Role of Dietary Fibre in Managing Periodontal Diseases-A Systematic Review and Meta-Analysis of Human Intervention Studies

Abstract

Background: Periodontitis is a chronic multifactorial inflammatory disease, that leads to tooth loss and is associated with other systemic diseases. The role of dietary fibre in the prevention and management of periodontal diseases is not well understood. The objective of this systematic review and meta-analysis was to assess how an intake of dietary fibre affects periodontal diseases in humans and any concomitant effects on systemic inflammation.

Methodology: Human interventional studies investigating the effects of oral fibre intake on various clinical parameters of periodontal diseases were included. Search strategy with MeSH and free-text search terms was performed on the following database: CINAHL Complete, EMBASE, MEDLINE, SciVerse Scopus^®, and Web of Science Core Collection on 21 October 2021 and updated on 19 February 2023 to identify relevant studies. Articles were filtered using the Covidence© web-based platform software. Data were pooled using random effects meta-analysis.

Results: From all databases, a total of 19,971 studies were obtained. Upon title and abstract screening, 101 studies were included for full-text screening. Upon full-text screening, six studies were included for analysis. Of these, five were randomised controlled trials, and one was a sequential feeding trial involving fibre-rich daily diet for a 4-8 weeks period. Fibre-rich dietary intervention significantly reduced Clinical Attachment Loss/Level by 0.48 mm/tooth (95% CI, -0.63 to -0.33, p < 0.001), Bleeding On Probing by 27.57% sites/tooth (95% CI -50.40 to -4.74, p = 0.02), Periodontal Inflamed Surface Area by 173.88 mm² (95% CI -288.06 to -59.69, p = 0.003), Plaque Index by 0.02 (95% CI -0.04 to -0.00, p = 0.04), and Gingival Index by 0.41 (95% -0.67 to -0.16, p= 0.002). A non-significant reduction was observed for Probing Depth (-0.17 mm/tooth; 95% CI, -0.37 to 0.02, p = 0.09).

Conclusions: Fibre-rich dietary interventions are associated with a reduction of clinical and particularly inflammatory markers of periodontal diseases. This shows a promising effect of dietary fibre as an intervention for inflammatory conditions like periodontal diseases.

Keywords: dietary fibre; gingivitis; humans; inflammation; periodontal diseases; periodontitis.

Figure 1

Study screening and identification flow chart.

Figure 2

Effect of fibre-rich diet on: (a) Probing Depth (mm/tooth) [28,29,30,33]; (b) Clinical Attachment Level/Loss (mm/tooth) [28,33]; (c) Bleeding On Probing (% sites/tooth) [28,29,30,33]; (d) Periodontal Inflamed Surface Area (mm²) [28,29,30]; (e) Plaque Index [28,29,30,33]; (f) Gingival Index [28,29,30,33]. The green squares represent each studies individual standardised mean difference (SMD) and the extending lines the confidence intervals. The black diamond is a visual representation of the pooled SMD and its confidence intervals.

Figure 2

Effect of fibre-rich diet on: (a) Probing Depth (mm/tooth) [28,29,30,33]; (b) Clinical Attachment Level/Loss (mm/tooth) [28,33]; (c) Bleeding On Probing (% sites/tooth) [28,29,30,33]; (d) Periodontal Inflamed Surface Area (mm²) [28,29,30]; (e) Plaque Index [28,29,30,33]; (f) Gingival Index [28,29,30,33]. The green squares represent each studies individual standardised mean difference (SMD) and the extending lines the confidence intervals. The black diamond is a visual representation of the pooled SMD and its confidence intervals.

Figure 3

Risk of bias graph (Cochrane risk of bias tool): review authors’ judgments about each risk of bias item presented as percentages across all included studies. RevMan Version 5.3. Copenhagen: The Nordic Cochrane Centre, the Cochrane Collaboration, 2014.

Figure 4

Risk of bias summary (Cochrane risk of bias tool) for included studies: review authors’ judgments about each risk of bias item for each included study [28,29,30,33]. Green circle with plus sign indicates low risk of bias and red circle with minus sign indicates high risk of bias. RevMan Version 5.3. Copenhagen: The Nordic Cochrane Centre, the Cochrane Collaboration, 2014.