Dietary supplements – good, bad or somewhere in-between?

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  Posted by: Dental Design      7th October 2024

The scope of the dental professional has expanded in recent years. We now provide information and advice on so much more than just oral hygiene, including exercise and diet recommendations. Our goal is to facilitate the overall wellbeing of our patients. Plus, all these areas connect so improving one will often simultaneously enhance a person’s physical, mental and oral health. When it comes to diet, I was interested to come across an article considering supplements and their effectiveness. Are they necessary? When are they most beneficial? Should we as dental professionals be recommending them to patients? I did some reading…

Common dietary supplements

The five most common supplements taken by adults in the UK are vitamin D, vitamin C, vitamin B complex, vitamin A and vitamin E, although half the population chooses a multivitamin to cover several bases at once.[i]

Vitamin D

Approximately 1 in 6 adults have low vitamin D levels in the UK, which increases their risk of rickets. The vitamin is also important for a lowest risk of oral health concerns like dental caries[ii] and periodontitis,[iii] with research suggesting beneficial indications for endodontic treatment in patients with systemic health conditions like diabetes.[iv] The majority of vitamin D is absorbed from sunlight and there are limited dietary sources. Current recommendations from the Department of Health and Social Care are that adults and children should consider taking 10mg supplements daily between October and March, with some at-risk groups advised to continue year-round.[v]

Vitamin C

Around 1 in 20 people in the UK has a vitamin C deficiency, otherwise known as scurvy. The body can usually get enough vitamin C through absorbing sunlight and eating adequate fruit and vegetables. Key symptoms of scurvy include yellowing of the skin and eyes, fever and bleeding gums.[vi] NHS guidance does not suggest that additional supplements are necessary for the general population,[vii] particularly as excessive intake can cause headaches, nausea and dizziness, and increase the risk of kidney stones.[viii]

Vitamin B12

Vitamin B12 helps the body make red blood cells, keep the nervous system functioning and release energy from food. The recommended daily amounts can usually be obtained from eating normal amounts of foods like meat, fish, milk, cheese and eggs. Official advice is not to take supplements unless specified by a doctor. Taking less than 2mg a day is unlikely to cause harm,[ix] though taking too much may lead to pain, fever, itching, numbness of joints, shortness of breath, rapid weight gain or bleeding, among other adverse effects.[x] However, there is some evidence to suggest that older adults, vegetarians, vegans and those with pernicious anaemia or gastrointestinal disorders may be more prone to vitamin B12 deficiency and may therefore consider supplements.[xi]

Vitamin A

Supporting the immune system, aiding vision and improving skin health, vitamin A is an important retinoid for the body. It also plays a crucial role in oral leukoplakia, oral sub mucous fibrosis and wound healing in the mouth.[xii] This is another substance that daily recommended amounts should be easy to achieve through a balanced diet – food like cheese, eggs, oily fish, milk and yogurt are ideal, though supplements may be useful in those with a proven deficiency. Consuming over the advised daily 1.5mg of vitamin A over many years can reduce the health of your bones and increase the risk of fracture in older age.[xiii] Excessive intake can also damage the liver.[xiv]

Vitamin E

Good for healthy skin, eyes and immune response, vitamin E is another substance that can be consumed adequately through a balanced diet. Found in plant oils, nuts and seeds, it can be stored by the body until needed so does not need to be eaten every day.[xv] An overdose of vitamin E can cause internal bleeding as well as thyroid problems, emotional disorders and gastrointestinal issues – it only becomes toxic with the use of supplements and rarely if ever due to diet alone.[xvi]

The verdict on dietary supplements

The above is only a snapshot of the dietary supplements available to the general population and the research surrounding it. The general consensus seems to be that supplements may be useful for some people, some of the time – although they are not needed by the majority of adults. If anything, excessive intake of certain vitamins can actually do more harm than good. There is also evidence to suggest that supplements do not lower risk of cardiovascular disease or malignancies when taken by otherwise healthy people.[xvii]

Like everything in healthcare, the recommendation for dietary supplements must be made on a case-by-case basis and tailored specifically to the individual’s needs. It may also be worth asking patients whether they already take extra vitamins to be included in their notes for future reference. Some food for thought!

For further information please call EndoCare on 020 7224 0999

Or visit www.endocare.co.uk

Author: DrMichael Sultan

EndoCare, led by Dr Michael Sultan, is one of the UK’s most trusted Specialist Endodontist practices. Through the use of the latest technologies and techniques, the highly-trained team can offer exceptional standards of care – always putting the patient first. What’s more, EndoCare is a dependable referral centre, to which dentists from across the country send their patients for the best in specialist endodontic treatment.

[i] ICP. Vitamins, minerals and supplements. Independent Pharmacist. September 2019. https://www.independentpharmacist.co.uk/clinical/vitamins-minerals-and-supplements-#:~:text=Britain’s%20top%20five%20single%20vitamin,of%20VMS%20users%20take%20multivitamins. [Accessed July 2024]

[ii] Li, Z., Wei, X., Shao, Z. et al. Correlation between vitamin D levels in serum and the risk of dental caries in children: a systematic review and meta-analysis. BMC Oral Health 23, 768 (2023). https://doi.org/10.1186/s12903-023-03422-z

[iii] Botelho J, Machado V, Proença L, Delgado AS, Mendes JJ. Vitamin D Deficiency and Oral Health: A Comprehensive Review. Nutrients. 2020 May 19;12(5):1471. doi: 10.3390/nu12051471. PMID: 32438644; PMCID: PMC7285165.

[iv] Su Y, Ye L. Can vitamin D intake assist in improving the outcome of endodontic treatment for diabetic patients? Med Hypotheses. 2010 Apr;74(4):673-5. doi: 10.1016/j.mehy.2009.11.005. Epub 2009 Dec 3. PMID: 19962249.

[v] Gov.uk. New review launched into vitamin D intake to help tackle health disparities. April 2022. Department of Health and Social Care and The Rt Hon Sajid Javid. https://www.gov.uk/government/news/new-review-launched-into-vitamin-d-intake-to-help-tackle-health-disparities [Accessed July 2024]

[vi] Livi. Scurvy (vitamin C deficiency). January 2023. https://www.livi.co.uk/medical-advice/general-health/scurvy/ [Accessed July 2024]

[vii] NHS. Vitamin C. Vitamins and minerals. https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-c/ [Accessed July 2024]

[viii] Abdullah M, Jamil RT, Attia FN. Vitamin C (Ascorbic Acid) [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499877/

[ix] NHS. B vitamins and folic acid. https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-b/#:~:text=You%20should%20be%20able%20to%20get%20all%20the%20vitamin%20B12,unlikely%20to%20cause%20any%20harm. [Accessed July 2024]

[x] Al Amin ASM, Gupta V. Vitamin B12 (Cobalamin) [Updated 2023 Jul 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559132/

[xi] National Institutes of Health. Vitamin B12 fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/ [Accessed July 2024]

[xii] Rathee, Manu & Bhoria, Mohaneesh & Kundu, Renu. (2013). Vitamin A and Oral Health: A Review. Indian Journal of Applied Research. 3. 10.15373/2249555X/OCT2013/109.

[xiii] NHS. Vitamin A. Vitamins and minerals. https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-a/ [Accessed July 2024]

[xiv] Olson JM, Ameer MA, Goyal A. Vitamin A Toxicity. [Updated 2023 Sep 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532916/

[xv] NHS. Vitamin E. Vitamins and minerals. https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-e/ [Accessed July 2024]

[xvi] Owen KN, Dewald O. Vitamin E Toxicity. [Updated 2023 Feb 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564373/

[xvii] Wierzejska RE. Dietary Supplements-For Whom? The Current State of Knowledge about the Health Effects of Selected Supplement Use. Int J Environ Res Public Health. 2021 Aug 24;18(17):8897. doi: 10.3390/ijerph18178897. PMID: 34501487; PMCID: PMC8431076.


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