Table 1
Summary of Literature Pertaining to the Influence of Nutritional Factors on the Incidence of Periodontal Problems

For more than 37 years we have been treating people from all walks of life and from practically all economic groups for their dental problems. From our records, using a random sampling technique, we have analysed these data. Table 2 shows the incidence of dental problems in Bombay Hospital. Bombay's population being so cosmopolitan in caste, creed, hygienic habits, nutritional behaviour and income groups that the figures might as well be taken as representative of the entire country (except, of courses for climatic and hereditary condition).

Table 2
Incidence of Dental Problems in Bombay

The Relationship of Nutrition with the Incidence of Dental Problems

To examine the effect of nutritional factors, the patients were divided in two main groups on the basis of inquiry regarding their food habits. These were classified into

1. Non-vegetarian and
2. Vegetarian

The protein and caloric groups were determined on the basis of average daily intake of food and on the basis of standard food value tables showing the nutritional values of various Indian foods. It could be summarised from these data (Table 3) that the incidence of caries is lower in vegetarians.

Table 3
Incidence of Dental Problems in Bombay in Relation to General Nutrition

The following ingredients in the food are connected with dental problems.

Vitamin C

Vitamin C has been implicated in various physiological and biochemical functions of the body. Besides its involvement in the functions like electron transport, metabolism of tyrosine, absorption of iron and incorporation of plasma iron in ferritin, adrenal cortex functions and formation of collagen and intercellular cement substance, it has also been shown to exert its influence on bone formation. It was therefore well within the context to examine intake of this vitamin in relation to the occurrence of periodontal problems. The sufficient and low vitamin C intakes were arbitrarily grouped according to the standard food-value tables and the inquiries regarding food-habits with the subjects. There seems an apparent influence of the high vitamin C intake in vegetarians on the occurrence of periodontosis.

Fluorides and Other Allied Agents

Aminoacids and proteins have potential of being classified as anti-caries nutrients, like fluorides and phosphates. Both the amount and quality of protein are important factors in influencing dental caries. In vegetarian diet, a large proportion of the ingested protein is digestible and therefore, utilizable. This is not so in the non-vegetarian diet. Only 6-8% of the protein from a steak is digestible whereas over 70-80% of the protein in pulses (dal) is digestible.

The other important aspect of the vegetarian food is its fibre content. Since almost 30-40% of the vegetarian food is cellulose and therefore non-digestible, it forms the major part of the roughage. This acts as a bolus and in turn helps in maintaining regular bowel movements. A stomach upset or constipation results in the formation of various organic acids such as lactic acid, pyruvic acid, citric acid etc. in the mouth. These organic acids are known to form dental plaque which is responsible for the formation of caries.

Total daily dietary fluoride in various countries ranges from 0.2 to 2.7 mg. Absorbed fluoride ions are transported in the blood in both exchangeable and bound forms. Soft tissues do not store fluoride other than in sites of ectopic calcification. Excretion of absorbed fluoride is chiefly by way of urine. Levels of skeletal fluoride are directly related to the levels of fluoride found in drinking water and to age. Fluoride is well known for its anti caries properties. The fluoride content of vegetarian and non-vegetarian diet is given below.

It can be seen from the table that vegetarian diet does not show wide variation in terms of its fluoride content and therefore in turn provides a constant dose of fluoride. A daily dose of 1-2 ppm seems optimal for the prevention of dental caries.

Other Considerations

The traditional belief and recent interest in 'natural food' suggests that fruits and vegetable make a positive contribution in dental health by inhibiting caries and increasing the resistance of the periodontal tissues.

Human dentition is better suited for vegetarian diet. Broad surface molars are specially suited to chew coarse fibrous food.

Most vegetarian foods have a cleansing action. A few gargles after a meal may be enough to clean the mouth. However, if some fibrous particle remains in between the teeth (inter dental space) unlike meat fibres, they do not ferment or traumatise the tissue. Thus brushing morning and night may be enough to prevent dental problems.

Vegetables and fruits are a very healthy source of natural vitamins like vitamin C and other minerals.

Salivary pH does not change fast and therefore vegetarian food does not decompose. Salivary pH has an important role to play in oral health. Most dairy products like milk, butter, and vegetable oil keep saliva almost neutral. Most vegetables, dry fruits, apples, grapes and bananas may keep saliva slightly alkaline. Meat, sea food and chicken are acid forming foods. Acidic saliva normally helps causing dental decay.

Hence, it appears that evidence is strongly in favour of a vegetarian diet. There seems to be no doubt that the incidence of dental problems is less in a vegetarian population.

REFERENCES

1. Thomson M.E., et al. Influence of nutritional factore, in periodontal diseases, J. NZ Soc.Periodontal diseases 1981, 51, 15-9.
2. Eeva Lukosalo et al. Caries, periodontal status and some salivary factore, in Lacto vegetarians Dept. of Community Health, University of Kupio, Finland.
3. Geddes D.A. et al. Apples, salted peanuts and plaque. PH British Dent J. 1977: 142, 317-9.

ACKNOWLEDGMENT

I am very thankful to:—

1. Dr. P. R. Sharma, M.Sc. D.Sc. Geneve Institute Des Science, II, 1211 Geneve 4
2. Dr. C.D.S. Laxmanan, L.D.S. RCS, England, Consultant, Dental Surgeon, Bombay Hospital.
3. Dr. H. M. Dholakia, L.D.S. RCS, England. Visiting Professor, Belgaum Dental College.
4. Dr. B. N. Apte, M.Sc., Ph.D, Consultant Molecular Geneticist. Bombay Hospital Institute of Medical Sciences.

Part of the article is from the paper read by Dr. N. C. Sharma in the Ist Int. Conference of the surgery in Tropics January 1978 at Bombay Hospital.