Antioxidants and their vital significance in periodontal health

Abstract

Given that periodontitis is so common worldwide, there is growing interest in this condition. The disruption of the vital balance between the virulence factors generated by bacteria and the inflammatory host response leads to this inflammatory disease. Several attempts have been made before to treat this illness and restore periodontal health. The gold standard has been seen to be nonsurgical debridement, which targets the underlying cause. Nonetheless, studies have indicated that an unbalanced diet and dietary deficiencies may have an impact on the periodontium. Therefore, an effort toward the maintenance of optimal conditions, as well as the improvement of oral health, necessitates the introduction of adjunctive nutritional therapy, which can benefit the patients. Antioxidants in the diet have some remarkable benefits and valuable properties that play an irreplaceable role in the maintenance of periodontal health. These have emerged as excellent adjuncts that can enhance the outcomes of conventional periodontal therapy. The aim of this review article is to highlight some of these dietary antioxidants that can make a notable difference by striking a balance between health and disease.

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IP International Journal of Medical Paediatrics and Oncology 2024;10(2):36–39
Content available at: https://www.ipinnovative.com/open-access-journals
IP International Journal of Medical Paediatrics and
Oncology
Journal homepage: https://www.ijmpo.com/
Original Research Article
Antioxidants and their vital significance in periodontal health
Siddharth Kumar Singh1, Anjali Gupta2*, Tushar Mathur3, Sayak Roy4
1Dept. of Oral Medicine and Radiology, Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India
2Dept. of Dentistry, Saraswati Medical College, Lucknow, Uttar Pradesh, India
3Dept. of Oral Medicine and Radiology, Saraswati Dental College, Lucknow, Uttar Pradesh, India
4Dr. Roy’s Dental Clinic and Oral Cancer Detection Centre, Kolkata, West Bengal, India
ARTICLE INFO
Article history:
Received 10-07-2024
Accepted 16-08-2024
Available online 29-08-2024
Keywords:
Periodontitis
Antioxidants
Oral health
Nutritional therapy
Wound healing
ABSTRACT
Given that periodontitis is so common worldwide, there is growing interest in this condition. The disruption
of the vital balance between the virulence factors generated by bacteria and the inflammatory host response
leads to this inflammatory disease. Several attempts have been made before to treat this illness and restore
periodontal health. The gold standard has been seen to be nonsurgical debridement, which targets the
underlying cause. Nonetheless, studies have indicated that an unbalanced diet and dietary deficiencies may
have an impact on the periodontium. Therefore, an effort toward the maintenance of optimal conditions, as
well as the improvement of oral health, necessitates the introduction of adjunctive nutritional therapy, which
can benefit the patients. Antioxidants in the diet have some remarkable benefits and valuable properties
that play an irreplaceable role in the maintenance of periodontal health. These have emerged as excellent
adjuncts that can enhance the outcomes of conventional periodontal therapy. The aim of this review article
is to highlight some of these dietary antioxidants that can make a notable difference by striking a balance
between health and disease.
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1. Introduction
A common, long-term, inflammatory illness that affects
the tissues that support teeth is called periodontitis. The
illness is brought on by a particular kind of bacterium or
a combination of germs, which ultimately results in the
gradual degradation of the alveolar bone and periodontal
ligament (PDL). An aberrant host response to the biofilm
organisms appears to be necessary for the development
of this devastating illness.1Although specific, primarily
facultative or anaerobic Gram-negative bacteria within the
subgingival biofilm are thought to be the primary etiological
agent of the disease, most periodontal tissue destruction is
thought to be caused by an inappropriate host response to
* Corresponding author.
E-mail address:Anjali462007@gmail.com (A. Gupta).
those microorganisms and their products.2,3
It can lead to tooth loss, impaired masticatory function,
changes in nutritional intake, and malnutrition if this
improper host response is not addressed and the condition
is not properly identified and treated. There are several risk
variables that have been shown to alter the host response
and shift the scales from health to illness. These variables
may be divided into three categories: genetic, environmental
(stress, bacterial challenge, etc.), and lifestyle/behavioral
(smoking, exercise, poor diet, etc.).
Furthermore, a variety of systemic disorders, including
diabetes, rheumatoid arthritis, and cardiovascular disease,
have been linked to periodontal disease as a major risk
factor. Thus, natural antioxidants as prospective adjuncts
are now receiving more attention, given the importance of
diet and the requirement to maintain appropriate antioxidant
https://doi.org/10.18231/j.ijmpo.2024.010
2581-4699/© 2024 Author(s), Published by Innovative Publication. 36

Singh et al. / IP International Journal of Medical Paediatrics and Oncology 2024;10(2):36–39
levels for the maintenance of periodontal health. These
antioxidants are easily gained via our everyday food intake
and are essential for maintaining an optimal level of health.4
2. Role of Key Nutrients in Periodontal Health
2.1. Carbohydrates
Consumption of sugar has long been known to be the
primary cause of plaque development. Because sugars
are fermented by bacteria and produce acid, which
demineralizes the tooth structure, they are linked to dental
caries and periodontal disease. One artificial sweetener that
is used in place of regular sugars is xylitol, a sugar alcohol
that is created when xylose sugar is hydrogenated. Against
periodontal pathogens like Porphyromonas gingivalis and
Aggregatibacter, it might have an antibacterial effect.
Hence, a reduction of sugar intake, coupled with scaling,
root planing, and the use of xylitol- and maltitol-containing
gums, have the potential to improve the periodontal health
of the general population.5
2.2. Vitamin C
It is discovered that vitamin C is in the aqueous phase
and is a strong antioxidant radical scavenger. A severe
periodontal disease known as "scorbutic gingivitis," or
"scurvy," is brought on by a severe vitamin C shortage and
is characterized by inflammatory gingivitis, fast periodontal
pocket formation, and attachment loss. With its quick
intestine absorption, ascorbic acid is an important nutrient.6
Certain cells, such as PMNLs, mononuclear cells,
platelets, and endothelial cells, accumulate high
concentrations of ascorbic acid.7PMNLs and macrophages
contain vitamin C concentrations that are 10–40 times
higher than those in the plasma. It has been thought that the
high ascorbic acid levels in these cells contribute to their
ability to respond to inflammatory stimuli and phagocytic
ability of neutrophils.8Vogel and Wechsler reported that
the everyday intake of vitamin C in a group of periodontitis
patients studied was considerably less than that in the
control group.9The daily recommended dietary allowance
(RDA) for women was raised to 75 mg and for males to
90 mg. According to Levine et al., consuming 200 mg
of vitamin C per day from a variety of fresh fruits and
vegetables is the recommended consumption.10
2.3. Vitamin D
There is little data indicating a connection between
periodontal health and vitamin D and calcium. According
to certain research, people with osteoporosis experience a
greater loss of periodontal bone.11
Due to its ability to suppress immune cell cytokine
expression and induce the release of potently antibiotic-
effecting molecules from monocytes and macrophages,
vitamin D is recognized to be important for maintaining
calcium and bone homeostasis as well as acting as an anti-
inflammatory drug. It is true that a vitamin D deficiency may
raise the risk of contracting infectious infections. Therefore,
in addition to its direct effects on bone metabolism, vitamin
D is helpful in the treatment of periodontitis.12
When it comes to vitamin D, the National Osteoporosis
Foundation advises persons under 50 to take 400–800 IU of
the vitamin once a day and those over 50 to take 800–1000
IU.13
2.4. Flavanoids
Polyphenolic substances are called flavonoids. Their
functions include anti-tumor, anti-inflammatory, anti-
allergic, antiplatelet, and antioxidant. Additionally, they
exhibit bacterial collagenase inhibitory properties. It has
also been demonstrated that flavonoids and vitamin C work
synergistically.14 Foods high in flavonoids can prevent
blood vessels from rupturing or leaking. They also aid in
preventing the body’s excessive inflammation and shield
cells from oxygen damage. Green tea, one of the most
widely consumed drinks in the world, is the most well-
known flavonoid. It contains up to 1 g of "catechins,"
which are flavonoids. Green tea catechins, including (-)
epigallocatechin gallate, have been shown in a number of
in vitro experiments to suppress periodontal pathogens and
stop the degeneration of periodontal tissue. With 157 mg of
flavonoids per day, tea was shown to be the most significant
source, particularly for flavan-3-ols and flavonols. The
majority of supplements available for sale have doses (daily)
ranging from 30 to 200 mg, which is suitable for everyday
maintenance.15,16
2.5. Carotenoids
Carotenoids are a group of pigments that occur naturally
in the body and include alpha-, beta-, crytoxanthin,
lutein, lycopene, and zeanxantin. They possess antioxidant
properties and safeguard the vitamins C and E. Additionally,
by scavenging reactive nitrogen species, they exhibit
synergistic effects. The primary dietary source of
provitamin A is β-carotene. Because of their profound
effects on other antioxidants, carotenoids are regarded as
essential components of antioxidant defense systems. In a
homogeneous group of Western European men, Linden et
al. evaluated the relationship between periodontal health
and the serum levels of several antioxidants, such as
carotenoids, retinol, and vitamin E. The authors observed
that there was a higher prevalence of periodontitis in these
patients who had low serum levels of several carotenoids,
specifically β-cryptoxanthin and β-carotene.17
It has been discovered that lycopene is one of the
most potent antioxidants among all the carotenoids.
There is a correlation between congestive heart failure
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Singh et al. / IP International Journal of Medical Paediatrics and Oncology 2024;10(2):36–39
risk and periodontitis, and in patients with periodontitis,
high lycopene consumption considerably modifies this
relationship. Additionally linked to malondialdehyde, a
crucial indicator of oxidative stress, lycopene has been
shown to dramatically lower stress levels. One of the main
types of carotenoids is vitamin A. Each person’s RDA for
vitamin A is different.18
The recommended daily allowance (RDA) for babies is
400 µg for ages 0–6 months and 500 µg for ages 7–12
months. The RDA for children is 400 µg/day. The RDA
for adult females is 700 µg/day, and for adult men, it is
900 µg/day. The recommended allowance for breastfeeding
women is approximately 1300 µg/day, whereas for pregnant
women, it is up to 770 µg/day.19
3. Role of Antioxidants in Periodontal Wound Healing
A few periodontal procedures may need wound healing,
and food may help promote wound healing in addition
to maintaining periodontal health. According to this
research, patients may benefit from macronutrients such
as docosahexaenoic acid (DHA) and eicosapentaenoic
acid (EPA) and micronutrients like vitamins D and B.
In comparison to patients with lower serum 25(OH)D
levels, those on a vitamin D-rich diet (serum 25(OH)D
> 50 nmol/L) before open-flap debridement surgery
had higher clinical attachment levels and decreased
probing depths after surgery. Furthermore, vitamin B
complex (50 mg thiamine HCl, riboflavin, niacinamide,
d-calcium pantothenate, pyridoxine HCl); 50 µg d-biotin
cyanocobalamin; and 400 µg folate) was beneficial to
patients following an access flap procedure.20,21 Combining
acetylsalicylic acid (81 mg) with fish oil (900 mg DHA
and EPA) reduced probing depths in patients in need
of curative treatment, increased clinical attachment, and
decreased salivary levels of MMP-8 and receptor activator
of nuclear factor kappa-B ligand (RANKL), two well-
known indicators of inflammation. Acetylsalicylic acid (75
mg), DHA (900 mg), and EPA (450 mg) together showed a
significant increase in clinical attachment levels, reductions
in probing depth, and decreases in interleukin-1βfound in
the GCF in patients with a furcation defect necessitating a
bone allograft.22
4. Conclusion
In conclusion, periodontitis is a slowly progressive
chronic inflammatory disorder, which generally occurs in
response to an imbalance between the antioxidant defense
mechanisms and repair efforts by ROS. If this balance
is tipped toward the increased generation of FRs, then
there is cell damage and tissue destruction. Therefore, for
the prevention of this tissue damage and maintenance of
optimal oral health, sufficient antioxidant levels are to be
present in the oral fluids. Many of these nutrients cannot
be manufactured by the body, and therefore, they must be
supplied in the diet.
Dietary antioxidants play a vital role in the maintenance
of oral health and have a potential to influence periodontal
disease management, which positively affects clinical
outcomes. A strong association exists between periodontal
health and antioxidants, both of which have an inverse
interrelationship. Thus, obtaining enough antioxidants
through our diet to promote healthier tissues is essential
to reduce the unwanted effects of these FRs. This explains
the indispensable role of dietary antioxidants in periodontal
health.
5. Source of Funding
None.
6. Conflict of Interest
None.
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Author biography
Siddharth Kumar Singh, Professor
Anjali Gupta, Professor
Tushar Mathur, Lecturer
Sayak Roy, Consultant
Cite this article: Singh SK, Gupta A, Mathur T, Roy S. Antioxidants
and their vital significance in periodontal health. IP Int J Med Paediatr
Oncol 2024;10(2):36-39.
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