Nutrition & Diet, Supplements, & Botanical Therapy

Nutritional and botanical therapies have been scientifically tested on individuals with gingivitis, gingival bleeding, periodontal pocketing, periodontal attachment loss and bone loss, and oral bone growth with positive results. Significant reductions were reported in gingivitis, gingival bleeding, and periodontal pocket depth and it was concluded that topical and systemic nutritional supplementation could be a beneficial adjunct to gingivitis and periodontitis therapy. These therapies have also been scientifically proven to be useful for the common oral disease, as well as oral and systemic disease connections.

Diet

In general, dietary strategies to reduce the risk of caries focus on limiting the number of times teeth are exposed to fermentable carbohydrates (i.e., sugar), and good oral hygiene to reduce the etiologic factor, bacteria.

The human body’s response to oral infection and inflammation is the production of inflammatory mediators (e.g., CRP, cytokines, etc.) and oxidative molecules that can damage or even kill cells and tissues. These inflammatory mediators also stimulate and enhance the formation of other more damaging end-products. It is very difficult for the natural defense mechanisms of the body, in the form of antioxidants to provide adequate defenses against oxidative molecules produced by the body’s immune system during inflammation. Slowing cytokine and inflammatory mediator production and maintaining antioxidant defenses, are both beneficial, but depend on adequate nutrient intake, absorption and utilization. That is, if all of the machinery in the body is working correctly, nutrients obtained from foodstuffs can influence the inflammatory aspects of the immune system and alter cytokine production and by limiting the cytokine responsiveness of target tissues.

A healthy diet that contains a variety of fruits and vegetables, and tea products, can provide the intake of antioxidant nutrients that include ascorbic acid, tocopherols, beta-carotene, lycopene, and bioflavonoids. These, along with the intake of certain macro- and micronutrients can influence antioxidant enzyme activities and total body health. Stimulation of the immune system can also increase antioxidant enzyme activities that can detoxify oxidative molecules, such as superoxide dimutase and catalase.

Nutritional Supplements

  • Vitamins

The body’s antioxidant defense usually involves a combination of antioxidants and other nutrients working together acting either directly or indirectly to maintain tissue antioxidant capacity. Vitamins E and C and glutathione have been intimately linked in antioxidant defenses. Vitamin E influences inflammatory and immune function; its deficiency impairs cellular and humoral immunity and its supplementation lowers the incidence of infectious disease, which is very important in oral – systemic disease interactions. Vitamin C is also a key component of antioxidant defense. Inflammation has been shown to be inversely related to the intakes of vitamins C and E in smokers. Vitamin C also significantly improves iron absorption.

Vitamins B1 (thiamin), B2 (riboflavin), B3 (niacin), and B5 (pantothenic acid) have many vital functions. Some that deserve special mention here are: vitamin B2, which aids in energy utilization from food; vitamins B3, B5, and B6, required for proper fat, carbohydrate, and protein metabolism; vitamins B5 and B6,  necessary for hormonal synthesis and function; vitamins B6 and vitamin C,  required for proper immune system function and wound repair; vitamins B12 and folic acid are required for nucleic acid formation; vitamins B6 and folic acid are required for amino acid formation. Vitamin B-complex deficiencies also reduce the body’s resistance to infection secondary to antibody formation, and in some instances can impair WBC formation. B vitamins also have widespread effects on immune function and are indirect contributors to antioxidant defenses. Vitamins B12 and B6 are co-factors in the metabolic pathway for the biosynthesis of cysteine which is necessary for glutathione synthesis. Deficiencies in B vitamins and vitamin E create abnormalities in the cell-mediated immune response, and supplementation with vitamins C, A, E, and B improve lymphocyte function.

  • Lactoferrin

Lactoferrin, a major component of whey protein, is an iron-binding glycoprotein that acts as an antioxidant systemically. Lactoferrin has been shown to: reduce the adhesion of several bacteria found in the oral cavity; stop the growth of certain periodontitis causing bacteria; and kill certain periodontitis and cavity causing bacteria. Lactoferrin powder, when locally applied, was found to be successful in resolving oral lesions. Lactoferrin is found ubiquitously and abundantly in human endocrine secretions, and has been widely used in both dentistry and medicine to monitor responses to inflammation.

  • Whey

Whey (milk serum) protein is isolated from milk. Its potent antioxidant activity is due to its high concentration of the amino acid cysteine, a component of glutathione. Whey contains several important biological components that have properties that enhance the immune system. Approximately 15% of whey proteins are immunoglobulins, the antibodies that confer immunity. Protein deficiencies impair the body’s immune mechanisms by reducing antibody formation, cellular activity that ingest bacteria, non-specific resistance factors, and the body’s formation of immunoglobulins.

  • C0-Enzyme Q10 (CoQ10)

Historically, the benefits of coenzyme Q 10 (CoQ10) in oral health have been known for decades. Oxidative damage occurs in periodontal disease, and research has demonstrated possible therapeutic effects of anti-oxidants in treating and/or preventing periodontal disease are useful, with special attention on CoQ10. Clinically, topical application of CoQ10 to periodontal pockets was evaluated with and without professional cleaning below the gingiva, and  significant improvements were seen that included the reduction of gingivitis, bleeding on probing and gingival enzyme activity, only at the CoQ10 treated sites. Additionally, a clinical study demonstrated that patients with periodontitis frequently have significant gingival and white blood cell CoQ10 deficiencies. This white blood cell CoQ10 deficiency indicated a systemic nutritional imbalance, and was not likely caused by neglected oral hygiene. A gingival deficiency of CoQ10 could predispose individuals to gingivitis and periodontitis, and periodontitis could even augment CoQ10 deficiency. Therefore CoQ10 supplementation is important not only for improvement of periodontal diseases, but also to increase the body’s response to infections. CoQ10 has been used to treat periodontal disease, and systemically as an adjunctive therapy of congestive heart failure.

  • DHEA

There is an inverse relationship between the DHEA levels in the body and a number of diseases, including some cancers, diabetes, CVD, and Alzheimer’s disease. Numerous animal studies have demonstrated that DHEA improves immune function and memory and prevents atherosclerosis, cancer, diabetes, and obesity. DHEA is a prohormone, and DHEA production peaks around the age of 25 and then declines approximately 2% each year until the end of life. DHEA and DHEAS (DHEA sulfate) can both be converted into numerous active metabolites. They are precursors of about half the andogens in men, 75% of active estrogens in premenopausal women, and all of the active estrogens after menopause.

  • Zinc

Zinc deficiency in humans is widespread. A significant association between zinc deficiency and the risk of periodontitis has been found. Experimental and clinical studies indicate that zinc deficiency may predispose individuals to glucose intolerance, diabetes mellitus, insulin resistance, atherosclerosis and coronary artery disease. Zinc deficiency also leads to hypogeusia (decreased taste acuity) in both humans and rats, and these symptoms can be reversed by the administration of zinc. Human and animal studies have reported inverse relationships between low dietary zinc intake and intake of low-nutrient-density foods and patterns of food selection. Zinc is also known as an immune stimulant.

Other Nutritional Supplements

The following nutritional supplements have both oral and systemic uses.

Calcium is required to maintain the integrity of the maxilla and mandible, and inadequate calcium may be implicated in tooth loss and periodontal disease; its systemic uses are for bone density maintainence. Lysine has been used to treat aphthous and herpes ulcers, and systemically as an essential amino acid in human metabolism. Omega-3 fatty acidshave been used as an adjunct in the treatment of temporo-mandibular dysfunction, and systemically to decrease inflammation. Vitamin C is required to maintain the integrity of the oral mucosa and gingival, and to improve healing; systemically it is necessary for collagen formation.

Botanical Medicines

New developments in Botanicals for Oral Diseases and Their Associated Systemic Diseases

  • Green Tea

Green tea has been indicated for oral and esophageal cancer prevention and the risk of dental caries. Green tea, which contains the polyphenol [(-) – Epigallocatechin gallate], has been shown to completely inhibit the production of n-butyric acid and proprionic acid, toxic end-products of P. gingivalis, that have been shown to play a role in gingivitis.  Green tea extract applied topically has been suggested for the prevention of periodontal diseases and dental caries. Tea bags are also recommended to control bleeding after oral surgery, if gauze and pressure alone do not help. Its systemic properties have been investigated in the prevention of cancer.

  • Lycopene

Lycopene is mainly supplied by tomatoes, which contain many other beneficial substances, such as high levels of vitamin A, vitamin C, vitamin E, folate, potassium, bioflavonoids (especially quercetin), and phytosterols. It has been shown that lycopene acts synergistically, as an effective antioxidant against LDL oxidation, with several natural antioxidants such as vitamin E, the flavonoid glabridin, the phenolics rosmarinic acid and carnosic acid, and garlic; suggesting a superior antiatherogenic characteristic in combination with different natural antioxidants and lycopene versus lycopene alone.  

      1. COMMON CAROTID ARTERY THICKNESS

A direct relationship between periodontitis and intima-medial thickening (IMT) of the common carotid artery (CCA); and an inverse relationship between plasma concentration of lycopene and intima-media thickness of the common carotid artery wall (CCA-IMT) in Finland. In men, low levels of plasma lycopene were associated with a significant percentage (17.8%) increase in CCA-IMT. This study concluded that low plasma lycopene concentrations are associated with early atherosclerosis, manifested as increased CCA-IMT. With coronary artery disease being the most common etiologic factor for left ventricular systolic dysfunction, the major symptom of CHF, reduction or maintenance of CCA-IMT could reduce CHF risk. An significant inverse association was also reported between serum lycopene and aortic calcifications. Antiproliferative effects of carotenoids in aortic smooth muscle cells have also been reported, with lycopene being the most potent. More recently, Wood and Johnson reported that periodontitis increased the risk of congestive heart failure (CHF), and that high tomato consumption (which contain high levels of lycopene, as well as other nutritients) reduced this risk of CHF. High tomato consumption appeared to have a cardioprotective in individuals with periodontal disease. Thus, individuals with periodontal disease should be made aware of nutrients that are helpful in reducing the risk of CHF.

2. EFFECTS AT THE MOLECULAR LEVEL

The intercellular adhesion molecule type 1(ICAM-1) plays a key role in the onset and manifestation of inflammatory responses. The periopathogen, Porphyromonas gingivalis lipopolysaccharides (LPS) induces ICAM-1 expression in human gingival fibroblasts. Pre-treatment of human aorta endothelial cells with lycopene significantly reduced the expression of ICAM-1 by 18 percent. Lycopene appears to be the most effective carotenoid in reducing both human aortic endothelial cell adhesion to monocytes and expression of adhesion molecules on the cell surface. Studies have shown that lycopene significantly reduced intercellular adhesion molecule adhesion in  the  aorta and low density lipid oxidation which is a hallmark in early atherosclerosis; and proliferative effects of aortic smooth muscle cells. High levels of certain dietary fats have been associated with the risk of coronary heart disease. Increased low density lipoprotein (LDL) oxidation is has also been causally associated with increasing risk of atherosclerosis and coronary heart disease. Preventing plaque from developing in coronary arteries could have profound effects on the incidence of CHF; in addition to dietary lipid reduction, blood pressure control, smoking cessation, weight reduction and exercise.

  • FLAVONOIDS (from tea, plants, fruits, and vegetables)

Bioflavonoids (i.e., biologically active flavonoids) are found ubiquitously in plants, fruits and vegetables; consumed in relatively significant amounts by animals and humans, and have a broad range of biochemical functions.

      1. CONNECTIVE TISSUES

Beneficial effects of bioflavonoids in connective tissue, including local circulation improvement, promotion of a strong collagen matrix, and protection of collagen against non-enzymatic proteolytic activity have been suggested. Recent studies have shown that bioflavonoids: exert potent inhibitory effects on bone resorption by stimulating osteoblastic proliferation activity and significantly reducing bone resorbing activity of osteoclasts in vitro; reduce prostaglandin E2-elevated collagenase-like peptidase activity; have a cyclic AMP phosphodiesterase inhibitory role; and stimulate sialoprotein transcription. More recently, an herbal-bioflavonoid supplement was found to be protective against alveolar bone loss in rats with induced periodontal disease, infected with A. viscous and P. gingivalis. It has also been reported that certain dietary bioflavonoid (rutin, quercetin, or naringin) supplementation significantly reduced molar crestal alveolar bone – cementoenamel junction distance during alveolar development in male albino rats, and that naringenin had a similar effect that was also dose-dependent.

      2. FREE RADICAL SCAVENGER

As free radical scavengers, flavonoids inhibit lipid peroxidation, promote vascular relaxation and help prevent atherosclerosis. A sufficient supply of antioxidants from diet might help prevent or delay the occurrence of pathological changes associated with oxidative stress. Oxidized LDLs are highly atherogenic stimulating macrophage cholesterol accumulation and foam cell formation; cytotoxic to cells of the arterial wall and stimulate inflammatory and thrombotic processes. All major cells in the arterial wall including endothelial cells, smooth muscle cells and monocyte derived macrophages can oxidize LDL. Macrophage-mediated oxidation of LDL is probably a hallmark in early atherosclerosis, and depends on the LDL oxidative state of macrophages. Antioxidants such as vitamin E, beta-carotene, and polyphenolic flavonoids have been found to be helpful in reducing LDL oxidation. Dietary flavonoid supplementation has also been shown to significantly reduce both neutral and polar lipids in rats fed a high coconut oil diet.

OTHER BOTANICAL SUPPLEMENTS

The following botanicals also have both oral and systemic uses.

Aloe vera has been used both as a mouth rinse and systemically as an anti-inflamatory. Bilberry has been used as an astringent rinse to treat mildly inflamed mucous membranes of the mouth and throat, and systemically to relieve diabetic neuropathy, and as an antiodant to improve eye sight. Calendula has been applied topically to treat inflammation of oral mucosa, and systemically as an anti-inflammatory, to reduce swelling, and improve wound healing.Cayenne has been applied topically for pain relief for toothache and trigeminal neuralgia, and systemically applied topically for pain relief (Warningfor topical use only). Echinacea has been locally applied as an antimicrobial for oral health and inflammation of the mouth, and also used for upper respiratory infections and wound healing. Garlic has been used to treat inflammation of the mouth, or as an aqueous extract for the treatment and prevention of oral candidiasis, and systemically to treat cardiovascular disease by helping to decrease blood pressure and LDL cholesterol. Gingeris an anti-emetic and stimulates the saliva and gastric juice. Mexican sanguinaria has astringent properties and may be useful as an adjunct with usual oral hygiene to reduce gingivitis when applied topically or used as a rinse. It has also been indicated for supportive treatment for coughs when taken systemically. St. John’s Worthas been used topically to relieve temporo-mandibular joint pain, and systemically to relieve mild depression and viral infections. Tea Tree Oilhas been used topically to treat bacterial and fungal infections of the oral mucosa, including candidiasis, and systemically to treat bacterial and fungal infections of the skin. Yohimbe has been used to increase salivary flow in individuals with xerostomia (dry mouth), and systemically to treat impotence, exhaustion, and diabetic neuropathy.

Supplements and Suggestions

Conventional therapy consists of routine dental examination and tooth cleaning at least every six months, or more frequently, as recommended by your dental health care professional. To reduce bacterial growth and their associated infections and inflammations, the primary cause of the common oral diseases associated with systemic diseases, the following are recommended:

Mouth Care Products, Toothpaste, Dental Floss, A Gum Stimulating Device, Tongue Scraper, and possibly A Non-Alcohol Mouthrinse, should be used at least twice daily. Toothpaste ingredients and mechanisms of action are discussed in detail on other pages of this website. These products have been shown in the scientific literature to be very helpful in the reduction of oral bacteria and gingivitis that can lead to periodontitis, as well as a reduction in dental caries formation.

In order to promote and maintain both oral and systemic health the following some of the following nutrients have been proven to be beneficial.

To enhance immune and antioxidant function:

If you feel you are not eating properly, nutrient formulationswhich contain nutrient compositions similar to those found in whole foodstuffs have been shown to be beneficial in increasing longevity, and also reducing the risk of certain systemic diseases in individuals with pre-existing periodontal disease.

beneficial mixture of antioxidants, which includes lycopeneand other nutrients found in tomatoes. High tomato intake significantly reduced the risk of congestive heart failure in individuals with periodontitis. Also, lycopene synergistically inhibits LDL oxidation in combination with vitamin E, glabridin, rosmarinic acid, carnosic acid, or garlic.

CoQ10 with bioflavonoids. CoQ10 has been shown to be both protective in oral health and cardiovascular health.

The benefits of dietary quercetin supplementation in oral bone development, and in the reduction of fat concentrations in the liver, have also been reported.

Chromium picolinate have been shown to lower the levels of inflammatory biomarkers that have been associated with both periodontal disease and cardiovascular diseases (IL-1B, TNF-alpha, and C-reactive protein). Reductions of these inflammatory markers, which are increased in individuals with periodontitis, have been shown to have a positive effect on cardiovascular diseases.

Fish Oils. Increasing the ratio of beneficial omega-3 fatty acidsrelative to harmful omega-6 fatty acids, has shown to have beneficial effects on systemic health. In terms of cardiovascular diseases, omega-3 fatty acids from fish oils have been shown to have a more consistent beneficial effect. Therefore, those suffering with cardiovascular diseases may also want to use Fish Oils. It has been suggested that an unknown factor in fish oils may enhance its benefits.

GLA (gamma-linolenic acid) inhibits PGE2 formation which has been shown to increase the risk of several systemic diseases

Glutathione. Glutathione helps to regulate cellular activity, is a major antioxidant that is made in the body, and is important in the production of lymphocytes and cytokines in response to inflammatory stimuli. Supplementing glutathione and its precursors (alpha-lipoic acid, N-acetyl-cysteine, S-adenosyl-L-methionine)increases glutathione levels in the body.

Alpha-Lipoic Acid (ALA) (Thioctic Acid). Alpha-lipoic acid,  another potent antioxidant that is synthesized in the body, plays a critical role in an energy-generating system in cells. ALA has also been studied as an adjunct for diabetes help, because it is known to reduce blood sugar levels.

N-Acetyl-cysteine (NAC). N-Acetyl-cysteine (NAC), is a powerful free radical scavenger, and is a precursor of glutathione. It increases the synthesis of glutathione only when there is a demand for it, and may only concentrate in the tissues where it is required. NAC also has the ability to adjust certain cytokine concentrations. Laboratory studies have shown that NAC increased IL-1 and IL-2 levels when they were at low concentrations, and decreased these same cytokines when they were at higher concentrations.

L-Glutathione, L-Cysteine & vitamin C are powerful free radical quenching supplements and provide the body with much needed antioxidant capability. These nutrients are enhanced with vitamin C, which is very important in preventing oxidation of L-cysteine and N-acetyl-cysteine. Vitamin C is also required to maintain tissue integrity.

Thymus Immune Factors should contain a full complement of herbal activators in addition to fresh, healthy thymus, lymph and spleen tissues. All of these factors are important in the maintenance and/or rejuvenation of sluggish tissues and organs that help immune function, as well as proper nutrient assimilation.

Digestive Aids are important for the re-inoculation and enhancement of digestive system and cellular functions, and are also recommended for patients that have been prescribed antibiotics for dental infections. A properly functioning digestive system is crucial for optimal health.

Selenium. Epidemiological investigations have found an association between low nutritional selenium status and increased risk of a variety of diseases. Selenium is a trace mineral necessary for correct immune system function. It has antioxidant properties, and is a co-factor in several metabolic pathways. Also, breakdown products of selenium in the body are also alleged to enhance immune cell activity. Selenium deficiency alone does not cause serious disease; however, it can make the body more susceptible to illness.

For depression, and to achieve restful sleep:

Sleep is very important, and is the time when our body rejuvenates and heals itself.

S-Adenosylmethionine (SAMe).SAMe has been shown to enhance mood and alleviate depression, as well as protect the joints. Stress and depression have been associated with periodontal disease.  SAMe is known internationally as a treatment for depression, arthritis and osteoporosis; as well as certain liver and gallbladder diseases.

Melatonin 3 mg (1-2/taken at bedtime) will help you get the rest required for rejuvenation of your body’s regulatory systems, including your immune system. It is also a natural antioxidant. Recent data has also shown that individuals that do not get enough sleep tend to eat a high-sugar and high-fat diet when compared to those that do get enough sleep.

To maintain bone:

Calcium Supplements. Both osteoporosis and periodontal disease are consequences of aging. Research has shown that individuals with osteoporosis and/or periodontal disease do not consume the RDAs for calcium, as well as other required minerals and vitamins to support adequate bone metabolism.

Trace Minerals can help increase insulin sensitivity, and help enhance bone metabolism.

To replace depleting hormones associated with aging, osteoporosis, tooth loss, and periodontitis:

DHEA. Aging men and women both suffer from inadequate levels of DHEA. Proper hormonal and endocrine function is required for proper assimilation and functioning of nutrients.

Estrogen (for women). Estrogen deficiency is a risk factor for periodontal disease, and also plays a role in the increased risk of osteopenia and osteoporosis seen in female patients.

To enhance digestion and absorption, and replace intestinalflora lost due to antibiotic therapy and other pharmacologics:

Digestive Enzymes. Digestive enzymes have been recommended to enhance absorption and assimilation of nutrients supplied from the diet. This product is especially recommended for individuals with age-related digestive enzyme depletion, and also for those individuals taking antibiotics prescribed by their dentists. A time release digestive aid has also proven to be very helpful. Note: antibiotics can disturb and even eliminate the natural intestinal microflora that aid in digestion and also the production of several B-complex vitamins (e.g., B1, B2, B3, B6, and folic acid). If antibiotics are used to treatment dental infections, reinoculation of intestinal friendly flora is very important to maintain or re-establish proper digestive functions. They also aid in the proper absorption and assimilation of required nutrients.

To increase dietary fiber:

Fiber Powder and Capsules. Scientific research has provided significant evidence that soluble fiber is superior to insoluble fiber in reducing cholesterol, and in survival after a heart attack. A recent study has supported a reduced risk of heart attack in individuals with periodontal disease that consume foods that contain higher levels of soluble fiber when compared to high insoluble fiber foods. Green Tea, Lactoferrin, and Whey Protein are also helpful.

Some other helpful products include:

Highly concentration formulation containing whole vegetable extracts. As previously suggested, whole foods may positively modify oral-systemic disease relationships.

Bioflavonoid Mixtures. As previously mentioned, quercetin, rutin, naringin, and naringenin have oral and systemic bone promoting and lipid lowering properties, as well as other systemic protective functions.

Sports Performance Products.Increased physical activity, in the form of walking, has been shown reduce the risk of periodontal disease. Increased physical activity and muscle tone has been associated with higher self-esteem and lower levels of depression, along with lower periodontal disease incidence.

PRACTICAL MEDICINE

The human body is made up of many mutually dependent physiological systems that can be influenced by both internal and external environmental and behavioral factors. Biological systems research is addressing these interactions. The oral cavity should be evaluated and treated as an integral part of the whole body, and not simply as an isolated set of parts. The influence and magnitude of poor nutrition on oral diseases and their associated systemic diseases is not yet known. However, the oral cavity is a portal for health or disease into the body by way of infection, and also a crucial system in the digestion and metabolism of essential foodstuffs, nutrients, and botanicals. Consequently, poor oral health can lead to an increased incidence and severity of systemic diseases.

Certain environmental and behavioral preventive measures such as adequate oral hygiene and care, dietary changes, increased exercise, avoidance of tobacco and alcohol use, and reducing stress and depression can significantly reduce the incidence and severity of the common oral diseases and their associated systemic diseases. Smoking, stress, and lack of physical activity have all been reported to be common denominators for periodontal disease, heart attack, and diabetes mellitus. Stress, depression and periodontitis are common conditions in older adults.

Avoidance of between meal snacks, especially those high in fermentable carbohydrates, has been proven to significantly decrease the incidence and severity of dental caries.

Being overweight or obese is strongly associated with decayed, filled or missing teeth, gingival bleeding and periodontitis. Large studies have found that central adiposity (i.e., higher waist-to-hip circumference ratio) and insulin-resistance were major determinants of the association of overweight and obesity and periodontitis. It was also found that periodontal treatment of diabetic subjects reduced glycosylated hemoglobin in these subjects. Thus, weight reduction and exercise can improve the risk of both oral and systemic diseases. Good nutrition has the ability to delay or deter both oral and systemic disease initiation and progression. Several studies have reported various degrees of association between nutritional elements/supplements and periodontal status, as well as some positive influences of nutritional supplementation on periodontal therapeutic outcomes, and with their associated systemic diseases. Dietary fiber consumption, especially soluble fiber, have been shown to be a beneficial modifying factor in the relationship between periodontitis and heart attack risk.

 Individuals with periodontitis and missing teeth, either due to dental caries or periodontitis, consume less dietary fiber. This is due to their inability to chew. This creates several problems for these individuals. Oral bacterial clearance from the mouth is significantly reduced in these individuals, along with reduction of salivary activity from chewing which help to digest food and neutralize the  acidic environment produced by certain bacterial microorganisms. Numerous studies have suggested that dietary fiber intake protects against HA. Also, higher levels of dietary fiber consumption has been reported to have a positive effects on CRP, blood lipids, factor VII coagulant activity, plasminogen activator inhibitor type 1, insulin levels, and fibrin network structure.

Therefore it is very important for an individual to maintain their ability to chew, especially with their natural teeth. Blood and dietary folate levels have also been reported to be significantly lower among denture-wearers and individuals with impaired dentition.

Pharmacological agents that are used to treat many systemic diseases have several uncomfortable side-effects that can be detrimental in terms of oral health and eating. These are xerostomia (dry mouth), sore mouth and altered taste.

Dietary Recommendations for Individuals with Dry Mouth

Individuals with xerostomia can suck of sugar-free hand candy, ice chips, frozen grapes; chew sugar-free gum; or consume sugar-free ice pops. Xylitol containing products help prevent dental caries. These individuals should also eat soft foods that are easier to swallow, such as custards, soups, ice cream, puddings, etc. Yogurt, cottage cheese, and bean soups are good sources of protein. Foods can also be dunked or soaked in liquids that make them softer and easier to swallow.

Foods can be cut into small pieces and mixed with sauces and gravy to make them moist and easier to swallow. Drink water while eating. Substitute mashed potatoes and rice for dry crackers and bread. Substitute applesauce, fruit cocktail and other canned fruits for raw fruits and citrus fruits. Herbs have been found to be helpful in place of spices, citrus juices and salt seasonings. Eating papaya should help to break up thick saliva. Have a bottle of water with fresh-squeezed lemon with you at all time for easy access. The use of lip balm can be used to keep the lips moist.

Dietary Recommendations for Individuals with Sore Mouth

Individuals with sore mouth should use the foods mentioned for xerostomia in order to make chewing and swallowing easier. In addition, these individuals should avoid foods that can cause oral mucosal irritation, such as oranges, grapefruits, lemons, and other citrus fruit or juice. Tomato sauces, spicy or salty foods, raw vegetables, granola, toast, crackers, and commercial mouthwashes that contain alcohol should also be avoided.

Dietary Recommendations for Individuals with Altered Taste

Chemotherapy, radiation, cancer by itself, diabetes, or other diseases and medications may cause food to taste different than your previous taste experiences. These individuals can modify their diet and continue to eat healthy balanced meals. To enhance flavor these individuals can: 1) marinate meat in a variety of sauces, such as soy, barbeque, and sweet-n-sour sauce, or salad dressing; 2) Use a variety of seasonings on vegetables such as garlic powder, lemon juice/lemon pepper, and basil; and 3) use fresh fruit or vanilla extract to enhance the flavor of milkshakes, ice cream and pudding. In order to minimize the metallic taste of food these in individuals should use plastic utensils. Also, tart foods such as citrus juices, pickles, relish, grapefruit, cranberry, and Granny Smith apples, can help these individuals overcome the metallic taste of food. If red meat tastes unusual, other protein sources can include chicken, turkey, fish, and dairy products. The addition of sugar can improve the flavor of salty foods (Warning: some diets involve salt and sugar restrictions. Other suggestions are: 1) serve foods cold or at room temperature to reduce their odors; 2) use a variety of foods to complement your taste preferences; and 3) serve foods attractively and in a pleasant atmosphere to enhance the individual’s acceptance.

Summary

Almost all essential nutrients enter the body by way of the oral cavity. Good oral health is an important component of overall health and well-being. When oral health is compromised, as in conditions such as periodontitis, consequences may reach far beyond the oral cavity. Periodontitis is associated with an increased risk of illnesses that affect the entire body. These include rheumatoid arthritis, diabetes, heart disease, obesity, osteoporosis, and complications of pregnancy. Protecting oral health is therefore critical to maintaining overall health. Conventional treatment for periodontitis may not always be enough to maintain optimal oral health. Nutritional therapeutics may be useful adjuncts in improving healing, reducing inflammation, and strengthening the body’s immune system.  These nutrients may be useful when used internally as well as when applied topically to the oral tissues. Optimizing oral health, through the adjunctive use of commercially available nutrients can be an important step in preventing disease and promoting a long and healthy life.