When reviewing oral hygiene instructions with patients, nutrition is a category that is too often overlooked or briefly discussed. Often the focus is on foods that are ‘bad for your teeth’, but we have the opportunity to transition the conversation to nutrients and food sources that can support or improve oral health.

Clinical Signs of Nutritional Deficiency

There is strong evidence that poor dietary intake may display signs via oral manifestations. Dental caries may be the most obvious sign of poor diet but it is not the only one. Inflammation, xerostomia, erosion, poor healing, and periodontal diseases are a few others that often present in these patients. Diet can work to change the oral environment, including alteration of pH, salivary changes, collagen repair, bone health and surprisingly, play a role in tooth development and eruption. According to a report from the Journal of Clinical and Diagnostic Research, “the teeth which are in a pre-eruptive phase are influenced by the nutritional status of the body. The deficiencies of vitamin(s) D, C, B, and A and protein have been associated with the disturbances in the oral structures.” Specifically, it has been noted that deficiencies in Vitamin A or D can contribute to enamel hypoplasia, which can create a more favorable environment for the development of cariogenic lesions. Lack of Riboflavin, which is found in Vitamin B2, can be responsible for oral manifestations including inflammation of the mucosa, ‘burning tongue’ syndrome, and dry, cracked lips. Poor dietary intake can also be a risk factor in the development of periodontal disease. A study in the Journal of Periodontology reported that adults consuming less than the recommended amount of Calcium were twice as likely to have periodontal disease. The same report mentioned the importance of Vitamin C, those consuming less than the RDA (approximately one orange) were one-and-a-half-times more likely to develop severe gingivitis.1 Vitamin C aids in the support and repair of connective tissue including collagen. The composition of saliva is also affected by diet. It has been shown that “moderate malnutrition, principally, a lack of protein and other micronutrients such as vitamins, zinc and iron, limits the protective effect of saliva on the oral cavity, by manipulating its composition and amount.” 2

Easy access foods for oral health

Dairy products like unsweetened yogurt and hard cheese are a source calcium and protein, both nutrients known to strengthen tooth enamel. The act of chewing a piece of hard cheese both cleanses the tooth surface and stimulates salivary flow. Yogurt (with no added sugar) may offer probiotic benefits. Probiotics are thought to change the bacterial environment in the body by ‘crowding out’ harmful bacteria and replacing it with healthy bacteria. This is important for caries protection and reducing the risk of periodontal disease.3 Fruits are not only loaded with nutrients but are known to be beneficial to the oral environment. Many people, especially diabetics, are concerned that fruit is high in sugar but some that have a lower glycemic index include; cherries, apricots, grapes, plums, strawberries, grapefruit and apples. Apples, especially green, are a great source of fiber and water. The act of chewing an apple, combined with its water content, stimulates salivary production. Saliva in turn cleanses the teeth and reduces adherence of bacteria. Fiber is important for many body functions but the act of chewing something fibrous, like an apple, helps stimulate the gingiva which is important for blood circulation to the area. Blueberries are an excellent source of vitamins and nutrients, and arguably, one of the most popular superfoods. Loaded with antioxidants, blueberries are anti-inflammatory and play a role in cellular regeneration which may aid in the prevention of periodontal disease. Fibrous vegetables such as carrots and celery are easy to find and affordable oral health boosters. Both contain Vitamin A, which can strengthen your immune system and maintain healthy oral mucosa. Gaining popularity are leafy green vegetables like spinach, bok choy and kale which deliver Folate, Calcium, A, C, K and B vitamins, real powerhouses of nutrients. As stated previously, Vitamin C aids in the production of collagen regeneration. Most people associate Vitamin C with citrus but other great sources include red and green bell peppers, kale, and broccoli. All of which provide 100% of an adult’s recommended daily intake. Proteins are also important to oral health. Lean proteins are important for mucosal, connective tissue, and immune health. An often underrated but easily incorporated source of protein comes in the form of almonds. Included in a single serving of almonds are Vitamin E, Calcium, Magnesium and Potassium-all important for oral health. All too often we get caught up in educating patients what ‘not to eat’ but the dental professional is in a unique position to recommend healthy additions to their diet. By adding healthy choices to our patients’ plates and snacks we have the opportunity to help them ‘crowd out’ unhealthy foods that lead to negative outcomes. Discussing nutrition with dental patients can be beneficial to their oral health by reducing the incidence of developmental abnormalities, caries, inflammation, gingivitis and periodontal disease. By making suggestions for foods beneficial to oral health, the dental professional creates a relationship of trust and caring becoming a partner in health.

See page 11 of the Prevention For Life E-Book for a NUTRITIONAL CHART including nutrients, oral implications and suggested foods.

1. Nishida M et al, “Calcium and the risk for periodontal disease.” J Perio 2000 Jul;71(7):1057-66. 2. Sheetal A, et al, “Malnutrition and its Oral Outcome” – A Review J Clin Diagn Res 2013 Jan; 7(1): 178–180. 3. Ravishankar Lingesha Telgi, et al. “In vivo dental plaque pH after consumption of dairy products.” General Dentistry, 2013 May;61(3):56-59 Additional Resources https://www.deltadentalins.com/oral_health/vitamins-and-minerals.html http://www.precisionnutrition.com/nutrition-teeth-dental-health