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Central Obesity’s Role in Periodontal Diseases

Discover the significant influence of central adiposity on periodontal health, from increased inflammation to compromised treatment responses, and the unique role dental professionals play in addressing this issue.

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Adipose tissue is an active endocrine organ, and the destructive wake of central adiposity is far-reaching. Obesity is defined as having a body mass index (BMI) ≥ 30%, with severe or morbid obesity as a BMI ≥ 40%. The age-adjusted prevalence of obesity in the United States is 42.4% and is highest among non-Hispanic black adults.1 These pa­tients have hyperactive, enlarged adipocytes that attract macro­phages and together produce tumor necrosis factor alpha, adiponectin and IL-6, which increase systemic inflammation and insulin resistance by directly changing the sensitivity of its receptors.2

The complete list of obesity-related complications is exhaustive and includes type 2 diabetes mellitus, coronary heart disease, obstructive sleep apnea, osteoarthritis, stroke, and end-stage renal disease.2 Compared to nonobese subjects, obese patients are 1.81 times more likely to have periodontitis, per a systematic review.3 Weight gain was determined to be just as detrimental. Another systematic review found a 33% likelihood of developing periodontitis among subjects who became obese.4

The type and location of fat contribute differently to the rate of periodontal disease. Visceral fat, for example, is more “active” than peripheral fat in its release of proinflammatory markers and adipokines.2 In fact, central obesity is a more important parameter for disease onset and progression than BMI. According to a national cross-sectional study, central obesity is a significant risk factor for tooth loss. A waist circumference of 37 to 39 inches for men, and 31 to 34.6 inches for women is considered high risk for having or developing periodontitis.5 A similar study design in Korea supports these findings, as the authors suggest that a larger waist circumference was significantly associated with periodontitis compared to participants of normal weight.6

Obesity is one of several disorders that increase the risk for metabolic syndrome, which requires having at least three of five criteria relating to elevated waist circumference, triglycerides, blood pressure, fasting glucose and lipoprotein levels. A random effects meta-analysis identified an almost twofold risk of having periodontitis with metabolic syndrome, and an increasing magnitude of association with every additional component.7 Obesity also compromises treatment response. In a clinical trial, obese participants showed less probing depth reduction and clinical attachment gain, similar to that of smokers, compared to the normal weight group two months after nonsurgical therapy.8 Significantly better clinical results were noted 3 months after nonsurgical therapy with dietary weight loss intervention.9

Dental professionals have a unique opportunity to engage with patients more frequently about nutrition than other healthcare providers. Overweight or obese patients with periodontitis should be screened for type 2 diabetes and hypertension as part of their initial exam and encouraged to visit their primary care provider. This is to help slow the rate of periodontitis, improve their responsiveness to interventional treatment, and prevent further systemic complications.

References

  1. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018
  2. Suvan JE, Finer N, D’Aiuto F. Periodontal complications with obesity. Periodontol 2000. 2018;78:98–128.
  3. Suvan J, D’Aiuto F, Moles DR, Petrie A, Donos N. Association between overweight/​obesity and periodontitis in adults. A systematic review. Obes Rev. 2011;12:e381–e404.
  4. Nascimento GG, Leite FR, Do LG, et al. Is weight gain associated with the incidence of periodontitis? A systematic review and meta-analysis. J Clin Periodontol. 2015;2:495–505.
  5. Kang J, Smith S, Pavitt S, Wu J. Association between central obesity and tooth loss in the non-obese people: results from the continuous National Health and Nutrition Examination Survey (NHANES) 1999–2012. J Clin Periodontol. 2019;46:430–437.
  6. Kim EJ, Jin BH, Bae KH. Periodontitis and obesity: a study of the Fourth Korean National Health and Nutrition Examination Survey. J Periodontol. 201;82:533–542.
  7. Nibali L, Tatarakis N, Needleman I, et al. Clinical review: association between metabolic syndrome and periodontitis: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2013;98:913–920.
  8. Suvan J, Petrie A, Moles DR, et al. Body mass index as a predictive factor of periodontal therapy outcomes. J Dent Res. 2014;93:49–54.
  9. Martinez-Herrera M, López-Domènech S, Silvestre FJ, et al. Dietary therapy and non-surgical periodontal treatment in obese patients with chronic periodontitis. J Clin Periodontol. 2018;45:1448–1457.

This information originally appeared in Saltz A. Periodontal medicine: from teeth to total body health. Decisions in Dentistry. 2021;7(3):25–31.

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