Volume 9 • 2022 • Issue 2

Many fats promote inflammation, including saturated fats, trans fat, and omega-6 fatty acids that are often found in industrial meat, animal products and common vegetable oils. “Hunter gatherers had a 1:1 ratio of omega-6 to omega-3 fatty acids,” says Dr. Wölber. “Modern humans tend to have a 16:1 ratio.” To increase omega-3 fatty acids in the diet, he recommends seafood, nuts and seeds. “I take oil derived from marine algae,” he says. An increase in omega-3 fatty acids in the diet can decrease periodontal inflammation. Plant-proteins reduce the risk of some of the chronic diseases related to inflammation, such as cardiovascular disease and diabetes. Some European dietary guidelines suggest reducing meat consumption to 500 grams a week. A study that compared vegetarian and non-vegetarians found that vegetarians had better periodontal health. Dr. Wölber says that vegetarians should supplements with B12 vitamins, because low serum levels of B12 are associated with a higher risk of periodontal lesions. Two clinical studies have found that eating fruits high in vitamin C reduce gingival and periodontal inflammation. 8,9 A study of synthetic vitamin C tablets found no effect compared to placebo. “Vitamins seem to act differently, more effectively, when they are in fruit form along with other phytochemicals and enzymes,” says Dr. Wölber. “I also like the studies where people eat two kiwis a day or two bell peppers, because a dietary change like that is easy for a patient to achieve.” Vitamin D is important in calcium absorptions and bone metabolism. “Vitamin D deficiency is common in places References: 1. Baumgartner S, Imfeld T, Schicht O, Rath C, Persson RE, Persson GR. The impact of the stone age diet on gingival conditions in the absence of oral hygiene. J Periodontol. 2009 May;80(5):759-68. 2. Wölber JP, Bremer K, Vach K, König D, Hellwig E, Ratka-Krüger P et al. An oral health optimized diet can reduce gingival and periodontal inflammation in humans — a randomized controlled pilot study. BMC Oral Health. 2016 Jul 26;17(1):28. 3. Anderson AC, Rothballer M, Altenburger MJ, Wölber JP, Karygianni L, Lagkouvardos I, et al.. In-vivo shift of the microbiota in oral biofilm in response to frequent sucrose consumption. Sci Rep. 2018 Sep 21;8(1):14202. 4. Wölber JP, Gärtner M, Breuninger L, Anderson A, König D, Hellwig E et al.. The influence of an anti-inflammatory diet on gingivitis. A randomized controlled trial. J Clin Periodontol. 2019; DOI: 10.1111/jcpe.13094 5. Tennert C, Reinmuth AC, Bremer K, Al-Ahmad A, Karygianni L, Hellwig E et al.. An oral health optimized diet reduces the load of potential cariogenic and periodontal bacterial species in the supragingival oral plaque: A randomized controlled pilot study. Microbiologyopen. 2020 Aug;9(8):e1056 6. Kruse AB, Kowalski CD, Leuthold S, Vach K, Ratka-Krüger P, Wölber JP. What is the impact of the adjunctive use of omega-3 fatty acids in the treatment of periodontitis? A systematic review and meta-analysis. Lipids Health Dis . 2020 May 21;19(1):100. 7. Bartha V, Exner L, Schweikert D, Wölber JP, Vach K, Meyer AL et al.. Effect of the Mediterranean diet on gingivitis: A randomized controlled trial. J Clin Periodontol . 2022 Feb;49(2):111-122. 8. Widén C, ColemanM, Critén S, Karlgren-Andersson P, Renvert S, Persson GR. Consumption of bilberries controls gingival inflammation. Int J Mol Sci . 2015 May 11;16(5):10665-73. 9. Graziani F, Discepoli N, Gennai S, Karapetsa D, Nisi M, Bianchi L, et al. The effect of twice daily kiwifruit consumption on periodontal and systemic conditions before and after treatment: A randomized clinical trial. J Periodontol . 2018 Mar;89(3):285-93. 10. Jockel-Schneider Y, Goßner SK, Petersen N, Stölzel P, Hägele F, Schweiggert RM, et al. Stimulation of the nitrate-nitrite-NO-metabolism by repeated lettuce juice consumption decreases gingival inflammation in periodontal recall patients: a randomized, double-blinded, placebo-controlled clinical trial. J Clin Periodontol . 2016 Jul;43(7):603-8. like Canada,” says Dr. Wölber. Higher levels of vitamin D is inversely correlated with tooth loss and attachment loss. Plant nitrates have health benefits, especially on inflammatory processes and hypertension. A study by Jockel-Schneider et al. showed that a daily dose of 300 mL of lettuce juice, which contains 200 mg of plant nitrates, significantly reduced gingival inflammation. 10 Real Life Implementation “Dentists have a great opportunity to share this kind of knowledge with their patients during a long and engaged relationship based on supporting patient health,” Dr. Wölber says. He knows that dietary change is a process, and it can be difficult to go against cultural norms. When asked how he approaches his own diet, Dr. Wölber says he is a flexitarian. “At home, we eat plant-based whole foods,” he says. “But if I’m at a dinner party, I’ll eat a sausage if it is served.” Dr. Wölber has two young children, which has given him a new point of view on the relationship between food culture and health. “We give them healthy food at home, but we don’t forbid them from eating cake or other foods when they are outside our home,” he says. “Sometimes when you forbid something, it becomes very attractive.” Dr. Wölber says during the 1970s and ’80s, there was a successful public health campaign in Sweden to encourage kids to only eat candy on Saturdays. “It encouraged moderation, which I think makes sense for all of us,” he says. 37 Issue 2 | 2022 | Issues and People