High-Fiber Foods Reduce Periodontal Disease Progression in Men Aged 65 and Older: The Veterans Affairs Normative Aging Study/Dental Longitudinal Study

Exploring the Nonlinear Relationship Between Dietary Flavonoid Intake and Periodontitis

INTRODUCTION AND AIMS

Flavonoids are non-nutrient bioactive substances widely found in plants, possessing antioxidant and anti-inflammatory properties. Periodontitis is a long-term inflammatory disease that impacts the tissues supporting the teeth, poses a substantial burden on public health and individuals alike. This study aims to explore the association between dietary flavonoid intake and periodontitis.

METHODS

This study included 3005 participants from the 2009 to 2010 National Health and Nutrition Examination Survey. We compared the weighted prevalence of periodontitis across different participant groups. Binary logistic regression analysis was conducted to evaluate the relationship between dietary flavonoid intake and periodontitis. The restricted cubic spline plot was used to explore nonlinear relationships.

RESULTS

The prevalence of periodontitis among participants with total flavonoid intake in quartiles Q1 to Q4 was 54.95%, 44.11%, 40.62%, and 48.28%, respectively. When compared to the Q1 group of total flavonoid intake, the OR values for Q2 to Q4 groups were 0.58 (95% CI: 0.39-0.86, P = .01), 0.50 (95% CI: 0.35-0.73, P = .001), and 0.68 (95% CI: 0.50-0.91, P = .01), respectively. A significant nonlinear association was observed between ln-transformed total flavonoid intake and the likelihood of developing periodontitis (nonlinearity P < .001). The inflection point was identified at an ln-transformed total flavonoid intake of 4.05, corresponding to a total flavonoid intake of 57.54 mg. Beyond this inflection point, as the total flavonoid intake value continues to rise, there was a diminishing protective effect against periodontitis.

CONCLUSIONS

Higher dietary flavonoid intake is associated with a reduced risk of periodontitis, with the greatest protective effect observed at moderate intake levels.

CLINICAL RELEVANCE

Understanding the association between flavonoid intake and periodontitis can guide dietary recommendations and interventions aimed at preventing periodontitis. This study supports the potential role of a flavonoid-rich diet in promoting periodontal health, suggesting that dietary modifications could be a viable strategy in periodontal disease prevention and management.

Nutritional status and dietary habits in older adults with fixed implant dental prostheses: a case-control study

Aim

To evaluate the nutritional status, nutritional risk, and dietary habits of patients treated with bimaxillary implant-supported fixed prostheses in comparison with a group of natural dentate patients.

Methods

A study group (n = 25, 8 women, mean age = 70.6 ± 7.5 years) with bimaxillary implant-supported fixed prostheses and a control group (n = 25, 13 women, mean age = 69.0 ± 5.3) with a mean of 27.7 ± 1.8 natural teeth were recruited. The nutritional status and nutritional risk of the participants were evaluated with Mini Nutritional Assessment (MNA) and Seniors in the Community: Risk Evaluation for Eating and Nutrition; (SCREEN-14), while the dietary habits were recorded by data from a three-day dietary record. The data were analyzed with the Mann-Whitney U-test and independent t-test to evaluate the differences between the groups.

Results

The results showed that although both the groups had normal nutrition status as revealed by the MNA scores the study group showed significantly higher BMI (p = 0.005) but lower SCREEN-14 (p = 0.012) scores, than the control group. The results also showed that higher SCREEN-14 scores were significantly associated with higher odds of being in the control group, with an odds ratio of 1.159 (p = 0.024). Further, the results of the analysis of the dietary records showed that the participants in the study group consumed fewer meals (p = 0.006) and fewer varieties of food (p < 0.001), particularly fewer fruits (p = 0.011) than the control group.

Conclusion

The results indicate that people with fixed implant prostheses may be susceptible to nutritional deficiencies according to the SCREEN-14 scores compared to their natural dentate counterparts. Further, people with implant prostheses also tend to have higher BMI and consume a smaller variety of foods, especially fruits, than the natural dentate control group.

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.

A pro-inflammatory diet is associated with an increased odds of periodontitis: finding from a case-control study

OBJECTIVE

This study aimed to evaluate the inflammatory effect of diet using the dietary Inflammatory Index (DII) on the odds of periodontitis. We hypothesized that a diet with high DII scores (a pro-inflammatory diet) is associated with high chronic and systematic inflammation resulting in periodontitis. Periodontitis is one of the most common inflammatory diseases that affect the tissues around the tooth and results from the interaction of bacterial infection and the host immune response. The DII shows the association between different food components and the level of specific inflammatory biomarkers.

METHOD

The food intake of 87 cases with diagnosed periodontitis and 87 control was assessed using a 163-item valid food frequency questionnaire (FFQ). The DII was calculated based on the FFQ data. Logistic and linear regression models adjusting for multivariable confounders were used to investigate the odds ratio (OR) and 95% confidence intervals (CI) of developing periodontitis.

RESULTS

There was a significant difference between the mean intake of micronutrients and food groups, including saturated fatty acids (SFAs), iron, magnesium, manganese, vitamin C, crude fiber, selenium, chromium, whole fiber, caffeine, dairy, and meat, between patients with periodontitis and the control group (p-value˂0.05). DII scores in this study ranged from -3.13 to + 0.99. However, the periodontitis OR in the raw and multivariable-adjusted models was not statistically significant (multivariable-adjusted OR tertiles 1 vs. tertiles 3 = 2.00, 95%CI: 0.4-90.42, p-value = 0.08). A similar result was also observed in the continuous model of DII (multivariable-adjusted OR DII continuous = 1.93, 95%CI: 0.30-98.79, p-value = 0.05).

CONCLUSION

Although the OR was not statistically significant in crude models, a significant trend was found in multivariable-adjusted models. The results were promising since this is the first study to examine the association between diet-induced inflammation and dental disease. It is advisable to conduct additional studies with high sample sizes and other designs, such as prospective studies.

Role of Dietary Fibre in Managing Periodontal Diseases-A Systematic Review and Meta-Analysis of Human Intervention Studies

BACKGROUND

Periodontitis is a chronic multifactorial inflammatory disease, that leads to tooth loss and is associated with other systemic diseases. The role of dietary fibre in the prevention and management of periodontal diseases is not well understood. The objective of this systematic review and meta-analysis was to assess how an intake of dietary fibre affects periodontal diseases in humans and any concomitant effects on systemic inflammation.

METHODOLOGY

Human interventional studies investigating the effects of oral fibre intake on various clinical parameters of periodontal diseases were included. Search strategy with MeSH and free-text search terms was performed on the following database: CINAHL Complete, EMBASE, MEDLINE, SciVerse Scopus®, and Web of Science Core Collection on 21 October 2021 and updated on 19 February 2023 to identify relevant studies. Articles were filtered using the Covidence© web-based platform software. Data were pooled using random effects meta-analysis.

RESULTS

From all databases, a total of 19,971 studies were obtained. Upon title and abstract screening, 101 studies were included for full-text screening. Upon full-text screening, six studies were included for analysis. Of these, five were randomised controlled trials, and one was a sequential feeding trial involving fibre-rich daily diet for a 4-8 weeks period. Fibre-rich dietary intervention significantly reduced Clinical Attachment Loss/Level by 0.48 mm/tooth (95% CI, -0.63 to -0.33, p < 0.001), Bleeding On Probing by 27.57% sites/tooth (95% CI -50.40 to -4.74, p = 0.02), Periodontal Inflamed Surface Area by 173.88 mm2 (95% CI -288.06 to -59.69, p = 0.003), Plaque Index by 0.02 (95% CI -0.04 to -0.00, p = 0.04), and Gingival Index by 0.41 (95% -0.67 to -0.16, p= 0.002). A non-significant reduction was observed for Probing Depth (-0.17 mm/tooth; 95% CI, -0.37 to 0.02, p = 0.09).

CONCLUSIONS

Fibre-rich dietary interventions are associated with a reduction of clinical and particularly inflammatory markers of periodontal diseases. This shows a promising effect of dietary fibre as an intervention for inflammatory conditions like periodontal diseases.

Association of vitamin K, fibre intake and progression of periodontal attachment loss in American adults

BACKGROUND

Periodontitis-related attachment loss is accompanied by mucosal bleeding and inflammatory lesions. Dietary vitamin K and fibre intake are known to be correlation factors of haemostasis and anti-inflammation, respectively.

OBJECTIVE

To explore the association between severe periodontal attachment loss and vitamin K or fibre intake in American adults.

METHODS

A cross-sectional analysis was conducted including 2747 males and 2218 females in the National Health and Nutrition Examination Surveys (NHANES) from 2009 to 2014. The number of teeth with severe periodontal attachment loss (above 5 mm attachment loss) was used as the dependent variable. The main independent variables included the intake of vitamin K and dietary fibre. The association among variables was examined using multivariable linear regression models, hierarchical regression, fitted smoothing curves, and generalized additive models.

RESULTS

Based on the indicators of 4965 subjects, we found that severe attachment loss tended to occur in elderly individuals or males and was accompanied by less intake of vitamin K or dietary fibre, as well as lower educational qualification. Vitamin K intake was stably negatively associated with attachment loss progression in each multivariable linear regression model. In subgroup analyses, a negative association between fibre intake and attachment loss progression was identified in all races except blacks (β = 0.0005, 95% CI: -0.0005 to 0.0016). The relationship between fibre intake and attachment loss progression was a broad U-shaped curve (inflection point: 753.4 mg), which especially manifested in males (inflection point: 967.5 mg).

CONCLUSION

There was an inverse association between vitamin K intake and the progression of periodontal attachment loss in American adults, while dietary fibre should be moderate in intake (below 753.4 mg), especially in males (below 967.5 mg).

Periodontitis and Preeclampsia in Pregnancy: A Systematic Review and Meta-Analysis

OBJECTIVES

A conflicting body of evidence suggests localized periodontal inflammation spreads systemically during pregnancy inducing adverse pregnancy outcomes. This systematic review and meta-analysis aim to specifically evaluate the relationship between periodontitis and preeclampsia.

METHODS

Electronic searches were carried out in Medline, Pubmed, Embase, Lilacs, Cochrane Controlled Clinical Trial Register, CINAHL, ClinicalTrials.gov, and Google Scholar with no restrictions on the year of publication. We identified and selected observational case-control and cohort studies that analyzed the association between periodontal disease and preeclampsia. This meta-analysis was conducted following the PRISMA checklist and MOOSE checklist. Pooled odds ratios, mean difference, and 95% confidence intervals were calculated using the random effect model. Heterogeneity was tested with Cochran's Q statistic.

RESULTS

Thirty studies including six cohort- and twenty-four case-control studies were selected. Periodontitis was significantly associated with increased risk for preeclampsia (OR 3.18, 95% CI 2.26 - 4.48, p < 0.00001), especially in a subgroup analysis including cohort studies (OR 4.19, 95% CI 2.23 - 7.87, p < 0.00001). The association was even stronger in a subgroup analysis with lower-middle-income countries (OR 6.70, 95% CI 2.61 - 17.19, p < 0.0001).

CONCLUSIONS

Periodontitis appears as a significant risk factor for preeclampsia, which might be even more pronounced in lower-middle-income countries. Future studies to investigate if maternal amelioration of periodontitis prevents preeclampsia might be warranted.

Dietary carbohydrate intake is associated with the subgingival plaque oral microbiome abundance and diversity in a cohort of postmenopausal women

Limited research exists on carbohydrate intake and oral microbiome diversity and composition assessed with next-generation sequencing. We aimed to better understand the association between habitual carbohydrate intake and the oral microbiome, as the oral microbiome has been associated with caries, periodontal disease, and systemic diseases. We investigated if total carbohydrates, starch, monosaccharides, disaccharides, fiber, or glycemic load (GL) were associated with the diversity and composition of oral bacteria in subgingival plaque samples of 1204 post-menopausal women. Carbohydrate intake and GL were assessed from a food frequency questionnaire, and adjusted for energy intake. The V3-V4 region of the 16S rRNA gene from subgingival plaque samples were sequenced to identify the relative abundance of microbiome compositional data expressed as operational taxonomic units (OTUs). The abundance of OTUs were centered log(2)-ratio transformed to account for the compositional data structure. Associations between carbohydrate/GL intake and microbiome alpha-diversity measures were examined using linear regression. PERMANOVA analyses were conducted to examine microbiome beta-diversity measures across quartiles of carbohydrate/GL intake. Associations between intake of carbohydrates and GL and the abundance of the 245 identified OTUs were examined by using linear regression. Total carbohydrates, GL, starch, lactose, and sucrose intake were inversely associated with alpha-diversity measures. Beta-diversity across quartiles of total carbohydrates, fiber, GL, sucrose, and galactose, were all statistically significant (p for PERMANOVA p < 0.05). Positive associations were observed between total carbohydrates, GL, sucrose and Streptococcus mutans; GL and both Sphingomonas HOT 006 and Scardovia wiggsiae; and sucrose and Streptococcus lactarius. A negative association was observed between lactose and Aggregatibacter segnis, and between sucrose and both TM7_[G-1] HOT 346 and Leptotrichia HOT 223. Intake of total carbohydrate, GL, and sucrose were inversely associated with subgingival bacteria alpha-diversity, the microbial beta-diversity varied by their intake, and they were associated with the relative abundance of specific OTUs. Higher intake of sucrose, or high GL foods, may influence poor oral health outcomes (and perhaps systemic health outcomes) in older women via their influence on the oral microbiome.

The oral microbiome: Role of key organisms and complex networks in oral health and disease

States of oral health and disease reflect the compositional and functional capacities of, as well as the interspecies interactions within, the oral microbiota. The oral cavity exists as a highly dynamic microbial environment that harbors many distinct substrata and microenvironments that house diverse microbial communities. Specific to the oral cavity, the nonshedding dental surfaces facilitate the development of highly complex polymicrobial biofilm communities, characterized not only by the distinct microbes comprising them, but cumulatively by their activities. Adding to this complexity, the oral cavity faces near-constant environmental challenges, including those from host diet, salivary flow, masticatory forces, and introduction of exogenous microbes. The composition of the oral microbiome is shaped throughout life by factors including host genetics, maternal transmission, as well as environmental factors, such as dietary habits, oral hygiene practice, medications, and systemic factors. This dynamic ecosystem presents opportunities for oral microbial dysbiosis and the development of dental and periodontal diseases. The application of both in vitro and culture-independent approaches has broadened the mechanistic understandings of complex polymicrobial communities within the oral cavity, as well as the environmental, local, and systemic underpinnings that influence the dynamics of the oral microbiome. Here, we review the present knowledge and current understanding of microbial communities within the oral cavity and the influences and challenges upon this system that encourage homeostasis or provoke microbiome perturbation, and thus contribute to states of oral health or disease.

Intervention with inulin prior to and during sanative therapy to further support periodontal health: study protocol for a randomized controlled trial

Background

Periodontal disease is a chronic state of inflammation that can destroy the supporting tissues around the teeth, leading to the resorption of alveolar bone. The initial strategy for treating periodontal disease is non-surgical sanative therapy (ST). Periodontal disease can also induce dysbiosis in the gut microbiota and contribute to low-grade systemic inflammation. Prebiotic fibers such as inulin can selectively alter the intestinal microbiota and support homeostasis by improving gut barrier functions and preventing inflammation. Providing an inulin supplement prior to and post-ST may influence periodontal health while providing insight into the complex relationship between periodontal disease and the gut microbiota. The primary objective is to determine if inulin is more effective than the placebo at improving clinical periodontal outcomes including probing depth (PD) and bleeding on probing (BOP). Secondary objectives include determining the effects of inulin supplementation pre- and post-ST on salivary markers of inflammation and periodontal-associated pathogens, as these outcomes reflect more rapid changes that can occur.

Methods

We will employ a single-center, randomized, double-blind, placebo-controlled study design and recruit and randomize 170 participants who are receiving ST to manage the periodontal disease to the intervention (inulin) or placebo (maltodextrin) group. A pilot study will be embedded within the randomized controlled trial using the first 48 participants to test the feasibility for the larger, powered trial. The intervention period will begin 4 weeks before ST through to their follow-up appointment at 10 weeks post-ST. Clinical outcomes of periodontal disease including the number of sites with PD ≥ 4 mm and the presence of BOP will be measured at baseline and post-ST. Salivary markers of inflammation, periodontal-associated pathogens, body mass index, and diet will be measured at baseline, pre-ST (after 4 weeks of intervention), and post-ST (after 14 weeks of intervention).

Discussion

We expect that inulin will enhance the positive effect of ST on the management of periodontal disease. The results of the study will provide guidance regarding the use of prebiotics prior to and as a supportive adjunct to ST for periodontal health.

Trial registration

ClinicalTrials.gov NCT04670133. Registered on 17 December 2020.

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.

Dietary flavonoid intake and risk of periodontitis

BACKGROUND

The anti-inflammatory effect associated with flavonoid-containing foods and beverages could potentially impact the risk of periodontal disease. We prospectively investigate the associations between habitual flavonoid intake and incidence of periodontitis.

METHODS

The study population was 34,940 men from the Health Professionals Follow-Up Study, who were healthy and free of periodontal disease at baseline (1986). Participants in the study provided medical and dental history through mailed questionnaires biennially, and provided dietary data through semi-quantitative food frequency questionnaires every 4 years. We examined the associations between total flavonoids and six flavonoid subclasses (flavonoid polymers, anthocyanins, flavan-3-ols, flavanones, flavones, and flavonols) and incidence of periodontitis using Cox proportional hazard models. We adjusted for age, smoking, body mass index, physical activity, alcohol consumption, Alternative Healthy Eating Index, and diabetes.

RESULTS

There was no association between total flavonoids and the risk of periodontitis. The hazard ratio comparing the highest quintile of total flavonoid to the lowest quintile was 0.97 (95% confidence interval: 0.87 to 1.08, P-value for trend = 0.61). Similar comparisons for flavonoids subclasses also did not show significant associations.

CONCLUSION

No association was detected between habitual flavonoid intake and risk of periodontitis in the study population.

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.

Effect of Dietary Fiber on the Composition of the Murine Dental Microbiome

The oral cavity houses a diverse consortium of microorganisms, heavily influenced by host diet, that can mediate dental health and disease. While the impact of dietary carbohydrates to the dental microbiome has been well-documented, the effect of fiber as a mechanical influence on the dental microbiome is unexplored. We performed 16S rRNA gene analysis to investigate the response of the dental microbiome to the presence of increased fiber in terms of microbial taxonomic abundance and diversity. Dental microbial community structure was significantly different in mice fed a diet supplemented with increased fiber and/or sugar. Fiber significantly affected measures of beta diversity at the phylum and genus levels, and a strong interactive effect on alpha diversity was observed between sugar and fiber at the phylum level. The addition of fiber also induced significant variation in relative taxonomic abundance. This study demonstrates that fiber can promote significant variations in the mouse dental microbiome.

Effect of oral health behavior and demographic variables on gingival health in 11-16-year-old school children in Chandigarh, India: A cross-sectional study

AIMS

The aims of the present study were to assess the prevalence and pattern of gingival bleeding on probing (BOP) and to evaluate the effect of oral health behavior and demographic determinants on gingival health in 11-16-year-old school children in Chandigarh, India.

METHODS

A cross-sectional study, using stratified random sampling, was conducted across two age groups, 11-13 years and 14-16 years, and two socioeconomic strata: upper and lower. The World Health Organization (WHO) Oral Health Questionnaire for Children was used to record the data, and the WHO Community Periodontal Index (modified) was used to assess gingival BOP.

RESULTS

Among all the 2294 children examined, an estimated 54.2% had gingival BOP. The odds of BOP were also higher in the younger age group (odds ratio [OR]: 1.261, 95% confidence interval [CI]: 1.068-1.487, P = 0.006), higher for boys (OR: 1.200, 95% CI: 1.017-1.416, P = 0.031), and lower in the upper strata (OR: 0.805, 95% CI: 0.682-0.951, P = 0.011). Gingival BOP was 58.5% in the mandibular and 41.5% in the maxillary arch (P < 0.0001); χ² -test found tooth cleaning frequency to be a significant contributing factor for gingival BOP (P = 0.014).

CONCLUSIONS

An inverse co-relation of gingival BOP with age, socioeconomic status, and a higher prevalence in boys was observed, necessitating periodic preventive dental education, particularly focusing on the target group. Additionally, early screening and prompt treatment to intercept the disease is advocated.

Consumption of apple-boysenberry beverage decreases salivary Actinomyces naeslundii and their adhesion in a multi-species biofilm model

We hypothesised that consumption of beverage rich in both fibre and polyphenols, rather than each bioactive alone, will modulate populations of selected salivary bacteria, and their adhesion characteristics and that some of these effects may be due to the anti-microbial activity of the beverage bioactives. We investigated the effect of 4 weeks' consumption of beverages, rich in apple fibre, boysenberry polyphenols, or both on salivary bacteria in healthy subjects. In this placebo-controlled crossover study, saliva samples were collected at the beginning and end of each treatment period, and used for qPCR quantitation of Lactobacillus spp., Actinomyces naeslundii and Streptococcus mutans. The counts of salivary A. naeslundii decreased after the consumption of the apple-boysenberry beverage (P<0.05, Student's t-test). We also examined the effect of the subjects' saliva on bacterial adhesion using a mixed species biofilm model. The salivary pellicles prepared before and after each treatment were inoculated with laboratory strains of A. naeslundii, Lactobacillus rhamnosus and S. mutans and tested for biofilm formation. The post appleboysenberry beverage salivary pellicle significantly decreased the adhesion of A. naeslundii at the end of both 3 and 24 h, in the in vitro biofilm. A 1/16 dilution of the apple-boysenberry beverage itself decreased the proliferation of test strains of A. naeslundii and S. mutans by 51 and 55%, respectively (P<0.005), indicating the antimicrobial activity of its bioactives. This study demonstrated that consumption of apple-boysenberry beverage, rather than apple or the boysenberry beverage alone or the placebo, decreased salivary A. naeslundii and their adhesion under laboratory conditions. These changes are factors that influence oral microecology and potentially oral health.

Dietary Fiber Intake Is Inversely Associated with Periodontal Disease among US Adults

BACKGROUND

Approximately 47% of adults in the United States have periodontal disease. Dietary guidelines recommend a diet providing adequate fiber. Healthier dietary habits, particularly an increased fiber intake, may contribute to periodontal disease prevention.

OBJECTIVE

Our objective was to evaluate the relation of dietary fiber intake and its sources with periodontal disease in the US adult population (≥30 y of age).

METHODS

Data from 6052 adults participating in NHANES 2009-2012 were used. Periodontal disease was defined (according to the CDC/American Academy of Periodontology) as severe, moderate, mild, and none. Intake was assessed by 24-h dietary recalls. The relation between periodontal disease and dietary fiber, whole-grain, and fruit and vegetable intakes were evaluated by using multivariate models, adjusting for sociodemographic characteristics and dentition status.

RESULTS

In the multivariate logistic model, the lowest quartile of dietary fiber was associated with moderate-severe periodontitis (compared with mild-none) compared with the highest dietary fiber intake quartile (OR: 1.30; 95% CI: 1.00, 1.69). In the multivariate multinomial logistic model, intake in the lowest quartile of dietary fiber was associated with higher severity of periodontitis than dietary fiber intake in the highest quartile (OR: 1.27; 95% CI: 1.00, 1.62). In the adjusted logistic model, whole-grain intake was not associated with moderate-severe periodontitis. However, in the adjusted multinomial logistic model, adults consuming whole grains in the lowest quartile were more likely to have more severe periodontal disease than were adults consuming whole grains in the highest quartile (OR: 1.32; 95% CI: 1.08, 1.62). In fully adjusted logistic and multinomial logistic models, fruit and vegetable intake was not significantly associated with periodontitis.

CONCLUSIONS

We found an inverse relation between dietary fiber intake and periodontal disease among US adults ≥30 y old. Periodontal disease was associated with low whole-grain intake but not with low fruit and vegetable intake.