Author(s): Nishida M
BACKGROUND: Dietary calcium has long been a candidate to modulate periodontal disease. Animal as well as human studies of calcium intake, bone mineral density, and tooth loss provide a rationale for hypothesizing that low dietary intake of calcium is a risk factor for periodontal disease. METHODS: We evaluated the role of dietary calcium intake as a contributing risk factor for periodontal disease utilizing the Third National Health and Nutrition Examination Survey (NHANES III), which is representative of the U.S. civilian non-institutionalized population. Dietary calcium intake was determined from a 24-hour dietary recall. The U.S. Department of Agriculture Nutrient Database was used as a source of nutrient composition data. Periodontal disease was measured by attachment loss. In addition, serum calcium was assessed using venous blood samples. Logistic regression analysis was used to examine the association between periodontal disease and dietary calcium intake or serum calcium levels after adjusting for covariants including age, gender, tobacco consumption, and gingival bleeding. RESULTS: The association of lower dietary calcium intake with periodontal disease was found for young males and females (20 to 39 years of age), and for older males (40 to 59 years of age). The relationship between low dietary calcium intake and increased levels of periodontal disease showed an estimated odds ratio (OR) of 1.84 (95% CI: 1.36 to 2.48) for young males, 1.99 (95% CI: 1.34 to 2.97) for young females, and 1.90 (95% CI: 1.41 to 2.55) for the older group of males. These odds ratios were adjusted for gingival bleeding and tobacco consumption. The dose response was also seen in females, where there was 54% greater risk of periodontal disease for the lowest level of dietary calcium intake (2 to 499 mg) and 27% greater risk in females who took moderate levels of dietary calcium (500 to 799 mg) as compared to those who took 800 mg or more dietary calcium per day. A statistically significant association between low total serum calcium and periodontal disease was found in younger females aged 20 to 39 with OR = 6.11 (95% CI: 2.36 to 15.84) but not for males or older females, after adjusting for tobacco use, gingival bleeding, and dietary calcium intake. CONCLUSIONS: These results suggest that low dietary intake of calcium results in more severe periodontal disease. Further studies will be needed to better define the role of calcium in periodontal disease and to determine the extent to which calcium supplementation will modulate periodontal disease and tooth loss.