Table 2: Studies Relating Dietary Components and Periodontal Health in Adults

Dietary Component [Reference] Study Type Characteristics of Participants Intervention Duration Intervention/Comparison Groups Outcomes
Number Age Clinical Condition Control Treatment
Macronutrients with Potential Anti-Inflammatory Activity
Saturated fat, PUFA, cholesterol [10] Prospective, randomized study 250 parents from 148 families Mean age: 34.2 y 29 mo "Normal diet” Anti-atherosclerotic diet (high PUFA/SFA, low SFA, low serum cholesterol, high HDL) NS differences in periodontal health.
SFAs [11] Prospective 264 75 y Dentate Non-smokers in the highest quartile of saturated fatty acids intake had an increased risk for periodontal disease events (ARR = 1.92, highest quartile).
DHA, EPA, LNA [14] Cross-sectional study NHANES 1999-2004 9182 ≥ 20 y Dentate Those in the highest tertile of DHA intake had lower odds of periodontal disease (OR = 0.78, highest tertile). NS associations with either EPA or LNA acid.
DHA, EPA [15] Prospective 36 74 y Dentate Those in the lowest tertile of DHA intake had increased incidence of periodontal disease events (IRR = 1.49, lowest tertile). NS associations with EPA.
Long chain n-3 PUFA, γ-linolenic acid [12] Pilot study 30 Adult With periodontitis 12 wk 3 g placebo 3 g fish oil, or 3 g borage oil, or 1.5 g of each Improvement in probing depth and gingival inflammation for borage oil group, trend for fish oil and combination groups. No significant differences in plaque index.
n-6 PUFA, n-3 PUFA [16] Prospective 235 75 y Dentate Those in highest tertile of total n-6 PUFA compared to total n-3 PUFA intake were at a greater risk of periodontal disease events (ARR = 1.29, highest tertile).
Total CHO [17] Single-blind crossover study 20 Young adults 3 wk Low sugar diet High sugar diet Higher bleeding scores in high sugar group. No significant differences in plaque score.
Dietary fibre [18] Prospective observation study, Health Professionals Follow-Up Study 34160 40-75y Excluded those with periodontitis, MI, stroke, diabetes hyperchol- esterolemia at beginning of study 12 y Those in highest quintile of whole grain intake were 23% less likely to get periodontitis than those in lowest quintile. Periodontitis was not associated with refined grain intake. Periodontal risk was inversely related to cereal fibre.
Micronutrients with Potential Osteogenic Activity
Calcium [19] Longitudinal study 189 59 y Healthy, dentate, post-menopausal women with normal spine density 2 y Placebo taken daily 500 mg elemental calcium either in calcium citrate malate or calcium carbonate daily Greater proportion of non-smoking placebo group lost teeth than non-smoking supplemented group. Those who lost teeth during 7 y follow up had greater reduction of BMD at whole body, femoral neck, and spine. For each 1%/y decrement in BMD, there was a higher relative risk of losing tooth.
Calcium [20] Randomized, clinical study 59 With advanced periodontal disease 180 d 1 g placebo tablets daily 1 g calcium tablet daily No significant differences in probing depth, gingival inflammation or plaque score.
Calcium [21] Cross- sectional study, NHANES III Association of lower calcium intake with periodontal disease for young males and females (20-39 y) and older males (40-59 y). Dose response in females (54% greater risk for lowest level of intake (<499 mg), 27% greater risk for moderate intake (500-799 mg) compared to those with higher intakes (>800 mg)). Association between low total serum calcium and periodontal disease in younger females 20-39 y but not for males or older females.
Calcium, vitamin D [22] Cross- sectional study 228 Mean age: 63.6 y With periodontal disease Only 7% of participants met RDAs of calcium and vitamin D. 66% did not take oral supplements. More males than females who did not take calcium supplements.
Dairy intake [23] Cross-sectional study, NHANES III 12764 Prevalence of periodontitis was 41% lower for people in highest quintile of dairy intake than those in lowest quintile.
Calcium, vitamin D [7] Cross- sectional study 51 With 2 or more interproximal sites with 3 mm clinical attachment loss or more Not taking supplements 1000 mg calcium and 400 IU vitamin D daily Trend in shallower probing depths, fewer bleeding sites, lower gingival index values, fewer furcation involvements, less attachment loss, and less alveolar crest height loss but results were not significant.
Calcium, vitamin D [8] Double-blind, randomized, placebo-controlled study 145 >65 y Healthy 3 y Placebo pills 500 mg calcium and 700 IU vitamin D daily Lower odds of tooth loss were associated with supplement status during study period, and total calcium intake during follow up. NS differences in probing depths.
Vitamin D [19] Longitudinal study 189 59 y Healthy, dentate, post-menopausal, with normal spine density 1 y Placebo with 377 mg calcium daily 400 IU vitamin D with 377 mg calcium daily No effect on tooth loss. Those who lost teeth during 7 y follow-up had greater reduction of BMD at whole body, femoral neck, and spine. For each 1% per y decrement in BMD, higher relative risk of losing tooth.
Vitamin D [19] Longitudinal study 189 59 y Healthy, dentate, post-menopausal, with normal spine density 2 y 100 IU vitamin D with 500 mg calcium daily 700 IU vitamin D with 500 mg calcium daily No effect on tooth loss. Those who lost teeth during 7 y follow-up had greater reduction of BMD at whole body, femoral neck, and spine. For each 1%/y decrement in BMD, higher relative risk of losing tooth.
Vitamin D [9] Cross- sectional study, NHANES III 3781 >50 y Inverse relationship between attachment loss and serum 25(OH)D
Vitamin D [24] Cross- sectional study, NHANES III 6700 >13 y Never smokers Participants in highest quintile of serum 25(OH)D were 20% less likely to bleed on probing.
Magnesium [25] Cross- sectional study 2931 >40 y 33% had hypo-magnesemia Inverse relationships between serum Mg and lower probing depth and attachment loss
Fluoride [26] Double-blind, randomized, parallel study 70 >18 y (mean age of 30 y) Generalized gingival inflammation with some dentinal sensitivity, no acute gingival or periodontal condition 4 wk Placebo(de-ionized water) Natural mineral dietary supplement with 3.6 mg I-1 of F and other minerals in trace amounts (Si, HCO3, Na, Cl, K, Ca etc) No significant differences in gingival inflammation.
Micronutrients and Food Bioactives with Potential Antioxidant Activity
Vitamin C [30] Cross-sectional study, NHANES III 12419 >20 y Reduction of dietary vitamin C was related with attachment level of >= 1.5 mm in overall population. Higher risk for current smokers and former smokers who took less dietary vitamin C. Dose response relationship exists (OR=1.3, 0-29 mg vitamin C; OR=1.16, 100-179 mg vitamin C, OR=1, 180 mg+ vitamin C)
Vitamin C [31] Cross- sectional study 413 70 y Inverse relationship between serum vitamin C and clinical attachment loss.
Vitamin C [32] Case-matched study 10 >30 y Non-deficient in vitamin C, with gingivitis 6 wk Placebo, 4 pills daily 250 mg ascorbic acid in each pill, 4 pills daily No significant differences in probing depth, attachment level, gingival inflammation, and plaque level.
Vitamin C [33] Single-blind study 30 >20 y ≥ 12 remaining teeth, ability to develop calculus, otherwise healthy 3 mo Vitamin C and sugar free chewing gum, 5 times daily or No chewing gum 60 mg vitamin C in each sugar free chewing gum, 5 times daily Lower bleeding scores in vitamin C gum chewers than non gum chewers. Lower visible plaque index in gum chewers than non gum chewers.
Vitamin C [34] Longitudinal, single- blinded randomized study 80 22-75y With chronic periodontitis, n=58 These subjects were divided into a test group (n=38) and diseased control group (n=20) 22 healthy subjects were also studied. 2 wk No consumption of grape-fruits for patients with chronic perio-dontitis or No consumption of grape-fruit for healthy subjects Two grapefruits daily for patients with chronic periodontitis Lower sulcus bleeding index. No effect on probing depth and plaque index.
Vitamin E [29] Randomized study 409 55-74y Smokers 3 yrs ASA or Neither vitamin E nor ASA 50 mg vitamin E supplement-ation daily or Both vitamin E and ASA daily Gingival inflammation was more common in vitamin E supplemented group than non receivers. Highest risk in group that received both. Higher prevalence of dental plaque in vitamin E supplemented group.
Vitamin C, vitamin E (α-tocopherol) [27] Prospective 224 71 y Dentate Middle and lowest tertiles of serum ascorbic acid levels increased risk of periodontal disease events (RR = 1.12, middle tertile; RR = 1.30, lowest tertile). Lowest tertile of serum α-tocopherol level increased risk of periodontal disease events (RR = 1.15, lowest tertile).
Vitamin C, vitamin E, β-carotene [28] Prospective study 264 75 y Dentate Middle and highest tertiles of vitamin C intake decreased periodontal disease progression (IRR = 0.76, middle tertile; IRR = 0.72, highest tertile). Middle and highest tertiles of vitamin E intake decreased periodontal disease progression (IRR = 0.79, middle tertile; IRR = 0.55, highest tertile). Highest tertile of β-carotene intake decreased periodontal disease progression (IRR = 0.73, highest tertile).
Lycopene [35] Randomized, double-blind, parallel, split mouth, clinical study 20 Signs of gingivitis but healthy individuals 2 wk Placebo daily 8 mg lycopene daily Reduction in bleeding, gingival, and plaque indices.
Green tea [36] Cross- sectional study 940 49-59y Inverse relationship between green tea intake and probing depth, attachment loss, and gingival inflammation
Green tea extract [37] Double-blind randomized study 47 Mean age: 25.76 4 wk 8 placebos with same flavour daily 8 chew candies with green tea extracts daily Improved sulcus bleeding and proximal plaque indices in the treatment group from week 3 to week 1. Worsened bleeding index in placebo group from week 3 to week 1.

ARR, adjusted relative risk; BMD, bone mineral density; CHO, carbohydrate; DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; IRR, incidence rate ratio; LNA, linolenic acid; OR, odds ratio; PDR, probing depth reduction; PUFA, polyunsaturated fatty acid; RLBG, radiographic linear bone gain; RR, relative risk; ROS, reactive oxygen species; SFA, saturated fatty acid.

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