Science Today

Is there a relationship between diet and oral health?

Introduction

Nutrition is the process by which human beings can get the nutrients they need in their day to day, but how does it all begin? We rarely ask that question, so it is important to know the role of the mouth at this stage since this is where feeding begins. Nutrition has been recognized as an essential component for the prevention of numerous chronic non-communicable diseases (NCDs) such as diabetes and hypertension, however, the impact it has on oral health as well as the prevention of major oral diseases has recently been studied.

Oral health

The main function of the mouth is to incorporate food into the digestive tract, which goes from digestion to absorption. Formed by the tongue and teeth, each with specific functions, such as the sense of taste and chewing for the formation of the food bolus. However, we cannot forget saliva, which plays a crucial role in food processing, lubrication, initiation of carbohydrate digestion with the enzyme amylase and control of oral infections.

Many oral conditions are preventable and treatable, however, the World Health Organization (WHO) in 2022, reported that, globally, about 3,500 million people suffer from some disease related to the oral cavity and that 3 out of 4 live in middle-income countries.

Main oral diseases

One of the most prevalent diseases around the world is tooth decay. Between 60 and 90% of school-age children are affected and almost 100% of the adult population. This condition is caused by the accumulation of bacteria on the surface of the teeth converting simple sugars into acids, which subsequently destroy the tooth. A bad brushing technique, together with a diet rich in sugars can cause cavities, pain and, sometimes, tooth loss and infection.

On the other hand, there are diseases that affect the gum, called periodontal diseases, being the most common gingivitis and periodontitis, caused by genetic and environmental actors that are determinants in its development, however, there are other factors widely studied, smoking and the presence of diabetes being the main ones. In its most severe form (periodontitis) the gums can separate from the teeth and the supporting bone, which causes them to loosen and subsequently lose the tooth. It is estimated that periodontitis affects approximately 19% of adults, representing more than 1,000 million cases worldwide.

The role of diet in oral health

The diet of the human being varies according to his culture, religion and availability of food and preferences. Composed of three main macronutrients: proteins, lipids and carbohydrates, the latter is the one with the greatest presence in the human body, providing up to 60% of our diet, and acts as the main supplier of energy. Much of it is found in foods such as fruits, dairy and vegetables, however, excess of these, particularly simple sugars, carries different types of risks and CNCDs, including those of the oral cavity. The National Health and Nutrition Examination Survey (NHANES), which included 2,437 young adults between the ages of 18 and 25, found that high sugar intake is associated with a high prevalence of periodontal conditions.

Depending on the type of carbohydrate consumed is the effect it can have on oral health. Excessive consumption of refined sugars promotes the imbalance between healthy and pathogenic bacteria that live in the oral cavity causing an inflammatory reaction, which leads to the appearance of this type of disease. A correct supply of micronutrients in the diet is important to maintain periodontal health and prevent its conditions. The antioxidant effects of certain vitamins such as A, C, E, folic acid and minerals such as calcium can have a positive effect on the prevention and treatment of periodontal diseases and, even, the deficiency of these is associated with their appearance.

Around the world, there are reports of vari-ous diets that have a positive impact on chronic diseases. The Mediterranean diet, the Okinawa diet, the Dietary Approaches to Stop Hypertension (DASH) diet and the vegetarian diet are perfect examples to prevent diseases related to the oral cavity, as well as cardiovascular diseases, diabetes and cancer. While a Western diet, which is characterized by excessive consumption of ultra-processed foods, refined sugars and saturated fats, increases the risk of CNCD and periodontals.

A study developed by researchers at the University of Würzburg, in Germany, evaluated the effect of a lettuce juice containing 200 mg of dietary nitrate (a nitrogenous compound present in green leafy vegetables) on gingival inflammation of 44 patients with chronic gingivitis who received non-surgical periodontal therapy (first line of treatment). They found that the group with the juice consumption had a greater reduction in gum inflammation, along with an increase in the number of good bacteria associated with oral health.

Conclusions

A correct diet characterized by a consumption rich in fruits and vegetables, as well as the correct contribution of vitamins and minerals can reduce inflammation of the gum, improve healing and reduce the number of teeth with bone loss, however, dental hygiene, as well as proper brushing are a fundamental part of the treatment of these diseases, therefore, balanced eating patterns rich in these compounds, together with correct professional advice to improve hygiene practices, could help for the prevention or treatment of oral diseases.

Erick Manuel Rodríguez

Student of the Degree in Nutrition. CUCS, UdeG.

Miguel A. Robledo Valdez

Clinical Nutritionist. PhD student in Translational Nutrition Sciences. CUCS. UdeG. Professor of Subject, Universidad La Salle. Saltillo, Coahuila.

Lucrecia Susana Carrera Quintanar

Head of the Food Science Laboratory. CUCS, UdeG. Member of the National System of Researchers level I.

Sources

1. World Health Organization. WHO fact sheet on Oral Health. [Internet]. 2022 [cited 2023 Jan 23]. Available from: https://www.who.int/news-room/fact-sheets/detail/oral-health

2. Fiorillo L. Oral Health: The First Step to Well-Being. Medicina . 2019. 7;55(10):676.

3. Isola G. The impact of diet, nutrition and nutraceuticals on oral and periodontal health. Nutrients. 2020;12(9):1–6.

4. Dodington DW, Fritz PC, Sullivan PJ, Ward WE. Higher intakes of fruits and vegetables, β -carotene, vitamin C, β -tocopherol, EPA, and DHA are positively associated with periodontal healing after nonsurgical periodontal therapy in nonsmokers but not in smokers. JNutr.2015;145(11):2512–9.

5. Woelber JP, Bremer K, Vach K, König D, Hellwig E, Ratka-Krüger P, et al. An oral health optimized diet can reduce gingival and periodontal inflammation in humans - a randomized controlled pilot study. BMC Oral Health. 2016;17(1):1–8.

6. Martinon P, Fraticelli L, Giboreau A, Dussart C, Bourgeois D, Carrouel F. Nutrition as a Key Modifiable Factor for Periodontitis and Main Chronic Diseases. JClinMed.2021;10(197).

7. Jockel-Schneider Y, Goßner SK, Petersen N, Stölzel P, Hägele F, Schweiggert RM, et al. Stimulation of the nitrate-nitrite-NO-metabolism by repeated lettuce juice consumption decreases gingival inflammation in periodontal recall patients: A randomized, double-blinded, placebo-controlled clinical trial. JClinPeriodontol.2016;43(7):603–8.