Periodontal disease

Sugar

Sugar intake increases plaque accumulation while decreasing chemotaxis and phagocytosis of polymorphonuclear leukocytes. (1) For example, in a double-blind study, 21 dental students consumed a 75 gram glucose drink 3 times daily, while 21 controls were given an artificially sweetened drink. On the fifth day, mean sulcus depth in the experimental group had increased significantly while the mean sulcus depth in the controls was unchanged. (2) Similarly, mean gingival inflammation in the experimental group significantly increased, while mean gingival inflammation in the controls was slightly reduced. (3)

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Vitamins

Folic Acid

Folic acid nutriture has been shown to be directly related to gingival health. In one study, following 30 days during which patients with normal plasma folate levels ingested 2 mg folic acid twice daily or placebo under double-blind conditions, folate increased the resistance of the gingiva to local irritants leading to a reduction in inflammation--even though plasma folate levels were unchanged. (4) Folate mouthwash is also effective, and may be even more effective than dietary supplements. (5)

Vitamin A

A deficiency of vitamin A is well known to predispose to periodontal disease. (6) For example, a group of pregnant women was found to show maximal inflammatory changes of the periodontium in the 8th month when the mean physiologic level of vitamin A declined. Shortly after delivery, by contrast, vitamin A levels became markedly elevated and periodontal inflammation improved, raising the question of whether periodontitis of pregnancy is related to changes in the levels of the vitamin. (7)

Vitamin C

Ascorbic acid protects the oral mucosal epithelium against the infiltration of antigenic materials such as bacterial endotoxins, (8) so it is not surprising that serum vitamin C levels have a significant (although weak) inverse association with periodontitis. (9) Dietary vitamin C intake shows a similar relationship, at least up to an intake of 180 mg daily. (10) Also, 500 mg daily of the vitamin for 90 days has been shown to reduce both dental plaque and stain. (11)

Vitamin E

When 800 mg of vitamin E in capsule form was bitten open and swished in the mouth before swallowing for 21 days, gingival inflammation was reduced. (12) This is a good example of the vitamin's effects on the inflammatory process in general.

Minerals

Calcium

The evidence is that adequate calcium intake is as important for protecting teeth from loss due to periodontal disease as it is for protecting bone from osteoporosis. Calcium intake is inversely related to the risk of periodontal disease; (13) in fact, since alveolar bone has the highest turnover of bone anywhere in the body, it is affected first by inadequate calcium nutriture. (13) Moreover, calcium supplementation has been found effective, not only in reversing jawbone loss, but also in reducing pockets of inflammation. (14)

Calcium nutriture can also be improved by reducing phosphorus intake, since excess dietary phosphorus impairs calcium absorption. (Phosphorus is high in meat, grains, potatoes and soft drinks.) Repletion of a vitamin D deficiency is also important, since adequate vitamin D is needed for normal calcium absorption.

Zinc

Animal work suggests that a zinc deficiency may increase the permeability of gingival tissues to foreign substances. (15) Moreover, serum zinc levels are negatively correlated with marginal alveolar bone loss. (16) A zinc mouthwash--but not supplemental zinc--was found effective in an open trial in inhibiting the growth of plaque at the alveolar margin. (17)

Coenzyme Q10

A gingival deficiency of coenzyme Q10 appears to be a regular finding among periodontal patients. (18) Only the diseased gingiva is deficient: normal levels are found in healthy tissue. (19)

Supplementation has been found effective in a number of studies. For example, in a double-blind study, 56 patients received either 60 mg of coenzyme Q10 or placebo without any local treatment. After 4 weeks, there was a significant difference in the mean depth of significant periodontal pockets between the CoQ10 group and the control group. (20)

References

1. Ringsdorf W et al. Sucrose, neutrophil phagocytosis and resistance to disease. Dent Surv 52:46-8, 1976

2. Cheraskin E. How quickly does diet make for change: A study in sulcus depth. Clin Prey Dent 10(4):20-2, 1988

3. Cheraskin E. How quickly does diet make for change? A study in gingival inflammation N Y J Dent 58(4):133-5, 1988

4. Vogel RI et al. The effect of folic acid on gingival health. J Periodontol 47(11):667-8, 1976

5. Thomson ME, Pack ARC. Effects of extended systemic and topical folate supplementation on gingivitis of pregnancy. J Clin Periodontal 9(3):275-80, 1982

6. Carranza F, Glickman's Clinical Periodontology. Philadelphia, PA, WB Saunders, 1984

7. Cerna H et al. Periodontium and vitamin E and A in pregnancy. Acta Univ Palacki Olomuc Fac Med 125:173-9, 1990

8. Alco JJ. Inhibition of endotoxin-induced depression of cellular proliferation by ascorbic acid. Proc Soc Exp Biol Med 164(3):248-51, 1980

9. Amarasena N et al. Serum vitamin C-periodontal relationship in community-dwelling elderly Japanese. J Clin Periodontol, January 1, 2005;32(1):93-7

10. Nishida M et al. Dietary vitamin C and the risk for periodontal disease. J Periodontol, August 1, 2000;71(8):1215-23

11. Cohen MM. The effect of large doses of ascorbic acid on gingival tissues at puberty. J Dent Res 34(5):750-1, 1955

12. Goodson, J.M., Bowles, D. The effect of alpha-tocopherol on sulcus flow in periodontal disease. J Dent Res 52:217, 1973

13. Nishida M et al. Calcium and the risk for periodontal disease. J Periodontol 2000 Jul:71(7):1057-66

14. Krook L et al. Human periodontal disease: Morphology and response to calcium therapy. Cornell Vet 62(1):32-53, 1972

15. Joseph CE et al. Zinc deficiency changes in the permeability of rabbit periodontium to 14C-phenytoin and 14C-albumin. J Periodontol 53:251-56, 1982

16. Frithiof L et al. The relationship between marginal bone loss and serum zine levels. Acta Med Scand 207(1):67-70, 1980

17. Harrap GJ et al. Inhibition of plaque growth by zinc salts. J Periodont Res 18:634-42, 1983

18. Folkers K, Watanabe T. Bioenergetics in clinical medicine. X Survey of the adjunctive use of coenzyme Q with oral therapy in treating periodontal disease. J Med 8(5):333-48, 1977

19. Littarru GP et al. Deficiency of coenzyme Q10 in gingival tissue from patients with periodontal disease. Proc Natl Acad Sci U S A 68(10):2332-5, 1971

20. Iwamoto Y et al. Clinical effect of Coenzyme Q10 on periodontal disease, in K Folkers, Y Yamamura, Eds. Biomedical & Clinical Aspects of Coenzyme Q. Vol 3. Amsterdam, Elsevier/North-Holland Biomedical Press, 1981:109-19

by Melvyn R. Werbach, MD

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