The role of nutrition in periodontal health

 

Experimentally, if you have people stop brushing their teeth, plaque starts to build up, and within    a few days the gums start to get inflamed. You can’t see anything yet, but if you take a biopsy at the gum line, you can see the inflammation starting to spread. And within a few weeks overt gingivitis becomes apparent, where your gums can get red, swollen, and bleed easily. And if you don’t do anything about it, you can develop periodontal disease, where the inflammation creeps down into the supporting structures of the tooth—the bone and ligaments—setting you up for tooth loss. Okay, but how did we get along for millions of years without brushing? Yeah, “[d]ental disease is…almost universal” these days, but thousands of years before the invention of the toothbrush, there are skulls with perfect teeth. Now, you can say, “Yeah, but that was also thousands of years before the invention of candy bars.” But you don’t know…until you put it to the test.

Okay, yeah, but where are you going to find people to not only stop brushing but also to forego eating processed junk? Security guards. That‘s how you do it. It was one of these survivor-type TV shows where people were forced to live under Stone-Age conditions; so, no toothbrushes, toothpaste, dental floss, toothpicks, or other oral hygiene products for a month. Now, they could use a twig or something, but they were pretty much on their own. But, no candy bars either. They were going for about 4,000 BC; so, lots of whole grains, with supplemental salt, herbs, honey, milk, and meat. And then, they could go out and pick berries, or see what they could catch. So, what happened?

With no oral hygiene, their plaque built up, but their gums got healthier. This is measuring BOP, bleeding on probing (whether or not their gums bled when poked with a dental tool), a measure of gingivitis. And, in almost every case, they got better. Here are before-and-after pictures.Yeah, lots of plaque buildup, but actually healthier gums. How is that possible? Well, many of the more disease-causing bacteria seemed to have disappeared from their mouths. They suggest this could be from the lack of refined sugars. But, they were eating honey; so, it wasn’t like a sugar-free diet. Ah, but what they were eating were lots of whole grains, and berries rich in antioxidant phytonutrients “with anti-inflammatory properties.” So, maybe it was a combination: sugar-intake restriction combined with the intake of really healthy foods. Thus, all those experimental studies where people stop brushing and their gums inevitably get inflamed “may only be applicable” for people eating lots of processed foods rich in sugar and low in anti-inflammatory whole plant foods.

What about “the role of nutrition in periodontal health?” Gingivitis can lead to periodontitis, “an inflammatory disease of the supporting tissues of the teeth,” which “if untreated,” can lead “to the “progressive loss of the…bone” that holds the teeth in place. Now, part of the development of periodontal disease may involve oxidative stress. So, not only do we need to reduce our intake of pro-inflammatory foods like refined carbs and saturated fats, maybe it would help if we sought out foods that are antioxidant-rich.

So, is there an association between dietary vitamin C intake, for example, with periodontitis? Apparently so, with increasing risk of periodontitis associated with lower levels of vitamin C intake. But you don’t know…until you put it to the test to figure out what effect vitamin C depletion and supplementation would have on periodontal health. They basically locked everyone up for three months so they can provide controlled amounts of vitamin C and… “measures of [gum] inflammation were directly related to their [vitamin C] status.” On about one orange worth of vitamin C a day, their gums improve, but then down to 5 mg a day, they got worse. But then on 10 oranges’ worth a day, they got better, then worse again when back down to 5. Pretty convincing, though 5 mg a day is like scurvy level. I mean, we know that your gums start bleeding and your teeth can fall out when you have scurvy, but that doesn’t mean taking extra helps.

And indeed, 1,500 mg of vitamin C a day did not seem to help prevent gingivitis. And even 2,000 a day failed to help periodontitis sufferers. Maybe vitamin C is just too weak of an antioxidant? Okay, what about lycopene, the powerful antioxidant pigment that makes tomatoes red? It worked! But that was from injecting the stuff directly into the gum pocket with a syringe. Does it work if you just eat it? Let’s find out.

“A randomised, placebo-controlled clinical trial” on the “efficacy of lycopene in the treatment of gingivitis.” Two weeks of less than a single tomato-a-day’s worth of lycopene versus placebo for two weeks, both along with the standard dental treatment, which helped—a 10 to 20% reduction in gingivitis in the placebo group, but nearly 30% improvement within just one week in the lycopene group. And this was just like the amount of lycopene found in a teaspoon and a half of tomato paste a day. Totally doable. Okay, so tomatoes may help with gingivitis. What about periodontitis?

Another randomized, double-blind, placebo-controlled trial again treated with the usual dental cleaning plus either that one tomato-a-day’s worth of lycopene or a placebo for two months, and… significant improvements in plaque gingivitis and bleeding, though not probe pocket depth and clinical attachment. You can see the difference. See how much better their gums look. They conclude that “[s]upplementation with lycopene seems to have augmented the healing sequence of inflamed gingival tissues.” Okay, but that was with a whole tomato’s worth a day. How about half-a-tomato’s worth, or just three-quarters of a teaspoon of tomato paste worth of lycopene a day? It didn’t work; no difference, so looks like you have to go the whole tomato.