Bleeding gums may indicate vitamin C deficiency
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Gingival bleeding may indicate low vitamin C — or ascorbic acid — intake, according to research published in Nutritional Reviews.
Researchers also reported that current daily ascorbic acid (AA) intake recommendations may be too low.
“When you see your gums bleed, the first thing you should think about is not, I should brush more,” Philippe Hujoel, PhD, DDS, MSD, MS, professor of oral health sciences in the department of epidemiology at the University of Washington School of Public Health, said in a press release. “You should try to figure out why your gums are bleeding. And vitamin C deficiency is one possible reason.”
According to Hujoel and colleagues, there have previously been concerns about whether the WHO recommendation for daily intake of AA to avoid scurvy — 10 mg — is enough to prevent other chronic and infectious diseases.
To evaluate this, Hujoel and colleagues conducted a systematic review and meta-analysis of controlled clinical trials that measured gingival bleeding tendency, other gingival health measures, AA supplementation levels and AA plasma levels at baseline.
The researchers reviewed data from 15 trials conducted in six countries — Germany, India, Indonesia, Italy, the United States and the United Kingdom — with a total of 1,140 participants. Among these participants, the medium AA supplementation dose was 222 mg, with a medial duration of 41 days.
They also reviewed data from 8,210 U.S. residents who participated in the NHANES III study and had available data on retinal hemorrhaging measures.
The researchers found that, among the included clinical trials, AA supplementation reduced gingival bleeding tendency in participants with low — less than 28mol/L — estimated baseline AA plasma levels (standardized mean difference [SMD] = –0.83; 95% CI, –1.16 to –0.49).
Additionally, they found that AA supplementation in those with higher baseline AA plasma levels — greater than 48 mol/L — did not unequivocally reduce bleeding tendency (SMD = –0.23; 95% CI, –0.45 to –0.01). Gingival bleeding was not unequivocally reduced in those with unknown AA plasma levels (SMD = –0.56; 95% CI, –1.19 to 0.06).
Among participants in NHANES III, Hujoel and colleges determined that when AA plasma levels were at a point considered to provide protection against scurvy (11–28 mol/L), there was still an increased prevalence of retinal hemorrhaging (prevalence ratio = 1.47; 95% CI, 1.22–1.77) and gingival bleeding tendency (prevalence ratio 1.64; 95% CI, 1.32–2.03) after adjusting for participants’ age and sex.
They wrote that because both retinal hemorrhaging and gingival bleeding were associated with low AA plasma levels, “AA plasma levels that are sufficient to prevent scurvy may be too low to prevent systemic microvascular pathologies.”
References:
Hujoel P, et al. Nutr Rev. 2021;doi:10.1093/nutrit/nuaa115.ame.