This document discusses the relationship between diet, nutrition, and periodontal health. It defines key terms like diet and nutrition and outlines food groups and recommended dietary allowances. It describes how different nutrients like proteins, carbohydrates, lipids, vitamins A, D, E, B complex, C, and minerals can impact periodontal health when deficient. The effects of various antioxidant nutrients are also covered. The document concludes with recommendations for nutritional counseling in periodontitis patients to improve their diet and periodontal condition.

1. DIET AND NUTRITION IN
PERIODONTOLOGY

2. Index :
● INTRODUCTION
● DIET AND NUTRITION DEFINITIONS
● CLASSIFICATION
● NUTRITIONAL INFLUENCES
● PHYSICAL CHARACTER OF DIET
● EFFECTS OF NUTRITION ON ORAL MICROORGANISMS
● PROTEIN, CARBOHYDRATES AND LIPIDS ROLE IN PERIODONTAL HEALTH
● FAT SOLUBLE VITAMIN DEFICIENCY AND ITS EFFECTS ON PERIODONTIUM
● WATER SOLUBLE VITAMIN DEFICIENCY AND ITS EFFECTS ON PERIODONTIUM
● POSSIBLE ETIOLOGIC RELATIONSHIP BETWEEN ASCORBIC ACID AND PERIODONTAL
DISEASE
● ROLE OF OTHER NUTRIENTS
● ANTIOXIDANTS AND PERIODONTIUM
● DIET AND NUTRITIONAL COUNSELLING IN PERIODONTITIS PATIENTS
● CONCLUSION
● REFERENCES

3. INTRODUCTION :
● It is clear till now that periodontal diseases are caused by specific
bacterias (Periodontal pathogens).
● But this pathogens do not cause disease simply by their presence. There
are multiple other factors associated with periodontal health ; and any
changes in them will cause periodontal disease.
● This factors divided into systemic factors, environmental factors ,
nutritional influence on the body etc.

4. Definitions :
● Diet : It is total oral intake of substance that provides nourishment and
energy ( Nizel,1989 )
● Nutrition : It is science of food and its relationship to health. It is
concerned primarily with part played by nutrients in body growth,
development and maintenance. ( WHO 1971)
● Balanced Diet : Diet which contains variety of food in such quantity and
properties that need for energy , amino acids, vitamins, minerals, fats,
carbohydrates and other nutrients is adequately met for maintaining
health, vitality and general well being. (Chauliac, 1984)

5. Classification :
● Based on quantitative requirements :
1. Macronutrients - required by body in relatively large amounts (measured
in grams) called “proximate principles” as they form the main bulk of food.
E.g. Carbohydrates (65-85%) , Proteins (7-15%) , Lipids (10-30%)
2. Micronutrients - required in small amounts ( measured in milligrams or
micrograms). E.g. Vitamins and Minerals

6. Recommended dietary allowance :
● Amount of nutrient that meets the need of 97 to 98% 0f all people of a
given age and sex. -Schifferle et al 2005

7. Food group pyramid :
● Five food groups guide proposed in march 1999 .

8. Nutritional influences on periodontium :
● Nutritional deficiency and imbalance causes periodontal disease.
1. There are nutritional deficiencies that produces change in the oral cavity
2. There are no nutritional deficiencies that by themselves can cause
gingivitis or periodontal pockets but they can affect the condition of
periodontium and can aggravate the injurious effects of local factors like
plaque, occlusal forces.

9. Physical character of diet :
● Soft diet may lead to plaque and calculus formation
● Hard fibrous food provides surface cleansing action and stimulation
which results in less plaque and gingivitis.
● High sucrose level in human diet favours production of thick plaque.

10. Effect of nutrition on oral microorganisms:
● Human dietary intake is also the source of nutrition for microorganisms
present in the body.
● Through its effect on oral bacteria, the diet may influence relative
distribution of types of organisms. Their metabolic activity and their
pathogenic potential, which in turn affect the occurrence and severity of
oral disease.
Sources of Nutrition
in microorganisms
exogenous
endogenous

11. ● Attachment and subsequent colonization of the tooth surface by certain
microorganisms also may be made possible by components of diet.

12. Proteins and periodontal health :
● Every cell in the human body contains protein. The basic structure of protein is a
chain of amino acids. You need protein in your diet to help your body repair cells
and make new ones.
● Protein is also important for growth and development in children, teens, and pregnant
women.
● Protein deprivation studies conducted on rats in the 1950s resulted in the breakdown
of periodontal ligaments, degeneration of gingival tissues, and resorption of the
alveolar bone.
● A recent study conducted in Denmark suggested an inverse relationship between
high protein intake and periodontitis.

13. Carbohydrates and periodontal health :
● Foods high in carbohydrates are an important part of a healthy diet.
Carbohydrates provide the body with glucose, which is converted to energy
used to support bodily functions and physical activity.
● High carbohydrate intake has been implicated in periodontal disease and dental
caries.
● Sugary diet encourages plaque formation and leads to the onset or worsening of
dental decay in reaction to poor oral hygiene.

14. Lipids and periodontal health :
● Lipids helps the body absorb vitamin A, vitamin D and vitamin E. These
vitamins are fat-soluble. Any fat that's not used by your body's cells or turned
into energy is converted into body fat.
● A strong link between obesity and periodontal diseases has been reported.
● higher body fat content has been associated with increased gingival
bleeding in older patients.
● On the other hand, polyunsaturated fats (such as omega-3s) have been
observed to have a positive effect on periodontal health.
● A study conducted on Japanese young adults also found an association
between high body mass index (BMI) and high risk of periodontal disease.

15. Fat soluble vitamins :
Serves as an antioxidant to limit free
radical reaction and to protect cells
from lipid peroxidation.
VITAMIN K
03
Essential for absorption of calcium
from GIT and maintains calcium
phosphorus levels.
VITAMIN D
02
Maintains health of epithelial
cells of skin and mucous membrane.
VITAMIN A
01

16. Effects of fat soluble vitamins on periodontium:
- Vitamin A is a group of unsaturated nutritional organic compounds
that includes retinol, retinal, and several provitamin A carotenoids.
- FUNCTION
- A fat soluble vitamin supplying carotenoids (α carotene, β carotene,
lycopene, cryptoxanthin and lutein) to our body which aids in normal
growth, reproduction and maintenance of epithelial cells due to the
presence of retinol and retinoic acid essential to prevent keratin synthesis.
- An antioxidant.
- Laboratory investigations: Retinol level blood test
- Normal: 15 to 60 mg/dl

17. VITAMIN A DEFICIENCY :
- Decreased epithelial tissue development, Impaired tooth formation, Enamel
hypoplasia.
- Deficiency may cause hyperkeratosis of gingival epithelium and retardation of
gingival wound healing.

18. •Vitamin D is an inclusive term for several forms of the hormone cholecalciferol.
• Calcitriol (1,25-dihydroxycholecalciferol): regulation of plasma calcium and
phosphorus levels.
• Has an essential role in bone and calcium metabolism.
• In vitro, calcitriol inhibits the production of pro-inflammatory cytokines and T-
lymphocytes proliferation, and also increases production of anti-inflammatory
cytokines.

19. •Miley et al found improved periodontal health with vitamin D intake from food and
supplements in patients with chronic periodontitis and suggested that low dietary
intake of vitamin D had a noticeable effect on bone loss and also had an impact on
inflammatory & antimicrobial effects in periodontal diseases.
•Laboratory investigations: Vitamin D blood test
•Normal: 20-50 ng/ml
•Less than 12 ng/ml indicates vit. D deficiency

20. ● VITAMIN D DEFICIENCY :
- Lowered plasma calcium, Hypomineralization, Compromised tooth integrity,
Delayed eruption pattern , Absence of lamina dura, Abnormal alveolar bone
patterns.
- Defective calcification and some cementum resorption and distortion of the
growth pattern of alveolar bone.
Vitamin D deficiency causes a decrease in bone mineral
density in the mandible, and an increase in alveolar
porosity.

21. Vitamin E
Function
1. It is a naturally occurring antioxidant named as Tocopherol.
2. It protects free radical reactions and shields the cells and cell membranes from
lipid peroxidation.
3.It shelters the major content of cell membranes i.e. polyunsaturated fatty acid from
peroxidation reactions.

22. VITAMIN E DEFICIENCY :
● Delayed wound healing, cell membrane which are high in polyunsaturated
lipids are major site of damage.

23. Water soluble Vitamins :
VITAMIN C
02
Deficiency can cause
SCURVY’
VITAMIN B
01
Includes thiamin, riboflavin,
niacin, pyridoxine(B6), biotin, folic
acid and cobalamin (B12)

24. ● VITAMIN B plays vital role in cell metabolism, repair and proliferation.
- It includes Thiamine (B1), Riboflavin (B2), Niacin (B3), Pyridoxine (B6), Biotin(B7) , Folic
acid (B9) and Cobalamin (B12).
- B1: 1.1 milligrams (mg)
- B2: 1.1 mg
- B3: 14 mg NE
- B5: 5 mg
- B6: 1.3 mg
- Biotin: 30 micrograms (mcg)
- Folic acid: 400 mcg DFE
- B12: 2.4 mcg

25. VITAMIN B DEFICIENCY :
● Oral changes common to B-complex deficiencies are gingivitis,
glossodynia, angular cheilitis and inflammation of their entire mucosa.

26. Riboflavin deficiency (ariboflavinosis) includes glossitis, angular
cheilitis, dermatitis and a superficial vascularizing keratitis. In severe
deficiency the entire dorsum is flat, with a dry and often fissured surface.
-candidiasis may develop in the commissures of debilitated persons this
lesion is termed as perleche
Magenta
discolouration,
Atrophy of pappila.

27. Thiamin deficiency causes hypersensitivity of oral
mucosa; under tongue or on the palate; and erosion of
oral mucosa.

28. Niacin deficiency causes PELLAGRA (mental confusion,
glossitis, alopecia, dermatitis, sensitivity to sunlight,
enlarged heart, peripheral neuritis, and dementia)

29. -Folic acid deficiency causes macrocytic anemia
with megaloblastic erythropoiesis, GI lesions,
diarrhea, intestinal malabsorption
-might show necrosis of gingiva, periodontal
ligament inflammation.
- ulcerated glossitis, cheilitis, generalized
stomatitis.
-ulcerative stomatitis is an early condition of the
toxic effect of folic acid antagonists used in
treatment of leukemia.
- significant reduction in gingival inflammation has
been seen after systemic or local use of folic acid
when compared with placebo.

30. ● VITAMIN C :
-Also known as Ascorbic acid. Fruits and vegetables are source
-Role of a coenzyme in hydroxylation of proline and lysine while proto collagen is
converted to collagen.
-The hydroxylation reaction is catalysed by lysyl hydroxylase and prolyl hydroxylase
and this reaction is dependent on vitamin C.
-Synthesis of collagen and bone formation.
-Helps in iron absorption by forming ferrous hydroxide which breaks down into ferric
ion (Fe+++) gets converted into ferrous ion (Fe++).

31. ● VITAMIN C DEFICIENCY :
- Causes Scurvy ( hemorrhagic diathesis and retardation of wound healing)
- Bleeding , swollen gingiva and loosened teeth are also common features
of scurvy.
- Deficiency may results in defective formation and maintenance of
collagen, retardation or cessation of osteoid formation, impaired
osteoblast functions.

32. Possible etiologic relationship b/w ascorbic acid and periodontal
disease :
● Lower levels of vit. C influences the metabolism of collagen within
periodontium, affects regeneration and repair.
● Deficiency interfere with bone formation leading to loss of periodontal
bone.
● Deficiency increases the permeability of the oral mucosa to triated
endotoxin and inulin and of normal human crevicular epithelium to
tritiated dextran.
● Higher levels of VIT. C enhances both chemotactic and migratory actions
of leukocytes without influencing their phagocytic activity.
● Optimal levels maintain the integrity of periodontal microvasculature as
well as the vasculature response to bacterial irritation and wound healing.
● Deficiency may interfere with ecologic equilibrium of bacteria in plaque
and thus increase its pathogenicity.

33. enlarged , hemorrhagic, bluish-red
gingiva; associated with vit. C
deficiency.

34. TITLE AUTHOR YEAR, JOURNAL
AND LEVEL OF
EVIDENCE
METHOD CONCLUSION
Evaluation of
Regenerative
Potential of Locally
Delivered Vitamin C
along with
Microneedling in the
Treatment of
Deficient Interdental
Papilla: A Clinical
Study
Ahuja A., Staffy
R. et. al.
Journal of
contemporary
practice of dentistry
2022.
LOE : 3
15 patients with black
triangles and loss of
papillary height were
selected. Vitamin C
injection was loaded
and inserted at 45°
angle, 2-3-mm apical
to the involved papilla
and all surrounding
areas. Involved papilla
was injected with an
amount till blanching
was visible. After that,
MN was done in the
required area. This
method was repeated
for 5 times at 7 days
intervals
consecutively.
An overall healthy
appearance of
gingiva with a
remarkable
increase in papilla
growth was
observed.

35. Role of other nutrients :
Calcium: Milk products, eggs, canned bony fish, leafy vegetables, nuts, seeds
Required for formation of teeth and bones. Supplementation improves outcomes of non-
surgical periodontal therapy. Local application enhances osseointegration.
Magnesium: Cocoa, soybeans, nuts, spinach, marine vegetables, tomatoes
Required for cell metabolism and bone formation. Supplementation may improve
outcomes of non-surgical periodontal therapy.
Iron: Red meat, tuna, dry beans, spinach
Possible antioxidant effect on periodontium.
Zinc: Protein-rich foods, spinach, grains
Possible antioxidant effect on periodontium. Reduces severity of diabetes-induced periodontitis
Fluoride: Grape fruits, cocoa, tea, dried fruits and nuts, fluoridated water
Supplementation and topical application prevents dental caries.

36. Antioxidants and periodontium :
● Periodontal disease is a complex process of infective and inflammatory processes
leading to production of reactive oxidative species (ROS), which in turn worsen
periodontitis. Antioxidants may improve periodontal health and outcomes of
periodontal therapy by reducing the oxidative stress via scavenging ROS.
● When this balance of ROS production and antioxidant enzymes (e.g., glutathione)
is disrupted, a state of oxidative stress occurs.

38. Diet and nutritional counselling in periodontitis patients :
1: Evaluate the diet and if necessary, demonstrate the method for keeping a food intake
diary. A food intake evaluation chart is one in which all foods are classified into 4 food
groups
- Vegetable fruit group.
- Bread cereal group.
- Milk cheese group.
- Meat, poultry, fish and beans group.

39. •2: Explain the nutrition periodontal relationship: Patients tend to be more
cooperative if the nature of problem and the rationale for making some
improvement in their dietary pattern is explained. Thus they should be advise:
- Reducing sugar intake
- Replacing sweets and other empty calorie foods with nutritious, firm and
fibrous foods that will stimulate and strengthen the periodontal tissues
- Selecting a well balanced, varied, adequate diet to provide all the essential
nutrients and to support overall health in general and the health of tooth
supporting structures in particular.

40. • 3: Assess nutritional status by taking a detailed medical history.
- Social and Diet histories: In order to prescribe a diet that patient will be able to fulfill with
ease, it is necessary to ascertain his/her daily routine, food likes and dislikes, food purchases,
preparations and eating habits
- Examine for clinical signs of malnutrition: Observe whether there are any clinical or oral
manifestations of malnutrition such as pallor, dry skin, overweight, underweight, cheilosis or
glossitis. Record the findings under clinical nutritional finding.
- Diagnosis: From the complaint, medical and dietary histories and clinical findings, a
nutritional diagnosis that includes the primary and secondary nutritional factors can be made.
• 4: Prescribe a balanced diet
• 5: Follow up

41. Conclusion :
● It is very important for all clinician to know the correlation between
nutritional deficiency and its harmful effects.
● Daily recommended nutrition values should be known by clinician to
provide proper diagnosis and treatment to the patients with deficiency.
● Nutritional deficiency might not be directly related to cause of
periodontal diseases but they increases microbial virulence and ultimately
disease activity become faster in nutrition deficient.

42. References:
1. Carranza’s clinical periodontology, 9th edition
2. Najeeb S., the role of nutrition in periodontal health : an
update.Nutrients 2016 Sep; 8(9): 530.
3. Kaye EK. Nutrition, dietary guidelines and optimal periodontal
health. Periodontology 2000. 2012 Feb;58(1):93-111.

43. Thank you !!