The influence of our diet on periodontal health
Do nutritional habits promote the development of gingivitis?
It is well established that oral health is influenced by oral hygiene, genetic factors and by systemic health.
What about nutrition? If indeed there is a relationship between diet and periodontal health, what is the evidence and how did studies establish the relationship?
In a study undertaken in Bern (Switzerland), Baumgartner, et al. examined the oral health of two families (10 people) who lived in Stone Age conditions for a month while participating in a television programme. This meant they ate a Stone Age diet and completely abandoned domestic dental care with toothbrush and toothpaste. The results are fascinating. Although pronounced plaque coverage was observed in almost all participants, no participant developed periodontitis. Moreover, there was a marked decrease in BoP levels compared to the baseline. Interestingly, it became clear that colonization with Tannerella forsythia (strongly implicated in the onset of periodontitis) was significantly reduced after four weeks - without antibiotics or chemotherapeutic agents.
Archaeological investigations on the skulls and jawbones from the Neolithic period support the results of the Baumgartner study. Adler, et al. succeeded in analysing the bacterial DNA from tartar of approx. 7000-year-old teeth from hunters and gatherers. The results of the analysis showed that humans at that time had three times as many different types of bacteria in their mouth, and yet were in a healthy periodontal state.
The analysis of further tartar samples revealed a dramatic decline in bacterial diversity with the onset of agriculture and the associated significant reduction in nutritional diversity, In these teeth, it was already possible to identify periodontitis-related alveolar bone loss. The authors concluded that modern oral microbiotic ecosystems are markedly less diverse than historic populations, which might be contributing to chronic oral (and other) disease in post-industrial lifestyles.
In summary, it is clear that diet is associated to oral bacterial diversity, and that less diverse oral microbiota may encourage the overgrowth of pathogenic bacteria. Similarly, accumulating data indicates that an imbalance of the oral microbial flora seems to contribute to both oral diseases and systemic diseases.
Can we therefore speculate that plaque alone may not cause gingivitis, but instead that plaque composition also plays a significant role? There are signs to back up this hypothesis.
Lettuce juice extract for gingivitis prevention
Given that diet influences metabolic function, does it also affect the composition of oral and gut microbiota? The fact that high-fibre diets are beneficial to health has been a well-known fact for some time. We now know that diet also has a considerable effect on the composition of the digestive (oral and gut) microbiota and that poor modern diets are associated with an intestinal microbiome that increases the risk of several chronic diseases, including inflammatory bowel disease, obesity, type 2 diabetes, cardiovascular disease, and cancer.
This is further backed up by new data from a randomised-controlled study carried out at the University of Würzburg in Germany. In this study, 44 periodontal recall patients with mild to moderate gingivitis were recruited. All patients received periodontal maintenance therapy without further oral hygiene instructions and were randomised to either a nitrate rich lettuce juice drink, or a placebo drink - three times daily for a period of 14 days. All patients were on a strict nitrate-poor diet. In the test group with the nitrate-rich beverage, the nitrate intake was increased by approx. 200 mg nitrate/day. The results after just 14 days were fascinating. There was a significant difference in the mean GI values (GI-gingival inflammation) in the nitrate group compared to the control group. The authors concluded that dietary nitrate consumption may be a useful adjunct in the control of chronic gingivitis.
A diet low in simple carbohydrates promotes oral health
At the University of Freiburg in Germany , ten subjects changed their diet for four weeks. The new diet was low in simple carbohydrates (i.e. foods containing easily digested natural sugars that provide quick energy, unlike healthy complex carbohydrates such as whole grains, beans, legumes, and oats), rich in omega-3 fatty acids, vitamin D and vitamin C. It was also designed to include antioxidants and fibre. The control group did not change their dietary behaviour. Again, although plaque levels remained constant in both groups, gingival inflammation (GI), bleeding on probing (BoP), and periodontal inflamed surface area (PISA) decreased by roughly 50% in the test diet group. This reduction was significantly different compared to the control (unchanged) diet group. This study again indicates that a healthy diet has clear influence on oral health (as measured by gingival and periodontal inflammation).
Dietary recommendations for Oral Health
Given that the relationship between diet and oral health is established, it is clear that good nutrition has a role in preventing tooth decay and gum disease. Recommendations for the prevention of chronic disease and oral heath by means of diet are in fact one and the same:
- Ensure generous consumption of fruits and vegetables and adequate folic acid intake.
- Replace saturated and trans fats with unsaturated fats, including sources of omega-3 fatty acids.
- Consume cereal products in their whole-grain, high-fiber form.
- Limit consumption of all of the following: sugar and sugar-based beverages, sodium intake, and excessive caloric intake from any source.
 Wölber, J. et al. Entzündungsparameter reduzieren. Ergebnisse einer randomisierten, kontrollierten, klinischen Studie. Jahrestagung der AfG, Mainz, 7.- 8. Januar 2016.