The Impact of Nutrition and Diet on Oral Health. Группа авторов

      Periodontal Disease

The role of macroelements in periodontal disease has not been the primary concern of studies relating to this disease, although a recent, comprehensive review summarized the current evidence for a range of elements [61], including those of interest here.

Some anecdotal evidence exists correlating urinary potassium excretion (linked to potassium food intake) inversely to the severity of periodontitis [62], although other studies were not able to demonstrate an association [63, 64].

The evidence for calcium intake, however, is stronger, and in particular to alveolar bone health. A total of 12 studies in humans and 5 in animals have been discussed [68], with the National Health and Nutrition Examination Survey (11,787 participants) [65] and Danish Health Examination Survey (3,287 participants) studies [66] being perhaps the most relevant, despite their cross-sectional nature. Both studies provided evidence for an inverse relationship between calcium intake and the severity of periodontitis. Further evidence was also provided by the earlier mentioned Niigata [67] and MONICA [10] studies. Some indirect evidence on the value of calcium (and vitamin D) supplements in preventing periodontal disease (bone loss from the hip and tooth loss were determined) was provided in an aforementioned study [13]. A trend for better periodontal health in participants taking calcium and vitamin D supplements was observed in a small cross-sectional study (51 participants) [68, 69]. However, further studies are necessary as there is insufficient evidence to recommend an appropriate dose of calcium and vitamin D.

      Similar to potassium, the evidence for phosphorus is equivocal as 2 studies reported no evidence, whereas one did [61]. It could be argued that because of phosphate’s importance in calcium metabolism, phosphorus deserves more attention.

      Saliva

It would perhaps be logical to assume that an increase in, for example, calcium intake would result in an increase in salivary calcium via systemic means, thereby reducing risk to caries, erosive tooth wear, and potentially also periodontal disease. However, this does not appear to be the case as salivary calcium (approximately 24 mg calcium is secreted via saliva daily [70]) is directly related to the tightly controlled plasma calcium concentration with excess calcium being excreted via the kidneys rather than in saliva [71] – intake of a single dose of calcium (1,215 mg) had no effect on salivary and plasma calcium concentrations [72]. Therefore, saliva does not appear to be contributing to calcium (and phosphate) homeostasis. Furthermore, it must be noted that our understanding of the intra-oral pharmacokinetics of the macroelements, when administered topically, is still rather poor.

      Conclusions

      The macroelements calcium, potassium, sodium, phosphorus and chlorine are of vital importance to human life. Adequate daily intake of these elements is required to maintain a wide range of bodily functions. From an oral health perspective, calcium in particular but also phosphate play a predominant role in maintaining the teeth and their function. Inadequate calcium intake has also been linked to an increased severity of periodontal disease. The roles of sodium, potassium, and in particular chloride, in maintaining oral health, however, are largely unstudied but they appear to be of limited relevance.

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