Plant Power for Supporting Gum Health: An Infographic

Gum disease affects 70% of Canadians and is associated with many systemic diseases for which the benefits of plant-based diets have been well-established.^1,2 In ‘A Plant-Based Diet and Periodontal Health’,2 published in last year’s October edition of Oral Health, we discussed the findings and potential implications of studies that have reported the association between plant-based diets and periodontal health.^3-6 Results from these studies suggest a beneficial association between plant-based diets and better periodontal outcomes–including decreased probing depths,3,5,6 decreased bleeding on probing,^3-5 and decreased inflammation,^3-6 though future research is still needed to comprehensively understand a ‘cause-and-effect’ relationship. As shown in the accompanying infographic, key components in a plant-based diet – higher intakes of polyunsaturated fatty acids, polyphenols, vitamin C, fiber, and proteins–combined with other healthy lifestyle choices such as better brushing and flossing habits, less smoking and alcohol consumption, and physical activity have been associated with
periodontal health and a lower risk of developing periodontal disease.^2-14

Polyunsaturated fatty acids, and in particular higher intakes of omega-3 fatty acids, have been associated with a lower prevalence and risk of periodontal disease in individual studies.^7,8 Moreover, a beneficial association between higher intakes of polyunsaturated fatty acids and lower risk of periodontal disease has also been noted in a systematic review.⁹

Polyphenols have also been associated with a decreased risk of periodontal disease likely due to their known antioxidant and anti-inflammatory properties.^8,10 A rapid review of the literature on polyphenols and periodontal disease in cellular, animal, and human studies demonstrated that polyphenols may be helpful in reducing inflammation of periodontal tissue and the growth of bacterial biofilm.¹⁰

Vitamin C is found in high quantities in fruits and vegetables and often consumed in greater quantities in plant-based diets. Higher vitamin C consumption may help reduce both the risk for periodontal disease^8,11 and also improve healing following periodontal therapy, particularly in non-smokers.¹²

Fiber has been linked to better periodontal health and reduced disease risk through its antioxidant properties and positive influence on glycemic control.^8,11,13 One study has shown that individuals who consumed diets higher in dietary fiber were less likely to have periodontal disease. Conversely, lower intakes of fiber were associated with a higher risk of periodontal disease, and the lower fiber intake was attributed to a low consumption of whole grains.¹³

Protein consumption may indirectly influence periodontal health through support of the immune system. Specifically, plant-based sources of protein have been linked to lower oxidative stress and inflammation in the body.¹⁴ Additionally, a higher protein intake has been associated with improved healing in non-smokers following non-surgical periodontal therapy.¹⁴ However, this study did not differentiate between plant and animal sources of protein such that this aspect requires future study.

How to consume more plant-based foods? There are practical tips to help patients consume more plant foods, shown at the bottom of the infographic.

Encourage patients to try a simple food swap in one or more of their daily meals. This could include a ‘swap’ of an animal protein for a plant-based protein (for more polyunsaturated fatty acids), a cup of coffee for a cup of tea (for more flavonoids and less caffeine), refined carbohydrates for whole grains (for more fiber) or a side of french fries for a side salad.
Remind patients that half of every plate should be fruits and vegetables, to align with Canada’s Eat Well Plate.
Daily brushing and flossing is of course another critical aspect to reinforce.

To summarize, literature to date suggest that a plant-based diet supports periodontal health. Moreover, helping individuals retain teeth enables them to consume a healthful diet. While more research is needed on plant-based diets and the amounts of foods or individual nutritional components that might benefit periodontal health, empowering patients to incorporate more plants in their diet can promote better overall health.

Oral Health welcomes this original article.

References

Canadian Dental Association. (2017, March). A snapshot of oral health in Canada. CDA-ADC. https://www.cda-adc.ca/stateoforalhealth/snap/
Rowdon, L. J., & Ward, W. E. (2021, October). A plant-based diet for periodontal health. Oral Health. https://www.oralhealthgroup.com/features/a-plant-based-diet-and-periodontalhealth/
Atarbashi-Moghadam, F., Moallemi-Pour, S., Atarbashi-Moghadam, S., Sijanivandi, S., & Akbarzadeh Baghban, A. (2020). Effects of raw vegan diet on periodontal and dental parameters. Tzu Chi Med J, 32(4), 357-361.
Woelber, J. P., Gartner, M., Breuninger, L., Anderson, A., Konig, D., Hellwig, E., Al-Ahmad, A., Vach, K., Dotsch, A., Ratka-Kruger, P., & Tennert, C. (2019). The influence of an anti-inflammatory diet on gingivitis. A randomized controlled trial. J Clin Periodontol, 46, 481-490.
Staufenbiel, I., Weinspach, K., Forster, G., Geurtsen, W., & Gunay, H. (2013). Periodontal conditions in vegetarians: a clinical study. European Journal of Clinical Nutrition, 67(8), 836-840.
Jenzsch, A., Eick, S., Rassoul, F., Purschwitz, R., & Jentsch, H. Nutritional intervention in patients with periodontal disease: clinical, immunological and microbiological variables during 12 months. (2009). British Journal of Nutrition, 101, 879-885.
Naqvi, A. Z., Buettner, C., Phillips, R. S., Davis, R. B., & Mukamal, K. J. (2010). n-3 fatty acids and periodontitis in US adults. J Am Diet Assoc, 110(11), 1669-1675.
Martinon, P., Fraticelli, L., Giboreau, A., Dussart, C., Bourgeois, D., & Carrouel, F. (2021). Nutrition as a key modifiable factor for periodontitis and main chronic diseases. J Clin Med, 10(2), 197.
Varela-Lopez, A., Giampieri, F., Bullon, P., Battino, M., & Quiles, J. L. (2016). Role of lipids in the onset, progression, and treatment of periodontal disease. A systematic review of studies in humans. Int J Mol Sci, 17(8), 1202.
Basu, A., Masek, E., & Ebersole, J. L. (2018). Dietary polyphenols and periodontitis – A mini-review of the literature. Molecules, 23(7), 1786.
Skoczek-Rubinska, A., Bajerska, J., & Menclewicz, K. (2018). Effects of fruit and vegetable intake in periodontal diseases: A systematic review. Dent Med Probl, 55(4), 431-439.
Dodington, D. W., Fritz, P. C., Sullivan, P. J., & Ward, W. E. (2015). Higher intakes of fruits and vegetables, β-carotene, vitamin C, α-tocopherol, EPA, and DHA are positively associated with periodontal healing after nonsurgical periodontal therapy in nonsmokers but not in smokers. J Nutr, 145, 2512-2519.
Nielsen, S. J., Trak-Fellermeier, M. A., Joshipura, K., & Dye, B. A. (2016). Dietary fiber intake is inversely associated with periodontal disease among US adults. J Nutr, 146(12), 2530- 2536.
Dodington, D. W., Young, H. E., Beaudette, J. R., Fritz, P. C., & Ward, W. E. (2021). Improved healing after non-surgical periodontal therapy is associated with higher protein intake in patients who are non-smokers. Nutrients, 13(11), 3722.

About the Authors

Larissa Rowdon is a MSc Candidate in Applied Health Sciences at Brock University and holds a BHK from the University of Windsor. Larissa’s research focuses on the impact of COVID-19 and the associated clinic closure on periodontal health, with a goal of mobilizing this knowledge to researchers, practitioners, and patients.

Wendy Ward is a Professor and Senior Research Fellow in the Faculty of Applied Health Sciences at Brock University. Her team’s overall research goal within the Nutrition, Bone and Oral Health Research Group is to develop dietary strategies that help protect against osteoporosis and related fractures while also understanding the complex relationships with other health conditions such as periodontal disease.