Longitudinal relationship between dietary ω-3 fatty acids and periodontal disease

Is There a Relationship Between the Dietary Inflammatory Index and Clinical Attachment Loss in Patients with Periodontitis?

OBJECTIVE

The pathogenesis of periodontal diseases is partially driven by oxidative stress. However, studies on the relationship between periodontitis and the inflammatory load of diet are still insufficient. Therefore, this study aimed to examine the relationship between the diet's inflammatory load and periodontitis and clinical attachment loss (CAL).

METHODS

This cross-sectional study included 119 participants diagnosed with periodontitis according to the 1999 classification. The dietary inflammatory index (DII) was calculated using three-day food consumption records and divided into quartiles (Q1, Q2, and Q3). Body mass index (BMI) was calculated as weight and height (kg/m2). Clinical attachment loss (CAL) score was determined, and the patients were grouped with those CAL scores as 7 < CAL and ≥7 CAL.

RESULTS

Of the 119 patients with periodontitis, aged 46.24 ± 12.84 years, 45.3% were found to have an anti-inflammatory diet profile (n = 54). When the daily energy and nutrient intake of individuals were examined, it was found that the intake of omega-3 fatty acids (p = 0.004), black tea (p = 0.021), and green pepper (p = 0.029) was higher in those with CAL < 7 compared to those with CAL ≥ 7. There was no relationship between the patients' DII and CAL values. Daily energy, protein, fiber, vitamin A, vitamin E, folic acid, Fe, Zn, and Mg intake in patients with an anti-inflammatory diet in Q1 were higher than in Q2 and Q3 (p < 0.001).

CONCLUSION

This study found no relationship between DII levels and CAL scores. However, it was observed that periodontitis patients following an anti-inflammatory diet had higher intakes of omega-3 fatty acids, vitamins A, E, and C, as well as zinc and magnesium which are nutrients known to be effective against inflammation. These patients also had CAL scores below 7. Therefore, reducing the inflammatory load of the diet may prevent the development of periodontitis, and further research in this regard would be beneficial.

Can vitamins improve periodontal wound healing/regeneration?

Periodontitis is a complex inflammatory disorder of the tooth supporting structures, associated with microbial dysbiosis, and linked to a number if systemic conditions. Untreated it can result in an irreversible damage to the periodontal structures and eventually teeth loss. Regeneration of the lost periodontium requires an orchestration of a number of biological events on cellular and molecular level. In this context, a set of vitamins have been advocated, relying their beneficial physiological effects, to endorse the biological regenerative events of the periodontium on cellular and molecular levels. The aim of the present article is to elaborate on the question whether or not vitamins improve wound healing/regeneration, summarizing the current evidence from in vitro, animal and clinical studies, thereby shedding light on the knowledge gap in this field and highlighting future research needs. Although the present review demonstrates the current heterogeneity in the available evidence and knowledge gaps, findings suggest that vitamins, especially A, B, E, and CoQ10, as well as vitamin combinations, could exert positive attributes on the periodontal outcomes in adjunct to surgical or nonsurgical periodontal therapy.

CLINICAL FINDINGS OF DENTAL DISEASE AND POTENTIAL CONTRIBUTING FACTORS IN PYGMY SLOW LORISES (NYCTICEBUS PYGMAEUS) UNDER HUMAN CARE

Dental disease is a common finding in pygmy slow lorises (Nycticebus pygmaeus) under human care, but the etiology is not fully understood. The small oral cavity in this species can make diagnosis of dental disease difficult. This retrospective study evaluated medical records and diet and husbandry protocols from 18 participating institutions with the objective of describing the signalment, clinical signs, physical exam findings, tooth type, tooth location, diagnostics used, and treatments performed to help guide care for dental disease. In addition, the study aimed to identify potential contributing factors to dental disease in this species. Of 59 animals with medical records evaluated, 42 (71.2%) had dental disease: 19 (44.2%) males, 20 (46.5%) females, and 3 (9.3%) without gender documented. Average age at onset of dental disease was 7.6 yr in males and 9 yr in females. Multiple lorises with dental disease (n = 12; 28.6%) had no premonitory clinical signs, and dental disease was found incidentally on examination. On dental examination, 30 lorises (71.4%) had evidence of gingivitis. In 13 cases skull radiographs were taken, but the majority of images (n = 8; 61.5%) were nondiagnostic for pathologic dental changes. A small proportion of cases with dental abnormalities (n = 4; 9.5%) were diagnosed using computed tomography. In total, 175 teeth were extracted from 31 patients; molars were the most frequently extracted tooth (n = 55; 31.4%). No substantial differences in diets were noted among many of the participating institutions, and not all slow lorises evaluated developed dental disease (n = 17; 28.8%). This retrospective study provides clinical findings on slow loris dental disease and guidance for the veterinary care and management of slow lorises under human care.

Periodontal Disease and Other Adverse Health Outcomes Share Risk Factors, including Dietary Factors and Vitamin D Status

For nearly a century, researchers have associated periodontal disease (PD) with risks of other adverse health outcomes such as cardiovascular disease, diabetes mellitus, and respiratory diseases, as well as adverse pregnancy outcomes. Those findings have led to the hypothesis that PD causes those adverse health outcomes either by increasing systemic inflammation or by the action of periodontopathic bacteria. However, experiments largely failed to support that hypothesis. Instead, the association is casual, not causal, and is due to shared underlying modifiable risk factors, including smoking, diet, obesity, low levels of physical activity, and low vitamin D status. Diabetes mellitus is also considered a risk factor for PD, whereas red and processed meat are the most important dietary risk factors for diabetes. Because PD generally develops before other adverse health outcomes, a diagnosis of PD can alert patients that they could reduce the risk of adverse health outcomes with lifestyle changes. In addition, type 2 diabetes mellitus can often be reversed rapidly by adopting an anti-inflammatory, nonhyperinsulinemic diet that emphasizes healthful, whole plant-based foods. This review describes the evidence that proinflammatory and prohyperinsulinemia diets and low vitamin D status are important risk factors for PD and other adverse health outcomes. We also make recommendations regarding dietary patterns, food groups, and serum 25-hydroxyvitamin D concentrations. Oral health professionals should routinely inform patients with PD that they could reduce their risk of severe PD as well as the risks of many other adverse health outcomes by making appropriate lifestyle changes.

Foods and Nutrients at Risk for Insufficient Intake by Community-Dwelling Healthy Older Women Eating Alone and Together in Japan-A Preliminary Finding

Eating alone and poor dental status have been reported to influence dietary intake in older adults. First, we compared nutrient and food intake and dental markers between women eating alone and together, who participated in a home health management program conducted by Kanazawa Medical University. The results showed the significantly higher intake of fresh fruit and some micro-nutrients and a lower decayed, missing, and filled teeth (DMFT) index (better dental status) in women eating alone after adjusting for age, suggesting that dental status may mediate the association between commensality and dietary intake. Then, we investigated nutrients and foods at risk for insufficient intake and associated with increasing dental markers. The risks for the insufficient intake of protein and n-3 and n-6 polyunsaturated fatty acids (PUFAs) were significantly increased with an increasing DMFT index. The risk for n-3 PUFA intake also increased with increasing numbers of missing teeth in women. Foods at risk for insufficient consumption included beans for women with an increasing DMFT index and green and yellow vegetables, fresh fruits, and meat and fish for women with increasing numbers of missing teeth. These findings suggest that good health management, including the treatment of decayed teeth, is important for the prevention of malnutrition in community-dwelling healthy older women.

The inverse association between a fish consumption biomarker and gingival inflammation and periodontitis: A population-based study

AIM

The metabolite 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF) is a fatty fish-intake biomarker. We investigated the association between plasma levels of CMPF in relation to gingival inflammation and periodontitis case definition, as well as the extent and severity variables.

MATERIALS AND METHODS

The Malmö Offspring Study is a population-based study, and the Malmö Offspring Dental Study (MODS) is its dental arm, including periodontal charting. Plasma CMPF was measured using liquid chromatography-mass spectrometry and studied in relation to periodontal diagnosis and parameters using multivariable linear or logistic regression modelling adjusting for age, sex, education, body mass index, fasting glucose, and smoking.

RESULTS

Metabolite data were available for 922 MODS participants. Higher CMPF levels were associated with less gingival inflammation (β = -2.12, p = .002) and lower odds of severe periodontitis (odds ratio [OR] = 0.74, 95% confidence interval [CI]: 0.56 to 0.98). Higher CMPF levels were also associated with more teeth (β = 0.19, p = .001), lower number of periodontal pockets (≥4 mm) (β = -1.07, p = .007), and lower odds of having two or more periodontal pockets of ≥6 mm (OR = 0.80, 95% CI: 0.65 to 0.98) in fully adjusted models.

CONCLUSIONS

CMPF, a validated biomarker of fatty fish consumption, is associated with less periodontal inflammation and periodontitis. Residual confounding cannot be ruled out, and future studies are warranted.

Role of adjunct use of omega 3 fatty acids in periodontal therapy of periodontitis. A systematic review and meta-analysis

BACKGROUND

Host modulation therapy has emerged as a new concept for the treatment of periodontal disease. Recently, a lot of research is being done in product containing docosahexaenoic acid (DHA) and eicosapentanoic acid (EPA). Omega-3 PUFA have therapeutic, anti-inflammatory and protective properties. This systematic review analysed the adjunctive use of omega-3 fatty acids in periodontal therapy of periodontitis patients.

METHODS

PICO question (patient, intervention, comparison, and outcome) was formed. Keywords were generated and were fed in databases. The databases were Pubmed, Cochrane library and LIVIVO. Studies selected are Randomized clinical trial, clinical studies, and longitudinal studies. Meta -analysis were performed for Pocket depth (PD), Clinical attachment level (CAL), Gingival index (GI) and Plaque Index (PI). Risk of bias was also assessed.

RESULTS

On analysis of all the 8 studies at 3 months showed significant effect of omega -3 fatty acid on clinical attachment level (CAL), Pocket depth (PD). There was significant effect of omega-3 fatty acids in 4 studies at 6 months.

CONCLUSION

Within the limitation of the review, omega- 3 polyunsaturated fatty acids seems to have a positive effect on periodontal healing following periodontal therapy. Chronic periodontitis patient should be counselled to incorporate omega -3 fatty acid in their diet along with standard periodontal therapy.

The relationship between inflammatory dietary pattern and incidence of periodontitis

The long-term inflammatory impact of diet could potentially elevate the risk of periodontal disease through modification of systemic inflammation. The aim of the present study was to prospectively investigate the associations between a food-based, reduced rank regression (RRR)-derived, empirical dietary inflammatory pattern (EDIP) and incidence of periodontitis. The study population was composed of 34 940 men from the Health Professionals Follow-Up Study, who were free of periodontal disease and major illnesses at baseline (1986). Participants provided medical and dental history through mailed questionnaires every 2 years and dietary data through validated semi-quantitative FFQ every 4 years. We used Cox proportional hazard models to examine the associations between EDIP scores and validated self-reported incidence of periodontal disease over a 24-year follow-up period. No overall association between EDIP and the risk of periodontitis was observed; the hazard ratio comparing the highest EDIP quintile (most proinflammatory diet) with the lowest quintile was 0·99 (95 % CI 0·89, 1·10, P-value for trend = 0·97). A secondary analysis showed that among obese non-smokers (i.e. never and former smokers at baseline), the hazard ratio for periodontitis comparing the highest EDIP quintile with the lowest was 1·39 (95 % CI 0·98, 1·96, P-value for trend = 0·03). In conclusion, no overall association was detected between EDIP and incidence of self-reported periodontitis in the study population. From the subgroups evaluated, EDIP was significantly associated with increased risk of periodontitis only among non-smokers who were obese. Hence, this association must be interpreted with caution.

Periodontal Disease: The Good, The Bad, and The Unknown

Periodontal disease is classically characterized by progressive destruction of the soft and hard tissues of the periodontal complex, mediated by an interplay between dysbiotic microbial communities and aberrant immune responses within gingival and periodontal tissues. Putative periodontal pathogens are enriched as the resident oral microbiota becomes dysbiotic and inflammatory responses evoke tissue destruction, thus inducing an unremitting positive feedback loop of proteolysis, inflammation, and enrichment for periodontal pathogens. Keystone microbial pathogens and sustained gingival inflammation are critical to periodontal disease progression. However, recent studies have revealed the importance of previously unidentified microbes involved in disease progression, including various viruses, phages and bacterial species. Moreover, newly identified immunological and genetic mechanisms, as well as environmental host factors, including diet and lifestyle, have been discerned in recent years as further contributory factors in periodontitis. These factors have collectively expanded the established narrative of periodontal disease progression. In line with this, new ideologies related to maintaining periodontal health and treating existing disease have been explored, such as the application of oral probiotics, to limit and attenuate disease progression. The role of systemic host pathologies, such as autoimmune disorders and diabetes, in periodontal disease pathogenesis has been well noted. Recent studies have additionally identified the reciprocated importance of periodontal disease in potentiating systemic disease states at distal sites, such as in Alzheimer's disease, inflammatory bowel diseases, and oral cancer, further highlighting the importance of the oral cavity in systemic health. Here we review long-standing knowledge of periodontal disease progression while integrating novel research concepts that have broadened our understanding of periodontal health and disease. Further, we delve into innovative hypotheses that may evolve to address significant gaps in the foundational knowledge of periodontal disease.

Macronutrient-induced modulation of periodontitis in rodents-a systematic review

CONTEXT

Consumption of dietary macronutrients is associated with the progression of a wide range of inflammatory diseases, either by direct modulation of host immune response or via microbiome. This includes periodontitis, a disease affecting tooth-supporting tissues.

OBJECTIVE

The aim of this work was to systematically review studies focusing on the effect of macronutrient (ie, carbohydrate, protein, fat) intake on periodontitis in rodents.

DATA SOURCES

Electronic searches were performed in February 2021 using the PubMed and Web of Science databases. Out of 883 articles reviewed, 23 studies were selected for additional analysis.

DATA EXTRACTION

Investigators extracted relevant data, including author names; the year of publication; article title; macronutrient composition; number and species of animals and their age at the start of the experiment; intervention period; method of periodontitis induction; and primary and secondary periodontitis outcomes. Quality assessment was done using the risk-of-bias tool for animal studies. After completing the data extraction, descriptive statistical information was obtained.

DATA ANALYSIS

High intakes of dietary cholesterol, saturated fatty acids, and processed carbohydrates such as sucrose, and protein-deficient diets were positively associated with periodontitis in rodents. This included greater amounts of alveolar bone loss, more lesions on periodontal tissues, and dental plaque accumulation. In contrast, high doses of milk basic protein in diets and diets with a high ratio of ω-3 to ω-6 fatty acids were negatively associated with periodontitis in rodents.

CONCLUSION

This work highlights the fact that, despite the large body of evidence linking macronutrients with inflammation and ageing, overall there is little information on how dietary nutrients affect periodontitis in animal models. In addition, there is inconsistency in data due to differences in methodology, outcome measurement, and dietary formulation. More studies are needed to examine the effects of different dietary macronutrients on periodontitis and investigate the underlying biological mechanisms.

The associations between major dietary patterns and risk of periodontitis

AIM

To prospectively investigate the associations between major dietary patterns and incidence of periodontitis.

METHODS

We included 34,940 men from the Health Professionals Follow-Up Study, free of periodontal disease and major illnesses at baseline. Detailed medical and dental history was collected through biennial mailed questionnaires, and dietary information was provided through quadrennial food frequency questionnaires. Using principal component analysis, we identified two major dietary patterns ("prudent" and "Western"). We used Cox proportional hazard models to examine the associations between the two dietary patterns and self-reported incidence of periodontitis over a 24-year follow-up period. We investigated each pattern separately.

RESULTS

There was no overall association between Western or prudent dietary patterns and periodontitis. Among obese, however, the Western dietary pattern was significantly associated with incident periodontitis. The hazard ratio for those in the highest quintile of Western diet versus those in the lowest (reference) was 1.83 (95% confidence interval: 1.21-2.76).

CONCLUSIONS

There was no overall association between Western or prudent dietary patterns and periodontitis; however, in subgroups analysis, the Western diet was significantly associated with higher periodontitis risk only among obese men, a finding that requires replication and biological explication.

Fish oil diet effects on alveolar bone loss, in hypercholesterolemic rats

This study evaluated the effects of replacing a saturated fat diet by n-3 polyunsaturated fatty acids (n-3PUFA), on alveolar bone loss in hypercholesterolemic rats with experimental periodontitis (PD).

METHODS

Eight week old Wistar rats were assigned according to dietary intake. Control group (C, n = 15) fed a commercial diet throughout the experiment. Atherogenic group (AT, n = 30) fed AT diet for 3 weeks; thereafter, AT was randomized to receive either a n-3PUFA (n = 15) or to continue with AT (n = 15) diet. Subsequently, PD was induced in all groups by unilateral ligature (L) of the first molar (M1) of the left mandible, non-ligated contralateral molars served as controls. After every week of PD induction, 5 rats per group were euthanized. Serum was collected for lipids assays and hemi-mandibles were subjected to histomorphometric (% upper and lower interradicular bone volume and periodontal ligament height, hPDL) and radiographic analyses (periodontal bone support, PBS, in ligated teeth, between M1-M2).

RESULTS

Rats fed n-3PUFA diet rapidly induced a significant reduction in the serum lipids (p < 0.001). In all rats the ligated teeth showed a greater bone loss as compared with the unligated molars. At the end of the experiment the AT + L was the worst in % lower bone volume (p < 0.01), hPDL and PBS (p < 0.05). In contrast, rats fed n-3PUFA + L was similar to those rats fed C diet (p > 0.05).

CONCLUSION

Alveolar bone and dyslipidemia improved by substituting saturated fat intake for a n-3PUFA rich diet, in hypercholesterolemic rats with PD.

Poor dietary intake of nutrients and food groups are associated with increased risk of periodontal disease among community-dwelling older adults: a systematic literature review

Context

Periodontal disease is a chronic inflammatory gum condition that is more prevalent in older populations. The development of periodontal disease has been directly linked to inflammatory dietary habits.

Objective

This systematic review aimed to 1) describe the relationship and 2) describe the direction of the relationship between dietary intake (nutrients and food groups) and periodontal disease in community-dwelling, older adults. PRISMA guidelines were followed for this review.

Data Sources

A systematic search of the databases MEDLINE, EMBASE, Global Health, CINAHL, Science Direct, Informit, and Cochrane Library was conducted from the earliest possible date until September 2018. Search terms were related to main themes: “periodontal disease,” “gingivitis,” “gum diseases,” “dietary intake” and “older adults.” The search produced 779 records, and after additional publications were obtained and duplicates were removed, 666 publications underwent title and abstract screening. Included papers were written in English and were based on populations of healthy, older adults living in community-based settings. Nine papers met inclusion criteria and were included in this review.

Data Extraction

Sample size, participant characteristics, inclusion and exclusion criteria, periodontal measures, dietary measures, confounders, and results were sorted by study type, author, year, and country.

Data Analysis

Quality of the extracted data was analyzed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.

Conclusions

Inverse associations were found between fatty acids, vitamin C, vitamin E, beta-carotene, fiber, calcium, dairy, fruits, and vegetables and risk of periodontal disease. Overall, this review found a relationship between poor dietary intake and increased risk of periodontal disease; however, this needs to be further explored.

Systematic Review Registration

PROSPERO Registration Number CRD42017065022.

n-3 Ingestion may modulate the severity of periodontal disease? Systematic review

The aim of this study was to determine the effects of n-3 ingestion on periodontal disease. Besides, we also investigated the relationship between plasma concentrations of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and/or aracdonic acid (AA), and periodontal disease. An electronic search was performed in several databases with the following keywords: "n-3," DHA, EPA and polynsaturated fatty acids (PUFA) in combination with the term "periodontal disease" (PD). Only studies conducted with humans, involving clinical parameters of PD assessment and use of n-3 were selected, without restriction to the date of publication. The search has returned 1368 articles, 11 of which were selected. The results were separated according to the type of n-3 ingestion: supplementation or n-3 content in normal diet. In the studies where n-3 has been supplemented, there was no significant difference in the clinical severity of PD compared to the control subjects. However, in patients where levels of n-3 were evaluated in a usual diet, a lower disease severity was reported. We have detected a preventive effect related to plasma levels of EPA and DHA against PD progression. Thus, n-3 ingestion may beneficially interfere in PD progression, depending on the duration and dosage of consumption.

Impact of Docosahexaenoic Acid Therapy on Subgingival Plaque Microbiota

BACKGROUND

Oral docosahexaenoic acid (DHA) + aspirin therapy has been shown to reduce periodontal probing depth (PD) and local inflammatory mediators in gingival crevicular fluid (GCF) among patients with untreated chronic periodontal disease. Whether DHA + aspirin therapy influences specific bacterial burden in this setting is unknown. Thus, the aim of this study is to evaluate the impact of DHA with low-dose aspirin therapy on periodontal bacterial profile in patients with periodontitis.

METHODS

Fifty-five adults with moderate-to-severe periodontitis were enrolled in a randomized, 3-month double-masked, placebo-controlled trial of daily 2 g DHA or placebo capsules enriched with 81 mg aspirin; 46 enrollees completed the trial. In addition to clinical measurements and GCF sampling, subgingival plaque samples were collected from four posterior sites in all participants and analyzed by the checkerboard DNA-DNA hybridization technique. Presence of 40 periodontal bacterial species at baseline and 3 months was semiquantitatively estimated.

RESULTS

Despite broad improvements in clinical parameters, total bacteria and individual species counts in dental plaque did not differ significantly between baseline and 3 months in either group (P >0.1 for all). A modest effect of DHA + aspirin on Porphyromonas gingivalis counts was associated with 14% (95% confidence interval: 3% to 35%) of the observed benefit of DHA on PD. DHA + aspirin had no significant effect on individual plaque bacterial counts in unadjusted models or those adjusted for age, sex, and race (P >0.1 for all).

CONCLUSIONS

This pilot randomized, controlled trial suggests that DHA + aspirin therapy improves periodontitis largely by modulating host inflammatory response. Changes in individual species levels in subgingival plaque microbiota were not detectable; however, a small portion of the benefit appears to stem from changes in P. gingivalis levels in the DHA + aspirin treatment group. Whether this change in P. gingivalis levels leads to biofilm alteration with reversal of dysbiosis requires further longitudinal and more specific investigations.

Omega 3 Fatty Acids Reduce Bone Resorption While Promoting Bone Generation in Rat Apical Periodontitis

INTRODUCTION

This study evaluated the effects of the dietary supplement omega 3 polyunsaturated fatty acids (ω-3 PUFAs) on pulp exposure-induced apical periodontitis (AP) in rats.

METHODS

Twenty-eight male rats were divided into groups: control untreated rats (C), control rats treated with ω-3 PUFAs alone (C-O), rats with pulp exposure-induced AP, and rats with pulp exposure-induced AP treated with ω-3 PUFAs (AP-O). The ω-3 PUFAs were administered orally, once a day, for 15 days before pulp exposure and, subsequently, 30 days after pulp exposure. Rats were killed 30 days after pulp exposure, and jaws were subjected to histologic and immunohistochemical analyses. Immunohistochemical analyses were performed to detect tartrate-resistant acid phosphatase-positive osteoclasts and osteocalcin-positive osteoblasts on the bone surface of periapical area. Results were statistically evaluated by using analysis of variance and Tukey honestly significant difference, and P < .05 was considered statistically significant.

RESULTS

The bone resorption lesion was significantly larger in the AP group compared with AP-O, C, and C-O groups (P < .05). The level of inflammatory cell infiltration was significantly elevated, and the number of tartrate-resistant acid phosphatase-positive osteoclasts was significantly higher in the periapical lesions of the AP group compared with AP-O, C, and C-O groups (P < .05). The number of osteocalcin-positive osteoblasts was significantly increased in the AP-O group compared with the AP group (P > .05).

CONCLUSIONS

Supplementation with ω-3 PUFAs not only suppresses bone resorption but also promotes new bone formation in the periapical area of rats with AP in conjunction with downregulation of inflammatory cell infiltration into the lesion.

Providing Flaxseed Oil but Not Menhaden Oil Protects against OVX Induced Bone Loss in the Mandible of Sprague-Dawley Rats

Higher intakes of polyunsaturated fatty acids (PUFA) are associated with benefits at several skeletal sites in postmenopausal women and in rodent models, but the effect of PUFA-containing oils on tooth-supporting alveolar bone of the mandible has not been studied. Moreover, direct comparison of the effect of flaxseed oil (a source of alpha-linolenic acid (ALA)) and menhaden oil (a source of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)) is unknown. One-month old female Sprague-Dawley rats (n = 48) were randomized to and fed a diet containing flaxseed oil or menhaden oil from one to six months of age. At three months of age, rats were randomized to receive SHAM or ovariectomy (OVX) surgery (n = 12/diet). The inter-radicular septum below the first molar of the mandible was imaged at 6 months of age (study endpoint) using micro-computed tomography (μCT) at a resolution of 9 μm. As expected, OVX significantly reduced percent bone volume (BV/TV), connectivity density (Conn. D.), trabecular number (Tb. N.), and increased trabecular separation (Tb. Sp.) compared to SHAM rats (p < 0.001). However, post hoc analysis revealed these differences were present in rats fed menhaden oil but not those fed flaxseed oil. These results suggest that providing flaxseed oil, possibly through its high ALA content, provides protection against the OVX-induced alveolar bone loss in rats.

Role of Lipids in the Onset, Progression and Treatment of Periodontal Disease. A Systematic Review of Studies in Humans

The risk of different oral problems (root caries, tooth mobility, and tooth loss) can be increased by the presence of periodontal disease, which has also been associated with a growing list of systemic diseases. The presence of some bacteria is the primary etiology of this disease; a susceptible host is also necessary for disease initiation. In this respect, the progression of periodontal disease and healing of the periodontal tissues can be modulated by nutritional status. To clarify the role of lipids in the establishment, progression, and/or treatment of this pathology, a systematic review was conducted of English-written literature in PubMed until May 2016, which included research on the relationship of these dietary components with the onset and progression of periodontal disease. According to publication type, randomized-controlled trials, cohort, case-control and cross-sectional studies were included. Among all the analyzed components, those that have any effect on oxidative stress and/or inflammation seem to be the most interesting according to current evidence. On one hand, there is quite a lot of information in favor of a positive role of n-3 fatty acids, due to their antioxidant and immunomodulatory effects. On the other hand, saturated fat-rich diets increase oxidative stress as well the as intensity and duration of inflammatory processes, so they must be avoided.

Periodontal condition in relation to intake of omega-3 and omega-6 polyunsaturated fatty acids

AIM

To examine whether the intake of omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) is associated with periodontal condition.

MATERIAL AND METHODS

The study population consisted of non-smoking, non-diabetic and non-rheumatoid individuals in the Health 2000 Survey in Finland. Analyses were made in two age groups: 30-49 years (n = 1212) and 50-79 years (n = 980). Clinically determined sextants with gingival bleeding and teeth with periodontal pockets were used as outcome variables. Dietary data were collected by a validated food frequency questionnaire. Energy-adjusted intakes of arachidonic acid (AA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), omega-3 and omega-6 PUFAs, as well as ratios of EPA/AA and of DHA/AA, and omega-3/omega-6 PUFAs were used as exposures. Prevalence rate ratios were estimated using Poisson regression models.

RESULTS

In this population, there were no statistically significant associations between the examined omega-3 or omega-6 fatty acids or their ratios and the periodontal outcome variables.

CONCLUSIONS

This cross-sectional study provided evidence that individual omega-3 or omega-6 fatty acids, their subclasses or ratios are not associated with periodontal health among a non-diabetic, non-rheumatoid and non-smoking population.

Omega-3 fatty acids as an adjunct for periodontal therapy-a review

OBJECTIVES

The aim of this article is to present an overview of omega-3 fatty acids, their anti-inflammatory properties and potential use as an adjunct for periodontal therapy.

MATERIALS AND METHODS

A general literature search was conducted to provide an overview of omega-3 fatty acids, their metabolism and anti-inflammatory properties. A more specific literature search of PubMed and EMBASE was conducted to identify articles dealing studies investigating the effects of omega-3 fatty acids in the treatment of periodontitis in animals and humans and included cross-sectional, longitudinal and intervention designs.

RESULTS

To date, there is good emerging evidence that dietary supplementation with fish oil may be of some benefit and this is enhanced if combined with aspirin. All clinical intervention studies to date have been on small sample sizes, and this indicates there is need for larger and more robust clinical trials to verify these initial findings.

CONCLUSIONS

Dietary supplementation with fish oil could be a cost-effective adjunctive therapy to the management of periodontal disease.

CLINICAL RELEVANCE

The host modulatory properties of omega-3 fatty acids warrant further assessment of their use as an adjunct in the management of periodontitis.

Higher Intakes of Fruits and Vegetables, β-Carotene, Vitamin C, α-Tocopherol, EPA, and DHA Are Positively Associated with Periodontal Healing after Nonsurgical Periodontal Therapy in Nonsmokers but Not in Smokers

BACKGROUND

Periodontitis is a chronic inflammatory disease and a significant risk factor for tooth loss. Although a link between diet and periodontal health exists, the relation between diet and healing after periodontal therapy has yet to be investigated.

OBJECTIVE

The objective was to determine whether higher intakes of fruits and vegetables or nutrients with antioxidant or anti-inflammatory activity are associated with greater healing, measured as reduced probing depth (PD), after scaling and root planing (SRP), a cost-effective treatment to manage periodontal disease and prevent tooth loss.

METHODS

Patients (63 nonsmokers, 23 smokers) with chronic generalized periodontitis who were undergoing SRP participated. Healing was evaluated based on PD, assessed at baseline and 8-16 wk after SRP. Intakes of fruits, vegetables, β-carotene, vitamin C, α-tocopherol, α-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) were estimated using the Block 2005 food frequency questionnaire and a supplement questionnaire. Serum 25-hydroxyvitamin D concentrations were also measured. PD (% sites >3 mm) was modeled in multiple linear regression and analysis of covariance by tertile of intake and adjusted for age, sex, body mass index (BMI), baseline PD, examiner, gingival bleeding, and study duration.

RESULTS

In nonsmokers, PD was associated with fruit and vegetable, β-carotene, vitamin C, α-tocopherol, EPA, and DHA intakes (P < 0.05). PD was not significantly associated with ALA intake or serum 25-hydroxyvitamin D concentration. Significant associations that included supplements (β-carotene, vitamin C, α-tocopherol) were attenuated or lost, depending on the statistical model used. There were no significant associations within the group of smokers.

CONCLUSIONS

Dietary intakes of fruits and vegetables, β-carotene, vitamin C, α-tocopherol, EPA, and DHA are associated with reduced PD after SRP in nonsmokers, but not smokers, with chronic generalized periodontitis. These findings may lead to the development of dietary strategies to optimize healing after periodontal procedures. This trial was registered at clinicaltrials.gov as NCT02291835.

Nutrigenomics: the role of nutrients in gene expression

Improved understanding of the mechanism behind periodontal tissue destruction, the potential protective role of nutrients and the advent of modern genomic measurement tools has led to an increased interest in the association between nutrition and periodontal disease. To date, evidence for a direct link between periodontal disease and nutrition has come mainly from large observational cross-sectional studies or very small double-blind randomized supplementation trials, with a large proportion finding no significant association between the nutrient being analyzed and markers of periodontal disease status. The advent of the 'genomic era' has introduced the concept of nutrigenomic studies, which aim to reveal the relationship between nutrition and the genome to provide a scientific basis for improved public health through dietary means. Used alongside relatively inexpensive high-throughput technology, this will allow the effect of diet on the etiology of periodontal disease to be studied in greater detail. As it is extremely likely that interactions between genotype and diet are important in determining the risk of the most common complex diseases, it is highly probable that these interactions will be important in determining periodontal disease risk. Numerous nutritional genetic studies where the outcome measures have been markers of disease risk, most notably cardiovascular disease and cancer, provide proof of principle, highlight the importance of understanding these interactions and illustrate where the effect of dietary modification on periodontal disease progression may have been overlooked previously by observational studies.

Understanding the gastrointestinal tract of the elderly to develop dietary solutions that prevent malnutrition

Although the prevalence of malnutrition in the old age is increasing worldwide a synthetic understanding of the impact of aging on the intake, digestion, and absorption of nutrients is still lacking. This review article aims at filling the gap in knowledge between the functional decline of the aging gastrointestinal tract (GIT) and the consequences of malnutrition on the health status of elderly. Changes in the aging GIT include the mechanical disintegration of food, gastrointestinal motor function, food transit, chemical food digestion, and functionality of the intestinal wall. These alterations progressively decrease the ability of the GIT to provide the aging organism with adequate levels of nutrients, what contributes to the development of malnutrition. Malnutrition, in turn, increases the risks for the development of a range of pathologies associated with most organ systems, in particular the nervous-, muscoskeletal-, cardiovascular-, immune-, and skin systems. In addition to psychological, economics, and societal factors, dietary solutions preventing malnutrition should thus propose dietary guidelines and food products that integrate knowledge on the functionality of the aging GIT and the nutritional status of the elderly. Achieving this goal will request the identification, validation, and correlative analysis of biomarkers of food intake, nutrient bioavailability, and malnutrition.

Oral health status: relationship to nutrient and food intake among 80-year-old Japanese adults

OBJECTIVES

The aim of this cross-sectional study was to investigate the relationship of oral health status defined on the basis of presence of posterior occluding pairs (POPs) and adequacy of removable denture fit as determined by self-report to nutrient and food intake among older Japanese.

METHODS

The subjects were 353 Japanese aged 80 years in 2008 and were classified into four groups according to the number of POPs, defined as pairs of occluding natural, restored, or fixed prosthetic postcanine teeth (range: 0-8) and removable denture status. The groups were: (i) good dentition (n = 56; 8 POPs and no removable prosthesis), (ii) well-fitting dentures (n = 158; <8 POPs with self-reported good-fitting dentures), (iii) ill-fitting dentures (n = 70; <8 POPs with self-reported ill-fitting dentures), and (iv) compromised dentition (n = 69; <8 POPs and no removable prosthesis). Multivariable analysis of the differences in nutrient and food intake outcome variables which were collected via validated food frequency questionnaire among the four oral health status groups was conducted using general linear models. Results: Intake of multiple nutrients was significantly (P < 0.05) lower in the group with ill-fitting dentures or compromised dentition than in the good dentition group. Vegetable, fish, and shellfish consumption was significantly lower in the ill-fitting dentures or compromised dentition groups. No significant differences were seen in dietary intake between the well-fitting dentures and good dentition groups. Conclusions: Dietary intake was poorer in those with self-perceived ill-fitting dentures or fewer POPs than among those having all POPs. Regular dental care to maintain intact dentition, as well as dental treatment to replace missing teeth and ensure adequate denture fit and function, may be important to the diet intake and subsequent nutritional status of older Japanese.

Oxidative Stress and Dietary Fat Type in Relation to Periodontal Disease

Oxidative stress is one of the main factors studied to explain the pathophysiological mechanisms of inflammatory conditions, such as periodontitis. In this respect, nutrition may be of great importance. Actually, research on nutrients' effects on periodontal diseases has expanded to include those influencing the redox status, which correlates to the inflammatory process. Dietary fat or lipids are often blamed as the major source of excess energy. Consequently, when caloric intake exceeds energy expenditure, the resultant substrate-induced increase in citric acid cycle activity generates an excess of reactive oxygen species (ROS). In addition, dietary fatty acid intake influences in relative fatty acid composition of biological membranes determining its susceptibility to oxidative alterations. From this standpoint, here, we reviewed studies analyzing the dietary fat role in periodontal disease. Research data suggest that periodontal health could be achieved by main dietary strategies which include substitution of saturated fats with monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA), particularly n-3 PUFA. Maybe in the future, we should analyze the diet and provide some advice to periodontitis patients to improve treatment outcomes.

Docosahexaenoic Acid and Periodontitis in Adults: A Randomized Controlled Trial

Periodontitis is a common chronic inflammatory disease initiated by bacteria, resulting in bone resorption, tooth loss, and systemic inflammation. Long-chain omega-3 fatty acids such as docosahexaenoic acid (DHA) reduce periodontitis in animals. We aimed to determine whether DHA supplementation with low-dose aspirin would reduce periodontitis in humans. We conducted a double-blind placebo-controlled parallel trial lasting 3 mo. Fifty-five adults with moderate periodontitis were randomized to 2,000 mg of DHA or identical soy/corn oil capsules. All participants received 81 mg of aspirin but received no other treatments. We analyzed the primary outcome of per-pocket change in pocket depth using mixed models among teeth with pocket depth ≥5 mm. Secondary outcomes assessed with generalized estimating equations included gingival index, plaque index, and bleeding on probing. Gingival crevicular fluid samples were analyzed for changes in high-sensitivity C-reactive protein (hsCRP) and interleukins 6 and 1β (IL-6 and IL-1β). Plasma was analyzed for changes in systemic inflammatory markers, including hsCRP. We confirmed adherence with erythrocyte fatty acid measurement. Forty-six participants completed the trial. While similar at baseline, the proportion of DHA in red blood cell plasma membranes increased from 3.6% ± 0.9% to 6.2% ± 1.6% in the intervention group but did not change among controls. DHA supplementation decreased mean pocket depth (-0.29 ± 0.13; p = .03) and gingival index (-0.26 ± 0.13; p = .04). Plaque index and bleeding on probing did not change. Significant adjusted differences were found between DHA and control for both gingival crevicular fluid hsCRP (-5.3 ng/mL, standard error [SE] = 2.4, p = .03) and IL-1β (-20.1 pg/mL, SE = 8.2, p = .02) but not IL-6 (0.02 pg/mL, SE = 0.71, p = .98) or systemic hsCRP (-1.19 mg/L, SE = 0.90, p = .20). In this randomized controlled trial, aspirin-triggered DHA supplementation significantly improved periodontal outcomes in people with periodontitis, indicating its potential therapeutic efficacy (clinicaltrials.gov NCT01976806).

DHA suppresses Prevotella intermedia lipopolysaccharide-induced production of proinflammatory mediators in murine macrophages

Several reports have indicated that dietary intake of DHA is associated with lower prevalence of periodontitis. In the present study, we investigated the effect of DHA on the production of proinflammatory mediators in murine macrophage-like RAW264.7 cells stimulated with lipopolysaccharide (LPS) isolated from Prevotella intermedia, a pathogen implicated in inflammatory periodontal disease, and its mechanisms of action. LPS was isolated from lyophilised P. intermedia ATCC 25,611 cells using the standard hot-phenol-water protocol. Culture supernatants were collected and assayed for NO, IL-1β and IL-6. Real-time PCR analysis was carried out to detect the expression of inducible NO synthase (iNOS), IL-1β, IL-6 and haeme oxygenase-1 (HO-1) mRNA. Immunoblot analysis was carried out to quantify the expression of iNOS and HO-1 protein and concentrations of signalling proteins. DNA-binding activities of NF-κB subunits were determined using an ELISA-based assay kit. DHA significantly attenuated the production of NO, IL-1β and IL-6 at both gene transcription and translation levels in P. intermedia LPS-activated RAW264.7 cells. DHA induced the expression of HO-1 in cells treated with P. intermedia LPS. Selective inhibition of HO-1 activity by tin protoporphyrin IX significantly mitigated the inhibitory effects of DHA on LPS-induced NO production. DHA significantly attenuated the phosphorylation of c-Jun N-terminal kinase induced by LPS. In addition, DHA suppressed the transcriptional activity of NF-κB by regulating the nuclear translocation and DNA-binding activity of NF-κB p50 subunit and inhibited the phosphorylation of signal transducer and activator of transcription 1. Further in vivo studies are needed to better evaluate the potential of DHA in humans as a therapeutic agent to treat periodontal disease.

Diets based on virgin olive oil or fish oil but not on sunflower oil prevent age-related alveolar bone resorption by mitochondrial-related mechanisms

Background/Objectives

Aging enhances frequency of chronic diseases like cardiovascular diseases or periodontitis. Here we reproduced an age-dependent model of the periodontium, a fully physiological approach to periodontal conditions, to evaluate the impact of dietary fat type on gingival tissue of young (6 months old) and old (24 months old) rats.

Methods/Findings

Animals were fed life-long on diets based on monounsaturated fatty acids (MUFA) as virgin olive oil, n-6 polyunsaturated fatty acids (n-6PUFA), as sunflower oil, or n-3PUFA, as fish oil. Age-related alveolar bone loss was higher in n-6PUFA fed rats, probably as a consequence of the ablation of the cell capacity to adapt to aging. Gene expression analysis suggests that MUFA or n-3PUFA allowed mitochondria to maintain an adequate turnover through induction of biogenesis, autophagy and the antioxidant systems, and avoiding mitochondrial electron transport system alterations.

Conclusions

The main finding is that the enhanced alveolar bone loss associated to age may be targeted by an appropriate dietary treatment. The mechanisms involved in this phenomenon are related with an ablation of the cell capacity to adapt to aging. Thus, MUFA or n-3PUFA might allow mitochondrial maintaining turnover through biogenesis or autophagy. They might also be able to induce the corresponding antioxidant systems to counteract age-related oxidative stress, and do not inhibit mitochondrial electron transport chain. From the nutritional and clinical point of view, it is noteworthy that the potential treatments to attenuate alveolar bone loss (a feature of periodontal disease) associated to age could be similar to some of the proposed for the prevention and treatment of cardiovascular diseases, a group of pathologies recently associated with age-related periodontitis.

Dietary strategies to optimize wound healing after periodontal and dental implant surgery: an evidence-based review

Methods to optimize healing through dietary strategies present an attractive option for patients, such that healing from delicate oral surgeries occurs as optimally as possible with minimal patient-meditated complications through improper food choices. This review discusses findings from studies that have investigated the role of diet, either whole foods or individual dietary components, on periodontal health and their potential role in wound healing after periodontal surgery. To date, research in this area has largely focused on foods or individual dietary components that may attenuate inflammation or oxidant stress, or foster de novo bone formation. These studies suggest that a wide variety of dietary components, including macronutrients and micronutrients, are integral for optimal periodontal health and have the potential to accelerate oral wound healing after periodontal procedures. Moreover, this review provides guidance regarding dietary considerations that may help a patient achieve the best possible outcome after a periodontal procedure.

Use of dietary supplements in patients seeking treatment at a periodontal clinic

Dietary supplement use may modify the risk of periodontal disease but effects on wound healing after periodontal procedures are less clear. This study characterized dietary supplement use by male and female patients (n = 376) attending a periodontal clinic—information that is essential for evidence-based intervention studies that may improve patient outcomes after periodontal procedures. Calcium, vitamin D, multivitamin and vitamin C were most commonly used. A greater (p ≤ 0.05) number of males took no supplements compared to females, and more (p ≤ 0.05) females than males took ≥ four supplements. Females took more (p ≤ 0.05) calcium, vitamin D, fish oil, green tea, magnesium, omega 3,6,9 and B vitamin complex. Younger patients (31–50 years) had the highest (p ≤ 0.05) frequency of no supplement use compared to older age groups. Patients over age 50 had a higher (p ≤ 0.05) frequency of using ≥ four supplements including calcium and vitamin D. Supplement use was lower (p ≤ 0.05) in smokers, particularly for calcium, fish oil, green tea and vitamin D. In conclusion, females, older individuals and non-smokers have higher supplement use. Future dietary intervention studies can focus on supplements with known biological activities—anti-inflammatory, antioxidant or osteogenic activity—that may enhance wound healing after reconstructive periodontal procedures.

Serum levels of long-chain polyunsaturated fatty acids in patients with periodontal disease

BACKGROUND

Long-chain polyunsaturated fatty acids omega-3 and omega-6 (LC-PUFA n-3 and n-6) can function as important inflammatory modulators and also have a strong effect in the proresolving inflammatory processes. The aim of the authors is to analyze the serum levels of docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and arachidonic acid (AA) in patients with generalized chronic periodontitis (GCP) and compare these results with serum levels of patients with gingivitis only.

METHODS

Twenty-one patients with untreated GCP (mean age: 46.0 ± 8.8 years) and 16 patients with gingivitis only (mean age: 31.5 ± 7.5 years) were investigated. The clinical examination included probing depth (PD), clinical attachment level, bleeding on probing, and plaque index. Blood samples were analyzed for the presence of DHA, EPA, DPA, and AA using gas chromatography.

RESULTS

Significantly higher levels of DHA, DPA, EPA, and AA were observed in patients with GCP when compared with patients with gingivitis (P = 0.007, P = 0.004, P = 0.033, and P = 0.001, respectively). The differences were still significant even after the adjustments for age and sex. The PD showed a significant positive correlation with DHA (r = 0.5; P = 0.003), DPA (r = 0.6; P <0.001), and AA (r = 0.6; P <0.001).

CONCLUSION

The present findings suggest that serum levels of LC-PUFA n-3 and n-6 may be affected by the severity of periodontal disease.

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

The longitudinal relationship between dietary n-6 to n-3 PUFAs ratio and periodontal disease in 235 Japanese subjects for whom data were available for the years 2003-2006 was investigated. PUFAs intake was assessed at baseline with a brief-type self-administered diet history questionnaire. Full-mouth periodontal status, measured as the clinical attachment level (CAL), was recorded at baseline and once a year for 3 years. The number of teeth with a change in the loss of CAL ≥3 mm at any site over a year was calculated as 'periodontal disease events'. Poisson regression analysis was conducted, with dietary n-6 to n-3 PUFAs ratio as the main predictor, to estimate its influence on periodontal disease events. A high dietary n-6 to n-3 PUFAs ratio was significantly associated with greater number of periodontal disease events. The findings suggest the dietary n-6 to n-3 PUFAs ratio is associated with periodontal disease among older Japanese.