Health Policy$ense

How Diet May Alter Risk of Periodontal Disease

Pass the Nuts, Hold the Red Meat

Can your overall diet, or specific foods, affect your risk for periodontal (gum) disease? The answer has major public health implications, since periodontal disease affects 47% of adults over the age of 30 in the United States and has an indirect economic cost of over $123 billion. In a new study in the Journal of Clinical Periodontologymy colleagues and I find that overall some categories of foods—nuts, red meat, and trans-fatty acids—may be associated with periodontal disease. In specific, nuts may be protective, while red meat and trans-fatty acids might increase your risk for periodontal disease.

Francesco DeMayo, MPH
Francesco DeMayo, MPH is an LDI Associate Fellow and a DMD candidate in the School of Dental Medicine at the University of Pennsylvania.

We studied 923 participants in the Oral Infections, Glucose Intolerance and Insulin Resistance Study (ORIGINS) at the Columbia University Irving Medical Center. The cohort was mostly female (73%), college-educated (76%), healthier than average, and disproportionately Hispanic (32%). To measure diet, participants completed the National Cancer Institute’s validated Diet History Questionnaire 1, from which we calculated two commonly used composite scores of diet quality: The Alternative Healthy Eating Index (AHEI) and A Priori Diet Quality Score (APDQI).   

We then conducted in-depth periodontal exams to assess a range of measures of gum disease, such as severe gum infection (periodontitis). We modeled the association between continuous measures of periodontal disease (e.g., average depth of the groove between gums and teeth) and the odds of developing severe gum infection. The models were adjusted for known risk factors, such as age, sex, race/ethnicity, education, smoking, body mass index, total caloric intake, and prediabetic status.

Notably, with a limited exception, overall diet quality as measured by AHEI and APDQS were not correlated with any periodontal outcomes. However, when we dug down into different components of diet, some trends emerged. Higher nut consumption was associated with better periodontal health. The opposite was true for consumption of red meat and trans-fats—as consumption of these foods rose, several measures of gum health deteriorated.

The upshot of these findings is that overall diet does not seem to correlate with gum disease. Instead, some specific foods might be more relevant. The researchers provide several potential explanations, including the anti-inflammatory and fiber properties of some foods.

This work has implications for how providers counsel their patients. Ideally, follow-up work would include a more nationally representative sample that controls for the regularity and quality of dental hygiene (i.e., flossing and brushing). If the results are replicated, it suggests that oral health providers may better serve patients by focusing on certain foods in dietary counseling, rather than providing advice on overall diet.

The study, Diet Quality and Periodontal Disease: Results From the Oral Infections, Glucose Intolerance and Insulin Resistance Study (ORIGINS), was published in the Journal of Clinical Periodontoloy in March 2021. Authors include Francesco DeMayo, Rebecca Molinsky, Muna J. Tahir, Sumith Roy, Jeanine M. Genkinger, Panos N. Papapanou, David R. Jacobs Jr, and Ryan T. Demmer.