October 2011, Volume 7, Issue 9
Published by AEGIS Communications
Question: Dietary Supplements: Can They Benefit Oral and Overall Health?
By Tieraona Low Dog, MD | Carole A. Palmer EdD, RD | Richard L. Wynn, PhD
Dr. Low Dog
If people regularly consumed a diet rich in fresh fruits and vegetables, grains, legumes, modest amounts of fish, poultry, and possibly dairy, there would be little need for a discussion about dietary supplements and health. Nutrition influences overall health and dietary components have both local and systemic effects within the body. For optimal health, experts recommend that individuals should aim for at least nine servings (~4.5 cups) of vegetables and fruits a day—not counting potatoes. But according to the Centers for Disease Control, only 32.6% of Americans eat two or more servings of fruit per day and even fewer, only 27.2%, eat vegetables three or more times per day.
Key nutrients present in whole, minimally processed food are critical for maintaining oral health and preventing gingival and periodontal disease. Certain vitamins/minerals are known to significantly impact the oral cavity such as vitamin C for collagen, vitamin A for epithelial integrity, and calcium/vitamin D for bone. There is a growing body of data that shows many Americans do not have adequate serum levels of vitamin D and that the majority of teenagers do not come anywhere close to meeting the recommended intake of 1,300 mg of calcium per day.
Deficiencies of certain nutrients may first appear in the mouth. For instance, the dental team may be the first to note glossitis, angular cheilitis, and recurrent oral ulcers in a patient with vitamin B12 deficiency. Clinicians should be alert for these signs especially in patients who may be on long-term medications that are known to impair the body’s ability to absorb and utilize vitamin B12.
Because periodontal disease is a highly oxidative and inflammatory process, in addition to eating a wholesome, healthy diet, many individuals would be well advised to take a once-per-day multi-vitamin/mineral product that provides 70% to 100% of most nutrients, with the exception of iron (eg, take only if pregnant, menstruating, or under a doctor’s recommendation), calcium (eg, most only need to supplement with 300 to 500 mg/day if consuming dairy) and vitamin D (eg, you might need more what it is in your multi-vitamin if your serum levels are low).
There is little evidence that supplementation of a nutritionally adequate diet will provide added health benefits or prevent disease. Furthermore, current regulations do not require that supplements be either safe or effective to be allowed on the market. More importantly, almost 70% of people who use supplements do not share this information with their healthcare providers. This is concerning, because supplements and drugs can interact (some increasing the potency of the drug, others decreasing it) and can cause other harmful effects.
Because the oral tissues are not independent of other body tissues, the same principles apply. There is no evidence that supplementation can cure or prevent oral disease in the absence of overt deficiency. However, there are situations for which supplementation may be indicated. Multi-vitamin/mineral supplements containing 100% of the Recommended Dietary Allowances (RDA) can always be suggested as a “margin of safety” for dental patients who have current or potential problem with eating. For older adults, a daily multi-vitamin/mineral supplement can help maintain nutritional status in the face of decreased function brought on by aging. Vitamin D and calcium supplements are often indicated at RDA doses for bone health. However, people should not be taking doses of higher than the RDA except when prescribed by a physician for diagnosed deficiency. Complete liquid supplements (like an “instant breakfast” type drink) can be recommended as meal replacements when there are mastication or other eating or chewing problems.
Emphasize to patients that a balanced diet is the foundation of health. Dietary supplements should only be an adjunct to a healthy diet.
I think we can all agree that a healthy diet consisting of plenty of fruits, nuts, vegetables, legumes, fish a couple of times a week, green salads with olive oil, with occasional wine or other spirits is good for overall health and must certainly be beneficial to oral health. The question is, do dietary supplements provide similar benefits? Supplements cannot substitute for a healthy diet in terms of benefiting oral health. However, emerging studies are describing potential oral health benefits of selected supplements such as green tea, fish oil, vitamin D, cranberry, and others. Green tea has demonstrated to be bactericidal against gram-negative anaerobic rods in periodontal disease, fish oil and omega-3 fatty acids may be beneficial in maintaining gingival health, vitamin D may prevent further loss of gingival attachment in periodontal disease, cranberry may inhibit Streptococcus mutans adherence to tooth enamel, and alpha-lipoic acid may be effective in treating burning mouth syndrome.
Properly designed, large-scale clinical trials are needed to verify and confirm the oral health effects of supplements. Until then, clinical reports and case studies are of interest in suggesting potential benefits of supplements in treating oral conditions.
Many herbal and antioxidant ingredients are being formulated into dentifrices, mouth rinses and other oral health products. None of these ingredients are considered as “active” ingredients by the Food and Drug Administration and must be labeled simply as “ingredient” or “inactive ingredient.” For example, a dentifrice formulated with sodium fluoride, Co-Q-10, cranberry, lemon balm, and Echinacea can only identify the fluoride component as the “active” ingredient because many large-scale clinical trials over the past 50 years have overwhelmingly confirmed the anti-caries effect of fluoride. The supplement ingredients have not been subjected to such trails.
With the availability of journal access over the Internet, consumers and healthcare providers can do their own research on the effects of the supplement of interest on oral health. Searches using key words and phrases could uncover enough reports and information for the inquirer to develop a file of studies to aid in decision making for, ideally, evidence-based interventions to maintain and/or improve oral health.
About the Authors
Tieraona Low Dog, MD
Dr. Low Dog is the Fellowship Director of the Arizona Center for Integrative Medicine and Clinical Associate Professor of Medicine at the University of Arizona Health Sciences Center.
Carole A. Palmer EdD, RD
Dr. Palmer is Professor and Head, Division of Nutrition and Oral Health Promotion, Department of Public Health and Community Service, at Tufts University School of Dental Medicine.
Richard L. Wynn, PhD
Dr. Wynn is Professor of Pharmacology at the Baltimore College of Dental Surgery, Dental School, University of Maryland at Baltimore.