The harmful effects of certain foods and beverages are well documented. As I write this, Halloween is right around the corner, so I’m sure the damage caused by junk food, especially sugary candies, will be at the forefront of many parents’ minds, but the same concerns apply year-round.

But what else should we consider when it comes to oral health? Besides avoiding the most obvious culprits of dental damage, what can we do to protect ourselves?

Our teeth are supported by a complex structure of tissues, bones, and ligaments known as the periodontium. Maintaining periodontal health is, therefore, essential to maintaining dental health. Commonly, we fail to do so. If we aren’t careful, this eventually results in gingivitis (an earlier stage of gum disease); left untreated or poorly managed, this can progress to periodontitis, a chronic inflammatory condition that affects the supporting structures. It’s a common cause of tooth loss in adults, particularly older adults. Symptoms include gum recession, persistent bad breath, and painful chewing.

Because periodontitis is initiated by oral bacteria, which accumulates in dental plaque, it is usually described as a consequence of poor oral hygiene (as well as smoking). In the past, it was often not considered related to diet.^[1] And yet, research in recent years suggests that it absolutely should be. In the first study to document an association between overall dietary patterns and periodontal-related tooth loss, involving statistical analysis of 6,887 participants, researchers found that “Adherence to an anti-inflammatory diet is associated with fewer missing teeth.”

Strengths and Weaknesses of the Study

Because they focused on periodontitis and tooth loss, the researchers excluded people from the study who were at high risk for cavities. As much as possible, they adjusted for known confounders, and they also specifically analyzed an older subgroup of the population, which is apt given that older age is a risk factor for periodontitis.

They also outline the strong biological plausibility of the association. Although initiated by oral bacteria, the development of periodontitis is immune-mediated, meaning it is likely affected by factors contributing to systemic inflammation: pro-inflammatory factors make us more susceptible hosts, and anti-inflammatory factors have the opposite effect. They cite the consistent “increased prevalence of periodontitis among diabetic patients as compared to normoglycemic controls” as evidence that illustrates systemic inflammation’s effect on our susceptibility to oral bacteria.

There are some gaps in the study. Most notably, oral hygiene awareness may be an important confounder, and smoking may not have been adequately adjusted for by the researchers. Nevertheless, the study makes a compelling case for the potential oral benefits of an anti-inflammatory diet. Considering the numerous other benefits of an anti-inflammatory diet relating to cardiovascular diseases, cancer, and overall mortality, it almost seems like a no-brainer.

What About Supplements?

They cite two studies that suggest a potential benefit of supplementing with anti-inflammatory omega-3 polyunsaturated fatty acids (PUFAs).^[2][3] The first is a 3-year follow-up study involving 235 older Japanese adults, and it found that a higher ratio of omega-6:omega-3 PUFAs was associated with more periodontal disease events. But this only confirms what we already know: an inflammatory diet (characterized by a higher omega-6:omega-3 ratio^[4]) leaves a person more susceptible to periodontal disease. Moreover, this Japanese study measured dietary PUFAs, not supplements.

The second study, conducted in Egypt, was a double-masked clinical study in which the experimental group received supplementation of fish oil and low-dose aspirin. The results showed promise, leading them to conclude: “Dietary supplementation [. . .] may provide a sustainable, low-cost intervention to augment periodontal therapy.”

But again, given the numerous benefits of an anti-inflammatory diet, as a whole, we are likely best off avoiding a myopic focus on only the potential benefits of omega-3 PUFAs in isolation. Even if we did want to focus only on this nutrient, it’s questionable whether supplementation is a more effective strategy than focusing on the whole diet.

Finally, while it’s important to avoid the foods and beverages that obviously contribute to poor oral health, it might be more psychologically motivating to focus on the positive message—to focus, in other words, on the foods we should eat. Numerous studies have shown a strong relationship between the intake of fruits and vegetables and better oral health.^[5][6][7][8] When it comes to reducing inflammation, nothing beats the whole food, plant-based diet.

References

1. Kotsakis, GA, Chrepa V., Shivappa N, Wirth M, Hebert J, Koyanagi A, Tyrovolas S. Diet-borne systemic inflammation is associated with prevalent tooth loss. Clinical Nutrition (2017); 37(4), 1306–1312. https://doi.org/10.1016/j.clnu.2017.06.001
2. Iwasaki M, Taylor GW, Moynihan P, et al. 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. Prostaglandins Leukot Essent Fatty Acids. 2011;85(2):107-112. doi:10.1016/j.plefa.2011.04.002
3. El-Sharkawy H, Aboelsaad N, Eliwa M, et al. Adjunctive treatment of chronic periodontitis with daily dietary supplementation with omega-3 Fatty acids and low-dose aspirin. J Periodontol. 2010;81(11):1635-1643. doi:10.1902/jop.2010.090628
4. Simopoulos AP. The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomed Pharmacother. 2002;56(8):365-379. doi:10.1016/s0753-3322(02)00253-6
5. Kwon Y, Kim S. How Much Does Plant Food (Fruits and Vegetables) Intake Affect the Prevention of Periodontal Disease in the Korean Elderly?. Nutrients. 2022;14(21):4589. Published 2022 Nov 1. doi:10.3390/nu14214589
6. Nanri H, Yamada Y, Itoi A, et al. Frequency of Fruit and Vegetable Consumption and the Oral Health-Related Quality of Life among Japanese Elderly: A Cross-Sectional Study from the Kyoto-Kameoka Study. Nutrients. 2017;9(12):1362. Published 2017 Dec 15. doi:10.3390/nu9121362
7. Wright DM, McKenna G, Nugent A, Winning L, Linden GJ, Woodside JV. Association between diet and periodontitis: a cross-sectional study of 10,000 NHANES participants. Am J Clin Nutr. 2020;112(6):1485-1491. doi:10.1093/ajcn/nqaa266
8. Santonocito S, Polizzi A, Palazzo G, Indelicato F, Isola G. Dietary Factors Affecting the Prevalence and Impact of Periodontal Disease. Clin Cosmet Investig Dent. 2021;13:283-292. Published 2021 Jul 9. doi:10.2147/CCIDE.S288137