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Periodontal Pathosis in Man: I. Effect of Relatively High Protein Low Refined Carbohydrate Diet Upon Sulcus Depth
Published in The Journal of Periodontology, Vol. 33, pp. 341-343, October 1962.
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A recent report1 has shown an interesting effect of a high-protein low-carbohydrate diet upon the periodontium of the mouse. Specifically, significantly less alveolar bone loss was noted with this particular dietary regime.
Methods and Results
Forty junior dental students were employed for this experiment. Sulcus depth on all four surfaces of the anterior teeth was determined to the nearest millimeter and a mean sulcus depth obtained. The subjects were then instructed to eliminate, as far as possible, refined carbohydrates from the diet. The recommendation was also made that protein intake be increased. Sulcus depth was remeasured by the same examiner four days later.
Table I outlines the percentage frequency of subjects with different mean sulcus depths. Two points deserve special mention. Firstly, the prediet range (2.8-1.8 = 1.0) is slightly greater than that noted after the diet (2.4-1.5 = 0.9). Secondly, the initial mode is much higher (2.1 – 2.3) than postdietary (1.9). The initial sulcus depth was found to be 2.1 ± 0.2. This can be interpreted to mean that approximately two-thirds of the subjects ranged from 1.9 to 2.3 mm. Four days later the values were 1.9 ± 0.2 (68 percent ranged from 1.7 to 2.1). The statistically significant difference is shown by a P<.001.
Table I–Percentage of Subjects
Discussion
Obviously, not all the students obeyed the instructions to the same degree. There is even the possibility that some of the subjects ignored the recommendations. Nonetheless, there is no question but that sulcus depth was changed during the four-day experimental period. This then is consistent with the previously reported observations in lower animals.1
The question arises as to whether the observed changes here and in the previous report in lower animals can be attributed exclusively to the local action (physical consistency) of the diet. Baer and White1 concluded that systemic influences must be operative.
Unfortunately, this question cannot be readily answered in the human. However, indirect evidence for systemic versus local influences can be derived. The sulcus depth of the ten subjects in this study with the most physiologic protein levels (as measured by total nonfasting serum protein2) and carbohydrate levels (as determined by nonfasting blood glucose3,4,5) is summarized (Table II). These ten individuals are plotted in Figure 1. It is noteworthy that the black dots (representing these persons) cluster about a mean sulcus depth of 1.9 mm. The sulcus depth of the ten subjects with the most pathologic total serum protein and sugar levels were also summarized (Table III) and also plotted (as the open circles) in Figure 1. It is interesting that these are the subjects with either relatively shallow or deep sulci. This type of information is indirect evidence of systemic influences operative during the experimental period.
Table II–Sulcus Depth of the Ten Subjects with the Most Physiologic Total Serum Protein and Blood Glucose Levels
Figure 1
Table III–Sulcus Depth of the Ten Subjects with the Most Pathologic Total Serum Protein and Blood Glucose Levels
It would be interesting to repeat this study: (1) under double-blind conditions, (2) with a larger sample, (3) patients rather than students, (4) measure other evidences of periodontal pathosis, (5) in the light of other systemic influences, and (6) for longer periods than four days.
Summary
A study of forty dental students subjected to a diet low in refined carbohydrates with increase in protein for four days resulted in a significant alteration in sulcus depth. The leveling off of mean sulcus depth at about 2 mm. seems to be in parallel with changes in total serum protein and blood glucose.
References Cited:
- Baer, P. N. and White, C. L. “Studies on periodontal diseases in the mouse. IV. The effects of a high protein, low carbohydrate diet.” Periodont. 32:4, 328-330, October 1961.
- Ringsdorf, W. M., Jr. and Cheraskin, E. “The effect of a low-refined-carbohydrate high-protein diet upon nonfasting blood protein.” Amer. Med. Women’s Assn. 17:1, 42-46, January 1962.
- Cheraskin, E. and Ringsdorf, W. M., Jr. “Physiologic fasting blood glucose: range or point?” Dent. Med. 16:2, 96-99, April 1961.
- Cheraskin, E. and Ringsdorf, W. M., Jr. “Stomatology and clinical chemistry.” Alabama Dent. Rev. IX:2, 7-14, Winter 1961-62.
- Page, M. E., Ringsdorf, W. M., Jr. and Cheraskin, E. “Effect of low-refined-carbohydrate high-protein diet upon nonfasting blood sugar.” Odontologisk Revy 12:1, 1-24, 1961.