Nutrition, micronutrition and periodontal inflammation: what the evidence shows
Diet influences gum inflammation: a few randomised trials show this, over short periods and with modest effects. The idea that periodontitis contributes to the chronic inflammation associated with ageing, or 'inflammaging', is a research hypothesis that Dr Hazout studied in his dissertation. This article separates what is established from what remains a lead, and draws realistic advice from it, without supplements or protocols.
Key points
- 'Inflammaging' refers to chronic, low-level inflammation without infection that increases with age [1]; the role of periodontitis in this process is a hypothesis.
- Reducing free sugars improves gum inflammation (meta-analysis of 9 studies) [2].
- A 4-week anti-inflammatory diet reduced gum bleeding without changing plaque [3].
- The EFP states that it is not yet known whether dietary counselling improves the outcome of periodontitis treatment [4].
- Micronutrition sheds light on the inflammatory background and accompanies mechanical treatment; it does not replace it, and supplements do not treat periodontitis.
Low-grade inflammation and 'inflammaging'
Acute inflammation is useful: it repairs a wound or fights an infection, then subsides. Low-grade inflammation is different: discreet, persistent, measurable by slight rises in blood markers such as high-sensitivity CRP or IL-6. The term inflammaging (a blend of inflammation and ageing) describes this chronic, sterile, low-level inflammation that develops with age and is associated with many age-related diseases [1].
Why is periodontitis of interest in this field? Because it is common after 50, chronic, and a source of inflammation that can be treated: after treatment, CRP falls on average [5]. Whether this modest fall has a measurable effect on long-term health remains to be seen; no trial has yet established it. That is the whole gap between a coherent hypothesis and a proven benefit.
Dr Hazout's dissertation: periodontitis as a marker and possible modulator
In his dissertation for the university diploma in anti-ageing and preventive medicine (2025), Dr Hazout examined the hypothesis that periodontitis may be both a marker (a visible sign) and a possible modulator (a contributor) of age-related chronic inflammation. The table below classifies the elements of this work by level of evidence: what rests on trials, and what remains to be demonstrated.
| Item | Level of evidence |
|---|---|
| Periodontal treatment lowers HbA1c in people with diabetes | Probable: average reduction of about 0.4 points at 3–4 months (randomised trials, moderate certainty) [6] |
| Periodontal treatment lowers CRP | Demonstrated on average (−0.69 mg/L at 6 months) [5] |
| Treatment improves endothelial function | Shown in a randomised trial at 6 months [7]; non-significant result in a more recent meta-analysis [8] |
| Treatment lowers blood lipids | Not confirmed by recent meta-analyses [8] |
| IL-6, microbiota, salivary calprotectin as monitoring markers | Research avenues; no validated clinical use in periodontology |
| Microbiota modulation, coenzyme Q10, curcumin, resveratrol, metformin, senolytics | Hypotheses; none is validated for slowing ageing or reducing general inflammation. European guidelines do not support metformin gel as an adjunct to treatment [4] |
The avenues in the last row of the table are mentioned because they appear in the research literature, not because they have a place in the consultation: none is offered at the practice, and the treatment of periodontitis remains root surface debridement, maintenance and control of risk factors.
What dietary trials on the gums show
Gingivitis, a reversible inflammation of the gums, is a good model for testing diet: it responds within a few weeks.
- Anti-inflammatory diet: in a randomised trial at the University of Freiburg, Germany (30 people with gingivitis, 4 weeks), a diet low in processed carbohydrates and animal proteins and rich in omega-3s, vitamins C and D, antioxidants, plant nitrates and fibre clearly reduced gum bleeding, with no difference in plaque between groups [3]. The effect therefore does not come from a change in hygiene.
- Free sugars: a meta-analysis of 9 controlled studies shows that restricting free sugars (added sugars, honey, syrups, juices) improves gum inflammation scores [2].
- Mediterranean diet and intermittent fasting: the EFP cites trials showing less bleeding when pocket depths are measured [9].
Limitations: these trials are small and short, and mainly concern gingivitis. They do not show that a diet cures established periodontitis or prevents general diseases.
The EFP position on dietary counselling
The 2020 European guidelines are cautious. For the treatment of periodontitis: 'we do not know whether dietary counselling may have a positive impact' (R1.9). For the maintenance phase, it is also not known whether physical activity, dietary counselling or weight loss are relevant (R4.20) [4]. On the other hand, stopping smoking (R1.6) and diabetes control (R1.7) are recommended [4]: these are the two lifestyle measures with an established benefit for the gums.
In its publications for clinicians, however, the EFP stresses that diet and obesity influence periodontal inflammation, and encourages clinicians to address diet as a daily risk factor [9]. Obesity is indeed associated with periodontitis [10]. The link with diabetes is detailed in the article on diabetes and periodontitis.
Micronutrition: definition and real role
Micronutrition focuses on micronutrients: vitamins, minerals, trace elements, essential fatty acids and polyphenols. It aims to identify insufficient or unbalanced intakes, first through diet and, only when necessary, through supplements prescribed by a doctor. It is not a medical specialty in its own right, and not all of its 'assessment' tools are validated.
What is established: severe vitamin C deficiency causes scurvy, with bleeding gums; vitamin C supplementation improves bleeding in gingivitis, but not pockets in periodontitis [11]. What is debated: omega-3s, vitamin D, coenzyme Q10 or probiotics as adjuncts to treatment; they are examined one by one in the article on blood tests and supplements. None of them is a treatment for periodontitis.
Practical advice consistent with the evidence
- Limit free sugars: sugary drinks, juices, sweets, biscuits.
- Favour minimally processed foods: vegetables, fruit, pulses, whole grains, nuts.
- Eat seafood, particularly oily fish, about twice a week to get enough omega-3s, as suggested by the EFP [9].
- Stop smoking: it is the most firmly established lifestyle measure in periodontology [4].
- Do not rely on diet instead of brushing, interdental brushes and periodontal treatment.
This advice accompanies the mechanical treatment of the pockets; it does not replace it. Treatment is described on the periodontitis treatment page, follow-up on the maintenance page, and the place of this topic among the links between periodontitis and general diseases on the general health page.
Frequently asked questions
Can a diet cure my periodontitis?
No. Diet can reduce gum inflammation, but established periodontitis needs professional treatment and appropriate hygiene.
What is inflammaging?
It is chronic low-level inflammation that increases with age. The role of periodontitis in this process is being studied but has not been demonstrated.
Should I take food supplements for my gums?
Not routinely. Most supplements have not shown a clear benefit as adjuncts to treatment. A confirmed deficiency is treated with your GP, who prescribes if necessary.
Should my CRP or IL-6 be measured to monitor my gums?
No. The state of the gums is monitored by periodontal examination (bleeding, pockets). These blood markers are not specific and do not guide periodontal treatment.
Why is a periodontist interested in nutrition?
Because gum inflammation responds to diet, smoking and diabetes. Dr Hazout has completed university diplomas in preventive medicine and micronutrition to address these factors rigorously, alongside treatment and not in its place.
References
- Franceschi C, Garagnani P, Parini P, Giuliani C, Santoro A. Inflammaging: a new immune-metabolic viewpoint for age-related diseases. Nat Rev Endocrinol. 2018;14(10):576-590. DOI
- Woelber JP, Gebhardt D, Hujoel PP. Free sugars and gingival inflammation: A systematic review and meta-analysis. J Clin Periodontol. 2023;50:1188-1201. DOI
- Woelber JP, et al. The influence of an anti-inflammatory diet on gingivitis. A randomized controlled trial. J Clin Periodontol. 2019;46(4):481-490. DOI
- Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Berglundh T, et al. Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47(Suppl 22):4-60. DOI
- Luthra S, et al. Treatment of periodontitis and C-reactive protein: A systematic review and meta-analysis of randomized clinical trials. J Clin Periodontol. 2023;50(1):45-60. DOI
- Simpson TC, Clarkson JE, Worthington HV, MacDonald L, Weldon JC, Needleman I, et al. Treatment of periodontitis for glycaemic control in people with diabetes mellitus. Cochrane Database Syst Rev. 2022;4:CD004714. PubMed
- Tonetti MS, D'Aiuto F, Nibali L, Donald A, Storry C, Parkar M, et al. Treatment of periodontitis and endothelial function. N Engl J Med. 2007;356(9):911-920. DOI
- Meng R, Xu J, Fan C, Liao H, Wu Z, Zeng Q. Effect of non-surgical periodontal therapy on risk markers of cardiovascular disease: a systematic review and meta-analysis. BMC Oral Health. 2024;24:692. DOI
- European Federation of Periodontology. How do diet and obesity affect periodontitis and the response to treatment? EFP Publications hub (consulté le 3 octobre 2026). efp.org
- Kim CM, Lee S, Hwang W, Son E, Kim TW, Kim K, Kim YH. Obesity and periodontitis: A systematic review and updated meta-analysis. Front Endocrinol. 2022;13:999455. DOI
- Fageeh HN, Fageeh HI, Prabhu A, Bhandi S, Khan S, Patil S. Efficacy of vitamin C supplementation as an adjunct in the non-surgical management of periodontitis: a systematic review. Syst Rev. 2021;10:5. DOI
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