Romanian Journal of Medical and Dental Education

Vol. 11, No. 5, September-October 2022

ARE PERIODONTAL TISSUES AND PERIODONTAL HEALTH

IMPACTED BY FOOD SUPPLEMENTS (PROTEIN AND
AMINOACIDS, NATURAL HERBAL PRODUCTS, MINERALS)? -
REVIEW.
George Alexandru Maftei1, Oana Ciurcanu2*, Odette Luca3*, Liliana Pasarin4, Cristina
Popa1, Mihaela Mares5, Maria Alexandra Martu4 , Ionut Luchian4
1
“Gr.T.Popa"U.M.Ph., Iași, Romania, Faculty of Dentistry, Department of Oral Medicine
2
“Gr.T.Popa"U.M.Ph., Iași, Romania, Faculty of Dentistry, Department of Dento-alveolar
Surgery,
3
“Gr.T.Popa"U.M.Ph. -Iași, Romania, Faculty of Dentistry, Department of Implantology,
Removable Dentures, Dental Technology.
4
“Gr.T.Popa"U.M.Ph. -Iași, Romania, Faculty of Dentistry, Department of Periodontology.
5
PhD Student “Dunarea de jos, Galati, Romania, Resident Doctor
*
Corresponding author : Ciurcanu Oana: [email protected]
Luca Odette: [email protected]
# All authors had an equal contribution equal with first author

Abstract:
The aim of this review is to provide an overview of the current evidence of some popular food
supplements and superfoods that might be of interest in periodontology.
Although the number of publications investigating the effect of these products on human health and their possible
use in medicine is increasing, only little is known so far regarding their effects on periodontal tissues and their
possible use in periodontal treatment or medicine.
In summary, an increasing number of studies have revealed aspects and effects of these so-called lifestyle or fitness
supplements and superfoods that may have an impact on periodontal health and healing after treatment. However,
some the current evidence is of a very low quality, and more validated scientific data are required before their
possible use in prevention or treatment of periodontal diseases can be made.
Keyword: food supplements, periodontal tissues, prevention or treatment of periodontal
diseases

INTRODUCTION inflammatory response to periodontopathic

The use of food supplements and so-called bacteria.
superfoods to increase fitness and This review investigating the effect impact
regeneration or just to improve health and of health and lifestyle food supplements on
well-being is very popular these days, periodontal tissues and health. (Protein and
particularly in people living the fitness Aminoacid Supplements, Glucosamine and
lifestyle. Some of the effects attributed to Chondroitin Sulfate, Natural herbal
these supplements and superfoods involve products and seeds, Minerals).[1]
tissues and processes that may also play a
role in periodontal healing and 1. Protein and Aminoacid Supplements
regeneration. However, some the current The most frequently used supplements in
evidence is of a very low quality, and more the fitness lifestyle are protein and amino
validated scientific data are required before acid supplements used to support muscle
their possible use in prevention or treatment growth and muscle regeneration.
of periodontal diseases can be made. Possible beneficial effects of protein and
Periodontitis is a dysbiotic inflammatory amino acid supplements have been
disease and the result of a host immuno- extensively studied in orthopedic and sports

20
 Romanian Journal of Medical and Dental Education
Vol. 11, No. 5, September-October 2022

medicine, and also in geriatric medicine, attributed to its action as an iron chelator, as
since proteins constitute an important well as of an immunomodulatory function.
structural and functional component of Lactoferrin has been shown to decrease the
skeletal tissues. secretion of interleukin- 1β and tumor
However, some of these so-called muscle necrosis factor alpha and to stabilize mast
supplements might also have effects on cells. [8-12]
periodontal tissues as well as on periodontal A significant decrease in tumor necrosis
wound healing. factor alpha serum levelsafter
Alteration in protein turnover following administration of a high-caloric protein-rich
tissue damage due to injury or extensive oral supplement was also reported in a
exercise is crucial to tissue repair. prospective randomized, double-blind,
Increasing knowledge has indicated the placebo-controlled study in patients with
need for increased protein intake during chronic heart failure and
tissue repair based on its important roles cachexia. [13]
supporting wound healing, maintaining This was also confirmed by a clinical trial
tissue integrity, and promoting in sarcopenic elderly patients where
convalescence.[2] supplementation with whey protein, amino
An insufficient protein intake has been acids, and vitamin D increased serum
shown to delay wound healing and to reduce insulin-like
the integrity of the repaired tissue. [3-5] growth factor 1 concentrations and lowered
Thus, milk can be considered as a natural C-reactive protein. [14]
biological liquid esculent providing Furthermore, protein deficiency may also
nutrition at a predispose patients to higher rates of
time of rapid body and particularly infectious complications. [15]
muscular-skeletal growth. Protein hydrolysates have the potential to
Total protein intake and animal protein promote different types of tissue repair and
intake have been associated with higher might be useful in situations where excess
bone mineral density and less bone mineral protein is needed, such as tissue repair,
density loss over time. regeneration, or wound healing.
The positive effects of dietary protein on However, further well-controlled human
bone mineral density may be due to trials are required to confirm these findings
increased levels of insulin-like growth and assess the clinical relevance in
factor 1 and suppression of parathyroid periodontal therapy.
hormone. Lipopolysaccharide of gram-negative
Further investigation of these whey protein bacteria, like most of the main periodontal
fractions revealed that lactoferrin was a pathogens, is known to induce the release of
constituent in many of these fractions.[6] proinflammatory cytokines such as
However, local concentrations can increase interleukin-1β, interleukin-6, interleukin,
during inflammation. [6,7] tumor necrosis factor-alpha, and nitric
Studies of lactoferrin on human, rat, and oxide in macrophages.
mouse cell cultures of the osteoblast and Furthermore, recent studies have also
osteoclast lineage and of bone marrow indicated that branched-chain amino acids
cultures showed that lactoferrin promotes may play a role in the development of
osteoblast growth, inhibits insulin resistance and might be associated
osteoclastogenesis, and reduces osteoblast with incident cardiovascular disease. [16-
apoptosis. 18]
Interestingly, besides its effects on bone Glutamine has also been shown to simulate
metabolism, there are also reports of collagen synthesis through the conversion
antimicrobial effects of lactoferrin,

21
 Romanian Journal of Medical and Dental Education
Vol. 11, No. 5, September-October 2022

process to proline and provides 75% of the component of glycosaminoglycans and is

intracellular free proline in fibroblasts. involved in maintaining strength,
Amman et al. [19] investigated the effect of flexibility, and elasticity of these tissues.
essential amino acid supplements in adult Numerous studies have shown the
osteoporotic rats. significant symptom-modifying effect of
Unfortunately, the number of studies glucosamine in osteoarthritis and its
investigating the effect of protein and amino beneficial effects on joint health. [22-24]
acid supplements on periodontal disease or There are also an increasing number of
therapy is very limited. studies investigating the effects of
Aral et al [20] investigated the effect of glucosamine in combination with
bodybuilding and protein supplements on chondroitin sulfate in osteoarthritis therapy.
periodontal tissues, comparing Supplementation with glucosamine has
bodybuilders with gingivitis with been shown to reduce inflammatory
nonexercising males with and without responses of joint cartilage by inhibiting the
gingivitis. activation of nuclear factor kappa-light-
They assessed clinical periodontal chain- enhancer of activated B cells, which
parameters and analyzed saliva and gingival lies upstream of inflammatory processes or
crevicular fluid samples for interleukin-1β, mediators such as interleukin-beta,
apoptosis-associated speck-like protein interleukin-8, tumor necrosis factor alpha,
containing and C-reactive protein.
C-terminal caspase-recruitment domain and Binding of proinflammatory cytokines to
caspase 1. their respective receptors amplifies immune
The authors indicated that bodybuilding and response by increasing proliferation of T
supplement usage may decrease gingival cells, promoting leukocyte infiltration and
inflammation by downregulating caspase 1, facilitating cell-cell signaling. [25-28]
interleukin-1β, and apoptosis-associated Cigarette smoking causes lung
speck-like protein containing C-terminal inflammation that is mainly regulated by
caspase-recruitment domain. redox-sensitive
Lee et al [21] investigated the effects of a pathways.
commercially available nutritional It was recommended that glucosamine
supplement drink on periodontal health or hydrochloride could be used as a
healing and tooth mobility after periodontal pharmaceutical supplement to alleviate
flap surgery. oxidative stress.[29]
Patients with a generalized moderate Interleukin-8 plays an essential role in
chronic periodontitis were, directly after directing the sequential process of
periodontal flap surgery, randomly neutrophil rolling, adhesion, and
allocated to either the intervention or the transmigration into inflamed
control group. microvasculature.
After 8 weeks, tooth mobility returned to Furthermore, proinflammatory mediators,
baseline levels again in both groups. such as interleukin-1β, interleukin-6, and
The authors concluded that the use of tumor necrosis factor alpha increase the
nutritional supplementation may improve expression of adhesion molecules on
early periodontal wound healing after endothelial cells and neutrophils. [25,30]
periodontal surgery. However, glucosamine also seems to
exhibit interesting effects on bone and
2. Glucosamine and Chondroitin Sulfate collagen metabolism. These results indicate
Glucosamine is a naturally occurring amino that glucosamine increases bone mineral
monosaccharide that is present in the density, induces osteoblastic
connective tissue and cartilage tissues as a differentiation, especially at middle and late

22
 Romanian Journal of Medical and Dental Education
Vol. 11, No. 5, September-October 2022

stages, and also suppresses osteoclastic cell In 2009, Baumgartner et al. [34] illustrated
differentiation, thereby increasing bone that diet may have a significant impact on
matrix deposition, decreasing bone periodontal inflammatory status.
resorption, and promoting bone formation. The Swiss study on 10 adults who were
[23,31] placed in a “Stone Age” environment and
Furthermore, risk factors for diabetes on
development are elevated triglycerides, diet rich in fibers, fish oils, and
blood pressure, body mass index, and micronutrients showed significant
family history of diabetes. reduction in bleeding on probing and pocket
The findings of this study indicate that there depth compared with baseline, even in the
is no effect of glucosamine sulfate on mean absence of oral hygiene. [34,35] An
hemoglobin A1c level or on obtaining a evidence-based review, based on 31 human
high hemoglobin A1c level or new-onset studies that explored the relationship
Diabetes mellitus over 6.5 years, especially between food supplements and
in participants with a normal hemoglobin periodontitis, showed substantial evidence
A1c level at baseline. of beneficial outcomes for treatment of
The results of an in vitro study using periodontal diseases from nutritional
inferior nerve preparation in a rat mandible intervention.
suggest that d-glucosamine hydrochloride It also suggested guidelines for
has a pain relief effect on patients with micronutrient supplement intake (mainly
dental pain. [32] vitamins C and D) that may improve results
in the treatment of periodontitis, especially
3. Natural herbal products and seeds in cases of refractory disease. [36]
“functional food or super food”(quinoa, Furthermore, it has been shown that the use
spirulina), of nutritional agents as adjuvants to
In recent years, the increasing number of nonsurgical periodontal therapy
people suffering from cardiovascular significantly reduced the periodontal
diseases, obesity, diabetes mellitus, disease severity, improved treatment
neurologic diseases, dementia, cancer, and prognosis in the short term (2-6 months),
other related diseases has shifted the focus and reduced susceptibility toward
from disease treatment to healthy lifestyle periodontal
changes. disease.[37]
Epidemiologic studies have shown that In the past few years, emerging evidence
physical inactivity and unhealthy diet from the studies have increased the
containing high amounts of refined awareness of the industry and consumers
carbohydrates combined with saturated related to the possible nutritional and health
fatty acids but lacking fiber, minerals, and attributes of certain natural herbal products.
antioxidant micronutrients may be an Apart from that, it is a source of many
important risk factor in the development of vitamins (thiamin, riboflavin, niacin, and
pathologic conditions. folic and ascorbic acids) and minerals
Whereas pre-Neolithic oral bacterial (calcium, phosphorus, potassium, and
ecosystems were more diverse and magnesium), as well as compounds with
dominated by the antioxidant properties. [38,39]
nonpathogenic family of Ruminococcaceae, Chia seeds extract has been tested in a
modern oral ecosystems are less diverse recent in vitro study and demonstrated
with an abundance of periodontopathogens, excellent antimicrobial efficacy against
such as P. gingivalis, Tannarella, and three periodontal pathogens: P. gingivalis,
Treponema, and cariogenic species, such as Aggregatibacter actinomycetemcomitans,
Streptococcus mutans. [33]

23
 Romanian Journal of Medical and Dental Education
Vol. 11, No. 5, September-October 2022

and F. nucleatum. Its inhibitory potential The content of micronutrients, such as

was similar to 0.2% vitamins and minerals, is also of great
chlorhexidine, which was used as positive importance, as the seed is rich in pyridoxine
control. [40] (vitamin B6), folic acid, ascorbic acid
As there are no clinical trials related to the (vitamin C), and vitamin E. Mineral
preventive or therapeutic properties of chia content, such as calcium, iron, and
seeds on the diseases that affect oral mucosa magnesium, is considerably higher
and periodontium, we can only suggest that than in other commonly used grains, such as
the systemic anti-inflammatory potential of wheat and corn.
chia seeds shown in some studies may play These components are known to exhibit a
a role in the prevention and treatment of wide range of health benefits, such as
periodontal diseases. antifungal, antiviral, antibacterial, and
It can also be stipulated that their cancer-suppressing effects.
antioxidative potential may have an effect They also exhibit hypoglycemic,
on oxidative stress that orchestrates antithrombotic, diuretic, anti-inflammatory,
proinflammatory cascades that underpin anabolic, antidiabetic, anti-osteoporotic,
tissue destruction in periodontitis and other and anti-obesity properties. [42]
inflammatory conditions associated with The evidence of some of these benefits is
periodontitis, such as type 2 diabetes, demonstrated in limited numbers of animal
cardiovascular disease, and obesity and and human studies.
related metabolic dysregulation. Vitamins: thiamine, riboflavin, niacin, folic
The seeds’ mineral content may also and ascorbic acids Minerals: calcium,
improve the quality of bone and prevent phosphorus, potassium, and magnesium
osteoporosis and its effect on the Antioxidants: polyphenols, chlorogenic
periodontal status of the patients. acid, caffeic
Quinoa seeds, leaves, and sprouts are used acid, quercetin, kaempferol Fatty acids:
as human and animal food owing to their omega-3 and omega-6 fatty acids [38,39]
nutritional values. Improvement of lipid profile; reduction of
Quinoa has been described as “one of the risk of diabetes and cardiovascular diseases.
grains of the 21st century,” and its [43]
production, preservation, and consumption Quinoa (Cehnopodium quinoa Wild.)
were promoted by the Food and Agriculture Vitamins: pyridoxine (vitamin B6), folic
Organization of the United Nations in 2013. acid, ascorbic
Quinoa is superior to many grains, such as acid, and vitamin E
rice, rye, barley, and oat, in relation to The antibacterial activity of quinoa against
protein and lipid content. It contains 13.1%- oral bacteria has rarely been reported. A
16.7% of high-quality proteins with well- recent in vitro study showed that alkali-
balanced essential amino acid content that transformed saponins derived from quinoa
satisfies the amino acid requirements for husk were efficient
adults suggested against three halitosis-related bacteria: P.
by the Food and Agriculture Organization gingivalis, Clostridium perfringens, and F.
of the United Nations/ nucleatum.
World Health Organization/United Nations The saponins altered membrane potential
University. and morphology, as well as interfered with
It contains a significant amount of essential its permeability, causing leakage of nucleic
amino acids, such as lysine, methionine, acids and proteins.
and threonine, that is higher than in The results of the study indicated that
essential cereals, such as wheat and maize. saponins derived from quinoa husk may
[41] have an important role in a new drug

24
 Romanian Journal of Medical and Dental Education
Vol. 11, No. 5, September-October 2022

delivery system against oral halitosis Gingival tissue of rats treated with S.
caused by oral microorganisms.[44] maxima showed reduced concentrations of
Spirulina. Arthrospira platensis is a proinflammatory cytokines, such as tumor
microscopic single-cell alga that inhabits necrosis factor alpha, interleukin-1β,
fresh and marine waters. interleukin-6,
Spirulina contains up to 70% of proteins; it and inflammatory transcription factor
is also rich source of vitamins (B-complex, nuclear factor kappa-light- chain- enhancer
β-carotenes, and vitamin K) and minerals of activated B cells. Activity of
(iron, magnesia, zinc, copper, selenium, and myeloperoxidase and expression of matrix
chromium). It can be easily cultivated, metalloproteinases were also decreased in
harvested, and processed into a variety of periodontal tissue of test rats.
final products, such as powder, tablets, In addition, treatment with S. maxima
flakes, and other edible profiles. [45] increased concentration of anti-
Owing to the high content of carotenoids inflammatory
and the protein-bound pigment C- cytokine interleukin-4 and the
phycocyanin osteoprotegerin/ RANKL expression ratio.
this blue-green algae has been shown to S. maxima-treated
have antioxidant and immunomodulatory groups showed reduced numbers of
properties in in vitro and in vivo studies. osteoclasts and less bone loss, as well as
These substances may act as scavengers of increased production of osteoblasts and
reactive oxygen species mainly generated osteogenesis-related factors. [48]
by host defense cells during an Scarce evidence so far exists on the effect
inflammatory reaction and increased of spirulina on periodontal health and
oxidative stress. [45] disease. One randomized controlled clinical
Oxidative stress was first described by Sies study tested the benefits of local application
in 1985, and some years later it was of spirulina-based
revealed that it underpins the pathogenesis Gel as adjunct to nonsurgical treatment
of numerous of inflammatory diseases, such (scaling and root planing) of chronic
as periodontitis, diabetes, cardiovascular periodontitis.
disease, and obesity/metabolic The results showed significant
dysregulation. [36,46] improvement of clinical parameters, such as
The antioxidative potential of spirulina has probing depth reduction and clinical
been demonstrated in several human studies attachment gain, in the experimental group
conducted on geriatric patients and when compared
onhealthy individuals after exercise. with the control group (scaling and root
Food supplemented by spirulina for 16 planing alone).
weeks showed significantly increased levels During the course of treatment, spirulina gel
of antioxidant status in plasma of geriatric did not cause any side or adverse
patients. [47] effects.[49]
In addition to its unproven role as an As this study is one of the first to use
antioxidant and immunomodulator, spirulina as a local adjunct agent in the
spirulina has been reported to improve treatment of periodontitis, further studies,
blood lipid profile, which may be of including more relevant clinical and
importance in prevention of diabetes and biochemical parameters,
cardiovascular diseases. [45] are necessary to confirm the findings and
Recently, Spirulina (Arthrospira) maxima explore underlying mechanisms.
was tested on rats as a potential agent in Turmeric is a dietary spice whose active
treatment of periodontitis. ingredient, curcumin, is isolated from the
rhizomes of Curcuma longa, a plant that

25
 Romanian Journal of Medical and Dental Education
Vol. 11, No. 5, September-October 2022

belongs to the ginger family. Turmeric is It has been widely used in photodynamic
yellow in color and is most used in Asian therapy of cancers owing to its low cost and
and Indian cuisine. high efficacy. De Paula Zago et al. [54]
Curcumin has been approved by the US have shown that curcumin can significantly
Food and Drug Administration to be a safe inhibit the growth of oral pathogens while
food supplement, and a daily intake of used as a photosensitizer.
curcumin at a dose of 0.1-3 mg/kg body In a clinical study, Sreedhar et al. [55] used
weight has been considered as an acceptable curcumin gel as a photosensitizer in
dose by the Food and Agriculture photodynamic therapy following
Organization of the United Nations/World subgingival instrumentation with ultrasonic
Health Organization Expert Committee on scaling in 15 patients with deep periodontal
Food Additives, 1996.[50] pockets.
Curcumin (mainly its analogues) has shown Curcumin showed enhanced antimicrobial
chemopreventive and chemotherapeutic properties against P. gingivalis, A.
properties in different cancer studies. actinomycetemcomitans, and Prevotella
It has been shown in vivo (paw edema intermedia.
model) to have analgesic and anti- These results were improved when the
inflammatory activity through suppression multiple applications of photodynamic
of gene expression and inhibition of therapy were performed. The curcumin
secretion of proinflammatory substances, binds to the cell wall of periodontal
such as tumor necrosis factor alpha, pathogens and when irradiated with light of
monocyte chemoattractant protein-1, specific wavelength produces reactive
interleukin- 10, and interleukin-6. oxygen species, which can destroy the
It has been delivered in the form of pathogens in the immediate vicinity. [55]
nanoparticles, tablets, capsules, powder, or This and other preliminary in vivo studies
solution in doses from 0.18 to 8 g/d. [51] provide initial evidence that curcumin may
In clinical trials, patients with periodontal offer periodontists a complementary
diseases usually use curcumin as adjuvant approach to the conventional periodontal
therapy following subgingival therapy through either systemic or local
instrumentation. application.[56]
All trials were conducted in India, with the Açai-berry, the fruit of the Amazonian
main objective to compare the efficacy of palm, Euterpe oleracea Martius, has been
turmeric and chlorhexidine, formulated extensively studied not only for its
either as a mouthwash or gel, in the nutritional properties but also its anti-
prevention and treatment of gingivitis. [52] inflammatory, antioxidant, and bioactivity
Three studies on prevention showed that, as properties. Açai pulp fraction contains a
an adjunct to mechanical plaque control, remarkable number of phytochemicals and
turmeric-based mouthwash significantly mono‑ and polyunsaturated fatty acids.[57]
reduced plaque accumulation and gingival Phytochemical analyses indicate that açai
inflammation after the experimental period extract is rich in anthocyanins and possesses
(14-21 days). a high number of polyphenols, especially
However, when compared with flavonoids, that exhibit promising
chlorhexidine, it was less efficient. [52,53] therapeutic potential.
Two studies tested the therapeutical Earlier in vitro studies demonstrated that
efficacy of turmeric and chlorhexidine as an acai extract may exhibit potent anti-
adjunct to mechanical treatment of inflammatory,
gingivitis and compared them with neuroprotective, and anticarcinogenic
mechanical treatment alone. properties. [57]

26
 Romanian Journal of Medical and Dental Education
Vol. 11, No. 5, September-October 2022

These findings may be of importance for active resorption through intestinal wall is
further testing and development of novel highly dependent on vitamin D.
therapeutic agents with potential to reduce Numerous clinical studies have emphasized
inflammatory bone loss that occurs as a the importance of calcium intake in bone
result of periodontitis. mineral density maintenance and tooth
retention, especially in the elderly
4. Minerals population.
Minerals belong to the group of Vitamin D deficiency is common in the
minor/micronutrients that are present in world, with an estimate that more than 1
food in small amounts, measured by billion people suffer from its insufficiency
microgram quantities. or deficiency. [60]
Minerals act as catalysts in a variety of The beneficial effect of supplementation
enzyme systems, either as ionic enzymatic with vitamin D and calcium has been well
cofactors or metalloenzymes. documented and recognized in the
Regular daily intake of food rich in minerals treatment of rickets, osteomalacia, and
is usually sufficient to maintain health; osteoporosis.
however, in some cases, pharmacological In recent times, vitamin D and calcium have
supplements are used to maintain also been considered as candidates to
satisfactory levels or treat deficiencies. [58] modulate periodontal disease, as some
Sodium is the cation and main major studies have found that their intake may
mineral in extracellular fluid. It plays a key reduce alveolar bone loss, gingival
role in cellular membrane potential and inflammation, and attachment loss.
nerve conduction, and together with Caution should be considered with patients
calcium, potassium, and magnesium has an reporting a risk of bowel cancer. [61]
important influence on cardiac output and The Third National Health and Nutrition
peripheral vascular resistance, the main Examination Survey large cohort of up to 12
determinants of blood pressure level. [59] 000 subjects suggested that low dietary
Sodium is mainly consumed as sodium intake of calcium results in more severe
chloride, “dietary salt,” but may be found in periodontal disease and progressive
food additives, too. attachment loss in a dose-
Potassium is the key cation in intracellular dependentmanner. [60]
fluid with a similar role to sodium. Another study that used data from the Third
Potassium is known to have a protective National Health and Nutrition Examination
effect on the cardiovascular system, and its Survey reported an inverse association
anti-atherosclerotic between the prevalence of periodontal
properties have attracted attention in the disease and the intake of dairy products, a
recent years. common dietary source of calcium and
Other health benefits of potassium may be vitamin D.[62]
related to diabetic patients and A recent cross-sectional study on 51
improvement of their glucose tolerance. subjects on periodontal maintenance
[58] therapy resulted in a trend toward better
Calcium is the main component of clinical (gingival inflammation, probing
hydroxyapatite, a mineral that is present in depth, and attachment loss and furcation
our skeletal system and teeth. It is important involvement) and radiological parameters
for normal bone turnover, nerve (cemento-enamel junction to alveolar crest
conduction, and blood coagulation. [59] distance) of periodontal disease in patients
Metabolism of calcium is regulated by who were voluntarily taking calcium (at
parathyroid hormone and calcitonin, and its least 1000 mg/day) and vitamin D (at least
400 IU/day) supplements for more than 18

27
 Romanian Journal of Medical and Dental Education
Vol. 11, No. 5, September-October 2022

months (average of 10.6 years) prior to attachment loss (P < 0.01) and a higher
commencement of the study. [60] number of remaining teeth than did their
Although some studies implied benefits of counterparts. The findings of the study
daily supplementation with vitamin D and indicate that magnesium supplementation
calcium, use of these microelements in may improve periodontal status and
healthy patients with periodontal disease improve tooth retention. [65]
requires further evidence.
Recommended daily intake of calcium for CONCLUSION
adults ranges from 1000 to 1300 mg/day. In summary, an increasing number of
[63] studies have revealed aspects and effects of
Magnesium is second most prominent these so-called lifestyle or fitness
intracellular cation and is present in all supplements and superfoods that may have
tissues, with majority (two-thirds) stored in an impact on periodontal health and healing
bones. Imbalances in magnesium after treatment. Against the background of
metabolism may be associated with periodontal disease
different pathologic conditions such as as a chronic inflammatory disease involving
cardiovascular diseases, diabetes, pre- bone and connective tissue degradation, a
eclampsia, eclampsia, and sickle cell deeper insight and understanding of the
disease.[36] Low magnesium intake has potential anti-inflammatory effects of
been linked to periodontitis. [64] supplements and their effects on bone and
In a cross-sectional epidemiologic study connective tissue metabolism could help to
involving 4290 subjects from 20 to 80 years develop new prevention and treatment
of age, periodontal health was determined strategies.
and correlated to concentrations of serum However, some the current evidence is of a
magnesium and calcium. In a matched very low quality, and more validated
study, the periodontal status of 60 subjects scientific data are required before their
from the same population using magnesium possible use in prevention or treatment of
drugs was compared with 120 nonusers. periodontal diseases can be made.
Subjects taking magnesium showed less

References
1. Axel Spahr,Tihana Divnic-Resnik. Impact of health and lifestyle food supplements on
periodontal tissues and health. Periodontology 2000. 2022;90:146–175.
2. Martu, MA.; Maftei, GA.; Luchian, I.; Popa, C.; Filioreanu, AM.; Tatarciuc, D.; Nichitean,
G.; Hurjui, LL.; Foia, LG. Wound healing of periodontal and oral tissues: Part II-Patho-
phisiological conditions and metabolic diseases. Rom. J. Oral Rehab. 2020, 12:30–40
3. Brosnan JT, Brosnan ME. Branched-chainamino acids: enzyme and substrate regulation. J
Nutr. 2006;136(1):207S-211S.
4. Thomson RL, Buckley JD. Protein hydrolysates and tissue repair. Nutr Res Rev.
2011;24(02):191-197.
5. Tui C. The value of protein and its chemical components (amino acids) in surgical repair.
Bull N Y Acad Med. 1945;21(12):631-635.
6. Cornish J, Callon KE, Naot D, et al. Lactoferrin is a potent regulator of bone cell activity
and increases bone formation in vivo. Endocrinology. 2004;145(9):4366-4374.
7. Caccavo D, Sebastiani GD, Di Monaco C, et al. Increased levels of lactoferrin in synovial
fluid but not in serum from patients with rheumatoid arthritis. Int J Clin Lab Res.
1999;29(1):30-35.

28
 Romanian Journal of Medical and Dental Education
Vol. 11, No. 5, September-October 2022

8. Baveye S, Elass E, Mazurier J, Spik G, Legrand D. Lactoferrin: a multifunctional

glycoprotein involved in the modulation of the inflammatoryprocess. Clin Chem Lab Med.
1999;37(3):281-286.
9. He S, McEuen AR, Blewett SA, et al. The inhibition of mast cell activation by neutrophil
lactoferrin: uptake by mast cells and interaction with tryptase, chymase and cathepsin G.
Biochem Pharmacol. 2003;65(6):1007-1015.
10. Kimber I, Cumberbatch M, Dearman RJ, Headon DR, Bhushan M, Griffiths CE.
Lactoferrin: influences on Langerhans cells, epidermal cytokines, and cutaneous
inflammation. Biochem Cell Biol.2002;80(1):103-107.
11. Weinberg ED. Human lactoferrin: a novel therapeutic with broad spectrum potential. J
Pharm Pharmcol. 2001;53(10):1303-1310.
12. Zimecki M, Właszczyk A, Zagulski T, Kübler A. Lactoferrin lowers serum interleukin 6
and tumor necrosis factor alpha levels in mice subjected to surgery. Arch Immunol Ther
Exp (Warsz). 1998;46(2):97-104.
13. Da Silva MS, Bigo C, Barbier O, Rudkowska I. Whey protein hydrolysate and branched-
chain amino acids downregulate inflammation-related genes in vascular endothelial cells.
Nutr Res 2017;38:43-51.
14. Rondanelli M, Klersy C, Terracol G, et al. Whey protein, amino acids, and vitamin D
supplementation with physical activity increases fat-free mass and strength, functionality,
and quality of life and decreases inflammation in sarcopenic elderly. Am J Clin Nutr.
2016;103(3):830-840.
15. Tkatch L, Rapin CH, Rizzoli R, et al. Benefits of oral protein supplementation in elderly
patients with fracture of the proximal femur. J Am Coll Nutr. 1992;11(5):519-525.
16. Bloomgarden Z. Diabetes and branched-chain amino acids: what is the link? J Diab.
2018;10(5):350-352.
17. Harris RA, Joshi M, Jeoung NH, Obayashi M. Overview of the molecular and biochemical
basis of branched-chain amino acid catabolism. J Nutr. 2005;135(6):1527S-1530S.
18. Tobias DK, Lawler PR, Harada PH, et al. Circulating branched-chain amino acids and
incident cardiovascular disease in a prospective cohort of US women. Circ Genom Precis
Med. 2018;11(4):e002157.
19. Ammann P, Laib A, Bonjour JP, Meyer JM, Rüegsegger P, Rizzoli R. Dietary essential
amino acid supplements increase bone strength by influencing bone mass and bone
microarchitecture in ovariectomized adult rats fed an isocaloric low-protein diet. J Bone
Miner Res. 2002;17(7):1264-1272.
20. Aral K, Berdeli E, Aral CA, Berdeli A, Atan M. Effects of bodybuilding and protein
supplements in saliva, gingival crevicular fluid, and serum. J Oral Sci. 2017;59(1):121-
130.
21. Lee Y-H, Bae S-C, Song G-G. Omega-3 polyunsaturated fatty acids and the treatment of
rheumatoid arthritis: a meta-analysis. Arch Med Res. 2012;43(5):356-362.
22. McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for
treatment of osteoarthritis: a systematic quality assessment and meta-analysis.
JAMA. 2000;283(11):1469-1475.
23. Nagaoka I, Igarashi M, Sakamoto K. Biological activities of glucosamine and its related
substances. In: Kim S-K, ed. Marine Medicinal Foods: Implications and Applications—
Animals and Microbes. Advances in Food and Nutrition Research. Vol 65. Academic
Press; 2012:337-352.
24. Reginster JY, Deroisy R, Rovati LC, et al. Long-term effects of glucosamine sulphate on
osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet.
2001;357(9252):251-256.

29
 Romanian Journal of Medical and Dental Education
Vol. 11, No. 5, September-October 2022

25. Bak YK, Lampe JW, Sung MK. Effects of dietary supplementation of glucosamine sulfate
on intestinal inflammation in a mouse model of experimental colitis. J Gastroenterol
Hepatol. 2014;29(5):957-963.
26. Largo R, Alvarez-Soria M, Dıez-Ortego I, et al. Glucosamine inhibits IL-1β– induced
1. NFκB activation in human osteoarthritic chondrocytes. Osteoarthritis Cartilage.
2003;11(4):290-298.
27. Mosmann TR, Sad S. The expanding universe of T-cell subsets: Th1, Th2 and more.
Immunol Today. 1996;17(3):138-146.
28. Xu C-X, Jin H, Chung Y-S, et al. Chondroitin sulfate extracted from ascidian tunic inhibits
phorbol ester-induced expression of inflammatory factors VCAM-1 and COX-2
2. by blocking NF-κB activation in mouse skin. J Agric Food Chem. 2008;56(20):9667-9675.
29. Jamialahmadi K, Arasteh O, Riahi MM, Mehri S, Riahi-Zanjani B, Karimi G. Protective
effects of glucosamine hydrochloride against free radical-induced erythrocytes damage.
Environ Toxicol Pharmacol. 2014;38(1):212-219.
30. Ardite E, Panes J, Miranda M, et al. Effects of steroid treatment on activation of nuclear
factor κB in patients with inflammatory bowel disease. Br J Pharmacol. 1998;124(3):431-
3.
31. Shimizu T, Nakatani S, Kobata K, Wada M. Oral administration of N-cetyl-
3. d-glucosamine and d-glucosamine chydrochlorite affects bone mineral density in
C57BL/6J mice. Chitin Chitonas Res. 2011;17:74-78.
32. Kaida K, Yamashita H, Toda K, Hayashi Y. Suppressive effects of d-glucosamine
4. on the 5-HT sensitive nociceptive units in the rat tooth pulpal nerve. Biomed Res Int.
2014;2014:187989.
33. Adler CJ, Dobney K, Weyrich LS, et al. Sequencing ancient calcified dental plaque shows
changes in oral microbiota with dietary shifts of the Neolithic and Industrial revolutions.
Nat Genet. 2013;45(4):450-455.
34. Baumgartner SIT, Schicht O, Baumgartner S, et al. The impact of the Stone Age diet on
gingival conditions in the absence of oral hygiene. J Periodontol. 2009;80:759-768.
35. ILC C, Milward MR, Ling-Mountford N, et al. Adjunctive daily supplementation
5. with encapsulated fruit, vegetable and berry juice powder concentrates and clinical
periodontal outcomes: a double blind RCT. J Clin Periodontol. 2012;39:61-71.
36. Van der Velden U, Kuzmanova D, Chapple ILC. Micronutritional approaches
6. to periodontal therapy. J Clin Periodontol. 2010;38(suppl11):142-158.
37. Sousa Né YG, Voss Martins B, Lopes Castro MM, et al. Is nutritional intervention an
improvement factor in the management of periodontitis? A systematic review. Clin Nutr.
7. 2020;39(9):2639-2646.
38. Ali NM, Yeap SW, Ho WY, Beh BK, Tan SW, Tan SG. The promising future of chia,
Salvia hispanica L. J Biomed Biotechnol. 2012;2012:171956.
39. Ixtaina VY, Nolasco SM, Tomas MC. Physical properties of chia (Salvia hispanica L.)
seeds. Industrial Crops Prod.2008;28(3):286-293.
40. Divyapriya GK, Veeresh DJ, Yavagal PC. Evaluation of antibacterial efficacy of chia
(Salvia hispanica) seeds extract against Porphyromonas gingivalis, Fusobacterium
nucleatum and Aggregatibacter actinomycetemcomitans—an in vitro study. Int J
8. Ayurveda Pharma Res. 2016;4(4):22-26.
41. Joint FAO/WHO/UNU Expert Consultation on Protein and Amino Acid Requirements in
Human Nutrition. Protein and Amino Acid Requirements in Human Nutrition: Report of a
Joint FAO/WHO/UNU Expert Consultation. WHO Technical Report Series, no. 935.
WHO,
9. Geneva, Switzerland.

30
 Romanian Journal of Medical and Dental Education
Vol. 11, No. 5, September-October 2022

42. Vilcacundo R, Hernández-Ledesma B. Nutritional and biological value of quinoa

(Chenopodium quinoa Willd.). Curr Opin Food Sci. 2017;14:1-6.
43. Vuksan V, Whitham D, Sievenpiper JL, et al. Supplementation of conventional therapy
with the novel grain salba (Salvia hispanica L.) improves major and emerging
cardiovascular risk factors in type 2 diabetes: results of a randomized controlled trial.
Diabetes Care.
10. 2007;30(11):2804-2810.
44. Pasko P, Barton H, Zagrodzki P, et al. Effect of diet supplemented with quinoa seeds on
oxidative status in plasma and selected tissues of high fructose-fed rats. Plant Foods Hum
Nutr. 2010;65:146-151.
45. Ravi M, De LS, Azharuddin S, SFD P. The beneficial effects of spirulina focusing on its
immunomodulatory and antioxidant properties. Nutr Dietary Suppl. 2010;2010:73-83.
46. Sies H, Cadenas E. Oxidative stress: damage to intact cells and organs. Phil Trans R Soc
Lond B. 1985;311(1152):617-631.
47. Park HJ, Lee YJ, Ryu HK, Kim MH, Chung HW, Kim WY. A randomized double-blind,
11. placebo-controlled study to establish the effects of spirulina in elderly Koreans. Ann Nutr
Metab. 2008;52(4):322-328.
48. Kang MS, Moon JH, Park SC, Jang YP, Choung SY. Spirulina maxima reduces
inflammation and alveolar bone loss in Porphyromonas gingivalis-induced
12. periodontitis. Phytomedicine. 2021;81:153420.
49. Mahendra J, Mahendra L, Muthu J, John L, Romanos GE. Clinical effects of subgingivally
delivered spirulina gel in chronic periodontitiscases: a placebo controlled clinical trial. J
Clin Diag Res. 2013;7(10):2330-2333.
50. Ghosh S, Banerjee S, Sil PC. The beneficial role of curcumin on inflammation, diabetes
and neurodegenerative disease: a recentupdate. Food Chem Toxicol. 2015;83:111-124.
51. Prasad S, Gupta SC, Tyagi AK, Aggarwal BB. Curcumin, a component of golden spice:
from bedside to bench and back. Biotechnol Adv. 2014;32(6):1053-1064.
52. Stoyell KA, Mappus JL, Gandhi MA. Clinical efficacy of turmeric use in gingivitis: a
comprehensive review. Complement Ther Clin Pract. 2016;25:13-17.
53. Waghmare P, Chaudhari A, Karhadkar V, Jamkhande A. Comparative evaluation of
turmeric and chlorhexidinegluconate mouthwash in prevention of plaque formation and
gingivitis: a clinical and microbiological study. J Contemp Dent Pract. 2011;12(4):221-
224.
54. de Paula Zago LH, de Annunzio SR, de Oliveira KT, et al. Antimicrobial photodynamic
therapy against metronidazole-resistant dental plaque bacteria. J Photochem Photobiol B.
2020;209:111903.
55. Sreedhar A, Sarkar I, Rajan P, et al. Comparative evaluation of the efficacy of curcumin
gel with and without photo activation as an adjunct to scaling and root planing in the
treatment of chronic periodontitis: a split mouth clinical and microbiological study. J Nat
13. Sci Biol Med. 2015;6(Suppl 1):S102-S109.
56. Zhou T, Chen D, Li Q, Sun X, Song Y, Wang C. Curcumin inhibits inflammatory response
and bone loss during experimental periodontitis in rats. Acta Odontol Scand.
2013;71(2):349-356.
57. Jensen GS, Wu X, Patterson KM, et al. In vitro and in vivo antioxidant and anti-
inflammatory capacities of an antioxidant-rich fruit and berry juice blend. Results of a pilot
and randomized, double-blinded, placebo-controlled, crossover study. J Agric Food Chem.
14. 2008;56(18):8326-8333.
58. Robert SE. Periodontal disease and nutrition: separating the evidence from current fads.
Periodontol 2000. 2009;50:78-89.

31
 Romanian Journal of Medical and Dental Education
Vol. 11, No. 5, September-October 2022

59. Karppanen H, Karppanen P, Mervaala E. Why and how to implement sodium, potassium,
calcium, and magnesium changes in food items and diets? J Hum Hypertens.
2005;19(S3):S10.
60. Miley DD, Garcia MN, Hildebolt CF, et al. Cross-sectional study ofvitamin D and calcium
supplementation effects on chronic periodontitis. J Periodontol. 2009;80(9):1433-9.
61. Crockett SD, Barry EL, Mott LA, et al. Calcium and vitamin D supplementation
15. and increased risk of serrated polyps: results from a randomised clinical trial. Gut.
2019;68:475-486 Gut. 2018 doi:10.1136/gutjnl-2017- 315242
62. Al-Zahrani MS. Increased intake of dairy products is related to lower periodontitis
prevalence. J Periodontol. 2006;77(2):289-294.
63. National Health and Medical Research Council, Australian Government Department of
Health and Ageing, New Zealand Ministry of Health. Nutrient Reference Values for
Australia and New Zealand, Including Recommended Dietary Intakes. Version 1.2.
National Health and Medical Research Council https://www. nhmrc.gov.au/guide lines
64. Staudte H, Kranz S, Völpel A, Schütze J, Sigusch BW. Comparison of nutrient intake
between patients with periodontitis and healthy subjects. Quintessence Int. 2012;43:907-
916.
65. Meisel P, Schwahn C, Luedemann J, John U, Kroemer HK, Kocher T. Magnesium
deficiency is associated with periodontal disease. J Dent Res. 2005;84(10):937-941.

32