Nutrition and the Mouth

        Not only is proper nutrition essential to overall physiological wellness, it also plays an imperative role in oral health. The wellbeing of both an individual’s dentition as well as their periodontium and oral soft tissues are reliant on the adequate intake of both macro- and micro-nutrients. Just as proper nourishment maintains an optimal oral cavity, deficient nutrition is often made evident in the hard and soft tissues of the mouth. Frequent oral exams can thus be conveniently utilized to diagnose specific vitamin and macronutrient deficiencies thanks to the signs and symptoms that present themselves in the mouth. Along with inadequate nutrient consumption, increased acid intake and trends in diet which result in an unhealthy BMI can also take a significant toll on the oral cavity. Just as the bodily systems depend heavily on appropriate management of diet, so do the teeth, bones, and soft tissue of the mouth. Failure to provide sufficient nourishment to the body will inevitably result in malfunction and negative presentations in both an individual’s overall health, as well as their oral health.

Interestingly, an individual’s body mass index has a significant correlation to periodontal health. A study of the health of a group of laborers in India “revealed that subjects had an increased risk of periodontitis by 57% for each 1-kg/m² increase in body mass index.” (p. 367).¹ Because high blood sugar, associated with obesity, contributes heavily to inflammation, “[a] higher body mass index could be a potential risk factor for periodontitis among adults aged 18 to 24 years. Thus, the evaluation of body mass index could be used in periodontal risk assessment.” (p. 368). ¹ Another study on the effect of obesity on peri-implant health took into account waist circumference and body fat percentage, as well as body mass index.³ A correspondence was found between waist circumference and levels of IL-1β in peri-implant sulcular fluid. IL-1β is an important component in the development of “peri-implant mucositis, a condition similar to gingivitis around natural teeth.” (p. 1433).³ While this study does not present a direct correlation between BMI and periodontal health, it does provide enough information to deduce that fitness has an overall effect on the wellbeing of the periodontium and the areas surrounding it. Overall, it is clear that body mass index has a distinct effect on oral health.

Along with a high BMI, nutrient deficiencies also play a huge role in maintaining a healthy mouth. Some examples of this are: “atrophy of the filiform and fungiform papillae on the dorsum of the tongue associated with iron deficiency anemia, riboflavin deficiency characterized by erythema, maceration, and soggy white debris at the commissures of the mouth, painful, beefy red, atrophic tongue, often with ulceration, associated with niacin deficiency [and] severe gingivitis associated with scurvy.” (p. 611).² These maladies, along with others, are helpful oral presentations that implicate nutrient deficiencies. Another fairly common oral sign of malnutrition, not mentioned previously, is angular cheilitis. This painful cracking and blistering in the corners of the mouth can be indicative of multiple deficiencies including iron, riboflavin, niacin, and zinc. From these facts it is evident that the oral cavity is definitely susceptible to complications arising from malnutrition and it is important to be aware of the signs that present in the mouth in order to be better equipped in determining how to achieve overall health.

While nutrients play a significant role in the maintenance of health in the soft tissues of the mouth, reduction in tooth exposure to acid and fermentable carbohydrates plays a similarly crucial role in maintaining the integrity of the hard tissues of the oral cavity. Enamel, the hardest substance in the human body which makes up the outer layer of the teeth, is constantly undergoing a demineralization-remineralization process. The demineralization process is expedited by exposure of the enamel to acid, either directly or through the anaerobic metabolism of fermentable carbohydrates into lactic acid by the bacteria of the mouth. The remineralization process is promoted by the buffering capacity of saliva and tooth exposure to minerals such as calcium and fluoride. These elements act as protective factors against cavities by making the teeth less susceptible to erosion, however “frequent consumption of fermentable carbohydrates subjects the tooth enamel to repeated acid exposures. The demineralization process weakens the tooth and leads to the formation of dental caries.” (p. 630). ² With that in mind, it is critical that one pays close attention to the amount of acid exposure they subject their teeth to through their dietary choices. One option of preventing demineralization is to reduce the amounts of acidic food and drink, such as citrus fruits, coffee, and wine, that one consumes, and also the consumed amounts of fermentable carbs present in foods such as raisins, bananas, and other high carb fruits, as well as crackers, breads, and other grain products. Reducing these components of one’s diet, however, may be particularly challenging. Fortunately, there are other ways to reduce the harmful effects of these types of foods. One method is to consume those foods along with a larger meal. This will increase salivary flow and thus increase the amount of buffering agents in the mouth when the acidic or high carb food is eaten, more effectively neutralizing the environment and decreasing acid exposure time. Similarly, eating the higher risk food along with a food that is high in calcium, protein, or fat reduces the negative effects by promoting buffering and remineralization. Overall, it is important to be cognizant of the impact that one’s diet has on the teeth, to prevent the incidence of acid erosion and development of dental caries.

All in all, it is very evident that overall health and oral health are indubitably connected. Body mass index, a tool used to assess physiological wellness, incidentally also has a distinct correlation to oral health. Similarly nutrient deficiencies often express themselves through issues in the oral cavity. Diet has a significant impact on the mouth in maintaining the integrity of the bone, mucosa, and even the teeth which are very susceptible to compromise by fermentable carbohydrates and acid. It is extremely crucial to maintain proper nutrition for the sake of the body and the oral health as a component of overall health. Employing knowledge and self-efficacy, one can make a outstanding impact on their own oral health simply through dietary choices.

REFERENCES

1. Santhosh Kumar, Rushabh J Dagli, Chandrakant Dhanni, Prabu Duraiswamy. Relationship of Body Mass Index with periodontal health status of green marble mine laborers in Kesariyaji, India. Braz Oral Res. 2009;23(4):365-9

2. Darby ML, Walsh MM, editors. Dental hygiene theory and practice. 3rd ed. St. Louis: Saunders/Elsevier; 2010.

3. Satheesh Elangovan, et al. Body Fat Indices and Biomarkers of In ammation: A Cross-Sectional Study with Implications for Obesity and Peri-implant Oral Health. Int J Oral Maxillofac Implants. 2014;29(6):1429-1434