Unravelling the benefits of thermal waters enhancing oral health: a pilot study

Background: Oral health represents a public health problem due to its remarkable social impact and medical costs. Crenotherapy with sulfur water is shown to be a complementary, less toxic, and traumatizing therapy, but the number of studies that evaluate the effect of natural mineral waters effect on oral health are scarce. The aim of this pilot study is to evaluate the impact of thermal water therapy on the oral health of the participants, assessing parameters such as plaque index, gingival bleeding index and periodontal probing depth as well on the perception of symptoms of oral mucosa diseases (OMD).

Methods: An observational, longitudinal and comparative study was designed, and 90 thermalists were randomly allocated to two treatment groups for 14 days: Thermal sulfuric natural mineral water of the Amarante Thermal baths group (TW_TA group) (n = 45) or saline solution (control group) (n = 45), in May 2022. The study was based on clinical observation and application of a self-response questionnaire involving sociodemographic data and quality of life assessment. The evaluation was carried out in 2 different moments: before and at the end of treatment (14 days).

Results: The study involved 90 thermal practitioners, evenly split between the TW_TA group and a control group. Most participants were women (70%), with a similar average age in both groups. Oral examination showed a high prevalence of filled and missing teeth, and around 25% of participants used removable prostheses, predominantly in the control group. Thermal treatment had a positive impact on oral health. In the TW_TA group, gingival bleeding significantly decreased from 68.9% to 40%, while it remained unchanged in the control group. Periodontal health improved, with no participants in the TW_TA group having pockets deeper than 5 mm by the end of the study, indicating reduced periodontal pathology. Also, plaque levels dropped in both groups after treatment, as assessed by the O'Leary index. Additionally, quality of life related to OMD improved, particularly in the TW_TA group. The overall reduction in symptoms was significant, although the differences between groups were not statistically significant.

Conclusions: This study demonstrates the positive effects of thermal water treatment on oral health, including reduced gingival bleeding and plaque levels, along with improved quality of life related to OMD. Further targeted research is needed to explore the benefits of thermal water effects and optimize oral health practices in Portugal using thermal waters.