Dietary patterns and periodontitis: A systematic review

The systematic review aimed to investigate the associations between index-based dietary patterns and the risk and severity of periodontitis. Four public databases were searched for relevant published articles. Two independent researchers conducted the study selection, quality assessment, and data extraction. Methodological quality of the selected studies was evaluated using Joanna Briggs Institute Checklists. The review was registered with PROSPERO (CRD42023395049). Twenty-five studies were eligible for this review, including 23 cross-sectional studies and two prospective cohort studies. The most utilized dietary indices were the Healthy Eating Index (HEI), the Mediterranean Diet Score (MDS), and the Dietary Inflammatory Index (DII). The results indicated a positive association between higher diet quality (i.e., higher HEI and MDSs and lower DII scores) and healthier periodontal status. Subgroup meta-analysis for four studies utilizing HEI and CDC/AAP case definition indicates the protective effect of higher HEI scores on the risk of periodontitis (OR [95% CI] = 0.77[0.68, 0.88]) with statistical significance (Z = 3.91 [p < 0.0001]). Dietary assessment was conducted by validated food frequency questionnaires (FFQ) in 52% of the studies and 24-h dietary recalls in 36% of the studies. One study utilized a validated 15-item questionnaire to measure patients' adherence to the Mediterranean Diet (QueMD). The quality assessment showed that all studies were of high quality. High HEI and MDSs and low DII scores were associated with a low risk of periodontitis and better periodontal conditions. The standardized and repeatable diet guidelines might be provided for preventing periodontitis. Future prospective studies and clinical trials are needed to confirm this causal association.