or in an overcast environment. Foods such as fatty fish are rich in vitamin D; raw mushrooms and eggs have low quantities. Many foods, such as milk, almond milk, and cereals, are fortified with vitamin D.

Vitamin E

Vitamin E is a collective of eight fat-soluble compounds that are strong antioxidants. Antioxidants protect against damage from free radicals. This free radical damage may be associated with some chronic diseases, such as cardiovascular disease and cancer.⁶ Vitamin E interacts with enzymes in inflammatory pathways.⁶

Topical vitamin E has been shown to reduce the severity of oral mucositis for patients undergoing cancer treatments.³ In combination with other nutrients, vitamin E may also help improve periodontitis by improving the immune response, though studies are inconclusive.⁷ Further studies are needed to evaluate the full effect of vitamin E on oral health and inflammation.

Vitamin E is abundant in whole grains, nuts, and seeds, green leafy vegetables such as broccoli and spinach, and some fruits such as kiwi, tomatoes, and mangos.

Vitamin K

Vitamin K is known as “the clotting vitamin” because one of its primary roles is to help produce prothrombin, which aids in clotting the blood. Matrix GLA protein, a vitamin K-dependent protein found in smooth muscle, bone, and cartilage, may help to reduce abnormal calcifications,⁸ though further studies are needed. Vitamin K is also involved in the carboxylation of vitamin K-dependent protein osteocalcin,^8-9 which is important for bone health and density.

Due to its role in bone remodeling,^8-9 a deficiency in vitamin K may contribute to bone loss and osteoporosis. Periodontal disease and osteoporosis have been closely associated since the 1960s; therefore, it’s important to be aware of vitamin K’s role in bone health. Vitamin K is found in large quantities in green leafy vegetables such as collards, spinach, and kale, and in lesser amounts in many colorful fruits and nuts.

Fat-soluble vitamins are important in epithelial function, inflammation, blood clotting, and bone health. Having adequate amounts of these vitamins in one’s diet helps promote proper functions in the body. Dental professionals should know how these vitamins affect gingival and oral mucosa inflammation as well as periodontal health. Patients should be encouraged to incorporate healthy foods into their diets to ensure they’re not lacking in available fat-soluble vitamins that are important for daily functions.

Editor's note: This article appeared in the November/December 2024 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.

References

1. Zinder R, Cooley R, Vlad LG, Molnar JA. Vitamin A and wound healing. Nutri Clin Prac. 2019;34(6):839-849. doi:10.1002/ncp.10420

2. Trasino SE, Gudas LJ. Vitamin A: a missing link in diabetes? Diabetes Manag (Lond). 2015;5(5):359-367. doi:10.2217/dmt.15.30

3. Chaitanya NC, Muthukrishnan A, Babu DGB, et al. Role of vitamin E and vitamin A in oral mucositis induced by cancer chemo/radiotherapy-a meta-analysis. J Clin Diagnos Res. 2017;11(5):ZE06-ZE09.

4.  Khammissa RA, Fourie J, Motswaledi MH, Ballyram R, Lemmer J, Feller L. The biological activities of vitamin D and its receptor in relation to calcium and bone homeostasis, cancer, immune and cardiovascular systems, skin biology, and oral health. BioMed Research Int. 2018;(1):9276380. doi.10.1155/2018/9276380

5. Okereke OI, Singh A. The role of vitamin D in the prevention of late-life depression. J Affect Disord. 2016;198:1-14. doi:10.1016/j.jad.2016.03.022

6. Sozen E, Demirel T, Ozer NK. Vitamin E: regulatory role in the cardiovascular system. IUBMB Life. 2019;71(4):507-515. doi.10.1002/iub.2020

7. Hong JY, Lee JS, Choi SH, et al. A randomized, double-blind, placebo-controlled multicenter study for evaluating the effects of fixed-dose combinations of vitamin C, vitamin E, lysozyme, and carbazochrome on gingival inflammation in chronic periodontitis patients. BMC Oral Health. 2019;4(3). doi.10.1186/s12903-019-0728-2

8. Vitamin K. NIH Office of Dietary Supplements. Accessed August 19, 2024. https://ods.od.nih.gov/factsheets/vitamink-healthprofessional/

9. Yu B, Wang CY. Osteoporosis and periodontal diseases–an update on their association and mechanistic links. Periodontol 2000. 2022;89(1):99-113. doi:10.1111/prd.12422