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

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.
Wilkinson, E. et al. Adjunctive treatment of periodontal disease with coenzyme Q10. Res. Commun. Chem. Pathol. Pharmacol 1976;14:715-9.
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
Hazan S & Cowan E: Diet, Nutrition, & Periodontal Disease. American Society of Preventive Dentistry, Chicago, IL, 1975.
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.
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.
Nakamura R, et al: Deficiency of coenzyme Q in gingiva of patients with periodontal disease. Int J Vit Nutr 43:84,1973.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Badmaev V & Majeed M: Comparison of nutrient bioavailability when ingested alone and in combination with Bioperine. Research Report, Sabinsa Corporation, 1996.
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.
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.
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
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.

Additional CoQ10 References

Effectiveness of CoQ10 Oral Supplements as an Adjunct to Scaling and Root Planing in Improving Periodontal Health. Manthena S, Rao MV, Penubolu LP, Putcha M, Harsha AV. J Clin Diagn Res. 2015 Aug;9(8):ZC26-8. doi: 10.7860/JCDR/2015/13486.6291. Epub 2015 Aug 1.
ABSTRACT
INTRODUCTION: Deficiency of CoQ 10 was found in human inflamed gingiva and has been found to be responsible for periodontal destruction.
AIM: To evaluate the effectiveness of CoQ 10 supplementation as an adjunct to scaling and rootplaning in reducing gingival inflammation and periodontal pocket depth.
MATERIALS AND METHODS: The study was a randomized, double-blind, controlled, parallel group design clinical trial. Thirty subjects with plaque induced gingival inflammation and having atleast three nonadjacent interproximal sites with a probing pocket depth ≥5mm were included in the study. The subjects were randomly divided into two groups. The test group (n=15) in which patients were given oral CoQ10 supplements after scaling and root planing and the control group (n=15) in which patients were given an oral placebo after scaling and rootplaning. The plaque index, gingival index and probing depth were recorded at baseline, 1 month and 3 months. Statistical analysis done by using Student's paired t-test for intragroup comparison and unpaired t-test for inter-group comparison.
RESULTS: Both the groups showed marked reduction of afore mentioned periodontal parameters at one month and three months when compared to baseline. Though there was no significant difference in plaque index and probing pocket depth between the two groups at any given time period, test group showed significant difference in gingival inflammation at one month and three months when compared to control group.
CONCLUSION: In the present study use of Coenzyme Q10 oral supplements as an adjunct to scaling and root planing showed significant reduction in gingival inflammation when compared to scaling and rootplaning alone.

Additional Zinc Gluconate References

Komai M, Goto T, Suzuki H, Takeda T, Furukawa Y. Biofactors 2000;12(1-4):65-70, Zinc deficiency and taste dysfunction; contribution of carbonic anhydrase, a zinc-metalloenzyme, to normal taste sensation. Division of Life Science, Graduate School of Agricultural Science, Tohoku University, Sendai, Japan. mkomai@biochem.tohoku.ac.jp
The present study was designed to clarify the effect of zinc deficiency on sodium chloride preference, the lingual trigeminal and taste nerves transduction, and carbonic anhydrase (CA) activity of the tongue surface and salivary gland. Male SD rats, 4 weeks old, were divided into four groups, and fed zinc-deficient (Zn-Def), low-zinc (Low-Zn), and zinc-sufficient diets with free access (Zn-Suf) and pair-feeding (Pair-fed). After taking part in the preference tests for 42 days, the rats were provided for the chorda tympani and lingual trigeminal nerves recordings, then finally sacrificed and the tongue and submandibular gland excised to measure CA activity. Sodium chloride preference increased only after 4 days of the feeding of zinc-deficient and low-zinc diets, which means that the taste abnormality appears abruptly in zinc deficiency and even though in marginal zinc deficiency. Reduced CA activities of the taste-related tissues in zinc-deficient group paralleled well with the decreased taste and lingual trigeminal nerves sensitivities.

Heyneman CA. Zinc deficiency and taste disorders. Ann Pharmacother 1996 Feb;30(2):186-7. Idaho Drug Information Center, Idaho State University, Pocatello 83209, USA.
Elemental zinc supplementation in daily dosages of 25-100 mg po appears to be an efficacious treatment for taste dysfunction secondary to zinc depletion. Insufficient evidence is available to determine the efficacy of zinc supplementation for the treatment of hypogeusia or dysgeusia secondary to drug therapy or medical conditions that do not involve low serum zinc concentrations.

Huttenbrink KB., [Disorders of the sense of smell and taste]. Ther Umsch 1995 Nov;52(11):732-7. Klinik und Poliklinik fur Hals-Nasen-Ohren-Heilkunde der Medizinischen Fakultat Carl Gustav Carus, Technischen Universitat Dresden.
Disorders of olfaction and taste are infrequent, but a complete loss of smell or taste reduces the quality of life significantly. The sensitivity of human olfaction is remarkable, even for specific stimuli: Just a few molecules are enough to induce the correct identification of sterilised and ultraheated milk. Olfaction and taste are called 'chemical senses' because in both cases the adequate stimulus consists of molecules that bind to receptors of the sensory cells. The perceptions of smell and taste are often combined. Taste differentiates only four qualities: sweet, sour, salty, and bitter. The typical flavor of food or drink is detected by olfaction. Disturbances of olfaction can be due to respiratory disorders such as nasal polyps, a deviation of the nasal septum or chronic sinusitis. Such conditions can reduce airflow through the olfactory cleft at the roof of the nasal cavity. They can be corrected by modern endoscopic surgery of the nose. Epithelial disorders involving the sensory cells are most often caused by viral infections (influenza-anosmia) or toxic destruction of the sensory epithelium (solvents or gases). Epithelial disorders can be cured only rarely by any treatment. Corticosteroids, zinc, and vitamin A are tried frequently. Neural disorders occur after frontobasal trauma and during neurological diseases such as Parkinson's or Alzheimer's disease. Disorders of olfaction can be an early sign of such neurological diseases and sophisticated examination of this sense can contribute to their early diagnosis. However, no specific treatments have yet been identified. Disorders of taste can be due to toxic, chemical or inflammatory damage to the sensory cells of the tongue.

Prasad AS, Fitzgerald JT, Hess JW, Kaplan J, Pelen F, Dardenne M. Zinc deficiency in elderly patients. Nutrition 1993 May-Jun;9(3):218-24. Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI.
Zinc is needed for growth and development, DNA synthesis, neurosensory functions, and cell-mediated immunity. Although zinc intake is reduced in elderly people, its deficiency and effects on cell-mediated immunity of the elderly have not been established. Subjects enrolled in "A Model Health Promotion and Intervention Program for Urban Middle Aged and Elderly Americans" were assessed for nutrition and zinc status. One hundred eighty healthy subjects were randomly selected for the study. Their mean dietary zinc intake was 9.06 mg/day, whereas the recommended dietary allowance is 15 mg/day. Plasma zinc was normal, but zinc in granulocytes and lymphocytes were decreased compared with younger control subjects. Of 118 elderly subjects in whom zinc levels in both granulocytes and lymphocytes were available, 36 had deficient levels. Plasma copper was increased, and interleukin 1 (IL-1) production was significantly decreased. Reduced response to the skin-test antigen panel and decreased taste acuity were observed. Thirteen elderly zinc-deficient subjects were supplemented with zinc, and various variables were assessed before and after zinc supplementation. Zinc supplementation corrected zinc deficiency and normalized plasma copper levels. Serum thymulin activity, IL-1 production, and lymphocyte ecto-5'-nucleotidase increased significantly after supplementation. Improvement in response to skin-test antigens and taste acuity was observed after zinc supplementation. A mild zinc deficiency appears to be a significant clinical problem in free-living elderly people.

Deems DA, Doty RL, Settle RG, Moore-Gillon V, Shaman P, Mester AF, Kimmelman CP, Brightman VJ, Snow JB Jr., Smell and taste disorders, a study of 750 patients from the University of Pennsylvania Smell and Taste Center. Arch Otolaryngol Head Neck Surg 1991 May;117(5):519-28. Department of Otorhinolaryngology and Human Communication, School of Medicine, University of Pennsylvania, Philadelphia.
Smell and taste disorders are common in the general population, yet little is known about their nature or cause. This article describes a study of 750 patients with complaints of abnormal smell or taste perception from the University of Pennsylvania Smell and Taste Center, Philadelphia. Major findings suggest that: chemosensory dysfunction influences quality of life; complaints of taste loss usually reflect loss of smell function; upper respiratory infection, head trauma, and chronic nasal and paranasal sinus disease are the most common causes of the diminution of the sense of smell, with head trauma having the greatest loss; depression frequently accompanies chemosensory distortion; low body weight accompanies burning mouth syndrome; estrogens protect against loss of the sense of smell in postmenopausal women; zinc therapy may provide no benefit to patients with chemosensory dysfunction; and thyroid hormone function is associated with oral sensory distortion. The findings are discussed in relation to management of patients with chemosensory disturbances.

Rareshide E, Amedee RG., Disorders of taste. J La State Med Soc 1989 Sep;141(9):9-11
At least 2 million Americans suffer with chemosensory dysfunction or disorders of taste and smell. In addition to the obvious aesthetic deprivation, loss of taste may affect an individual's health and psychosocial situation. Most taste disorders are associated with antecedent upper respiratory infection, trauma, or allergic rhinitis, or have an idiopathic etiology. They may reflect underlying neoplastic, neurologic, endocrine, infectious, or nutritional disturbances; only 1% of these patients have a functional disorder. Evaluation consists of a history and physical, followed by a screening test battery searching for any of the treatable etiologies. One third of patients will respond to exogenous zinc therapy after a treatment period of 2 to 4 months. The remainder must rely on supportive measures such as additives, flavor enhancers, and rinses.

Stoll AL, Oepen G., Psychopharmacology Unit, Brigham and Women's Hospital, Boston, MA 02115. Zinc salts for the treatment of olfactory and gustatory symptoms in psychiatric patients: a case series. J Clin Psychiatry 1994 Jul;55(7):309-11.
BACKGROUND: Zinc salts have been used extensively in medical settings to treat disorders of gustatory and olfactory function. However, zinc supplements have not been tested in psychiatric patients with smell or taste symptoms.
METHOD: The authors examined the effects of zinc supplements on five consecutive patients with symptoms of abnormal taste and smell perception in the context of acute psychiatric illness or treatment.
RESULTS: All five patients had complete or partial amelioration of these olfactory and gustatory symptoms after treatment with zinc sulfate or zinc gluconate, apparently independent of the improvement in their underlying psychiatric disorder.
CONCLUSION: We recommend treating unusual olfactory and gustatory symptoms with zinc salts, independent of the treatment for the underlying psychiatric disorder.

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