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This study describes the relationship between varying ascorbate intake, periodontal status, and subgingival microflora as part of a multidisciplinary investigation of ascorbic acid (AA) metabolism in young men housed for 13 weeks in a nutrition suite that provided controlled periods of ascorbic acid depletion and repletion. Twelve medically healthy non-smoking men, aged 25 to 43 years, ate a rotating four-day diet adequate in all nutrients except ascorbic acid. Following an initial baseline period during which the subjects received 250 mg AA/day, the subjects received 5 mg AA/day for a 32-day depletion period. Eight of the 12 subjects participated in a subsequent 56-day repletion period designed to replace the reduced body AA pool slowly. Plasma and leukocyte ascorbate levels, Plaque Index, Gingival Index, probing depths, and attachment level were monitored at the beginning and end of the depletion and repletion periods. Subgingival plaque samples were obtained and examined for selected organisms by indirect immunofluorescence microscopy. A uniform oral hygiene program was reinforced after each examination. Ascorbate concentrations in plasma and leukocytes responded rapidly to changes in vitamin C intake. There were no significant changes in plaque accumulation, probing pocket depth, or attachment level during the study. In contrast, gingival bleeding increased significantly after the period of AA depletion and returned to baseline values after the period of AA repletion. However, no relationship could be demonstrated between either the presence or proportion of target periodontal micro-organisms and measures of bleeding or ascorbate levels.

To determine if systemic levels of vitamin C influence periodontal health, changes in plaque accumulation, gingival health and periodontal probing depth were measured in healthy subjects housed for 3 months in a nutrition suite that provided controlled periods of ascorbic acid depletion and supplementation. Eleven healthy, nonsmoking men, aged 19 to 28 years, ate a rotating 7-day diet adequate in all nutrients except ascorbic acid. This basal diet, which contained less than 5 mg/day ascorbic acid, was supplemented with 60 mg/day ascorbic acid for 2 weeks, 0 mg/day ascorbic acid for 4 weeks, 600 mg/day ascorbic acid for 3 weeks and 0 mg/day ascorbic acid for 4 weeks. Plasma, urine and leukocyte ascorbate levels, Plaque Index, Gingival Index, Bleeding Index and probing depths were monitored throughout the study. A uniform oral hygiene program was maintained in which oral hygiene instructions were reinforced bi-weekly. Ascorbate concentrations in body fluids and leukocytes responded rapidly to changes in ascorbic acid intake. No mucosal pathoses or changes in plaque accumulation or probing depths were noted during any of the periods of depletion or supplementation. However, measures of gingival inflammation were directly related to the ascorbic acid status. The results suggest that ascorbic acid may influence early stages of gingivitis, particularly crevicular bleeding.

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Providing oral health care to rural populations in the United States is a major challenge. Lack of community water fluoridation, dental workforce shortages, and geographical barriers all aggravate oral health and access problems in the largely rural Northwest. Children from low-income and minority families and children with special needs are at particular risk. Familycentered disease prevention strategies are needed to reduce oral health disparities in children. Oral health promotion can take place in a primary care practitioner's office, but medical providers often lack relevant training. In this project, dental, medical, and educational faculty at a large academic health center partnered to provide evidence-based, culturally competent pediatric oral health training to family medicine residents in five community-based training programs. The curriculum targets children birth to five years and covers dental development, the caries process, dental emergencies, and oral health in children with special needs. Outcome measures include changes in knowledge, attitudes, and self-efficacy; preliminary results are presented. The program also partnered with local dentists to ensure a referral network for children with identified disease at the family medicine training sites. Pediatric dentistry residents assisted in didactic and hands-on training of family medicine residents. Future topics for oral health training of family physicians are suggested.

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