Contributing authors
Annelise Collins, MBA, RD US
Ellen R. Guritzky, MJS, RDH, FADHA
Alpa Shah, MS, RDN US
Vitamin C, or ascorbic acid, is a water-soluble vitamin. It plays a vital role in collagen synthesis and some neurotransmitter synthesis, acts as an antioxidant, and works to regenerate other antioxidants in the body.1 Vitamin C may be best known for its role in immune function. This is usually the reason people take vitamin C supplements in the winter to reduce illness, though studies show only a minimal decrease in illness incidence in certain populations.1
The human body cannot synthesize vitamin C on its own and the vitamin can’t be stored in the body, which means we need daily dietary vitamin C. While it's readily available in many fruits and some vegetables, know patients may be at higher risk of vitamin C deficiency. For instance, patients who smoke may need greater quantities of vitamin C due to the high oxidative stress of smoking.1 Patients who limit their food choices may also be at risk. Some cancer patients or those with malabsorption issues may also be at greater risk for deficiency.1
Vitamin C as an antioxidant
Free radicals can cause oxidative stress and damage cells, but antioxidants scavenge these free radicals throughout the body. Vitamin C is an antioxidant that not only reduces the damaging effects of free radicals but may also regenerate other important antioxidants, such as vitamin E.1 Because of the antioxidant properties in vitamin C, it’s been studied for a potential role in the prevention and treatment of certain health conditions.
In a 2024 review of the literature, a significant link between periodontal disease and vitamin C intake or its levels in the blood was identified.2 This review revealed a consistent association between vitamin C intake, its levels in the blood, and the incidence of periodontal disease, indicating that high vitamin C intake and blood levels are linked to a decreased risk of developing periodontal disease.2
Vitamin C and cardiovascular health
Vitamin C, along with antioxidants, has been shown to regulate nitric oxide (NO) metabolism. NO is an important part of normal function and vasodilation of the endothelium because it controls the level of inflammation of the vessels, among other functions.
Vitamin C deficiency has been associated with cardiovascular disease as well as other inflammatory diseases.3-4 In a 2020 meta-analysis on patients with hypertension, vitamin C was shown to reduce systolic and diastolic blood pressures in patients ages 60 and older.5 People should consult with their health-care providers about the appropriate treatment for their health conditions.
Vitamin C and cancer
Vitamin C has been studied for its potential role in the prevention and treatment of cancer; however, at this time, the evidence does not support a link between vitamin C and cancer incidence or mortality.6-7 Vitamin C has a well-known antioxidant effect. High doses of vitamin C are used for their pro-oxidative effect to target cancer cells in preclinical studies.1,8 Much like patients with chronic inflammatory diseases, low serum vitamin C has been observed in those who have been diagnosed with oral cancers.9
Vitamin C and dental caries
Vitamin C has been shown to inhibit the growth of Streptococcus mutans in certain concentrations.6 S. mutans are considered to be the primary culprit linked to dental decay. Vitamin C helps to deposit calcium and mineralizes the tooth structure that may help reduce the rate of secondary decay in children, according to a single 2017 study, though more research is needed to support this claim.6,10
Vitamin C deficiency and periodontal anatomy and risk
Vitamin C works as an antioxidant and plays a role in the synthesis of collagen, which provides the structural matrix for the periodontal ligament and gingiva. A vitamin C deficiency can result in scurvy, affecting collagen synthesis. Scurvy is characterized by bleeding gums and increased tooth mobility related to loosening of the periodontal ligament, and over long periods of time, the loss of teeth.
Due to the role of vitamin C in the synthesis of collagen, adequate daily vitamin C is needed for oral wound healing and periodontal function. A study showed a reduction in spontaneous bleeding and redness of the gums in patients with gingivitis who took vitamin C.6
Vitamin C plays many roles in the body, such as in collagen synthesis, immune function, and free radical scavenging. It’s been studied for its potential to impact endothelial function. Vitamin C is essential to support overall health, but some patients may not be getting enough vitamin C due to absorption issues or limited food variability.
Vitamin C is important for oral health as vitamin C deficiency can impact gum health and tooth mobility. Daily dietary vitamin C may help keep periodontal disease and gingivitis from becoming worse and it may support oral wound healing.
Fruits and vegetables are high in vitamin C and daily dietary intake is important because vitamin C is not stored in the body. One red bell pepper has enough vitamin C to meet the recommended daily amount. While vitamin C deficiency is rare, it's important to know which patients could be at risk or could benefit from more dietary vitamin C. Dental hygienists are encouraged to educate patients about the advantages of vitamin C intake to help avoid or improve health issues and dental risks.
Editor's note: This article appeared in the April/May 2025 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.
References
1. Office of dietary supplements - vitamin C. NIH Office of Dietary Supplements. Accessed December 16, 2024. https://ods.od.nih.gov/factsheets/vitaminc-healthprofessional/
2. Rosa A, Pujia AM, Arcuri C. The protective role antioxidant of vitamin C in the prevention of oral disease: a scoping review of current literature. Eur J Dent. 2024;18(4):965-970. doi:10.1055/s-0044-1786845
3. Isola G, Polizzi A, Muraglie S, Leonardi R, Lo Giudice A. Assessment of vitamin C and antioxidant profiles in saliva and serum in patients with periodontitis and ischemic heart disease. Nutrients. 2019;11(12):2956. doi:10.3390/nu11122956
4. Bogdan M, Meca AD, Boldeanu MV, et al. Possible involvement of vitamin C in periodontal disease. Diabetes Mellitus Association. Nutrients. 2020;12(2):553. doi:10.3390/nu12020553
5. Morelli MB, Gambardella J, Castellanos V, Trimarco V, Santulli G. Vitamin C and cardiovascular disease: an update. Antioxidants (Basel). 2020;9(12):1227. doi:10.3390/antiox9121227
6. Murererehe J, Uwitonze AM, Nikuze P, Patel J, Razzaque MS. Beneficial effects of vitamin C in maintaining optimal oral health. Front Nutri. 2022;8(1):805809. doi:10.3389/fnut.2021.805809
7. Vitamin C. Linus Pauling Institute. January 3, 2025. Accessed January 15, 2025. https://lpi.oregonstate.edu/mic/vitamins/vitamin-c
8. Ngo B, Van Riper JM, Cantley LC, Yun J. Targeting cancer vulnerabilities with high-dose vitamin C. Nat Rev Cancer. 2019;19(5):271-282. doi:10.1038/s41568-019-0135-7
9. Rai B, Kharb S, Jain R, Anand SC. Salivary vitamins E and C in oral cancer. Redox Rep. 2007;12(3):163-164. doi:10.1179/135100007X200245
10. Shaik PS, Pachava S. The role of vitamins and trace elements on oral health: a systematic review. Int J Med Rev. 2017;4:22-31. doi:10.29252/ijmr-040105
