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Review of obesity and periodontitis: an epidemiological view
Abstract
Obesity and periodontitis are among the most common non-communicable diseases, and epidemiological studies report the influence of obesity in the onset and progression of periodontitis. Data indicate that increased body mass index, waist circumference, percentage of subcutaneous body fat, and serum lipid levels are associated with increased risk to develop periodontitis. The underlying biological mechanisms of this association involve adipose tissue-derived cytokines, such as tumour necrosis factor-α and interleukin-6, which affect whole-body metabolism and contribute to the development of a low-grade systemic inflammation. Multiple studies report a positive association between these two diseases across diverse populations. Obesity does not appear to impair the success of periodontal therapy. However, currently available evidence is variable and therefore inconclusive. Despite the limited evidence about recommendations on treatment planning, oral healthcare professionals need to be aware of the complexity of obesity to counsel their patients about the importance of maintaining healthy body weight and performing good oral hygiene procedures.
... The metabolic consequences of obesity include insulin resistance and compensatory hyperinsulinemia, which decrease lipolysis and increase adipogenesis. It is well known that obesity is associated with either PCOS or periodontitis [28,29]. In comparison to age-matched and BMI-matched controls, women with PCOS tend to have visceral adiposity [30]. ...
... between metabolic syndrome and periodontitis, the risk of periodontitis was 38% higher for individuals with metabolic syndrome [34]. The underlying biological mechanism for this association involves cytokines such as tumor necrosis factor-α and interleukin-6, produced by adipose tissue, which affect the whole body and contribute to development of a low-grade systemic in ammation [29]. NLRP12 is a member of the NOD-like receptors (NLRs) family, which inhibits in ammation and osteoclast genesis by inhibiting the NF-κB pathway, contributes to the prevention of periapical bone destruction in mice [35]. ...
Background: Over the last decade, there has been an increasing number of clinical and laboratory evidence supporting associations between Polycystic ovary syndrome (PCOS) and periodontitis, but few studies have been conducted on the underlying mechanisms of the two diseases through the transcriptomic approach. In this study, gene co-expression networks between PCOS and periodontitis were analyzed by bioinformatics tools.
Methods: PCOS and periodontitis expression data were downloaded from the GEO database, and the differentially expressed genes (DEGs) were identified. After obtaining Intersected genes, GO and KEGG pathway enrichment analysis and random forest (RF) algorithm were used to screen hub genes in PCOS and periodontitis. The functions of the hub genes were analyzed by GSEA, and the correlations between hub genes and immune infiltration in two diseases were examined. Furthermore, a TF-ceRNA regulatory network of hub genes was constructed.
Results: There were 1,661 DEGs in PCOS and 701 DEGs in periodontitis compared to the controls. After overlapping, 66 intersected genes were shown to be involved in PCOS and periodontitis, and were mainly enriched in immune and inflammation-related biological processes and pathways. 40 common genes were selected from the PPI network constructed by STRING. The RF algorithm demonstrated that ACSL5, NLRP12, CCRL2, and CEACAM3 were hub genes in PCOS and periodontitis, and the GSEA result revealed their close relationship with the antigen processing and presentation, and chemokine signaling pathway. Moreover, the data showed that those 4 hub genes may serve as diagnostic genes for PCOS and periodontitis.
Conclusion: This study identified ACSL5, NLRP12, CCRL2, and CEACAM3 as the diagnostic genes at the intersection of PCOS and periodontitis, and establish a ceRNA network, which could provide a molecular basis for future experimental studies on the association between PCOS and periodontitis.
... When a statistical comparison with the US population was done, it was observed that 21.25 % of the population is obese and suffering from various comorbidities including periodontal issues, while about 24 % of English people are obese [20][21] and suffering from the periodontal state. In some studies, it is estimated that periodontal diseases are more common in young obese having aged between 19 to 35 years as compared to the older ones. ...
Background: Obesity is one of the highly emerging chronic disease. It is a major health concern now a days. The BMI of more than 35% of the adults were in the overweight category in 2008 but now the values are reported to be exceeded. The study aimed to assess the relationship between body mass index and chronic periodontitis. Study Design: It is a cross-sectional study with statistical approach, conducted at Karachi medical and dental college, Karachi Material and Methods: The study was conducted on 200 patients visited the dentist department of the hospital. The study was conducted for six month duration from Jan 2022 to June 2022. The ethical and review board of the hospital approved the study. Results: Among 200, 100 specimens belong to the normal weight category, 73 are overweight, and 27 are from the obese category. In each category, all the specimens are from similar age groups, but more males were present in the overweight and obese categories. Complete data analysis of these patients was performed. Then logistic regression analysis was performed, and it was predicted that periodontitis has a direct relation with the body mass index (BMI). About a 17% risk rate increases with an increase in each unit of BMI. Conclusion: This study supports the hypotheses of the association of obesity with periodontal issues. The body mass index is a factor for the assessment of different health risk factors. The body mass index and smoking are linked with periodontal issues. Smokers and obese people specifically young obese have a more critical periodontal state. Keywords: Body mass index and periodontitis.
... Weight of individuals must be examined along with the oral examination on regular basis. Promotion of healthy lifestyles ,physical activity should be recommended to reduce the burden of disease [25]. ...
Obesity is multifactorial disease affecting developing and developed countries worldwide. It is systemic condition associated with several diseases with
increased rate of morbidity and mortality. It is major public health problem with various comorbidities affecting general as well as oral health. Periodontitis is an
inflammatory condition resulting in destruction of supporting structures of teeth, connective tissue, periodontal ligament and alveolar bone resorption. There is
possible correlation of obesity and periodontal disease. This article aim to review about the relationship about periodontitis and obesity and recommend some
possible measures to detect cases at an early stage.
... In the literature, it has been reported that obesity did not appear to impair the success of periodontal therapy but available evidence was variable and inconclusive [15]. Our clinical outcomes suggest that periodontal treatment is effective in reducing local clinical signs of periodontal inflammatory burden and obesity does not have an unfavorable impact on periodontal clinical healing response. ...
Objectives
Adipocytokines and oxidative stress (OS) are involved in the pathogenesis of both obesity and periodontitis. The aim of this study was to evaluate periodontal therapy outcomes in terms of serum and gingival crevicular fluid (GCF) levels of adipocytokines and OS markers in obese patients with periodontitis, in order to have an insight into the association between obesity and periodontitis.
Materials and methods
A total of 39 patients (20 obese, 19 non-obese) with periodontitis were included in this study. Clinical periodontal parameters were assessed; serum and GCF levels of adipocytokines and OS markers were evaluated by ELISA at baseline and 3 months after non-surgical periodontal therapy.
Results
Significant improvements in clinical periodontal parameters were observed in both groups at 3 months (p < 0.01). While serum levels of TNF-α, leptin, and total oxidant status (TOS) in the obese group were higher at baseline (p < 0.01), leptin levels remained higher at 3 months despite a significant decrease (p < 0.01). Although NSPT improved GCF levels of total antioxidant status (TAS) and TOS in both groups, they were significantly different between the groups after therapy (p < 0.05).
Conclusions
It seems that leptin, TNF-α, and TOS contribute to systemic inflammatory and oxidative state in patients with obesity. Despite improvements in clinical periodontal parameters, obesity might be a modulating factor in the development and progression of periodontal disease in terms of some adipocytokines and OS markers.
Clinical relevance
Since the global burden of both obesity and periodontitis is continuously increasing, the management of these inflammatory diseases has become more important. The current study contributes to our understanding of the role of OS and adipocytokines on the relationship between obesity and periodontitis by response to periodontal treatment.
... Meniere's disease showed a higher prevalence in older and obese individuals [10]. Epidemiological studies reported obesity and old age as risk indicators for periodontitis [29,30]. Our findings suggested that, although Meniere's disease and periodontitis are less common in young and non-obese individuals, the systemic inflammation associated with periodontitis may significantly influence the development of Meniere's disease in younger individuals and individuals with a low BMI. ...
To investigate the association of the oral health parameters with Meniere’s disease in a nationwide population-based longitudinal cohort database. The data of the participants who underwent an oral health screening by dentists in 2003 (n = 2,415,963) were retrieved from the National Health Insurance Database of the Korean National Health Insurance Service. The main outcome was the occurrence of Meniere’s disease, defined as two or more claims of the diagnostic code H810 with a previous audiometric examination. The occurrence of Meniere’s disease was analyzed using a Cox proportional hazard model according to the presence of periodontitis and the oral health examination findings, including missing teeth, the frequency of tooth brushing and dental scaling. Overall, the analysis included 2,240,282 participants. During a median follow-up of 16.7 years, Meniere’s disease developed in 112,106 (5.0%) participants. Poor oral health status was characterized by the presence of periodontitis (adjusted hazard ratio [aHR]: 1.18, 95% confidence interval [CI]: 1.14–1.22, p < 0.001) and an increased number of missing teeth (≥15; aHR: 1.25, 95% CI: 1.18–1.32, p < 0.001) was associated with an increased risk of Meniere’s disease. Better oral hygiene behaviors, such as frequent tooth brushing (≥3 per day; aHR: 0.75, 95% CI: 0.73–0.76, p < 0.001) and dental scaling within 1 year (aHR: 0.98, 95% CI: 0.97–0.99, p = 0.003) were negatively associated with the occurrence of Meniere’s disease. The presence of periodontitis and an increased number of missing teeth may augment the risk of the occurrence of Meniere’s disease. However, maintaining good oral hygiene through tooth brushing and dental scaling may be associated with a decreased risk of Meniere’s disease. Further studies should confirm the association between oral health and Meniere’s disease.
... Accordingly, for early prevention and treatment of periodontitis, it is critical to identify the clinical factors that contribute to its pathogenesis. Previous studies have revealed many factors that are associated with the risk of periodontitis, such as aging (4), obesity (5), smoking (6), alcohol consumption (7), and diabetes (8). Besides, accumulating evidence suggests that various inflammatory diseases are associated with higher odds of periodontitis, such as rheumatoid arthritis (9), systemic lupus erythematosus (10), Crohn's disease (11) and ulcerative colitis etc. (12), suggesting that systemic inflammation may be an important determinant of periodontitis (13). ...
Background:
Systemic inflammation is a feature of sleep-disordered breathing (SDB) as well as periodontitis. The association between SDB and periodontitis, however, has been inconsistent in previous studies. In order to fully evaluate the above association, we conducted a meta-analysis.
Material and methods:
Observational studies related to the aim of the meta-analysis were identified by search of PubMed, Embase, Web of Science, Wanfang, and CNKI databases. Only studies with SDB diagnosed with the objective polysomnography examination were included. The results were analyzed using a random-effects model that incorporated potential heterogeneity between studies.
Results:
Ten cross-sectional or case-control studies with 43,296 participants contributed to the meta-analysis. Pooled results showed that SDB was significantly associated with periodontitis (odds ratio [OR]: 1.83, 95% confidence interval [CI]: 1.52 to 2.20, I2 = 40%, p < 0.001). Sensitivity analysis showed consistent association for severe periodontitis (OR: 1.39, 95% CI: 1.20 to 1.61, I2 = 0%, p < 0.001). Subgroup analyses showed consistent results in patients with mild (OR: 1.66, p < 0.001), moderate (OR: 2.23, p = 0.009), and severe SDB (OR: 2.66, p < 0.001). Moreover, the association between SDB and periodontitis was consistent in Asian and non-Asian studies, in cross-sectional and case-control studies, in studies with univariate and multivariate regression models, and in studies with different quality scores (p for subgroup effects all < 0.05).
Conclusions:
Polysomnography confirmed diagnosis of SDB is associated with periodontitis in adult population.
... Several cross-sectional studies reported an association between obesity and periodontitis [27,28]. Also, increased BMI and lipid percentage are associated with higher risk of periodontitis [29]. In the present study, 75.5% of dentists and 65% of students were aware of the association of obesity and increased risk of periodontal disease, and 62.2% ...
Background: Inadequate nutrition can affect oral health, including periodontitis and caries. Compromised oral health can also alter food choices and negatively lead to poor nutritional status. Therefore, current and future dentists should not neglect the nutritional issues of patients.This study aimed to assess the perceptions and practice of general dentists and dental students regarding nutrition counseling.
Materials and Methods: In this cross-sectional study, a questionnaire was used which included four parts of demographic information, 9 questions regarding knowledge, 6 questions regarding attitude, and 10 questions regarding practice with respect to nutrition counseling. The questionnaires were administered among senior students and dentists in Yazd. Data were analyzed by the Chi-square test and t-test (alpha=0.05).
Results: 98 (71%) dentists and 40 (29%) students participate. The mean knowledge score was 7.12±1.75 in dentists and 6.48±1.2 in students out of 9. The mean knowledge score of dentists was significantly higher than students (P=0.03). Mean practice score of dentists and senior students were 3.26± 2.43 and 3.20± 1.82 out of 10, respectively. No significant difference was found in mean practice score of two groups (P=0.879).
Conclusions: The knowledge level of both groups was acceptable but the quality of practice was poor in dentists and students.
Objective:
Evaluate the association of genetic variants of the interferon gamma inducible protein 16 (IFI16) and absent in melanoma 2 (AIM2) genes with periodontitis.
Methods:
The study involved 117 individuals with periodontitis and 389 without periodontitis, all Brazilians, miscegenated. Individuals with periodontitis presented at least 4 teeth with ≥ 1 site with probing depth ≥ 4 mm; clinical attachment level ≥ 3 mm on the same site and bleeding upon stimulus. Genotyping was performed using the Infinium Multi-Ethnic AMR/AFR-8 Bead Chip focused on Hispanic and African American populations with approximately 2 million markers of the human genome. Multivariate logistic regression was performed to identify associations in additive, dominant and recessive models adjusted for covariates age, obesity, mouth breathing, flossing, asthma, and ancestry.
Results:
In IFI16, the rs75985579-A is positively associated with periodontitis in the additive (Odds Ratio adjusted (ORadjusted) 2.65, 95% confidence interval (CI):1.25-5.60, p value: 0.007) and dominant models (ORadjusted 2.56, 95%CI:1.13-5.81, p value: 0.017). In AIM2, the rs76457189-G, is associated negatively with periodontitis in two genetic models evaluated, additive (ORadjusted 0.21, 95%CI:0.05-0.94, p value: 0.022) and dominant (ORadjusted 0.21, 95%CI:0.05-0.94, p value: 0.022).
Conclusions:
These results have shown that variants in the IFI16 and AIM2 genes are associated with periodontitis. Individuals with at least one A (adenine) allele of the rs75985579 (IFI16) are more than twice as likely to have periodontitis, while individuals with the G (guanine) allele of rs76457189 (AIM2) are less likely to be diagnosed with periodontitis, providing a negative association with periodontitis.
Obesity is a major health burden and its prevalence is rapidly increasing. Endoscopic treatments may help patients with obesity to interrupt or slow down the weight gain, thereby reducing complications associated with excess weight. In patients with morbid obesity, the weight loss obtained with endoscopic procedures represents a chance to reduce the bariatric surgical and anesthesiologic complications. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures are available, but many aspects lack standardization. Many intragastric balloon (IGB) devices are available with their own peculiarities; some are US Food and Drug Administration approved while others are currently being investigated. We discuss several aspects of IGB treatment and present the evidence regarding safety and efficacy of the most common IGBs. Overall, IGBs are reasonably safe devices and represent a practical tool to aid weight loss when managed in the context of multidisciplinary team. Patients should be thoroughly evaluated for the procedure and adequate medical and nutritional follow-up is needed. For some devices, the evidence is strong both in terms of safety and efficacy; for other newer devices, further prospective studies are necessary.
Background:
This report presents weighted average estimates of the prevalence of periodontitis in the adult US population during the 6 years 2009-2014 and highlights key findings of a national periodontitis surveillance project.
Methods:
Estimates were derived for dentate adults 30 years or older from the civilian noninstitutionalized population whose periodontitis status was assessed by means of a full-mouth periodontal examination at 6 sites per tooth on all non-third molar teeth. Results are reported according to a standard format by applying the Centers for Disease Control and Prevention/American Academy of Periodontology periodontitis case definitions for surveillance, as well as various thresholds of clinical attachment loss and periodontal probing depth.
Results:
An estimated 42% of dentate US adults 30 years or older had periodontitis, with 7.8% having severe periodontitis. Overall, 3.3% of all periodontally probed sites (9.1% of all teeth) had periodontal probing depth of 4 millimeters or greater, and 19.0% of sites (37.1% of teeth) had clinical attachment loss of 3 mm or greater. Severe periodontitis was most prevalent among adults 65 years or older, Mexican Americans, non-Hispanic blacks, and smokers.
Conclusions:
This nationally representative study shows that periodontitis is a highly prevalent oral disease among US adults.
Practical implications:
Dental practitioners should be aware of the high prevalence of periodontitis in US adults and may provide preventive care and counselling for periodontitis. General dentists who encounter patients with periodontitis may refer these patients to see a periodontist for specialty care.
Background:
Obesity is a very prevalent chronic disease worldwide and has been suggested to increase susceptibility of periodontitis. The aim of this paper was to provide a systematic review of the association between obesity and periodontal disease, and to determine the possible mechanisms underlying in this relationship.
Material and methods:
A literature search was carried out in the databases PubMed-Medline and Embase. Controlled clinical trials and observational studies identifying periodontal and body composition parameters were selected. Each article was subjected to data extraction and quality assessment.
Results:
A total of 284 articles were identified, of which 64 were preselected and 28 were finally included in the review. All the studies described an association between obesity and periodontal disease, except two articles that reported no such association. Obesity is characterized by a chronic subclinical inflammation that could exacerbate other chronic inflammatory disorders like as periodontitis.
Conclusions:
The association between obesity and periodontitis was consistent with a compelling pattern of increased risk of periodontitis in overweight or obese individuals. Although the underlying pathophysiological mechanism remains unclear, it has been pointed out that the development of insulin resistance as a consequence of a chronic inflammatory state and oxidative stress could be implicated in the association between obesity and periodontitis. Further prospective longitudinal studies are needed to define the magnitude of this association and to elucidate the causal biological mechanisms.
Background:
Obesity and periodontitis are important chronic health problems. Obesity is associated with an increased prevalence of periodontitis. Whether obesity also affects the outcome of non-surgical periodontal therapy is to date still unclear.
Methods:
A systematic review of studies referenced in SCOPUS, MEDLINE, PubMed, Cochrane, CINAHL, Biosis and Web of Science was performed. Titles, abstracts and finally full texts were scrutinized for possible inclusion by two independent investigators. Quality and heterogeneity of the studies were assessed and the study designs were examined. Probing pocket depth reduction was analyzed as primary surrogate parameter for therapeutic success after non-surgical periodontal therapy.
Results:
One-hundred-and-fifty-nine potentially qualifying studies were screened. Eight studies fulfilled the inclusion criteria and were analyzed. Three of eight studies failed to show an influence of obesity on pocket depth reduction after non-surgical therapy. The remaining five studies documented a clear negative effect on the outcome of non-surgical periodontal therapy. The finally included studies did not correspond to the highest level of quality (RCTs). Due to the heterogeneity of the data a meta-analysis was not possible.
Conclusion:
The literature on the effect of obesity on the treatment outcome of non-surgical periodontal therapy remains controversial. The data, however, support that obesity is not only a factor associated with poorer periodontal health but might also result in inferior response to non-surgical treatment of periodontitis.
To investigate the cytokine profile as biomarkers in the gingival crevicular fluid (GCF) of chronic periodontitis (CP) patients with and without obesity. MEDLINE/PubMed, EMBASE, Science direct, and SCOPUS databases were combined with hand searching of articles published from 1977 up to and including May 2016 using relevant MeSH terms. Meta-analyses were conducted separately for each of the cytokines; resistin, adiponectin, TNF-α, leptin, IL-6, IL-8, and IL-1β. Forest plots were produced reporting standardized mean difference of outcomes and 95% confidence intervals. Eleven studies were included. Three studies showed comparable levels of leptin among obese and non-obese patients with CP. Four studies reported comparable levels of interleukin (IL)-6 and resistin whereas five studies reported comparable levels of adiponectin. Two studies reported similar levels of CRP in patients with periodontitis with and without obesity. One study showed higher levels of tumor necrosis factor-alpha in obese patients with CP. One study showed higher levels of IL-1β and IL-8 in obese patients with CP. The level of localized periodontal inflammation may have a greater influence on the GCF proinflammatory biomarker levels as compared to systemic obesity. Whether patients having chronic periodontitis with obesity have elevated proinflammatory GCF biomarkers levels than non-obese individuals remains debatable.
Objective:
To determine population-average risk profiles for severe and non-severe periodontitis in US adults (30 years and older) using optimal surveillance measures and standard case definitions.
Methods:
We used data from the 2009-2012 National Health and Nutrition Examination Survey (NHANES), which for the first time used the "gold standard" full-mouth periodontitis surveillance protocol to classify severity of periodontitis following the suggested CDC/AAP case definitions. The probabilities of periodontitis by socio-demographics, behavioral factors, and co-morbid conditions, were assessed using prevalence ratios (PR) estimated by the predicted marginal probability from multivariable generalized logistic regression models. The analyses were further stratified by gender for each classification of periodontitis.
Results:
The likelihood of periodontitis increased with age for overall and non-severe relative to non-periodontitis. Compared to non-Hispanic whites, periodontitis was more likely among Hispanics (aPR=1.38; 1.26-1.52) and non-Hispanic blacks (aPR=1.35; 1.22-1.50), whereas severe periodontitis was most likely among non-Hispanic blacks (aPR=1.82; 1.44-2.31). There was at least a 50% greater likelihood of periodontitis among current smokers compared to non-smokers. Among males, the likelihood of periodontitis among adults 65 years and older was greater (aPR=2.07; 1.76 - 2.43) than adults 30-44 years old. This probability was even greater among women (aPR=3.15; 95% CI 2.63 - 3.77). The likelihood of periodontitis was higher among current smokers relative to non-smokers regardless of gender and periodontitis classification. Periodontitis was more likely among men with un-controlled diabetes compared to persons with no diabetes only.
Conclusions:
An assessment of risk profiles for periodontitis in US adults based on gold standard periodontal measures show important differences by severity of disease and gender. Cigarette smoking, specifically among current smokers remains an important modifiable risk for all levels of periodontitis severity. The higher likelihood of periodontitis in older adults and in males with uncontrolled diabetes is noteworthy. These findings could improve the identification of target populations for effective public health interventions to improve periodontal health of US adults.
Aim
The aim of this study was to systematically review the literature to answer the questions: (i) “Is periodontal treatment effective to improve clinical and immunological conditions in obese subjects?”; (ii) “Do obese subjects present different clinical and immunological response after periodontal therapy when compared to non-obese subjects?”
Methods
Searches were performed in six databases up to August 2014. Interventional studies were included if the following data were described: (1) Obesity/overweight assessment; (2) definition of periodontal disease; (3) periodontal therapy; (4) inflammatory marker in serum/plasma, and/or clinical parameters of periodontal disease. Assessment of quality was performed with the Downs and Black scale. Meta-analyses were conducted with the available data.
Results
Of 489 articles, 5 were included, and only 3 proceeded to meta-analysis of clinical outcomes. Included studies presented fair methodological quality. Statistical analysis demonstrated that periodontal therapy in obese subjects was effective to improve clinical outcomes. No clinical differences between post-therapy results of obese and non-obese were observed. Effects of periodontal therapy on inflammatory markers remain unclear.
Conclusions
Periodontal treatment seems to be effective to improve healing in obese individuals. No differences on periodontal healing between obese and non-obese subjects were observed; however, only limited and fragile base of evidence was available for analysis.
Clinical relevance
Periodontal treatment is effective to improve clinical and immunological periodontal parameters in adults. Also, obesity seems to not modify the periodontal healing after treatment.
Obesity is a chronic disease that is strongly associated with an increase in mortality and morbidity including certain types of cancer, cardiovascular disease, disability, diabetes mellitus, hypertension, osteoarthritis, and stroke. In adults, overweight is defined as a body mass index (BMI) of 25 kg/m(2) to 29 kg/m(2) and obesity as a BMI of greater than 30 kg/m(2). If current trends continue, it is estimated that, by the year 2030, 38% of the world's adult population will be overweight and another 20% obese. Significant global health strategies must reduce the morbidity and mortality associated with the obesity epidemic.
In recent years, it has become apparent that the pathogenesis of periodontal diseases is more complex than the presence of virulent microorganisms. In fact, it is now widely accepted that susceptibility to periodontitis varies greatly between individuals who harbor the same pathogenic microflora. To date, the bulk of evidence points to the host response to bacterial challenge as a major determinant of susceptibility. In this review, we will assess the data implicating various inherited and acquired risk factors for susceptibility to periodontal diseases.