Determining the Tri-directional Relationship Between Oral Health, Nutrition, and Comprehensive Health

September 2023

Oral and Comprehensive Health Program
Center for Clinical Research
Division of Extramural Research

Goal

The purpose of this initiative is to support research to better understand the mechanisms of the tri-directional relationship between nutrition, systemic health, and oral, dental, and craniofacial (DOC) health and to develop nutritional interventions for the dental setting.

Background

Diet-related metabolic and cardiovascular diseases are among the leading causes of death and disability in the U.S. One in 10 Americans has type 2 diabetes.¹ More than 4 in 10 Americans have hypertension,² which is linked to heart disease and stroke, the leading causes of death for Americans.³ Diseases related to poor nutrition and food insecurity are largely preventable conditions.

Because the mouth is the entryway for foods and fluids, any changes in the oral cavity, including tooth loss and caries, can skew food choices toward carbohydrates and foods with low nutritional value, thus further negatively affecting oral and systemic health. ⁴ Diabetes exacerbates periodontal disease and delays wound healing. Mid-pregnancy maternal vitamin D deficiencies have been associated with enamel hypoplasia in children’s teeth, which increases susceptibility to dental caries. Sweetened beverage intake is strongly associated with tooth decay and tooth loss in U.S. children. ⁵ Parents and caregivers play a role in preventing and controlling childhood dental caries through oral hygiene practices and healthy food choices. Individuals from rural, lower socioeconomic and minority populations have a higher incidence of oral diseases, which ultimately impacts food intake and nutrition.⁶  The public health need for improved nutritional status gained further recognition in September 2022 with the release of the White House National Strategy on Hunger, Nutrition, and Health.⁷ Pillar 5 of the strategy states the White House’s (WH) goal of investing in creative approaches to advance research regarding the prevention and treatment of diet-related diseases while specifically mentioning conducting research on the interplay between nutrition, oral disease, and comprehensive health.

Gaps and Opportunities

The link between oral health, nutrition and comprehensive health is still being investigated. This initiative will enhance the scientific knowledge regarding the interplay of nutrition/food insecurity, oral diseases, and comprehensive health. Knowledge gained may identify preventive, diagnostic and therapeutic interventions to improve the oral health, nutritional status, and comprehensive health across the life span.

This concept has shared interest with other NIH Institutes and offices and builds upon current initiatives. The 2020-2030 Strategic Plan for NIH Nutrition Research was released in May 2020, and NIDCR is supporting research to meet the goals and objectives outlined in the plan. NIDCR participates in the Nutrition Research Coordinating Committee which coordinates research within NIH and other government agencies. In collaboration with the Nutrition Interagency Policy Council (IPC), NIDCR is working to advance the White House National Strategy on Hunger, Nutrition,and Health and supporting research investigating the interplay between nutrition, oral disease, and comprehensive health.

Specific Areas of Interest

Potential areas of research include but are not limited to:

• Elucidating oral conditions that impact the ability to maintain a healthy diet, thus affecting therapeutic/surgical responsiveness, healing, and susceptibility to infection or disease progression.
  • Oral diseases associated with aging (caries, periodontal disease, tooth loss and replacement)
  • Developmental craniofacial disorders (e.g., cleft lip and palate, craniofacial microsomia, craniosynostosis, Treacher Collins syndrome)
  • Salivary dysfunction in patients with Sjögren’s Disease, polypharmacy (elderly)
  • Oral complications in patients undergoing radiation/chemotherapy or myelosuppressive therapy (mucositis/stomatitis, xerostomia, infection, taste alterations, tooth loss)
  • Neurologic conditions’ (stroke, multiple sclerosis) impact on oral health and nutrition
• Elucidating dietary influences affecting comprehensive health through effects on the oral microbiome
• Understanding the mechanisms involved in proper nutrition for optimal growth, maturation, and maintenance of the DOC hard tissues
• Developing and assessing feasibility/acceptability of medical/pharmaceutical interventions, nutritional behavioral interventions, community level interventions, nutritional health screening and referral to treatment or services in the dental setting

References

1. Centers for Disease Control and Prevention, National Diabetes Prevention Program. About prediabetes & type 2 diabetes. Published December 21, 2021.
2. Ostchega Y, Fryar CD, Nwankwo T, Nguyen DT. Hypertension Prevalence Among Adults Aged 18 and Over: United States, 2017-2018. NCHS Data Brief. 2020 Apr;(364):1-8.
3. Centers for Disease Control and Prevention, National Center for Health Statistics. Leading causes of death. Published September 6, 2022.
4. Sachdev PK, Freeland-Graves J, Babaei M, Sanjeevi N, Zamora AB, Wright GJ. Associations Between Diet Quality and Dental Caries in Low-Income Women. J Acad Nutr Diet. 2021 Nov;121(11):2251-2259. doi: 10.1016/j.jand.2021.04.015. Epub 2021 May 13.
5. Chi DL, Scott JM. Added Sugar and Dental Caries in Children: A Scientific Update and Future Steps. Dent Clin North Am. 2019 Jan;63(1):17-33. doi: 10.1016/j.cden.2018.08.003. Epub 2018 Oct 29.
6. National Institute of Dental and Craniofacial Research. Oral Health in America: Advances and Challenges. p. 1-64. Published December 2021.
7. The White House. Biden-Harris Administration national strategy on hunger, nutrition, and health. p. 33. Published September 2022.