Aspects of nutriment in maintaining gum wellbeing: A literature review

INTRODUCTION

A wholesome (balanced) diet epitomizes excellent physical condition [1] and often leads to healthy buccal health and a beautiful smile (Fig. 1) [2,3]. A vital aspect of long-term health, growth, and metabolic consequences in the deterrence and therapeutic intervention of disease hinges on nutrition [4–6]. Nutrition is the biochemical and physiological activity by which living creatures utilize food components [7] to sprout, mature, sustain themselves, and reproduce [7,8]. The influence of nutrition on the body’s tissues and organs exists locally and systemically [9–11]. Nutrition strongly affects the integrity of the periodontium [12,13].

The availability of a sufficient supply of essential nutrients to the host significantly impacts the viability of the periodontal tissues in both health and disease [14,15].

Nutrients are generally categorized into micronutrients, macronutrients, and essential nourishments [16]. A range of nutrients can significantly influence periodontal health [12,17]. Macronutrients comprise proteins, lipids, and carbohydrates, indispensable nutrition constituents [18]. However, micronutrients include water and fat-soluble vitamins, trace minerals, minerals, and organic acids, frequently necessitated to conserve vital physiological functions [19]. Essential nutrients are biological molecules and embrace selected amino and fatty acids, sterols, and vitamins [20]. Essential nutrients are expressed as those that cannot be produced or are insufficiently made from the beginning by animals, including human beings, to accommodate their physiological need [16].

Figure 1. Schematic representation showing dental, especially periodontal-health-friendly diets. This figure has been drawn with the premium version of BioRender (https://biorender.com/ accessed on 30th December 2023) with the license number NX269Y56XP. Image Credit: Susmita Sinha. [Click here to view]

Micronutrients are the constituents of food that are needed in small or negligible quantities [21,22]. Carotenoids and carotene (vitamin A), ascorbic acid (vitamin C), tocopherol (vitamin E), folate and folic acid (vitamin B9), iron, zinc, copper, phosphorus, calcium, glutathione, quercetin, tannic acid, N-acetyl cysteine (NAC), and melatonin are typical examples of micronutrients and trace elements and act as antioxidants [23–26]. If not consumed at the apposite level, these micronutrients are often reported to provoke inflammatory disorders in periodontal tissues [17,21,27–29].

In concomitance with oxygen and water, macronutrients such as minerals, proteins, carbohydrates, and fats must be consumed appropriately [30]. High carbohydrate (HC) [31], especially sugar-sweetened beverages [32,33], saturated fat with low fiber [17,34], and scarce protein, vitamin C, and B12 [35–37] consumption has been attributed to gingival bleeding, gingivitis dental cavities, periodontal disease, overall poor oral health [17,38].

Typical cellular metabolism yields reactive oxygen species (ROS). After that, ROS performs several physiological activities [39]. Nevertheless, excessive synthesis of ROS starts exhibiting injurious or pathological outcomes by oxidizing nucleic acids such as deoxyribonucleic acid (DNA), lipid peroxidation, protein carbonylation, and ultimately infuriating tissue impairment, including cellular aging and death [40–42]. Multiple studies reported that periodontal disorders generate ROS in very high amounts from inflammatory cells. The extra quantity of ROS diffuses out and ultimately damages vital organs, causing systematic diseases, such as cataracts, malignancy, and cardiovascular disease [43]. It also denotes individuals suffering from chronic periodontitis possess threatened antioxidant competence [44–48]. It has been reported that ROS increases osteoclast growth while suffering from periodontal disorders, leading to growth deterioration of maxillary and mandibular bone, thereby damaging periodontal anatomy and loss of tooth [49,50].

It has been reported that antioxidants’ pharmacodynamic properties possess the potential to alleviate the irreparable teeth-supportive anatomical mutilation triggered by unrestrained amounts of ROS [44,51,52]. Antioxidants’ pharmacological potential includes several vibrant belongings [53]. Free radicals neutralizing molecules scavenge free radicals and confiscate changeover metal ions, disintegrating hydrogen peroxide or hydroperoxides. It also extinguishes operational pro-oxidants and augments endogenic antioxidant protection; nevertheless, it repairs damaged cells through ROS [54,55].

Antioxidants archetypally differed principally into two forms: endogenous and exogenous [56,57]. Endogenous antioxidants signify that these molecules can be formed by the human body [58]. Common endogenic enzymatic antioxidant particles include “superoxide dismutase, catalase, glutathione peroxidase, and reduced glutathione or glutathione-reductase” [59–62].

Endogenous antioxidants, accompanied by vitamins and minerals, are the most functional and competent enzymatic set-up at odds with oxidative stress under physiological equilibrium [63,64]. Exogenous antioxidants denote that the human system is incompetent to produce these molecules of their own. They are usually naturally derived from fruits, vegetables, meat, and fish. These days, exogenous antioxidants are manufactured in laboratories [65,66]. Frequently utilized exogenous antioxidants are “ascorbic acid (vitamin C), tocopherol (vitamin E), quercetin, tannic acid, and NAC” in dental issues [51].

PROBLEM STATEMENT OF THE STUDY

The research question evaluates the effect of micronutrient and macronutrient fortification on periodontal parameters in healthy people with healthy periodontium.

OBJECTIVES OF THE STUDY

This review’s primary objective is to assess micronutrients’ impact on periodontal health by consulting the accessible substantiation from pertinent research results and inspecting the effect of different doses of micronutrients on periodontal health outcomes. To help formulate public strategies for public health workers, to restrict the gap between the prevailing scientific papers, and to highlight areas where further research is required.

MATERIALS AND METHODS

A wide-ranging literature review was steered to congregate applicable information on the impact of macronutrients and micronutrients on periodontal health. Databases such as PubMed and Scopus were systematically searched for articles published up to 2023. Key words included were “periodontal disease,” “macronutrients,” “micronutrients,” and specific nutrients such as carbohydrates, proteins, lipids, and vitamins A, D, E, K, C, B complex, and minerals. The articles included were based on their relevance to the connection between nutrition and periodontal health. Studies focusing on the impact of macronutrients and micronutrients on periodontal tissues were selected. Studies investigating dietary patterns, nutritional intake, and their association with periodontal diseases were prioritized (Fig. 2). Information regarding the recommended daily doses for various was also collected. Special attention was given to the quality of evidence, study designs, and methodologies for assessing the rapport concerning nutrients and periodontal health.

Figure 2. The materials and method section of the current study was portrayed. This figure has been drawn with the premium version of BioRender (https://biorender.com/ Accessed on 21st December 2023) with the license number BI268O2W3Q. Image Credit: Susmita Sinha. [Click here to view]

IMPACT OF MACRONUTRIENTS ON PERIODONTAL DISEASE

Carbohydrates

Multiple studies reported no clear-cut or comprehensive explanation regarding the terms HC and low-carbohydrate (LC)-containing diet. This issue is raised as the paramount impediment to deducing the research findings. After that, the HC or LC diet is a comparative notion [67–71]. However, it has been broadly reported that it is considered an HC diet when an individual derives over 45% of total energy from carbohydrates [67–71].

Carbohydrates are a crucial energy resource and contribute to fat metabolism [72–74]. Incorporating low-glycemic, unprocessed, and fiber-rich complex carbohydrates containing phytochemicals such as fruits, whole grains, or coarsely milled grains, vegetables, and legumes into the diet is generally considered healthy. These foods possess conceivable anti-inflammatory and antioxidant assets [75–78]. Conversely, high-glycemic, processed, and low-fiber carbohydrates such as refined sugar, white wheat flour, and sugary drinks can potentially contribute to several chronic inflammatory diseases [79–81]. Diet, including fermentable carbohydrates, can impact oral biofilm composition and potentially contribute to evolving oral conditions such as dental caries and periodontitis [82–84]. Contrary to expectations, it has been noted that incorporating raw vegetables into one’s diet can positively impact periodontal health [17,31,85].

Chewing raw vegetables has been recognized for supporting natural oral detoxification processes, leading to reduced plaque accumulation on the tooth surface, decreased periodontal inflammation, and a lower risk of developing tooth decay. This practice can contribute to improved periodontal and dental health [17,86].

Recent evidence indicates that consuming high-glycemic foods on their own may contribute to increased inflammation through activating nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), high-sensitivity C-reactive protein, and oxidative stress [87–89]. Thereby, causing bleeding of the gums, as well as an elevated risk of gingivitis and periodontitis [90–92]. On the other hand, a diet copious in complex carbohydrates, without a corresponding increase in overall energy intake, can potentially decrease the risk of gingivitis and periodontitis [12,91–94].

Carbohydrates, because of their numerous functions, are present in all life forms [95]. Carbohydrates make up most of the organic stuff on earth [96,97]. Carbohydrates provide fuels, energy reserves, and metabolic intermediaries [74,98,99]. Plants and bacteria have polysaccharides as structural components in their cell walls [100–103] (Fig. 3). One of the most prevalent organic chemicals in the biosphere is cellulose, the primary component of plant cell walls [104,105]. Ribonucleic acid (RNA) and DNA are constructed from nucleobases related to a phosphate sugar, which remains the mainstay [106]. Ribose and deoxyribose sugars form part of the physical skeleton of RNA and DNA, respectively [107,108].

Figure 3. Schematic representation of cellulose chains in plant cell walls. This figure has been drawn with the premium version of BioRender (https://biorender.com/ accessed on 21st December 2023) with the license number EY268O3CFY. Image Credit: Susmita Sinha. [Click here to view]

Periodontal implication of carbohydrates

The presence of considerable portions of carbohydrates in individuals’ diets, especially in the form of refined crystallized sugar and refined carbs (devoid of fiber, minerals, vitamins, and so on), encouraged microbioma (microbiome) dysbacteriosis (an imbalance in the microbiota community) in the buccal cavity. This oral dysbiosis possesses the ultimate potential to cause an inflammatory process, pursuing periodontal diseases with pocket formation extending severe clinical manifestation [109–112].

Glycosaminoglycans (GAGs) are exceedingly negative-charged polysaccharides (carbohydrates) constituted of reiterating disaccharide molecules [113]. GAGs are cataloged into four different clusters grounded on their carbohydrate remnants, such as hyaluronic acid (HA), chondroitin sulfate (CS), dermatan sulfate (DS), and heparan sulfate (HS), and keratan sulfate (KS) [114,115]. Thereby, carbohydrates are vital in synthesizing chondroitin, KS, and DSs and are essential for developing connective tissue components. After that, these molecules are extensively found on the cell membrane, in the extracellular matrix, and in connective tissue [116–118]. It has been reported that one of the chief extracellular matrix constituents is chondroitin sulfate proteoglycan (CSPG). CSPG performs an imperative role in organogenesis [119,120].

CS is involved in adding cells to dental tissue. CS furthermore determines the functional distinction of vital cells of the dental pulp. CS improves vascular cells, enhancing dental pulp tissue’s restorative process after tooth damage [120].

Morquio syndrome [Mucopolysaccharidosis (MPS) type IV A)] is a sparse congenital (autosomal recessive) metabolic (lysosomal storage) disease instigated by the insufficiencies in the metabolism and dilapidation of unique enzymes named GAGs [121–125]. Morquio syndrome resulted in diverse continuing and long-lasting skeletal deformities. It also involves enamel defects of teeth and “broad mouth, unerupted, malposition, and spaced permanent teeth” [121]. The diagnosed cases of MPS between 1982 and 2009 were 1.53 per 100,000 live births were reported [126,127].

KS is considered the most novel GAG from the evolutionary perspective; little is known about this carbohydrate-derived new compound [128,129]. KS dispersed throughout the length of collagen (an unsolvable fiber composed of protein among all animals having a bony structure and vertebral column) fibrils in the predentin extracellular matrix to preserve constant texture. It has been reported that KS possesses properties to deflect collagen fibrillogenesis [130]. KS and other glycoproteins had a biological half-life (t½) of 6.8 days [131]. The principal action of proteoglycan GAGs, especially KS and CS, is tissue hydration and organization [128].

Proteoglycan KS and DS disseminated in the predentin impede the calcification activity of collagen fibrils; those are not calcified extracellular matrix and halt the calcification process [130,132]. There has been reported to be an intensification in KS immune-related activity around the wound area along with macrophages, reactive microglia, and oligodendrocyte precursors [128,133–135]. It has been reported that due to hereditary causes, KS can be deficient; nevertheless, little is known about the detailed reasons for deficiency [136]. One more study revealed that Morquio syndrome, or MPS, is primarily an inherited disease instigated by the insufficiency of the N-acetylglucosamine-6-sulfate sulfatase enzyme [137].

Archetypally, diminished biosynthesis KS is concomitant with inflammation, signifying proinflammatory cytokines downregulated ion of KS formation, thereby causing delayed wound healing [138].

HA is a carbohydrate-containing polysaccharide (GAG). It is considered a unique biomolecule serving multiple purposes, such as osteoarthritis, vesicoureteral reflux, urinary incontinence, skin wrinkles, dry eyes, and interstitial cystitis. HA also addresses pharmaceutical, aesthetic, and cosmetic issues through wound restoration and tissue rejuvenation [139–142].

HA GAG is a foremost and organic constituent of the extracellular matrix. However, HA contributes to diverse living cellular accomplishments by incorporating growth factors and comparative receptors. Nevertheless, the controlling physiological role of HS on the vasculogenesis of mesenchymal stem cells remains obscure [143]. Hayano et al. [144] first reported the “functional roles of HS proteoglycans’ sulfation in dentin formation.” Duplancic et al. [145] said that consuming manmade derivatives of heparan sulfate glycosaminoglycan (HS GAG) and blemished extracellular matrix (ECM) with therapeutic intention effectively regenerates periodontal tissue among animal models suffering from periodontal diseases. However, the pharmacodynamics of HS GAG therapeutic intervention for periodontal disease in humans is still undetermined [145].

HA is essential in maintaining the appropriate physiology of extracellular matrices in both pulpy and solid constituents of gum and tooth [146]. HA possesses anti-inflammatory, anti-edematous, osteoinductive, pro-angiogenetic properties, and antimicrobial effective pharmacodynamics, especially for periodontal diseases in managing gum infection and hemorrhage [140,141,147]. It has been reported that topical (gel formulation) HA has been documented as an accessory medication to improve long-lasting inflammatory illnesses like periodontitis, especially after dental surgical intervention through reducing inflammatory intercessors and improving healing and tissue regeneration [148–151] and oral lichen planus (topical 0.2% HA) [152–154]. HA also potentiates the periodontal wound healing process [150]. It has been reported that HA 0.8% and chlorhexidine digluconate 0.05%–0.2% avert the growth and development of dental biofilm [155–158]. High molecular weight HA and chlorhexidine thoroughly fine-tune the gums and humidify, dampen, and rinse the buccal mucus-secreting membrane [158–160]. Therefore, it revealed day-to-day oral cleanliness after periodontal therapeutic intervention, oral, or peri-implant surgery [158,161,162].

Proteins

The specific role of dietary proteins in systemic inflammation has not been elucidated [163]. It has been reported that animal and plant proteins generate insulin-like growth factors (IGFs) equally [164,165].

Furthermore, reducing the animal protein-rich diet decreases all-embracing and all forms of cardiovascular death compared to plant protein-based food [166,167]. IGFs are mitogens that promote the carcinogenesis process. These IGFs are indispensable components for developing diverse cancers and their metastatic activity. IGF biomolecules surmount normal apoptosis and promote cell cycle progression and angiogenesis process. The IGF events are arbitrated and completed by the IGF-1 receptor involved in cell transformation provoked by carcinoma [168–172].

Conversely, the ingesting of a high vegetable-proteins-based diet has been associated with a decreased risk of cardiovascular disease, type 2 diabetes mellitus, and chronic kidney disease [173–175]. In a study by Staufenbiel et al. [176], a comparison was made between the periodontal health of 100 vegetarians and 100 nonvegetarians. The findings revealed that the vegetarian group exhibited considerably shallower periodontal pockets, less bleeding upon probing, and better oral hygiene than the nonvegetarian participants. Therefore, the vegetarian diet appears to exert a beneficial impact on periodontal health [176].

A randomized clinical trial was conducted for 4 weeks to determine the relationship between dietary vegetables (vegetables half in quantity with a high-fat diet) and animal protein and periodontal health [177]. A vegetable-rich diet containing, e.g., seeds, nuts, cereals, marine vegetables, extra-virgin olive oil, cocoa, legumes, tomatoes, and so on, contain Mg²⁺ was more favorable toward oral health when compared with a diet rich in HC and animal protein [12,177]. Relevant studies also found that nutritional supplementation, especially protein, minimizes periodontal probing depth, reduces clinical attachment of teeth salvage, which was about to be lost, and curtails inflammatory oozing fluid caused by periodontitis. In addition, the hemorrhagic tendency was reduced on probing 2–6 months later while conduction surgical intervention was conducted for check-ups [177,178]. Multiple studies reported that individuals consuming a diet containing plenty of vegetables, fruits, soya containing various foods, and fish get more micronutrients and antioxidants [179]; after that, these folks suffer much less from periodontal diseases and dental carries than a diet rich in animal protein (Fig. 4) [12,17,38,179]. One more study revealed that a substantial portion of red meat consumption was expectantly connected with vaster periodontal probing depth and hemorrhage on probing. Correspondingly, a small amount of red and/or processed meat intake was linked to bringing down the likelihood of emerging periodontal diseases [180,181].

Figure 4. Illustrates the beneficial effect of a diet containing high vegetable protein on periodontal health compared to consuming high animal protein. This figure has been drawn with the premium version of BioRender (https://biorender.com/ accessed on 30th December 2023) with the license number NU269YDO3T. Image Credit: Rahnuma Ahmad. [Click here to view]

Function of proteins over periodontal health

We receive amino acids [small carbon-based particles that contain an α (central) carbon atom linked to an amino, and a carboxyl group, atomic hydrogen, and a wavering constituent termed a side chain] from proteins, which are the building blocks of protein [182]. It has been revealed that protein is responsible for nearly all physiological commitments and rheostats gene countenance. A considerable portion of the essential constituents of every single cell of a living creature are made with protein [183,184]. Around 50% of the body’s dry weight is made up of protein [185,186]; it is the second most prevalent material after water. The intracellular protein network’s cytoskeleton preserves cells’ physical integrity and shape [187]. The contractile components of muscle are made up of actin and myosin filaments [188].

Periodontal implication

Proteins are necessary for effective host defenses [189]. They are elements of protective molecules and barriers that aid in limiting the spread of disease [190]. The complement system, innate immunity, antibody or humoral immunity, and cell-mediated immunity are all part of the periodontal defenses [191]. The junctional and crevicular epithelia provide an epithelial barrier function against invaders for periodontium [192–194]. This epithelium surface, which has a rapid turnover, is a significant defense barrier against invading microorganisms, poisonous substances, and antigens [195]. The epithelial defense barrier needs enough protein, Zn²⁺, folic acid, iron, vitamin A, and vitamin C to maintain good periodontal health [21,196,197].

Osteoporosis of the alveolar, supporting bone, and removing fibroblasts and connective tissue fibers in the periodontal membrane are degenerative lesions created in the periodontium [198,199]. Protein deficiency hinders periodontal wound healing by preventing angiogenesis, fibroblast growth, and collagen production, build-up, and remodeling [200–202].

The mechanisms by which protein deficiency enhances periodontal disease

The salivary antimicrobial peptides (AMPs) act as natural primary protective strategies for the oral and gastrointestinal anatomical structures from pathogenic microbes [203]. Oral saliva contains AMPs such as Mucin-7 and lactoferrin [204]. These salivary AMPs consent to beneficial microbes (microbiota) colony formation of the buccal space. However, microbiota avert wide-ranging pathogenic microbial settlement and prevent infection. Subsequently, maintain stability and composure around the mouth and oropharyngeal anatomical structure. Thus, it prevents infectious disorders in and around the mouth cavity [203,205]. Patients admitted to the intensive care unit with ventilators often produce minimal salivary secretion, enhancing poor oral hygiene [206,207]. These issues raise the possibility of developing pathogenic microbes [208,209]. Therefore, these pathogens cause oral infective diseases, including periodontitis [203–209].

Individuals consuming protein more than 1 g/kg/day is related to a diminution of periodontal infective and inflammatory disorders [35,210], and dietary Ca²⁺, principally adequate amount drinking milk also shows defensive activities against gum disorders [211]. Periodontitis is highly prevalent in the elderly community (82%) and older adults [211–213]. It can be assumed that the elderly community regularly does not consume enough amount protein and maintain oral hygiene properly, causing periodontal diseases [35,214]

IMPACT OF MICRONUTRIENTS ON PERIODONTAL DISEASE

Healthy, nutritious food-consuming habits and regular exercise with strict avoidance of principal risk factors of NCDs such as chronic alcohol, cigarette, processed food intake, and mainly sedentary life eventually prevent or decrease the rate of NCDs [261–265]. Furthermore, overuse of proton pump inhibitors, antimicrobials, chelating agents, and nonsteroidal anti-inflammatory drugs leads to micronutrient deficiencies [266–268]. Systemic conditions such as pregnancy, breastfeeding, and physical/mental stress require increased nutrient consumption [269–272]. Vitamins are commonly classified as fat-soluble [273] and water-soluble [274]. Fat-soluble vitamins comprise vitamins A, D, E, and K [275]. Fat-soluble vitamins cannot be excreted by the kidneys through urine [275] and stored in the tissues [276]. However, most water-soluble vitamins, except vitamins B6 and B12, get easily excreted via the kidneys [277].

Vitamin D

Vitamin D maintains normal blood Ca²⁺ levels and metabolism of skeletal issues [291–296]. It also regulates calcium absorption from the intestines [297]. A blood Ca²⁺ deficiency leads to inadequate osseous tissue calcification, causing rickets and osteomalacia [298,299]. Fortified milk stands to be the primary dietary source for vitamin D. Loss of periodontal attachment has been reported with vitamin D deficiency [300]. Several studies concluded that the anti-inflammatory outcomes of vitamin D diminish the proneness of gum and periodontal diseases [301–303].

Table 1. Certain critical randomized controlled trials regarding diet and periodontal diseases were published in the last 5 years [Accessed on December 9, 2023] in the PubMed database. [Click here to view]

Minerals

Minerals comprise 4% to 5% of the body weight [369,370]. Minerals maintain “heart rhythm” [371], “muscle contraction” [372], “nerve conduction” [373], and “acid-base balance” [374]. Minerals required in the amount of >100 mg/day are called significant minerals [375], and those needed in the amounts of <100 mg/day are termed trace minerals [376]. Leading minerals include “Na⁺, K⁺, Ca²⁺, Mg²⁺, P³⁻, and S^2-” for maintaining human physiology [377]. In contrast, silhouette amounts of elements include “Fe³⁺, Zn²⁺, I^- , Se⁺⁴, F⁻, Cu²⁺, Cu³⁺, Co⁺³, Cr⁺³, Mn²⁺, Mn³⁺, and Mo³⁺” [378,379].

Na⁺ is the primary electrolyte in the body, constituting a significant part of extracellular fluid [380]. The body’s fluid balance and nerve conduction are maintained by Na⁺ [381]. Ha reported in 2014 that 5 to 6 g/day is the set daily requirement of Na⁺ hypertensive patients [382]. K⁺ is the notable cation for intracellular fluid and functions similarly to sodium but intracellularly [381]. Low K+ levels are more common as it is not often added as a dietary supplement, resulting in muscle cramps, confusion, irregular heartbeats, and life-threatening situations (Fig. 5) [381].

Research by Nishida et al. [383] recommended that inadequate food available calcium intake resulted in severe periodontal diseases. Shimazaki et al. [384] suggested an optimistic relationship between the intake of lactic acid-comprehending foods and the inhibition of the development of periodontal diseases. The electron transport functions of mitochondria are regulated by coenzyme Q10, which is dispersed from end to end of human tissues [385]. Treatment of periodontally compromised patients with this coenzyme has significantly improved in periodontal conditions [386,387]. Zinc acts on ROS and neutralizes, hence reducing the chronic inflammatory process and improving periodontal health [388–392].

Table 3 [19] was created summarizing the recommended daily doses for essential nutrients and their importance in periodontal health. References supporting the recommended doses were added to enhance the credibility of the information. The reliability and validity of selected studies were critically appraised to ensure the robustness of the evidence. Potential biases, limitations, and gaps in the existing literature were acknowledged and discussed.

Table 2. Several analytical, systematic reviews and meta-analyses regarding diet and periodontal diseases were published in the last 5 years [Accessed December 9, 2023] in the PubMed database. [Click here to view]

Figure 5. Illustrates the impact of micronutrients on periodontal disease. This figure has been drawn with the premium version of BioRender (https://biorender.com/ accessed on 21st December 2023) with the license number IS268O3U4S. Image credit: Susmita Sinha. [Click here to view]

Table 3. Recommended daily doses to maintain periodontal health. [Click here to view]

LIMITATIONS OF THIS REVIEW

The limitation of this review was the complete reliance on the previously published manuscript. Only PubMed, Medline, and Scopus databases were consulted. We may have missed the research work published in Web of Science and other smaller databases. In addition, multiple studies reported that narrative review possesses integral limitations such as substandard research paper exploration [393], scarcity of explicit substantiation of search strategy [394], imaginable preferential in the evaluation of selected scientific articles [395,396], according to SANRA scale score below four denotes poor quality of the paper [397], and not appropriate specific clinical situation [398]. These traditional reviews help as potential resources for the speedy accessibility of recent references for precise arenas of interest of authors [399–401]. However, it has been reported that narrative reviews postulate better explanation and appraisal; the strategic impact of these old-style review papers extends comprehension level [402–404].

CONCLUSION

As is observed throughout this review, nutrition plays a vital role in oral cavity health. Each nutrient has its own function, and nutrients also interact to boost and sustain a healthy periodontium. Nutrients such as carbohydrates in the form of GAG are essential for extracellular matrix formation, proteins contribute to host immunity, and lipids like omega-3 fatty acids may decrease the chronic inflammatory process. Vitamin C is needed to avoid gum bleeding, and vitamin K deficiency leads to periodontal disorders such as gum hemorrhage and tooth clinical attachment. Mineral deficiency, like calcium deficiency, causes periodontal disease, and zinc neutralizes ROS. Poor oral health may hamper physical, mental, and social well-being. To maintain oral health, it is, therefore, vital to know about the benefits of these nutrients. It is essential to spread this knowledge among the general population. Dentists, other health workers, and policymakers need to work together to ensure the dissemination of knowledge regarding proper balanced diet consumption in adequate amounts, sources of various nutrients, and harmful effects of an unhealthy diet, as well as a diet deficient in essential nutrients on oral health. Research in this field of study must continue to build awareness and prevent damage to oral health so that the global population can enjoy a healthy smile.

ACKNOWLEDGMENT

The graphical abstract has been drawn with the premium version of BioRender (https://biorender.com/ accessed on 29th December 2023) with the license number MF269TMZ3R. Image Credit: Rahnuma Ahmad.

AUTHOR CONTRIBUTIONS

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work. All the authors are eligible to be an author as per the International Committee of Medical Journal Editors (ICMJE) requirements/guidelines.

FINANCIAL SUPPORT

This research received no external funding.

CONFLICTS OF INTEREST

The authors report no financial or any other conflicts of interest in this work.

ETHICAL APPROVALS

This study does not involve experiments on animals or human subjects.

DATA AVAILABILITY

All the data is available with the authors and shall be provided upon request.

USE OF ARTIFICIAL INTELLIGENCE (AI)-ASSISTED TECHNOLOGY

The authors declares that they have not used artificial intelligence (AI)-tools for writing and editing of the manuscript, and no images were manipulated using AI.

PUBLISHER’S NOTE

All claims expressed in this article are solely those of the authors and do not necessarily represent those of the publisher, the editors and the reviewers. This journal remains neutral with regard to jurisdictional claims in published institutional affiliation.

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