Supporting Healthy Gums with the 3G Rule

Seven out of ten Canadians will develop gum disease at some point in their lives, making gum disease and resulting tooth loss the two biggest threats to oral health.¹ Gum disease –and the resulting tooth loss– are associated with chronic diseases such as diabetes, cardiovascular disease and cancer.^2-6 This may occur partly because, with fewer teeth, it is more challenging to consume fruits and vegetables, key protein sources like meats and nuts, and whole grains.^7-9

Based on the guidance for patients’ section in our earlier publication ‘Periodontal Disease and Type 2 Diabetes,’⁶ we created the ‘3G rule’: Get good nutrition, Get moving, and Get proper gum care: a healthy diet, regular exercise and oral hygiene help prevent gum disease and tooth loss.

Fig. 1

Get good nutrition.

Canada’s food guide, specifically the “Eat Well Plate,” promotes healthy eating and overall nutritional well-being, including oral health. Half of each meal should be fruits and vegetables, with the remaining half an equal amount of protein (25%) and whole grains (25%). Diet has been shown to promote oral health by reducing harmful oral bacteria, plaque formation, and inflammation.^10-15 While inflammation is a natural occurrence in the body, it can be heightened by excessive consumption of refined sugars and highly processed foods.¹⁶ A strategic food swap can help displace such foods. Thus, encourage patients to try a beverage and food swap:

• Swap carbonated drinks and sugary beverages for water, milk, plant-based beverages (unsweetened) or tea.
• Swap chips, chocolate, and cookies for yogurt, nuts or fruit.

Get moving!

Exercise has been associated with better oral health.^17,18 Canada’s 24-Hour Movement Guidelines recommend performing a variety of exercises that include:

• 150 minutes of aerobic exercise can be performed over five days a week in 30-minute sessions. For example, you can enjoy running, swimming, or cycling for 30 minutes five days a week.
• 20 minutes of strength exercises that activate the large muscle groups (chest and arm muscles, back muscles, abdominal muscles, and leg muscles), such as lunges, push-ups, squats, and planking, at least two days per week.
• Several hours of light activity throughout the day by aiming to move more and sit less. For example, break up long periods of sitting and standing or take walking breaks.

Although moving is excellent, ensuring 7-9 hours of sleep every night is beneficial for reducing food cravings.^19,20 Visit https://csepguidelines.ca for age and health-based specific recommendations.

Get proper gum care.

Practitioners should encourage patients to visit their dental health professional regularly and to follow the Canadian Dental Association recommendations:

• Brush your teeth for 2 to 3 minutes after meals to remove harmful oral bacteria.
• Floss at least once daily or after snacking to reduce plaque formation.

The message to share with patients: Encourage patients to follow the ‘3G rule’, Get good nutrition, Get moving, and Get proper gum care for better oral health.

Oral Health welcomes this original article.

References

1. Gum disease. Canadian Dental Association. 2023. Accessed July 28, 2023. https://www.cda-adc.ca/en/oral_health/faqs/gum_diseases_faqs.asp#:~:text=Very.,disease%20before%20it%20becomes%20serious.
2. Arbes SJ Jr, Slade GD, Beck JD. Association between extent of periodontal attachment loss and self-reported history of heart attack: an analysis of NHANES III data. J Dent Res. 1999;78(12):1777-1782. doi:10.1177/00220345990780120301
3. DeStefano F, Anda RF, Kahn HS, Williamson DF, Russell CM. Dental disease and risk of coronary heart disease and mortality. BMJ. 1993;306(6879):688-691. doi:10.1136/bmj.306.6879.688
4. Nwizu NN, Marshall JR, Moysich K, et al. Periodontal disease and incident cancer risk among postmenopausal women: Results from the women’s health initiative observational cohort. Cancer Epidemiol Biomarkers Prev. 2017;26(8):1255-1265. doi:10.1158/1055-9965.EPI-17-0212
5. Zhang Y, Leveille SG, Shi L. Multiple chronic diseases associated with tooth loss among the US adult population. Front Big Data. 2022;5:932618. doi:10.3389/fdata.2022.932618
6. Periodontal Disease and Type 2 Diabetes. Oral Health. 2022. Accessed July 28, 2023. https://www.oralhealthgroup.com/features/periodontal-disease-and-type-2-diabetes/
7. Bortoluzzi MC, Traebert J, Lasta R, Da Rosa TN, Capella DL, Presta AA. Tooth loss, chewing ability and quality of life. Contemp Clin Dent. 2012;3(4):393-397. doi:10.4103/0976-237X.107424
8. Hsu KJ, Yen YY, Lan SJ, Wu YM, Chen CM, Lee HE. Relationship between remaining teeth and self-rated chewing ability among population aged 45 years or older in Kaohsiung City, Taiwan. Kaohsiung J Med Sci. 2011;27(10):457-465. doi:10.1016/j.kjms.2011.06.006
9. Nowjack-Raymer RE, Sheiham A. Numbers of natural teeth, diet, and nutritional status in US adults. Journal of Dental Research. 2007;86(12):1171-1175.oi:10.1177/154405910708601206
10. Dodington DW, Young HE, Beaudette JR, Fritz PC, Ward WE. Improved healing after non-surgical periodontal therapy is associated with higher protein intake in patients who are non-smokers. Nutrients. 2021;13(11):3722. doi:10.3390/nu13113722
11. Nielsen SJ, Trak-Fellermeier MA, Joshipura K, Dye BA. Dietary fiber intake is inversely associated with periodontal disease among US adults. J Nutr. 2016;146(12):2530-2536. doi:10.3945/jn.116.237065
12. Woelber JP, Bremer K, Vach K, et al. An oral health optimized diet can reduce gingival and periodontal inflammation in humans – a randomized controlled pilot study [published correction appears in BMC Oral Health. 2016 Oct 6;16(1):109]. BMC Oral Health. 2016;17(1):28. doi:10.1186/s12903-016-0257-1
13. Canada’s Food Guide. Government of Canada. Updated August 29, 2023. Accessed August 30, 2023. https://food-guide.canada.ca/en/
14. Chapple IL, Milward MR, Ling-Mountford N, et al. Adjunctive daily supplementation with encapsulated fruit, vegetable and berry juice powder concentrates and clinical periodontal outcomes: a double-blind RCT. J Clin Periodontol. 2012;39(1):62-72. doi:10.1111/j.1600-051X.2011.01793.x
15. Vaillancourt K, Ben Lagha A, Grenier D. Effects of a berry polyphenolic fraction on the pathogenic properties of Porphyromonas gingivalis. Front Oral Health. 2022;3:923663. doi:10.3389/froh.2022.923663
16. Ma X, Nan F, Liang H, et al. Excessive intake of sugar: An accomplice of inflammation. Front Immunol. 2022;13:988481. doi:10.3389/fimmu.2022.988481
17. Omori S, Uchida F, Oh S, et al. Exercise habituation is effective for improvement of periodontal disease status: A prospective intervention study. Ther Clin Risk Manag. 2018;14:565-574. doi:10.2147/TCRM.S153397
18. Al-Zahrani MS, Borawski EA, Bissada NF. Increased physical activity reduces prevalence of periodontitis. J Dent. 2005;33(9):703-710. doi:10.1016/j.jdent.2005.01.004
19. 24-Hour Movement Guidelines. Canadian Society for Exercise Physiology. 2021. Accessed July 28, 2023. https://csepguidelines.ca/guidelines/adults-18-64/
20. Lv W, Finlayson G, Dando R. Sleep, food cravings and taste. Appetite. 2018;125:210-216. doi:10.1016/j.appet.2018.02.013

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About the Authors

Sara Madanat holds a BSc in Honours Kinesiology from McMaster University and an MSc from Brock University. Sara is a Ph.D. Candidate at Brock University, focusing on preclinical research investigating how food bioactives, vitamin D, and calcium impact bone and cognitive health.

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.