Many of the world’s most significant health problems are linked to poor dietary practices and to undernutrition and over-nutrition. That includes health problems in the oral cavity. Yet, as is the case in much of the medical world, oral health education, research and practice are not closely integrated with the work of the nutrition community.
The denominator common to overnutrition, poor dietary practices and risk of chronic as well as oral diseases is the lack of an evidence-based approach to nutrition, medicine and dental medicine. In the past decade, nutrition research has seen a major shift in emphasis from epidemiology and food intake studies to outcomes research, clinical studies, molecular biology, genetics, nutrigenomics and physiology. Thus, the evidence base for causal links between nutrition and specific diseases and disorders, including oral disease, is about to explode. Dentists are in a prime position to screen patients for many disorders relative to nutrition and provide appropriate referrals into the health care system.
The oral cavity is the gateway to the gastrointestinal tract. It is essential for mastication and swallowing foods and fluids. It is the first point of contact of nutrients with body tissues, organs and fluids. Since the time of Aristotle—who noted that figs, being soft and sweet, damaged the teeth1—the study of nutrition and dentistry has focused primarily on oral infectious diseases, particularly dental caries. Research has explored the links between diet and nutrition and craniofacial birth defects, as well as periodontal disease, tooth loss and systemic diseases. There is a great deal of literature linking oral infections, nutrition and immunological response.
Nutrition plays a fundamental role in health, and the dental community has the opportunity to be a critical link between discovery and wellness.
In addition to these relationships, the oral cavity exhibits signs and symptoms of most nutrient deficiency disorders. Oral manifestations of eating disorders (such as bulimia nervosa) include symptoms that a dental professional would note easily on examining the patient. In the same regard, dental procedures such as provision of full-mouth dentures, implants and significant surgery merit dietary education and guidance.
Unfortunately, there is a stark dichotomy between the logical position of the American Dietetic Association—"that nutrition is an integral component of oral health ... . Collaboration between dietetics and dental professionals is recommended for oral health promotion and disease prevention and intervention"2—and the realities of clinical practice. Since 1966, we calculate, JADA has published 61 articles on this topic; 37 percent of these were on the topic of caries and only 6 percent addressed clinical practice and systemic diseases. Although the importance of integrating diet and nutrition guidance into dental practice has been advocated for more than three decades by dental educators and clinicians,3–6 it continues to be ignored except by a handful of prevention-oriented practitioners.
Nutrition and oral health discovery has been plagued by a legacy of poorly controlled studies, oversimplified research results and the lack of an evidence-based approach to integrating diet and nutrition practices for prevention and management of oral diseases and disorders. Consequently, clinicians fail to appreciate fully that the scientific bridge between oral and systemic health often is mediated by diet and nutrition.
Furthermore, because of an insufficient number of appropriately trained and credentialed nutrition professionals in dental education and a paucity of insurance reimbursement for nutrition care, the dental education community pays little attention to nutrition in the curriculum, and only a handful of practitioners apply diet and nutrition principles to their practices. As a result, nutrition is largely ignored and the dental patient continues to be at risk of developing oral diseases and disorders.
A 2005 JADA editorial7 addressed the role of the dentist in overweight and obesity screening. The "globesity" epidemic facing our country is significantly affecting the incidence and severity of diabetes and cardiovascular disease, as well as overall lifespan. There is clear evidence linking diabetes, obesity and oral disease.8 In light of that, the dental community has the opportunity to integrate with the nutrition and medical communities and have a significant impact on this growing global epidemic. As with the growing body of data linking systemic health conditions—including adverse pregnancy outcomes, cardiovascular disease and stroke—to oral infection, the expanding understanding of gene-nutrient reaction may result in more profound discoveries. As data continue to unfold, and the evidence for action and intervention becomes clear, the clinical practitioner will be able to use an evidence-based approach for the public good.
With the vast array of information available about the human genome, the role of nutrients and, by implication, dietary practices on gene expression, nutrient-relevant metabolomics and proteomics will enable an understanding of the response of whole systems to nutrients.9 The application of these "nutrigenomic" tools will provide a fundamental basis for understanding how, for example, craniofacial defects can be prevented; how oral cancer can be detected early; how periodontal inflammation and metabolic stress are related; and how a person’s molecular biomarkers can be used to reduce the risk of developing oral diseases and disorders. So nutrition plays a fundamental role in health, and the dental community has the opportunity to be a critical link between discovery and wellness.
Nutrition is one of the truly integrative sciences in which molecules derived from the genome can be traced to use in metabolic pathways. Thus it is likely that data forthcoming from genomics and proteomics will provide confirmatory evidence for the real role of nutrition and dietary practice to disease and disorders.
This issue of JADA sees the introduction of a new feature on nutrition coordinated by the Nutrition Research Scientific Group of the International Association for Dental Research. This feature aims to present a contemporary and forward-thinking look at diet, nutrition and oral health and clinical information that can be used in dental practice. It also aims to expose the reader to the best cutting-edge science that links nutrition with oral diseases and disorders and that supports the evidence-based integration of scientific advances in nutrition into the clinical practice of dentistry. The beneficiary will be the dental patient, the treatment of whom is our privilege, and the ultimate outcome will be the prevention of disease and the promotion of an integrated health care system.
TOP
REFERENCES
