The Benefits of TheraBreath Oral Care Vitamins

Here is what's in TheraBreath Oral Care Supplements (and why they help). Scientific references to studies listed in bibliography at bottom of page.

VITAMIN D:

• Diets low in Vitamin D may lead to:
  • Burning Mouth Syndrome
  • Metallic or Bitter Taste
  • Dry MouthGum problems
  • Increased tooth decay (Vitamin D helps to stimulate cathelicidin - a natural antibiotic that attacks oral bacteria)
• Higher levels of Vitamin D provide a decreased risk of bleeding gums
• Vitamin D also upregulates a specific gene that produces over 200 anti-microbial peptides, some of which work like broad-spectrum antibiotics, including cathelicidin that attacks oral bacteria, including those involved in tooth decay, and defensins, which reduce the number of bacteria in the mouth.
• Reduces matrix metalloproteinases (MMPs). MMPs are enzymes that are associated with red, swollen, bleeding, tender, or irritated gums.
• People with lower vitamin D levels had more attachment loss than people with higher vitamin D levels.
• African-Americans had a greater risk of PD than white Americans. African-Americans had average vitamin D blood levels of about 16 ng/mL (40 nmol/L) compared to 26 ng/mL (65 nmol/L) for white Americans. Most vitamin D is obtained from solar UVB exposure. Less UVB reaches the lower layer of dark skin, where vitamin D is produced.
• Pregnant women with PD had lower vitamin D levels and were twice as likely to have vitamin D insufficiency.
• Increasing vitamin D blood levels to 40 ng/mL (100 nmol/L) may lower the risk of red, swollen, bleeding, irritated or tender gums. For most people, it would take 1000-5000 international units (IU) (25-125 mcg)/day of vitamin D3 (cholecalciferol) to reach this level. Vitamin D blood levels should be measured before starting vitamin D. The levels should be tested again after several months. A rule of thumb is that for each 1000 IU (25 mcg)/day of vitamin D3, vitamin D blood levels rise by 6-10 ng/mL (15-25 nmol/L). However, there is considerable variation from person to person. The primary source of vitamin D3 for most people is solar UVB. However, most people do not get enough from the sun.
• Those with PD should consider taking measures to raise their vitamin D blood levels to 40 ng/mL (100 nmol/L). This can be done by moderate UVB exposure (without sunburn) and oral intake of vitamin D and calcium supplements. These measures could help reduce gum redness, swelling, bleeding irritation and tenderness or at least prevent them from getting worse.

COQ10:

• When a CoQ10 tissue deficiency approaches 25 percent, it is almost always associated with gum issues such as redness, swelling, bleeding, tenderness or irritation.
• CoQ10 also functions as a powerful antioxidant by fighting off oxidative stress and free radicals (contributors to aging) and promotes the antioxidant activity of vitamin E.
• Improves gum and tissue rejuvenation because CoQ10 is vital to production of cellular energy and immune system function.
• Helps pregnant women because they need 50% more to help development of the placenta.
• Statins used to lower cholesterol (like Lipitor) can also lower CoQ10 levels, so it is important to take supplements to keep CoQ10 levels even.
• Coenzyme Q10 (CoQ10) is chemically similar to vitamin E and is involved in electron transfer in the mitochondria. Early work suggested that people with poor gums may be deficient in CoQ10.¹ In double blind trials, 50mg a day of CoQ10, given for three weeks, led to a significant reduction in gum problems such as redness, swelling, bleeding, tenderness and irritation.^9,10 More recent studies have shown that the topical application of CoQ10 may also improve these gum conditions.³

CoEnzyme Q10: Benefits for oral health maintenance

CoEnzyme Q10 (CoQ10) is a fat-soluble quinone found in the mitochondria of mammalian cells. It is an indispensable carrier in the production of adenosine triphosphate (ATP) which is involved in the production of cellular energy in the Citric Acid Cycle (CAC). To maintain optimal oral health, your gum tissue requires an extremely high level of cellular energy — to insure that repair of damaged tissue exceeds daily destructive factors. Consequently, CoQ10 has been shown to be a basic requirement. Studies have shown that CoQ10 deficiencies are related to limited host resistance and an increase in periodontal tissue destruction.

For example, studies have reported that insufficiencies of gingival & leukocytic CoQ10 found in patients suffering from red, swollen, bleeding, tender or irritated gums predispose to or emphasize progression of these conditions.^4,5,6,7,8 In Hansen's study, gingival biopsies of 29 patients showed that all 29 (100%) had a reduction of CoQ10 activity of at least 20-63%. Blood studies showed that 86% of those patients had a reduction of Leukocyte CoQ10 activity of 20-66% compared to controls, indicating that the deficiency was likely systemic.⁵ However, treatment with CoQ10 supplementation restored gingival CoQ10 activity.^9,10

CoQ10 has shown impressive results in reducing periodontal scores (p less than 0.01) as well as decreasing periodontal pocket depth (p less than 0.05).⁹ In a 3 week, double-blind clinical trial, eighteen patients with gum conditions including redness, swelling, bleeding, tenderness or irritation were given either 50 mg CoQ10 or a placebo and evaluated according to a "Periodontal Score" for a variety of periodontal testing factors such as swelling, bleeding, redness, pain, exudate, periodontal pocket depth, and mobility of teeth. All 8 patients in the CoQ10 group (100%) improved, while only 3 of 10 (30%) of the placebo group improved.¹⁰

Restoration of adequate levels of CoQ10 in the periodontium reverses bioenergetic cellular dysfunction of the Citric Acid Cycle (leading to hypercitricemia), enhances host resistance, raises the rate of repair above the degree of damage and helps to reduce and even reverse gum redness, swelling, bleeding, irritation and tenderness.¹¹

ZINC GLUCONATE:

• Low Zinc levels are linked to sour, bitter, metallic tastes
• Zinc Gluconate is the most tolerable of all zinc compounds and works quickly.
• Zinc compounds may reduce morning breath

VITAMIN C:

• Necessary to help build collagen (gum tissue) and bone (to help prevent loose teeth and gum problems)
• People deficient in vitamin C (including diabetics) may be at risk of developing red, swollen, bleeding, tender or irritated gums.¹² In one study, a group of subjects with such conditions who normally consumed only 25 to 30 mg of vitamin C daily were supplemented with an additional 70 mg. They experienced marked improvement in gum tissue after only six weeks.¹³
• Although it is established that smoking contributes to gum problems, tobacco users may especially benefit from vitamin C supplementation, as smoking depletes the body of vitamin C.¹⁵
• Spongy gums with bad breath, dry mouth and bleeding gums have been documented as early as 1894 when health problems were linked to the lack of vitamin C in diets.
• Directly functions to promote and assist the tissue in providing a protective barrier, lessening permeability against bacterial endotoxins. Thus, the necessary amounts of vitamin C for a healthy gingiva may be greater than the recommended daily allowance. Collagen is also a significant factor when considering healthy tissue fibers in the gingival and periodontal ligament and is a major contributor to alveolar bone health.
• Necessary if consumers take antibiotics, aspirin or other meds which may deplete natural Vitamin C levels.
• An update on Vitamin C dosing from the Linus Pauling Institute: Although the current RDA for vitamin C is 75-90 mg/day, most multivitamin supplements contain only 60 mg (the DV for vitamin C). Five servings of fruits and vegetables may provide about 200 mg. Aim for a total daily intake of at least 400 mg, which is associated with the saturation of plasma and circulating cells. This is one of the reasons why TheraBreath Oral Health Vitamins contains 250 mg of Vitamin C per capsule.
• Ascorbic acid (vitamin C) is an intracellular and intercellular aqueous antioxidant. It is the first line of antioxidant protection in the body, possessing direct oxygen free radical scavenging ability. It also works synergistically with bioflavonoids and vitamin E, by regenerating their oxidized states.
• Ascorbic acid may also play an important role in regulating histamine's effects in gingivitis. Ascorbic acid deficiency has been shown to be a conditioning factor in the development of gingivitis. When humans are placed on ascorbic acid deficient diets there is increased edema, redness and swelling of the gingiva. These changes have been attributed to deficient collagen production by gingival blood vessels. However, this may also be due to an antihistamine role of ascorbic acid. This vitamin may act to directly detoxify histamine or effect a change in the level of enzymes responsible for histamine metabolism. This could occur through the influence of ascorbic acid in altering cyclic AMP (c-AMP) levels. Such changes in the level of this regulatory molecule could result in increased histamine-N-methyl transferase and other enzymes responsible for the breakdown of histamine.¹⁶

Vitamin C dosing of 250 mg vs 60 mg in standard multivitamins: (From the Vitamin C Foundation)

Recently the National Academy of Sciences (NAS) issued dietary antioxidant recommendations. The new recommendations call for 90 mg. for vitamin C for healthy adults, up from 60 mg per day under the previous standard. Yet the government keeps preaching five servings of fresh fruits and vegetables, which supplies more than 200 mg. of vitamin C. [Am J Clin Nut 62: 1347-56S, 1995]

These two figures do not correlate. Just months before the 90 mg vitamin C recommendation was issued, various government scientists were calling for 120-200 mg per day in published reports. [Proc Natl Acad Sci 93:3704-09, 1996; Nutrition Reviews 57: 222-24, 1999; Am J Clin Nut 69:1086-1107, 1999]

One researcher at the Massachusetts Institute of Technology, Laboratory of Human Nutrition, using a technique called saturation kinetics, suggested that even the 200-mg level was not adequate to meet individual vitamin C needs by as much as 2-3 fold. [Proc Natl Acad Sci 93: 14344,48, 1996]

One assumption is that people do not need antioxidant supplement until they become unhealthy. But the Journal of the American Medical Association admits the destructive process of oxidation is involved in virtually every disease. [J Am Med Assn 271: 1148-49, 1994]

VITAMIN B12:

• Helpful in preventing Mouth Sores.^18,19
• A study showed that taking inexpensive Vitamin B12 supplements was more effective than expensive topical gel treatments in treating Recurrent Aphthous Ulcers (canker sores). "Effectiveness of Vitamin B12 in Treating Recurrent Aphthous Stomatitis: A Randomized, Double-Blind, Placebo-Controlled Trial", Journal of the American Board of Family Medicine, January 2009. Posted March 19, 2009.
• A common oral effect of vitamin B deficiency is a burning sensation in the mouth, especially on the tongue. People with this deficiency can also have trouble swallowing. The tongue may feel swollen. The tissue of the inner cheeks can be pale and may break apart easily and slough off.
• Vitamin B deficiency also may increase your risk of:
  • Angular cheilitis — A painful reddening and cracking in the corners of the mouth. It usually is related to a fungal infection.^19,20
  • Recurrent aphthous stomatitis — Also known as recurring canker sores. Anemia, which can occur because of vitamin B deficiency, can increase your risk of these sores.^18,19,20
  • Chronic oral mucosal candidiasis — A fungal condition in the mouth. The Candida albicans fungus is found naturally in the mouth. It does not normally cause problems. However, poor nutrition or poor absorption of vitamins makes you more susceptible.²⁰
  • Atrophic glossitis — A condition that causes the taste buds to break down, making the tongue look "bald." This condition affects the sense of taste. It can occur with a severe vitamin deficiency.²⁰

BLACK PEPPER FRUIT EXTRACT:

• Black Pepper Fruit Extract can dramatically increase absorption of the building blocks of oral tissue (vitamin B, Vitamin C, CoQ10) as well as body nutrients (selenium, curcumin, and beta-carotene). Unless your oral supplement contains Black Pepper Fruit Extract, you may be flushing valuable ingredients down the toilet.
• Black Pepper Fruit Extract can also attenuate free radicals and reactive oxygen species and has been shown to protect against oxidative damage in vitro.
• Black pepper fruit, has been shown in human clinical trials to significantly enhance the bioavailability of various supplemented nutrients through increased absorption.²¹ These studies conducted on healthy volunteers in the U.S., showed dramatic increases in the blood levels of all nutrients tested compared to the control group receiving the nutrients alone. Nutrients tested included fat-soluble vitamins (beta-carotene), water-soluble vitamins (vitamin B6), minerals (selenomethionine), and coenzymes (Coenzyme Q10). Absorption rates were shown to increase 30 to 60 percent.
• Because these absorption rates may increase to such an extent, up to 60%, a dosage of 30 mg can be interpreted as equal to a dosage of CoQ10 of 48 mg, without the presence of Black Pepper fruit extract.

FOLIC ACID:

• A majority of the people over 20 years of age has been found to be suffering from gum disease. Folic acid if taken along with Vitamin C, helps the cells inside the mouth repair the gum disease before it progresses
• Although the benefits of oral folic acid in protecting against heart disease and birth defects are well documented, new evidence suggests that using folic acid can also strengthen one's oral defenses. Studies have demonstrated folic acid's ability to improve gingivitis symptoms, reduce gum tissue's inflammatory response, and make gum tissue more resilient to irritants such as bacteria and plaque.²²
• Study done at Department of Preventive Dentistry, Division of Oral Health Science, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan suggest that dietary intake of folic acid, an important indicator of gingival bleeding in adults, may provide an important clinical target for intervention to promote gingival health.²³
• Studies have demonstrated that folic acid is very effective in preserving gum tissue and reducing the risk of gingivitis and periodontitis.²⁴
• Folic acid is an essential nutrient for cell growth, cell repair, and disease prevention. It's a water-soluble vitamin, which means that it is not stored in the body for very long and must be taken in daily in order to maintain optimum health and avoid deficiency complications.²⁵

1. Nakamura, R., Littarru, G. and Folkers, K. Deficiency of coenzyme Q in gingiva of patients with periodontal disease. Int. J. Vitam. Nutr. Res 1973;43:84-92.
2. Wilkinson, E. et al. Adjunctive treatment of periodontal disease with coenzyme Q10. Res. Commun. Chem. Pathol. Pharmacol 1976;14:715-9.
3. Hanioka, T., Tanaka, M., Shiskuisi, S. and Folkers, K. Effect of topical application of coenzyme Q10 on adult periodontitis. Mol. Aspects Med 1994;15:Suppl:241
4. Hazan S & Cowan E: Diet, Nutrition, & Periodontal Disease. American Society of Preventive Dentistry, Chicago, IL, 1975.
5. Hansen IL et al.: Bioenergetics in clinical medicine. IX. Gingival and leucocytic deficiencies of coenzyme Q10 in patients with periodontal disease. Res Commun Chem Pathol Pharmacol 1976 Aug;14(4):729-738.
6. Matsumura T et al.: Evidence for enhanced treament of periodontal disease by therapy with coenzyme Q. Int J Vitam Nutr Res 1973 Apr;43(4):537-548.
7. Nakamura R, et al: Deficiency of coenzyme Q in gingiva of patients with periodontal disease. Int J Vit Nutr 43:84,1973.
8. Nakamura R, et al: Study of CoQ-enzymes in gingiva from patients with periodontal disease and evidence for a deficiency of coenzyme Q10. Proc Natt Acad Sci 71:1456,1974.
9. Wilkinson EG et al.: Bioenergetics in clinical medicine. II. Adjunctive treaTMent with coenzyme Q in periodontal therapy. Res Commun Chem Pathol Pharmacol 1975 Sep;12(1):111-123.
10. Wilkinson EG et al.: Treatment of periodontal and other soft tissue diseases of the oral cavity with coenzyme Q. In: Biomedical and Clinical Aspects of Coenzyme Q, Vol 1. Folkers K and Yamamura Y (eds.). Elsevier / North-Hollarn Biomedical Press, Amsterdam, 1977, ppl. 251-265.
11. Tsunemitsu A, Matsumura T : Effect of coenzyme Q administration on hypercitricemia of patients with periodontal disease. J Dent Res 1967 Nov;46(6):1382-1384.
12. Väänänen MK, Markkanen HA, Tuovinen VJ, Kullaa AM, Karinpää AM, Kumpusalo EA., Proc Finn Dent Soc. 1993;89(1-2):51-9., Periodontal health related to plasma ascorbic acid.
13. Aurer-Kozelj J, Kralj-Klobucar N, Buzina R, Bacic M (1982) The effect of ascorbic acid supplementation on periodontal tissue ultrastructure in subjects with progressive periodontitis. Int J Vitam Nutr Res 52: 333-341.
14. Pirkko J. Pussinen, Tiina Laatikainen, Georg Alfthan, Sirkka Asikainen, and Pekka Jousilahti Clin Diagn Lab Immunol. 2003 Sep; 10(5): 897-902. doi:  10.1128/CDLI.10.5.897-902.2003. PMCID: PMC193894. Periodontitis Is Associated with a Low Concentration of Vitamin C in Plasma.
15. Nishida M1, Grossi SG, Dunford RG, Ho AW, Trevisan M, Genco RJ., J Periodontol. 2000 Aug;71(8):1215-23. Dietary vitamin C and the risk for periodontal disease.
16. Nakamoto T et al.: The role of ascorbic acid deficiency in human gingivitis-a new hypothesis. J Theor Biol 1984 May 21;108(2):163-171.
17. J Clin Periodontol. 2016 Jan;43(1):2-9. doi: 10.1111/jcpe.12483. Epub 2016 Jan 18. Serum vitamin B12 is inversely associated with periodontal progression and risk of tooth loss: a prospective cohort study. Zong G, Holtfreter B, Scott AE, Völzke H, Petersmann A, Dietrich T, Newson RS, Kocher T.
    AIM:The aim of this study was to investigate the association of serum vitamin B12 with the progression of periodontitis and risk of tooth loss in a prospective cohort study.
    MATERIALS AND METHODS: In the Study of Health in Pomerania, 1648 participants were followed from 2002-2006 to 2008-2012 (mean duration 5.9 years). Serum vitamin B12 was measured by chemiluminescent enzyme immunoassay. Probing pocket depth (PD) and clinical attachment loss (CAL) were measured to reflect periodontal status on a half-mouth basis at each survey cycle. Tooth numbers are based upon a full-mouth tooth count.
    RESULTS AND CONCLUSIONS: In multivariate regression models, baseline vitamin B12 was inversely associated with changes in mean PD (Ptrend  = 0.06) and mean CAL (Ptrend  = 0.01), and risk ratios of tooth loss (TL; Ptrend  = 0.006) over time. Compared to participants in the highest vitamin B12 quartile, those in the lowest quartile had 0.10 mm (95%CI: 0.03, 0.17; Pdifference  = 0.007) greater increase in mean PD, 0.23 mm (95%CI: 0.09, 0.36; Pdifference  = 0.001) greater increase in mean CAL and a relative risk of 1.57 (95%CI: 1.22, 2.03; Pdifference  < 0.001) for TL. Stratified analyses showed stronger associations between vitamin B12 and changes in mean CAL among never smokers (Pinteraction  = 0.058). Further studies are needed to understand the potential mechanisms of these findings. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
18. Liu HL1, Chiu SC2. The Effectiveness of Vitamin B12 for Relieving Pain in Aphthous Ulcers: A Randomized, Double-blind, Placebo-controlled Trial. Pain Manag Nurs. 2015 Jun;16(3):182-7. doi: 10.1016/j.pmn.2014.06.008.
    ABSTRACT: Aphthous ulcers, the most common oral mucosal lesions seen in primary care, occur in up to ˜2%-50% of the general population. Our objective was to confirm the analgesic benefit of treatment of mouth ulcers with vitamin B12 as adjunctive therapy. A randomized, double-blind, placebo-controlled trial was performed with primary care patients. The intervention group received vitamin B12 ointment for 2 days. In total, 42 patients suffering from aphthous ulcers participated in the study: 22 were included in the intervention group and 20 in the control group. All parameters of aphthous ulcers of patients in the intervention group were recorded and compared with those in the control group. We assessed the patients' pain levels before and after treatment using a visual analog scale. The statistical analyses were performed using a nonparametric Mann-Whitney test. Statistically significant differences in pain levels were found between the intervention group and the control group after 2 days of treatment (mean visual analog scale, 0.36 [95% CI, 0.01-0.71] vs. 1.80 [1.16-2.44]; p < .001). In conclusion, the results of this research study provide evidence that vitamin B12 is an effective analgesic treatment for aphthous ulcers. This study indicates that healthcare providers could use vitamin B12 as an adjunctive therapy for mouth ulcers, providing more effective pain management and improving the quality of life for patients with mouth ulcers. Copyright © 2015 American Society for Pain Management Nursing. All rights reserved.
19. Wray D, Ferguson MM, Hutcheon WA, Dagg JH. Nutritional deficiencies in recurrent aphthae. J Oral Pathol. 1978;7(6):418-23.
    ABSTRACT: A series of 330 patients with recurrent aphthae was screened for deficiencies of iron, folate and vitamin B12. In 47 patients (14.2%) such deficiencies were found; 23 were deficient in iron, seven in folic acid, six in vitamin B12 and in addition 11 patients had combined deficiencies. Clinical examination of the aphthae was not helpful in identifying individual patients with a nutritional deficiency although patients with an associated glossitis or angular cheilitis were more likely to suffer from such deficiencies. Screening of the patients by examination of their peripheral blood alone (estimation of haemoglobin and absolute values, and blood film examination) detected only a proportion of those with deficiencies of iron or folic acid, although in this series such screening was able to identify the small number of cases with vitamin B12 deficiency. The 33 patients with a proven nutritional deficiency who were available for follow-up showed a favourable response to corrective therapy; 23 showed a complete remission of ulcers, 11 were improved and five were not helped. The significance of these findings is discussed. It is suggested that the results indicate the need for full haematological screening of all patients with recurrent aphthae.
20. Pontes HA, Neto NC, Ferreira KB, Fonseca FP, Vallinoto GM, Pontes FS, Pinto Ddos S Jr., Oral manifestations of vitamin B12 deficiency: a case report. J Can Dent Assoc. 2009 Sep;75(7):533-7.
    ABSTRACT: Megaloblastic anemias are a subgroup of macrocytic anemias, in which distinctive morphologic abnormalities occur in red cell precursors in bone marrow, namely megaloblastic erythropoiesis. Of the many causes of megaloblastic anemia, the most common are disorders resulting from cobalamin or folate deficiency. The clinical symptoms are weakness, fatigue, shortness of breath and neurologic abnormalities. The presence of oral signs and symptoms, including glossitis, angular cheilitis, recurrent oral ulcer, oral candidiasis, diffuse erythematous mucositis and pale oral mucosa offer the dentist an opportunity to participate in the diagnosis of this condition. Early diagnosis is important to prevent neurologic signs, which could be irreversible. The aim of this paper is to describe the oral changes in a patient with megaloblastic anemia caused by a dietary deficiency of cobalamin.
21. Badmaev V & Majeed M: Comparison of nutrient bioavailability when ingested alone and in combination with Bioperine. Research Report, Sabinsa Corporation, 1996.
22. Pack AR, Thomson ME., Effects of topical and systemic folic acid supplementation on gingivitis in pregnancy., J Clin Periodontol. 1980 Oct;7(5):402-14.
    ABSTRACT: A double-blind study evaluated the effects of systemic and topical folate on gingival inflammation during the fourth and eighth months of pregnancy. Thirty women were randomly divided into three groups. Group A received placebo mouthwash and tablets; Group B; placebo mouthwash and 5 mg folate tablets; Group C: folate mouthwash and placebo tablets. Supplementation lasted for 14 days during months 4 and 8. Subjects took one tablet daily and rinsed twice daily for 1 min with the mouthwash. At the start and finish of each 14-day period, fasting serum and red cell folate levels were estimated and oral status assessed by a plaque index (P1I), a gingival index (GI), and gingival exudate flow meter (GEF). Subjects completed 1-week diet sheets which were analysed for dietary folate. All groups were similar in each parameter at the start. Correlation was demonstrated between GI and P1I, and between GI and GEF. GI tended to increase throughout pregnancy in all groups except Group C, when in the eighth month there was a highly significant improvement (0.001 less than P 0.01) despite no significant change in P1I. Although dietary intake of folate was significantly higher during the eighth month in Group C as compared with Groups A and B, (0.001 less than P less than 0.01), the folate mouthwash produced highly significantly improvement in gingival health in pregnancy.
23. Esaki M1, Morita M, Akhter R, Akino K, Honda O. , Relationship between folic acid intake and gingival health in non-smoking adults in Japan. Oral Dis. 2010 Jan;16(1):96-101. doi: 10.1111/j.1601-0825.2009.01619.x. Epub 2009 Aug 28.
    OBJECTIVE: To assess the relationship between dietary intake of folate and gingival bleeding in non-smoking adults in Japan.
    MATERIALS AND METHODS: Data were obtained from residents who participated in the regional nutrition survey and survey of dental diseases conducted by the administrative office of northernmost prefecture of Japan. Dietitians visited households to collect data on dietary intake. Clinical parameters, including Community Periodontal Index (CPI) and bleeding on probing (BOP), were examined in community centers. Information on smoking habit was obtained from the interview. Then the data from 497 non-smoking adults with 20 teeth or more, aged 18 years or older, were analyzed. The relationship between dietary intake of folic acid and gingival bleeding status was estimated using multivariate analysis.
    RESULTS: Pearson's correlation coefficient showed a significant negative correlation between dietary folate level and bleeding on probing. The negative association between folate level and bleeding on probing remained statistically significant in multiple regression analysis (standardized beta = -0.204, P < 0.001). However, no significant association was found between CPI scores and folate intake level.
    CONCLUSIONS: The results suggest that dietary intake of folic acid, an important indicator of gingival bleeding in adults, may provide an important clinical target for intervention to promote gingival health.
24. Gary M. Stein, and Henry Lewis (Westmoreland Hospital, Greensburg, Pennsylvania) , Oral Changes in a Folic Acid Deficient Patient Precipitated by Anticonvulsant Drug Therapy, Journal of Periodontology. October 1973, Vol. 44, No. 10, Pages 645-650 , DOI 10.1902/jop.1973.44.10.645
25. Thomas DM1, Mirowski GW. Nutrition and oral mucosal diseases. Clin Dermatol. 2010 Jul-Aug;28(4):426-31. doi: 10.1016/j.clindermatol.2010.03.025.
    ABSTRACT: Oral manifestations of nutritional deficiencies can affect the mucous membranes, teeth, periodontal tissue, salivary glands, and perioral skin. This contribution reviews how the water-soluble vitamins (B(2), B(3), B(6), B(12), C, and folic acid), fat-soluble vitamins (A, D, and E), and minerals (calcium, fluoride, iron, and zinc) can affect the oral mucosa.

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.