Low Vitamin D, Higher Gum Damage?

New Study Links Vitamin D Deficiency to Inflammatory Enzyme in Periodontal Disease

Why Vitamin D Matters for Your Gums

Vitamin D deficiency has become a global health issue, driven by modern lifestyles with limited sun exposure, aging populations, and widespread sunscreen use. While vitamin D is best known for its role in bone health, growing evidence suggests it also plays an important part in immune regulation and inflammation  including in the mouth.

Periodontal disease, a chronic inflammatory condition affecting the tissues that support teeth, remains one of the leading causes of tooth loss worldwide. Scientists have long suspected that vitamin D deficiency may worsen gum disease, but the biological link has not been fully understood.

A new study published in the Journal of Periodontology sheds light on this connection by focusing on an enzyme called matrix metalloproteinase-9 (MMP-9) a molecule known to break down connective tissue during inflammation.

What Did the Researchers Investigate?

The research team from Türkiye aimed to explore whether low blood levels of vitamin D are associated with higher levels of MMP-9 in the gums, and whether this relationship differs across periodontal health conditions.

They examined 200 adults, dividing them into two groups based on serum vitamin D levels:

• Deficient: < 10 ng/mL

• Higher: ≥ 10 ng/mL

Participants were further classified into three periodontal categories:

• Periodontally healthy

• Gingivitis

• Periodontitis

To assess local inflammation, the researchers measured MMP-9 levels in gingival crevicular fluid (GCF)  a fluid found in the small space between teeth and gums — using ELISA laboratory analysis.

Key Findings: Vitamin D and MMP-9 Move in Opposite Directions

The results revealed a clear pattern:

• MMP-9 levels increased with disease severity, from healthy gums to gingivitis and highest in periodontitis.

• Individuals with vitamin D deficiency consistently showed higher MMP-9 levels than those with higher vitamin D levels.

• This difference was statistically significant in patients with gingivitis and periodontitis, but not in periodontally healthy individuals.

In patients with periodontitis, those with vitamin D deficiency had almost double the median MMP-9 levels compared to patients with higher vitamin D levels highlighting a strong association between systemic vitamin D status and local tissue destruction.

Stronger Disease, Stronger Link

Correlation analysis showed an inverse relationship between vitamin D and MMP-9 across all groups:

• The association was strongest in periodontitis patients

• Moderate in gingivitis

• Weaker but still significant in healthy individuals

In other words, as vitamin D levels increased, MMP-9 levels decreased, especially in more severe gum disease.

Further statistical modeling confirmed that both periodontal disease status and vitamin D levels independently predicted MMP-9 levels, even after adjusting for age and sex. Among clinical parameters, clinical attachment loss a key marker of tissue destruction was the strongest predictor of elevated MMP-9.

Why This Matters

MMP-9 plays a dual role in the body: it is necessary for tissue remodeling and healing, but when excessively activated, it can accelerate tissue breakdown. In periodontal disease, overactive MMP-9 contributes to the destruction of connective tissue and bone around teeth.

This study suggests that vitamin D deficiency may amplify inflammatory tissue damage by increasing MMP-9 activity, offering a possible biological explanation for the link between low vitamin D levels and worse periodontal outcomes.

Takeaway: A Systemic Factor with Local Impact

This research provides new clinical evidence that vitamin D status is closely tied to inflammatory processes in periodontal disease. While gum health remains the strongest determinant of MMP-9 levels, maintaining adequate vitamin D may help moderate destructive inflammation particularly in patients with gingivitis or periodontitis.

Although the study’s cross-sectional design cannot prove cause and effect, it opens the door for future research exploring whether vitamin D optimization could support periodontal therapy and inflammation control.

Reference

Yıldırım YAY, Ozturk A, Doğruel F, Saraçoğlu H, Yazıcı C.

Serum vitamin D concentration is inversely associated with matrix metalloproteinase-9 level in periodontal diseases.

Journal of Periodontology. 2025;96:663–674.

DOI: 10.1002/JPER.24-0106