Editorial: Nutrition and oral health: at the micro-level

• Influence of macronutrient (carbohydrates, proteins, fats, and lipids) and micronutrient (vitamins and minerals) intake on oral health Diet affects the oral microbiome and the body's response to inflammation throughout life, not just during development. High-sugar and high-fat/low-fiber diets promote pathogenic bacteria, lower plaque pH, and lead to caries and periodontitis 3 . Fiber, antioxidants, and omega-3 fatty acids, on the other hand, help maintain a healthy microbial balance and lower inflammation 4 .A NHANES-based cross-sectional study (2009-2014) found that greater adherence to the Dietary Index for Gut Microbiota (DI-GM) was associated with a lower prevalence of periodontitis. Systemic inflammation biomarkers, particularly C-reactive protein and white blood cell count, elucidated this correlation, supporting a gut-oral axis in which microbiome-friendly diets (rich in fermented foods and polyphenols) may alleviate periodontal inflammation via anti-inflammatory metabolites, such as short-chain fatty acids. These results enhance prior studies on comprehensive food quality indices by highlighting DI-GM's distinctive emphasis on the microbiome.A 2023 systematic literature review linked dietary patterns and eating disorders to periodontal disease. Findings indicate that high-carbohydrate/sugar, high-fat, and low-fiber diets, as well as eating disorders like anorexia and bulimia, increase periodontal risk through nutritional deficiencies, microbiota disruption, and inflammation. Emerging evidence indicates that unhealthy dietary patternshigh in carbohydrates/sugars, fats, and low in fiber-as well as eating disorders, are associated with increased risk of periodontal diseases, exacerbated by nutritional and vitamin deficiencies. Balanced diets high in nutrients such as vitamins A, B, and C, calcium, zinc, and polyphenols seem to protect against these diseases. However, the roles of micronutrients like D, E, K, and magnesium are still not clear. Eating disorders are consistently associated with greater plaque accumulation and gingival inflammation.• The effect of chronic diseases on oral health Systemic chronic illnesses worsen damage to oral tissues by using networks of pro-inflammatory cytokines and reactive oxygen species signaling. Eating disorders, on the other hand, cause cumulative damage by repeatedly eroding acid and depleting micronutrients. Periodontitis, a prevalent chronic inflammatory disease affecting over 1 billion individuals worldwide, illustrates this interaction by generating bidirectional systemic sequelae, in which vitamin deficiencies often result in recurrent ulcers and prolonged wound healing in susceptible populations 5, 6 .The 2024 Colombian study examined the correlation between consultations for oral disorders and systemic conditions. There were strong connections between oral and systemic consultations, driven by shared risk factors like poor biofilm control and high sugar consumption, with robust links to caries/gingivitis and moderate ones to malnutrition or certain circulatory issues. Socioeconomic indicators demonstrated a significant correlation with increased consultation rates for both oral and systemic disorders. Principal component analysis identified clusters linking caries/gingivitis to dietary pathologies and inequality indicators, circulatory diseases/diabetes to chronic periodontitis, and demographic factors to other disorders.Emerging evidence robustly demonstrates that hypovitaminosis-specifically deficiencies in vitamins B12, folate, and C-constitutes a significant, modifiable factor in the aetiology of Recurrent Aphthous Stomatitis (RAS). The bidirectional oral-systemic axis is evident in mucosal disorders such as RAS, a common and distressing oral ulcerative condition with various aetiologies, including hypovitaminosis, a phenomenon gaining increasing recognition. Deficiencies undermine mucosal integrity, cellular repair, and immunological responses, often arising from malabsorption, nutritional inadequacy, or systemic disorders.Developmental enamel defects, micronutrient protection against caries, vitamin deficiencies linked to oral ulcers, gut-oral microbial mediation, and systemic disease interactions all demonstrate that nutrition is a fundamental determinant of oral health. To optimize tooth development and combat oral diseases linked to systemic inflammation, prioritize nutrition and integrated care, especially in vulnerable periods and populations, is important: 1. Prioritize Nutrient-Dense Diets for Lifelong Dental Health -During pregnancy, infancy, and childhood-when enamel is most vulnerableemphasize foods rich in phosphorus and fat-soluble vitamins (A, E, and K) to support mineralization and reduce caries risk. 2. Adopt Integrated Public Health Policies -Oral and systemic disease management, tackling social determinants and shared risks like excess sugar, poor hygiene, and limited access. Target vulnerable groups to prevent caries, periodontitis, RAS, diabetes, hypertension, and obesity through coordinated, community-level interventions.Collaboration -Screen patients with recurrent ulcers, periodontitis, or caries for hypovitaminosis and comorbidities using biochemical and social evaluations. Train dentists/hygienists to detect signs of eating disorders/malnutrition and integrate them into teams with nutritionists, physicians, psychiatrists, and psychologists for early referrals and holistic care.Oral health at the micro-level is like nutritional status, which keeps the whole body healthy. By prioritizing nutrition across the life course, cycles of oral and chronic disease can be broken, thereby reducing global health disparities.