Micronutrients and oral health

Alongside this, nutrition can either strengthen or weaken the teeth and periodontal attachment apparatus. Micronutrient deficiency can considerably damage oral health. Conversely, diseases in the mouth – the first section in the digestive tract – can lead to micronutrient deficits in nourishment, .e.g. if food cannot be chewed properly because of pain or impairments, the body cannot properly benefit from it, either. Tooth and gum disorders in industrialized countries are found most frequently in the socially deprived, uneducated classes. This is particularly true of caries, which is mainly a problem for children and young people. Since the amount of older people is increasing worldwide, the problem of tooth loss due to disorders of the periodontal attachment apparatus and jawbone depletion is also on the rise.

Only a vitamin D deficiency in pregnant women can have a systemically negative effect on the quality of the dental germs in the fetus. Deficient nutrition of an expectant mother does not otherwise affect tooth development in the fetus, as the mineral requirement of the dental germs is relatively low (1). Studies have shown that, unlike bones, teeth that were formed in the fetus during situations of calcium and phosphate deficiency present a normal mineral composition. Conversely, with a deficiency in childhood and adulthood, calcium and phosphates can no longer be mobilized from teeth (2).

Vitamin D

Teeth can only anchor themselves securely in a stable, healthy jawbone and only a healthy, intact periodontal attachment apparatus can guarantee such a secure anchorage. A good vitamin D supply is essential for preserving the health of the whole musculoskeletal system, including the jawbone and gums. An insufficient vitamin D supply can contribute both to the loss and softening of bony substance (osteoporosis, osteopenia), as well as to the development of chronic inflammatory disorders caused by a disturbance of the mineral balance (e.g. of calcium absorption). Recent studies have investigated the connections between the density of jawbones (alveolar bones), osteoporosis and tooth loss. They showed that the health of the periodontal attachment apparatus depends on a sufficiently high concentration of vitamin D in the blood (3-5). In addition, vitamin D status also seems to be crucial for healing successfully after receiving an operation because of inflammatory changes in the gums (periodontitis) (6). Patients with chronic periodontitis seem to benefit from the administration of additional vitamin D in combination with calcium (7). Essentially, however, a good supply of vitamin D is recommended for the prevention of disorders of the jawbone and periodontal attachment apparatus.

Apart from vitamin D’s basic immune-strengthening, anti-inflammatory properties, the immune defense of the gum tissue against inflammatory germs seems to be connected with certain gene variants (polymorphisms) of the vitamin D receptor (VDR) as well. Thus, researchers discovered that it was principally people with a particular VDR polymorphism who suffered from chronic, aggressive periodontitis (8). The conjecture is that vitamin D induces the synthesis of an antimicrobial peptide via the bond with VDRs.

Pregnant women in particular often suffer from bleeding gums or even an inflammation of the gums or periodontium. Studies suggest that aside from diligent oral hygiene and dental checkups, a good supply of vitamin D can also help prevent this (9). An optimal vitamin D status appears to benefit not only the pregnant woman, but the dental health of her future offspring as well. Study results indicate that children from ages 9 to 23 months who have mothers with good blood levels of vitamin D have considerably less caries (10, 11).

Antioxidants

The antioxidant vitamins E and C as well as carotenoids (e.g. beta-carotene) neutralize oxidative stress in all cells and tissues of the organism. Thus, they appear to strengthen the immune resistance of the gums via antioxidants, and in particular to act against invading germs in the mucous membrane of the mouth. Studies found a connection between low levels of antioxidants in serum and an increased occurrence of periodontitis (12, 13). Insufficient levels of vitamin C appear to promote the risk of disorders of the gums and periodontal attachment apparatus. Conversely, a good supply of vitamin C could prevent these disorders (14, 15). One disorder typical of severe vitamin C deficiency is scurvy; a less severe vitamin C deficiency may cause gingivitis (the bleeding of receded gums).

B Vitamins

A disturbed DNA synthesis as a result of vitamin B12 and folate deficiency can lead to an alteration of the rapidly dividing (epithelial) cells in the mucous membrane of the mouth. Typical vitamin B deficiency can cause a red, swollen and burning tongue, cracked lips and corners of the mouth, as well as alter the sensation of taste (16, 17).

Fluorides

Locally acting fluorides make up a crucial element of keeping teeth healthy and protecting against caries and attack by acids. Fluoride ions strengthen the hard tooth tissue by depositing themselves in the tooth enamel, thus preventing the dissolution of the essential tooth nutrient calcium and promoting the depositing of calcium in the tooth (21). There are also indications that fluorides can inhibit the metabolism of caries bacteria so that they produce fewer organic acids that attack the tooth enamel (22).

Calcium

Apart from vitamin D and phosphate, calcium is the most important component of teeth and bones. With low blood levels, calcium is removed from the target tissues and finds its way into the blood; with high blood levels, calcium is deposited again into the bones and teeth. When blood concentrations of calcium are too low, the body appears to want to first supply the teeth with calcium and then the bones. Calcium is especially important for the development of hard tooth enamel in children, where it acts locally on the teeth from the outside (1).

1. Navia J. M. Nutrition in dental development and disease. Hum Nutr .1979; 1:333–362.
2. Hartles R. L and Leach S. A. Effect of diet on dental caries. Brit med Bull. 1975; 31:137–141.
3. Stein S. H. and Tipton D. A. Vitamin D and its impact on oral health -an update. J Tenn Dent Assoc. 2011; 91(2):30–33; quiz 34–35.
4. Al Habashneh R. et al. Association between periodontal disease and osteoporosis in postmenopausal women in Jordan. J Periodontol. 2010; 81(11):1613–1621.
5. Moedano D. E. et al.  Osteoporosis, the risk of vertebral fracture, and periodontal disease in an elderly group in Mexico City. Gerodontology. 2011; 28(1):19–27.
6. Bashutski J. D. et al. The impact of vitamin D status on periodontal surgery outcomes. J Dent Res. 2011; 90(8):1007–1012.
7. Garcia M. H. et al. One-year effects of vitamin D and calcium supplementation on chronic periodontitis. J Periodontol. 2011; 82(1):25–32.
8. Martelli F. S. et al. VDR TaqI polymorphism is associated with chronic periodontitis in Italian population. Arch Oral Biol. 2011.
9. Boggess K. A. et al. Vitamin D status and periodontal disease among pregnant women. J Periodontol. 2011; 82(2):195–200.
10. Schrott R. et al. Influence of maternal vitamin D status on infant oral health. Abstract No. 1646; Internat. Assoc for Dental Research. 2008.
11. Schrott R. et al. Prevalence of Caries among Preschool-Aged Children in a Northern Manitoba Community: J Can Dent Assoc. 2005; 71(1):27.
12. Chapple I. L. et al. The prevalence of inflammatory periodontitis is negatively associated with serum antioxidant concentrations. J Nutr. 2007;137(3):657–664.
13. Linden G. J. et al. Antioxidants and periodontitis in 60-70-year-old men. J Clin Periodontol. 2009; 36(10):843–849.
14. Staudte H. et al.  Vitamin C attenuates the cytotoxic effects of Porphyromonas gingivalis on human gingival fibroblasts. Arch Oral Biol. 2010; 55(1):404–405.
15. Amaliya, Timmerman M. F. et al. Java project on periodontal diseases: the relationship between vitamin C and the severity of periodontitis. J Clin Periodontol. 2007; 34(4):299–304.
16. DeRossi S. S. et al. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003; 95(2):131–141.
17. Red-blue lesions. In: Regezi J. A. et al. Oral pathology: clinical pathologic correlations. Philadelphia: Saunders; 2007. 107–125.
18. Featherstone J. B. The Continuum of Dental Caries – Evidence for a Dynamic Disease Process. J Dent Res. 2004; 83:C39.
19. Jawed M. et al. Dental caries in diabetes mellitus: role of salivary flow rate and minerals. J Diabetes Complications. 2011; 25(3):183–186.
20. Rao A. and Malhotra N. The role of remineralizing agents in dentistry; a review. Compend Contin Educ Dent. 2011; 32(6):26–33; quiz 34–36.
21. Navarro M. et al. Calcium Fluoride Uptake by Human Enamel after Use of Fluoridated Mouthrinses. Braz Dent J. 2001; 12(3):178–182.
22. CDC Centers for Disease Control and Prevention: Recommendations for Using Fluoride to prevent and Control Dental Caries in the United States, MMWR Recommendations and Reports August 1 2001/50(RR14);1–42.
23. De Bruyne L. K. et al. Nutrition an diet therapy: principles and practice. 7th edition 2008; Thomas Brooks Cole; ISBN-13: 978-0-459-11916-6, pages 313–314.