Free sugars and gingival inflammation: A systematic review and meta‐analysis

Abstract

AimConsumption of free sugars has been associated with chronic non‐communicable diseases. The aim of the study was to investigate the effect of free‐sugar consumption on gingival inflammation using a systematic review and meta‐analysis based on the PICO question ‘What impact does the restriction of free sugars have on the inflammation of gingival tissue?’Materials and MethodsLiterature review and analyses were based on the Cochrane Handbook for Systematic Reviews of Interventions. Controlled clinical studies reporting on free‐sugar interventions and gingival inflammation were included. Risk of bias was performed with ROBINS‐I and ROB‐2, and effect sizes were estimated with robust variance meta‐regressions.ResultsOf the 1777 primarily identified studies, 1768 were excluded, and 9 studies with 209 participants with gingival inflammation measures were included. Six of these studies reported on the dental plaque scores of 113 participants. Restriction of free sugars, when compared with no such restriction, was associated with statistically significantly improved gingival health scores (standard mean difference [SMD] = −0.92; 95% confidence interval [CI]: −1.43 to −0.42, p < .004; I2 [heterogeneity] = 46.8) and a trend towards lower dental plaque scores (SMD = −0.61; 95% CI: −1.28 to 0.05, p < .07; I2 = 41.3). The observed improvement of gingival inflammation scores with restricted consumption of free sugar was robust against various statistical imputations. No meta‐regression models were feasible because of the limited number of studies. The median publication year was 1982. Risk‐of‐bias analysis showed a moderate risk in all studies.ConclusionRestriction of free sugar was shown to be associated with reduced gingival inflammation. The systematic review was registered at PROSPERO (CRD 42020157914).

Sugar‐sweetened beverage consumption and periodontitis among adults: A population‐based cross‐sectional study

“…Furthermore, the destruction of periodontal tissue creates a highly protein-nourishing environment for the biofilm (Hajishengallis, 2014), establishing a feedback loop that exacerbates periodontitis (Loos & Van Dyke, 2020). Therefore, limiting free-sugar intake seemed to reduce gingival inflammation (Woelber et al, 2023).…”

Effectiveness of Salvadora persica toothbrush and Salvadora persica chewing stick in plaque and gingivitis control: a randomized control trial

“…The potential effects of confounding factors on gingival inflammation, such as dietary influence and lifestyle, were not addressed in the present study. Considering more communities are exposed to sedentary modern lifestyle and western diet that further evoke gingival inflammatory state [ 8 , 56 ], it is hence essential to approach the interpretation of the findings with caution.…”

“…Dental caries is caused by a complex interplay between acid-forming biofilm microorganisms in the presence of sugar [ 7 ]. The metabolism of sugar by dental biofilm bacteria also leads to the formation of short-chain carboxylic acids, which in turn may contribute to gingival inflammation [ 8 ]. Moreover, the overwhelming prevalence of dental caries and periodontal disease is strongly linked to behavior, particularly with regards to unsatisfactory oral hygiene and a high dietary intake of carbohydrates [ 7 ].…”

“…Moreover, the overwhelming prevalence of dental caries and periodontal disease is strongly linked to behavior, particularly with regards to unsatisfactory oral hygiene and a high dietary intake of carbohydrates [ 7 ]. Thus, while sugar restriction has been associated with reduced gingival inflammation and caries development [ 8 ], interventional techniques and armamentarium are indispensable to help curb the disease progression and further affects individual’s quality of life [ 9 ]. This preventive strategy involves physically disrupting dental plaque biofilms and reducing the bacterial bioburden through effective mechanical oral hygiene measures, such as toothbrushing [ 10 ].…”

Healthier Smile: The Role of Diet and Nutrition in the Prevention and Therapy of Caries, Gingivitis, and Periodontitis

“…Although oral hygiene and fluorides have a significant impact on people's oral health, we must not forget that the causes of oral diseases are often related to malnutrition and other unhealthy behavioral factors, such as smoking, being sedentary, and chronic stress. While dental caries is clearly a diet-related disease [1,2], there is also growing evidence that gingivitis and periodontitis are greatly influenced by diet [3][4][5][6][7][8][9]. A peculiarity in this context is that malnutrition with far too much sugar and pro-inflammatory fats and a lack of fiber and micronutrients (which is also what the average Western diet represents) shows up extremely quickly in oral diseases [5,[10][11][12]-much quicker than other diseases also caused by Western diets, such as obesity, diabetes, or atherosclerosis.…”