Vitamin D deficiency and oral health in the Middle East and North Africa (MENA): A public health perspective.

Objectives: To examine evidence regarding the relationship between vitamin D deficiency and oral health in Middle East and North Africa (MENA) populations, where vitamin D deficiency and oral diseases remain important public health challenges, emphasizing biological mechanisms, dental caries, periodontal diseases, other oral outcomes, and public health implications. Methods: This narrative review synthesizes systematic reviews, meta-analyses, randomized controlled trials, observational studies, and regional public health reports identified in electronic databases and through reference screening, focusing on vitamin D deficiency, oral health outcomes, biological mechanisms, and preventive strategies relevant to MENA populations. Results: Evidence suggests that vitamin D contributes to oral health through tooth mineralization, calcium and phosphate homeostasis, immune regulation, antimicrobial defense, inflammation control, and alveolar bone maintenance. Low vitamin D status has been associated with dental caries, periodontal diseases, developmental enamel defects, alveolar bone loss, impaired wound healing, and oral mucosal conditions. Evidence regarding oral cancer remains insufficient to establish a relationship. Periodontal disease shares inflammatory and metabolic pathways with systemic conditions, particularly diabetes, and emerging evidence suggests a possible association with cognitive decline and dementia. However, evidence remains heterogeneous and predominantly observational; therefore, causality has not been established. The coexistence of vitamin D deficiency and a high oral disease burden in MENA supports integrated public health strategies based on shared risk factors and the Common Risk Factor Approach. Conclusion: Vitamin D deficiency should be considered a potentially modifiable component of oral health promotion rather than a standalone cause or treatment of oral diseases. Integrating nutritional strategies with established oral disease prevention programs may strengthen public health efforts throughout the MENA. Longitudinal studies and randomized controlled trials are needed to clarify causal relationships and guide evidence-based policy and clinical practice.