Nutrition and Oral Health – An Update

Introduction

Oral health and nutrition have many important connections. Many people consider dental caries to be the only concern related to nutritional imbalance. But, what if dental caries is actually a surrogate marker for systemic malfunction?  The foods, beverages and habits taken into the mouth, have effects in the mouth and also continue into body systems. There are many areas of scientific evidence in this oral health, oral microbiome and nutrition connection.

Soda and Energy Drinks

Soda and energy drinks are selling to ages 18-30 in very high numbers. Consumption of theses beverages is harmful to the teeth in several ways. When the pH of the oral cavity drops below 5.5 the dental enamel begins to demineralize and the mouth stays acidic for 15-20 minutes. All soda and energy drinks are strongly acidic and should be used with caution.  If the beverage contains high fructose corn syrup then other harmful effects take place. When sucrose hits the blood stream, 80% goes to the brain and muscles and 20% is stored in the liver for future use. The difference with fructose and sucrose (table sugar) is that 100% of fructose is processed by the liver with the storage of produced in vivo fat remaining in the liver. The brain and muscles do not process fructose and this is a problem. Many thin, overweight and obese persons begin to have fat build up in the liver from over consumption of snacks and sodas. This condition is called Non-Alcoholic Steatohepatitis (Fatty Liver) and can damage the function of the liver.  Also, prenatal and early life fructose intake is associated with asthma. The human body has a cellular fuel called water. The rule for safe water consumption is to divide your body weight in pounds and consume half of that number in ounces of water per day. Some persons do not drink water each day. To be healthy, water should be the main beverage consumed, for the liver and for overall health.

Periodontal Disease

How periodontal disease is affected by nutrition is a newer question. Food intake itself is not a known cause of periodontal disease but the quality of the daily diet combined with neglect can affect the oral environment to where over time gingivitis and periodontal disease can occur. Periodontal disease is a condition that starts with gingivitis. With age and poor oral hygiene the oral microflora shifts to more pathogenic species. Add time, poor oral hygiene and a high simple carbohydrate diet, the gum tissue protection fails and the bone around the teeth begins to erode away. This loss of supporting bone is called periodontal disease. This condition can get so severe that teeth are lost. The other major problem that occurs is that deep pockets form that cannot be cleaned by the individual. Inside those pockets live many types of bacteria: aerobic, anaerobic and spirochetes. In fact subgingival plaque holds over 500 bacterial species.  Many of these oral bacteria thrive on a high sugar diet producing acidic waste and causing dental caries and tissue damage. This leaves a state of chronic inflammation and an altered oral microbiome. One of the most aggressive bacterial species is Porphyromonas gingivalis (p. gingivalis). This bacterial species has been heavily studied in the past years. P.gingivalis is a very virulent bacterial species. P. gingivalis has been found in metastases of colon cancer and if one has P. gingivalis, it has been shown to greatly increase risk for pancreatic cancer. Smoking increases risk of periodontal disease by 50%. Periodontal disease also has multiple effects on systemic health, mostly related to chronic inflammation. There are links to periodontal disease and diabetes as well as atherosclerosis in coronary vessels. Periodontal disease can occur in cases of malnutrition and other factors, such as smoking, and genetics. Periodontal disease starts in a subtle way and becomes much more aggressive given time. Oral Care, prevention of disease and healthy diet are the best way to protect your oral health.

Conclusion

We are clearly to a point where oral health is connected with systemic health. Oral Hygiene is important to keep cavities away. What we eat and drink is just as critical. The 18-30 age groups are considered a high risk time for oral health deterioration. Many in this group are not living at home and do not have adequate insurance.  Hygiene can suffer because of cost or motivation, and food and drink intake can be low quality and high sugar. Beware of fructose! It is great in fruit because the fiber content slows fructose absorption. Please do not drink fructose, high fructose corn syrup or full sugar beverages daily. Diet soda is slightly less harmful but still strongly acidic and damaging. Energy drinks are a disaster. A healthy diet and healthy beverage choices are best. Healthy low sugar and lower fat foods, combined with exercise is the best road map to a healthy oral condition and a healthy body. Health choices such as diet, not smoking, eating healthy food and regular oral hygiene will be the best protection for a healthy oral condition.

Author
Val Joseph Cheever DDS, MS
College of Dental Medicine
Roseman University of Health Sciences

 

References

  • Vargas, C et al. How Dental Care Can Preserve and Improve Oral Health, Dent Clin of N Am 53 (2009) 399-420
  • Position of the Academy of Nutrition and Dietetics: Oral Health and Nutrition, May 2013, Vol. 113, Number 5
  • Seymour GJ, et al. Relationship between periodontal infections and systemic disease, European Journal of Clinical Microbiology and Infectious Diseases, CMI, 139 (Suppl. 4) 3-10
  • Jenkins, K Gum Disease and Increased Link to Many Cancers, Medscape Medical News, Aug 1, 2017
  • Hujoels PP, et al. Nutrition, dental caries and periodontal disease: a narrative review. Journal of Clinical Periodontology, 2017 (44)( Supplement 18) S79-S84
  • Lustig RH, Fructose: It’s Alcohol Without the Buzz, Advances in Nutrition, Volume 4, March 2013 Pages 226-235