Volume 9 • 2022 • Issue 2

In medicine, we’ve seen the huge impact diet and nutrition have on the prevention of diseases, includingheart disease and cancer, I want to see the same impact in dentistry. in a cycle of sugar cravings where I’d eat it and feel energized only to later crash and want more.” After the initial challenges, he felt better and had increased concentration. His chronic tonsillitis also went away. “In medicine, we’ve seen the huge impact diet and nutrition have on the prevention of diseases, including heart disease and cancer,” says Dr. Wölber. “I want to see the same impact in dentistry.” The History of Food Highly processed foods and refined sugars have become normalized in the diets of much of the world. Dr. Wölber talks to his patients about the history of food to make it clear that there are other ways to eat. “I ask them to think about what humans ate for most of human history,” he says. “Those things that were available in the natural environment. Fruits, vegetables, greens, nuts, water, maybe occasionally meat.” The Neolithic revolution, when people started living in villages and growing crops, saw a transition away from hunter-gatherer diets toward less varied diets based on grains. Anthropological evidence suggested that humans who lived in villages and towns were less healthy than those who lived a hunter-gatherer lifestyle and their life spans were shorter. “The industrial revolution completely changed how food was produced and what we ate,” says Dr. Wölber. “Now the average German eats 36 kilograms of sugar a year.” The effects of an industrialized diet have been profound for human health and the environment. “According to the World Health Organization, in most of the world, obesity kills more people than starvation,” he says. But Dr. Wölber is hopeful that more people have been thinking critically about food and nutrition in the past few decades. “People are asking questions about the environmental toll of eating meat or the carbon consequences of their food,” he says. “More people are learning about the health implications of their dietary choices.” He believes that dentistry has an opportunity to improve oral health and contribute to the overall health of patients by understanding and communicating how diet affects our mouths. What Does the Research Show? In a small randomized controlled trial (RCT), Dr. Wölber and colleagues had an experimental group eat a diet low in carbohydrates, rich in omega-3 fatty acids, vitamin C and D, antioxidants and fibre for four weeks. 2 During the trial, participants did not floss or use other interdental tools. Plaque index, gingival bleeding, probing depths, and bleeding upon probing were assessed before the trial to determine a baseline and then tested each week during the experiment. Both the control and experimental groups had constant plaque values. In the experimental group, inflammatory parameters fell by half. “We were surprised that the impact was so strong,” says Dr. Wölber. “It also refuted the expectation that plaque causes inflammation. Ever since Löe et al. in 1965 found that when people discontinue oral hygiene, plaque builds up and then inflammation increases, we’ve assumed that plaque was the culprit. In both our study and the Swiss one, plaque was stable or increased, yet inflammation decreased.” In a study published in 2018, Dr. Wölber and colleagues had 11 participants wearing enamel slabs suck on 10g of sucrose each day for three months. 3 When they tested oral biofilm samples, they found that the biodiversity of bacteria decreased and the abundance of non-mutans streptococci increased. Enamel roughness increased. “This supported the extended ecological plaque hypothesis,” says Dr. Wölber. “This is the idea that a shift in the environment of the mouth— frequent fermentable carbohydrate availability—results in a change in the biome that increases the number of keystone pathogens that cause oral disease.” Later, Dr. Wölber and colleagues tested the optimal oral health diet among a small population of people who suffered from gingivitis with another RCT. 4 Again, there was significant reduction in gingival bleeding among the experimental group. “This showed that an anti-inflammatory diet was able to reduce gingival inflammation in a clinically relevant range,” says Dr. Wölber. “The people in our experimental group also had increased vitamin D serum levels and lost weight.” 35 Issue 2 | 2022 | Issues and People