The Role of Diet in Periodontal Inflammation: A Controlled Clinical Study

Experimental Gingivitis in Omnivores and Vegans. The Role of Diet in Periodontal Inflammation: A Controlled Clinical Study

Diet can influence the body's healing and repair mechanisms. A dietary imbalance obviously cannot trigger periodontal disease in the absence of a primum movens, which is bacterial plaque. However, it can condition its severity and extent by altering the permeability of the oral mucosa, the effectiveness of the immune response and the reparative potential of the gingival tissues.

Nutraceuticals is the science that studies the effects of the so-called food-drug, i.e. those foods that contain substances capable of performing a pharmacological function, modifying the functions of the organism. In particular, some molecules that are assimilated through various foods are able to penetrate the cell nucleus and influence, through an epigenetic mechanism, the expression or otherwise of some genes. The aim of the present longitudinal quasi-experimental study was to evaluate the gingival inflammatory response to experimentally induced plaque accumulation in periodontally healthy vegans and omnivores and to explore whether systemic biomarkers mediated the observed clinical effects.

Study Overview

• Status: Completed
• Conditions: Periodontal Diseases; Periodontal Inflammation
• Intervention / Treatment: Dietary supplement: Vegan/vegetarian diet; Dietary supplement: Omnivorous diet

• Study Type: Interventional
• Enrollment (Actual): 36
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Italy
  • CH
    • Chieti, CH, Italy, 66100
      • G. d'Annunzio University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Optimal systemic health conditions
• Non-Smoking
• Absence of cardio-vascular pathologies
• Absence of pulmonary pathologies
• Non-diabetic
• Not pregnant
• Presence of 28 teeth without prosthetic crowns or subgingival/juxtagingival interproximal restorations
• FMPS <20% at baseline
• FMBS <20% at baseline
• Omnivorous or vegan diet for at least a year
• Absence of periodontitis

Exclusion Criteria:

• Smokers
• Presence of systemic pathologies
• Presence of cardio-vascular disease
• Presence of periodontitis
• FMPS>20% at baseline
• FMBS>20% at baseline
• Pregnant women
• Presence of blood pathologies
• Taking medicines (hydantoins, nifedipine or cyclosporine)
• Taking oral contraceptives
• Bacterial, viral or fungal infections
• Idiopathic gingival fibromatosis
• Mucocutaneous disorders
• Allergic reactions to toothpastes and mouthwashes

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Patients with a vegan diet; After excluding patients with clinical signs of periodontitis, the patients recruited at baseline underwent prophylaxis and home oral hygiene instructions were given with brushing and flossing in order to reduce the parameters of inflammation and the presence of plaque (FMPS andFMBS). After patient recruitment and prior to baseline assessment, fasting venous blood samples will be collected to evaluate metabolic, inflammatory, oxidative stress, and hematological parameters, including fasting glucose, lipid profile, CRP, d-ROMs, BAP, and complete blood count. The Systemic Immune-Inflammation Index (SII) will be calculated. After 15 days from baseline (T0) all patients were recorded the parameters of FMPS, FMBS, and Eastman Interdental Bleeding Index (EIBI) and were asked to stop using dental floss and mouthwash. All patients were recalled weekly 4 times after T0 (T1, T2, T3,T4) in order to monitor the parameters of inflammation and plaque accumulation by recording FMBS, FMPS and EIBI.	Dietary supplement: Vegan/vegetarian diet; At baseline, following the compilation of a periodontal chart in which pocket probing depth (PPD) and FMPS and FMBS were recorded, patients with pathological probing depths >3mm associated with periodontitis were excluded. Healthy patients underwent a prophylaxis session and oral hygiene instructions with brushing and flossing. A mouthwash based on chlorhexifdine 0.20% to be used twice a day was prescribed. At 15 days from the baseline (T0) the periodontal chart was compiled again and the parameters relating to PD, FMP, FMBS and the Eastman Interdental Bleeding Index (EIBI) were collected. Patients with FMBS and FMPS values >20% were excluded. From time T0 all patients were asked to suspend the interdental hygiene maneuvers by interrupting the use of dental floss and abandoning the use of mouthwash. All patients were recalled weekly, for a total of 4 times (T1, T2, T3, T4) in which parameters related to FMBS, FMPS and EIBI were recorded.
Active Comparator: Patients with an omnivorous diet; After excluding patients with clinical signs of periodontitis, the patients recruited at baseline underwent prophylaxis and home oral hygiene instructions were given with brushing and flossing in order to reduce the parameters of inflammation and the presence of plaque (FMPS and FMBS). After patient recruitment and prior to baseline assessment, fasting venous blood samples will be collected to evaluate metabolic, inflammatory, oxidative stress, and hematological parameters, including fasting glucose, lipid profile, CRP, d-ROMs, BAP, and complete blood count. The Systemic Immune-Inflammation Index (SII) will be calculated. After 15 days from baseline (T0) all patients were recorded the parameters of FMPS, FMBS and Eastman Interdental Bleeding Index (EIBI) and were asked to stop using dental floss and mouthwash. All patients were recalled weekly 4 times after T0 (T1, T2, T3, T4) in order to monitor the parameters of inflammation and plaque accumulation by recording FMBS, FMPS and EIBI.	Dietary supplement: Omnivorous diet; At baseline, following the compilation of a periodontal chart in which pocket probing depth (PPD) and FMPS and FMBS were recorded, patients with pathological probing depths >3mm associated with periodontitis were excluded. Healthy patients underwent a prophylaxis session and oral hygiene instructions with brushing and flossing. A mouthwash based on chlorhexifdine 0.20% to be used twice a day was prescribed. At 15 days from the baseline (T0) the periodontal chart was compiled again and the parameters relating to PD, FMP, FMBS and the Eastman Interdental Bleeding Index (EIBI) were collected. Patients with FMBS and FMPS values >20% were excluded. From time T0 all patients were asked to suspend the interdental hygiene maneuvers by interrupting the use of dental floss and abandoning the use of mouthwash. All patients were recalled weekly, for a total of 4 times (T1, T2, T3, T4) in which parameters related to FMBS, FMPS and EIBI were recorded.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Eastman Interdental Bleeding Index	A wooden wedge is inserted buccally into the interdental space 1-2 mm, perpendicular to the long axis of the tooth, to assess for the presence of interdental inflammation (Yes/No).	Four weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Full Mouth Plaque Score	Index that evaluates the general presence of bacterial plaque for all teeth. Through the passage of the probe, the presence of plaque deposits is reported for 4 surfaces for each tooth. A ratio is made between the contaminated surfaces and the total surfaces investigated to obtain a percentage value.	Four weeks
Full Mouth Bleeding Score	Index that evaluates the general presence of bleeding for all teeth. Through the insertion of a periodontal probe, the presence of bleeding on probing is signaled for 4 sites for each tooth. A ratio is made between the bleeding sites and the total sites investigated to obtain a percentage value.	Four weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Fasting glucose	Measurement of blood glucose levels after fasting to assess glycemic status.	Before T0
Total cholesterol	Measurement of total circulating cholesterol.	Before T0
High-Density Lipoprotein (HDL)	Assessment of HDL cholesterol	Before T0
Low-Density Lipoprotein (LDL)	Assessment of LDL cholesterol	Before T0
C-Reactive Protein (CRP)	Systemic inflammatory biomarker used to evaluate inflammatory status	Before T0
Reactive Oxygen Metabolites (d-ROMs)	Marker of oxidative stress reflecting circulating reactive oxygen metabolites	Before T0
Biological Antioxidant Potential (BAP)	Measurement of antioxidant capacity in plasma	Before T0
Complete blood count (CBC)	Hematological assessment including leukocytes, erythrocytes, hemoglobin, hematocrit, and platelet count.	Before T0
Systemic Immune-Inflammation Index (SII)	Composite inflammatory index calculated as platelet count × neutrophil count / lymphocyte count.	Before T0
Body Mass Index (BMI)	Anthropometric index calculated as weight (kg) divided by height squared (m²) to assess body composition.	Before T0

Collaborators and Investigators

• Sponsor: G. d'Annunzio University
• Investigators: Principal Investigator: Michele Paolantonio, MD; DDS, University G. D'Annunzio Chieti-Pescara

Study record dates

Study Major Dates

• Study Start (Actual): February 16, 2023
• Primary Completion (Actual): April 30, 2025
• Study Completion (Actual): April 30, 2025

Study Registration Dates

• First Submitted: January 23, 2023
• First Submitted That Met QC Criteria: May 16, 2023
• First Posted (Actual): May 18, 2023

Study Record Updates

• Last Update Posted (Actual): May 28, 2026
• Last Update Submitted That Met QC Criteria: May 25, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Nutraceutical; Experimental Gengivitis; Periodontal Inflammation
• Additional Relevant MeSH Terms: Mouth Diseases; Stomatognathic Diseases; Periodontal Diseases; Therapeutics; Diet, Food, and Nutrition; Physiological Phenomena; Nutritional Physiological Phenomena; Diet, Plant-Based; Diet Therapy; Nutrition Therapy; Diet; Diet, Vegetarian; Diet, Vegan
• Other Study ID Numbers: 11012023

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No