Nutrition and Oral Medicine (Nutrition and Health)

278 Part IV / Select Diseases and Conditions(24). In humans, zinc-containing dental materials are frequently used in clinical dentistry.Small quantities of zinc oxide-eugenol diffuse through the dentin to the pulp andexert anti-inflammatory and local anesthetic effects on the dental pulp. Temporaryfillings with this compound may facilitate pulpal healing (25,26). Clinical studies haveshown that the administration of zinc may enhance wound healing in conditions of lowzinc nutriture, but zinc supplementation in the presence of normal zinc status has notbeen shown to speed the healing process (27).Glutamine, an essential amino acid, is a principal nutrient for the gastrointestinal (GI)mucosa and helps maintain GI structure and function. The role of glutamine in the healingof oral mucositis is an emerging area of study. Oral mucositis is often a complicationfollowing chemotherapy with or without radiation. Some studies have demonstratedpositive results when patients swish and swallow an oral glutamine suspension duringand after chemotherapy. Results of these studies indicate a reduction in the incidence,duration, and severity of chemotherapy-induced mucositis (28,29). Although the resultsare conflicting, adjunctive therapy utilizing oral glutamine suspension may benefit cancerpatients undergoing chemotherapy in helping to minimize complications and discomfortfrom oral mucositis.Antioxidants including vitamin C, -carotene, selenium, and vitamin E also offerpotential benefits to oral-tissue wound healing. It has long been hypothesized that tissuedestruction in periodontal disease may be promoted by extended exposure to reactiveoxygen species (ROS) that are created during the periodontal inflammatory process bypolymorphonuclear leukocytes (30). The free-radical scavenging capabilities of antioxidantsmay help to protect periodontium cell structures from tissue damage mediated byROS. Investigators are currently studying the antioxidant activity of saliva in healthyindividuals and in patients with periodontal diseases (30–33). The possible therapeuticeffects of antioxidants in preventing or treating periodontal disease is an active area ofresearch (34). The potential role of nutritional therapy in the treatment of periodontitiswill likely follow (35).One interesting randomized, controlled clinical study compared the use of nutritionalsupplements and nutraceuticals in conjunction with routine oral hygiene for 60 d on thereduction of gingivitis, bleeding, probing depth, and attachment levels in patients withperiodontal disease vs healthy individuals (36). There were no significant changes forattachment levels with either the experimental or control group; however, in a subset ofpatients with deep pocket depths (>4 mm), there was significant improvement in thegingival index and periodontal pocket depth from baseline to 60 d in the experimentalgroup. This concept merits further investigation but data at present are insufficient tosupport routine supplementation.7. LIFESTYLE AND MEDICAL FACTORSSmoking, chronic diseases, and medications can also affect oral tissue healing. Smokingnegatively impacts wound healing and periodontal health. The deleterious effects onthe periodontium include alterations of the periodontal tissue vasculature and bacterialmicroflora, inhibitory effects of immunoglobulin levels, and antibody responses to plaquebacteria (37). Although the mechanism of how tobacco smoking influences periodontaldisease is not completely understood, smoking is thought to interfere with protease