The mouth is often considered the terrain of the dentist, with the oral cavity being treated in isolation from the rest of the body, and often separately from the ‘rest of medicine’.
The mouth, however, IS attached to the rest of the body, and it is not a case of ‘what happens in the mouth, stays in the mouth’. On the contrary, what happens in the mouth can often be a sure sign of what is happening in the rest of the body.
It is now well established that there are direct links between oral diseases and other chronic diseases e.g., cardiovascular diseases, chronic obstructive pulmonary diseases, diabetes, rheumatoid arthritis, and cancer, due to their shared preventable risk factors, linked to diet and lifestyle (1,2).
This week’s blog aims to highlight the nutrients which may help to minimise the risk of developing dental disease, support resolution and help improve treatment outcomes. It also explores key issues and concepts which are often overlooked, and how a more systemic approach to managing oral diseases, could have a beneficial impact on overall health outcomes.
What is dental disease?
The most common dental diseases are periodontal disease and dental caries (decay)(3).
Periodontal disease is a non-communicable, inflammatory condition with a multifactorial aetiology. A genetic propensity and an imbalance (dysbiosis) of the oral microbiome is central to its development, but the host response, and resilience, is critical to its progression.
Periodontal disease results in loss of the alveolar bone (bone specific to the jawbone which supports the teeth). As bone support is lost, teeth become mobile or drift out of alignment. Chewing ability may become impaired as teeth are less able to withstand masticatory forces, and tooth loss is common in advanced stages of the disease.
Gingivitis, inflammation of the gingivae, is diagnosed when there is increased bleeding of the gums. Gingivitis and periodontal disease are considered as a continuum of the same disease(4) although gingivitis does not always progress to periodontal disease. Gingivitis is reversible if the underlying cause is addressed and corrected, whereas the bone loss of periodontal disease destruction cannot be reversed.
Dental caries (decay) occurs when organic acids are produced by oral bacteria in the plaque, in response to dietary intake of refined carbohydrates and simple sugars. The increased acidity leads to demineralisation of teeth, and proteolytic destruction of the organic portion of the tooth (dentine), resulting in cavities(5).
Dental erosion involves the dissolution of the tooth structure from acids of non-bacterial origin. It is not specifically a disease but occurs when acidic food and drinks are consumed, including soft drinks and fruit juice(6).
The impact of specific diets on dental health
It is unlikely that your dentist will discuss nutrition, or the role of specific nutrients on dental health. This is because nutrition is not a subject that is taught extensively at dental school.
A dietary approach to dental disease is not a new concept. Dr Western A. Price, a dentist in the 1920-30’s, from Cleveland USA, became aware of increased frequency of dental caries, malformed facial structures and crowded dental arches in his dental patients. He hypothesized that the ‘modern diet’, high in refined flour and sugar, and low in nutrients required for bone growth and remodelling, was responsible for the increase in dental disease and malformation he was seeing in his dental patients.
He embarked on a worldwide expedition, across five continents, to assess indigenous people of Switzerland, Gaelic communities in the Outer Hebrides, Eskimos and Indians of North America, Melanesian and Polynesian South Sea Islanders, African tribes, Australian Aborigines, New Zealand Mauri and the Indians of South America.
He compared those still eating a traditional diet to those from similar communities, now consuming a more ‘modern diet’.
He concluded that dental caries and malformed dental and facial architecture was the result of nutritional deficiency, more specifically the fat-soluble vitamins A and D, and ‘factor X’ which was determined much later as Vitamin K2(7).
Many dentists will not have heard of Western A. Price, as his research appears to have been overlooked by mainstream dentistry in favour of the ‘germ theory of dental disease’ (8), and removal of bacteria to prevent disease.
Recent research, however, is drawing on Dr Price’s conclusions, and establishing robust associations between specific diets (9–11), and other nutrients on dental disease, bone formation and bone remodelling (12). Supportive evidence also exists for the role of vitamin C (13,14), antioxidants (15), specific minerals (16,17) essential fatty acids (18) and B vitamins(19) in the prevention of dental disease, or enhancement of treatment outcomes(20).
Diet and caries
It is well established that sugar has a role in the aetiology of dental caries.
Studies dating back as far as 1920s reported significantly lower caries rates in children who were given a low carbohydrate diet to manage their diabetes (21).
Recent research supports the consumption of a diet high in refined carbohydrates, and low in fruits and vegetables, with the onset, and progression of dental caries (22,23). Decreasing dietary sugar is still recommended to prevent dental decay but brushing teeth to remove bacteria has often been the focus, and the easier option. In response to the studies linking dental caries to sugar (late 1920’s), the sugar industry promoted oral hygiene practices, and fluoride to prevent dental caries. Coca Cola advertisements claimed, ‘dental hygiene is key!’ (24).
Newer concepts are considering plaque biofilms to be protective of teeth, and it is the consumption of sugar, and refined carbohydrates, which is changing the ecology of the biofilm to favour demineralisation (25).
Diet and periodontal disease
The impact of a variety of diets on periodontal disease outcomes has also been addressed. Anti-inflammatory diets (high in omega 3 fats, fibre and antioxidant nutrients, and low in carbohydrates) have been shown to significantly decrease gingival bleeding, without alterations in plaque levels (26–28). Similar results have been seen with the administration of the stone age diet (10) and the Mediterranean diet (29).
Calorie restriction and intermittent fasting may also have positive associations due to the systemic benefits of these practices, but further research is required to establish their role in dental diseases (30).
According to these studies, the transition towards a more whole foods, low carbohydrate, high fibre, anti-inflammatory diet, which is high in antioxidants, could have a major role in oral disease prevention, even in the absence of biofilm removal.
Nutrients to support oral structures
Micronutrients can have a significant impact on both the hard and soft tissues of the oral cavity, and it is becoming more apparent that dental diseases, such as periodontal disease and dental caries, may be managed more successfully with additional nutritional support.
Teeth and Bones
Vitamin A, D, and K2, magnesium, calcium, and phosphorous are important in bone formation, and mineralisation of teeth. They work together, to create and maintain bone, and the mineral content of teeth (5,31). This enables broken bones to mend, tooth sockets to heal, and teeth to actively be moved into a straighter alignment (orthodontics).
Vitamin D is essential for the absorption of calcium from the gut, and magnesium is required for vitamin D to function. Vitamin K2 and magnesium ensure calcium is shunted into our bones and teeth, and not into soft tissues, which could otherwise lead to atherosclerosis, kidney stones or gall stones. These nutrients are essential for dental treatments, which require osseointegration (implants), or tooth movement (orthodontics) (20,32).
Vitamin D deficiency has been associated with childhood caries since 1928 (33), and more recent studies confirm these findings. (23,34,35) Yet, this is still relatively overlooked in dental practice.
Collagen consists of the amino acids glycine and proline, and is abundant in connective tissue system, skin, joints, and periodontium and alveolar bone. Collagen fibrils connect the roots of teeth to bone, and its production relies on vitamin C, zinc and copper.
Deficiency of vitamin C leads to scurvy, clinically seen as profusely bleeding gums, and periodontal disease ((14). Significant improvements in periodontal disease outcomes have been demonstrated with oral collagen supplements combined with professional plaque control practices (36).
Vitamin A, zinc, glutamine and arginine are important nutrients for maintaining mucous membranes (37). When the barriers are robust, they protect the inner body from toxins, bacteria, chemicals or any substance, including food proteins, which should not be within the system. The term ‘leaky gut’ is often used to describe increased permeability of the mucosal gut barrier. ‘Leaky gums’ is a newer term related to the increased permeability of the gingival mucosa as a result of bleeding gums, or periodontal lesions.
This may result in translocation of pathogenic oral bacteria to other sites and may be the link to other systemic diseases including Alzheimer’s disease, and rheumatoid arthritis (38,39).
Nutrients to support the immune system.
An inflammatory response should ideally be short lived, with the immune system returning to a state of surveillance following resolution of the healing process, or eradication of the offending pathogen. Problems arise when the inflammatory response is overzealous, or fails to resolve the underlying infection, or clear debris from damaged cells.
Periodontal disease is a chronic inflammatory disease which occurs in response to a dysbiotic oral microbiome. If eradication does not occur, or dysbiosis is not resolved, the inflammatory process may become chronic.
The germ theory of disease in the 19th century and the advent of antibiotics, antifungals, antivirals and antiseptics had led us to believe that all bacteria are detrimental to health, and eradication is essential for health.
We now understand that the human body is inhabited by trillions of bacteria, and other microbes which are protective, and without which, we could not survive.
As well as regulating the immune system, the commensal bacteria crowd out the pathogenic bacteria, minimise invasion from pathogens, and protect the mucosal barriers. They also produce vitamin K2, B vitamins, and short chain fatty acids (SCFAs) which are beneficial to the host.
There is still much to learn about the microbiome, and its role, but balance is important.
When the microbiome is in balance health outcomes are positive, the opposite is true of an imbalanced microbiome. Dental diseases have an imbalanced microbiome at their core, and strategies to rebalance rather than remove, the oral microbiome may be key to the management of oral disease (31).
Building and maintaining a healthy microbiome
Diets high in fibre, vegetables, fruits antioxidants and prebiotics help to create healthy microbial balance, whereas diets low in fibre, fruits and vegetables and high in sugar, refined carbohydrates, and processed foods create dysbiosis.
Fermented foods such as kimchi, sauerkraut and fermented vegetables are rich in probiotics (friendly bacteria), which can positively influence the metabolic activity of the microbiome (40).
Inflammation creates free radicals, which damage surrounding tissues, leading to oxidative stress. Antioxidants ‘soak up’ free radicals and prevent the damage to localised tissues which would otherwise occur (26,41).
Vitamin C, vitamin E, and glutathione are the major antioxidants which help to decrease oxidative stress; they are recycled within the body to maintain their antioxidant capacity. Coenzyme Q10 (CoQ10) (42) green tea extract, lycopene and quercetin have also shown to have a beneficial effect on periodontal disease (43–47).
Immune modulation – essential fatty acids, vitamin D and zinc.
There are many nutrients which have a role in immune modulation.
Omega 3 fatty acids are anti-inflammatory in their action, but the balance of omega 6 to omega 3 polyunsaturated fatty acids is important. A ratio of 3:1 (omega 6 to omega 3) is ideal, and a higher omega 6 to 3 is considered inflammatory. Those consuming a western style diet have a higher intake of vegetable oils, and higher omega 6 to omega 3 ratios, which has been correlated to periodontal disease (27), and increased risk of periodontal disease progression(48).
Increasing omega 3 fats can improve periodontal disease markers(49), but reduction of the inflammatory omega 6 component is also necessary, for optimal inflammatory balance. Oily fish is a rich source of omega 3 fats, flaxseeds and walnuts however have a decreased impact due to the inefficiency of the conversion to DHA and EPA.
Vitamin D is known to be immunomodulatory. It is anti-inflammatory and has antiproliferative effects. Vitamin D’s role in periodontal disease prevention goes beyond just preventing bone loss (50,51).
Lower serum levels of zinc have been identified in those with periodontal disease.
Zinc has immunomodulatory effects, having an essential role in maintaining the integrity of mucous membranes, and in wound healing (52).
The impact of nutrition on oral health is seemingly apparent, yet nutrition education is still not reaching those at the forefront, delivering care.
Incorporating nutritional therapy into dental practices could be a practical way of offering a more systemic approach to oral health, with the added benefit of enhancing overall health.
- Dental disease has systemic involvement despite the localised presentation, and the prevention and treatment should take this into consideration.
- Periodontal disease is an irreversible, multifactorial inflammatory condition. A systemic approach, addressing and correcting the specific underlying aetiology for the chronic inflammation, dysbiosis, and nutritional deficiency of the specific individual may to lead to greater level of prevention and resolution.
- Dental diseases are directly linked to other chronic inflammatory diseases e.g., diabetes, cardiovascular disease, rheumatoid arthritis and Alzheimer’s disease. In part, this may be related to the pathogenic oral bacteria, and increased permeability of the oral mucosa.
- Nutritional deficiency renders the host more susceptible to dental disease.
- Food is fundamental in all aspects of health. An anti-inflammatory diet can enhance dental disease outcomes, in the absence of oral hygiene practices.
- Specific nutrients are important in dental disease, but it is the combination of these nutrients which should be considered.
- Vitamin A, D, and K2, magnesium, calcium, and phosphorous are important in bone formation, and mineralization of teeth.
- Vitamin A, zinc, glutamine and arginine are important in maintaining mucous membranes, which act as physical barriers and are an essential part of the immune system.
- Antioxidants e.g., vitamin C, E and D, glutathione, coenzyme Q10, green tea, and other phytonutrients limit the damage, and oxidative stress, which occurs as a result of inflammation.
- Vitamin D, omega 3 and 6, zinc, prebiotics and probiotics are involved in immune modulation
- A balanced oral and gut microbiome is essential for health. Steps should be taken to create and preserve a healthy microbiome to prevent disease.
- Martinon P, Fraticelli L, Giboreau A, Dussart C, Bourgeois D, Carrouel F. Nutrition as a Key Modifiable Factor for Periodontitis and Main Chronic Diseases. J Clin Med [Internet]. 2021 Jan 2 [cited 2023 Jan 29];10(2):1–26. Available from: https://pubmed.ncbi.nlm.nih.gov/33430519/
- Bourgeois D, Inquimbert C, Ottolenghi L, Carrouel F. Periodontal Pathogens as Risk Factors of Cardiovascular Diseases, Diabetes, Rheumatoid Arthritis, Cancer, and Chronic Obstructive Pulmonary Disease-Is There Cause for Consideration? 2019; Available from: www.mdpi.com/journal/microorganisms
- Jin LJ, Lamster IB, Greenspan JS, Pitts NB, Scully C, Warnakulasuriya S. Global burden of oral diseases: emerging concepts, management and interplay with systemic health. Vol. 22, Oral Diseases. 2016.
- Abusleme L HAHBDP. Microbial signatures of health, gingivitis, and periodontitis. Periodontol 2000. 2021 Jun;86(1):57–78.
- Nyvad B, Crielaard W, Mira A, Takahashi N, Beighton D. Dental caries from a molecular microbiological perspective. Caries Res [Internet]. 2013 [cited 2023 Jan 29];47(2):89–102. Available from: https://pubmed.ncbi.nlm.nih.gov/23207320/
- Amaechi BT, Higham SM. Dental erosion: possible approaches to prevention and control. J Dent [Internet]. 2005 [cited 2023 Jan 30];33(3):243–52. Available from: https://pubmed.ncbi.nlm.nih.gov/15725524/
- Nutrition and Physical Degeneration by Weston A. Price, DDS | Price-Pottenger [Internet]. [cited 2023 Jan 24]. Available from: https://price-pottenger.org/store/nutrition-and-physical-degeneration/
- Black G v. DENTAL CARIES, AND ITS RELATIONS TO THE GERM THEORY OF DISEASE. AMERICAN JOURNAL OF DENTAL SCIENCE.
- Parveen S. Impact of calorie restriction and intermittent fasting on periodontal health. Periodontol 2000 [Internet]. 2021 Oct 1 [cited 2023 Jan 30];87(1):315–24. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/prd.12400
- Baumgartner S, Imfeld T, Schicht O, Rath C, Persson RE, Persson GR. The impact of the stone age diet on gingival conditions in the absence of oral hygiene. J Periodontol [Internet]. 2009 May [cited 2023 Jan 29];80(5):759–68. Available from: https://pubmed.ncbi.nlm.nih.gov/19405829/
- Bartha V, Exner L, Schweikert D, Woelber JP, Vach K, Meyer AL, et al. Effect of the Mediterranean diet on gingivitis: A randomized controlled trial. 2021; Available from: https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13576
- Dommisch H, Kuzmanova D, Jönsson D, Grant M, Chapple I. Effect of micronutrient malnutrition on periodontal disease and periodontal therapy. Periodontol 2000 [Internet]. 2018 Oct 1 [cited 2023 Jan 30];78(1):129–53. Available from: https://pubmed.ncbi.nlm.nih.gov/30198127/
- Leggott PJ, Robertson PB, Jacob RA, Zambon JJ, Walsh M, Armitage GC. Effects of Ascorbic Acid Depletion and Supplementation on Periodontal Health and Subgingival Microflora in Humans. J Dent Res. 1991;70(12):1531–6.
- Leggott PJ, Robertson PB, Rothman DL, Murray PA, Jacob RA. The effect of controlled ascorbic acid depletion and supplementation on periodontal health. J Periodontol [Internet]. 1986 Aug [cited 2023 Jan 24];57(8):480–5. Available from: https://pubmed.ncbi.nlm.nih.gov/3462381/
- Chapple ILC. Role of free radicals and antioxidants in the pathogenesis of the inflammatory periodontal diseases. Clin Mol Pathol [Internet]. 1996 [cited 2022 Oct 10];49(5). Available from: https://pubmed.ncbi.nlm.nih.gov/16696085/
- Thomas B, Gautam A, Rajendra Prasad B, Kumari S. Evaluation of micronutrient (zinc, copper and iron) levels in periodontitis patients with and without diabetes mellitus type 2: A biochemical study. Indian Journal of Dental Research. 2013 Jul;24(4):468–73.
- Thomas B, Kumari S, Ramitha k, Kumari AshwiniMB. Comparative evaluation of micronutrient status in the serum of diabetes mellitus patients and healthy individuals with periodontitis. J Indian Soc Periodontol [Internet]. 2010 [cited 2023 Jan 24];14(1):46. Available from: https://pubmed.ncbi.nlm.nih.gov/20922079/
- Iwasaki M, Taylor GW, Moynihan P, Yoshihara A, Muramatsu K, Watanabe R, et al. Dietary ratio of n-6 to n-3 polyunsaturated fatty acids and periodontal disease in community-based older Japanese: a 3-year follow-up study. Prostaglandins Leukot Essent Fatty Acids [Internet]. 2011 Aug [cited 2023 Jan 24];85(2):107–12. Available from: https://pubmed.ncbi.nlm.nih.gov/21601439/
- Zong G, Holtfreter B, Scott AE, Völzke H, Petersmann A, Dietrich T, et al. Serum vitamin B12 is inversely associated with periodontal progression and risk of tooth loss: a prospective cohort study. J Clin Periodontol [Internet]. 2016 Jan 1 [cited 2023 Jan 24];43(1):2–9. Available from: https://pubmed.ncbi.nlm.nih.gov/26613385/
- Paz A, Stanley M, Mangano FG, Miron RJ. Vitamin D Deficiency and Early Implant Failure: Outcomes from a Pre-surgical Supplementation Program on Vitamin D Levels and Antioxidant Scores. Oral Health Prev Dent [Internet]. 2021 Jan 7 [cited 2023 Jan 24];19(1):495–502. Available from: https://pubmed.ncbi.nlm.nih.gov/34585875/
- BOYD JD, DRAIN CL, NELSON M v. DIETARY CONTROL OF DENTAL CARIES. American Journal of Diseases of Children [Internet]. 1929 Oct 1 [cited 2023 Jan 24];38(4):721–5. Available from: https://jamanetwork.com/journals/jamapediatrics/fullarticle/1175177
- Humphrey LT, de Groote I, Morales J, Barton N, Collcutt S, Ramsey CB, et al. Earliest evidence for caries and exploitation of starchy plant foods in Pleistocene hunter-gatherers from Morocco. Proc Natl Acad Sci U S A [Internet]. 2014 Jan 21 [cited 2023 Feb 10];111(3):954–9. Available from: /pmc/articles/PMC3903197/
- Hujoel PP. Vitamin D and dental caries in controlled clinical trials: systematic review and meta-analysis. Nutr Rev [Internet]. 2013 Feb [cited 2023 Jan 24];71(2):88–97. Available from: https://pubmed.ncbi.nlm.nih.gov/23356636/
- Hujoel PP, Lingström P. Nutrition, dental caries and periodontal disease: a narrative review. J Clin Periodontol [Internet]. 2017 Mar 1 [cited 2023 Feb 10];44:S79–84. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/jcpe.12672
- Kaidonis J, Townsend G. The ‘sialo–microbial–dental complex’ in oral health and disease. Annals of Anatomy – Anatomischer Anzeiger. 2016 Jan 1;203:85–9.
- Rajaram S, Nisha S, Ali N, Shashikumar P, Karmakar S, Pandey V. Influence of a Low-Carbohydrate and Rich in Omega-3 Fatty Acids, Ascorbic Acid, Antioxidants, and Fiber Diet on Clinical Outcomes in Patients with Chronic Gingivitis: A Randomized Controlled Trial. J Int Soc Prev Community Dent [Internet]. 2021 Jan 1 [cited 2022 Oct 10];11(1):58–67. Available from: https://pubmed.ncbi.nlm.nih.gov/33688474/
- 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 [Internet]. 2016 Jul 26 [cited 2022 Oct 10];17(1). Available from: https://pubmed.ncbi.nlm.nih.gov/27460471/
- Tennert C, Reinmuth AC, Bremer K, Al-Ahmad A, Karygianni L, Hellwig E, et al. An oral health optimized diet reduces the load of potential cariogenic and periodontal bacterial species in the supragingival oral plaque: A randomized controlled pilot study. Microbiologyopen. 2020 Aug 1;9(8).
- Bartha V, Exner L, Schweikert D, Woelber JP, Vach K, Meyer AL, et al. Effect of the Mediterranean diet on gingivitis: A randomized controlled trial. 2021; Available from: https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13576
- Parveen S. Impact of calorie restriction and intermittent fasting on periodontal health. Periodontol 2000 [Internet]. 2021 Oct 1 [cited 2023 Feb 6];87(1):315–24. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/prd.12400
- Kaidonis J, Townsend G. The “sialo-microbial-dental complex” in oral health and disease. Annals of Anatomy. 2016 Jan 1;203:85–9.
- Almoammar K. Vitamin D and orthodontics: an insight review. Clin Cosmet Investig Dent [Internet]. 2018 [cited 2023 Jan 30];10:165. Available from: /pmc/articles/PMC6072678/
- Mellanby M, Pattison CL. THE ACTION OF VITAMIN D IN PREVENTING THE SPREAD AND PROMOTING THE ARREST OF CARIES IN CHILDREN. Br Med J [Internet]. 1928 Dec 15 [cited 2023 Jan 24];2(3545):1079–82. Available from: https://pubmed.ncbi.nlm.nih.gov/20774325/
- Almoudi MM, Hussein AS, Abu Hassan MI, Schroth RJ. Dental caries and vitamin D status in children in Asia. Pediatr Int [Internet]. 2019 Apr 1 [cited 2023 Jan 24];61(4):327–38. Available from: https://pubmed.ncbi.nlm.nih.gov/30740822/
- Chhonkar A, Arya V. Comparison of Vitamin D Level of Children with Severe Early Childhood Caries and Children with No Caries. Int J Clin Pediatr Dent. 2018 Jun;11(3):199–204.
- Jockel-Schneider Y, Stoelze P, Hess J, Haubit I, Fickl S, Schlagenhauf U. Impact of a Specific Collagen Peptide Food Supplement onPeriodontal Inflammation in Aftercare Patients—A RandomisedControlled Trial. Nutrients. 2022;14(4473).
- Farré R, Fiorani M, Rahiman SA, Matteoli G. Intestinal Permeability, Inflammation and the Role of Nutrients. Available from: www.mdpi.com/journal/nutrients
- Loyola-Rodriguez JP, Martinez-Martinez RE, Abud-Mendoza C, Patiño-Marin N, Seymour GJ. Rheumatoid arthritis and the role of oral bacteria. J Oral Microbiol [Internet]. 2010 [cited 2023 Jan 30];2(2010). Available from: /pmc/articles/PMC3084578/
- Elwishahy A, Antia K, Bhusari S, Ilechukwu NC, Horstick O, Winkler V. Porphyromonas Gingivalis as a Risk Factor to Alzheimer’s Disease: A Systematic Review. J Alzheimers Dis Rep. 2021 Jan 1;5(1):721–32.
- Wastyk HC, Fragiadakis GK, Perelman D, Dahan D, Merrill BD, Yu FB, et al. Gut-microbiota-targeted diets modulate human immune status. Cell. 2021 Aug 5;184(16):4137-4153.e14.
- Chapple ILC, Milward MR, Ling-Mountford N, Weston P, Carter K, Askey K, et al. Adjunctive daily supplementation with encapsulated fruit, vegetable and berry juice powder concentrates and clinical periodontal outcomes: a double-blind RCT. J Clin Periodontol [Internet]. 2012 Jan 1 [cited 2023 Jan 28];39(1):62–72. Available from: https://research.birmingham.ac.uk/en/publications/adjunctive-daily-supplementation-with-encapsulated-fruit-vegetabl
- Manthena S, Ramoji Rao MV, Penubolu LP, Putcha M, Sri Harsha AVN. Effectiveness of CoQ10 Oral Supplements as an Adjunct to Scaling and Root Planing in Improving Periodontal Health. J Clin Diagn Res [Internet]. 2015 Aug 1 [cited 2023 Jan 28];9(8):ZC26–8. Available from: https://pubmed.ncbi.nlm.nih.gov/26436041/
- Wasti J, Wasti A, Singh R. Efficacy of antioxidants therapy on progression of periodontal disease – A randomized control trial. Indian Journal of Dental Research. 2021 Apr 1;32(2):187–91.
- Belludi SA, Verma S, Banthia R, Bhusari P, Parwani S, Kedia S, et al. Effect of lycopene in the treatment of periodontal disease: A clinical study. Journal of Contemporary Dental Practice. 2013;14(6):1054–9.
- Tripathi P, Blaggana V, Upadhyay P, Jindal M, Gupta S, Nishat S. Antioxidant therapy (lycopene and green tea extract) in periodontal disease: A promising paradigm. J Indian Soc Periodontol [Internet]. 2019 Jan 1 [cited 2023 Jan 28];23(1):25–30. Available from: https://pubmed.ncbi.nlm.nih.gov/30692739/
- Wei Y, Fu J, Wu W, Ma P, Ren L, Yi Z, et al. Quercetin Prevents Oxidative Stress-Induced Injury of Periodontal Ligament Cells and Alveolar Bone Loss in Periodontitis. 2021 [cited 2023 Jan 28]; Available from: https://doi.org/10.2147/DDDT.S315249
- Tripathi P, Blaggana V, Upadhyay P, Jindal M, Gupta S, Nishat S. Antioxidant therapy (lycopene and green tea extract) in periodontal disease: A promising paradigm. J Indian Soc Periodontol [Internet]. 2019 Jan 1 [cited 2023 Jan 28];23(1):25–30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30692739
- Iwasaki M, Taylor GW, Moynihan P, Yoshihara A, Muramatsu K, Watanabe R, et al. Dietary ratio of n-6 to n-3 polyunsaturated fatty acids and periodontal disease in community-based older Japanese: A 3-year follow-up study. Prostaglandins Leukot Essent Fatty Acids. 2011 Aug 1;85(2):107–12.
- Kujur S, Goswami V, Nikunj A, Singh G, Bandhe S, Ghritlahre H. Efficacy of omega 3 fatty acid as an adjunct in the management of chronic periodontitis: A randomized controlled trial. Indian Journal of Dental Research. 2020 Mar 1;31(2):229–35.
- Jagelavičienė E, Vaitkevičienė I, Šilingaitė D, Šinkūnaitė E, Daugėlaitė G. The Relationship between Vitamin D and Periodontal Pathology. Medicina (B Aires) [Internet]. 2018 Jul 1 [cited 2023 Feb 6];54(3). Available from: /pmc/articles/PMC6122115/
- Hewison M. Vitamin D and immune function: an overview. Proc Nutr Soc [Internet]. 2012 Feb [cited 2023 Feb 6];71(1):50–61. Available from: https://pubmed.ncbi.nlm.nih.gov/21849106/
- Frithiof L, Lavstedt S, Eklund G, Söderberg U, Skårberg KO, Blomqvist J, et al. The relationship between marginal bone loss and serum zinc levels. Acta Med Scand [Internet]. 1980 [cited 2023 Feb 6];207(1–2):67–70. Available from: https://pubmed.ncbi.nlm.nih.gov/7368976/
Guest blog by Keeley Nicholas BDS. MFGDP(UK). MSc (Nutritional Therapy). IFMCP. mBANT. rCNHC. mIFM. mGDC.
Keeley is a registered Nutritional Therapist, and a Certified Functional Medicine Practitioner.
She worked as a General Dental Surgeon for twenty-five years, but now focuses on nutrition. She is co-founder of The Emporium of Health (www.emporiumofhealth.com), where she uses Functional Medicine to support her 1-2-1 clients, and is in the process of establishing a corporate offering, to make Functional Medicine more accessible. She has special interest in biotoxin illness, autoimmunity, and brain health.
Thank you to Keeley for this excellent article. If you have questions regarding the topics that have been raised, or any other health matters, please do contact our team of Nutritional Therapists.
Last updated on 28th July 2023 by cytoffice