I discuss the best and worst foods for gum inflammation and bad breath.

Yes, saturated fats produce an inflammatory response, and, yes, inflammation is “recognized as one of the key underlying etiologic [causal] factors in periodontal disease.” That could explain why moderating our intake of meat and dairy could “promote periodontal health,” but plant-based diets don’t just offer lower levels of saturated fat, cholesterol, and animal protein. They also have higher levels of complex carbohydrates, dietary fiber, vitamins, minerals, antioxidants, and phytochemicals. So, we don’t necessarily know what the mechanism is. Saturated fat intake is associated with the progression of periodontal disease, but, at the same time, dietary fiber intake may be protective. Either way, you don’t know until you put it to the test. 

As I discuss in my video Best Foods for Halitosis and Gingivitis, a randomized controlled trial investigated the effect of a dietary intervention on dental health. At seven months of age, more than a thousand infants were randomized, and about half were assigned to a low saturated fat and cholesterol intake to see if they get less heart disease when they grow up. They’re still just in their twenties, but, as children and adolescents, those randomized to the healthier diets ended up with better saliva production. The researchers had them chew on items like wax cubes, and those randomized since infancy to the better diet produced more saliva. “Saliva is essential for the maintenance of oral health,” for example, clearing out sugar and acid faster from our teeth. The researchers “believe that the greater increase of salivary flow was due to the greater intake of fibre-rich food items like grains, vegetables, fruit and berries requiring more chewing which in turn is known to increase salivary flow rate,” that is, saliva production. Is it possible the subjects’ bodies were just used to putting out more saliva? “In other words…in addition to general health benefits, dietary fibre may have benefits on oral health as well,” but it might not necessarily be the fiber itself but simply the act of chewing. 

That reminds of me of another study I review in my video, in which a single high-fiber meal was able to reduce bad breath for hours. Halitosis is caused by gaseous sulfur compounds that are produced by a certain type of bacteria concentrated on the back of our tongue. When we eat, the reason bad breath gets better may be “due to the ‘self-cleaning’ of the mouth while chewing food.” So, it makes sense that foods that need to be chewed more intensively have a stronger self-cleaning effect on the back of our tongue than foods that require less chewing, but you don’t know until you put it to the test.  

Study subjects ate two very similar meals: One had a whole–grain roll, a raw apple, and jam, so there was more fiber and more chewing, while the other meal had white bread, jelly, and cooked apples, so less fiber and less chewing. Then, the researchers measured the halitosis compounds in the participants’ breath at two hours after the meal and then again at eight hours. Bad breath levels dropped even after the low-fiber meal, but they dropped significantly more after the higher-fiber meal and stayed down even eight hours later, as you can see in the graph below and at 2:38 in my video. 

The reason a high-fiber diet may improve periodontal disease may be the fiber, the lower saturated fat intake, or just the chewing—or perhaps another possibility. Maybe it’s the nitrate-containing vegetables. We know “the ingestion of dietary nitrate”—in the form of greens and beets—“has been proven to exert many beneficial and clinically relevant effects on the general health,” including maintaining good blood flow and reducing inflammation in general. So, might improved circulation to the gums and anti-inflammatory effects benefit periodontal patients?  

Let’s find out. A randomized, double-blind, placebo-controlled clinical trial investigated the repeated consumption of lettuce juice? Why lettuce juice? That sounds so unappealing! Not to worry, though. “To improve patient acceptance,” the lettuce juice and the placebo juice were seasoned with a chamomile-honey flavor and sweetened with an artificial sweetener. (That sounds even worse!)

But, the lettuce juice concoction worked. “This clinical intervention trial demonstrated an attenuating effect of dietary nitrate on gingival inflammation.” You can see the results graphically below and at 4:00 in my video. In the placebo group, most of their teeth (about 60 percent) had no gingivitis, but 40 percent did have mild gingivitis and there was almost no moderate gingivitis. After drinking placebo lettuce juice for two weeks, there was no real change, as you might expect. In the lettuce group, they started out a bit worse; about half of their teeth had mild or moderate gum disease. But, then, after two weeks of actual lettuce juice, there were significant improvements. There was no more moderate disease, the mild disease rates were cut in half, and three-quarters of their teeth had no gingivitis at all. 

The researchers concluded that their “findings suggest that the ingestion of dietary nitrate,” such as from greens and beets, “may be a clinically useful adjunct in the control of chronic gingivitis in periodontal recall patients.” They may be useful for controlling other chronic diseases, too. What’s good for the mouth—not smoking and eating a healthier diet, for instance—is good for the rest of our body. Many dental professionals, who may see their patients more frequently than do physicians, should be counseling them on living more healthfully. And, indeed, in one study surveying dental hygienists, “[n]early all (95%) felt that dental hygienists have a role in helping patients improve nutrition,” yet that’s not what happens at all. When a group of patients were asked, less than one in ten said they got dietary advice from their dental professionals. Why? Because “although dentists were motivated to include nutrition in their clinical care, most felt unqualified to provide dietary guidance and thus shied away from doing so.” That never stopped physicians!  

But it’s true. Nutrition is neglected in dental school, just like in medical school, and, “in most cases, courses in nutrition education were taught by biochemists, and only a few individuals (hired part-time or on an ad hoc basis) had training in applied nutrition.” It’s really not rocket science, or is it? Get it? (Rocket is another name for arugula, an excellent source of dietary nitrite!) Dietary nitrate is hard to “beet!” 

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Plant-based diets are put to the test in the treatment of periodontal disease.

How does nutrition affect periodontal disease? First, what is it? “Periodontal disease is a bacterial infection that results in inflammatory destruction of the connective tissue and bone that support the teeth.” As such, it is therefore one of the leading causes of our teeth falling out. Like most infections, though, the way in which our body responds may play a critical role. The presence of bacteria is the primary cause, but a susceptible host is necessary to initiate disease. 

The standard explanation of periodontal disease is the plaque theory, which posits that the buildup of plaque leads to gingivitis or gum inflammation, which then leads to periodontitis or inflammation lower down beneath the gums. But, in some forms of periodontal disease, plaque doesn’t appear to play a critical role. There has been more interest in the last few years in the importance of systemic health, our body’s response. In this respect, nutrition may be of great importance because it’s been implicated in a number of other inflammatory diseases, all of which carry elevated periodontal disease risk. 

Traditionally, when we think of the effects of nutrition on dental diseases, we’re only thinking about cavities. But what about the role of diet in periodontal disease? There has been less research, but if it’s about inflammation, one would expect diets rich in saturated fat to make things worse, increasing oxidative stress as well as inflammation. So, we may want to cut down on saturated fat, but let’s not just speculate. Is there an association between cholesterol levels and periodontitis? If not, it would be hard to implicate saturated fat. In fact, there does appear to be a link. Those with high cholesterol do appear to have up to double the risk. 

So, what about periodontal conditions in vegetarians? A hundred vegetarians versus non-vegetarians were studied, and those eating vegetarian had “better periodontal conditions (less inflammation signs, less periodontal damage, and better dental home care).” It should be considered, however, that vegetarians may not just be avoiding meat but may also be healthier in other ways, like practicing better dental care. 

Do people who eat more saturated fat get more periodontitis? Yes, in one study, participants had double the risk at the highest levels of saturated fat intake. That was a study in Japan, where they eat less than half the meat and dairy than do Americans in the United States. The only way to know for sure, though, is to do an interventional trial where you change people’s diets and see what happens. And, researchers did just that and found that bone loss was indeed magnified by a diet high in saturated fat and cholesterol—at least in the rats they studied. 

 In my video How to Treat Periodontitis with Diet, I talk about the kind of study that I was looking for. Its title kind of ruins the suspense: “A High-Fiber, Low-Fat Diet Improves Periodontal Disease Markers” in terms of probing depth, clinical attachment loss, and bleeding on probing—all of the standard measures. And, of course, eating a healthier diet also improves body weight, blood sugar control, and systemic inflammation, but that complicates matters. Maybe people’s mouths got better just because they lost so much weight.  

Researchers have shown that you can improve periodontal disease with bariatric surgery, such as stomach stapling. After eight weeks on a diet, the study participants went back on their regular diet and gained back most of that weight. But, the periodontal disease improvements persisted, suggesting that it was more than just the weight loss that lead to the improvements. Might the high-fiber diet have altered their good gut flora or perhaps their oral flora? What exactly was going on? 

German researchers took 20 women with mild to moderate chronic periodontitis and, for a year, tried to transition their diets towards more wholesome nutrition. This meant more plant foods, more whole foods, more fresh foods—trying to center their diets around vegetables, fruits, whole grains, potatoes, and legumes (beans, split peas, chickpeas, and lentils). After 12 months, the patients showed a significant reduction of probing pocket depth and gingival inflammation. And, for the first time, the researchers measured decreased concentrations of inflammatory chemicals inside the crevice between the tooth and gums. These chemicals, which are thought to be responsible for the tissue destruction in periodontal disease, decreased by as much as 75 percent. And all the while, their oral hygiene status didn’t change, suggesting it was the diet that did it. But what was missing here? A control group. Nevertheless, there’s never been any randomized, double-blind, placebo-controlled trials of diet for periodontal disease until now, which I’ll cover next. 

You can also watch my video Best Foods for Halitosis and Gingivitis.

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