SSP Position Paper
The Influence of Nutrition on Active and Supportive Periodontal Therapy
DOI:
https://doi.org/10.61872/sdj-2026-02-06PMID:
42454677Keywords:
Periodontitis, Nutrition, Diet, Prevention, Periodontal TherapyAbstract
Periodontitis is currently understood as a multifactorial, biofilm-associated, and immunoinflammatory disease. Modern dietary patterns, often characterized by a high intake of free sugars and ultra-processed foods, deviate from evolutionary adaptations and are frequently associated with systemic inflammatory processes. This position paper by the Swiss Society of Periodontology (SSP) evaluates the role of nutrition as a modifiable risk factor and integrates nutritional considerations across all phases of periodontal therapy. Available evidence suggests that a plant-based, fiber-rich, and low-sugar diet can reduce gingival inflammation and support microbial homeostasis in prevention (Stage 1). During the active therapy phases (Stages 2 and 3), the modulation of the host response by nutrients may be clinically relevant. Adjunctive intake of omega-3 fatty acids and antioxidants appears to positively influence the outcomes of non-surgical therapy, while an adequate supply of proteins and vitamin D is discussed as a supportive factor for wound healing following surgical interventions. In supportive periodontal care (SPC/ Stage 4), a sustained anti-inflammatory dietary pattern may support long-term stability. Consequently, nutrition should be considered an integral, modifying component of periodontal care that meaningfully complements mechanical therapy.
References
1. Adler CJ, Dobney K, Weyrich LS, Kaidonis J, Walker AW, Haak W, u. a. Sequencing ancient calcified dental plaque shows changes in oral microbiota with dietary shifts of the Neolithic and Industrial revolutions. Nat Genet. April 2013; 45 (4): 450–5, 455e1. doi:10.1038/ng.2536 PubMed Central PMCID: PMC3996550.
2. Alt KW, Al-Ahmad A, Woelber JP. Nutrition and Health in Human Evolution-Past to Present. Nutrients. 31. August 2022;14(17). doi:10.3390/nu14173594 PubMed Central PMCID: PMC9460423.
3. Hublin JJ, Ben-Ncer A, Bailey SE, Freidline SE, Neubauer S, Skinner MM, u. a. New fossils from Jebel Irhoud, Morocco and the pan-African origin of Homo sapiens. Nature. 7. Juni 2017;546(7657):289–92. doi:10.1038/nature22336.
4. Murray CJ, Atkinson C, Bhalla K, Birbeck G, Burstein R, Chou D, u. a. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. Jama. 14. August 2013; 310 (6): 591–608. doi:10.1001/jama.2013.13805 PubMed Central PMCID: PMC5436627.
5. van Woudenbergh GJ, Theofylaktopoulou D, Kuijsten A, Ferreira I, van Greevenbroek MM, van der Kallen CJ, u. a. Adapted dietary inflammatory index and its association with a summary score for low-grade inflammation and markers of glucose metabolism: the Cohort study on Diabetes and Atherosclerosis Maastricht (CODAM) and the Hoorn study. Am J Clin Nutr. Dezember 2013; 98 (6): 1533–42. doi:10.3945/ajcn.112.056333.
6. Konner M, Eaton SB. Paleolithic nutrition: twenty-five years later. Nutr Clin Pr. Dezember 2010; 25 (6): 594–602. doi:10.1177/0884533610385702.
7. Woelber JP, Al-Ahmad A, Alt KW. On the Pathogenicity of the Oral Biofilm: A Critical Review from a Biological, Evolutionary, and Nutritional Point of View. Nutrients. 23. Mai 2022;14(10). doi:10.3390/nu14102174 PubMed Central PMCID: PMC9144701.
8. Woelber JP, Bartha V, Baumgartner S, Tennert C, Schlagenhauf U, Ratka-Krüger P, u. a. Is Diet a Determining Factor in the Induction of Gingival Inflammation by Dental Plaque? A Secondary Analysis of Clinical Studies. Nutrients. 22. März 2024;16(7). doi:10.3390/nu16070923 PubMed Central PMCID: PMC11013428.
9. Boehlke C, Rupf S, Tenniswood M, Chittur SV, Hannig C, Zierau O. Caries and periodontitis associated bacteria are more abundant in human saliva compared to other great apes. Arch Oral Biol. März 2020; 111: 104648. doi:10.1016/j.archoralbio.2020.104648.
10. Papapanou PN, Sanz M, Buduneli N, Dietrich T, Feres M, Fine DH, u. a. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. Juni 2018;89 Suppl 1: S173-s182. doi:10.1002/jper.17-0721.
11. Theilade E, Wright WH, Jensen SB, Löe H. Experimental gingivitis in man. II. A longitudinal clinical and bacteriological investigation. J Periodontal Res. 1966; 1:1–13. doi:10.1111/j.1600-0765.1966.tb01842.x.
12. Newman MG, Socransky SS, Savitt ED, Propas DA, Crawford A. Studies of the microbiology of periodontosis. J Periodontol. Juli 1976; 47 (7): 373–9. doi:10.1902/jop.1976.47.7.373.
13. Loe H, Theilade E, Jensen SB. EXPERIMENTAL GINGIVITIS IN MAN. J Periodontol 1930. Juni 1965; 36: 177–87. doi:10.1902/jop.1965.36.3.177.
14. Socransky SS, Ha9ajee AD, Dzink JL. Relationship of subgingival microbial complexes to clinical features at the sampled sites. J Clin
Periodontol. August 1988;15(7):440–4. doi:10.1111/j.1600-051X.1988.tb01598.x.
15. Marsh PD. Microbial ecology of dental plaque and its significance in health and disease. Adv Dent Res. Juli 1994;8(2):263–71. doi:10.1177/08959374940080022001.
16. Hajishengallis G, Lamont RJ. Beyond the red complex and into more complexity: the poly-microbial synergy and dysbiosis (PSD) model of periodontal disease etiology. Mol Oral Microbiol. Dezember 2012;27(6):409–19. doi:10.1111/j.2041-1014.2012.00663.x Pub-Med Central PMCID: PMC3653317.
17. Hajishengallis G, Chavakis T, Lambris JD. Current understanding of periodontal disease patho-genesis and targets for host-modulation therapy. Periodontol 2000. Oktober 2020; 84 (1): 14–34. doi:10.1111/prd.12331 PubMed Central PMCID: PMC7457922.
18. Kashket S, Zhang J, Niederman R. Gingival inflammation induced by food and short-chain carboxylic acids. J Dent Res. Februar 1998; 77 (2): 412–7. doi:10.1177/00220345980770021001.
19. Woelber JP, Gebhardt D, Hujoel PP. Free sugars and gingival inflammation: A systematic review and meta-analysis. J Clin Periodontol.
September 2023; 50 (9): 1188–201. doi:10.1111/jcpe.13831.
20. Moynihan PJ, Kelly SA. E9ect on caries of restricting sugars intake: systematic review to inform WHO guidelines. J Dent Res. Januar 2014; 93 (1): 8–18. doi:10.1177/0022034513508954 PubMed Central PMCID: PMC3872848.
21. Discepoli N, De Rubertis I, Tavella G, Guazzelli A, Konstantinidou S, Paolini B. Ultra-Processed Foods Reduction Enhances Clinical Outcomes and Dietary Profiles in Patients With Gingivitis: Results From a Randomised Controlled Trial. J Clin. Periodontol. 14. September 2025. doi:10.1111/jcpe.70034 PubMed PMID: 40947524.
22. Huang L, Ge S, Yang K, Duan L, Gao L, Li YZ, u. a. E9ects of oral gavage with periodontal pathogens and plaque biofilm on gut microbiota ecology and intestinal tissue architecture in mice: a mechanistic study. Front Cell Infect Microbiol. 2025; 15: 1589055. doi:10.3389/fcimb.2025.1589055 PubMed Central PMCID: PMC12370644.
23. Hujoel PP, Lingström P. Nutrition, dental caries and periodontal disease: a narrative review. J Clin Periodontol. März 2017; 44 Suppl 18: S79-s84. doi:10.1111/jcpe.12672.
24. Baumgartner S, Imfeld T, Schicht O, Rath C, Persson RE, Persson GR. The impact of the stone age diet on gingival conditions in the absence of oral hygiene. J Periodontol. Mai 2009; 80 (5): 759–68. doi:10.1902/jop.2009.080376
25. Jenzsch A, Eick S, Rassoul F, Purschwitz R, Jentsch H. Nutritional intervention in patients with periodontal disease: clinical, immunological and microbiological variables during 12 months. Br J Nutr. März 2009; 101 (6): 879–85. doi:10.1017/s0007114508047776.
26. Pamuk F, Kantarci A. Inflammation as a link between periodontal disease and obesity. Periodontol 2000. Oktober 2022; 90 (1): 186–96. doi:10.1111/prd.12457.
27. Ottosson F, Hultgren L, Fernandez C, Engström G, Orho-Melander M, Kennbäck C, u. a. The inverse association between a fish consumption biomarker and gingival inflammation and periodontitis: A population-based study. J Clin Periodontol. April 2022; 49 (4): 353–61. doi:10.1111/jcpe.13602 PubMed Central PMCID: PMC9303516.
28. Van Ravensteijn MM, Timmerman MF, Brouwer EAG, Slot DE. The e9ect of omega-3 fatty acids on active periodontal therapy: A systematic review and meta-analysis. J Clin Periodontol. Oktober 2022; 49 (10): 1024–37. doi:10.1111/jcpe.13680 PubMed Central PMCID: PMC9795982.
29. Muluke M, Gold T, Kiefhaber K, Al-Sahli A, Celenti R, Jiang H, u. a. Diet-Induced Obesity and Its Di9erential Impact on Periodontal Bone Loss. J Dent Res. Februar 2016; 95 (2): 223–9. doi:10.1177/0022034515609882 PubMed Central PMCID: PMC4720954.
30. Shikama Y, Kudo Y, Ishimaru N, Funaki M. Possible Involvement of Palmitate in Pathogenesis of Periodontitis. J Cell Physiol. Dezember 2015;230(12):2981–9. doi:10.1002/jcp.25029.
31. Shikama Y, Kudo Y, Ishimaru N, Funaki M. Potential Role of Free Fatty Acids in the Pathogenesis of Periodontitis and Primary Sjögren’s Syndrome. Int J Mol Sci. 14. April 2017; 18 (4). doi:10.3390/ijms18040836 PubMed Central PMCID: PMC5412420.
32. Dommisch H, Kuzmanova D, Jönsson D, Grant M, Chapple I. E9ect of micronutrient malnutrition on periodontal disease and periodontal therapy. Periodontol 2000. Oktober 2018;78(1):129–53. doi:10.1111/prd.12233 PubMed PMID: 30198127.
33. Chapple IL, Milward MR, Ling-Mountford N, Weston P, Carter K, Askey K, u. a. Adjunctive daily supplementation with encapsulated fruit, vegetable and berry juice powder concentrates and clinical periodontal outcomes: a double-blind RCT. J Clin Periodontol. Januar
2012; 39 (1): 62–72. doi:10.1111/j.1600-051X.2011.01793.x PubMed Central PMCID: PMC3267052.
34. Chapple L, Chapple I. Risk Assessment in Periodontal Disease. Dent Update. 2. November 2018; 45: 920–6. doi:10.12968/denu.2018.45.10.920.
35. Staufenbiel I, Weinspach K, Förster G, Geurtsen W, Günay H. Periodontal conditions in vegetarians: a clinical study. Eur J Clin Nutr.
August 2013; 67 (8): 836–40. doi:10.1038/ejcn.2013.101.
36. Yilmaz F, Görgin N. The role of probiotics and dietary interventions in the treatment of periodontitis: a pilot randomized controlled clinical trial. BMC Oral Health. 31. Juli 2025; 25 (1): 1287. doi:10.1186/s12903-025-06510-4 Pub-Med Central PMCID: PMC12315224.
37. Woelber JP, Gärtner M, Breuninger L, Anderson A, König D, Hellwig E, u. a. The influence of an anti-inflammatory diet on gingivitis. A randomized controlled trial. J Clin Periodontol. April 2019;46(4):481–90. doi:10.1111/jcpe.13094.
38. Littarru GP, Nakamura R, Ho L, Folkers K, Kuzell WC. Deficiency of coenzyme Q 10 in gingival tissue from patients with periodontal disease. Proc Natl Acad Sci U A. Oktober 1971; 68 (10): 2332–5. doi:10.1073/pnas.68.10.2332 Pub-Med Central PMCID: PMC389415.
39. Meisel P, Schwahn C, Luedemann J, John U, Kroemer HK, Kocher T. Magnesium deficiency is associated with periodontal disease. J
Dent Res. Oktober 2005; 84 (10): 937–41. doi:10.1177/154405910508401012.
40. Najeeb S, Zafar MS, Khurshid Z, Zohaib S, Almas K. The Role of Nutrition in Periodontal Health: An Update. Nutrients. 30. August 2016;8(9). doi:10.3390/nu8090530 PubMed Central PMCID: PMC5037517.
41. Amaliya A, Laine ML, Loos BG, Van der Velden U. Java project on periodontal diseases: e9ect of vitamin C/calcium threonate/citrus flavonoids supplementation on periodontal pathogens, CRP and HbA1c. J Clin Periodontol. Dezember 2015; 42 (12): 1097–104. doi:10.1111/jcpe.12478.
42. Jockel-Schneider Y, Goßner SK, Petersen N, Stölzel P, Hägele F, Schweiggert RM, u. a. Stimulation of the nitratenitrite-NO-metabolism by repeated lettuce juice consumption decreases gingival inflammation in periodontal recall patients: a randomized, double-blinded, placebo-controlled clinical trial. J Clin Periodontol. Juli 2016; 43 (7): 603–8. doi:10.1111/jcpe.12542.
43. Shivappa N, Steck SE, Hurley TG, Hussey JR, Hébert JR. Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutr. August 2014; 17 (8): 1689–96. doi:10.1017/s1368980013002115 PubMed Central PMCID: PMC3925198.
44. Kushiyama M, Shimazaki Y, Murakami M, Yamashita Y. Relationship between intake of green tea and periodontal disease. J
Periodontol. März 2009; 80 (3): 372–7. doi:10.1902/jop.2009.080510.
45. Chopra A, Thomas BS, Sivaraman K, Prasad HK, Kamath SU. Green Tea Intake as an Adjunct to Mechanical Periodontal Therapy for the Management of Mild to Moderate Chronic Periodontitis: A Randomized Controlled Clinical Trial. Oral Health Prev Dent. 2016; 14 (4): 293–303. doi:10.3290/j.ohpd.a36100.
46. Woelber JP, Bremer K, Vach K, König D, Hellwig E, Ratka-Krüger P, u. a. An oral health optimized diet can reduce gingival and periodontal inflammation in humans - a randomized controlled pilot study. BMC Oral Health. 26. Juli 2016; 17 (1): 28. doi:10.1186/s12903-016-0257-1 PubMed Central PMCID: PMC4962497.
47. Bartha V, Exner L, Schweikert D, Woelber JP, Vach K, Meyer AL, u. a. E9ect of the Mediterranean diet on gingivitis: A randomized controlled trial. J Clin Periodontol. Februar 2022; 49 (2): 111–22. doi:10.1111/jcpe.13576.
48. Aalizadeh Y, Khamisi N, Asghari P, Safari A, Mottaghi M, Taherkhani MH, u. a. The Mediterranean diet and periodontitis: A systematic review and meta-analysis. Heliyon. 15. August 2024; 10 (15): e35633. doi:10.1016/j.heliyon.2024.e35633 PubMed Central PMCID: PMC11336861.
49. Kruse AB, Kowalski CD, Leuthold S, Vach K, Ratka-Krüger P, Woelber JP. What is the impact of the adjunctive use of omega-3 fatty acids in the treatment of periodontitis? A systematic review and meta-analysis. Lipids Health Dis. 21. Mai 2020; 19 (1): 100. doi:10.1186/s12944-020-01267-x PubMed Central PMCID: PMC7240972.
50. Woelber JP, Reichenbächer K, Groß T, Vach K, Ratka-Krüger P, Bartha V. Dietary and Nutraceutical Interventions as an Adjunct to Non-Surgical Periodontal Therapy — A Systematic Review. Nutrients. 22. März 2023; 15 (6): 1538. doi:10.3390/nu15061538.
51. De Angelis P, Gasparini G, Manicone PF, Passarelli PC, Azzolino D, Rella E, u. a. The E9ect of an Optimized Diet as an Adjunct to Non-Surgical Periodontal Therapy in Subjects with Periodontitis: A Prospective Study. Healthc Basel. 21. März 2022; 10 (3). doi:10.3390/healthcare10030583 PubMed Central PMCID: PMC8950350.
52. Pappe CL, Peters B, Pivovarova-Ramich O, Schremmer R, Adam A, Vach K, u. a. E9ects of a 4-week free-sugar avoidance during periodontal therapy: An explorative randomized controlled clinical trial. J Periodontol. Juni 2025; 96 (6): 675–90. doi:10.1002/jper.24-0208 PubMed Central PMCID: PMC12273752.
53. Glavin C, Gartshore J, Jackson G, Bonsor S. Does adopting a healthy diet improve periodontal parameters in patients susceptible to periodontal disease? A systematic review. Evid Based Dent. Juni 2025; 26 (2): 111. doi:10.1038/s41432-024-01098-0 PubMed Central PMCID: PMC12204859.
54. Doshi D, Kumar S, Patel B, Chaudhari D, Patel S, Hirani T, u. a. Micronutrients and the Periodontium: A Narrative Review. Cureus. April 2025; 17 (4): e81694. doi:10.7759/cureus.81694 PubMed Central PMCID: PMC11970441.
55. Mahmoud O, Mammdoh J, Saeed M. Histo-pathological and Scores Assessment of Using Omega-3 for Improvement Gingival Wound Healing Process in Rabbit Model. Egypt J Vet Sci. 1. Dezember 2022; 53 (4): 517–27. doi:10.21608/ejvs.2022.147321.1358.
56. Berg Y, Gabay E, Božić D, Shibli JA, Ginesin O, Asbi T, u. a. The Impact of Nutritional Components on Periodontal Health: A Literature Review. Nutrients. 15. November 2024; 16 (22). doi:10.3390/nu16223901 PubMed Central PMCID: PMC11597335.
57. Barnawi BM, Alrashidi NS, Albalawi AM, Alakeel NS, Hamed JT, Barashid AA, u. a. Nutritional Modulation of Periodontal Diseases: A Narrative Review of Recent Evidence. Cureus. Dezember 2023; 15 (12): e50200. doi:10.7759/cureus.50200 PubMed Central PMCID: PMC10771989.
58. Hartono V, Setiadharma Y, Rizany AK, Sulijaya B, Lessang R, Haerani N, u. a. Mobile Application-Based Support for Periodontal Treatment Improves Clinical, Cognitive, and Psychomotor Outcomes: A Randomized Controlled Trial Study. Dent J Basel. 4. März 2024; 12 (3). doi:10.3390/dj12030063 PubMed Central PMCID: PMC10969222.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Nicolas Fankhauser, Aaron Frische, Manuela E. Kaufmann, Norbert Cionca, Philipp Sahrmann , Giovanni E. Salvi, Johan P. Woelber, Patrick R. Schmidlin
This work is licensed under a Creative Commons Attribution 4.0 International License.
