Inulin Supplementation to Support Periodontal Health

Abstract

Periodontal disease is a chronic state of inflammation that can destroy the supporting tissues around the teeth, leading to the resorption of alveolar bone. The initial strategy for treating periodontal disease is non-surgical sanative therapy (ST). Periodontal disease can also induce dysbiosis in the gut microbiota and contribute to low-grade inflammation. Prebiotic fibres, such as inulin, can selectively alter the intestinal microbiota and support homeostasis by improving gut barrier function, preventing systemic inflammation which may help local inflammation in the periodontal tissues. Providing an inulin supplement may benefit periodontal health while providing insight into the complex relationship between periodontal disease and the gut microbiota. The primary objective is to determine if a daily 10 g dose of inulin for 14 weeks is more effective than the placebo at improving clinical periodontal outcomes including probing depth (PD) and bleeding on probing (BOP). Secondary objectives include determining the effects of inulin supplementation pre and post ST on salivary markers of inflammation and periodontal-associated pathogens, as these outcomes reflect more rapid changes than clinical periodontal outcomes. This thesis has involved the design and registration of a single-center, randomized, double-blind, placebo-controlled study design in which 170 participants who are receiving ST to manage periodontal disease will be randomized to the intervention (inulin) or placebo (maltodextrin) group. The intervention period will begin 4 weeks before ST through to their follow up appointment at 10 weeks post ST. Clinical outcomes of periodontal disease including number of sites with PD ≥ 4 mm and the absence of BOP will be measured at baseline and post ST. Salivary markers of inflammation (interleukin-1beta, interleukin-6, c-reactive protein and matrix metalloproteinase-8), periodontal-associated pathogens (Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia and Aggregatibacter actinomycetemcomitans), body mass index (BMI) and diet assessments will be measured at baseline, pre ST and post ST. Inulin is expected to enhance the positive effect of ST on the management of periodontal disease. The results of the study results will help to provide guidance regarding the use of prebiotics prior to and as a supportive adjunct to ST for periodontal health.