“For a heavy smoker, reaching a healthy level of vitamin C is not possible.” Read key points from the webinar on micronutrients in the treatment of risk patients, by Dr. Andrija P. Bošnjak

Why is an adequate intake of micronutrients essential in successful dental treatments for risk patients? Read the takeaways from the webinar by Dr. Andrija Petar Bošnjak, an expert in periodontology and implant dentistry from Croatia.

Balanced nutrition is known to play a key role in maintaining good overall health. When it comes to dental health status, excessive sugar intake is often mentioned – as this directly affects the health of the teeth and the composition of the microflora in the mouth. What is often forgotten, however, is the equally important adequate intake of essential micronutrients, which can be divided mainly into vitamins and minerals.
In the webinar The role of micronutrients in periodontal treatment of risk patients, Dr. Bošnjak talks about the connection between the above-mentioned micronutrients intake and the course of periodontal disease in risk patients. 

Andrija Petar Bošnjak, DDM, MSc, PhD
With almost 20 years of clinical experience in periodontology and implant dentistry, Dr. Bošnjak is a professor at the University of Rijeka’s School of Dental Medicine and a visiting professor at the University of Mostar’s School of Medicine, as well as a lecturer for the postgraduate PhD course at the University of Zagreb’s School of Dental Medicine.He has published over 100 publications, 28 of which are cited in CC and SCI. He is a multiple mentor of graduate, MSc and PhD theses in Croatia and Bosnia & Herzegovina and regularly reviews articles for several scientific journals. For the last 15 years he has been running a private practice specialised in periodontology and implant dentistry. He balances thiswith an academic career, teaching career, and giving lectures and practical courses in oral hygiene, periodontology, and periodontal and implant surgery. Additionally, he figures as a lead surgeon at the Arena Dental Polyclinic in Zagreb, Croatia. Recently he completed a course in phytoaromatherapy, bringing further added value to the complex task of obtaining periodontal, oral, and general health of his patients.

In the webinar, Dr. Bošnjak talks mainly about the four most common types of risk patients:

  • Patients with diabetes mellitus
  • Patients with cardiovascular disease
  • Smokers
  • Elderly patients (70+)

Periodontitis in these groups of risk patients needs three main pillars in order to develop – the first is a susceptible host, the second is biofilm composition and its shifts, and the third is inadequate nutrition. Especially in genetically challenged individuals, the last pillar: nutrition, can have a strong impact on the condition of periodontal health.

A depletion of specific nutrients can be caused by various factors. Some of these are:

  • Drugs (medication)
  • Malabsorption caused by other health issues (for example diarrhoea)
  • Lifestyle factors (smoking, alcohol abuse, fast food diet)
  • Systemic disorders (diabetes mellitus, psoriasis, thyroid disorders and others)
  • Increased requirements on one’s body (pregnancy, illness, after-surgery healing, stress)
  • Sudden intensive loss (burns, surgery, hemodialysis)

It is known that the most common micronutrients that we need for the normal functioning of our bodies are: vitamins(A, B, C, D, E), coenzyme Q10, and minerals (Ca, Mg, Fe, Zn, K, Cu, Mn, Se). Typical micronutrient requirements vary geographically, according to different soil composition, but also food preparation techniques, habits, lifestyle and other factors. There are many significant connections between a person’s micronutrients intake and periodontal disease, however. In his webinar, Dr. Bošnjak explains all the important connections concerning every vitamin and mineral mentioned above.

Here are a few quick facts based on various studies on the subject, that may be of particular interest when treating recurring periodontal cases in the dental office:

  • In cases with an increased dietary intake of vitamin A, a lower percentage of sites with >3mm PD after initial periodontal therapy can been found (Dodington et al, 2015)
  • A higher monthly tomato consumption reduces the risk of congestive heart failure in patients with periodontitis –this is thanks to the carotenoid lycopene that naturally occurs in tomatoes (Wood and Johnson, 2004)
  • Depleted serum vitamin C may amplify rapid tissue destruction (de Jong et al, 2014)
  • Vitamin C is crucial for optimal periodontal healing (Abou Sulaiman et al, 2010)
  • Bone-mineral density is directly related to levels of vitamin D (Bischoff – Ferrari et al, 2006)
  • Periodontitis significantly reduces serum magnesium levels in diabetic patients (Shetty et al, 2016)

Do you want to learn more about the role of micronutrients in the periodontal health of risk patients? 

Enrich your knowledge by watching the webinar led by this expert in periodontology and implant dentistry, Andrija Petar Bošnjak, DDM, MSc, PhD, from the University of Rijeka School of Dental Medicine, Croatia.

Watch now

Five questions about micronutrients in the treatment of risk patients

In the Q&A session of the webinar, dentists from all over the world raised various questions. We have selected some of those most relevant to the use of micronutrients in periodontal treatment, along with Dr. Bošnjak’s responses.

1. What are the alternative methods for elderly patients that have a malabsorption problem?

“There are treatment possibilities for so-called ‘leaky intestine’, which is when too many of the minerals and vitaminsbeing consumed naturally are not being absorbed into the body via the intestine. In this case, a prescription of high amounts of L-glutamine, zinc, and vitamin A can help. These three components together form a very powerful tool to help close these gaps in the intestine, so that it can start functioning normally.”

2. What is the recommended dose of vitamin C for chronic smokers?

“Research and studies have shown that supplementing smokers with excessive amounts of vitamin C is not effective, because their body is not able to process or use it properly. So, in other words, there is no use in taking supplements of vitamin C, because a heavy smoker will not benefit from it at all. It is not possible to reach the healthy level of vitamin C when smoking excessively. You can go up to 2,000 mg of vitamin C per day, which is the extreme amount usually prescribed for patients recovering from surgeries, etc. Normal amounts for a relatively healthy person are around 120 mg per day – which is easily provided through a balanced diet. The best thing in the case of smokers is to discuss the possibilities of breaking their smoking habit for good.”

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3. Should we recommend patients to take minerals and vitamins on our own? 

“Sometimes you can suggest them on your own, but other times – especially when patients have systemic diseases – it is better to discuss it with their physicians and/or with their local pharmacists. After combining your own input, the pharmacist’s input, and the physician’s input, you can then provide the patient with a list of suggested supplements.” 

4. Do you make a lab blood analysis before prescribing micronutrients?

“Not necessarily. I’ll often use lab analysis for the patients who are at high risk or have some general health issues. But usually I start by talking about the patient’s diet, and once I know their vitamins and minerals intake from food, then we discuss the possibility of supplements.”

5. What micronutrients would you recommend to patients with generalised aggressive genetic periodontitis?

“For a patient with a severe loss of periodontal tissue at a young age, I would definitely do a lab blood analysis to find out what vitamins and minerals the patient is lacking, and then consult with a pharmacist as to what prescription is best for such a patient. In patients with generalised periodontitis grade 3 or grade 4 I would also discuss the problem of leaky intestine, and probably work on this as well as treating the periodontal disease.”

Key points from the lecture on micronutrients in periodontal treatment

  • An overwhelming number of micronutrients have an independent association with periodontal disease and its prevalence. Whichever vitamin or mineral you take into consideration, an inadequate intake will play a certain role in the development of periodontal disease, and vice versa; an adequate intake plays an important role in periodontal healing and health.

  • Even well-fed and affluent populations that are mostly nutritionally replete are affected by inadequate intakes of certain micronutrients. Besides this, there are some specific patterns that lead to micronutrient deficiencies,such as smoking, alcohol abuse, medication, or comorbidities.

  • It is often a challenge for a dentist to address the topic of nutrition. Many patients are not easily approachable when it comes to this topic, and there is a need for a special and effective type of communication. For this reason,nutrition training in dental undergraduate studies is desirable.

  • Risk patients and at-risk groups may benefit from an all-round and precise approach to periodontal medicine.