Folic acid: A positive influence on periodontal tissues during health and disease

Abstract

Periodontal disease is a multifactorial disease, the origin of which remains obscure. However, the manifestation and progression of periodontitis is influenced by a wide variety of determinants including social and behavioral factors, systemic factors, environmental and genetic factors. Periodontal tissue integrity is dependent on the adequate intake of proteins, carbohydrates, fats, vitamins, and mineral salts. Chronic deficiencies in the availability of one or more of these nutrients are expected to produce pathological alterations in the expression and progression of periodontal disease. Folic acid, also known as vitamin B 9 or folacin, is one such vitamin that is essential for numerous bodily functions ranging from nucleotide biosynthesis to the remethylation of homocysteine. Folic acid deficiency causes absence of keratinization of gingival surface, decreased resistance to infection, necrosis of gingiva, periodontal ligament, and alveolar bone destruction in animals and humans. This may be accompanied by ulcerative glossitis and cheilitis. Repair and maintenance of periodontal tissues generates a high turnover rate of squamous epithelium and without folic acid, epithelial cells do not divide properly. Folic acid deficiency is the most common nutrient deficiency in the world. Organic nitrites, nitrous oxide, cyanates, and isocyanates found in cigarette smoke have been shown to interact with folic acid, transforming them into biologically inactive compounds and thereby leading to lower folic acid levels in serum, red blood cells, and respiratory tract. Folic acid supplementation as an adjunct in the management of periodontal disease in smokers will prove to have beneficial effect on the periodontal tissues during repair and turnover.