"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.