Nutrition in Periodontal Health

The periodontium consists of hard and soft tissues that surround the dentition and include the gingiva, periodontal ligament, connective tissue, alveolar bone, and cementum.  Periodontal health relies on a delicate balance between the host, environmental, and bacterial factors.  The primary etiology of periodontal disease is bacterial (plaque biofilm), but a susceptible host is also necessary for disease initiation.¹  Nutrition is one of the modifiable factors that impact the host's immune response and the integrity of the hard and soft tissues of the oral cavity.

Integrity of the Oral Mucosa

The soft tissues of the oral cavity are made up of epithelial cells that have rapid rates of replication, metabolism, and maturation which require a steady supply of essential nutrients.  Typically these cells turnover every three to seven days, which makes the tissues of the oral cavity a sensitive indicator of adequate nutritional status.  Like skin, an intact oral mucosa is the first line of defense against the invasion of pathogens into the body.  Maintenance of an intact oral mucosa can be difficult because of constant exposure to bacteria and the high risk for trauma.

The B-complex vitamins, such as niacin, thiamin, riboflavin, folic acid, and B12, are co-factors in energy metabolism and needed in DNA and RNA synthesis.  This makes them indispensable for tissue maintenance and the production of new cells during development and healing.  Descriptions of vitamin B deficiencies appear as early as 2600 BC, but a majority of the reports of B vitamin deficiencies originate in the early 1900's when these conditions reached nearly epidemic proportions.²  Epidemiologic and experimental studies conducted in the early 1900's identified the most common symptom of B vitamin deficiencies to be the loss of the integrity of the oral mucosa.  The oral manifestations of the loss of integrity include stomatitis, angular cheilitis, and glossitis.^3,4

Vitamin C prevents oxidative cell damage and aids in maintaining the integrity of the oral mucosa.  Gingival inflammation appears to be one of the most sensitive indicators of vitamin C deficiency in subjects made vitamin C deficient under experimental conditions.⁵  Another study found that vitamin C supplementation of 250 milligrams/day decreased bleeding scores, which may be related to the vitamin's role in maintaining the microvasculature of the sulcus.⁶  However, these studies were done under very controlled conditions with small groups of subjects making it difficult to generalize these findings to patient populations without further research.

Other nutrients such as protein, vitamin A, and zinc are important in DNA and RNA replication, transcription of RNA, and the translation of proteins necessary for new cell growth.  For instance, a decrease in the rate of proliferation of epithelial cells is one of the earliest symptoms of vitamin A deficiency.⁷  Given that nutrients function together and nutrient deficiencies rarely occur in isolation, it is important to have adequate supplies of all nutrients to ensure adequate growth and maintenance of the oral tissues.

Click Here To Navigate Within Article >> Abstract Introduction Nutrition in Periodontal Health Integrity of the Oral Mucosa Nutrient Effects on Collagen Healing and Maintenance Maintenance of Calcified Tissues Maintenance of the Host Immune Response Patient Populations at Nutritional Risk Dietary Recommendations References About the Authors
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Citation Number: Vol. 2, No. 2, Page 038