Whether it is boosting your immunity, supporting your heart health or giving your body an antioxidant boost, vitamin C plays diverse roles in maintaining your health. Studies show that vitamin C may also have a significant role in preventing periodontitis or gum disease. In addition, research shows that periodontitis increases one’s risk of heart disease, and there is robust scientific evidence that vitamin C is extremely helpful in mitigating this risk.
What is gum disease?
Gum disease is the inflammation of the tissues and structures that surround your teeth. It begins with the formation of plaque – sticky, colorless film on teeth – when bacteria, present normally in your mouth, interacts with mucus and food particles.
In the absence of oral hygiene, this plaque begins to harden under the gumline and form tartar that cannot be removed by usual brushing or flossing. Tartar contains bacteria, which release toxins and cause infection. This also activates your immune system to launch an attack to get rid of the pathogenic bacteria and infection, eventually causing chronic inflammation.
Initially, it can cause inflammation along the gumline, making gums sensitive, red and swollen. This stage, called gingivitis, is the earliest form of gum disease. With time, gingivitis can progress into more serious condition called periodontitis, which is marked by receding, painful, and bleeding gums. Ongoing inflammation gives rise to the formation of pockets or spaces between the tooth and gums. These tartar and bacteria filled spaces gradually become deeper, leading to more infection and inflammation. This results in a loss of structures that support teeth including connective tissue and even the alveolar bone.
Signs of Gum Disease
- Swollen, red or tender gums
- Receding gums
- Bleeding gums or gums that are prone to bleeding
- Loose teeth
- Bad breath
- Pus between teeth and gums
The link between Vitamin C deficiency and gum disease
There are many factors that increase your risk of developing gum disease – including poor oral hygiene, age, smoking, diabetes, hormonal changes in girls and women, drugs that reduces saliva flow in the mouth and genetic factors. In addition, inadequate nutrition and vitamin C deficiency, in particular, is another significant risk factor.
The best way to prevent any stage of gum disease is to practice good oral hygiene by making regular visits to your dentist. But is it also possible to prevent gingivitis or periodontitis by taking vitamin C supplements?
A recent randomized clinical trial investigated the effect of guava and synthetic vitamin C on the development of gingival inflammation under supervised conditions. It concluded that “consumption of either 200g guava/day or 200mg synthetic vitamin C/day, prior to and during the oral hygiene abstention period, has a preventive effect on the development of experimental gingivitis” in young non‐smoking adults. 
Another 2016 study found that “Vitamin C is an effective adjunctive treatment in reducing various degrees of chronic gingival inflammation.” 
A 2013 study showed that vitamin C levels were lower in healthy people with gingivitis and diabetics with periodontitis. It also reported that daily vitamin C supplements reduced bleeding in people with gingivitis and diabetics with periodontitis. 
Nutrition plays a crucial role in maintaining your overall health and oral health is certainly no exception. A 2016 randomized controlled pilot study found that a diet low in carbohydrates, rich in Omega-3 fatty acids, and rich in vitamins C and D, antioxidants and fiber can significantly reduce inflammation associated with gingivitis and periodontitis.  In addition, daily supplementation of CoQ10 has also been shown to control gum inflammation, improve gum health, heal inflamed gums, reduce depth of gum pockets and strengthen immunity in gum tissue.  
What makes vitamin C so useful in preventing gum disease?
Vitamin C works in multiple ways to help prevent and heal gum disease.
Gum disease is a chronic inflammatory condition. The deep pockets or spaces around the gumline that are present in people with periodontal disease provide a favorable environment for the pathogenic bacteria to grow, allowing the bacteria and their toxins to then migrate to the bloodstream. This leads to an increased immune response, resulting in elevated levels of oxidative stress and inflammatory mediators such as tumor necrosis factor–alpha, interleukin (IL)-6, IL-1β, prostaglandin E2, and C-reactive protein.
Reducing oxidative stress and inflammation in the body by nourishing it with the right nutrition can go a long way in treating gum infection and disease. And that’s where vitamin C helps. Vitamin C is a powerful antioxidant that is well-known for its neutralizing action on free radicals that cause inflammation and disease.
Vitamin C is not only an important antioxidant, but it also functions as an essential co-factor in carrying out a number of critical enzymatic reactions. One such process is the synthesis of collagen, a fibrous protein that lends structure and strength to various connective tissues including the gums, skin, ligaments, blood vessels and bone. Vitamin C also helps in healing wound and formation of new connective tissue.
Shortage of vitamin C results in the impaired production of collagen, which causes gum tissue to fall apart. Bleeding and swollen gums is one of the most telling signs of scurvy, a condition that develops when you have chronic deficiency of vitamin C in the body.
Gum disease increases the risk of other diseases
According to the UK national Health Service, “Gum disease may increase your risk of all kinds of other health complications, including stroke, diabetes and heart disease. Gum disease has even been linked with problems in pregnancy and dementia.”
It is believed that bacteria and their toxins present in the infected gum tissue can also enter the bloodstream. This triggers an immune response that causes ongoing inflammation, responsible for all kinds of health problems including cardiovascular disease. Studies also show the link between periodontal disease and an increased risk of coronary artery disease, stroke, myocardial infarction, and atherosclerosis.  In fact, studies have confirmed the presence of oral bacteria in coronary atherosclerotic plaques. 
In a nutshell, gum disease has been strongly linked with:
- Coronary heart disease (heart attack and stroke)
- Diabetes and its control
- Rheumatoid arthritis
- Adverse pregnancy outcomes such as spontaneous preterm birth
- A study showed that “simple, non-invasive periodontal therapy may improve health outcomes in pregnancy and other systemic conditions.” 
Smokers, periodontal disease and vitamin C
Smokers are particularly at risk for developing periodontal disease. While oral bacterial infection is the main reason for gum disease, smoking is one of the strongest behavioral risk factor for the occurrence and development of periodontitis. According to CDC, smoking weakens the immune system, making it more difficult to fight any infection. Smoking also slows down the healing process. 
Smokers have significantly lower levels of vitamin C in their blood than people who don’t smoke. Smoking not only depletes vitamin C, it also generates free radicals – resulting in increased oxidative stress and tissue damage. This creates an additional demand for vitamin C and other antioxidants to neutralize free radicals and reduce the oxidative stress caused by smoking.
In addition, vitamin C helps maintain your heart health through various mechanisms. As an antioxidant, it inhibits the oxidation of LDL cholesterol particles, a process known to play a critical role in increasing the risk of atherosclerosis, heart attack and stroke.
Vitamin C also helps in forming healthy collagen that keep arteries and endothelium (inner surface of the blood vessels) smooth and supple. Healthy arteries and endothelium are more adept at preventing oxidized LDL particles from penetrating and lodging in the vessel wall, where they can trigger unwanted immune and inflammatory reactions that contribute towards plaque formation in the arteries. Orthomolecular scientists like Dr. Linus Pauling and Dr. Rath believe that long-term vitamin C deficiency in the body is one of the primary causes of coronary heart disease, due to impaired production of collagen, and the resulting weakening of coronary arteries. Collagen is an important structural component of your connective tissues including gums and blood vessels.
The best way to prevent gum disease is to follow a program of good oral hygiene. In addition, maintaining healthy levels of vitamin C in the body also ensures you have healthy gums and a healthy immune system to fight off gum infections and heal inflamed tissues faster.
- Amaliya et al. Effect of guava and vitamin C supplementation on experimental gingivitis A randomized clinical trial. Journal of Periodontology. 2018.
- Yussif et al. Evaluation of the Anti-Inflammatory Effect of Locally Delivered Vitamin C in the Treatment of Persistent Gingival Inflammation: Clinical and Histopathological Study. Journal of Nutrition and Metabolism. 2016.
- Gokhale et al. A short-term evaluation of the relationship between plasma ascorbic acid levels and periodontal disease in systemically healthy and type 2 diabetes mellitus subjects. J Diet Suppl. 2013
- Woelber et al. An oral health optimized diet can reduce gingival and periodontal inflammation in humans – a randomized controlled pilot study. BMC Oral Health. 2016
- Wilkinson et al. Bioenergetics in clinical medicine. II. Adjunctive treatment with coenzyme Q in periodontal therapy. Res Commun Chem Pathol Pharmacol. 1975
- S Prakash et al. Role of coenzyme Q(10) as an antioxidant and bioenergizer in periodontal diseases. Indian J Pharmacol. 2010
- Leishman et al. Cardiovascular disease and the role of oral bacteria. J Oral Microbiol. 2010
- Mahendra et al. 16S rRNA-based detection of oral pathogens in in coronary atherosclerotic plaque. Indian J Dent Res. 2010
- Jeffcoat et al. Impact of Periodontal Therapy on General Health: Evidence from Insurance Data for Five Systemic Conditions. American Journal of Preventive Medicine. 2014.
- Centres for Disease Control and Prevention. Smoking, Gum Disease, and Tooth Loss