New research connects the Mediterranean way of eating with healthier gums and lower inflammation, adding oral health to the diet’s growing list of benefits.
Study: Relationship between Mediterranean diet and periodontal inflammation in a UK population: A cross-sectional study. Image credit: monticello/Shutterstock.com
A balanced diet is key to periodontal health. A recent paper in the Journal of Periodontology explored how gum health varied with adherence to a Mediterranean-style diet, reflecting periodontitis severity and markers of local or systemic inflammation.
Introduction
Periodontitis is a disease that damages the gums’ grip on the teeth and their supporting bone. It begins with microbial buildup on the gum pockets, where biofilms release enzymes and inflammatory chemicals. These trigger the body’s immune response, causing local inflammation that can spill over into systemic inflammation. The outcome is tooth loss and chronic disease mediated by low-grade chronic inflammation.
Inflammatory biomarkers are produced in response to microbial and physical injury, which activate the immune system. These include C-reactive protein (CRP), found at higher levels in periodontal disease than in those with healthy gums.
CRP is commonly observed at elevated levels and has been suggested as a marker of association with systemic disease in patients with periodontitis, an association mediated by inflammation. Notably, higher CRP levels are linked to increased risks for heart attacks and strokes, as well as driving atherosclerosis.
An unbalanced diet may predispose patients to periodontitis, while eating plenty of fresh green vegetables, fruit, and salads improves periodontal health.
The Mediterranean diet is well-studied and widely recognized as a healthy eating strategy. It focuses on fruits, nuts, vegetables, legumes, whole grains, and olive oil. Dairy, fish, eggs, and unprocessed meat are consumed at moderate levels, along with moderate red wine intake with meals. Sweet and processed foods are minimally consumed.
Its health benefits include protection against cardiovascular and neurodegenerative disease, some cancers, and periodontitis. Even so, the proportion of people across Europe who closely follow this dietary approach is relatively low and dropping.
While large samples have shown that diet affects periodontal disease incidence, the association with inflammatory markers is unclear. The current study sought to explore this area.
The study included 200 consecutive hospital patients with a full periodontal evaluation and blood tests to measure inflammatory markers like high-sensitivity CRP (hs-CRP). Their diet was captured using a food frequency questionnaire to assess Mediterranean diet compliance.
Study findings
Of the 195 participants who submitted complete data, 112 showed higher adherence to the Mediterranean diet. About 56% were never-smokers, while former smokers made up 34%. Severe periodontitis was present in 170 participants.
Individuals who did not stick to the Mediterranean diet were more likely to have more severe periodontitis (stages III and IV). Those who ate red meat more often were more likely to have more severe periodontitis. The association could be explained by plausible mechanisms suggested in earlier studies, such as the increased availability of protein and the somewhat alkaline environment provided by the meat. Additionally, heme iron may drive oxidative stress, causing chronic inflammation.
Systemic inflammation (in the form of raised interleukin-6 (IL-6) levels) was associated with worse gum health, whether signaled by higher periodontitis stage or by comparing no periodontitis with mild to moderate or severe periodontal disease. In contrast to other studies, there was no association of hs-CRP with periodontitis, perhaps because the sample was too small.
Several food groups, including vegetables, legumes, and dairy, were inversely correlated with systemic inflammation, with some reduced levels or trends observed for markers like hs-CRP, IL-6, and other interleukins. This is consistent with the earlier Oral Infections, Glucose Intolerance, and Insulin Resistance Study (ORIGINS) findings. However, overall adherence to the Mediterranean diet was not directly associated with inflammatory biomarker levels in this study.
The study showed that people who most closely followed the Mediterranean diet were less likely to have severe periodontal disease and showed better periodontal measures, even after adjusting for good brushing habits, other diseases like diabetes or hypertension, and body mass index.
These corroborate prior research, though some contradictory findings have also been reported. Interestingly, high compliance with this dietary pattern also coincided with a higher proportion of never-smokers, though the authors caution that smoking may act as a confounder.
Conclusions
“Low adherence to Mediterranean diet and higher red meat consumption may be associated with severity of periodontal disease.” Future studies should have a large sample size to validate and extend these findings.
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