Die Ernährung aus der Steinzeit und die Zahngesundheit - Ein Update
Abstract and Figures
Dieser Übersichtsartikel untersucht die verschiedenen Ernährungsbestandteile (Kohlenhydrate, Fette, Proteine, Antioxidanzien und Vitamine) im Zusammenhang mit der Prävention und Behandlung von Gingivitis und Parodontitis. Es werden Entzündungsreaktionen aufgezeigt, welche auch bei systemischen Krankheiten wie Übergewicht, Diabetes oder Atherosklereose vorkommen. In dieser Entzündungskaskade spielen Zytokine und oxidativer Stress eine wichtige Rolle. Aufgrund der vorhandenen Evidenz werden Ernährungsrichtlinien genannt, welche somit nicht nur zur Verbesserung der parodontalen, sondern auch der allgemeinen Gesundheit beitragen könnten.
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Diet has powerful effects upon inflammatory status, arguably as strong or stronger than microbial plaque. Despite a relationship between diet and periodontal inflammatory markers being established over 30 years ago, it is only recently that the mechanisms underpinning these effects have begun to be examined in detail. Following an analysis of the evidence base in 2011, this review focuses upon the most contemporaneous evidence relating specifically to the micronutrient vitamins C and D and their potential impact upon periodontal disease pathogenesis and/or therapeutic outcomes. The authors bring together both epidemiological and laboratory data and aim to outline avenues for potential studies given the limited number of larger well-conducted clinical interventional trials completed to date.
Background
The aim of this pilot study was to investigate the effects of four weeks of an oral health optimized diet on periodontal clinical parameters in a randomized controlled trial.
Methods
The experimental group (n = 10) had to change to a diet low in carbohydrates, rich in Omega-3 fatty acids, and rich in vitamins C and D, antioxidants and fiber for four weeks. Participants of the control group (n = 5) did not change their dietary behavior. Plaque index, gingival bleeding, probing depths, and bleeding upon probing were assessed by a dentist with a pressure-sensitive periodontal probe. Measurements were performed after one and two weeks without a dietary change (baseline), followed by a two week transitional period, and finally performed weekly for four weeks.
Results
Despite constant plaque values in both groups, all inflammatory parameters decreased in the experimental group to approximately half that of the baseline values (GI: 1.10 ± 0.51 to 0.54 ± 0.30; BOP: 53.57 to 24.17 %; PISA: 638 mm2 to 284 mm2). This reduction was significantly different compared to that of the control group.
Conclusion
A diet low in carbohydrates, rich in Omega-3 fatty acids, rich in vitamins C and D, and rich in fibers can significantly reduce gingival and periodontal inflammation.
Trial registration
German Clinical Trials Register; https://www.germanctr.de (DRKS00006301). Registered on 2015-02-21.
Electronic supplementary material
The online version of this article (doi:10.1186/s12903-016-0257-1) contains supplementary material, which is available to authorized users.
A healthy diet is important to the maintenance of good general health. An imbalanced diet can increase risk for the development of obesity and insulin resistance which can eventually lead to the onset of diabetes. Nutrition, obesity, and diabetes are all known risk factors for periodontal diseases. Periodontitis in turn is a risk factor for the development of diabetes and can complicate the management of those who suffer from obesity and/or diabetes. The interplay of these three common chronic inflammatory diseases suggests that a syndemic approach to prevention and management would best address the shared risk for all of these diseases and help to break the cycle of pro-inflammatory events leading to chronic inflammation as assessed by elevations in C-reactive protein, driven by elevations in cytokines such as IL-6 and TNF-α as well as oxidative stress. These interactions may synergistically increase risk for cardiovascular disease, the number one cause of death worldwide. Oral health care providers can play a major role, as members of an interdisciplinary team of healthcare providers, in addressing this syndemic.
Aim:
To investigate the association of serum vitamin B12 with the progression of periodontitis and risk of tooth loss in a prospective cohort study.
Materials and methods:
In the Study of Health in Pomerania 1,648 participants were followed from 2002-2006 to 2008-2012 (mean duration 5.9 years). Serum vitamin B12 was measured by chemiluminescent enzyme immunoassay. Probing pocket depth (PD) and clinical attachment loss (CAL) were measured to reflect periodontal status on a half mouth basis at each survey cycle. Tooth numbers are based upon a full-mouth tooth count.
Results and conclusions:
In multivariate regression models, baseline vitamin B12 was inversely associated with changes in mean PD (Ptrend =0.06) and mean CAL (Ptrend =0.01), and risk ratios of tooth loss (TL; Ptrend =0.006) over time. Compared to participants in the highest vitamin B12 quartile, those in the lowest quartile had 0.10mm (95%CI: 0.03, 0.17; Pdifference =0.007) greater increase in mean PD, 0.23mm (95%CI: 0.09, 0.36; Pdifference =0.001) greater increase in mean CAL and a relative risk of 1.57 (95%CI: 1.22, 2.03; Pdifference <0.001) for TL. Stratified analyses showed stronger associations between vitamin B12 and changes in mean CAL among never smokers (Pinteraction =0.058). Further studies are needed to understand the potential mechanisms of these findings. This article is protected by copyright. All rights reserved.
Bioactive molecules in berries may be helpful in reducing the risk of oral diseases. The aim of this study was to determine the effect of bilberry consumption on the outcome of a routine dental clinical parameter of inflammation, bleeding on probing (BOP), as well as the impact on selected biomarkers of inflammation, such as cytokines, in gingival crevicular fluid (GCF) in individuals with gingivitis. Study individuals who did not receive standard of care treatment were allocated to either a placebo group or to groups that consumed either 250 or 500 g bilberries daily over seven days. The placebo group consumed an inactive product (starch). A study group, receiving standard of care (debridement only) was also included to provide a reference to standard of care treatment outcome. Cytokine levels were assayed using the Luminex MagPix system. The mean reduction in BOP before and after consumption of test product over 1 week was 41% and 59% in the groups that consumed either 250 or 500 g of bilberries/day respectively, and was 31% in the placebo group, and 58% in the standard of care reference group. The analysis only showed a significant reduction in cytokine levels in the group that consumed 500 g of bilberries/day. A statistically significant reduction was observed for IL-1b (p = 0.025), IL-6 (p = 0.012) and VEGF (p = 0.017) in GCF samples in the group that consumed 500 g of bilberries daily. It appears that berry intake has an ameliorating effect on some markers of gingival inflammation reducing gingivitis to a similar extent compared to standard of care.
There is significant evidence linking chronic periodontitis (CP) and oxidative stress (OS). CP is a multifactorial infecto-inflammatory disease caused by the interaction of microbial agents present in the biofilm associated with host susceptibility and environmental factors. OS is a condition that arises when there is an imbalance between the levels of free radicals (FR) and its antioxidant defences. Antioxidants, defined as substances that are able to delay or prevent the oxidation of a substrate, exist in all bodily tissues and fluids, and their function is to protect against FR. This systematic review assessed the effects of the complimentary use of antioxidant agents to periodontal therapy in terms of oxidative stress/antioxidants. Only randomised, controlled, double-blind or blind studies were included. The majority of the included studies were performed in chronic periodontitis patients. Lycopene, vitamin C, vitamin E, capsules with fruits/vegetables/berry and dietary interventions were the antioxidant approaches employed. Only the studies that used lycopene and vitamin E demonstrated statistically significant improvement when compared to a control group in terms of periodontal parameters. However, oxidative stress outcomes did not follow the same pattern throughout the studies. It may be concluded that the use of some antioxidants has the potential to improve periodontal clinical parameters. The role of antioxidant/oxidative stress parameters needs further investigations.
Copyright © 2015 Elsevier Ltd. All rights reserved.
Studies into the mechanisms in resolution of self-limited inflammation and acute reperfusion injury have uncovered a new genus of pro-resolving lipid mediators coined specialized pro-resolving mediators (SPM) including lipoxins, resolvins, protectins and maresins that are each temporally produced by resolving-exudates with distinct actions for return to homeostasis. SPM evoke potent anti-inflammatory and novel pro-resolving mechanisms as well as enhance microbial clearance. While born in inflammation-resolution, SPM are conserved structures with functions discovered in microbial defense, pain, organ protection and tissue regeneration, wound healing, cancer, reproduction, and neurobiology-cognition. This review covers these SPM mechanisms and other new omega-3 PUFA pathways that open their path for functions in resolution physiology.
Copyright © 2015 Elsevier Ltd. All rights reserved.