The Natural History of Periodontitis in Man: The Past, the Present, the Future

Abstract

Over the last few decades there is increased awareness about the role of nutrition in periodontal diseases. This is evident from the numerous studies published over the years. A systematic review on this issue found inverse associations between a poor dietary intake of omega-­3 fatty acids, vitamin C, vitamin E, beta-­carotene, fiber, calcium, dairy, fruits and vegetables and an increased risk of periodontal disease in older adults [11]. On the basis of NHANES data it was shown that patients with a higher healthy eating index had a lower prevalence of periodontitis [12]. A systematic review further demonstrated that higher Healthy Eating Index scores, higher Mediterranean Diet scores, and lower Dietary Inflammatory Index scores were associated with a reduced risk of periodontitis and improved periodontal conditions [13]. In an 11 year follow-­up study among middle-­ aged adults, poor-­quality diet appears to be associated with the development of periodontal disease [14]. Another study using NHANES data showed that a healthy plant-­based diet was inversely related to an increased risk of periodontitis [15]. Results of a 4-­week replica study of “Stone Age” life and diet showed that gingivitis decreased, although plaque scores increased due to the lack of oral hygiene [16]. Since “Stone Age” living conditions, and especially a diet without refined sugars, are able to reduce gingivitis it can be hypothesized that it may also prevent the development of periodontitis.