Possible role of calcium in periodontal disease

Effects of specific nutrients on periodontal disease onset, progression and treatment

OBJECTIVES

The aim of this paper is to review the available literature pertaining to the effects of specific nutritional elements (e.g. vitamin B-complex, vitamin C and dietary calcium) on general wound healing, periodontal disease status and response to periodontal therapy.

METHODS

Critical appraisal of various studies that have evaluated the effects of calcium, ascorbic acid and vitamin B-complex in wound healing and periodontal treatment.

RESULTS

Periodontal disease onset, progression and response to therapeutic interventions have been shown to be influenced by several systemic, local and environmental modifying factors. Nutritional supplementation has been suggested as a possible influencing factor on periodontal status and wound healing. Several studies have reported various degrees of association between nutritional elements/supplements and periodontal status, and others have reported possible positive influences of nutritional supplementation on periodontal therapeutic outcomes. Future research needs to more fully explore the presence and strength of association between nutrition and periodontal health.

CONCLUSIONS

Data collected from the literature suggests that nutrient supplementation causes minimal or no side effects. However, the efficacy of prophylactic nutrient supplementation for the prevention of the onset and progression of periodontal disease, or for the enhancement of periodontal wound healing, remains to be determined.

Dietary shifts may explain the incidence of periodontitis in industrialized countries

A new hypothesis for the etiology of periodontal disease is presented. We suggest that the formation of calcifying dental plaque, together with an established gingival sulcus, leads to circumstances which favor the growth of pathogenic microbes associated with the destruction of the periodontium. We assume that, in ancient humans, this problem was avoided by the nonexistence of sulci around the teeth. Such a situation may have resulted from the usage of a hard and gritty diet which caused occlusal attrition compensated by tooth eruption. Unfortunately, in modern humans, sulcus formation is normal. However, only a part of the population in industrialized countries has hard, calcifying dental plaque any more. Soft plaque may be associated with the lower calcium content of the modern diet. The impetus behind the introduction of this alternative hypothesis now is our fear that routine treatment of this disease by antibiotics will lead into an insoluble dilemma.

Alteration by ouabain of rat submandibular glands function

1. Effects of various doses of intraperitoneal ouabain (1,2 and 5 mg/kg) on rat submandibular saliva were investigated in this study. 2. Potassium and calcium and their product (K+ x Ca2+) were found to be elevated in all groups. 3. Changes in salivary flow were not the major cause of the alterations in electrolytes. 4. Protein concentrations were elevated in the doses of 1 and 2 mg/kg of the drug and somewhat reduced in the dose of 5 mg/kg of ouabain but still above the base line. 5. The results show that there is an ouabain-induced close parallelism between magnesium and total protein secretion from rat submandibular glands.

pH changes during simultaneous metabolism of urea and carbohydrate by human salivary bacteria in vitro

The effect of the wide natural variation in oral ureolysis rates on the pH changes resulting from simultaneous metabolism of 25 mM urea and 2.8 mM glucose in salivary-sediment bacteria were investigated. The pH curves were complex, and included distinctive plateaux indicative of balanced acid and base production. These neutralization plateaux occurred at different pHs, which were a function (r2 = 0.98) of the ureolytic rate as measured by the log of the initial pH-change rate in the urea-only reaction. In the simplest case, the pH curve was characterized by a rise or fall to the neutralization plateau, a variable period of time at the plateau (up to 1 h), then a pH rise. The pattern of pH changes induced by glucose alone varied between different sediments: in some cases, the pH decreased smoothly to an end-point; in others, the curve was more complex, and these features became superimposed on the urea/glucose curve. The rate of ureolytic ammonia release was almost constant and unaffected by simultaneous carbohydrate metabolism. Concomitant metabolism of endogenous carbohydrate present in sediments prepared 1-2 h following a meal was of sufficient magnitude to affect ureolytic pH curves. If the ureolytic activity was high, this effect was negligible; if it was low, metabolism of the endogenous carbohydrates could completely suppress the ureolytic pH rise. Soluble salivary components had little effect on ureolysis but pH changes were modified by buffering, and the presence of urea, ammonia, N-catabolic and acidogenic substrates in the saliva.

In-vitro urea-dependent pH-changes by human salivary bacteria and dispersed, artificial-mouth, bacterial plaques

The pH effects of urea metabolism were studied in washed salivary-sediment bacteria from subjects that had up to 10-fold variation in oral ureolytic activity, and in dispersed artificial-mouth plaques. Adequate evaluation required analysis of the [OH-] as well as the pH curve. An initial constant rate of pH-change, lasting until pH 7.8, was derived from the pH curve; this gave the best correlation (r = 0.95) with the ureolysis rate. From the [OH-]-curve, between pH 7.8 and 8.3 (approx.), a constant and maximal rate of change in [OH-] was determined. Although theoretically this was directly related to the rate of ammonia release, it was 10(-2) to 10(-3) times its value and correlated less well (r = 0.83) with ureolysis. Together with the initial and final pH, these two rates largely described urea-induced pH changes. After 12.5-fold dilution of the cells, changes in the pH curve were minor. Although the rate of ureolytic ammonia release was proportional to cell-protein concentration, the reduction in ureolytic activity was compensated by a corresponding reduction in cell pH-buffering. Consequently, in order to relate pH and [OH-] changes to ureolysis, it was necessary to control, or correct for, variations in the cell mass present. Buffering capacity in plaques was greater than in sediments. The 10-fold range in oral ureolytic activity by salivary bacteria gave a 10-20-fold range in base changes.