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ORIGINAL ARTICLE
Year : 2022  |  Volume : 12  |  Issue : 3  |  Page : 153-156

Comparative Evaluation of Periodontal Health in Vegetarians and Nonvegetarians – A Cross-Sectional Study


1 Department of Periodontology, Haldia Institute of Dental Sciences & Research, Haldia, West Bengal, India
2 Department of Prosthodontics and Crown and Bridge, Haldia Institute of Dental Sciences & Research, Haldia, West Bengal, India
3 Medinipur, West Bengal, India

Date of Submission02-Apr-2022
Date of Decision27-Apr-2022
Date of Acceptance10-May-2022
Date of Web Publication3-Oct-2022

Correspondence Address:
MDS Swet Nisha
Associate Professor, Department of Periodontology, Haldia Institute of Dental Sciences & Research, Haldia, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnpnd.ijnpnd_12_22

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Keywords: Diet, nutrition, oral hygiene index, periodontitis, periodontium, vegetarian, vegetarian diet


How to cite this article:
Roy Chowdhury M, Sunari Rajaram S, Kumar Sen U, Roy Mahapatra A, Nisha S. Comparative Evaluation of Periodontal Health in Vegetarians and Nonvegetarians – A Cross-Sectional Study. Int J Nutr Pharmacol Neurol Dis 2022;12:153-6

How to cite this URL:
Roy Chowdhury M, Sunari Rajaram S, Kumar Sen U, Roy Mahapatra A, Nisha S. Comparative Evaluation of Periodontal Health in Vegetarians and Nonvegetarians – A Cross-Sectional Study. Int J Nutr Pharmacol Neurol Dis [serial online] 2022 [cited 2022 Dec 8];12:153-6. Available from: https://www.ijnpnd.com/text.asp?2022/12/3/153/357248




   Introduction Top


Periodontal inflammation is multifactorial in origin. Nutrition plays an important role in the maintenance of periodontium. The biofilm that accumulates on tooth surfaces and oral tissues can penetrate deep into connective tissue and initiates host responses. The immune response to microbial insult depends on various factors such as the patient’s immunity, microbial colonization, and the presence of systemic diseases. The diet plays a significant role in immune response and both directly and indirectly affects periodontium.[1] The micro- and macronutrients affect the inflammatory process and antioxidant and oxidant balance.

Morzel et al. suggested an association between food consumption and saliva composition and regulation of immune responses.[2] This study illustrated the dietary influence on saliva that affects overall periodontal health. The link between nutrition and periodontal health is being suggested in the literature and Van der Velden et al. stressed micronutrients and their positive effect on periodontal health.[3] Santonocito et al. reviewed dietary factors and their influence on periodontal health and suggested that nonvegetarian proteins and vitamins may increase periodontal inflammation.[4]

The vegetarian diet comprises a plant-based diet, and meat and poultry are eliminated. It can be further divided into lacto vegan (only plant-based and dairy supplies), lacto-ovo vegan (plant, dairy, and egg-based diet), and pesco-vegetarian (plant, dairy, egg, and fish).[5] The influence of a vegetarian diet on periodontal health needs special consideration as very few interventional or association studies are present to understand vegetarian dietary effects. The present study aims to compare vegetarian and nonvegetarian dietary effects on periodontal health.


   Materials and Methods Top


This was a prospective study conducted at the Periodontology Department of Haldia Institute of Dental Sciences and Research, Haldia from December 2020 to November 2021. The study was approved by the ethical committee of the institution and written consent was obtained from the participants. A total of 240 subjects were included in this study. They were divided into two groups. Group 1 consisted of 120 subjects with a vegetarian diet and Group 2 had 120 subjects with a nonvegetarian diet. Both the groups were age and gender matched. Inclusion criteria were 1) subjects with at least 20 teeth and 2) on a vegetarian diet for more than 2 years (Group 1). Exclusion criteria were 1) any systemic disease, 2) pregnancy, lactating mother, 3) previous drug abuse, and 4) smoker.

The periodontal examination included the following:
  1. Measurement of probing pocket depth – WHO periodontal probe was used.
  2. Gingival recession.
  3. Clinical attachment loss.
  4. Bleeding on probing.[6]
  5. Periodontal screening index (PSI) was obtained.[7] In addition, tooth mobility degree and furcation involvement were measured.
  6. Oral hygiene index was assessed.[8]


Dental examination

This included the presence of dental restorations, caries, crowns, and missing teeth. The index for decayed, missing, and filled teeth and surfaces was evaluated.[9]

Questionnaire

An interviewer–administered questionnaire was used to gather the information related to demographic details, diet, oral habits, and dental visits duly from the subjects.

Statistical analysis

The sample size was calculated based on the previous study by Staufenbiel et al.[10] The power of 80% showed a sample size of 100, and considering an attrition rate of 20%, a final sample size of 120 subjects in each group was considered. The data were analyzed in SPSS 22.0 for Windows (SPSS, Chicago, IL, USA). The data were expressed in mean and standard deviation for all parameters. The Mann–Whitney U test was used for intergroup comparison.


   Results Top


A total of 240 subjects were enrolled in this study, and the demographic details are illustrated in [Table 1]. A total of 200 patients, 120 vegetarians (65 female and 55 male) with a mean age of 42.12 ± 15.1 years and 120 nonvegetarians (65 female and 55 male) with a mean age of 41.23 ± 12.13 years were enrolled in this study.
Table 1 Demographic details

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Periodontal parameters

All the periodontal parameters were expressed as mean and standard deviation [Table 2]. Vegetarians had significantly lower bleeding on probing, probing pocket depth, plaque index, PSI, and oral hygiene index (P < 0.05) as compared to nonvegetarian groups. However, clinical attachment loss, gingival recession, and the number of mobile teeth had insignificant differences between the two groups.
Table 2 Clinical periodontal parameters

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Dental examination

DMF-T, DMF-S, DT, MT, and FT were expressed in mean and standard deviation. No significant difference was seen among groups in terms of decayed, missing, and filled teeth [Table 3].
Table 3 Dental parameters

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Questionnaire

Group 1 had a higher frequency of oral hygiene maintenance procedures as compared to Group 2 (P < 0.05). Dental visits more than twice were statistically significant between the groups with more dental visits seen in Group 2 than in Group 1 [Table 4]. No oral habit was noted among subjects in both groups. The mean duration of the vegetarian diet in the vegetarian group was 33.1 ± 5.32.
Table 4 Questionnaire analysis

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   Discussion Top


The present study attempted to understand the effect of a vegetarian diet on periodontal health. The rationale of the present study was based on nutrition-based studies and their influences on the periodontium. Limited research regarding the vegetarian diet and periodontal parameters is present to understand its true picture. In the present study, a vegetarian diet meant only a plant-based diet and dairy product intake. The null hypothesis was that no association exists between a vegetarian diet and periodontal parameters. To eliminate any differentiation in relation to diet, Vaishnav populations were considered in this study under Group 1. Studies have demonstrated the effect of a vegetarian diet on systemic diseases such as diabetes and cancer.[11] A vegan diet has conferred a lower incidence of cancer and ischemic heart diseases.

The strength of the present study is adequate sample size consideration. Periodontal parameters were considered like the PSI; the oral hygiene index was considered unlike previous publications where only bleeding on probing was calculated.

In this study, for the first time, the correlation between a vegetarian diet and periodontal health among the Indian population is being studied. Bleeding on probing was less in a vegetarian diet as compared to nonvegetarian diet. This is in accordance with the study by Staufenbiel et al.[12] Linkosalo et al. also demonstrated lower bleeding on probing as compared to the control group in vegetarians.[13] It can be attributed to lower inflammation seen in vegetarians; a study by Laffranchi et al. showed that vegetarians have more physical activity and high metabolism and less body mass index leading to better oxidative stress management.[14]

Periodontal inflammation is a chronic inflammation, and various risk factors are associated with the disease. However, the immune response of the host is an important aspect to be considered and in vegetarians the local inflammatory response is less.[15] When we consider the diet intake in vegetarians, it comprises dairy products such as cow milk, fruits and nuts, and vegetables having a higher number of antioxidants, which improve immune response.

Plaque scores were lower in vegetarians suggesting better oral hygiene measures by vegetarians. This can be attributed to the high fiber diet consumption, which causes less food accumulation and biofilm accumulation.[16] Periodontal scores revealed lower PSI among vegetarians, and similar findings were reported by Alewaeters et al.[17] This might be due to lower plaque scores and better oxidative balance seen in vegetarians. Consumption of a diet containing meat can cause an accumulation of fibers in interdental areas. Oral hygiene measures like flossing can help reduce inflammation in interdental areas. In the present study, very few subjects were using floss. Smits et al. in their systematic review of the vegetarian diet and its influence on dental health suggested that there lies an association between a vegetarian diet and oral conditions.[18]

A dental examination showed no significant difference in Decayed, Missing and Filled Teeth (DMFT) scores among vegetarians and nonvegetarians. This is in contrast to the study by Sherfudhin et al. in which higher DMFT, dental erosion, and malocclusion were observed in the Indian population.[19]

Allen et al. suggested an incidence of less cancer in vegan subjects as compared to non-vegan. Insulin-like growth factor 1 expression was reduced in cancer subjects.[20]

Jenzsch et al. studied the immunological and microbiological aspects of nutritional interventions in periodontal disease and highlighted the importance of a balanced diet and its benefits on the periodontium.[21] A vegan diet is a balanced diet and this study also supports the positive influence of balanced diet on the periodontium. A study by Rajaram et al. suggested that diet rich in omega 3 fatty acids, antioxidants, fiber and ascorbic acid can reduce gingival inflammation.[22] A vegetarian diet comprises all these elements in high quantity except for omega 3 fatty acids, which are present mainly in fish. A balanced diet can help in reducing inflammatory load and maintaining good periodontal health.

The limitation of the present study is the presence of confounding factors that were not possible to completely eliminate in this study. Though subjects were matched in relation to age and gender, other oral habits and past history of smoking and its long-term effect on periodontium were not considered. Also, no measurement of oxidative stress or any inflammatory markers was done to understand the amount of inflammatory load in both the groups. Nutrition-based studies are not only regarding the dietary intake but they also reflect the overall lifestyle of an individual. Vegetarians consume less tobacco and alcohol than nonvegetarians.


   Conclusion Top


A vegetarian diet has a positive association with periodontal health. Incorporation of a diet containing dairy products, fruits and nuts, and vegetables can help in reducing inflammation and initiating less periodontal damage. Vegetarians have better oral hygiene maintenance that can help in preventing periodontal disease and other oral conditions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Dommisch H, Kuzmanova D, Jönsson D et al. Effect of micronutrient malnutrition on periodontal disease and periodontal therapy. Periodontol 2000 2018;78:129–53.  Back to cited text no. 1
    
2.
Morzel M, Truntzer C, Neyraud E et al. Associations between food consumption patterns and saliva composition: specificities of eating difficulties children. Physiol Behav 2017;173:116–23.  Back to cited text no. 2
    
3.
Van der Velden U, Kuzmanova D, Chapple I. Micronutritional approaches to periodontal therapy. J Clin Periodontol 2011;38:142–58.  Back to cited text no. 3
    
4.
Santonocito S, Polizzi A, Palazzo G, Indelicato F, Isola G. Dietary factors affecting the prevalence and impact of periodontal disease. Clin Cosmet Investig Dent 2021;13:283–92.  Back to cited text no. 4
    
5.
Olfert MD, Wattick RA. Vegetarian diets and the risk of diabetes. Curr Diab Rep 2018;18:1–6.  Back to cited text no. 5
    
6.
Löe H. The Gingival Index, the Plaque Index and the Retention Index Systems. J Periodont 1967;38:610–6.  Back to cited text no. 6
    
7.
Landry RG, Jean M. Periodontal Screening and Recording (PSR) Index: precursors, utility and limitations in a clinical setting. Int Dent J 2002;52:35–40.  Back to cited text no. 7
    
8.
Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc 1964;68:7–13.  Back to cited text no. 8
    
9.
World Health Organization. Oral Health Surveys: Basic Methods. 4th ed. Geneva: World Health Organization; 1997.  Back to cited text no. 9
    
10.
Staufenbiel I, Weinspach K, Forster G, Geurtsen W, Gunay H. Periodontal conditions in vegetarians: a clinical study. Eur J Clin Nutr 2013;67:836–40.  Back to cited text no. 10
    
11.
Dinu M, Abbate R, Gensini GF, Casini A, Sofi F., Vegetarian, vegan diets and multiple health outcomes: a systematic review with meta-analysis of observational studies. Crit Rev Food Sci Nutr 2017;57:3640–9.  Back to cited text no. 11
    
12.
Staufenbiel I, Adam K, Deac A, Geurtsen W, Gunay H. Influence of fruit consumption and fluoride application on the prevalence of caries and erosion in vegetarians–a controlled clinical trial. Eur J Clin Nutr 2015;69:1156–60.  Back to cited text no. 12
    
13.
Linkosalo E, Syrjanen S, Alakuijala P. Salivary composition and dental erosions in lacto‐ovo‐vegetarians. Proc Finn Dent Soc 1988;84:253–60.  Back to cited text no. 13
    
14.
Laffranchi L, Zotti F, Bonetti S et al. Oral implications of the vegan diet: observational study. Minerva Stomatol 2010;59:583–91.  Back to cited text no. 14
    
15.
Orlich MJ, Jaceldo‐SieglK, Sabate J, Fan J, Singh PN, Fraser GE. Patterns of food consumption among vegetarians and non‐vegetarians. Br J Nutr 2014;112:1644–53.  Back to cited text no. 15
    
16.
Herman K, Waszkiewicz CA, Zajac KM, Dobrzynski M. Assessment of the influence of vegetarian diet on the occurrence of erosive and abrasive cavities in hard tooth tissues. Postepy Hig Med Dosw 2011;65:764–9.  Back to cited text no. 16
    
17.
Alewaeters K, Clarys P, Hebbelinck M, Deriemaeker P, Clarys JP. Cross‐sectional analysis of BMI and some lifestyle variables in Flemish vegetarians compared with non‐vegetarians. Ergonomics 2005;48:1433–44.  Back to cited text no. 17
    
18.
Smits KPJ, Listl S, Jevdjevic M. Vegetarian diet and its possible influence on dental health: a systematic literature review. Community Dent Oral Epidemiol 2020;48:7–13.  Back to cited text no. 18
    
19.
Sherfudhin H, Abdullah A, Shaik H, Johansson A. Some aspects of dental health in young adult Indian vegetarians. A pilot study. Acta Odontol Scand 1996;54:44–8.Sherfudhin H, Abdullah A, Shaik H, Johansson A. Some aspects of dental health in young adult Indian vegetarians. A pilot study. Acta Odontol Scand. 1996 Feb;54(1):44-8  Back to cited text no. 19
    
20.
Allen NE, Appleby PN, Davey GK, Kaaks R, Rinaldi S, Key TJ. The associations of diet with serum insulin-like growth factor I and its main binding proteins in 292 women meat-eaters, vegetarians, and vegans. Cancer Epidemiol Prev Biomark 2002;11:1441–8.  Back to cited text no. 20
    
21.
Jenzsch A, Eick S, Rassoul F et al. Nutritional intervention in patients with periodontal disease: clinical, immunological and microbiological variables during 12 months. Br J Nutr 2009;101:879–85.  Back to cited text no. 21
    
22.
Rajaram SS, Nisha S, Ali NM, Shashikumar P, Karmakar S, Pandey V. Influence of a low-carbohydrate and rich in omega-3 fatty acids, ascorbic acid, antioxidants, and fiber diet on clinical outcomes in patients with chronic gingivitis: a randomized controlled trial. J Int Soc Prev Community Dent 2021;11:58–67.  Back to cited text no. 22
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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