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                                                        DR. DAN PETERSON

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Nutrition and Oral Health

Nutrition affects oral health and oral health affects nutrition. This interdependent relationship sees good nutritional health promoting good oral health (encompassing gum tissue status, the well-being of teeth and jaw, salivary quantity and quality, and sensatory dimensions of taste and pain),1 and vice versa. On the other hand, poor nutritional health is associated with poor oral health, and vice versa.

Malnutrition, Infectious Diseases, and the Immune System

Nutrition is a major factor in infection and inflammation.
2 Several reports emphasize the synergistic relationship between malnutrition, infectious diseases and the immune system; for example, infections promote malnutrition, the malnutrition elicits dysfunctions of the immune system, and this impaired immunity intensifies the infectious disease.3 In oral health, cavities and gum disease, as well as many diseases of the mucous membranes, tongue and salivary glands, are infectious.4 These oral infections can not only disrupt the integrity of the oral cavity, but can also affect general health 4

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Nutrition and Periodontitis

Periodontal (gum) diseases, characterized by chronic inflammation and a loss of the bone and soft tissues that surround the teeth,
2 constitute one of the most common chronic infections in humans.  A nutritious diet, including adequate amounts of protein, vitamins, essential fatty acids and micronutrients, can play an important role in the resistance to infectious conditions, including periodontitis.2,3 For example . . .
bulletAntioxidants, vitamin A, zinc, iron and dietary fish oils improve host resistance to infections;
bulletZinc, copper, selenium, N-acetylcysteine, vitamin E and dietary fish oils reduce inflammation;
bulletVitamins C, D, E and fish n-3 fatty acids reduce tissue destruction, enhance wound healing, and increase bone strength and rate of bone formation;
bulletCalcium and vitamin D have a beneficial effect on bones and on tooth retention.2
A well-balanced diet, consisting of a complex mixture of good quality carbohydrates, lipids, proteins, vitamins and minerals, is required for maintenance of optimal general and oral health.3

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Nutrition on Saliva and Oral Health

Nutritional intake influences the oral tissues to which bacteria bind (i.e., epithelium, collagen, bone, teeth), as well as saliva.
2 Secretory proteins (mucins) found within saliva provide an effective barrier against desiccation, penetration, physical and chemical irritants, and bacteria.4 The contents of saliva are likely influenced by nutrients consumed daily, with consequences to oral health.2

bulletSynthesis of glycoproteins, such as mucin, requires vitamin A. In protein-energy malnutrition, retinol deficiency can reduce mucin production, leading to compromised salivary flow, weakened tooth integrity, and a marked increase in risk for caries.4
bulletThe presence of immunologic and non-immunologic antibacterial systems within saliva, in addition to the neutralizing and buffering components, can counter the acids formed in bacterial plaques when cariogenic bacteria ferment sugars and soluble starches.4
bulletSaliva is saturated with calcium and phosphate salts that can remineralize submicroscopic defects in tooth minerals when plaque acids initiate the caries process.4
bulletIn the presence of fluoride in the oral environment, saliva’s function of remineralization can potentially reverse the caries process.4 5

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Nutrition on Stress Hormones and Oral Health

Malnutrition is also characterized by increased production and secretion of stress hormones (glucocorticoids) and decreased secretion of insulin.
3 Elevated circulating levels of cortisol in malnutrition imply a similar change in the content of this hormone in saliva and gingival fluid.
bulletElevated circulating glucocorticoid levels, even at physiological concentrations, elicit macrophage dysfunction and reduce the production of cytokines in response to inflammatory stimuli.
bulletCytokines play a prominent role in growth, differentiation, host defenses, and tissue damage.
bulletCytokines also inhibit chemokines and other cells involved in attracting inflammatory cells at the site of inflammation, which ultimately impact the tissue healing process.3

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Oral Health on Nutrition and General Health

Poor oral health can affect dietary quality and nutrient intake in a manner that potentially increases the risk of several systemic diseases.
bulletTooth loss can result in chewing difficulty because of inadequate occlusive surfaces.1
bulletReduced masticatory ability alters food selection and dietary quality, which can affect nutritional status.6
bulletOral pain resulting from caries, advanced periodontal disease, soft tissue lesions or poorly fitting prostheses may also lead to changes in diet and subsequent nutritional status.1
Most studies relating tooth loss and nutrition suggest that nutrient intake deteriorates in quality with fewer teeth.1 In one study, participants with more teeth generally consumed fewer calories, more vegetables, more fiber, more carotene, and less cholesterol and saturated fat than their counterparts with fewer teeth.6 Edentulous individuals are particularly prone to inappropriate dietary intake, ingesting too few nutrient-dense foods and too many calorie-rich, high fat foods. Research indicates that loss of natural teeth causes reduced masticatory efficiency even after replacement with dentures.6 Among community-dwelling older adults, edentulousness is an important risk factor for weight loss, as chewing difficulty or oral discomfort due to poorly fitting dentures can contribute to food aversion and diminished nutrient intake.7 It has also been reported that denture-wearing individuals consume more refined carbohydrates, sugar and dietary cholesterol than dentate individuals.1 Such detrimental changes in food choices may, in turn, increase the risks of certain systemic diseases. The general health status of the individual, the use of alcohol, drugs or medications, and behaviors such as smoking, can all alter appetite, nutrient requirements and nutritional intake.1 Ample evidence has been presented here to show that nutrition affects oral well-being, and oral well-being affects nutrition. 

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1. Ritchie CS, Joshipura K, Hung HC, Douglass CW. Nutrition as a mediator in the relation between oral and systemic disease: Associations between specific measures of adult oral health and nutrition outcomes. Crit Rev Oral Biol Med 2002;13(3):291-300.
2. Mangan DF. Nutrition and oral infectious diseases: Connections and future research. Compend Cont Educ Dent 2002; 23(5):416-422.
3. Enwonwu CO, Phillips RS, Falkler WA, Jr. Nutrition and oral infectious diseases: State of the science. Compend Cont Educ Dent 2002;23(5):431-434, 436, 438.
4. Mandel ID. Oral infections: Impact on human health, well-being, and health-care costs. Compend Cont Educ Dent 2002;23(5):403-413.
5. Burt BA, Satishchandra P. Sugar consumption and caries risk: A systematic review. J Dent Educ 2003;65(10):1017-1023.
6. Joshipura KJ, Willett WC, Douglass CW. The impact of edentulousness on food and nutrient intake. JADA 1996;127(4):459-467.
7. Ritchie CS, Joshipura K, Silliman RA, Miller B, Douglass CW. Oral health problems and significant weight loss among community-dwelling older adults. J Gerontol 2000;55(7): M366-371.

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PLEASE NOTE: The information contained herein is intended for educational purposes only.  It is not intended and should not be construed as the delivery of dental/medical care and is not a substitute for personal hands on dental/medical attention, diagnosis or treatment.  Persons requiring diagnosis, treatment, or with specific questions are urged to contact your family dental/health care provider for appropriate care.
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