The Role of Nutrition in Periodontal Health: an Update
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nutrients Review The Role of Nutrition in Periodontal Health: An Update Shariq Najeeb 1, Muhammad Sohail Zafar 2,*, Zohaib Khurshid 3, Sana Zohaib 4 and Khalid Almas 5 1 Restorative Dental Sciences, Al-Farabi College, Riyadh 361724, Saudi Arabia; [email protected] 2 Department of Restorative Dentistry, College of Dentistry, Taibah University, Al Madinah, Al Munawwarah 41311, Saudi Arabia 3 College of Dentistry, King Faisal University, P.O. Box 380, Al-Hofuf, Al-Ahsa 31982, Saudi Arabia; [email protected] 4 Department of Biomedical Engineering, School of Engineering, King Faisal University, P.O. Box 380, Al-Hofuf, Al-Ahsa 31982, Saudi Arabia; [email protected] 5 Division of Periodontology, University of Dammam, College of Dentistry, Dammam 31441, Saudi Arabia; [email protected] * Correspondance: [email protected]; Tel.: +966-50-754-4691 Received: 26 June 2016; Accepted: 23 August 2016; Published: 30 August 2016 Abstract: Periodontal health is influenced by a number of factors such as oral hygiene, genetic and epigenetic factors, systemic health, and nutrition. Many studies have observed that a balanced diet has an essential role in maintaining periodontal health. Additionally, the influences of nutritional supplements and dietary components have been known to affect healing after periodontal surgery. Studies have attempted to find a correlation between tooth loss, periodontal health, and nutrition. Moreover, bone formation and periodontal regeneration are also affected by numerous vitamins, minerals, and trace elements. The aim of this review is to critically appraise the currently available data on diet and maintenance of periodontal health and periodontal healing. The effects of nutritional intervention studies to improve the quality of life and well-being of patients with periodontal disease have been discussed. Keywords: periodontium; periodontal health; micronutrients; wound healing; periodontal regeneration 1. Introduction Periodontitis is defined as “an inflammatory disease of the supportive tissues of the teeth caused by specific microorganisms or groups of specific microorganisms, resulting in progressive destruction of the periodontal ligament and alveolar bone with increased probing depth formation, recession, or both” [1]. If untreated, it leads to the progressive loss of the alveolar bone and loss of teeth [2,3]. It has been estimated that 40%–90% of the global population is affected by periodontitis, making it one of the most prevalent epidemics in the world [4,5]. The major microorganisms implicated in periodontal diseases include the red-complex bacteria Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola [6–8]. Additionally, Fusobacterium nucleatum, Prevotella species, Eikenella corrodens, Peptostreptococcus micros, and Campylobacter rectus have also been found in periodontal pockets [9]. It has been suggested that an aggressive immune response leading to the release of inflammatory cytokines like IL-1β against the microorganisms causes the destruction of the periodontal tissues [10]. A variety of factors have been linked with the etiology of periodontitits [11,12]. The primary cause is poor oral hygiene, which leads to the formation of dental plaque containing microorganisms [13]. In addition to these local elements, a number of systemic factors such as diabetes [5], cardiovascular disease [14,15], and pregnancy [16] have also been associated with Nutrients 2016, 8, 530; doi:10.3390/nu8090530 www.mdpi.com/journal/nutrients Nutrients 2016, 8, 530 2 of 18 Nutrients 2016, 8, 530 2 of 18 periodontitis.have also been Additionally, associated periodontitiswith periodontitis. has beenAdditionally, suggested periodontitis to contribute has been towards suggested instigating to the aforementionedcontribute towards systemic instigating diseases the aforementioned [17] and may evensystemic trigger diseases adverse [17] pregnancyand may even outcomes trigger [18]. Moreover,adverse habits pregnancy such asoutcomes smoking, [18]. tobacco, Moreover, and habits betel such nut as chewing smoking, and tobacco, drug and abuse betel also nut contribute chewing to the progressionand drug abuse of periodontitis also contribute [19 to,20 the]. progression of periodontitis [19,20]. ManagementManagement of periodontitis of periodontitis is achieved is achieved mainly mainly by removingby removing the causativethe causative factors factors (dental (dental plaque, plaque, microbial biofilm, and calculus) by means of scaling and root planing along with oral hygiene microbial biofilm, and calculus) by means of scaling and root planing along with oral hygiene instructions [21,22]. The relationship of calculus, gingival pocket, and periodontal tissues is shown in instructions [21,22]. The relationship of calculus, gingival pocket, and periodontal tissues is shown in Figure 1. Antibiotics are considered helpful in severe conditions or in the case of systemic Figureinvolvement1. Antibiotics [23]. are In considered order to enhance helpful the in functional severe conditions life of natural or in teeth the case with of severe systemic periodontal involvement bone [ 23]. In orderloss, to guided enhance tissue the regeneration functional life (GTR) of natural and bone teeth grafting with severeare employed periodontal [24,25]. bone Implant loss, therapy guided is tissue regenerationused to replace (GTR) andteeth bone lost due grafting to extensive are employed and uncontrolled [24,25]. Implantdegeneration therapy of bone is used and toperiodontal replace teeth lost duetissues to extensive [26,27]. and uncontrolled degeneration of bone and periodontal tissues [26,27]. FigureFigure 1. Periodontitis 1. Periodontitis is mainly is mainly caused caused by by the the presence presence of calculus, calculus, the the calcified calcified form form of dental of dental plaque. plaque. CalculusCalculus harbors harbors a number a number of pathogenicof pathogenic microbes microbes that that cause periodontitis. periodontitis. If not If not treated, treated, periodontal periodontal inflammation may cause progressive destruction of periodontal tissues. inflammation may cause progressive destruction of periodontal tissues. Destruction of periodontal tissues is brought about by the production of inflammatory factors Destructionreleased from of immune periodontal cells. Polymorphonuclear tissues is brought leukocytes about by are the attracted production to the of site inflammatory of periodontitis factors releaseddue from to the immune presence cells. of bacteria. Polymorphonuclear Following stimulation leukocytes by are bacterial attracted antigens, to the siteleukocytes of periodontitis produce due to thereactive presence oxidative of bacteria. species Following (ROS), enzymes, stimulation and by defensins bacterial that antigens, degrade leukocytes the pathogens produce during reactive oxidativephagocytosis species (ROS), [28]. Due enzymes, to the non and‐selective defensins nature that of degrade ROS, healthy the pathogens tissues are during also affected. phagocytosis Hence, [28]. Due toROS the destroy non-selective healthy naturecells during of ROS, inflammation healthy tissues by damaging are also DNA affected. and stimulating Hence, ROS the destroy production healthy cells duringof cytokines inflammation from macrophages by damaging and monocytes DNA and [29]. stimulating Furthermore, the it has production been suggested of cytokines that ROS from may play a part in activating osteoclasts, cells responsible for resorbing bone [30]. Diseased macrophages and monocytes [29]. Furthermore, it has been suggested that ROS may play a part in periodontal tissues contain a higher amount of ROS than healthy tissues because of oxidative tissues’ activatingdestruction osteoclasts, [31,32]. cells responsible for resorbing bone [30]. Diseased periodontal tissues contain a higher amountA variety of of ROS nutrients than healthyhave a major tissues impact because on periodontal of oxidative health tissues’ [33–35]. destruction Nutrients [ are31, 32of]. two Atypes: variety micronutrients of nutrients and have macronutrients. a major impact Micronutrients on periodontal are those health components [33–35 ].of food Nutrients that are are of two types:required micronutrients in small or trace and amounts. macronutrients. The human Micronutrients diet contains a number are those of antioxidants components in of the food form that of are requiredmicronutrients in small or [36]. trace Antioxidant amounts. micronutrients The human diet include contains vitamin a number A (carotenoids of antioxidants and β‐carotene) in the [37], form of micronutrientsvitamin C (ascorbic [36]. Antioxidant acid) [38], vitamin micronutrients E (α‐tocopherol) include [39], vitamin glutathione A (carotenoids [40], and melatonin and β-carotene) [41,42]. [37], vitamin C (ascorbic acid) [38], vitamin E (α-tocopherol) [39], glutathione [40], and melatonin [41,42]. Studies suggest that antioxidants may overcome the ROS-mediated inflammation of periodontal tissues [43,44]. Nutrients 2016, 8, 530 3 of 18 Macronutrients are nutrients required in large quantities, for example minerals, proteins, carbohydrates, and fats in addition to oxygen and water. High carbohydrate intake has been implicated in periodontal disease and dental caries [45]. The relationship of nutrition and oral health is well known [46,47]. For example, a sugary diet encourages plaque formation and leads to the onset or worsening of dental decay in reaction to poor oral hygiene [48].