A logical start when we think about nutrition is the mouth. The mouth is the first point of entry for all nutrients, in the form of the food we consume. Oral health and periodontal disease and their connection to nutrition run bi-directionally, where several studies have shown associations between individual micronutrients and periodontitis [1, 2]. Additional associations have been found between cumulative histories of oral problems including untreated caries, poor oral health, dental pain, restorations, extractions, use of prosthetics and food insecurity [3].

Periodontitis is defined as an inflammatory disease of the supportive tissues of the teeth caused by microorganisms which result in progressive destruction of periodontal ligaments and alveolar bone [4]. Periodontitis impacts 40-90% of the world’s population and is one of the most prevalent epidemics globally. Several micronutrients also impact periodontal health and include vitamin A (carotenoids, β-carotene), vitamin C (ascorbic acid), vitamin E (α-tocopherol), glutathione and melatonin [5,6]. These anti-oxidants have been shown to help overcome reactive-oxygen species mediated inflammation present in periodontal tissue which leads to periodontitis.

It is estimated that 15.8 million children under the age of 18 years in the United States live in households that are unable to access nutritious food necessary for healthy growth on a consistent basis [7]. In addition, over-nutrition in the form of childhood obesity and overweight, particularly among lower income children, is compounded by a preponderance to more cariogenic foods. A study conducted in Japan documented association between high body mass index (BMI) and increased risk of periodontal disease among young adults [8]. An abundance of fast food, poor quality, high sugar and simple carbohydrate-based diets in lower income neighborhoods predispose children to the development of plaque, dental decay and caries [9, 10]. Inadequate consumption of fruits and vegetables deprive children of the nutrients they need for healthy growth and development [10]. Proper oral health care started at a young age is essential to ensure good nutrition and oral hygiene into adolescence and adulthood.

Pregnant women are more prone to periodontitis, gingivitis and gingival hyperplasia. Increased secretion of estrogen during pregnancy has also been linked to periodontal disease during pregnancy [11]. Periodontal disease both during preconception and in pregnancy has been linked to adverse outcomes including premature birth, preeclampsia, gestational diabetes, fetal loss, small for gestational age babies [12]. Antioxidant rich foods consumed during pregnancy, in addition to diets high in fiber and low in refined sugar are important to prevent periodontal disease. Improved oral hygiene is also essential.

In America, life spans have increased by upwards of 30 years in the last century. It is estimated that by 2050, people will live to an average age of 100 [13]. The elderly, in addition to children and pregnant women, are also susceptible to the impacts of nutrition on oral health. Among this age group, compromised oral health care, due to age-related factors such as tooth loss, use of oral prosthetics, a lack of appetite and mastication ability, in addition to altered taste and gastrointestinal conditions, are important concerns. An inability to consume certain foods due to difficulties with chewing and swallowing can compound food insecurity [14, 15]. Oral care in the elderly and customized nutrition to account for their complex needs is essential to ensure good quality of life.

The link between good oral health and nutrition is undeniable and complex. It is time for more concerted efforts to be made to link the two interconnected areas of health, across the lifespan. Increased efforts to educate oral health providers on the importance of nutrition education, in addition to ensuring proper nutrition security for at risk groups, will ensure healthy bodies and wide toothy smiles!

 

References:

[1] Dommisch, Kuzmanova, Jonsson, Grant & Chapple. (2018). Effect of micronutrient malnutrition on periodontal disease and periodontal therapy. Periodontology 2000, 78, 129-153.

[2] Najeeb, S., Zafar, M.S., Khurshid, Z., Zohaib, S., & Almas, K. (2016). The role of nutrition in periodontal health: An update. Nutrients, 8, 530.

[3] Santin, G.C., Martins, C.C., Pordeus, I.A., & Ferreira, F.M. (2014). Food insecurity and oral health: A systematic review. Pesquisa Brasileira em Odontopediatria e Clinica Integrada, 144, 335-246.

[4] Newman, G.M., Takei, H.H., Klokkevol, R.P., Carranza, A.F. (2012). Carranza’s clinical periodontology. Classification of diseases and conditions affecting the periodontium. In Carranza’s Clinical Periodontology, 12th ed.; Michael, G.N., Henry, H.T., Perry, R.K., Fermin, A.C., Eds.; Elsevier: Amsterdam, The Netherlands, pp. 45-67.

[5] Garcia, J.J., Reiter, R.J., Guerrero, J.M., Escames, G., Yu, B.P., Oh, C.S., & Munoz-Hoyos, A. (1997). Melatonin prevents changes in microsomal membrane fluidity during induced lipid peroxidation. FEBS Letters, 408, 297-300.

[6] Najeeb, S., Khurshid, Z., Zohaib, S., & Zafar, M.S. (2016). Therapeutic potential of melatonin in oral medicine and periodontology. Kaohsiung Journal of Medical Sciences, 32, 391-396.

[7] Coleman-Jensen A, Gregory C, Singh A. (2014). Household Food Security in the United States in 2013. USDA ERS.

[8] Ekuni., D., Yamamoto, T., Koyama, R., Tsuneishi, M., Naito, K., & Tobe, K. (2008). Relationship between body mass index and periodontitis in young Japanese adults. Journal of Periodontitis Research, 43, 417-421.

[9] Moynihan P, Petersen PE. (2004). Diet, nutrition and the prevention of dental diseases. Public Health Nutrition, 7(1A):201-226.  Accessed 7/7/2015 at http://www.who.int/nutrition/publications/public_health_nut7.pdf.

[10] Edgar, W. (1993). Extrinsic and instinsic sugars: A review of recent UK recommendations on diet and caries. Caries Research, 27, 64-67.

[11] Hemalatha, V., Manigandan, T., Sarumathi, T., Aasthi Nisha, V., & Amudhan, A. (2013). Dental considerations in pregnancy – A critical review on oral care. Journal of Clinical Diagnostics Research, 7, 948.

[12] Ziegler, J., & Mobley, C.C. (2014). Pregnancy, child nutrition and oral health. Chapter 2: In Nutrition and Oral Medicine; Touger-Decker R., Mobley, C., & Epstein, J.B., Eds. Springer Science+Business Media, New York, pp. 19-37.

[13] Ham-Chande, R., (2005). Shapes and limits of longevity in Mexico. In proceedings of the living to 100 and beyond symposium, Orlando, FL, USA, 12-14 January 2005.

[14] Sheiham, A., & Steele, J. (2001). Does the condition of the mouth and teeth affect the ability to eat certain foods, nutrient and dietary intake and nutritional status amongst older people? Public Health Nutrition, 4, 797-803.

[15] Brodeur, J., Laurin, D., Vallee, R.,&  Lachapelle, D. (1993). Nutrient intake and gastrointestinal disorders related to masticatory performance in the edentulous elderly. Journal of Prosthetics and Dentistry, 70, 468-473.

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