By: Ms. Liz Pearson

Should an anti-inflammatory diet be part of your treatment plan, especially for patients at high risk for periodontal disease or those already suffering from poor periodontal health? While pathogenic bacteria are responsible for the initiation of periodontal disease, inflammation is the key player when it comes to the severity of tissue destruction. Placing more emphasis on a patient’s dysregulated inflammatory response makes sense. Prescribing an anti-inflammatory diet can reduce inflammation throughout the body, including the oral cavity. In contrast, a pro-inflammatory diet can contribute significantly to periodontal inflammation.

Recent research supports the benefits of an anti-inflammatory diet for good oral health. In the Hamburg City Health Study, researchers developed an anti-inflammatory diet score based on specific foods in relation to specific inflammatory biomarkers in the body. Anti-inflammatory foods included vegetables (especially green leafy vegetables), fruit, nuts, seeds and legumes. Pro-inflammatory foods included options like fast food and processed meats. Periodontal disease was assessed using probing depth, gingival recession and bleeding on probing in 5,642 participants. Researchers found a significant inverse association between the anti-inflammatory diet score and periodontitis. Their conclusion was, “Individuals with higher intake of proinflammatory nutrition should be specifically addressed to avoid periodontitis.”

Research involving people with diabetes has also been impressive. Diabetes, especially when poorly controlled, can lead to an inflammatory environment within the body and poor oral health. In this study, patients with Type 2 diabetes followed the Nordic Diet, which is very similar to the Mediterranean diet. It features whole grains, fruits, vegetables, legumes, fish, poultry and nuts; while limiting the intake of sugar, red meat and dairy products. After two weeks following the Nordic Diet, reduction in gingival bleeding was as substantial as might be expected from one  session of professional tooth cleaning. Markers of inflammation were reduced and management of diabetes also improved (less insulin required, along with lower blood sugar levels).

Finally, adherence to an anti-inflammatory diet is also associated with fewer missing teeth. In the National Health and Examination Survey in the United States, involving 6,887 participants, a pro-inflammatory diet resulted in significantly more tooth loss, compared to those following an anti-inflammatory diet, even after adjusting for known factors impacting periodontal health. Researchers concluded a protective dietary pattern is a modifiable protective factor for tooth loss and should be incorporated for the prevention of tooth loss.

What does an effective anti-inflammatory diet look like? Researchers reviewed 20 randomized controlled trials to assess the effects of various anti-inflammatory diets on 14 different inflammatory markers in adults. The results demonstrated that a Mediterranean diet can bring about statistically significant and clinically meaningful changes in inflammatory status. Diets defined as “Mediterranean” had common features—increased consumption of extra virgin olive oil, nuts, fatty fish, vegetables, and lean meat, and a reduction in the consumption of red meat and refined or ultra-processed food products.

Current research suggests more than 50% of the U.S. population consumes a pro-inflammatory diet at any given time. Although dental health professionals often talk to their patients about limiting the sugar in their diets, few are talking about the importance of following an anti-inflammatory diet pattern. For optimal oral health, as well as overall health and risk of disease, reducing inflammation in the body is critical. This includes following a diet focused on plant-based foods like fruits, vegetables, whole grains, nuts and seeds, legumes, and higher fat fish, like salmon. Regularly consuming fermented foods, like yogurt, kefir, or kimchi, is also key to keeping inflammation low. Lastly, limiting the intake of nutrient-poor, ultra-processed foods is an essential part of this equation.

Ms. Liz Pearson is a Registered Dietitian who has been researching, speaking and writing about nutrition for over 25 years. She was the nutrition columnist for Chatelaine magazine for many years and appears regularly on radio and television. She is the author of four books, including two award-winning, national bestsellers.

REFERENCES

• Holmer, H., et al. “Improved General and Oral Health in Diabetic Patients by an Okinawan-Based Nordic Diet: A Pilot Study.” International Journal of Molecular Sciences. 2018 Jul 3;19(7):1949.
• Kotsakis, G. “Diet-borne systemic inflammation is associated with prevalent tooth loss.” Clinical Nutrition. 2018 Aug;37(4):1306-1312.
• Lieske, B., et al. “Association between an Anti-Inflammatory Dietary Score and Periodontitis—Evidence from the Population-Based Hamburg City Health Study.” Nutrients. 2023 Jul 21;15(14):3235.
• Meadows, R., et al. “Socio-demographic differences in the dietary inflammatory index from National Health and Nutrition Examination Survey 2005-2018: a comparison of multiple imputation versus complete case analysis.” Public Health Nutrition. 2024 Sep 27;27(1):e184.
• Meng, Z., et al. “The association of composite dietary antioxidant index with periodontitis in NHANES 2009-2014.” Frontiers in Immunology. 2024 Jun 24;15:1384272.
• Mukherjee, M., et al. “Effect of anti-inflammatory diets on inflammation markers in adult human populations: a systematic review of randomized controlled trials.” Nutrition Reviews. 2022 Dec 6;81(1):55-74.