Association between Serum Vitamin D Status and Gingival Bleeding among School-Aged Children: A Cross-Sectional Study

Abstract

Background: Vitamin D (VD) has immunomodulatory and anti-inflammatory effects that may influence the health of gingiva. Current pediatric evidence, however, remains limited, particularly in South Asia where deficiency is common. Objective: To examine the association between serum vitamin D status and gingival inflammation, measured by bleeding on probing percentage (BOP%), among school-aged children in Lahore, Pakistan. Materials and Methods: This comparative cross-sectional study was conducted from 1st Feb 2023 to April 30th 2024, after approval from the ERB of the University of Lahore (REC-UOL-/577/11/23), dated: 27th January 2023. Two hundred children aged 8 to 16 years were recruited using consecutive sampling and grouped by serum 25-hydroxyvitamin D [25(OH)D] as sufficient (30–100 ng/mL; n=100) or deficient (<30 ng/mL; n=100). BOP was recorded using a WHO probe at six sites per tooth for erupted permanent teeth; the primary outcome was BOP%. Group differences were evaluated using an independent samples t-test. A univariate general linear model assessed whether the association persisted after adjusting for covariates. Results: BOP% was significantly lower in the VD sufficient group (22.25±1.16) than the deficient group (24.96±1.16), with a mean difference of -2.71 percentage points (95% CI: -3.03 to -2.38; p<0.001). In the adjusted model, VD status showed a strong association with BOP% (F=251.12, p<0.001; partial η²=0.567; adjusted R²=0.569). Conclusion: VD deficiency was independently associated with increased gingival bleeding in school-aged children, suggesting VD status contributes to early gingival inflammatory burden in this population. Keywords: Gingiva, Pediatrics, Micronutrients, Deficiency, Inflammation.