href="#ulink_bd6f63a5-aada-5a4f-ad58-a22e0a6c6187">10] studies. Some indirect evidence on the value of calcium (and vitamin D) supplements in preventing periodontal disease (bone loss from the hip and tooth loss were determined) was provided in an aforementioned study [13]. A trend for better periodontal health in participants taking calcium and vitamin D supplements was observed in a small cross-sectional study (51 participants) [68, 69]. However, further studies are necessary as there is insufficient evidence to recommend an appropriate dose of calcium and vitamin D.
Similar to potassium, the evidence for phosphorus is equivocal as 2 studies reported no evidence, whereas one did [61]. It could be argued that because of phosphate’s importance in calcium metabolism, phosphorus deserves more attention.
Saliva
It would perhaps be logical to assume that an increase in, for example, calcium intake would result in an increase in salivary calcium via systemic means, thereby reducing risk to caries, erosive tooth wear, and potentially also periodontal disease. However, this does not appear to be the case as salivary calcium (approximately 24 mg calcium is secreted via saliva daily [70]) is directly related to the tightly controlled plasma calcium concentration with excess calcium being excreted via the kidneys rather than in saliva [71] – intake of a single dose of calcium (1,215 mg) had no effect on salivary and plasma calcium concentrations [72]. Therefore, saliva does not appear to be contributing to calcium (and phosphate) homeostasis. Furthermore, it must be noted that our understanding of the intra-oral pharmacokinetics of the macroelements, when administered topically, is still rather poor.
Conclusions
The macroelements calcium, potassium, sodium, phosphorus and chlorine are of vital importance to human life. Adequate daily intake of these elements is required to maintain a wide range of bodily functions. From an oral health perspective, calcium in particular but also phosphate play a predominant role in maintaining the teeth and their function. Inadequate calcium intake has also been linked to an increased severity of periodontal disease. The roles of sodium, potassium, and in particular chloride, in maintaining oral health, however, are largely unstudied but they appear to be of limited relevance.
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