Nutritional therapy for gum disease

Gum disease is a prevalent condition estimated to affect more than half of all adults in the UK to some degree and most people experience it at least once in their life.

What is it?

Signs of gum disease include tenderness, redness and bleeding during brushing. This stage of gum disease is known as gingivitis. This stage can be treated by maintaining a good level of oral hygiene i.e. brushing your teeth at least twice a day and flossing regularly. If gingivitis is not treated, a condition called periodontitis can develop. This affects the tissues that support teeth and hold them in place. 

In the UK, up to 15% of adults are estimated to have severe periodontitis, with many more affected less severely. If periodontitis is not treated, the bone in your jaw can decay and small spaces can open up between the gum and teeth. Your teeth can become loose and may eventually fall out. In adults over the age of thirty, more teeth are lost from periodontal disease than from tooth decay.

In addition to causing pain, general discomfort, fatigue and bad breath, periodontal disease is associated with a higher risk of heart disease, respiratory disease and nutritional deficiencies.

The most popular approach to periodontitis is through procedures such “scale and polish" which is removal of plaque and tartar that builds up on the teeth as well as "root planing" which is a deep clean under the gums that gets rid of bacteria from the roots of your teeth. These procedures, along with oral hygiene instructions, eliminate many of the pathogenic bacteria associated with gum disease. 

What causes it?

Bacteria in the mouth are the cause of almost all forms of gum disease, through the development of plaque. Plaque gradually becomes mineralised and hardens into tartar and calculus, through the action of acid in the saliva. It cannot be removed by brushing and provides a base for further build-up of bacteria. Plaque-forming bacteria produce free radicals, toxins, and connective tissue-destroying enzymes which initiate the inflammatory process. The mouth, like the gut, naturally supports a population of good and bad bacteria necessary for oral and digestive health. These bacteria are present in people who don’t develop gum disease, as well as in those who do. 

How nutrition can help

Generally a diet needed for good gum health is no different from one required for good health for the entire body. It should be balanced and nutrient-rich based on fresh natural foods, whole grains, vegetables, fruit, fish, beans and seeds. It should be low in sugar, refined carbohydrates, salt and alcohol and should avoid damaged fats and artificial additives.

Vitamin C is vital in forming the amino acids needed for the production of collagen, an important component of the tissues that support the teeth. Adults who consume less vitamin C in their diets are more likely to develop gum disease, according the a study published in the Journal of Periodontology. Researchers who studied more than 12,000 adults found that those who consumed less than 60 mg of vitamin C daily were far more likely to develop severe gingivitis than those consuming at least 180 mg per day. Vitamin C is believed to help gum disease because it is an antioxidant and is needed to repair connective tissue and accelerate bone regeneration. 

Bioflavonoids are thought to significantly enhance the absorption of Vitamin C, and possibly to prolong the effectiveness when they are combined together. Like vitamin C, the bioflavonoid nutrient is not made by the body and so has to be ingested. 

Vitamin E can help to control periodontal disease is through its ability to prevent inflammation. Chronic inflammation plays an important role in some cases of periodontal disease. Taking vitamin E can help to reduce the levels of inflammation in your body, potentially helping to control the chronic inflammation that can occur in periodontal disease. Vitamin E is also an antioxidant; it prevents the activity of harmful free radicals, which oxidise and damage your tissues. The presence of antioxidants in your mouth can damage your gum tissue, helping promote the development of periodontal disease. A study published in "Advances in Medical Science" found that epilepsy patients with periodontal disease displayed abnormally low levels of vitamin E (as well as other antioxidants) in their mouths and saliva. As a result, consuming vitamin E might help to restore vitamin E levels in and around gum tissue, potentially helping to treat or prevent periodontal disease in some individuals. 

Vitamin A is necessary for collagen synthesis, maintaining the integrity of periodontal tissues and enhancing immune function. Beta-carotene may be the best form of vitamin A to take, due to its affinity with gum tissue, potent antioxidant activity and safety at high dosages. Zinc functions synergistically with vitamin A, inhibits plaque growth and helps to stabilise membranes in the periodontal tissues

Vitamin D has been found to have anti-inflammatory effects and may reduce susceptibility to gum disease. A study by the Boston University evaluated the association between vitamin D status and gingivitis. They analyzed data from 77,503 teeth in 6700 people in the third National Health and Nutrition Examination Survey and found that people with higher blood levels of vitamin D were less likely to experience bleeding gums during probing of the gums. 

Deficiencies in vitamin D or calcium may lead to the resorption of bone around the teeth and destruction of the periodontal ligaments that anchor the teeth to the jawbones. Women with severe osteoporosis are three times more likely to experience tooth loss. Vitamin D is essential for calcium absorption from the gut and helps maintain the proper balance of calcium and phosphorus in the bones.

Calcium - a study found that people who do not consume adequate amounts of calcium each day are at significantly higher risk for periodontal disease. According to research men and women who have low calcium intake (below the recommended dietary allowance) were almost twice as likely to have periodontal disease, as measured by the loss of attachment of the gums to the teeth.

Folic Acid - studies have demonstrated that folic acid is very effective in preserving gum tissue and reducing the risk of gingivitis and periodontitis. Studies have demonstrated folic acid's ability to improve gingivitis symptoms, reduce gum tissue's inflammatory response, and make gum tissue more resilient to irritants such as bacteria and plaque. A study of 30 patients compared supplementation with 4000 mcg of ingested folic acid to placebo - after one month results showed that folic acid supplementation appeared to increase the resistance of the gums to local irritants, leading to a reduction in inflammation.

Coenzyme Q10 is a vital nutrient needed by every cell in the body to make energy, is beneficial for a variety of diseases and disorders, including periodontal disease. In addition to energy production, CoQ10 plays a vital role as an antioxidant at the cellular level by neutralising free radicals. Researchers have found that gum tissue in people with periodontal disease was often deficient in CoQ10. Subsequent studies have shown that CoQ10 doses of 50 to 75 mg daily can stop deterioration of the gums and allow healing to occur, sometimes within days of starting therapy. In one trial, 50 mg daily of CoQ10 was significantly more effective than placebo in reducing symptoms of gingivitis after three weeks of treatment.

Fish oil and borage (starflower) oil - due to the association between gum disease and inflammation, researchers have begun looking at anti-inflammatory nutrients in the context of gum disease. In one study, 30 adults with gum disease were given omega-3 fatty acids from fish oil and omega-6 fatty acids from borage oil. At the end of the study, clinically significant improvements were measured in both gingival inflammation and the depth of gum pockets. Another preliminary human study found that omega-3 fatty acids tended to reduce inflammation, but called for more thorough research. However, in light of the established connection between omega-3 and omega-6 fatty acids and inflammation, as well as fatty acids’ lack of side effects, it is reasonable for people with gum disease to consider using these supplements.