Table 1.
Observational studies on minerals’ associations with periodontal disease.
| Study Type | Sample | Sex, Age, N | Dietary Intake Assessment | Nutritional Status Assessment | Periodontal Status | Association Assessment | Main Results/Conclusions | Ref. |
|---|---|---|---|---|---|---|---|---|
| CS | NHANES III participants (USA) | Both, ≥ 20 years, N = 11787 | Dietary intake of Ca (<500, 500–799, & ≥ 800 mg/day) by 24-h recall | Serum levels 1 of total Ca | Periodontal disease (CAL > 1.5 mm) | Adj OR (multiple logistic regression) | Inverse association with intake & serum levels but only in certain age groups & gender | [20] |
| CS | 2007–2008 DANHES participants (Denmark) | Both, ≥18 years, N = 3287 | Dietary intake of Ca (continous, & < & ≥ RDA) by FFQ | - | Severe chronic periodontitis 2 mean CAL | Adj OR (multiple logistic regression) Adj β (multiple linear regression) | Negative association with mean CAL for intakes ≥ RDA | [21] |
| CS | Dental clinic patients (USA) | Both, N/A, N = 80 | Dietary intakes of Ca, P, Fe, Zn & K by 24-h recall (N = 56) | Serum levels of Ca, Mg, P (Fe, Cu, Zn & K) | RPI | Linear correlation coefficient for intake Adj β for serum levels (multiple linear regression) | Inverse association with Cu serum levels | [22] |
| CS | Pregnant women (Japan) | Female, 31.5 ± 4 years, N = 1162 | Dietary intake of Ca (quartiles) by DHQ | - | Periodontal disease (PPD ≥ 4 mm in ≥1 tooth) | Adj OR (multiple logistic regression) | Inverse association (highest qt vs. lowest qt) | [23] |
| CS | Non-smoker adults with ≥20 teeth (Japan) | Both, ≥18 years, N = 497 | Dietary intake of Ca by 24-h recall | - | CPI & %BOP | Adj β (multiple linear regression) | No associations | [24] |
| CS | SHIP participants (Germany) | Both, 20–80 years, N = 4290 | Ca-antagonists regular use & Mg-containing drugs intake | Serum Mg/Ca (quartiles) | % PPD ≥ 4 mm, %CAL > 4 mm, number of teeth | Adj OR (multiple logistic regression) | Inverse association of serum Mg/Ca with %PPD > 4 mm & %CAL > 4 mm, only in subjects aged ≥ 40 years (lowest quartil vs. highest quartil). People taking Mg-containing drugs showed less CAL | [36] |
| S | 135 subjects from 3rd follow-up of COHSS (Denmark) | Both, >65 years, N = 135 | Dietary intakes of dairy food & Ca (100 g increments) by DHI | - | Periodontitis (number of teeth with additional CAL ≥ 3 mm) | Adj IRR (multiple logistic regression) | Inverse association with intakes of total dairy Ca, from milk & fermented foods | [25] |
| CS | non-smokers & non-alcoholic women from CARDIAC study (Tanzania) | Female, 46–58 years, N = 81 | Dietary intake of Mg (N/A) & 24-h urinary excretions of K | - | number of teeth, & CPITN | Simple correlation coefficients | Negative association of K urinary levels with CPITN | [38] |
| CS | NHANES non-pregnant participants (Japan) | Both, ≥20 years, N = 3043 | Dietary intake of Cu by 24-h recall | - | CPI = 3–4 | Adj OR (multiple logistic regression) | No association | [39] |
| CS | KNHANES participants (South korea) | Both, ≥19 years, N = 1679 | - | Whole blood levels of Mn (quartiles) | CPI ≥ 3 | Adj OR (multiple logistic regression) | Inverse asociation | [40] |
| CC | Female non-smoker adolescents (Italy) | Female, 17–19 years, N = 54 | Dietary intake of Ca, P & K (<2/3 RDA) by 3-days record | - | Gingivitis-affected (≥1 site with BOP) vs. non-affected | Differences between groups | Negative association of Ca intake with gingivitis risk | [28] |
| CC | Subjects from a Health Center (China) | Both, 16–64 years, N = 178 | - | Plasma level of Ca & P (quartiles) | Aggressive periodontitis vs. chronic periodontitis—affected 3 vs. healthy (Staff) | Differencies among groups (ANCOVA) | Patints had lower levels of P | [27] |
| CC | Non-smokers outpatients (India) | Both, 30–60 years, N = 60 | - | Serum levels of Cu & Zn | DM2 & periodontal disease-affected vs. only periodontal disease-affected (30% sites with CAL ≥ 5 mm & BOP) vs. healthy | Differences among groups | Subjects with perioedontitis showed higher Zn levels respect to than those with DM2 | [41] |
| CC | Non-smokers individuals with ≥20 teeth (India) | Both, 30–60 years, N = 150 | - | Serum levels of Se | DM2 & chronic periodontitis-affected 4, only chronic periodontitis-affected 4 vs. healthy | Differences between groups | Subjects with periodontitis (with or without DM2) showed the lowest Se levels | [42] |
| C (5 years) | MONICA study participants (Denmark) | Both, 30–60 years, N = 2113 | Dietary intakes of Ca (total, E-adjusted as well as < & ≥ RDA) by 7-days record | - | Tooth loss | Adj IRR (multiple logistic regression) | Inverse association only in men | [26] |
| C (6 years) | Niigata city citizens (Japan) | Both, 70 years, N = 266 | - | Serum levels of Ca | Progression of periodontal diseae (number of teeth with additional CAL ≥ 3 mm) | Adj β (multiple linear regression) | Negative association | [29] |
| C (6 years) | Niigata city inhabitants (Japan) | Both, 73 years, N = 309 | - | Serum Ca/Mg (quartiles) | Periodontal disease events (CAL ≥ 3 mm/year at any teeth) | Adj OR (multiple logistic regression) | Negative association of Ca/Mg ratio with periodontal disease events only among smokers | [37] |
1 Serum levels were adjusted by daily intake of calcium in subsequent analyses, 2 ≥2 inter-proximal sites with CAL ≥ 6 mm in different teeth & ≥1 inter-proximal site with PPD ≥ 5 mm. 3 according to IWCPDC criteria [43]. 4 according to AAP/CDC criteria for severe generalized chronic periodontitis. Abbreviations: %: percentage of sites, β: linear regression coefficient, AAP: American Association of Periodontology, Adj: adjusted, ABL: alveolar bone loss, AL: attachment loss, ANCOVA: Analysis of covariance, BMD: bone mass density, BOP: bleeding on probing, C: cohort study, Ca: calcium, CAL: clinical attachment loss, CARDIAC: Cardiovascular Diseases and Alimentary Comparison, CC: case-control study, CDC: Center for Diseases control and Prevention, COHSS: Copenhagen Oral Health Senior Study, CPI: Community Periodontal Index, CPITN: Community Periodontal Index Treatment Needed, CS: cross-sectional study, Cu: Copper, DHI: diet history interview, DHQ: diet history questionnaire, DM2: type 2 diabetes mellitus, Fe: iron, FFQ: food frequency questionnaire , GI: Gingival Index, h: hours, IRR : incidence rate ratio, IWCPDC: International Workshop for the Classification of Periodontal Diseases and Conditions in 1999 [39], K: potassium, KNHANES: 4th Korean National Health and Nutrition Examination Survey, v m: months, Mg: magnesium, Mn: Manganese, MONICA: Monitoring Trends and Determinants in Cardiovascular Disease, N: sample size, N/A: not available, NHANES: National health and Nutrition Examination Survey, NHANES III: Third National Health and Nutrition Examination Survey, OR: odds ratio, P: phosphorus, PI: Plaque Index, PPD: periodontal probing depth, RDA: recommended daily amount, RPI: Russel´s Periodontal Index, Se: selenium, SHIP: Study of Health in Pomerania; SOF: Study of Osteoporotic Fractures, USA: United States of America, vs: versus, Zn: Zinc.