Impact of diet on periodontitis

Background + Aims

• Periodontitis is a chronic inflammatory disease affecting the supporting structures of the teeth, leading to progressive periodontal tissue destruction and eventual tooth loss if untreated. The main aetiological factor for periodontitis is plaque. However, the two main risk factors for progression of the disease have been identified as smoking and diabetes.
• Recently, there has been a global increase in the consumption of sugar-sweetened beverages (SSBs), which can be characterised by artificial sweetening with mono or disaccharides. Examples of SBBs include soft drinks, fruit juices, energy drinks, hot chocolate, sweetened teas, and coffees. It has been well established that these beverages are known to contribute to several health issues, such as obesity, diabetes and cardiovascular disease, primarily due to their high sugar content. However, the impact of SSB consumption on oral health, particularly its potential role in the development and progression of periodontitis, is less well understood.
• This study aims to investigate the relationship between the consumption of sugar-sweetened beverages (SSBs) and the prevalence of periodontitis in an adult population.

Materials + Methods

• A cross-sectional population-based study means that data was collected at a single point in time from a large sample of adults to assess the association between SSB consumption and periodontitis. The study involved a representative sample of adults in the United States aged between 30-50 years. The participants were selected using a stratified sampling technique to ensure a diverse and representative cohort based on factors such as age, gender, and socioeconomic status. The following groups were not examined for periodontal diseases due to a risk of bacteraemia: pregnant women, individuals with a risk of infective endocarditis, rheumatic fever and individuals undergoing dialysis.
• Data were gathered through structured interviews and clinical examinations. Participants were asked about their dietary habits, specifically their frequency of SSB consumption. Clinical periodontal examinations of two randomly selected quadrants were conducted to diagnose periodontitis. Probing pocket depth (PPD) and clinical attachment loss (CAL) were recorded for each tooth’s buccal and mesiobuccal surfaces.
• The data was analysed using statistical methods to examine the relationship between SSB consumption and periodontitis. Multivariate logistic regression models were employed to control for potential confounding variables such as age, gender, smoking status, oral hygiene practices, and socioeconomic factors. Effect modification analysis was performed considering self-reported diabetes.

Results

• The study found that a significant proportion (27.4%) of the sampled adult population had periodontitis of varying severity (4.2% mild, 19.8% moderate, 3.4% severe). Self-reported diabetes was evident in 2.9% of participants. SBB consumption ranged from 0 to 49.8 times per week, with 36.3% of the sample consuming ≥5 SBBs per week, 23.4% ≥7 SBBs per week and 10.7% ≥14 SBBs per week.
• There was a positive association between higher SSB consumption and an increased prevalence of periodontitis. Participants who frequently consumed SSBs (≥5/per week)) were more likely to have periodontitis compared to those who consumed these beverages less often. The results indicated a dose-response relationship, meaning that the risk of periodontitis increased with higher levels of SSB consumption. Those with the highest intake of SSBs had the highest odds of having periodontitis. SSB consumption was associated with an increased chance of periodontitis only among those who reported not having diabetes. The study also conducted subgroup analyses, which showed that the association between SSB consumption and periodontitis was consistent across different demographic groups, including age and gender, although the strength of the association varied slightly.
• After adjusting for potential confounding factors such as age, gender, smoking, socioeconomic status, and oral hygiene practices, the association between SSB consumption and periodontitis remained statistically significant. This suggests that the relationship is not solely due to these other factors.

Limitations