Smaragda Diamanti

Background: The Mediterranean diet (MD) represents a nutritionally balanced eating pattern characterized by high consumption of fruits, vegetables, legumes, nuts, whole grains, olive oil, fish, and extra-virgin olive oil as the principal fat source and limited intake of red meat and refined sugars. Emerging evidence indicates that the MD’s anti-inflammatory and antioxidant properties extend beyond systemic health, potentially reducing the risk and severity of periodontitis. This narrative review aimed to synthesize current evidence on the relationship between adherence to the MD and periodontal health outcomes. Methods: A comprehensive electronic literature search was conducted in PubMed without restrictions on publication date. Fourteen studies, ranging from 2019 to 2025, were included, encompassing human, clinical, experimental, and review designs that examined MD adherence and its effects on periodontal parameters. Eligible studies included cross-sectional, cohort, randomized controlled trials; systematic reviews; and animal models assessing clinical periodontal indices, inflammatory biomarkers, or microbial composition. Extracted data included study design, population characteristics, dietary assessment methods, and primary periodontal findings. Results: Most studies demonstrated that greater adherence to the MD was associated with improved periodontal parameters, including reduced probing pocket depth, clinical attachment loss, and bleeding on probing. Interventional trials showed significant reductions in systemic inflammatory markers such as IL-1β, TNF-α, and CRP, along with decreased counts of periodontopathogenic bacteria. Experimental studies further revealed the protective role of oleic acid and polyphenols in regulating macrophage activity, suppressing osteoclastogenesis, and enhancing IL-10 expression via epigenetic modulation. However, heterogeneity in dietary scoring systems, sample characteristics, and follow-up duration limited direct comparison, and not all associations reached statistical significance. Conclusions: Current evidence supports a beneficial association between MD adherence and periodontal health, mediated through anti-inflammatory, antioxidant, and microbiome-stabilizing mechanisms. Further standardized longitudinal and interventional studies are needed to confirm causality and refine nutritional strategies for periodontal disease prevention and management.