Hygiene Tribune Middle East & Africa No. 3, 2020
Want to maintain good oral health? Start eating smarter / “Diets rich in plant foodsare increasingly associated with longevity and healthy ageing”
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NL
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www.dental-tribune.me
May-June 2020 | No. 3, Vol. 10
© Artemidovna/Shutterstock.com
Published in Dubai
Fruits, vegetables, herbs and spices are the main source of dietary flavonoids. The antimicrobial, antioxidant and anti-inflammatory properties of these flavonoids and the role flavonoids can play in the prevention of periodontal disease are becoming ever clearer.
By Kasper Mussche, Dental Tribune
International
With an estimated 743 million people affected, periodontitis is a major
global health burden. The condition is usually initiated by bacterial
biofilm resulting from poor oral hygiene and mediates the destruction
of soft and hard periodontal tissue,
and has been linked to systemic diseases such as diabetes and cardiovascular disease. A healthy diet is a
well-known factor in the prevention
and management of periodontitis,
but there is one group of completely
organic chemicals that could play a
larger role than previously assumed:
polyphenols.1
Our periodontal health is influenced
by our oral hygiene habits, genetic
factors and systemic health. In recent
years, however, there has been growing academic interest in nutrition as
a way to keep our mouths healthy
and prevent the development and
progression of periodontitis. For
example, a number of studies have
shown a strong correlation between
oral health and the intake of foods
high in vitamin C— of which fruits
and vegetables are the main source.
The actual compounds in fruits and
vegetables that are so beneficial to
our oral health are called polyphenols, and their benefits in the dental
field are only just beginning to be
realised.2
What are polyphenols?
Polyphenols are organic plant compounds that protect the plant against
disease causative agents, such as
fungi, bacteria and viruses. They are
abundant in seeds, leaves and other
plant-derived foods, and are wellknown for their health-promoting
properties. In addition to benefitting
our periodontal health, dietary polyphenols are asso- ciated with a lower
risk of inflammatory and chronic
diseases such as diabetes, cardiovascular disease, cancer and neurodegenerative conditions. Polyphenols
can be divided into many different
subcategories, of which tannins,
lignin–carbohydrate complexes and
flavonoids are some examples.
Powerful and natural
antioxidants
Dietary flavonoids, especially, have
been widely studied for their natural
antimicrobial and anti-inflammatory properties and, increasingly, because of their reputation as powerful
natural antioxidants. Antioxidants
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are substances that scavenge free
radicals—damaging compounds in
the body that alter cells, tamper with
DNA and even cause cell death. This
antioxidant activity of polyphenols
can neutralise free radicals and may
reduce or even help prevent some of
the damage they cause. Considerable
evidence indicates that increased
oxidative damage is associated with
the development of most major agerelated degenerative and inflammatory diseases, and polyphenols could
therefore play an important role in
the prevention of these3 conditions.
Sources of flavonoids and thus antioxidants are fruits, vegetables, herbs,
dark chocolate, olives and spices
such as curcumin, cinnamon and
anise. In particular, green tea, which
is a rich source of the flavonoid catechin, has been shown to exert significant antioxidant and antibacterial
activities in small clinical trials. Polyphenols and oral health4
The role of dietary nutrients in oral
health has typically been studied
from a negative perspective, namely
how sugars and other carbohydrates
can promote dental caries and gingival bleeding. The fermentative metabo- lism of carbohydrates results
in the release of acids that dissolve
the minerals of teeth; consequently,
high con- sumption is associated
with a greater prevalence of periodontal disease. Obviously, it is important to consume as little added
sugars as possible, but consciously
incorpo- rating polyphenols into our
daily diets can benefit our oral microbiome just as much.
This oral microbiome is what we call
the community of microorganisms
in our mouths. These microorganisms are naturally in a state of bal-
© grafvision/Shutterstock.com
Want to maintain good oral health?
Start eating smarter
The catechins contained in green tea have been found to be especially effective in
reducing inflammation and limiting the growth of certain bacteria associated with
periodontal disease.
ance, but when pathogenic bacteria
gain the upper hand—a state called
dysbiosis—oral diseases can develop. Luckily, in vitro and in vivo studies have shown that dietary polyphenols are able to target oral pathogens
and change the composition of our
oral microbiome for the better. They
have also been found to have a beneficial impact on probing depth, gingival index and clinical attachment
level—indicators of the severity of
periodontitis.5
Consequently, certain dietary flavonoids are already used in clinical
practice. The organic antiseptic CITROX, which is a mix of flavonoids
sourced from the bitter orange,
has been proved to selectively target bacterial strains implicated in
periodontitis, such as methicillinresistant Staphylococcus aureus,
Porphyromonas gingivalis, Clostridium difficile, hepatitis A, hepatitis
B and Streptococcus, while sparing
normal-microbiota members of the
dental biofilm. The possibilities of
polyphenols are plentiful, be it in
restoring the mouth to a healthy balance by selectively targeting pathogens or as an aid in the battle against
antibiotic resistance. Further designing polyphenol-based oral health
products may present an emerging
line of natural therapy for periodontitis and improve oral health in more
people.
Editorial note:
A list of references can be obtained
from the publisher.
This article was originally published
in prevention-international magazine for oral health, Issue 1/2020.
[2] =>
E2
HYGIENE TRIBUNE
Dental Tribune Middle East & Africa Edition | 3/2020
“Diets rich in plant foodsare increasingly
associated with longevity
and healthy ageing”
An interview with Prof. Marcello Iriti, Milan State University, Italy.
“The world of plants is fascinating,”
Prof. Marcello Iriti says, in starting off
the interview. “Since the beginning
of humanity, plants have represented, and still represent, an unlimited
source of food and medication. Studying plants is equally fascinating and
stimulating,” he adds. A life scientist
at the Faculty of Agricultural and
Food Science of Milan State University in Italy, Iriti mainly researches
medicinal and food plants, with an
emphasis on their biological activities. The health benefits of such plant
compounds are only just beginning
to be realised, and it appears that our
diet—and the Mediterranean diet in
particular—may harbour some secrets in this regard.
I would like to talk about the link
between the prevention of disease
and nutrition. It seems that polyphenols are key here. Can you explain what they are?
First of all, polyphenols are exclusively produced by plants, so plants
and plant-based foods are naturally
rich in these secondary metabolites.
Polyphenols are a group of phy- tochemicals, which are part of the
plant’s innate immune system
involved in defence against infections, insect at- tacks and abiotic
stresses—such as ultraviolet radiation, environmental pollutants and
weather conditions. Consequently,
the polyphenol levels in plants can
vary depending on the harvest year,
and post-harvest conditions too can
further modify the polyphenol levels in plant foods.
In recent decades, diets rich in plant
foods have been increasingly associated with longevity and healthy ageing. Dietary patterns involving plenty of fruit, vegetables and legumes
have been associated with reduced
risk and incidence of chronic degenerative diseases, such as Type 2 diabetes, metabolic syndrome, cardiovascular disease, neurodegenerative
disorders, certain types of cancers
and periodontal disease.
Is it true that the Mediterranean
diet, in particular, is a typical example of such a diet?
The Mediterranean diet can be considered the arche type of a healthpromoting diet in this regard. This
is due to high intake of low-fat
dairy products and healthy lipids—
mainly from seafood—as well as low
consumption of refined sugars, red
meat and saturated fats. The beneficial\effects of diets rich in plant
foods—such as the Mediterranean
one—can be ascribed, at least in part,
to the huge phytochemical diversity
© Prof. Marcello Iriti
By Kasper Mussche, Dental Tribune
International
of plant foods. Food plants typically
contain hundreds of bioactive phyto
chemicals, including polyphenols.
Probably, polyphenols, a class of
widespread phenylalanine derivatives, including flavonoids, stilbenes
and proanthocyanidins, have been
the most investigated dietary phytochemicals in recent decades and represent a paradigm of the relationship
between food and health.
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Melatonin, present in red wine, is a powerful antioxidant and anti- inflammatory
agent promoting bone metabolism in the oral cavity.
What are some examples of food
sources rich in polyphenols?
All plant-derived foods and beverages are significant sources of polyphenols, including fruit, vegetables,
pulses, coffee, tea, cocoa and red
wine. As I previously said, these metabolites arise from phenylalanine,
an aromatic amino acid produced
exclusively by plants. This implies
that meat does not contain polyphenols, even though it is essential for a
well-balanced diet.
You described polyphenols as bioactive components. What does that
mean for our health?
Dietary polyphenols possess a number of well-demonstrated biological
activities, since they are powerful in
vitro antioxidant, anti-inflamm tory,
vaso-dilating, anti-thrombotic, antimicrobial and anti-cancer agents.
This means that they can play a role
in the prevention of cardiovascular
disease, neurodegenerative disorders and certain types of cancers.
Indeed, oxidative stress and inflammation are mechanistically involved
in the aetio-pathogenesis of the
main chronic degenerative diseases,
including some oral diseases, such as
periodontitis.
You were the first researcher to
touch upon the role plant compounds could play in periodontal
regeneration.
The ultimate goal of periodontal
treatment is to achieve periodontal
soft- and hard-tissue regeneration. In
this regard, polyphenols can be considered as bone tissue protectants,
suppressing osteoclast differentiation and activation, impairing bone
resorption and improving bone
anabolism–osteoblast activity and
bone matrix synthesis.
ÿPage E3
[3] =>
E3
HYGIENE TRIBUNE
Dental Tribune Middle East & Africa Edition | 3/2020
◊Page E2
Polyphenols are strong antioxidants and are present in red wine.
Is there any hope for wine lovers
that red wine could benefit oral
health?
Red wine is an alcoholic beverage,
and obviously, I advise against using it to cure oral disease. Some years
ago, we suggested that melatonin,
another compound significantly
present in some typical Mediterranean foods and beverages as well
as, more generally, in many plant
foods, could explain, at least in part,
the health-promoting effects of the
Mediterranean diet by acting in synergy or additively with polyphenols
and other bioactive phytochemicals,
such as carotenoids and glucosinolates.
prevent atherosclerosis. Regular low
to moderate red wine consumption
at main meals has shown to be cardioprotective.
Remarkably, melatonin is a powerful
antioxidant and anti- inflammatory
agent promoting bone metabolism
in the oral cavity. Therefore, a certain
degree of synergy between melatonin and polyphenols has been hypothesised. However, the melatonin
and polyphenols we get from our
diet are far from effective in the oral
cavity, because they should be administered as topical formulations
to reach pharmacologically active
concentrations in saliva and oral tissue and also bypass the Phase I and
Phase II metabolic transformation
by our digestive system. Low oral
bioavailability represents the major
drawback of dietary phytochemicals.
Antibiotic resistance is becoming
an increasingly common problem.
Do you think a transition towards
more organically sourced polyphenols in oral care products could offer a solution here?
This is a very relevant topic. Antibiotic resistance is one of the biggest
threats to global health, as is anticancer drug resistance. In this scenario, polyphenols could be promising natural antibiotics. Indeed,
plant extracts rich in polyphenols
can be active on different bacterial
and fungal targets, thus reducing the
risk of selecting resis- tant microbial
populations. In addition, polyphenols can reverse chemoresistance by
targeting some microbial resistance
mechanisms. In this regard, polyphenols could be used as adjuvants
in combination with con- ventional
antibiotics with the goal of slowing
down the occurrence of resistance.
Nonetheless, morbidity and mortality due to cardiovascular disease are
low in Mediterranean countries, and
epidemiological data indicates that
adherence to a Mediterranean diet
and polyphenol intake are cardioprotective factors. As vaso-dilating,
anti-thrombotic and antioxidant
agents, polyphenols can mitigate
endothelial dysfunction, reduce lowdensity lipoprotein oxidation and
Are there examples of organic
plant compounds that have already become commonplace in the
treatment of disease?
A plethora of dietary supplements
based on botanicals and nutraceuticals have been developed. However,
these products are not drugs and
care should be taken not to try to
cure major diseases with dietary supplements. With regard to oral health,
aloe vera gel and Melaleuca alternifolia (tea-tree) essential oil have proven
to be effective as antimicrobial and
wound-healing agents.
Lastly, has your research changed
the way you eat and live?
Yes, of course, even though I was
already “Mediterranean” before becoming a researcher. I am Italian and
Morbidity and mortality due to cardiovascular disease are low in Mediterranean countries. Epidemiological data indicates that the
Mediterranean diet and polyphenol intake are cardioprotective factors.
come from a southern region where
traditional Mediterranean dishes are
part of everyday life. The Mediterranean diet is one piece of the puzzle,
but the Mediterranean lifestyle also
includes sociocultural aspects relevant in terms of well-being, such as
low- to moderate-intensity physical
activity and of course conviviality.
Editorial note:
This article was originally published
in prevention-international magazine for oral health, Issue 1/2020.
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