Abstract and Introduction
Abstract
Objectives To determine whether foods that are good to excellent sources of fiber reduce periodontal disease progression in men.
Design Prospective, observational study.
Setting Greater Boston, Massachusetts, metropolitan area.
Participants Six hundred twenty-five community-dwelling men participating in the Department of Veterans Affairs Dental Longitudinal Study.
Measurements Dental and physical examinations were conducted every 3 to 5 years. Diet was assessed using food frequency questionnaires (FFQs). Mean follow-up was 15 years (range: 2–24 years). Periodontal disease progression on each tooth was defined as alveolar bone loss (ABL) advancement of 40% or more, probing pocket depth (PPD) of 2 mm or more, or tooth loss. Good and excellent fiber sources provided 2.5 g or more of fiber per serving. Multivariate proportional hazards regression estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of periodontal disease progression and tooth loss in relation to fiber sources, stratified according to age younger than 65 versus 65 and older, and controlled for smoking, body mass index, calculus, baseline periodontal disease level, caries, education, exercise, carotene, thiamin and caffeine intake, and tooth brushing.
Results In men aged 65 and older, each serving of good to excellent sources of total fiber was associated with lower risk of ABL progression (HR = 0.76, 95% CI = 0.60–0.95) and tooth loss (HR = 0.72, 95% CI = 0.53–0.97). Of the different food groups, only fruits that were good to excellent sources of fiber were associated with lower risk of progression of ABL (HR = 0.86 per serving, 95% CI = 0.78–0.95), PPD (HR = 0.95, 95% CI = 0.91–0.99), and tooth loss (HR = 0.88, 95% CI = 0.78–0.99). No significant associations were seen in men younger than 65.
Conclusion Benefits of higher intake of high-fiber foods, especially fruits, on slowing periodontal disease progression are most evident in men aged 65 and older.
Introduction
Periodontitis is a chronic inflammatory disease characterized by gum recession, formation of deep pockets between gums and teeth, and erosion of the alveolar bone structure that supports the teeth in the jaw. Overall, approximately 10% of U.S. adults have moderate or severe periodontitis. The prevalence increases with age, from 5% in persons aged 35 to 49 to 20% in persons aged 75 and older. The presence of bacteria is required for the initiation of periodontal disease, but host characteristics can influence its course and severity. The role of dietary carbohydrates in modulating the progression of periodontal disease is unclear. Simple sugars and starches provide substrate for oral bacteria to synthesize extracellular polysaccharides that enhance plaque mass, which in turn harbors cariogenic and periodontal pathogens and irritates gingival tissue. Lowering the consumption of sugars is associated with modest reductions in gingival bleeding, but a diet rich in fiber, fruits, and vegetables may protect against periodontal disease through several mechanical actions, including cleansing the tooth surfaces of plaque and forcing more chewing, which stimulates the parotid salivary gland to increase salivary flow and remove harmful bacteria.
Additional interest in dietary fiber and periodontal health stems from fiber's beneficial effects on diabetes mellitus, cardiovascular disease, and obesity. Fiber has been shown to provide significant health benefits by controlling serum glucose levels and lowering lipids, blood pressure, and body mass index (BMI). Because each of these systemic conditions has been associated with periodontal disease, further study of the association between dietary fiber intake and periodontal health is warranted. Likewise, the weight-controlling effects of fiber, coupled with associations between the inflammatory agents excreted by adipose tissue and periodontal disease, further support the rationale for conducting such research.
Examination of the relationship between sources of fiber intake and periodontal health has been limited. In a cross-sectional study of nutrition in relation to gingival health in 17- to 19-year-old girls, 27 of whom exhibited gingival bleeding on at least one tooth during a dental examination and 27 of whom had no bleeding, the average frequency of fiber intake, but not grams consumed per day, was higher in the group of girls without gingival bleeding. Another study estimated the risk of periodontal disease incidence in male health professionals according to levels of various sources of whole grains and dietary fiber and reported that men who consumed three to four servings per day (one serving was equivalent to 0.75 cups of whole-grain cereal or one slice of whole-wheat bread) were 23% less likely to self-report development of periodontitis than men who consumed zero to one serving of whole grains per day. No significant associations were found between periodontal disease risk and total fiber, fruit fiber, or vegetable fiber. The hypothesis of the present study is that higher intakes of dietary fiber and more daily servings of foods that are good to excellent sources of fiber would lower the risk of periodontal disease progression in a cohort of middle-aged and elderly men.