Nutrition and Periodontal Disease

Adequate nutrition, along with other host factors, is necessary to maintain resistance to periodontal disease. Although the role of diet and nutritional factors in development of periodontal disease is unclear, it is known that the defense mechanisms of the gingival tissues and saliva can be affected by nutritional intake and status. For example, healthy gum tissue normally prevents penetration of bacteria that can lead to gingivitis. Deficiencies of vitamin C, folic acid, and zinc may increase the permeability of gingival tissue, making these clients more susceptible to bacterial plaque that causes periodontal disease. Studies examining vitamin C and calcium intake found that individuals with low intakes of vitamin C and calcium are at increased risk for periodontal disease.28,29 This effect is accentuated in current and former tobacco users with suboptimal vitamin C intakes who show an even greater risk of periodontal disease.28

Nutritional status is also linked to immune response. With periodontal infection, the ability of the oral tissues to utilize nutrients is altered, thus interfering with normal healing and repair. At the same time, nutritional deficiencies can weaken the resistance of oral tissues to plaque bacteria, causing increasing inflammation. Oral health care professionals are in a position to identify possible nutrient deficiencies by looking for certain signs and symptoms, including stomatitis, glossitis, soreness, tingling, or burning of the tongue, bleeding gingiva without the obvious presence of periodontitis or gingivitis, angular cheilosis, and oral ulcerations. (See Table V for oral signs and symptoms of possible nutrient deficiencies.) If a nutritional deficiency is suspected or if a person’s oral health puts them at risk for a deficiency, a referral to a registered dietitian or physician may be helpful to evaluate the person’s nutritional intake and status, and ultimately prevent serious consequences resulting from nutritional deficiencies.

Prior to and following periodontal surgery, it is important to ensure adequate nutrients for wound healing and to maintain a healthy immune response to prevent infection. Adequate intakes of vitamins Aand C, zinc, and protein are essential. If the procedure or the wound prevents normal intake of foods for an extended period, a soft or liquid diet and multivitamin supplementation may be recommended by a registered dietitian.