Vitamin C as a modulator of periodontal oxidative stress: current perspectives and clinical relevance. Narrative literature review
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Published:
Jul 15, 2026
Keywords:
Vitamin C, oxidative stress, periodontal disease, periodontitis, antioxidants.
Main Article Content
Abstract
Introduction. Periodontal disease is a multifactorial condition characterized by the progressive destruction of the tooth-supporting tissues. Its development has been associated with increased oxidative stress, resulting from an imbalance between the production of reactive oxygen species and antioxidants. Vitamin C plays a role in collagen synthesis, immune response, and the neutralization of free radicals, which may influence periodontal health. Objective. To analyze the relationship between vitamin C, oxidative stress, and periodontal disease. Methodology. An exploratory literature review of scientific publications published between 2020 and 2026 was conducted using the PubMed, Scopus, ScienceDirect, and Google Scholar databases. Studies in humans analyzed the relationship between vitamin C, oxidative stress, and periodontal disease were included. After applying the inclusion and exclusion criteria, a total of 10 studies were selected for analysis. Results. The reviewed studies indicated that patients with periodontal disease exhibit alterations in biomarkers associated with oxidative stress and, in some cases, lower levels of vitamin C compared with periodontally healthy individuals. Furthermore, vitamin C intake showed positive effects on certain inflammatory and antioxidant biomarkers. However, clinical outcomes regarding reductions in probing depth and improvements in clinical attachment levels varied among the studies. Conclusion. The relationship between vitamin C, oxidative stress, and periodontal disease was identified. Although vitamin C possesses antioxidant properties and may serve as an adjunct in periodontal treatment, the available clinical evidence remains variable, highlighting the need for studies with standardized methodologies and longer follow-up periods to more accurately determine its therapeutic effect. General Area of Study: Dentistry. Specific area of study: Periodontology. Type of study: Narrative bibliographic review.
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Aguayza Rodas, L. T., & Carvajal Endara, A. S. (2026). Vitamin C as a modulator of periodontal oxidative stress: current perspectives and clinical relevance. Narrative literature review. Anatomía Digital, 9(3), 40-62. https://doi.org/10.33262/anatomiadigital.v9i3.3715
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References
1. Fageeh HN, Fageeh HI, Prabhu A, Bhandi S, Khan S, Patil S. Efficacy of vitamin C supplementation as an adjunct in the non-surgical management of periodontitis: a systematic review. Systematic review update [Internet]. 2021 [cited 8 May 2026];10(1):5. Available from: https://doi.org/10.1186/s13643-020-01554-9
2. Hashim NT, Rahman MM, Islam MS, Padmanabhan V, Chaitanya NCSK, Mohammed R, et al. Salivary and GCF vitamin C levels: implications for local and systemic periodontal defense. International Journal of Dentistry [Internet]. 2025 [cited 8 May 2026];2025(1):8367922. Available from: https://doi.org/10.1155/ijod/8367922
3. Carvajal P, Campos de Almeida Carrer F, Lopes Galante M, Vernal R, Barboza Solis C. Prevalence of periodontal diseases: Latin America and the Caribbean Consensus 2024. Brazilian Oral Research [Internet]. 2024 [cited 8 May 2026];38(suppl 1): e116. Available from: https://doi.org/10.1590/1807-3107bor-2024.vol38.0116
4. Sosa V, Aicardo A, Valez V. Oxidative stress in saliva induced by tobacco smoke: impact on periodontitis and perspectives with redox pharmacology. Odontoestomatologia [Internet]. 2022 [cited 8 May 2026]; 24(39):1-14. Available from: https://doi.org/10.22592/ode2022n39e307
5. Georgiou AC, Cornejo Ulloa P, Van Kessel GMH, Crielaard W, Van der Waal SV. Reactive oxygen species can be traced locally and systemically in apical periodontitis: a systematic review. Archives of Oral Biology [Internet]. 2021 [cited 8 May 2026]; 129:105167. Available from: https://doi.org/10.1016/j.archoralbio.2021.105167
6. Pizzino G, Irrera N, Cucinotta M, Pallio G, Mannino F, Arcoraci V, et al. Oxidative stress: harms and benefits for human health. Oxidative Medicine and Cellular Longevity [Internet]. 2017 [cited 8 May 2026];2017(1):8416763. Available from: https://doi.org/10.1155/2017/8416763
7. Mochol M, Jablonowski L, Pawlik A, Rasławska-Socha J, Chamarczuk A, Lipski M, et al. The role of vitamin C in selected autoimmune and immune-mediated diseases: exploring potential therapeutic benefits. International Journal of Molecular Sciences [Internet]. 2025 [cited 8 May 2026];26(19):9375. Available from: https://doi.org/10.3390/ijms26199375
8. Wintergerst ES, Maggini S, Hornig DH. Immune-enhancing role of vitamin C and zinc and effect on clinical conditions. Annals of Nutrition and Metabolism [Internet]. 2006 [cited 8 May 2026];50(2):85-94. Available from: https://doi.org/10.1159/000090495
9. Buzatu R, Luca MM, Bumbu BA. Does vitamin C supplementation provide a protective effect on periodontal health? A systematic review and meta-analysis. International Journal of Molecular Sciences [Internet]. 2024 [cited 8 May 2026];25(16):8598. Available from: https://doi.org/10.3390/ijms25168598
10. Dethlefs-Canto J, Osses-Barría F, Vergara-Zenteno R, Bustos-Ponce A, Villavicencio-Duarte J. The effectiveness of vitamin C in dental alveolus healing after dental extraction: a scoping review. Medicina Oral, Patología Oral y Cirugía Bucal [Internet]. 2025 [cited 8 May 2026];30(1), e124–e128. Available from: https://doi.org/10.4317/medoral.26893
11. Mi N, Zhang M, Ying Z, Lin X, Jin Y. Vitamin intake and periodontal disease: a meta-analysis of observational studies. BMC Oral Health [Internet]. 2024 [cited 8 May 2026];24(1):117. Available from: https://doi.org/10.1186/s12903-024-03850-5
12. Assaf M, Rabi H. Assessment of vitamin C levels in periodontal patients: a cross-sectional study in Palestine. Journal of Pharmacy and Bioallied Sciences [Internet]. 2022 [cited 8 May 2026];14(Suppl 1). Available from: https://doi.org/10.4103/jpbs.jpbs_94_22
13. Sherif MA, Anter E, Graetz C, El-Sayed KF. Injectable platelet-rich fibrin with vitamin C as an adjunct to non-surgical periodontal therapy in the treatment of stage-II periodontitis: a randomized controlled clinical trial. BMC Oral Health [Internet]. 2025 [cited 8 May 2026];25(1):772. Available from: https://doi.org/10.1186/s12903-025-06115-x
14. Elbehwashy MT, Hosny MM, Elfana A, Nawar A, Fawzy El-Sayed K. Clinical and radiographic effects of ascorbic acid-augmented platelet-rich fibrin versus platelet-rich fibrin alone in intra-osseous defects of stage-III periodontitis patients: a randomized controlled clinical trial. Clinical Oral Investigations [Internet]. 2021 [cited 8 May 2026];25(11):6309-6319. Available from: https://doi.org/10.1007/s00784-021-03929-1
15. Ozmeric N, Enver A, Isler SC, Gökmenoğlu C, Topaloğlu M, Selamet H, et al. Evaluating the effects of chlorhexidine and vitamin C mouthwash on oral health in non-surgical periodontal therapy: a randomized controlled clinical trial. Scientific Reports [Internet]. 2025 [cited 8 May 2026];15(1):3703. Available from: https://doi.org/10.1038/s41598-025-88100-6
16. Nisha S, Bettahalli Shivamallu A, Prashant A, Shashikumar P, Ganganna A, Das D. Effect of non-surgical periodontal therapy and vitamin C supplementation on total antioxidant capacity in patients with chronic generalised periodontitis: a randomised controlled trial. Journal of Oral Biology and Craniofacial Research [Internet]. 2023 [cited 8 May 2026];13(4):511-516. Available from: https://doi.org/10.1016/j.jobcr.2023.05.003
17. Jaafer SS, Alasady MS, Hanfoosh HS. Evaluation of Vitamins C, D, and E in Periodontal Health Before and After Therapeutic Intervention. Odontia: Journal of Dental Innovations and Oral Health. 2025;2(1):1-8
18. Dixit D, Kaushal S, Lal N, Singh R, Verma UP, Pathak AK. Sulfiredoxin levels in gingival crevicular fluid: a new antioxidant defence system-case control study. Journal of Oral Biology and Craniofacial Research [Internet]. 2025 [cited 8 May 2026]; 15:1373-1377. Available from: https://doi.org/10.1016/j.jobcr.2025.08.020
19. Mohideen K, Chandrasekaran K, Veeraraghavan H, Faizee SH, Dhungel S, Ghosh S. Meta-analysis of assessment of total oxidative stress and total antioxidant capacity in patients with periodontitis. Disease Markers [Internet]. 2023 [cited 8 May 2026];2023(1):9949047. Available from: https://doi.org/10.1155/2023/9949047
20. Dönmez MF, Balci N, Ergene Sunkar A, Toygar H, Kantarcı A. Taurine levels in periodontitis: a pilot study. Journal of Periodontology [Internet]. 2025 [cited 8 May 2026];96():984-993. Available from: https://doi.org/10.1002/JPER.24-0574
21. Rosa A, Pujia AM, Arcuri C. The protective role antioxidant of vitamin C in the prevention of oral disease: a scoping review of current literature. European Journal of Dentistry [Internet]. 2024 [cited 8 May 2026];18(4):965-970. Available from: https://doi.org/10.1055/s-0044-1786845
22. Ustianowski Ł, Ustianowska K, Gurazda K, Rusiński M, Ostrowski P, Pawlik A. The role of vitamin C and vitamin D in the pathogenesis and therapy of periodontitis: narrative review. International Journal of Molecular Sciences [Internet]. 2023 [cited 8 May 2026];24(7):6774. Available from: https://doi.org/10.3390/ijms24076774
23. Van der Velden U. Vitamin C and its role in periodontal diseases: the past and the present: a narrative review. Oral health & preventive dentistry [Internet]. 2020 [cited 8 May 2026];18(2):115-124. Available from: https://doi.org/10.3290/j.ohpd.a43334
24. Aytekin Z, Toraman A, Karaçam K. Investigation of effects of local vitamin C application on inflammatory response and periodontal tissue destruction in rat periodontitis model. Selcuk Dental Journal [Internet]. 2023 [cited 2026May.082026];10(2):371-376. Available from: https://doi.org/10.15311/selcukdentj.1115391
25. Espinoza Arias CJ, Pulgarin Fernández CM. Frequent oral pathologies in adults with fixed orthodontic appliances. Literature review. Anatomía Digital [Internet]. 2023Nov.3 [cited 2026May.08];6(4.1):35-8. Available from: https://doi.org/10.33262/anatomiadigital.v6i4.1.2767
26. Muñoz Delgado MS, Cabrera Padrón MI. Periodontal health in patients with fixed orthopedic devices. Literature Review. Anatomía Digital [Internet]. 2024Mar.5 [cited 2026May.08];7(1.2):76-5. Available from: https://doi.org/10.33262/anatomiadigital.v7i1.2.2996
27. Abad Cordero DS, Reinoso Ortiz SA, Cedeño Zambrano DA, León Velastegui M. Deep margin elevation, systematic review. Anatomía Digital [Internet]. 2023Dec.28 [cited 2026May.08];6(4.3):401-24. Available from: https://doi.org/10.33262/anatomiadigital.v6i4.3.2813
2. Hashim NT, Rahman MM, Islam MS, Padmanabhan V, Chaitanya NCSK, Mohammed R, et al. Salivary and GCF vitamin C levels: implications for local and systemic periodontal defense. International Journal of Dentistry [Internet]. 2025 [cited 8 May 2026];2025(1):8367922. Available from: https://doi.org/10.1155/ijod/8367922
3. Carvajal P, Campos de Almeida Carrer F, Lopes Galante M, Vernal R, Barboza Solis C. Prevalence of periodontal diseases: Latin America and the Caribbean Consensus 2024. Brazilian Oral Research [Internet]. 2024 [cited 8 May 2026];38(suppl 1): e116. Available from: https://doi.org/10.1590/1807-3107bor-2024.vol38.0116
4. Sosa V, Aicardo A, Valez V. Oxidative stress in saliva induced by tobacco smoke: impact on periodontitis and perspectives with redox pharmacology. Odontoestomatologia [Internet]. 2022 [cited 8 May 2026]; 24(39):1-14. Available from: https://doi.org/10.22592/ode2022n39e307
5. Georgiou AC, Cornejo Ulloa P, Van Kessel GMH, Crielaard W, Van der Waal SV. Reactive oxygen species can be traced locally and systemically in apical periodontitis: a systematic review. Archives of Oral Biology [Internet]. 2021 [cited 8 May 2026]; 129:105167. Available from: https://doi.org/10.1016/j.archoralbio.2021.105167
6. Pizzino G, Irrera N, Cucinotta M, Pallio G, Mannino F, Arcoraci V, et al. Oxidative stress: harms and benefits for human health. Oxidative Medicine and Cellular Longevity [Internet]. 2017 [cited 8 May 2026];2017(1):8416763. Available from: https://doi.org/10.1155/2017/8416763
7. Mochol M, Jablonowski L, Pawlik A, Rasławska-Socha J, Chamarczuk A, Lipski M, et al. The role of vitamin C in selected autoimmune and immune-mediated diseases: exploring potential therapeutic benefits. International Journal of Molecular Sciences [Internet]. 2025 [cited 8 May 2026];26(19):9375. Available from: https://doi.org/10.3390/ijms26199375
8. Wintergerst ES, Maggini S, Hornig DH. Immune-enhancing role of vitamin C and zinc and effect on clinical conditions. Annals of Nutrition and Metabolism [Internet]. 2006 [cited 8 May 2026];50(2):85-94. Available from: https://doi.org/10.1159/000090495
9. Buzatu R, Luca MM, Bumbu BA. Does vitamin C supplementation provide a protective effect on periodontal health? A systematic review and meta-analysis. International Journal of Molecular Sciences [Internet]. 2024 [cited 8 May 2026];25(16):8598. Available from: https://doi.org/10.3390/ijms25168598
10. Dethlefs-Canto J, Osses-Barría F, Vergara-Zenteno R, Bustos-Ponce A, Villavicencio-Duarte J. The effectiveness of vitamin C in dental alveolus healing after dental extraction: a scoping review. Medicina Oral, Patología Oral y Cirugía Bucal [Internet]. 2025 [cited 8 May 2026];30(1), e124–e128. Available from: https://doi.org/10.4317/medoral.26893
11. Mi N, Zhang M, Ying Z, Lin X, Jin Y. Vitamin intake and periodontal disease: a meta-analysis of observational studies. BMC Oral Health [Internet]. 2024 [cited 8 May 2026];24(1):117. Available from: https://doi.org/10.1186/s12903-024-03850-5
12. Assaf M, Rabi H. Assessment of vitamin C levels in periodontal patients: a cross-sectional study in Palestine. Journal of Pharmacy and Bioallied Sciences [Internet]. 2022 [cited 8 May 2026];14(Suppl 1). Available from: https://doi.org/10.4103/jpbs.jpbs_94_22
13. Sherif MA, Anter E, Graetz C, El-Sayed KF. Injectable platelet-rich fibrin with vitamin C as an adjunct to non-surgical periodontal therapy in the treatment of stage-II periodontitis: a randomized controlled clinical trial. BMC Oral Health [Internet]. 2025 [cited 8 May 2026];25(1):772. Available from: https://doi.org/10.1186/s12903-025-06115-x
14. Elbehwashy MT, Hosny MM, Elfana A, Nawar A, Fawzy El-Sayed K. Clinical and radiographic effects of ascorbic acid-augmented platelet-rich fibrin versus platelet-rich fibrin alone in intra-osseous defects of stage-III periodontitis patients: a randomized controlled clinical trial. Clinical Oral Investigations [Internet]. 2021 [cited 8 May 2026];25(11):6309-6319. Available from: https://doi.org/10.1007/s00784-021-03929-1
15. Ozmeric N, Enver A, Isler SC, Gökmenoğlu C, Topaloğlu M, Selamet H, et al. Evaluating the effects of chlorhexidine and vitamin C mouthwash on oral health in non-surgical periodontal therapy: a randomized controlled clinical trial. Scientific Reports [Internet]. 2025 [cited 8 May 2026];15(1):3703. Available from: https://doi.org/10.1038/s41598-025-88100-6
16. Nisha S, Bettahalli Shivamallu A, Prashant A, Shashikumar P, Ganganna A, Das D. Effect of non-surgical periodontal therapy and vitamin C supplementation on total antioxidant capacity in patients with chronic generalised periodontitis: a randomised controlled trial. Journal of Oral Biology and Craniofacial Research [Internet]. 2023 [cited 8 May 2026];13(4):511-516. Available from: https://doi.org/10.1016/j.jobcr.2023.05.003
17. Jaafer SS, Alasady MS, Hanfoosh HS. Evaluation of Vitamins C, D, and E in Periodontal Health Before and After Therapeutic Intervention. Odontia: Journal of Dental Innovations and Oral Health. 2025;2(1):1-8
18. Dixit D, Kaushal S, Lal N, Singh R, Verma UP, Pathak AK. Sulfiredoxin levels in gingival crevicular fluid: a new antioxidant defence system-case control study. Journal of Oral Biology and Craniofacial Research [Internet]. 2025 [cited 8 May 2026]; 15:1373-1377. Available from: https://doi.org/10.1016/j.jobcr.2025.08.020
19. Mohideen K, Chandrasekaran K, Veeraraghavan H, Faizee SH, Dhungel S, Ghosh S. Meta-analysis of assessment of total oxidative stress and total antioxidant capacity in patients with periodontitis. Disease Markers [Internet]. 2023 [cited 8 May 2026];2023(1):9949047. Available from: https://doi.org/10.1155/2023/9949047
20. Dönmez MF, Balci N, Ergene Sunkar A, Toygar H, Kantarcı A. Taurine levels in periodontitis: a pilot study. Journal of Periodontology [Internet]. 2025 [cited 8 May 2026];96():984-993. Available from: https://doi.org/10.1002/JPER.24-0574
21. Rosa A, Pujia AM, Arcuri C. The protective role antioxidant of vitamin C in the prevention of oral disease: a scoping review of current literature. European Journal of Dentistry [Internet]. 2024 [cited 8 May 2026];18(4):965-970. Available from: https://doi.org/10.1055/s-0044-1786845
22. Ustianowski Ł, Ustianowska K, Gurazda K, Rusiński M, Ostrowski P, Pawlik A. The role of vitamin C and vitamin D in the pathogenesis and therapy of periodontitis: narrative review. International Journal of Molecular Sciences [Internet]. 2023 [cited 8 May 2026];24(7):6774. Available from: https://doi.org/10.3390/ijms24076774
23. Van der Velden U. Vitamin C and its role in periodontal diseases: the past and the present: a narrative review. Oral health & preventive dentistry [Internet]. 2020 [cited 8 May 2026];18(2):115-124. Available from: https://doi.org/10.3290/j.ohpd.a43334
24. Aytekin Z, Toraman A, Karaçam K. Investigation of effects of local vitamin C application on inflammatory response and periodontal tissue destruction in rat periodontitis model. Selcuk Dental Journal [Internet]. 2023 [cited 2026May.082026];10(2):371-376. Available from: https://doi.org/10.15311/selcukdentj.1115391
25. Espinoza Arias CJ, Pulgarin Fernández CM. Frequent oral pathologies in adults with fixed orthodontic appliances. Literature review. Anatomía Digital [Internet]. 2023Nov.3 [cited 2026May.08];6(4.1):35-8. Available from: https://doi.org/10.33262/anatomiadigital.v6i4.1.2767
26. Muñoz Delgado MS, Cabrera Padrón MI. Periodontal health in patients with fixed orthopedic devices. Literature Review. Anatomía Digital [Internet]. 2024Mar.5 [cited 2026May.08];7(1.2):76-5. Available from: https://doi.org/10.33262/anatomiadigital.v7i1.2.2996
27. Abad Cordero DS, Reinoso Ortiz SA, Cedeño Zambrano DA, León Velastegui M. Deep margin elevation, systematic review. Anatomía Digital [Internet]. 2023Dec.28 [cited 2026May.08];6(4.3):401-24. Available from: https://doi.org/10.33262/anatomiadigital.v6i4.3.2813