What to eat to save your teeth

Beware of sticky candy and starchy foods that get trapped between your teeth, brush and floss. You must have heard this annoying advice endless times. 

It’s good advice, though. That much of the advice is targeted at sugar and carbs makes sense. Sugars have long been established as a major contributor to the formation of cavities. Bacteria in tooth plaque ferment sugars and produce acids that lead to tooth damage.

But to keep teeth healthy diet advice goes well beyond just sugar control.

Because beyond cavities, there’s a more serious dental disorder: periodontitis. Periodontitis is a chronic inflammatory disorder that slowly destroys the gums and the tissues that support the teeth. Untreated, it eventually leads to tooth loss. Severe periodontitis affects more than one in ten people worldwide, while mild disease may affect up to 90 percent. Gum disease starts with gingivitis: Plaque along and under the gum line can get gums infected, red, tender and prone to bleeding. Gingivitis, left untreated, can advance to periodontitis. The inner layer of the gum and bone pull away from the teeth to form pockets, which collect debris and become infected and activate an immune response, which together with the bacterial excretions, breaks down the supporting structures of the teeth, leading to their loss.

Periodontitis is a major public health issue, and preventing its development can help avoid a lot of suffering and expense. Gum disease is influenced by many factors beyond dental hygiene, including genetics, smoking, and alcohol consumption. An association between a balanced diet and periodontal health has been observed for centuries.

Sailors leaving the ports of Europe felt just fine, but after a few months at sea their gums were bleeding and inflamed, so painful that they couldn't eat. They became extremely fatigued, their limbs swelled up and bruised easily, and soon after, their teeth fell off like the leaves of autumn. The discovery that fresh citrus prevented this deadly syndrome led to the recommendation that sailors on the Royal Navy drink lemon or lime juice on long journeys at sea. Many other fresh fruits and vegetables prevented this clinical syndrome, called scurvy; later on the etiology of the syndrome was revealed: vitamin C deficiency. Vitamin C is critical for gum health, but isn’t the only one: vitamin D and B-12 deficiencies also increase the risk of periodontitis.

Fortunately, vitamin deficiencies – and vitamin C deficiency especially – are now uncommon in the developed world. Despite that, rates of periodontal disease and its severity continue to rise.

We know that other chronic inflammatory conditions – such as cardiovascular disease, type 2 diabetes and cancer – are influenced by diet. Is periodontal disease linked with dietary patterns in the same way? We also know that periodontitis is correlated with the chronic inflammatory conditions listed above, among others. Is diet-related inflammation a common mechanism for all of these diseases?

Ideal dental diet isn't just about candy and soda

A new study in the American Journal of Clinical Nutrition looked at the connection between whole diet – not just specific nutrients such as sugar and vitamins – and periodontitis.

The researchers looked at a large cohort of 10,000 people and investigated the association between their overall diet and periodontitis, which was evaluated with a full-mouth periodontal exam. They didn’t look at any one single nutrient, but rather at foods and general dietary themes. The dietary pattern associated with healthy gums was a varied diet, rich in fruits, vegetables, salad, plain water and tea. People who adhered to this pattern most had less than half the periodontitis occurrence than those who followed this pattern the least. 

Could it be that people with periodontitis avoid fruits, vegetables and green salad in response to their weakened chewing ability? The authors think it’s highly unlikely, since periodontitis is symptomless until very late in the process – when teeth are falling off – and adjusting the study population to exclude people with advanced tooth loss did not change its findings.

Why would these foods matter? 

“One hypothesis is that high intake of carbohydrates, especially sucrose and fructose in added sugars, may influence periodontal health through chronic systemic inflammation,” the authors suggest.

So refined sugar may not just act locally inside your mouth, but systemically, raising inflammation and thus increasing the risk of periodontitis in the same way that it raises the risk of heart disease and stroke.

That periodontitis tracks with heart disease is pretty well established. It very well may be that the same risk factors that increase the risk of heart disease increase the risk of severe gum disease.

Studies like this should of course be followed by prospective, careful trials to further investigate the diet-periodontitis link. 

But since this dental diet is in concordance with what’s recommended to eat anyway, why wait? We already have too many reasons to limit added sugar and eat more salad.

Dr. Ayala