Antioxidants and their vital significance in periodontal health

Carbohydrates

Consumption of sugar has long been known to be the primary cause of plaque development. Because sugars are fermented by bacteria and produce acid, which demineralizes the tooth structure, they are linked to dental caries and periodontal disease. One artificial sweetener that is used in place of regular sugars is xylitol, a sugar alcohol that is created when xylose sugar is hydrogenated. Against periodontal pathogens like Porphyromonas gingivalis and Aggregatibacter, it might have an antibacterial effect. Hence, a reduction of sugar intake, coupled with scaling, root planing, and the use of xylitol- and maltitol-containing gums, have the potential to improve the periodontal health of the general population.^[5]

Vitamin C

It is discovered that vitamin C is in the aqueous phase and is a strong antioxidant radical scavenger. A severe periodontal disease known as "scorbutic gingivitis," or "scurvy," is brought on by a severe vitamin C shortage and is characterized by inflammatory gingivitis, fast periodontal pocket formation, and attachment loss. With its quick intestine absorption, ascorbic acid is an important nutrient.^[6]

Certain cells, such as PMNLs, mononuclear cells, platelets, and endothelial cells, accumulate high concentrations of ascorbic acid.^[7] PMNLs and macrophages contain vitamin C concentrations that are 10–40 times higher than those in the plasma. It has been thought that the high ascorbic acid levels in these cells contribute to their ability to respond to inflammatory stimuli and phagocytic ability of neutrophils.^[8] Vogel and Wechsler reported that the everyday intake of vitamin C in a group of periodontitis patients studied was considerably less than that in the control group.^[9] The daily recommended dietary allowance (RDA) for women was raised to 75 mg and for males to 90 mg. According to Levine et al., consuming 200 mg of vitamin C per day from a variety of fresh fruits and vegetables is the recommended consumption.^[10]

Vitamin D

There is little data indicating a connection between periodontal health and vitamin D and calcium. According to certain research, people with osteoporosis experience a greater loss of periodontal bone.^[11]

Due to its ability to suppress immune cell cytokine expression and induce the release of potently antibiotic-effecting molecules from monocytes and macrophages, vitamin D is recognized to be important for maintaining calcium and bone homeostasis as well as acting as an anti-inflammatory drug. It is true that a vitamin D deficiency may raise the risk of contracting infectious infections. Therefore, in addition to its direct effects on bone metabolism, vitamin D is helpful in the treatment of periodontitis.^[12]

When it comes to vitamin D, the National Osteoporosis Foundation advises persons under 50 to take 400–800 IU of the vitamin once a day and those over 50 to take 800–1000 IU.^[13]

Flavanoids

Polyphenolic substances are called flavonoids. Their functions include anti-tumor, anti-inflammatory, anti-allergic, antiplatelet, and antioxidant. Additionally, they exhibit bacterial collagenase inhibitory properties. It has also been demonstrated that flavonoids and vitamin C work synergistically.^[14] Foods high in flavonoids can prevent blood vessels from rupturing or leaking. They also aid in preventing the body's excessive inflammation and shield cells from oxygen damage. Green tea, one of the most widely consumed drinks in the world, is the most well-known flavonoid. It contains up to 1 g of "catechins," which are flavonoids. Green tea catechins, including (-) epigallocatechin gallate, have been shown in a number of in vitro experiments to suppress periodontal pathogens and stop the degeneration of periodontal tissue. With 157 mg of flavonoids per day, tea was shown to be the most significant source, particularly for flavan-3-ols and flavonols. The majority of supplements available for sale have doses (daily) ranging from 30 to 200 mg, which is suitable for everyday maintenance.^[15], ^[16]

Carotenoids

Carotenoids are a group of pigments that occur naturally in the body and include alpha-, beta-, crytoxanthin, lutein, lycopene, and zeanxantin. They possess antioxidant properties and safeguard the vitamins C and E. Additionally, by scavenging reactive nitrogen species, they exhibit synergistic effects. The primary dietary source of provitamin A is β-carotene. Because of their profound effects on other antioxidants, carotenoids are regarded as essential components of antioxidant defense systems. In a homogeneous group of Western European men, Linden et al. evaluated the relationship between periodontal health and the serum levels of several antioxidants, such as carotenoids, retinol, and vitamin E. The authors observed that there was a higher prevalence of periodontitis in these patients who had low serum levels of several carotenoids, specifically β-cryptoxanthin and β-carotene.^[17]

It has been discovered that lycopene is one of the most potent antioxidants among all the carotenoids. There is a correlation between congestive heart failure risk and periodontitis, and in patients with periodontitis, high lycopene consumption considerably modifies this relationship. Additionally linked to malondialdehyde, a crucial indicator of oxidative stress, lycopene has been shown to dramatically lower stress levels. One of the main types of carotenoids is vitamin A. Each person's RDA for vitamin A is different.^[18]

The recommended daily allowance (RDA) for babies is 400 μg for ages 0–6 months and 500 μg for ages 7–12 months. The RDA for children is 400 μg/day. The RDA for adult females is 700 μg/day, and for adult men, it is 900 μg/day. The recommended allowance for breastfeeding women is approximately 1300 μg/day, whereas for pregnant women, it is up to 770 μg/day.^[19]