title: Higher Intakes of Fruits and Vegetables, β-Carotene, Vitamin C, α-Tocopherol, EPA, and DHA Are Positively Associated with Periodontal Healing after Nonsurgical Periodontal Therapy in Nonsmokers but Not in Smokers.
abstract: BACKGROUND
  Periodontitis is a chronic inflammatory disease and a significant risk factor for tooth loss. Although a link between diet and periodontal health exists, the relation between diet and healing after periodontal therapy has yet to be investigated.
  
  
  OBJECTIVE
  The objective was to determine whether higher intakes of fruits and vegetables or nutrients with antioxidant or anti-inflammatory activity are associated with greater healing, measured as reduced probing depth (PD), after scaling and root planing (SRP), a cost-effective treatment to manage periodontal disease and prevent tooth loss.
  
  
  METHODS
  Patients (63 nonsmokers, 23 smokers) with chronic generalized periodontitis who were undergoing SRP participated. Healing was evaluated based on PD, assessed at baseline and 8-16 wk after SRP. Intakes of fruits, vegetables, β-carotene, vitamin C, α-tocopherol, α-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) were estimated using the Block 2005 food frequency questionnaire and a supplement questionnaire. Serum 25-hydroxyvitamin D concentrations were also measured. PD (% sites >3 mm) was modeled in multiple linear regression and analysis of covariance by tertile of intake and adjusted for age, sex, body mass index (BMI), baseline PD, examiner, gingival bleeding, and study duration.
  
  
  RESULTS
  In nonsmokers, PD was associated with fruit and vegetable, β-carotene, vitamin C, α-tocopherol, EPA, and DHA intakes (P < 0.05). PD was not significantly associated with ALA intake or serum 25-hydroxyvitamin D concentration. Significant associations that included supplements (β-carotene, vitamin C, α-tocopherol) were attenuated or lost, depending on the statistical model used. There were no significant associations within the group of smokers.
  
  
  CONCLUSIONS
  Dietary intakes of fruits and vegetables, β-carotene, vitamin C, α-tocopherol, EPA, and DHA are associated with reduced PD after SRP in nonsmokers, but not smokers, with chronic generalized periodontitis. These findings may lead to the development of dietary strategies to optimize healing after periodontal procedures. This trial was registered at clinicaltrials.gov as NCT02291835.
authors.affiliation: Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada; and.
authors.forename: David W
authors.identifier: http://orcid.org/0000-0003-3575-3259
authors.initials: DW
authors.lastname: Dodington
authors.affiliation: Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada; and Reconstructive Periodontics and Implant Surgery Clinic, Fonthill, Ontario, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Fritz
authors.affiliation: Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada; and.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Sullivan
authors.affiliation: Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada; and wward@brocku.ca.
authors.forename: Wendy E
authors.identifier: http://orcid.org/0000-0001-9518-9608
authors.initials: WE
authors.lastname: Ward
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000975:Antioxidants / Q000008:administration & dosage; D001205:Ascorbic Acid / Q000008:administration & dosage*; D015992:Body Mass Index; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D019587:Dietary Supplements; D004281:Docosahexaenoic Acids / Q000008:administration & dosage*; D015118:Eicosapentaenoic Acid / Q000008:administration & dosage*; D002149:Energy Intake; D005260:Female; D005638:Fruit; D006801:Humans; D007249:Inflammation / Q000188:drug therapy; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D010518:Periodontitis / Q000628:therapy*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D014675:Vegetables; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D017962:alpha-Linolenic Acid / Q000008:administration & dosage; D024502:alpha-Tocopherol / Q000008:administration & dosage*; D019207:beta Carotene / Q000008:administration & dosage*
chemical_list: D000975:Antioxidants; D019207:beta Carotene; D017962:alpha-Linolenic Acid; D014807:Vitamin D; D004281:Docosahexaenoic Acids; C104450:25-hydroxyvitamin D; D015118:Eicosapentaenoic Acid; D024502:alpha-Tocopherol; D001205:Ascorbic Acid
keywords: anti-inflammatory; antioxidants; bone; healing; oral health; periodontal health; tooth retention