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Paranhos K, Oliveira S, Bonato R, Niknami N, Vinayak S, Loomer P. The impact of obesity on the outcome of periodontal disease treatment: Systematic review and meta-analysis. Dent Res J (Isfahan) 2023; 20:108. [PMID: 38020246 PMCID: PMC10680074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/25/2022] [Accepted: 07/31/2023] [Indexed: 12/01/2023] Open
Abstract
Background Obesity and periodontitis are two commonly occurring disorders that affect a considerable amount of the world's population. Several studies have mentioned that there may be a link between the two. The purpose of this systematic review was to determine whether there was a difference in response to nonsurgical periodontal therapies (NSPTs) between obese and nonobese individuals. Materials and Methods An online search was assembled with a combination of Medical Subject Headings terms and free-text words of the literature published up to December 2020, to identify interventional studies limited to an adult human population. Titles, abstracts, and finally full texts were scrutinized for possible inclusion by two independent investigators. Reduction in periodontal pocket depth was the primary parameter used to assess the outcome of NSPT. Results The primary search yielded 639 significant titles and abstracts. After filtering, data extraction, and quality assessment, 34 full-text studies were selected. All studies matching inclusion criteria, suggest a positive association between obesity and periodontal disease. Conclusion Although a possible correlation exists between periodontitis and obesity, as with other oral-systemic disease implications, some controversy exists. While some studies have reported a distinct correlation between periodontitis and obesity, other papers have suggested only moderate or no association between the two conditions at all. These results advise of a difference between response to NSPT amid obese and nonobese individuals. However, with few quality studies and variable reported findings, there is limited evidence of any significant difference in clinical practice. However, it can be a positive warning that obesity is a risk factor toward the outcome of periodontal disease treatment.
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Affiliation(s)
- Klenise Paranhos
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY, USA
| | | | | | - Neda Niknami
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY, USA
| | | | - Peter Loomer
- Dental Science Department at UT Health San Antonio, San Antonio, Texas, USA
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Lê S, Laurencin-Dalicieux S, Minty M, Assoulant-Anduze J, Vinel A, Yanat N, Loubieres P, Azalbert V, Diemer S, Burcelin R, Canceill T, Thomas C, Blasco-Baque V. Obesity Is Associated with the Severity of Periodontal Inflammation Due to a Specific Signature of Subgingival Microbiota. Int J Mol Sci 2023; 24:15123. [PMID: 37894804 PMCID: PMC10606428 DOI: 10.3390/ijms242015123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
The aim of this study was to analyze the link between periodontal microbiota and obesity in humans. We conducted a cohort study including 45 subjects with periodontitis divided into two groups: normo-weighted subjects with a body mass index (BMI) between 20 and 25 kg/m2 (n = 34) and obese subjects with a BMI > 30 kg/m2 (n = 11). Our results showed that obesity was associated with significantly more severe gingival inflammation according to Periodontal Inflamed Surface Area (PISA index). Periodontal microbiota taxonomic analysis showed that the obese (OB) subjects with periodontitis were characterized by a specific signature of subgingival microbiota with an increase in Gram-positive bacteria in periodontal pockets, associated with a decrease in microbiota diversity compared to that of normo-weighted subjects with periodontitis. Finally, periodontal treatment response was less effective in OB subjects with persisting periodontal inflammation, reflecting a still unstable periodontal condition and a risk of recurrence. To our knowledge, this study is the first exploring both salivary and subgingival microbiota of OB subjects. Considering that OB subjects are at higher periodontal risk, this could lead to more personalized preventive or therapeutic strategies for obese patients regarding periodontitis through the specific management of oral microbiota of obese patients.
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Affiliation(s)
- Sylvie Lê
- Département d’Odontologie, Faculté de Santé, Université Paul Sabatier Toulouse III, 3 Chemin des Maraîchers, CEDEX 9, 31062 Toulouse, France; (S.L.); (S.L.-D.); (M.M.); (A.V.); (N.Y.); (P.L.)
- Service d’Odontologie Toulouse Rangueil, CHU Toulouse, 3 Chemin des Maraîchers, CEDEX 9, 31062 Toulouse, France
- UMR1297 Inserm, Team InCOMM/Intestine ClinicOmics Metabolism & Microbiota, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Paul Sabatier, 1 Avenue Jean Poulhes, 31432 Toulouse, France; (J.A.-A.); (V.A.); (S.D.); (R.B.)
| | - Sara Laurencin-Dalicieux
- Département d’Odontologie, Faculté de Santé, Université Paul Sabatier Toulouse III, 3 Chemin des Maraîchers, CEDEX 9, 31062 Toulouse, France; (S.L.); (S.L.-D.); (M.M.); (A.V.); (N.Y.); (P.L.)
- Service d’Odontologie Toulouse Rangueil, CHU Toulouse, 3 Chemin des Maraîchers, CEDEX 9, 31062 Toulouse, France
- INSERM U1295, CERPOP, Epidémiologie et Analyse en Santé Publique, Risques, Maladies Chroniques et Handicaps, 37 Allées Jules Guesdes, 31000 Toulouse, France
| | - Matthieu Minty
- Département d’Odontologie, Faculté de Santé, Université Paul Sabatier Toulouse III, 3 Chemin des Maraîchers, CEDEX 9, 31062 Toulouse, France; (S.L.); (S.L.-D.); (M.M.); (A.V.); (N.Y.); (P.L.)
- Service d’Odontologie Toulouse Rangueil, CHU Toulouse, 3 Chemin des Maraîchers, CEDEX 9, 31062 Toulouse, France
- UMR1297 Inserm, Team InCOMM/Intestine ClinicOmics Metabolism & Microbiota, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Paul Sabatier, 1 Avenue Jean Poulhes, 31432 Toulouse, France; (J.A.-A.); (V.A.); (S.D.); (R.B.)
| | - Justine Assoulant-Anduze
- UMR1297 Inserm, Team InCOMM/Intestine ClinicOmics Metabolism & Microbiota, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Paul Sabatier, 1 Avenue Jean Poulhes, 31432 Toulouse, France; (J.A.-A.); (V.A.); (S.D.); (R.B.)
| | - Alexia Vinel
- Département d’Odontologie, Faculté de Santé, Université Paul Sabatier Toulouse III, 3 Chemin des Maraîchers, CEDEX 9, 31062 Toulouse, France; (S.L.); (S.L.-D.); (M.M.); (A.V.); (N.Y.); (P.L.)
- Service d’Odontologie Toulouse Rangueil, CHU Toulouse, 3 Chemin des Maraîchers, CEDEX 9, 31062 Toulouse, France
- UMR 1297 Inserm, Team ESTER, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Paul Sabatier, 1 Avenue Jean Poulhes, 31432 Toulouse, France
| | - Noor Yanat
- Département d’Odontologie, Faculté de Santé, Université Paul Sabatier Toulouse III, 3 Chemin des Maraîchers, CEDEX 9, 31062 Toulouse, France; (S.L.); (S.L.-D.); (M.M.); (A.V.); (N.Y.); (P.L.)
- Service d’Odontologie Toulouse Rangueil, CHU Toulouse, 3 Chemin des Maraîchers, CEDEX 9, 31062 Toulouse, France
| | - Pascale Loubieres
- Département d’Odontologie, Faculté de Santé, Université Paul Sabatier Toulouse III, 3 Chemin des Maraîchers, CEDEX 9, 31062 Toulouse, France; (S.L.); (S.L.-D.); (M.M.); (A.V.); (N.Y.); (P.L.)
- UMR1297 Inserm, Team InCOMM/Intestine ClinicOmics Metabolism & Microbiota, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Paul Sabatier, 1 Avenue Jean Poulhes, 31432 Toulouse, France; (J.A.-A.); (V.A.); (S.D.); (R.B.)
| | - Vincent Azalbert
- UMR1297 Inserm, Team InCOMM/Intestine ClinicOmics Metabolism & Microbiota, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Paul Sabatier, 1 Avenue Jean Poulhes, 31432 Toulouse, France; (J.A.-A.); (V.A.); (S.D.); (R.B.)
| | - Swann Diemer
- UMR1297 Inserm, Team InCOMM/Intestine ClinicOmics Metabolism & Microbiota, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Paul Sabatier, 1 Avenue Jean Poulhes, 31432 Toulouse, France; (J.A.-A.); (V.A.); (S.D.); (R.B.)
| | - Remy Burcelin
- UMR1297 Inserm, Team InCOMM/Intestine ClinicOmics Metabolism & Microbiota, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Paul Sabatier, 1 Avenue Jean Poulhes, 31432 Toulouse, France; (J.A.-A.); (V.A.); (S.D.); (R.B.)
| | - Thibault Canceill
- Département d’Odontologie, Faculté de Santé, Université Paul Sabatier Toulouse III, 3 Chemin des Maraîchers, CEDEX 9, 31062 Toulouse, France; (S.L.); (S.L.-D.); (M.M.); (A.V.); (N.Y.); (P.L.)
- Service d’Odontologie Toulouse Rangueil, CHU Toulouse, 3 Chemin des Maraîchers, CEDEX 9, 31062 Toulouse, France
- UMR1297 Inserm, Team InCOMM/Intestine ClinicOmics Metabolism & Microbiota, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Paul Sabatier, 1 Avenue Jean Poulhes, 31432 Toulouse, France; (J.A.-A.); (V.A.); (S.D.); (R.B.)
| | - Charlotte Thomas
- Département d’Odontologie, Faculté de Santé, Université Paul Sabatier Toulouse III, 3 Chemin des Maraîchers, CEDEX 9, 31062 Toulouse, France; (S.L.); (S.L.-D.); (M.M.); (A.V.); (N.Y.); (P.L.)
- Service d’Odontologie Toulouse Rangueil, CHU Toulouse, 3 Chemin des Maraîchers, CEDEX 9, 31062 Toulouse, France
- UMR1297 Inserm, Team InCOMM/Intestine ClinicOmics Metabolism & Microbiota, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Paul Sabatier, 1 Avenue Jean Poulhes, 31432 Toulouse, France; (J.A.-A.); (V.A.); (S.D.); (R.B.)
| | - Vincent Blasco-Baque
- Département d’Odontologie, Faculté de Santé, Université Paul Sabatier Toulouse III, 3 Chemin des Maraîchers, CEDEX 9, 31062 Toulouse, France; (S.L.); (S.L.-D.); (M.M.); (A.V.); (N.Y.); (P.L.)
- Service d’Odontologie Toulouse Rangueil, CHU Toulouse, 3 Chemin des Maraîchers, CEDEX 9, 31062 Toulouse, France
- UMR1297 Inserm, Team InCOMM/Intestine ClinicOmics Metabolism & Microbiota, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Paul Sabatier, 1 Avenue Jean Poulhes, 31432 Toulouse, France; (J.A.-A.); (V.A.); (S.D.); (R.B.)
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Kaye E, McDonough R, Singhal A, Garcia RI, Jurasic M. Effect of Overweight and Obesity on Periodontal Treatment Intensity. JDR Clin Trans Res 2023; 8:158-167. [PMID: 35148660 PMCID: PMC10029136 DOI: 10.1177/23800844221074354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Obesity is associated with greater utilization of medical resources, but it is unclear if a similar relationship exists for dental care. OBJECTIVES This retrospective cohort study compared periodontal disease treatment among obese, overweight, and normal-weight patients attending an urban US dental school clinic. METHODS Periodontal, demographic, and medical history data for 3,443 adult patients examined between July 1, 2010, and July 31, 2019, were extracted from electronic health records. Body mass index (BMI) was computed from self-reported height and weight and categorized as obese (≥30 kg/m2), overweight (25-29.9 kg/m2), or normal (18-24.9 kg/m2). Periodontal disease was categorized using clinical probing measures. Procedure codes defined treatment type (surgical, nonsurgical, local chemotherapeutics, or none). Logistic regression models controlling for initial periodontal disease severity, age, gender, tobacco use, history of diabetes, dental insurance type, and follow-up (log of days) estimated odds ratios (ORs) and 95% confidence intervals (CIs) of any treatment among obese and overweight relative to normal-weight patients. The association between BMI and a periodontal treatment intensity score, based on treatment type, number of teeth treated, and number of visits, was evaluated with multivariable negative binomial regression. RESULTS Mean age at baseline was 44 ± 15 y, and severe periodontal disease was present in 32% of obese, 31% of overweight, and 21% of normal-weight patients. Average follow-up was 3.9 ± 1.6 y. Obese and overweight patients were more likely to have nonsurgical scaling and root planing or surgical procedures than normal-weight patients. Adjusted odds of any treatment were higher among obese (OR = 1.34; 95% CI, 1.14-1.72) and overweight (OR = 1.18; 95% CI, 0.97-1.42) relative to normal weight. Obese and overweight patients had 40% and 24% higher treatment intensity scores, respectively, than normal-weight patients. CONCLUSION These results indicate obese and overweight individuals require more intensive periodontal treatment compared to normal-weight individuals, independent of initial disease severity. KNOWLEDGE OF TRANSFER STATEMENT The results of this study can be used by dental providers and policymakers to better understand patient characteristics that influence the variability in frequency and length of periodontal treatment. Knowledge of a patient's body mass index may be useful in identifying patients who possibly will have a poorer periodontal prognosis.
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Affiliation(s)
- E Kaye
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - R McDonough
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - A Singhal
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - R I Garcia
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - M Jurasic
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
- Department of General Dentistry, Director of the Center for Clinical Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
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Silva-Boghossian CM, Dezonne RS. What Are the Clinical and Systemic Results of Periodontitis Treatment in Obese Individuals? ACTA ACUST UNITED AC 2021; 8:48-65. [PMID: 34367878 PMCID: PMC8327900 DOI: 10.1007/s40496-021-00295-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 12/24/2022]
Abstract
Purpose of Review Periodontitis and obesity are characterized by a dysregulated inflammatory state. Obese individuals have a higher chance of presenting periodontitis. Clinical studies in different populations demonstrate that individuals with obesity have worse periodontal conditions. This current review aims to explore recent literature to understand what the impacts of obesity on periodontal treatment outcomes are and to learn whether periodontal treatment can improve systemic biomarkers in obese individuals. Recent Findings Short- and long-term evaluations demonstrated that non-surgical periodontal treatment could improve clinical parameters in obese individuals, represented as the reduction in mean probing depth, sites with probing depth ≥ 4 mm, and extension of bleeding on probing. However, obese individuals may have less clinical improvement when compared to normal-weight individuals with a similar periodontal profile. Additionally, periodontal treatment may contribute to a reduction in systemic levels of retinol-binding protein 4 and leptin, while promoting an increase in systemic levels of adiponectin. Summary Overall, obese individuals with periodontitis can significantly benefit from non-surgical periodontal treatment. However, clinical improvements seem to be less prominent in obese individuals with periodontitis compared to non-obese individuals with similar periodontal status. Nevertheless, periodontal treatment may impact significantly on the reduction of several biochemical biomarkers of obesity with or without weight reduction. Further investigations are needed to improve our comprehension of the mechanisms underlying those findings.
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Affiliation(s)
- Carina M. Silva-Boghossian
- Periodontics, School of Dentistry, Federal University of Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 325, Cidade Universitaria, Rio de Janeiro, RJ CEP 21941-617 Brazil
| | - Romulo S. Dezonne
- Postgraduate Program in Translational Biomedicine, University of Grande Rio, Duque de Caxias, RJ Brazil
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Association between clinical measures of gingival inflammation and obesity in adults: systematic review and meta-analyses. Clin Oral Investig 2021; 25:4281-4298. [PMID: 33904994 DOI: 10.1007/s00784-021-03961-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/20/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study aimed to systematically review the literature about the association between clinical measures of gingival inflammation and obesity in adults. MATERIAL AND METHODS Searches for studies were performed in five databases (Medline-PubMed, Scopus, Web of Science, Cochrane Library, and Embase) to compile studies of any design that evaluated the association between clinical measures of gingival inflammation and obesity in adults. Selection of studies, data extraction and risk of bias analysis were performed independently by two reviewers, and a third researcher was involved to resolve disagreements. Meta-analyses were performed for measures of gingival inflammation as compared to body mass index (BMI). Independent analyses were performed for studies involving periodontitis, gingivitis, and population-based/studies that did not provide a periodontal diagnosis. Standard mean deviation (SMD) and its 95% confidence interval (95%CI) were estimated. RESULTS Ninety studies were included (cross-sectional/clinical trials [n=82], case-control [n=3], cohorts [n=5]). Most of the studies demonstrated no significant difference in the measures of gingival inflammation regardless of the comparison performed. However, meta-analysis showed that among individuals with periodontitis, significantly higher levels of gingival inflammation are observed in those with obesity (n of individuals=240) when compared to those who were not obese (n of individuals=574) (SMD:0.26; 95%CI:0.07-0.44). When considering population-based/those studies that did not provide periodontal diagnosis, significantly higher measures of gingival inflammation were observed in the groups with higher BMI. CONCLUSIONS Within the limitations of the present study, it was concluded that higher measures of gingival inflammation may be expected for those with higher BMI. CLINICAL RELEVANCE Clinicians must be aware that higher measures of gingival inflammation may be expected for individuals with higher BMI. However, there is a necessity for further longitudinal studies regarding the association between obesity and gingival inflammation.
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de Andrade DR, Silva PA, Colombo APV, Silva-Boghossian CM. Subgingival microbiota in overweight and obese young adults with no destructive periodontal disease. J Periodontol 2021; 92:1410-1419. [PMID: 33386623 DOI: 10.1002/jper.20-0187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/13/2020] [Accepted: 12/27/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study analyzed the levels of a specific group of periodontal health/disease-related oral bacteria in the subgingival biofilm of young adults with overweight (OW) and obesity (OB), and no destructive periodontal disease. METHODS Full-mouth periodontal assessment and subgingival biofilm sampling were performed in individuals with normal weight (NW) (BMI [body mass index] ≥18.5 to ≤24.9 kg/m2 ; n = 29), OW (BMI ≥25 to ≤29.9 kg/m2 ; n = 26), or OB (BMI ≥30 kg/m2 ; n = 22). BMI, waist (WC) and hip (HC) circumferences, and waist-hip ratio (WHR) were established for every individual. Biofilm samples were analyzed by checkerboard. Spearman coefficient, linear, and logistic regression analyses were obtained. RESULTS Gingivitis was detected in 45% NW, 65% OW, and 73% OB individuals. NW patients presented significantly less calculus and supragingival biofilm than OB. OW, and OB individuals had significantly higher levels of Porphyromonas gingivalis and Tannerella forsythia than NW patients (P <0.05). Treponema denticola correlated with BMI (rho = 0.31), WC (rho = 0.28), and HC (rho = 0.29), P≤0.01. Linear regression analysis showed significant (P <0.05) positive associations between BMI, WC, HC, and WHR indicators and Prevotella spp., Lactobacillus spp., V. parvula, and A. actinomycetemcomitans (Aa); negative associations were found between Capnocytophaga spp., WC, and HC (β = -0.29 and β = -0.37, respectively; P <0.01). However, the interaction of Prevotella spp. and T. forsythia decreased the likelihood of an individual to be diagnosed as OW/OB (OR 0.183 [95% CI, 0.062-0.540]). CONCLUSIONS Few periodontal pathogens differed in levels between NW and OW/OB individuals without destructive periodontal disease. Moreover, Aa, T. denticola, and Prevotella spp. were associated with clinical parameters of obesity.
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Affiliation(s)
- Danielle Rodrigues de Andrade
- Postgraduate Program in Translational Biomedicine, University of Grande Rio, Duque de Caxias, Rio de Janeiro, Brazil
| | - Paulo André Silva
- Postgraduate Program in Translational Biomedicine, University of Grande Rio, Duque de Caxias, Rio de Janeiro, Brazil
| | - Ana Paula V Colombo
- Department of Medical Microbiology, Institute of Microbiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carina Maciel Silva-Boghossian
- Postgraduate Program in Translational Biomedicine, University of Grande Rio, Duque de Caxias, Rio de Janeiro, Brazil.,Postgraduate Program in Dentistry, University of Grande Rio, Duque de Caxias, Rio de Janeiro, Brazil
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