Introduction
Periodontitis is a chronic inflammatory disease driven by the accumulation of bacterial plaque and the host’s immune response, leading to the destruction of periodontal tissues. Nutrition, particularly the intake of micronutrients with anti-inflammatory and antioxidant properties, plays a vital role in maintaining periodontal health.
Deficiencies in specific nutrients can exacerbate damage to periodontal tissues by impairing immune responses, increasing oxidative stress, and hindering the regeneration of bone and soft tissue. While several populations are particularly vulnerable to these deficiencies, such as those following Western diets or living in low- and middle-income countries, suboptimal nutrient intake is also associated with poorer periodontal outcomes in developed nations.
Objective
This literature review investigates the role of various micronutrients, including vitamins A, B, C, D, and E; minerals such as calcium, iron, zinc, potassium, copper, manganese, and selenium; and omega-3 fatty acids in the prevention and management of periodontal disease.
Vitamin A
Vitamin A is a group of fat-soluble vitamins, which include retinol (found in animal products) and carotenoids (e.g., beta-carotene, a form of vitamin A found in fruits and vegetables). Several studies have shown that vitamin A deficiency is associated with an increased risk and severity of periodontal disease. Increased beta-carotene is associated with reduced periodontal pocket depths following nonsurgical periodontal therapy. However, there is limited clinical evidence on the effects of vitamin A supplementation on periodontal healing and regeneration.
B vitamins
Vitamin B is a complex of several water-soluble vitamins, including folic acid (B9) and cobalamin (B12), both of which are important for periodontal health. Folic acid deficiency is associated with impaired wound healing. In periodontal health, folic acid is critical for the proliferation of epithelial cells. Low serum levels of folic acid are associated with severe periodontal disease. Folic acid deficiency may increase the risk of periodontal disease progression by impairing cell turnover in the junctional epithelium. The effectiveness of folic acid supplementation in preventing periodontal disease and improving treatment outcomes remains unproven. Low serum B12 levels are associated with increased clinical attachment loss in individuals with periodontitis.
Vitamin C
Vitamin C is crucial for collagen synthesis and maintaining the structural integrity of periodontal tissues. Vitamin C deficiency is associated with gingival inflammation, bleeding and tooth mobility (i.e., scurvy). Research indicates that lower plasma concentrations of vitamin C are associated with increased probing depths and clinical attachment loss, suggesting that inadequate vitamin C levels may lead to compromised periodontal tissue health. Vitamin C supplementation may improve periodontal treatment outcomes.
Vitamin D
Vitamin D helps to regulate calcium and phosphate levels. Vitamin D enhances the antibacterial defence of gingival epithelial cells, which can help reduce levels of gingivitis. Vitamin D deficiency may increase alveolar bone resorption and delay healing and osseointegration after surgical procedures.
Vitamin E
The antioxidant properties of vitamin E help mitigate oxidative stress, which is known to contribute to periodontal inflammation and tissue damage. Higher serum levels of vitamin E are inversely correlated with probing pocket depth in individuals with periodontitis, suggesting this antioxidant may play a protective role against periodontal tissue destruction. However, some studies did not find a significant relationship between vitamin E levels and periodontitis.
Calcium
Calcium is critical for oral health, including the formation and maintenance of bones and teeth. It plays a key role in preserving bone density and structure. Calcium deficiency can lead to increased bone resorption, exacerbating periodontal disease.
Iron
Iron is important for maintaining periodontal health, and a deficiency can impair the ability to fight periodontal pathogens. Individuals with iron deficiency anemia and periodontitis have shown a higher frequency of bleeding upon probing, a greater percentage of sites with clinical attachment loss of 6 mm or greater, and deeper periodontal pockets compared to those with periodontitis alone. Further research is needed to determine the benefits of iron supplements as an adjunct to periodontal therapy and their potential impact on periodontal disease progression.
Zinc
Zinc is vital for tissue repair and regeneration. It is also essential for maintaining periodontal health. Zinc deficiency can contribute to the development of gingival inflammation, increasing susceptibility to periodontitis.
Potassium
Potassium plays a crucial role in various cellular functions, such as metabolism, growth, enzyme activity, and DNA synthesis. Low potassium intake may worsen periodontal inflammation.
Copper
Research has shown elevated copper levels in individuals with periodontitis, particularly those with diabetes, compared to individuals without periodontitis. Additionally, copper levels in individuals with periodontitis, both with and without diabetes, significantly improved after nonsurgical periodontal therapy
Manganese
Manganese plays a role in the immune system, metabolism, and bone formation. Consequently, a manganese deficiency reduces bone formation and density. A negative correlation was found between plasma manganese levels and periodontal health.
Selenium
Selenium plays essential roles, including antioxidant, anti-inflammatory, and antiviral functions. Research found serum selenium levels were significantly lower in individuals with periodontitis, both with and without type 2 diabetes, but were highest in healthy individuals.
Omega-3 fatty acids
Omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have anti-inflammatory properties that may inhibit the activity of periodontal pathogens, such as Porphyromonas gingivalis, Fusobacterium nucleatum, and Prevotella intermedia. Research indicates that omega-3 fatty acid supplementation, when used as an adjunct to nonsurgical periodontal therapy, can lead to significant improvements in clinical parameters, including probing depths and clinical attachment levels. These findings suggest that incorporating omega-3 fatty acids into the diet could be an effective strategy for managing periodontal disease. However, some studies have reported inconsistent results due to variations in omega-3 dosages, study lengths, and outcomes.
Conclusions
The findings of this literature review enhance the understanding of the role of micronutrients in periodontal health. Future studies should aim to develop clear dietary recommendations and supplementation strategies specifically for individuals at risk of or with periodontitis. By adopting a comprehensive approach that includes nutritional considerations, the prevention and management of periodontal disease can be enhanced, ultimately improving client outcomes and quality of life.
Given the complex nature of periodontal disease, a multidisciplinary treatment approach is essential, such as involving a registered dietician to provide dietary guidance, address nutrient deficiencies, and potentially improve client outcomes. Future research should focus on well-structured, high-quality studies to establish clear dietary recommendations and investigate the synergistic effects of nutrition with other therapies.
