A Combination of Vitamin C, Vitamin E, and Lysozyme Treatment for Chronic Periodontitis

Written by Angeline A. De Leon, Staff Writer. Supplementing with a combination of vitamin C, vitamin E, lysosome and carbazochrome significantly improved gingival inflammation in study participants with chronic periodontitis.

Periodontitis, a serious gum infection associated with damage to soft tissue and bone supporting teeth, involves local inflammation triggered by periodontal bacteria ¹. The pathogenesis of periodontitis involves a host of biological factors, including pro-inflammatory cytokines and reactive oxygen species (ROS) ^2,3. While research has focused on finding ways to control the gingival inflammation associated with periodontitis through bisphosphonates and nonsteroidal anti-inflammatory agents ^4,5, there is evidence to suggest that antioxidant-rich micronutrients, such as vitamins, carotenoids, and polyphenols, can also serve as a form of periodontal therapy by effectively reducing oxidative stress ^6,7. Clinical studies show, for example, an inverse relationship between vitamin C and vitamin E and periodontal disease ^8,9. In a research study ¹⁰ published by BMC Oral Health (2019), researchers sought to determine whether a fixed-dose combination of vitamin C and vitamin E, along with lysozyme (an antimicrobial enzyme) and carbazochrome (a hemostatic agent used to improve gingival bleeding ¹¹ could improve gingival inflammation and other measures of periodontal health in patients with chronic periodontitis.

A total of 93 patients (aged 19-80 years) with generalized chronic moderate periodontitis were enrolled in a randomized, controlled, double-blind prospective trial. Subjects were randomly assigned to receive either a fixed-dose combination of vitamin C (150 mg), vitamin E (10 mg), lysozyme (30 mg), and carbazochrome (2 mg) (CELC) or placebo for the first 4 weeks, with both groups receiving CELC for the remaining 4 weeks of the study. At baseline and at the end of Week 4 and Week 8, participants underwent a periodontal examination, which included assessment of gingival index (GI), plaque index, (PI), probing depth (PD), gingival recession/enlargement (GR/GE), and clinical attachment level (CAL). Measurements were performed at 4 sites for GI and PI and 6 sites for PD and CAL per tooth, using a periodontal probe. A visual analogue scale (VAS) was also administered to assess subjective reports of discomfort, bleeding, and swelling in the gingiva.

Analyses showed that for the CELC group, GI significantly diminished from baseline to Week 4 (p < 0.001) and from baseline to Week 8 (p < 0.001). Compared with the control group, mean GI in the CELC group significantly decreased over the course of 4 weeks (p = 0.015). After controlling for age, gender, and visit times, the CELC group exhibited an improvement in GI that was 2.5 times that of the control group (p = 0.022). VAS scores in the CELC group was also seen to significantly diminish, in comparison to the control group, after 8 weeks (p = 0.027). Although no between-group differences were found for PI or PD, within the CELC group, PI showed significant reduction from baseline to Week 8 (p = 0.045) and PD showed significant reduction from baseline to Week 4 and Week 8 (p = 0.022, p = 0.018, respectively).

Based on study findings, researchers conclude that a combination of vitamin C and vitamin E, along with lysozyme and carbazochrome, can effectively diminish gingival inflammation in patients suffering from chronic moderate periodontitis. Significant improvement in the mean change of GI was evident for the CELC group within the first 4 weeks, with subjects showing about 2.5 times greater improvement than the control group. Improvements in self-reported gingival discomfort was also improved in CELC patients. Although no changes were found for other periodontal parameters, evidence from the study underscores the valuable clinical effects associated with CELC. Findings are consistent with previous studies suggesting the role of micronutrients like vitamins C and E in supporting periodontal health ^{7,8, 9}.Additional studies are needed to determine whether the effects observed in the present study are the result of a synergistic action or are primarily driven by the anti-inflammatory effects of vitamins C and E. The current study could also be strengthened by including a larger sample size and more comprehensive clinical data based on full mouth examinations of patients in the future.

Source: Hong JY, Lee JS, Choi SH, et al. A randomized, double-blind, placebo-controlled multicenter study for evaluating the effects of fixed-dose combinations of vitamin C, vitamin E, lysozyme, and carbazochrome on gingival inflammation in chronic periodontitis patients. BMC Oral Health. 2019; 19: 40. DOI: 10.1186/s12903-019-978-2.

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Posted August 19, 2019.

Angeline A. De Leon, MA, graduated from the University of Illinois at Urbana-Champaign in 2010, completing a bachelor’s degree in psychology, with a concentration in neuroscience. She received her master’s degree from The Ohio State University in 2013, where she studied clinical neuroscience within an integrative health program. Her specialized area of research involves the complementary use of neuroimaging and neuropsychology-based methodologies to examine how lifestyle factors, such as physical activity and meditation, can influence brain plasticity and enhance overall connectivity.

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