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Nutrition and obesity as risk factors in periodontal disease

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We have always associated sugar with dental caries, but there is growing evidence that carbohydrates can be contributing to gingivitis and periodontal disease.

Oxidative stress is the main cause of chronic inflammation and therefore inflammatory diseases such as cardiovascular disease, arthritis and periodontitis. Oxidative stress is when the balance of oxidants and antioxidants tips towards the unhealthy oxidants which can cause damage to healthy cells, and even altering DNA. The sequence of events that follows means that an amplification of the inflammatory process occurs and it may even be initiated by this cell damage.

So, what causes this oxidative stress? Increased dietary intake of simple sugars and saturated fats has been identified as a significant contributor. Even the excessive consumption of fruit sugars can contribute to this destructive process. Smoking can also increase levels of oxidative stress and it is thought that this is one of the many ways that smoking increases the risk of periodontitis.

This damage can be reduced by eating less pro-inflammatory foods such as carbohydrates and saturated fats, but also by eating foodstuffs that are classed as anti- inflammatory. Examples of anti-inflammatory foods are:

strawberries, blueberries, broccoli, spinach, avocado, walnut oil, kiwi, dark (70%) chocolate, red wine, cherries, kidney beans, pinto beans, kale, prunes, blackberries, raspberries, cranberries, pomegranate, grapes, raisins, plums, sprouts, alfafa, beetroot, red peppers, onions, buckwheat, aubergines and oranges.

Carbohydrates will give us a blood sugar spike straight after a meal which can lead to something called meal-induced inflammation. White carbohydrates such as white flour, white pasta and rice and potatoes are absorbed very quickly by the digestive tract and can give rise to a more pronounced blood sugar spike, increasing the potential for oxidative stress. Carbohydrates that are high in fibre such as brown rice, wholemeal bread and grains are absorbed through the intestinal wall far more slowly and give a lower, more sustained blood sugar spike which is a lot less destructive. Therefore, fibre is essential in reducing oxidative stress. This whole process is complex and is affected by many issues such as the gut’s absorption of nutrients and the frequency of pro-inflammatory food intake which appears to differ from individual to individual. However, what is clear is that periodontitis is associated with reduced serum micronutrient levels. The 2011 European Workshop on Periodontology recommends that the dental team should include in its oral health advice an increase in fish oils, fibre and fruit and vegetables that are high in antioxidants, as well as an overall reduction of white carbohydrates, particularly simple sugars. There is growing evidence that obesity is a risk factor in periodontal disease. Although the obvious overlap with diabetes may skew the statistics, it would appear that, taking this into account, there are still strong correlations between high body mass indices and increased incidence of periodontitis. Conversely, studies have shown that people who are physically fit have lower risk of periodontitis. It is accepted that more studies in these areas are needed to understand the full relationship of these risk factors and their impact on oral health.

Author Jo Dickinson

Posted by Gemma

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