Nutrient Effects on Collagen Healing and Maintenance

Collagens constitute about 30% of the total body proteins, and it is involved in forming the matrix of dentin, cementum, alveolar bone, and the periodontal ligament.  About 10 to 15% of the amino acids that make up collagen are hydroxyproline, which is essential in stabilizing the structure of collagen through cross-linking.  Marginal or deficient nutrient intakes may be associated with changes in the connective tissue that result in altered growth and wound healing, but studies of these effects are difficult due to the "long half-life of connective tissue proteins and the extracellular nature of events."⁷

Animal models suggest that even short-term fasting (4 days) results in a 40% reduction in collagen production, and low intakes of protein result in a significant reduction in collagen synthesis.⁸ However, it is unclear how this finding might apply to collagen synthesis and wound healing in humans.

Ascorbic acid (vitamin C) is involved in hydroxyproline formation and has been shown to stimulate collagen formation by fibroblast three- to four-fold in vitro.⁹  The classic symptoms of scurvy (vitamin C deficiency) includes swollen and inflamed gingiva, loosening of the teeth, follicular hyperkeratosis, perifollicular hemorrhage, weakness, malaise, sore joints, bruising, and weight loss.^10,11  The most recent epidemiologic data from the National Health and Nutrition Examination Survey (NHANES III) suggests the odds of having periodontal disease are 1.2 times greater in those with low dietary vitamin C intakes.¹²  In the same study, smokers and former smokers with low vitamin C intakes are at 1.6 times greater risk of having periodontal disease.¹²  Even though overt deficiencies are seldom seen in the healthy population, marginal vitamin C intakes may be a conditioning factor in the development of gingivitis because of the underhydroxylation of the collagen and increase in intracellular permeability of blood vessels as well as the sulcular epithelium.^10,13  However, megadoses of vitamin C have not been shown to have a strong effect on the healing response in initial periodontal therapy and, therefore, pharmacologic doses should not be recommended to patients until further research confirms its utility.

Vitamin A is involved in collagen metabolism by affecting cell differentiation.¹⁴  In animal studies, supplemental vitamin A increases the breaking strength of healing wounds, and in vivo it has enhanced collagen accumulation.¹⁵  The caveat to remember is excessive intakes of vitamin A result in an increase in collagen catabolism and resorption of bone so moderation is the key.^7,11

Boron, copper, manganese, silicon, and zinc are also important participants in collagen metabolism and wound healing.  Copper in particular is an essential nutrient for the cross-linking of both collagen and elastin.16  A deficiency results in a decrease in the tensile strength of collagen and osteoporotic-like bone lesions.16  Zinc is important for its effect on protein synthesis including DNA and RNA synthesis.  Zinc concentrations increase around the wound margin during formation of granulation tissue, scar formation, and re-epithelization.17 Zinc, copper, and iron all compete for absorption so they need to be kept in balance for optimum wound healing.  Supplementation of minerals above the recommended daily allowance (RDA) is not recommended at this time.

Click Here To Navigate Within Article >> Abstract Introduction Nutrition in Periodontal Health Integrity of the Oral Mucosa Nutrient Effects on Collagen Healing and Maintenance Maintenance of Calcified Tissues Maintenance of the Host Immune Response Patient Populations at Nutritional Risk Dietary Recommendations References About the Authors
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Citation Number: Vol. 2, No. 2, Page 039