Correlation between Nutrition and Periodontal Disease (Research Paper Sample)

Francelia Medina Texas Woman’s University 22FANFS536350 HUMAN NUTRITION IN DISEASE Abstract: Background: Periodontal diseases refer to a group of multifactorial diseases that develop in progressive stages, from gingivitis to deformities. Nutrition is an etiological factor that envisages both environmental and behavioral domains due to one’s lifestyle as influenced by what they consume and their behaviors.  Objective: This report aims to review the literature and determine whether there is a correlation between nutrition and periodontitis. Method: Literature review of previously conducted researches using the keywords "nutrition," "periodontal disease, " and "correlation". Results: Results from a review of the literature indicate that a poor diet with high carbohydrates aids in the formation of dental plaque, which is the first step towards the progression of periodontal diseases. Moreover, poor lifestyle habits such as drug use and abuse, which include tobacco use and smoking, further aid in the development of dental plaque. Nonetheless, good nutrition, marked by the ingestion of polyunsaturated fats and micronutrients, is useful in the buildup of a strong immune system. The body is, thereby, able to fight disease-causing pathogens before they can increase and get deposited at different parts of the body, including the gingiva margin.  Conclusion: There is a correlation between nutrition and periodontal diseases in the prevention and management of these diseases. Therefore, in addition to maintaining oral hygiene, it is important to consume diets rich in PUFAs and micronutrients with low carbohydrates. Moreover, one should avoid negative living habits such as drug use and abuse as these impede nutrition processes, for example, nutrient absorption.  Keywords: Nutrition, Correlation, Periodontal diseases Introduction: Nutrition is an essential risk factor in the pathogenesis and pathophysiology of periodontal diseases, though it is often neglected. Nutrition plays an indispensable role in creating an equilibrium between pathogens and the occurrence of periodontal diseases. The realization that certain nutrients have a beneficial role in the attainment of good health and the prevention of disease has led to the development of nutraceuticals. As a result, through the review of the literature to examine the relationship between nutrition and periodontal diseases, the association between the two variables is irrefutable. History and Background of Periodontal Diseases: Periodontal disease was first referred to as Riggs disease because John Hankey Riggs was the one who first identified the disease. However, it is hardly referred to as Riggs disease now since the common terms used today are gingivitis, gum disease, or periodontal disease (1). The correct wording, however, is periodontitis because 'periodontal diseases' is used when referring to a category of inflammatory diseases marked by the continual destruction of the periodontium (2). These periodontal diseases merely indicate the progressive breakdown of the periodontium. The classification of periodontal diseases has changed over time, but the most recent nomenclature and classification system date back to 1999, as shown in the figure below. The classification system represents the diagnosis of periodontal diseases using clinical history and findings. Figure 1, shown below, guides the diagnosis of periodontal diseases by indicating the closely related conditions for which diagnosis of periodontal diseases should be ensured. The underlying rationale is that these disorders harm the periodontal tissues because chemical elements are linked to the various disorders accumulated on dental surfaces, resulting in dental plaque. Figure 1: 1999 classification of periodontal diseases and conditions2 Periodontal disease is a manageable condition through good nutrition and hygiene. Proper mouth and teeth hygiene cleans the pockets around the teeth and removes the bacteria and toxins that collate between the teeth and bone, as shown in the figure below (3). Dr. Riggs developed scalers and curettes, which are instruments that are useful in removing tartar and thickened dead tissue adjacent to the tartar1. Figure 2: An Anatomy of the tooth and formation of calculus, which is a calcification of dental plague (3) Epidemiology: The distribution of periodontal diseases varies across the lifespan based on reports by the World Health Organization that use community periodontal index (CPI) scores (4). These scores range from zero to four to indicate progression stages that denote different periodontal diseases. The distribution of these conditions in different populations is indicated in the figures below. Figure 3: Adolescents between 15 and 19 years with and without periodontal diseases (4) Figure 4: Adults between 35 and 44 years with and without periodontal diseases (4) Figure 5: Elderly between 65 and 74 years with and without periodontal diseases (4) There is a great variation in the distribution of periodontal diseases across regions, with developing nations denoting higher prevalence compared to developed nations. Nonetheless, it is evident that the prevalence of these diseases is directly proportional to age; thereby, suggesting the increased importance of nutrition across the lifespan. Pathophysiology When the immune system responds to periodontal microbes, their production of inflammatory factors destroys the periodontal tissue (2). The presence of bacteria in the microbial film attracts the polymorphonuclear leukocytes, which produce reactive oxidative species (ROS), defensins, and enzymes after stimulation by bacterial antigens. The leukocytes degrade the microorganisms through phagocytosis, but due to non-selection, healthy tissues are also attacked (3). A sequence of periodontal diseases emerges, and nutrition plays a significant role in the progression of these diseases. For example, gingivitis, which develops from the accrued dental plague, if left untreated, advances to periodontitis. Etiology: Poor Oral Hygiene Dental plaque, a biofilm consisting of bacteria, glycoproteins, and mucin, collects in the oral cavity. The plaque mineralizes after a few days to form calculus, which provides a favorable ground for the dwelling of periodontal pathogens. These pathogens include Tannerella forsythia, Porphyromonas gingivalis, Treponema denticola, and Prevotella intermedia (3). Nutrition Nutrition can either act as a risk factor or an element that aids in the management of periodontal diseases. Good nutrition through micronutrients and polyunsaturated fats minimizes the effect of systemic factors such as cardiovascular disease and diabetes (5). On a different note, macro-nutrients, including sugars and carbohydrates, stimulate plaque formation and initiation of inflammatory events leading to poor oral health. Pregnancy and Lactation During pregnancy, the body’s nutritional needs are high, and the immune response is weak (3,5). The same can be said for lactating mothers considering individuals with increased physiological needs are bound to experience nutrient deficiencies. As a result, pregnant women are at an increased risk of infections which are linked to the presence of microbes in the body. Nutrient deficiencies causing inflammation further increase the susceptibility of pregnant and lactating mothers to periodontal diseases, though this is an area where more research is needed. Lifestyle Habits The use and abuse of drugs influence the progression of periodontitis because of the mediating role of these habits on nutrition. For example, in a systematic literature review by Varela-López et al., the inverse association between supplementation with vitamin A and periodontitis was found in those who did not smoke (6). Genes The fact that genes are involved in the pathogenesis of periodontal diseases indicates that the condition is inheritable (7). There are various genes linked to various genetic disorders, such as Son of Sevenless (SOS), which lead to the development of hereditary gingival fibromatosis, which is a monogenic disorder (8). Figure 5 below shows gene mutations in a single locus leading to HGF (figure 6). There are also complex genetic diseases that result from the interaction of several gene loci mutations, behavioral factors, and environmental factors (8,9). Figure 5: Non-syndromic variation of HGF where gene mutation on chromosome 2 is on two loci (GINGF on 2p21-p22 and GINGF3 on 2p22.3-p23.3), one locus on chromosome 4 (GINGF5 on 4q12), one locus on chromosome 5 (GINGF2 on 5q13-q22) and one locus on chromosome 11 (GINGF4 on chromosome 11p15). The pathogenic SOS gene is associated with GINGF (10). Figure 6: Phenotypic variation of HGF in A, a ten-year-old Caucasian male, and B, a fifteen-year-old Caucasian female (10). Treatment and Management: Management entails eliminating the cause, which includes dental plaque, calculus, and microbial film through scaling, root planning, and periodontal surgery (3,6). When systematic factors are involved or when dealing with severe periodontitis, the use of antibiotics is recommended. When there is severe bone loss due to periodontitis, the functionality of the teeth can be restored through guided tissue regeneration and bone grafting (3). Implant therapy is used in severe cases when there is the loss of a tooth. Nonetheless, nutrition has been deemed a pertinent factor in determining a host’s response to treatment because it has a significant regulatory role in inflammation, such as in arthritis, diabetes, and cardiovascular disease (11). Correlation Between Nutrition and Periodontal Disease: Nutrition is seen to play a significant role in preserving periodontal tissue in the prevention and management phases. Nutrition helps to prevent periodontal disease by suppressing the effect of systemic factors and promoting the formation of healthy tissue (3). Moreover, i...