When it comes to diet and dental problems, most people think of sugar first. Everyone knows that “sugar rots your teeth.” But when it comes to periodontal disease and not just cavities, there’s a more interesting part of the story: inflammation. Inflammation connects periodontal infection to metabolic diseases like Type 2 Diabetes, cardiovascular disease, and obesity. Sugar is definitely a part of that connection, but the research also points to several other ways that diet can help keep your teeth health.
Periodontal Disease (It's Not the Same Thing as Cavities)
Periodontal disease is an inflammatory bacterial disease in the mouth. Everyone has bacteria in their mouth, and it’s perfectly normal. If you clean them off your teeth regularly, they don’t cause any issues. But if they’re left on the teeth, they can harden into tartar, cause inflammation, and infect the gums underneath (this is called gingivitis).
If gingivitis gets left untreated, it can get worse: the bacteria infects little pockets between the gums and the teeth, which separates the teeth from the gums and makes them loose in their sockets. The infection starts breaking down the bone underneath the teeth. Eventually, the teeth might need to be removed. As soon as pockets of infection develop, it’s called periodontitis.
It’s hard to quantify exactly how many people have periodontal disease or how the rate of disease is changing, because different systems of measuring the problem give all different results. But it’s very clear that it’s a big deal, and most American adults will have at least a brush with gingivitis in their lives.
One of the most interesting aspects of periodontal disease from a Paleo perspective is the association with Type 2 Diabetes and metabolic disease.
Diabetes: a Risk Factor for Periodontal Disease
People with Type 2 Diabetes get periodontal disease more often, and the disease is worse when they do get it. Better blood sugar control helps people with diabetes manage their dental problems.
This makes perfect sense if you know how Type 2 Diabetes works.
People with Type 2 Diabetes have a problem with the hormone insulin. Insulin is the hormone that stores carbohydrates after you eat them. People with Type 2 Diabetes are insulin resistant, meaning that their body doesn’t listen to the insulin signal.
Diabetes is an immune-related inflammatory disease – the inflammatory immune response is one big contributing factor to insulin resistance. Periodontal disease is also an inflammatory disease, and there’s evidence that the inflammation caused by diabetes can contribute to the inflammation that causes periodontal disease. It may be less about the particular bacteria in a person’s mouth and more about how their immune system responds to those bacteria – how well-controlled is the immune-inflammatory response? How effective is it? How long does it continue? In people with diabetes, inflammation isn’t well-controlled, which could make periodontal disease worse.
Other changes in the immune system can also make it harder to fight off the disease for people with diabetes. Diabetes promotes the growth of different species of bacteria in the mouth, which might lead to more serious periodontal disease. Diabetics also have a harder time healing wounds in general, and when it comes to periodontal disease in particular, collagen is very relevant. Diabetics have a harder time synthesizing collagen to repair their bones, so injuries to the bones and connective tissue of the tooth and jaw progress more quickly and are harder to heal.
There’s even some evidence that it’s a two-way street: treating periodontal disease produces a small improvement in blood sugar in people with diabetes. This study goes over the two-way connection between inflammatory periodontal disease and inflammatory “lifestyle diseases” like Type 2 Diabetes and obesity. Periodontal disease is also associated with other inflammatory diseases like Alzheimer’s, cardiovascular disease, and Fatty Liver Disease, possibly also through inflammation.
The inflammatory connection makes sense when you think about another big risk factor for periodontal disease: smoking.
Smoking and Periodontal Disease: The Inflammatory Connection
It’s very well established that smoking increases the risk of periodontal disease, and the connection here may be inflammatory as well. Smoking is very highly inflammatory in general, and the inflammation caused by smoking may be the link between smoking and periodontal disease (among other problems).
Diet and Periodontal Disease: Anti-Inflammatory Strategies
Various studies have looked at different anti-inflammatory diet changes for preventing periodontal disease or helping people heal from it. A lot of them focused on antioxidants, but there’s also some research on other vitamins and minerals, Omega-3 fats, and various other aspects of diet:
- This study found that in nonsmokers, higher intakes of fruits, vegetables, beta-carotene (that’s the orange pigment in foods like carrots), vitamin C, vitamin E, and Omega-3 fats were associated with better periodontitis healing.
- This study found that more dietary antioxidants (Vitamins C and E; alpha and beta-carotene) were associated with lower rates of periodontitis in older Japanese people.
- This study found that people with gingivitis or diabetics with periodontitis, levels of Vitamin C were lower. Supplements helped people in those groups improve their oral health.
- This review suggested that zinc and B vitamins may also be helpful.
For general anti-inflammatory eating, here are some more tips.
Since diabetes may have a causal relationship to periodontal disease, anything that helps control blood sugar and insulin metabolism may also be helpful for dental health. Things like finding a carb level that works for you, avoiding refined carbs in general, and improving insulin sensitivity in other ways might give oral health a boost.
Can you Exercise your Way out of Periodontal Disease?
Diet isn’t the only factor in inflammation, though. Lifestyle factors are also very important – your diet could be perfect, but if you’re sleep deprived and stressed out, inflammation is going to be a problem. And then there’s exercise.
Regular exercise is anti-inflammatory. A recent study found that even when you control for diet, gender, age, marital status, and other factors, a low level of physical activity is still associated with higher rates of periodontal disease than a high level. In other words, it’s not just that physical activity is associated with a better diet. That doesn’t explain the connection, because even when you control for diet, more active people still have better dental health.
The authors didn’t go into the reasons why exercise seemed to be protective, but it’s possible that the anti-inflammatory benefits are one way that it helps. It’s also possible that exercise improves insulin sensitivity, which helps manage diabetes, which helps with periodontal disease. That’s basically just a circular way of getting the same benefit: less inflammation.
Summing it Up
All of this suggest that if you’re worried about periodontal disease, one of the best ways to prevent it or speed up the healing process is to reduce systemic inflammation.
That includes eating less sugar, but sugar isn’t the only factor. Vitamins, minerals, antioxidants, and Omega-3 fats are all important, and lifestyle choices like exercise, sleep, and managing your stress will also probably be helpful. And the research on Type 2 Diabetes and periodontal disease also suggests that managing blood sugar levels and avoiding refined carbs can help with oral health in ways that go way beyond sugar “rotting your teeth"