Nutrition for Dental Health

The associations between oral health, diet, nutritional status, and general health are complex with many interrelating factors. Inadequate nutrition can affect many aspects of oral health including contributing to dental caries, periodontal diseases, a decrease in tissue healing, and infectious diseases. Poor oral health in turn can result in malnutrition as it can affect what can be eaten thus altering food choices and negatively impact food intake leading to suboptimal nutritional status (1).

See blog posts Healthy Mouth, Healthy Body for information on the importance of good dental and gum health to prevent systemic and chronic diseases. And see blog post Gum Health ~ Gingivitis and Periodontitis for more information about gum disease and the impact it can have on overall health.

Biomineralisation

Biomineralization is a dynamic, lifelong process by which living organisms control biological tissues including tooth enamel, dentin, cementum, and bone. Throughout life our teeth are at risk of demineralisation as they are exposed to food, drink, and the microbiota of the mouth. Although they have developed a high resistance to demineralisation without adequate nutrition their natural defences are compromised (2).

Biofilms

Biofilms are naturally found in all wet environments. Human oral biofilms have existed since our earliest ancestors and have evolved symbiotically with the teeth over many millennia within a Palaeolithic, hunter-gatherer lifestyle. The relationship between saliva, biofilm and teeth provides oral health benefits and offers a different perspective to the old dental paradigm that associated oral biofilms (plaque) with disease (caries). This new paradigm emphasises that oral biofilms are essential for the mineral maintenance of teeth. Oral biofilms provide physical protection from dietary acid and together with bacterial metabolic acids cause the resting pH of the biofilm to become slightly acidic. This is then followed by the re-establishment of a neutral environment by chemical interactions mediated by the saliva within the biofilm. Such pH fluctuations are often responsible for the cyclic demineralisation, then remineralisation of teeth, a process necessary for tooth maturation. However, since the industrial revolution, the increase in consumption of carbohydrates, refined sugars and acidic drinks has changed the ecology of biofilms. Biofilm biodiversity is significantly reduced together with a proliferation of acid producing organisms, tipping the balance of the cycle towards net mineral loss and hence caries. In addition, the consumption of acidic drinks has removed the protective nature of the biofilm, leading to erosion. Erosion and caries are modern-day diseases and reflect an imbalance within the oral biofilm resulting in the demineralisation of teeth (3).

Good nutritional health promotes good oral health and vice versa (4). Here are some of the key nutrients needed for tooth and gum health:

Minerals – magnesium, calcium, and phosphorus constitute the main structural components of the tooth. Inadequacy of any of these leads to increased tendency to bleeding gums, bone resorption, looseness, and tooth loss. Inadequacy of these essential minerals is associated with delayed tooth development and with enamel or dentin hypoplasia. Taking calcium without magnesium results in soft dental enamel, which cannot resist the acids that cause tooth decay (5). Fluoride strengthens the enamel layer of the teeth and may help prevent caries, but too much can lead to fluorosis (enamel defects) (6).

Vitamin A – a lower intake of vitamin A has been associated with decreased oral epithelial development, impaired tooth formation, enamel hypoplasia and periodontitis (7).

Vitamin B – deficiencies in B vitamins are associated with enamel hypomineralization, halitosis, gingivitis, glossitis and atrophy of the lingual papillae (7).

Vitamin C – there is significant evidence that vitamin C contributes to a reduced risk of periodontal disease. Patients with periodontitis tend to have a lower vitamin C intake and lower blood-vitamin C levels than those without periodontal disease. Deficiency in vitamin C also results in changes in the gingivae and bone. Vitamin C administration reduces gingival bleeding in gingivitis (8).

Vitamin D – during growth and adulthood vitamin D deficiency is associated with a variety of oral health disorders. In children, severe vitamin D deficiency can induce defective tooth mineralization, resulting in dentin and enamel defects. As a consequence, these defects may increase the risk of dental caries. Adequate vitamin D status could delay the onset and progression of dental caries. Vitamin D deficiency is also associated with higher prevalence of periodontitis and gingival inflammation. Vitamin D supplementation may contribute to the successful treatment of periodontitis.  Vitamin D exerts anti-inflammatory effects and helps in calcium absorption and bone remodelling (9).

Vitamin K – deficiency in vitamin K affects the utilisation of vitamin D and has a systemic effect, increasing the risk of haemorrhage, which may affect individuals undergoing oral surgery or suffering an oral injury (7).

References

1. Dis Mon. 2019 Jun;65(6):147-154. Nutrition and oral health. Gondivkar SM et al.

2. Int J Nanomedicine. 2016 Sep 19;11:4743-4763. Demineralization-remineralization dynamics in teeth and bone. Ensanya Ali Abou Neel.

3. Ann Anat. 2016 Jan;203:85-9. The ‘sialo-microbial-dental complex’ in oral health and disease. Kaidonis J, Townsend G.

4. Monogr Oral Sci. 2020;28:114-124. Chapter 12: Nutrient Deficiencies and Oral Health. Rahman N, Walls A.

5. Steroid Biochem Mol Biol. 2020 Jun;200:105636. Oral manifestations of magnesium and vitamin D inadequacy. Uwitonze AM et al.

6. Cochrane Database Syst Rev. 2019 Mar 4;3(3):CD007868. Fluoride toothpastes of different concentrations for preventing dental caries. Walsh T et al.

7. Monogr Oral Sci. 2020;28:59-67. Chapter 6: Vitamins and Oral Health. Gossweiler AG et al.

8. Int J Environ Res Public Health. The Relationship between Vitamin C and Periodontal Diseases: A Systematic Review. Tada A, Miura H.

9. 2020 May 19;12(5):1471. Vitamin D Deficiency and Oral Health: A Comprehensive Review. Botelho J.