Systemic inflammation, often diet-related such as type 2 diabetes mellitus, has been directly linked to periodontal disease. Though it may be a bidirectional link, as poor nutrition may influence the onset of systemic diseases that preclude the onset of periodontal disease, there is also the issue of poor diet due to loss of function from periodontal disease. In a recent systematic review published in February 2020 in the journal Nutrition Reviews, the authors aimed to “investigate the direction of the association between dietary intake and periodontal health in community-dwelling older adults > 60 years.”1
The authors note that only one other systematic review has been published that assessed the association between nutrients and periodontal disease. This study was inconclusive, stating no association or weak evidence of an association of nutritional deficiencies and periodontal disease in elderly people. This previous systematic review relied on serum levels to determine an association. The current review will evaluate literature that focused on dietary intake rather than serum levels.
Nine papers met the inclusion criteria for the current systematic review. Determining specific nutrient’s role in the onset and progression of periodontal disease is quite difficult as all the studies included in the review were conducted in developed countries that tend to consume nutrients in aggregate rather than in isolation. Furthermore, some nutrients are counteracted by other foods ingested (e.g., calcium may be counteracted by saturated fats).
Two studies included in the review assessed the relationship between dietary calcium and periodontal disease, the conclusions on each were conflicting. One study found dairy intake was inversely associated with periodontal disease while the other found no substantial differentiation. These conflicting results show a need for further quality research on the association of calcium and periodontal disease.
Two other studies included assessed the association between vitamin C and periodontal disease. These two studies also had conflicting results. The conflicting results may be due to the methods used, nonetheless again this indicates the need for further quality studies. Only one study assessed overall dietary intake, however, the food grouping was unconventional and was ultimately a huge limitation.
Several studies were considered weak in quality making it unable to reach conclusions. Other limitations included the lack of diversity among the participants, as most were Japanese or Caucasian. At least one study had a very small sample size (n=36) which is not representative of a larger population. Additionally, several studies did not control for poor oral hygiene, which could be a huge confounder in studies assessing periodontal disease.
Though there were multiple limitations, the authors confirm a relationship was identified between dietary intake and periodontal health. All the studies included assessed the same direction of association from dietary intake to periodontal disease which leaves questions regarding the possibility of a bi-directional association.
The authors conclude by stating, “Based on the available literature found by this systematic review, positive associations were identified between dietary intake and periodontal health among the populations in developed countries, as shown by the results of the 9 reviewed studies. Included studies identified associations between periodontal disease and lower intakes of DHA, vitamin C, vitamin E, beta-carotene, milk, fermented dairy products, dietary fiber, fruits and vegetables, and higher intakes on the n-6 to n-3 PUFA ratio and SFAs. The overall evidence base needs to be further explored to assess whether periodontal health leads to dietary change in older adults.”
Do you talk with your patients about nutrition? Have you noticed a correlation between patients who have a healthy diet vs those who do not regarding periodontal disease?
- O’Connor JP, Milledge KL, O’Leary F, Cumming R, Eberhard J, Hirani V. Poor dietary intake of nutrients and food groups are associated with increased risk of periodontal disease among community-dwelling older adults: a systematic literature review. Nutr Rev. 2020 Feb 1;78(2):175-188. doi: 10.1093/nutrit/nuz035. PMID: 31397482.