"Exploring the Interplay of Vitamin D, Salivary Antimicrobial Peptides, and Cytokines in Oral Immunity and Disease Prevention: An Insight for Implications in Oral Health Policy"

Ashwini Shivakumar tumkur^1,2*Sumana Mahadevaiah³Supreeta Shettar³G K Megha³Sowmya Halasabalu Kalgeri¹Varsha D. Shiragannavar³Keshava Prasad⁴Prasanna K. Santhekadur^3*

• ¹JSS Dental College and Hospital, Mysore, India
• ²JSS Academy of Higher Education and Research, Mysuru, India
• ³JSS Medical College, Mysuru, India
• ⁴RV Dental College and Hospital, Bengaluru, India

Introduction Oral diseases such as caries and periodontitis are complex, multifactorial diseases; they remain the most prevalent worldwide. Both diseases are associated with vitamin D deficiency (VDD) and its pathophysiological process. The prevalence of metabolic syndrome has risen in developing countries; studies have shown that oral diseases are more prevalent among the metabolic group. The aim is to assess and correlate the relationship between serum vitamin D, salivary antimicrobial peptides, and their role in oral health. Materials and Methods: A total of 80 individuals aged 35–75 years were recruited. 40 patients in the metabolic syndrome group, following the NCEP ATP III criteria, and 40 in the non-metabolic group. Serum vitamin D levels and salivary AMPs were estimated using enzyme-linked immunosorbent assay (ELISA). Oral health status was assessed using the Decayed, Missing, Filled Teeth (DMFT) index and by recording the presence or absence of periodontal pockets. The data obtained were subjected to statistical analysis to determine correlations between systemic status, biochemical markers, and oral health parameters. Results: Mann–Whitney U test was applied to compare continuous variables between the metabolic and non-metabolic groups, as well as between subgroups. The Chi-square test was applied to assess associations between categorical variables. Patients with metabolic syndrome exhibited reduced serum vitamin D levels, though differences were not statistically significant. Salivary β-defensin and cathelicidin levels were relatively higher in the metabolic group, but without significant intergroup variation. A higher DMFT score and greater prevalence of periodontal pockets were recorded among metabolic syndrome patients compared with non-metabolic individuals. Conclusions: Within the study's limitations, it indicates a potential link between metabolic syndrome and compromised oral health, demonstrated by increased caries incidence and periodontal involvement. While variations in serum vitamin D and salivary AMPs did not achieve statistical significance, findings suggest an altered host defence mechanism in metabolic syndrome patients. Larger, longitudinal studies are required to further elucidate these associations and emphasize the importance of routine oral screening in individuals with metabolic disorders, and the implementation of oral health polices is mandatory to maintain good oral health and wellbeing among both metabolic and non-metabolic populations.