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Perio Reports

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Perio Reports  Vol. 24, No. 11
Not all the summaries in this edition of Perio Reports are from current studies. The older works are included as classic studies or text books that still provide valuable information today.
Drs. Mellanby Discover the Health Impact of Vitamin D Deficiency

Both Edward and his wife, May, were physicians responsible for the discovery that vitamin D plays a key role in rickets. Over a period of 20 years, their research showed that a diet deficient of vitamin D resulted in poorly formed teeth. The rickets work began with children, but May noticed the impact of poor diet on the bones and teeth of dogs, so this became the research model used. Animal studies are quicker to show the influence of diet on tooth formation than human studies.

Dogs fed a diet of porridge developed rickets and poor enamel calcification. Adding cod liver oil to the diet prevented both these problems. This led to the discovery that lack of vitamin D caused both rickets and poor tooth development.

Chapter two of Dr. Edward Mellanby's book, Dental Structure and Disease, is based on the work of his wife, May Mellanby. In this chapter the role of Vitamin D in the calcification process of teeth is discussed and supported by numerous animal studies. The importance of a calcifying diet for the pregnant mother and the baby in its early months of life was stressed. White flour was one of the diets tested that showed very poor calcification of enamel. This introduced the concept that dental decay was not so much a problem of sugar and bacteria-causing decay after eruption, but that a diet based on wheat was deficient in vitamin D and led to poorly calcified enamel which could easily be broken down by the acids produced by bacteria's metabolism of sugar.
Clinical Implications: Prevention of dental caries begins with nutrition of the mother during pregnancy.

Mellanby, E.: Nutrition and Disease, The Interaction of Clinical and Experimental Work. London: Oliver and Boyd, 1934.
Weston Price on the Value of Traditional Diets

Weston Price was a dentist in Cleveland, Ohio, with a thriving dental practice and many published articles. Over the years, he observed changes in his patients - narrower dental arches, crowded teeth and more disease. With the financial means to travel, in the 1930s Dr. Price and his wife went to isolated regions of the world in search of healthy people to see what made them healthy. He found that their hunter-gatherer nutrition provided overall good health, long life and virtual immunity to dental disease. Dr. Price and his wife's travels took them to remote parts of Scotland, Switzerland, Canada, Alaska, Peru, Africa and Australia. In each of these areas they found similarly healthy and isolated populations following dietary traditions of many generations. They were not exposed to the processed food and farming those in urban areas were experiencing.

Most of the populations Dr. Price met in isolation subsided on what was available in their area, which was often meat or fish. The Swiss living in the Alps subsided on unpasteurized and cultured dairy products, especially cheese and butter. Gaelic people of the Outer Hebrides ate no dairy products but subsided on seafood. Eskimos ate almost 100 percent animal products. The Maori of New Zealand ate seafood along with fatty pork and a variety of fruit. When the foods were analyzed, they contained tenfold the amount of fat-soluble vitamins and four times the amount of water soluble vitamins found in Westernized foods. Dr. Price concluded that nutrition was the way to health and returning to more traditional diets was the answer.
Clinical Implications: Take into account the nutrition of your patients when evaluating their oral and general health.

Price, W.: Nutrition and Physical Degeneration. New York: Paul B. Hoeber, Inc., 1939.
Traditional Diet Improves Diabetic Health

As Australian Aborigines move from the bush to urbanized areas, the incidence of Type II diabetes increases. This is likely due to the dramatic changes they experience in diet and lifestyle. Aborigines are traditionally hunter-gathers, living off the land. Hunting on foot provides built-in exercise and the diet is one free from processed foods and low in calories.

Researchers at the University of Melbourne in Victoria, Australia tested the theory that diabetes in urbanized Aborigines could be reversed with a return to traditional hunter-gatherer lifestyle. Ten middle-age male Aborigines with diabetes from the Nowanjum Community in Derby, Western Australia were tested before and after spending seven weeks living as hunter-gathers in the bush of Northwestern Australia. A detailed food dairy was recorded for two of the seven weeks.

The 1,200-calorie daily diet consisted primarily of wild game (64 percent) but was low in fat (13 percent) due to the low-fat content of the wild animals. The men all steadily lost weight over the seven weeks, due to increased exercise and a low-calorie diet. Blood tests before and after the traditional lifestyle experiment showed marked reduction in fasting plasma triglycerides, glucose clearance and fasting plasma insulin levels.

The major metabolic abnormalities associated with Type II diabetes were either greatly improved or completely normalized in this group of male Aborigines, simply by returning to their traditional lifestyle. The higher caloric intake of processed foods and reduced exercise of urban life has proven to be a health risk for this group.

Clinical Implications: Three factors impact diabetic health: weight loss, lowfat diet and increased physical activity.

O'dea, K.: Marked Improvement in Carbohydrate and Lipid Metabolism in Diabetic Australian Aborigines After Temporary Reversion to Traditional Lifestyle. Diabetes 33:(6)596-603, 1984.
Paleo Diet Changes Gut Microflora – A Theory

Obesity is a complex condition implicated in several systemic diseases. Rates of both obesity and diabetes are alarmingly high today among those eating a Westernized diet that includes many processed foods. Fat is often identified as the culprit in obesity, but new evidence suggests it may actually be the flours, sugar and refined fats. Transition from the paleolithic diet to today's processed diet brought with it many health problems. People still eating diverse ancestral diets today with abundant whole foods and no processed foods seem to function well without the same levels of obesity and diabetes. A low-carbohydrate diet, one high in protein and fat, spontaneously decreases weight in a way that low-fat diets do not.

A theory suggested by Canadian researchers is that the gastrointestinal microbiota is influenced and changed by the modern processed grains and sugars. This theory suggests a parallel with the bacterial effects of flours and sugars on caries and periodontal disease. Just as refined carbohydrates provide a food source for acid-producing bacteria in the mouth, dropping the oral pH and creating an environment conducive to increasing numbers of acid producing bacteria, eating flours, sugars and processed foods produces an inflammatory microbiota in the upper gastrointestinal tract, encouraging obesity. Refined fats complicate this altered microflora by increasing systemic absorption of lipopolysaccharides.

A diet of grain-free whole foods with carbohydrate from cellular tubers, leaves and fruits might produce a gastrointestinal microbiota consistent with what our ancestors, the hunter-gathers, experienced.

Clinical Implications: Diet counseling should focus on the mouth and the digestive tract.

Spreadbury, I.: Comparison with Ancestral Diets Suggests Dense Acellular Carbohydrates Promote an Infammatory Microbiota, and May be the Primary Dietary Cause of Leptin Resistance and Obesity. Diabetes Metab Syndr Obes 5: 175-189, 2012.
Early Childhood Caries and Vitamin D Levels

Early childhood caries is often severe enough to require treatment in the hospital with general anesthesia. Early childhood caries can affect overall childhood health and well-being.

Researchers at the University of Manitoba, in Winnipeg, Canada, wanted to know if there was a difference between vitamin D levels in children suffering from early childhood caries and caries-free children. This pilot study took place in Southern Manitoba and included 38 children six years of age or younger. The 19 test subjects were recruited from those receiving treatment for early childhood caries. An age- and gender-matched group of 19 caries-free children comprised the control group. Parental permission was granted and a questionnaire completed about each child. Blood samples were taken to measure vitamin D levels.

A majority of the entire group had inadequate vitamin D levels, 32 of the 38 children or 84.2 percent. Children with early childhood caries had lower levels than the dentally healthy children, 53nmol/L compared to 64nmol/L. The early childhood caries children were twice as likely to have inadequate vitamin D levels compared to the controls. The children with early childhood caries as a group also had significantly higher serum parathyroid hormone levels compared to the caries-free children, 54cm/L compared to 34cm/L. Significantly more children in the early childhood caries group had elevated serum parathyroid hormone levels compared to the control group, 13 versus four.

Clinical Implications: This pilot study raises questions that need further investigation to determine the role vitamin D and parathyroid hormone might play in early childhood caries.

Schroth, R., Jeal, N., Kliewer, E., Sellers, E.: The relationship between vitamin D and severe early childhood caries: a pilot study. Int J Vitam Nutr Res, 82(1):53 62, 2012.
Cola Drinking Linked to Lower Bone Mineral Density

Soft drink consumption is on the rise and, with it, many adverse effects. Soft drink consumption takes the place of healthier beverages or water. The lowering of bone mineral density (BMD) is just one the adverse effects. Cola drinks in particular contain caffeine and phosphoric acid, which might adversely affect BMD.

Researchers at Tufts University in Boston, Massachusetts, hypothesized that consumption of cola drinks was associated with lower BMD. They analyzed the data from the Framingham Osteoporosis Study, comparing BMD levels measured in the spine and three hip sites to the frequency of soft drink consumption. The study included 1,413 women and 1,125 men. BMD was measured using dual-energy X-ray absorptiometry. The data were adjusted for body mass index, height, age, energy intake, physical activity, smoking, alcohol use, calcium, vitamin D, and, for women, menopausal status and estrogen use.

Data analysis showed significant differences between men and women. There was an association between cola intake and significantly lower BMD scores in each hip site, but not spine, for women and not for men. Daily cola drinkers had four to five percent lower BMD reading compared to those who drank less than one cola per month.

Results for those drinking diet and decaffeinated colas were similar. Non-colas did not result in significant loss of BMD. Calcium-to-phosphorus ratios were lower in cola drinkers.
Clinical Implications: There are many reasons to counsel patients to avoid carbonated soft drinks and loss of bone density in women is one more.

Tucker, K., Morita, K., Qiao, N., Hannan, M., Cupples, L., Kiel, D.: Colas, but not other Carbonated Beverages, are Associated with Low Bone Mineral Density in Older Women: The Framingham Osteoporosis Study. Am J Clin Nutr, 84(4):936-942, 2006.
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