Healthy eating is important for overall health and periodontal health. Nutrition plays an integral part in the complex balance among healthy oral tissues, host response, and oral microorganisms. Dental professionals can contribute to a healthier population by educating patients about healthy eating, for the sake of oral health and to support general health.
The overall effect of healthy eating
The importance of a healthy diet for overall health is indisputable. A large body of research has explored the relationship between nutrition and health. Several reviews have been published that support a higher intake of fruit and vegetables to reduce the risk of cardiovascular diseases, diabetes, cancer, and many other systemic diseases.1,2 There is also support for certain substances in the diet having an anti-inflammatory influence on the body.3 Shifting to an anti-inflammatory diet seems to decrease the risk of many systemic diseases.4,5
Nutrients in our diet are traditionally divided into macronutrients and micronutrients. Macronutrients (i.e., carbohydrates, proteins, fat) are required in large quantities. Micronutrients are vitamins and minerals, of which we need a minimal amount; however, they are essential for the production of hormones and enzymes.6,7
Healthy eating and periodontal health
Aside from the impact on general health, a healthy diet may also influence periodontal health, disease development, and treatment outcomes.6-12 Fruits and vegetables contain important nutrients that are generally beneficial. Several studies have explored their effect on periodontal health—for instance, the role of various vitamins.8,9 The effect of vitamin C on the prevalence of periodontitis has been studied quite thoroughly,6,8,11,12 as well as the importance of vitamin D for teeth and bone.6,8 There also seems to be some association between vitamin D and periodontal health.
In a randomized controlled trial, patients in the test group were asked to change to an anti-inflammatory diet containing low carbohydrates and animal proteins, more omega-3 fatty acids, and a lot of vitamins C and D, antioxidants, plant nitrates, and fiber. During the four-week intervention period, they did not perform any interdental cleaning.
According to the results, the anti-inflammatory diet contributed to a significant reduction in gingival bleeding compared to the control group. No difference in plaque levels, subgingival microbiome composition, or inflammatory serological parameters was found between the groups.13
The impact of fruit intake on the progression of periodontal disease has also been researched, concluding that at least five servings of fruit and vegetables per day may prevent the progression of periodontal diseases.14
One study put a particular focus on the benefits of kiwi in relation to the outcome of periodontal treatment, since the kiwifruit contains exceptionally high concentrations of vitamin C, as well as minerals and polyphenols—substances that have shown anti-inflammatory, antimicrobial, and antioxidant effects. The test group was prescribed two kiwis a day for five months, before and after the treatment.
The results showed that participants who added two kiwifruits to their daily diet had a significant reduction in gingival inflammation, even before oral hygiene instructions or any instrumentation were carried out, compared to the control group. The intervention group also presented less plaque formation. In this case, the intake of kiwi didn't impact the outcome of the actual periodontal treatment, though other studies have indicated that some vitamins and minerals could affect the treatment.15
Lifestyle effects on micronutrients
A considerable proportion of individuals seem to have an inadequate intake of vitamins and minerals. Many different lifestyle factors affect the quantity of micronutrients in the body, such as usage of nicotine, drugs, alcohol, certain medications, as well as heavy sweating. Processed food should be avoided. It is better to eat healthy and freshly prepared food, but the combination of ingredients also affects the bioavailability of the micronutrients. The requirement of micronutrients varies during life. Age, growth, body composition, pregnancy, breastfeeding, menopause, and systemic diseases are some factors of influence.6
The field of nutrigenetics (i.e., the individual’s biological response to a specific nutrient) is growing, and research has shown that some individuals have difficulty making efficient use of micronutrients from food due to genetics.6
A diet containing fruits, berries, vegetables, root crops, nuts, whole grains, fiber, and unsaturated fat seems to have a positive effect on overall health and might also be beneficial for oral health. The dental profession has an important role in advising patients not just on how to achieve optimal oral hygiene but also a healthier diet.
Editor’s note: This article is sponsored by TePe Oral Hygiene Products. Content has been reviewed for editorial integrity per RDH guidelines. For more information on our editorial standards, see rdhmag.com/page/submission-guidelines.
- Aune D, Giovannucci E, Boffetta P, et al. Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality—a systematic review and dose-response meta-analysis of prospective studies. Int J Epidemiol. 2017;46(3):1029-1056. doi:10.1093/ije/dyw319
- Aune D, Keum N, Giovannucci E, et al. Dietary intake and blood concentrations of antioxidants and the risk of cardiovascular disease, total cancer, and all-cause mortality: a systematic review and dose-response meta-analysis of prospective studies. Am J Clin Nutr. 2018;108(5):1069-1091. doi:10.1093/ajcn/nqy097
- Shivappa N, Godos J, Hébert JR, et al. Dietary inflammatory index and cardiovascular risk and mortality—a meta-analysis. Nutrients. 2018;10(2):200. doi:10.3390/nu10020200
- Phillips CM, Chen LW, Heude B, et al. Dietary inflammatory index and non-communicable disease risk: a narrative Review. Nutrients. 2019;11(8):1873. doi:10.3390/nu11081873
- Park SY, Kang M, Wilkens LR, et al. The Dietary Inflammatory Index and all-cause, cardiovascular disease, and cancer mortality in the Multiethnic Cohort Study. Nutrients. 2018;10(12):1844. doi:10.3390/nu10121844
- Dommisch H, Kuzmanova D, Jönsson D, Grant M, Chapple I. Effect of micronutrient malnutrition on periodontal disease and periodontal therapy. Periodontol 2000. 2018;78(1):129-153. doi:10.1111/prd.12233
- Hujoel PP, Lingström P. Nutrition, dental caries and periodontal disease: a narrative review. J Clin Periodontol. 2017;44(suppl 18):S79-S84. doi:10.1111/jcpe.12672
- Varela-López A, Navarro-Hortal MD, Giampieri F, Bullón P, Battino M, Quiles JL. Nutraceuticals in periodontal health: a systematic review on the role of vitamins in periodontal health maintenance. Molecules. 2018;23(5):1226. doi:10.3390/molecules23051226
- Najeeb S, Zafar MS, Khurshid Z, Zohaib S, Almas K. The role of nutrition in periodontal health: an update. Nutrients. 2016;8(9):530. doi:10.3390/nu8090530
- Chapple IL, Bouchard P, Cagetti MG, et al. Interaction of lifestyle, behaviour or systemic diseases with dental caries and periodontal diseases: consensus report of group 2 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol. 2017;44(suppl 18):S39-S51. doi:10.1111/jcpe.12685
- Widén C, Coleman M, Critén S, Karlgren-Andersson P, Renvert S, Persson GR. Consumption of bilberries controls gingival inflammation. Int J Mol Sci. 2015;16(5):10665-10673. doi:10.3390/ijms160510665
- Chapple IL, Milward MR, Ling-Mountford N, 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. 2012;39(1):62-72. doi:10.1111/j.1600-051X.2011.01793.x
- Woelber JP, Gärtner M, Breuninger L, et al. The influence of an anti-inflammatory diet on gingivitis. a randomized controlled trial. J Clin Periodontol. 2019;46(4):481-490. doi:10.1111/jcpe.13094
- Skoczek-Rubinska A, Bajerska J, Menclewicz K. Effects of fruit and vegetables intake in periodontal diseases: a systematic review. Dent Med Probl. 2018;55(4):431-439. doi:10.17219/dmp/99072
- Graziani F, Discepoli N, Gennai S, et al. The effect of twice daily kiwifruit consumption on periodontal and systemic conditions before and after treatment: a randomized clinical trial. J Periodontol. 2018;89(3):285-293. doi:10.1002/JPER.17-0148
Anna Nilvéus Olofsson, DDS, is a 1992 graduate from the Institute of Odontology at the University of Gothenburg. With a research focus in the periodontal field, she was awarded an Odont. Lic. degree in 2001. In 2004, she became a certified specialist in pediatric dentistry on the faculty of odontology at Malmö University. Dr. Nilvéus Olofsson has been the manager of odontology and scientific affairs at TePe Oral Hygiene Products since 2009.