Table 1.
Diet and Periodontal Diseases.
| Nutrient(s) | Type of Study | Methodology | Follow-Up Period | Clinical Outcomes | Subclinical Outcomes | Author(s) and Year |
|---|---|---|---|---|---|---|
| Mediterranean diet | RCT | 42 patients with gingivitis were divided into 2 groups. Test group had to adhere to Mediterranean diet (DM) for 6 weeks and control group did not have to change their diet. Gingival parameters were assessed at baseline, week 2 (beginning of the MD intervention), and week 8. | 8 weeks | Test group showed better results in gingival inflammatory parameters (GI, BOP) after treatment. No differences in dental bacterial plaque scores between test and control groups. | Test group achieved weight loss and waist compliance after treatment. | Bartha et al., 2021 [13] |
| Low in carbohydrates, rich in omega-3 fatty acids, vitamins C and D, antioxidants, and fiber | Pilot RCT | 15 patients with gingivitis were divided into 2 groups. The test group was started on a diet low in carbohydrates, high in omega-3 fatty acids, and rich in vitamins C and D, antioxidants, and fiber for 4 weeks. Periodontal parameters were measured after 1 and 2 weeks, followed by a 2-week transition period, and then measured weekly for 4 weeks. | 4 weeks | Test group showed significant improvement in GI, BOP, PI, PPD, and CAL parameters. | N/A | J. P. Woelber et al., 2016 [14] |
| Low in carbohydrates, rich in omega-3 fatty acids, vitamins C and D, antioxidants, and fiber | RCT | 54 patients with gingivitis were divided into 2 groups. The test group was started on a diet low in carbohydrates, high in omega-3 fatty acids, and rich in vitamins C and D, antioxidants, and fiber for 4 weeks. Periodontal parameters were measured once a week for 4 weeks, followed by a 2-week transition period, and then measured weekly for 4 weeks. | 4 weeks | Test group showed significant improvement in BOP and GI. | N/A | Sava Sunari Rajaram et al., 2021 [15] |
| High-fiber and low-fat diet | Pilot Study | 47 volunteers were included in the study. Subjects received a high-fiber, low-fat test meal 3x/day for 8 weeks, followed by a regular diet for 24 weeks. Periodontal parameters were evaluated at the beginning and end of treatment. | 8 weeks | The high-fiber, low-fat diet effectively improved PPD, CAL, and BoP in patients after treatment. | After treatment, there was improvement in metabolic profiles (body weight, HbA1c, and high-sensitivity C-reactive protein levels). | Keiko Kondo et al., 2014 [16] |
| Nordic diet | Cohort | 2187 healthy Finns eating a Nordic diet were divided into two age groups and then into two oral hygiene groups (good and poor oral hygiene). Periodontal parameters were used as outcome variables. Dietary data were collected using a validated food frequency questionnaire. | 6 weeks | Nordic diet provides evidence that it is associated with less gingival bleeding and reduced PPD in patients with poor oral hygiene. | N/A | Jauhiainen L et al., 2016 [17] |
| Nitrate | RCT | 44 patients with gingivitis were divided into 2 groups. Test group received 100 mL of a lettuce juice drink (200 mg of nitrate) to be consumed daily for 14 days, and the control group received placebo. Periodontal parameters of salivary nitrate were evaluated before and after treatment. | 2 weeks | Test group showed better results in GI on day 14. | Test group showed higher levels of salivary nitrate. | Jockel-Schneider Y et al., 2016 [18] |
| Nitrate | RCT | 37 patients with gingivitis and reduced periodontium were divided into 2 groups. Test group received lettuce juice (200 mg of nitrate) daily for 14 days and test group received placebo. Microbial samples, salt collection, and assessment of gingival inflammation were analyzed before and after treatment. | 2 weeks | Test group showed reduction in gingival inflammation after treatment. | Test group showed compositional changes within the subgingival microbiome after treatment. | Yvonne Jockel-Schneider et al., 2020 [19] |
| Atkins low-carb ketogenic diet | Pilot Clinical Trial | 20 patients were placed on a ketogenic diet. Adherence was monitored by measuring their urinary ketones daily and keeping 7-day records. Periodontal, physical, and serological parameters were evaluated at baseline and after treatment. | 6 weeks | No changes in clinical periodontal parameters. Tendency to lower plaque values after treatment. | Reduction in body weight and BMI after treatment. | Johan Peter Woelber et al., 2021 [20] |
| Fruit | RCT | 30 patients were included in the study; they were randomized to supplement their diet with extra fruits or nuts, each at +7 kcal/for 2 months. Periodontal parameters were analyzed before and after treatment, as well as serum vitamin C, β-carotene/cholesterol, and α-tocopherol/cholesterol. | 8 weeks | Significant reduction in the number of subjects with PPD ≥4 mm in group with fruits compared to nuts, while PI and BoP remained unchanged in both groups. | Vitamin C levels increased in both groups and α-tocopherol/cholesterol increased in the fruit group and decreased in the nut group, as did β-carotene/cholesterol. | Sara Fridell et al., 2018 [21] |
| Kiwifruit | RCT | 50 patients were divided into 2 groups. Test group received 2 kiwis/day for 5 months and control group did not. The first SRP was performed after 2 months of treatment. Periodontal parameters and blood samples were evaluated after 2 and 5 months. | 2 and 5 months | Test group showed reduced gingival bleeding in 2 months, which was also maintained after treatment. | Systemic biomarkers and vital signs showed no clinically relevant differences between groups. | Filippo Graziani et al., 2017 [22] |
Abbreviations: RCT: Randomized controlled trial; PPD: Probing pocket depth; CAL: Clinical attachment level; SRP: Scaling and root planing; GCF: Gingival crevicular fluid; BOP: Bleeding on probing; GI: Gingival index; PI: Plaque index; BMI: Bone Mass Index; N/A: Not available.