How to Treat Periodontitis with Diet

How to Treat Periodontitis with Diet

August 18, 2019 64 By William Morgan


“How to Treat Periodontitis with Diet” What’s the effect of nutrition
on periodontal disease? Periodontal disease is a
bacterial infection that results in inflammatory destruction of
the connective tissue and bone that supports the teeth, and is therefore one of the leading
causes of our teeth falling out. Like most infections though, how our
body responds may play a critical role. Yes, the presence of bacteria
is the primary cause, but a susceptible host is also
necessary for disease initiation. The standard explanation of periodontal
disease is the plaque theory: the buildup of plaque leads to
gingivitis, gum inflammation, which leads to periodontitis,
inflammation lower down beneath the gums.
But in some forms of periodontal disease plaque
doesn’t appear to play a critical role. Therefore, in the last few years,
there’s been more interest in the importance of systemic
health, our body’s response. In this respect, nutrition may
be of great importance since it’s been implicated in a number
of other inflammatory diseases, all of which carry elevated
periodontal disease risk. Traditionally, when we think of the
effects of nutrition on dental diseases, we’re only thinking about cavities. However, there’s been less research on
the role of diet in periodontal diseases. Well, if it’s about inflammation, one
would expect saturated fat-rich diets to make things worse,
increasing oxidative stress as well inflammation,
so we may want to cut down on saturated fat.
But, look, let’s not just speculate. I mean is there an association between
cholesterol levels and periodontitis? If not, it would be hard
to implicate saturated fat. But no, there does
appear to be a link. Those with high cholesterol do
appear to have up to double the risk. What about periodontal
conditions in vegetarians? A 100 vegetarians versus
non-vegetarians were studied, and those eating vegetarian did
have better periodontal conditions (less inflammation signs,
less periodontal damage, and better dental home care). However, it should be
considered that vegetarians may not just be avoiding meat, but are healthier in other ways,
like better dental home care. But do people who eat more
saturated fat get more periodontitis? Yes, about double the risk at
the highest levels of intake, and this study was in Japan
where they eat less than half the meat and dairy
compared to the US. The only way to know for sure, though,
is to do an interventional trial where you change people’s
diets and see what happens. In other words, you
have to put it to the test. And bone loss was indeed
magnified by a diet high in saturated fat
and cholesterol. But if you’re thinking, hmm…
that’s a weird-looking jaw, that’s because it was
a study done on rats. This is what I was looking for, though
the title kind of ruins the suspense. “A high-fiber, low-fat diet improves
periodontal disease markers” in terms of probing depth,
clinical attachment loss, and bleeding on probing—
all the standard measures. And, of course, eating a healthier diet,
body weight, blood sugar control, and systemic inflammation
improved as well. Ah, but that complicates things. Maybe their mouths got better just
because they lost so much weight? You can improve
periodontal disease with just bariatric surgery,
like stomach stapling. Well, after eight weeks on the diet,
they went back on their regular diet and so gained most
of that weight back, but the periodontal disease
improvements persisted, suggesting that it was more than just the weight
loss that lead to the improvements. They’re thinking maybe the high-fiber
diet altered their good gut flora, or maybe their oral flora?
What exactly was going on? Well, German researchers
took 20 women with mild to moderate chronic periodontitis, and for a year tried
to transition their diets towards more wholesome nutrition,
meaning more plant foods, more whole foods, more fresh foods,
trying to center their diets around vegetables and fruit,
whole grains, potatoes, and legumes—beans, split
peas, chickpeas and lentils. And after 12 months, the patients
showed a significant reduction of probing pocket depth,
gingival inflammation, and measured for the first time
decreased concentrations of inflammatory chemicals inside the
crevice between the tooth and gums, which are thought responsible
for the tissue destruction in periodontal disease, a
decrease by as much as 75%. And all the while, their oral
hygiene status didn’t change, suggesting it was
the diet that did it. But what was missing here?
A control group. But there’s never been any randomized,
double-blind, placebo-controlled trials of diet for periodontal disease
until now, which we’ll cover next.