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The identification of inflammatory periodontal disease and education in local and systemic risk factors and their management forms the foundation of the treatment of this disease. Nutrition is potentially a modifiable risk factor that could drive or abrogate the underlying oxidative stress in periodontitis. As research in this area is still in its infancy, clinical guidance on the delivery of dietary advice for susceptible patients is scarce. This paper will explain the possible mechanisms linking nutrition and periodontal disease, as well as the guidelines currently available to the dental profession.
CPD/Clinical Relevance: With a growing evidence base, an appreciation of the links between nutrition and inflammatory periodontal disease can help guide clinicians in educating patients on this potentially important modifiable risk factor.
Article
Periodontitis is an ubiquitous, chronic inflammatory condition affecting 45% of the UK adult population,1 with 11.2% of adults worldwide experiencing severe periodontitis according to the WHO sponsored global burden of diseases study.2 It is initiated by the accumulation of a pathogenic biofilm at and below the gingival margin, which in turn drives a host response which, in susceptible people, is responsible for the substantive tissue damage that arises in periodontitis.
Periodontal health is associated with a ‘health promoting biofilm’, but when the latter is infrequently disrupted/removed by thorough and regular oral hygiene practices it becomes ‘dysbiotic’ and pathogenic species emerge, which drive excess inflammation in those at risk of periodontitis due to such patients possessing a ‘hyper-inflammatory’ immune response. Periodontal therapy has traditionally been directed at reduction of the bacterial load to a level that encourages heath-promoting bacteria, which co-exist symbiotically with a proportionate host response that is in turn associated with resolution of destructive inflammatory cascades. However, to provide long-term stability, it is important that the patient is educated in meticulous home care to maintain the low bacteria load and also address any other underlying risk factors, such as smoking or poorly controlled diabetes.
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