Date Published: March 13, 2019
Publisher: Public Library of Science
Author(s): Juliano Morimoto, Alistair Senior, Kate Ruiz, Jibran A. Wali, Tamara Pulpitel, Samantha M. Solon-Biet, Victoria C. Cogger, David Raubenheimer, David G. Le Couteur, Stephen J. Simpson, Joerg Eberhard, Juan J Loor.
While there is a burgeoning interest in the effects of nutrition on systemic inflammatory diseases, how dietary macronutrient balance impacts local chronic inflammatory diseases in the mouth has been largely overlooked. Here, we used the Geometric Framework for Nutrition to test how the amounts of dietary macronutrients and their interactions, as well as carbohydrate type (starch vs sucrose vs resistant starch) influenced periodontitis-associated alveolar bone height in mice. Increasing intake of carbohydrates reduced alveolar bone height, while dietary protein had no effect. Whether carbohydrate came from sugar or starch did not influence the extent of alveolar bone height. In summary, the amount of carbohydrate in the diet modulated periodontitis-associated alveolar bone height independent of the source of carbohydrates.
Gingivitis and periodontitis belong to a spectrum of inflammatory periodontal diseases caused by bacterial accumulation that damage the tooth-supporting tissues. Irreversible high-level inflammatory periodontitis, if left untreated, leads to tooth loss . The prevalence of moderate to severe periodontitis in Western populations is approximately 50%, while the prevalence of gingivitis is as high as 62–94% [2, 3]. In addition to local inflammatory processes periodontitis and gingivitis increase susceptibility to many systemic diseases including cardiovascular and respiratory diseases, immune deficiencies and type 2 diabetes mellitus .
Our study confirms that dietary carbohydrate intake has a negative impact on periodontal health in a mouse model of naturally occurring periodontitis. In addition, we have shown the effect of carbohydrates is independent of dietary protein or the type of carbohydrate—sucrose, wheat starch and resistant starch all have the same negative effects on alveolar bone height, measured as the distance between the CEJ and ABC in this study. The quantity of carbohydrate eaten—rather than the type of carbohydrate (among those tested)—influences oral health in mice. This observation is in agreement with studies that demonstrated that starch has the potential to be cariogenic, mediated by elongated retention times in the oral cavity compared to sucrose . We varied the protein-to-carbohydrate ratio in the diet because our recent studies have shown that the interaction between carbohydrate and protein in the diet influences multiple aspects of physiology and health . While the cariogenic potential of carbohydrates is solely related to its local effects on the tooth surfaces, it is possible that dietary components modulate periodontal disease by shaping the systemic immune response. This hypothesis has been supported by animal experiments which demonstrated that the administration of probiotics positively affects periodontal health in mice, irrespectively of the administration by lavage or gavage . The systemic modulation of the periodontal immune response is in accordance with the concept that periodontitis arises from an inappropriate inflammatory reaction to the normal microbiota .
In summary, this is the first study to explore macronutrient composition and types of carbohydrate on the development of natural occurring periodontitis in older animals. There was a positive correlation between a reduced bone height and the intake of dietary carbohydrate, whether in the form of sucrose, wheat starch, or resistant starch.