Sugar-sweetened beverages and periodontitis

Research Topic:

Background + Aims

Periodontitis is a chronic inflammatory disease affecting the supporting structures of the teeth, leading to progressive periodontal tissue destruction and eventual tooth loss if untreated. The main aetiological factor for periodontitis is plaque. However, the two main risk factors for progression of the disease have been identified as smoking and diabetes.
Recently, there has been a global increase in the consumption of sugar-sweetened beverages (SSBs), which can be characterised by artificial sweetening with mono or disaccharides. Examples of SBBs include soft drinks, fruit juices, energy drinks, hot chocolate, sweetened teas, and coffees. It has been well established that these beverages are known to contribute to several health issues, such as obesity, diabetes and cardiovascular disease, primarily due to their high sugar content. However, the impact of SSB consumption on oral health, particularly its potential role in the development and progression of periodontitis, is less well understood.
This study aims to investigate the relationship between the consumption of sugar-sweetened beverages (SSBs) and the prevalence of periodontitis in an adult population.

Materials + Methods

A cross-sectional population-based study means that data was collected at a single point in time from a large sample of adults to assess the association between SSB consumption and periodontitis. The study involved a representative sample of adults in the United States aged between 30-50 years. The participants were selected using a stratified sampling technique to ensure a diverse and representative cohort based on factors such as age, gender, and socioeconomic status. The following groups were not examined for periodontal diseases due to a risk of bacteraemia: pregnant women, individuals with a risk of infective endocarditis, rheumatic fever and individuals undergoing dialysis.
Data were gathered through structured interviews and clinical examinations. Participants were asked about their dietary habits, specifically their frequency of SSB consumption. Clinical periodontal examinations of two randomly selected quadrants were conducted to diagnose periodontitis. Probing pocket depth (PPD) and clinical attachment loss (CAL) were recorded for each tooth’s buccal and mesiobuccal surfaces.
The data was analysed using statistical methods to examine the relationship between SSB consumption and periodontitis. Multivariate logistic regression models were employed to control for potential confounding variables such as age, gender, smoking status, oral hygiene practices, and socioeconomic factors. Effect modification analysis was performed considering self-reported diabetes.

Results

The study found that a significant proportion (27.4%) of the sampled adult population had periodontitis of varying severity (4.2% mild, 19.8% moderate, 3.4% severe). Self-reported diabetes was evident in 2.9% of participants. SBB consumption ranged from 0 to 49.8 times per week, with 36.3% of the sample consuming ≥5 SBBs per week, 23.4% ≥7 SBBs per week and 10.7% ≥14 SBBs per week.
There was a positive association between higher SSB consumption and an increased prevalence of periodontitis. Participants who frequently consumed SSBs (≥5/per week)) were more likely to have periodontitis compared to those who consumed these beverages less often. The results indicated a dose-response relationship, meaning that the risk of periodontitis increased with higher levels of SSB consumption. Those with the highest intake of SSBs had the highest odds of having periodontitis. SSB consumption was associated with an increased chance of periodontitis only among those who reported not having diabetes. The study also conducted subgroup analyses, which showed that the association between SSB consumption and periodontitis was consistent across different demographic groups, including age and gender, although the strength of the association varied slightly.
After adjusting for potential confounding factors such as age, gender, smoking, socioeconomic status, and oral hygiene practices, the association between SSB consumption and periodontitis remained statistically significant. This suggests that the relationship is not solely due to these other factors.

Limitations

As the study has a cross-sectional design, it cannot establish a definitive cause-and-effect relationship but only shows an association at a single time point. Longitudinal studies would be needed to confirm these findings and improve understanding of the temporal relationship between SBB consumption and the progression of periodontitis.
The diagnosis of periodontitis was based on clinical indicators assessed at a single examination of two quadrants (half mouth). This may have underestimated the prevalence of periodontitis, and the single examination might not have captured the full extent of the disease’s progression or its variability over time.
SSB consumption was assessed through self-reported data, which may be subject to recall bias or social desirability bias. Participants might have underreported or inaccurately recalled their beverage intake, affecting the accuracy of the data.
Although the study adjusted for several known confounders like age, gender, smoking, and oral hygiene practices, there may be other unmeasured factors (e.g., genetic predispositions and specific dietary patterns) that could influence the relationship between SSB consumption and periodontitis.

Conclusion

This study adds to the growing body of evidence that diet, particularly the consumption of high-sugar foods and beverages, plays a crucial role in oral health. Given the widespread consumption of SSBs and the global burden of periodontitis, these findings have important public health implications. They suggest that public health interventions aimed at reducing SSB consumption could have a beneficial impact not only on general health outcomes, such as obesity and diabetes, but also on the prevention of periodontal diseases.
The findings of this study suggest a significant and potentially causal relationship between the consumption of SSBs and the prevalence of periodontitis among adults. The dose-response relationship strengthens the evidence for this link, implying that reducing SSB intake could be an effective strategy for lowering the risk of periodontitis.
There is a need for further research, particularly longitudinal studies, to establish causality.
Understanding the exact mechanisms by which SSB consumption contributes to periodontitis could help in developing targeted prevention strategies.
Future research could explore whether specific types of SSBs are more harmful or whether the frequency and timing of consumption play a role.

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