Nutrition and Oral Medicine (Nutrition and Health)

120 Part III / Nutrition and Oral HealthIn a study of more than 12,000 adults, Nishida et al. (106) found a statistically significantassociation between lower dietary calcium intake and periodontal disease in young malesand females and for older males. For the females with the lowest level of dietary calciumintake, there was a 54% greater risk of periodontal disease.6.4. Other Nutrients and Periodontal DiseaseA recent study of older adults reported that an intake of calcium and vitamin D,maintained at the US DRI values (in order to prevent osteoporosis) had a beneficialeffect on tooth loss (112). However, the number of teeth lost depended on self-reports,and the authors conclude that these findings need to be confirmed in an intervention trial.Although many human studies have evaluated the effect of both calcium and vitamin Ddeficiency, only a limited number of studies have looked at vitamin D separately. In oneof the few studies, young rats were fed diets deficient in calcium, calcium plus vitaminD, or vitamin D (113). Whereas the first two diets resulted in obvious effects on theperiodontal tissues, the rats were found to be insensitive to vitamin D deficiency as longas an adequate supply of calcium was available. In one of the few studies evaluating theintake of a wide range of nutrients, dietary protein and vitamin A together with calciumwere found to correlate to periodontal disease (114).6.5. Antioxidant Nutrients and Periodontal DiseaseIn response to periodontal pathogens, neuthrophils release oxidants, proteinases, andother destructive factors (115). Different antioxidants, present in all body fluids andtissues, may protect against tissue-destructive effects of oxidants. These include, forexample, ascorbic acid (vitamin C), -tocopherol (vitamin E), and -carotene found inextracellular fluid and dietary-derived components such as uric acid, nonprotein thiols,and glutathione (116). In relation to periodontal disease, it has been found that P. gingivalistriggers the release of cytokines, resulting in increased activity of polymorphonucleocytes(PMN) and that increased oxidative damage to gingival tissue, periodontal ligament, andalveolar bone may occur (116). A similar increase in PMN cells has been found after only3 d plaque accumulation during experimental gingivitis (117).Data considering antioxidant status and periodontal disease are rare, but a reducedsalivary antioxidant activity in patients suffering from periodontal disease has beenreported (116). In another study of only 28 healthy and 7 diseased subjects, no differencein salivary antioxidant capacity between diseased and healthy patients was found (118).It has been suggested that an improved understanding of the role that antioxidants playin periodontal health and disease and the influence of diet and nutrition on antioxidantstatus may lead to a possible nutritional strategy for the treatment of periodontal disease(116). However, there is no evidence to support supplementation with megadoses ofantioxidant vitamins; once again, an adequate intake may be obtained by consumption ofa healthy, balanced diet.6.6. Nutrition and Diet in Relation to Dental PlaqueIt is important to bear in mind the overall pathogenesis of periodontal disease and thatthe changes seen may vary both inter- and intraindividually in relation to the presence ofdental plaque. Good dietary practices and optimal nutritional status are important inreducing the severity of inflammatory periodontal lesions but are likely to be of limited