It has long been acknowledged that the food you eat can have a significant impact upon the levels of inflammation in the body which is associated with a range of diseases such as heart disease, depression, and diabetes. Periodontitis may be part of this picture.
How Do Carbohydrates Affect Periodontal Health?
Carbohydrates differ in composition and so their inflammation-triggering effect will also differ. It largely depends on the type of carbohydrate: high glycemic index foods, like simple or refined carbohydrates (sugar, baked goods, white rice (apart from basmati), potatoes, etc.) can result in spikes in blood sugar which stimulates the release of cytokines (pro-inflammatory markers) and advanced glycation end (AGEs) molecules, or AGEs which trigger inflammation. Spikes in blood sugar also lead to increased levels of insulin which over time can lead to insulin resistance.
One study reported that a diet with an excess of refined carbohydrates can increase inflammation of the gums and periodontal tissue. In this study, the participants that ate a low-carbohydrate, anti-inflammatory diet displayed a marked improvement in oral health after the four-week study period. Interestingly, even though plaque levels stayed the same in both groups, inflammation in the low-carb group was reduced by half after four weeks. In the group eating a typical Western diet full of refined carbohydrates, gum inflammation actually increased over that time.
How are vitamins important for periodontal health?
Vitamins are necessary for general health and optimum functioning; likewise, various vitamins are required in order to maintain the health of oral and periodontal tissues.
Vitamin A can be found in different forms: preformed (in dairy, fish and meat); provitamin A such as beta-carotene (found in plant-based products such as fruits and vegetables); and retinol (known as Vitamin A1) found in organ meat, oily fish and eggs as well as dairy. It is one of the fat-soluble vitamins which means it is absorbed along with fats and can be stored in the body's fatty tissue. Owing to its antioxidant potential (and alongside vitamin K, being required to enable the conversion of vitamin D into its active form) vitamin A has been used to supplement periodontal treatment. A healthy individual needs approximately 900 µg/day.
Vitamin B Complex
The vitamin B complex consists of vitamins B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine, pyridoxal, pyridoxamine) B7 (biotin), B9 (folic acid), and B12 (cobalamins). The B vitamins are necessary for cell growth and influential in the quality of blood, both of which are essential for healthy gums. Studies indicate that B-vitamin complex supplementation may promote and even speed up the healing of wounds after periodontal flap surgery.
Studies have found that smokers may have reduced serum vitamin B9 levels, which may lead to periodontitis. Alongside anemia, vitamin B12 deficiency may also cause gums to bleed. Furthermore, a recent study purported there was an inverse association between serum vitamin B12 levels and the severity of periodontitis meaning that the lower the levels, the more severe the periodontitis. Vitamin B can be found in whole grains, meat, dairy, legumes, nuts and seeds, green leafy vegetables and fruits.
Vitamin C is essential for tissue repair and growth and vitamin C deficiency is known to cause bleeding and inflamed gums. Without vitamin C, collagen cannot be formed which is necessary for healthy connective fibers, which maintain strong tissues and blood vessels that secure teeth into gums. Vitamin C is thought to lower the risk of periodontal disease and perhaps facilitate healing of the periodontium; it is renowned for supporting the immune system which may perhaps be due to it having strong antioxidant properties.
Vitamin C may also be used as a key ingredient in coatings and/or gel forms to assist with the bone connection necessary for successful dental implants and to improve periodontal healing following surgery. Vitamin C can be found in many fruits and vegetables but especially citrus fruits as well as some crucifers such as brussels sprouts and broccoli.
Low vitamin D levels are associated with an increased incidence of chronic inflammatory diseases generally, due in part to its anti-inflammatory properties. Clinical studies indicate that a deficiency of dietary vitamin D can cause gingival inflammation and that periodontitis is more prevalent among those who are deficient. In addition, vitamin D deficiency may also cause a delay in post-surgical periodontal healing.
Vitamin D can be found in protein foods such as oily fish, liver, dairy products, soy, eggs, for example.
Vitamin D is of interest to those concerned with periodontal health because of its known benefits to bone metabolism as well as anti-inflammatory activity. Most studies seem to evaluate vitamin D alongside calcium supplementation which can make isolating the effect of vitamin d difficult however studies report positive outcomes with supplementation, particularly in terms of a decrease in the amount of bone destruction and inflammation. Therefore, it may have a positive impact upon the rate of tooth loss in vitamin-deficient patients with periodontal diseases.
Vitamin E is regarded as a powerful antioxidant that is thought to assist with tissue healing and especially with reducing gum bleeding. A few studies have reported positive results in terms of vitamin E and the maintenance of periodontal health and minimizing inflammation. Furthermore, reduced vitamin E levels have been observed in patients with periodontal diseases in comparison to those without. Diets high in vitamin E include those containing poultry, meat, fish, nuts, seeds, and cereals.
Vitamin K2 works in conjunction with Vitamin D. Vitamin K is needed (along with vitamin A) in order to convert of Vitamin D into its active form. It has an anti-inflammatory impact upon the immune system in the following ways:
Reducing inflammatory markers production
Regulating inflammation-causing immune cells
Decreasing fibroblast (commonly-found connective tissue) cells
Vitamin K is generally found in dark green leafy vegetables.
Periodontal health And The Effect of Antioxidants
Certain vital vitamins and minerals are dietary antioxidants and also contain certain important phytochemicals that help to resist periodontal damage; they can actually protect cells from most of the diseases that are associated with inflammation and the process of aging.
Dietary components that can function as antioxidants have shown possible results in improving periodontal health and healing. These include:
Vitamins A, C, and E have all been noted to moderate the anti-oxidant defense system. So far, dietary vitamins C and E have been examined for their possible role in reducing oxidative stress occurring in the periodontium.
Lycopene is a red pigment found in vegetables like tomatoes, carrots, and watermelons and studies suggest that lycopene supplementation may improve periodontal health, as well as assisting therapeutically in periodontitis management.
Topical forms of melatonin may be used alongside surgical and non-surgical periodontal therapy. In fact, animal studies indicate that melatonin reduces the bone reabsorption resulting from periodontitis.
Dietary minerals, trace elements, and periodontal health
Mineral deficiencies also have an impact on periodontal health and so it is worth exploring the association between mineral intake and periodontal health.
Calcium can be found in dairy products, eggs, tinned bony fish, pulses such as lentils and beans, leafy vegetables, nuts, and seeds and is necessary for tooth and bone formation; indeed supplementation is thought to improve the outcome of non-surgical periodontal treatment. Applying calcium locally or topically is thought to enhance osseo-integration (bone integration necessary to allow implants to 'take').
Magnesium is required for cell metabolism and bone formation and it is magnesium rather than calcium, that generates hard enamel that resists decay. Magnesium deficiency is also associated with periodontal disease and so supplementation may improve dental health and result in more successful non-surgical periodontal treatment outcomes. Magnesium-rich foods include dark chocolate/cacao, seafood/shellfish, green leafy vegetables, soybeans, nuts, and marine vegetables.
Iron and zinc
Iron and zinc may have anti-oxidant effects on the periodontium but overall, both are essential to immune health, which in turn is necessary for a healthy mouth. Animal studies suggest that deficiency increases the risk of developing periodontal disease. Zinc, in particular, is thought to help with wound healing and assists with the transportation of vitamin A to fight inflammation, both of which are key in the fight against gum disease. Red meat, tuna, dry beans, and spinach are full of iron, while zinc can be found in protein-rich foods, spinach, and grains.