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Table 2 Study and participants characteristics, case definition of periodontitis, intervention, and summary of result (N = 6)

From: Efficacy of vitamin C supplementation as an adjunct in the non-surgical management of periodontitis: a systematic review

Author, year, country

Study design, follow-up period

Sample size calculation, random allocation, examiner calibration

Participant characteristics: age range, gender, mean age, ethics approval; pre-treatment instruction

Periodontitis definition, probe used, professional who performed SRP

Covariates and dropout

Intervention (Test)

Intervention (Control)

Summary of result

Kunsongkeit et al., 2019 [16], Thailand

RCT-double-blind, 1 and 2 month

Yes, yes, NR

31 uncontrolled type 2 diabetes mellitus and periodontitis patients; all participants received OHI + motivation until PI was ≤ 0.5 pre-treatment

PI, GI, SBI, PD, CAL; UNC 15-probe

Plasma vitamin C, FBS, HbA1c; no dropout

500 mg/day vitamin C [30 days] + FMSRP

FMSRP + placebo

The periodontal parameters of PI, SBI, GI, PD, and CAL significantly improved in the treatment group and the placebo group. No significant differences were observed in periodontal parameters in treatment group and the placebo group.

Chitsazi et al., 2017 [17], Iran

RCT, single masked; 3 and 6 month

Yes, yes, NR

60 periodontitis patients, 23-65 years, mean age 41 years, three groups [20 pts each], all participants were given OHI to toothbrush with modified bass technique + flossing twice a day

GI, PD, CAL; UNC 15-probe; periodontist

Age, sex; no dropout

Treatment group 1, NSPT + melatonin + vitamin C, treatment group 2, and NSPT + melatonin. All groups received NSPT using ultrasonic scaler and curettage. Melatonin dose, 2 mg/day for 4 weeks, and vitamin C dose, 60 mg/day for females and 75 mg/day for males for 4 weeks

NSPT only

Significant improvement in PD and CAL scores at 6-month interval compared to 3 months in the melatonin+ vitamin C group (P < 0.05), while the differences in PD and CAL scores between the mentioned intervals were not significant between the control and melatonin groups (P > 0.05).

Dodington et al., 2015 [18], Canada

RCT, NR; 3, 4 month

Yes, yes, yes

98 chronic generalized periodontitis patients [PD of 4 mm or greater in at least 30% of probed sites], mean age 59 years for non-smokers, 53 years for smokers

PD, BoP, % of sites with PD > 3 mm, electronic probe, two oral hygienists

FFQ, age, sex, health condition, medication used, smoking status, beta-carotene, alpha-tocopherol, vitamin D, alpha-linolenic acid (ALA), EPA, and DHA; 31 dropout or lost to follow-up or had missing data

NSPT in non-smokers + dietary intake recording; vitamin C intake (both treatment and control):

1. 42–107 mg/day

2. 108–149 mg/day

3. 151–241 mg/day

NSPT in smokers

A dose-response relationship was observed between vitamin C [dietary and total] intake and reduction in % of sites with PD > 3 mm in people who underwent NSPT. Fruits and vegetables, beta-carotene, alpha-tocopherol, EPA, and DHA are associated with reduced PD after SRP in non-smokers, but not smokers, with chronic generalized periodontitis.

Shimabukuro et al., 2015 [21], Japan

RCT, double-blind; 3 month

Yes, yes, yes

300 participants [150 test, 150 control], 20–64 years

GI, GSI

Gingival redness, gingival severity index, total antioxidant activity (TAOC) of the saliva

Dentifrice containing l-ascorbic acid 2-phosphate magnesium salt [0.3%]

Dentifrice without APM

GI, gingival redness, and GSI significantly reduced in the intervention group as compared to the control group. The result suggested that dentifrice containing ascorbic acid were effective in reducing gingivitis.

Gokhale et al., 2013 [23], India

RCT, double blinded; 14 days

NR, NR, NR

121 participants with SBI ≥ 2, 30–60 years, four groups: 30 healthy without periodontitis, 30 healthy with periodontitis, 30 healthy with chronic gingivitis, and 30 diabetics with periodontitis

PI, PPD, SBI; periodontitis was defined based on Armitage 1999 definition; chronic gingivitis was defined based on SBI; single dentist

Plasma ascorbic acid concentration

Group1: SRP over two appointment + ascorbic acid supplementation [450 mg] as chewable tablet

SRP over two appointment + lemon flavored chewable tablet

Vitamin C supplementation as an adjunct to NSPT significantly improved the SBI in participants with gingivitis, and diabetics with periodontitis.

Abou Sulaiman and Shehadeh, 2010 [19], Syria

RCT, single masked; 1 and 3 months

Yes, yes

60 chronic periodontitis patients [30 treatment group and 30 control group]

PPD, CAL, BOP, GI; standard periodontal probe; single specialist; periodontist

Age, sex; total antioxidant activity (TAOC) of plasma (1 month after periodontal treatment)

Group 1: NSPT + vitamin C (dose of vitamin C, 2000 mg a day for 4 weeks); group 2: NSPT with no vitamin C

NSPT only

There were significant improvements in PPD, CAL, GI, and BOP scores at the 1-month and 3-month interval post-treatment in both the ChP1 and ChP2 groups compared to baseline measures. Vitamin C did not offer a therapeutic effect. No significant difference between group plasma levels post 1-month.