Obesity in relation to oral health behaviors: An analysis of the Korea National Health and Nutrition Examination Survey 2008-2010

Class 3 Obesity and Oral Health in Adults: A Scoping Review of the Challenges for Oral Healthcare Services

Background: Obesity is one of the most neglected public health problems affecting both developed and developing countries. The most clinically severe obesity (Class 3 obesity) has both clinical and service delivery implications on dental services. However, associations between Class 3 obesity and oral health are minimally explored in the literature and thus poorly understood. Aims: This scoping review aimed to explore the existing evidence on Class 3 obesity and oral health. Methods: A literature search was performed via Medline, Scopus, Google scholar and Embase research databases. Results: A total of 375 papers were sourced from the database search. Twenty seven full-text papers were included in the final literature review. Results revealed findings from both quantitative and qualitative studies. Papers included results pertaining to associations with dental disease, oral health and associated behaviours, oral health-related quality of life and the barriers experienced by adults with Class 3 obesity in accessing dental services. Conclusions: While mixed findings were identified, this scoping review reports associations between Class 3 obesity and poor oral health across various domains including clinical parameters and oral health related quality of life. The literature has also highlighted important barriers to dental care in those with the most severe Class 3 obesity. Based upon our findings, we have summarised current oral health management implications and directions for future research.

Unique dietary and oral hygiene behaviors in a cohort with clinically severe obesity: A cross sectional study

BACKGROUND

An association between increased risk of dental caries with increased levels of clinically severe obesity has been reported. Data linking body mass index (BMI) and dietary behaviors, including at-risk dietary factors and oral hygiene habits, are lacking in a cohort with clinically severe obesity. This study aimed to explore the dietary and oral hygiene behaviors in individuals with clinically severe obesity attending a hospital-based obesity service.

METHODS

Adult patients attending a hospital-based obesity service in Greater Western Sydney with clinically severe obesity were invited to participate in a self-administered survey, which collected data on their nutritional and oral hygiene behaviors. Demographic data (age, gender) and BMI were extracted from the participants' medical records. The primary outcome was the relationship between BMI and frequency of toothbrushing. RESULTS: Of the 82 individuals who consented to participate, 81 (98.8%) completed the study questionnaire. The median BMI of the cohort was 49.1 kg/m2 (interquartile range [IQR]: 43.2-57.3 kg/m2) and median age 51 (IQR: 39-63) years. BMI was not significantly correlated with individual oral health behaviors (p > .05). Many participants reported dietary risk behaviors, which have the potential to influence their oral health.

CONCLUSIONS

While oral health behaviors were not associated with increasing BMI, patients with clinically severe obesity in this study reported unique dietary behaviors and mixed oral hygiene habits that may complicate nutritional and dental management. Awareness of these behaviors among clinicians including dental professionals is required in this cohort.

Association between toothbrushing and cardiovascular risk factors: a cross-sectional study using Korean National Health and Nutrition Examination Survey 2015-2017

BACKGROUND

Previous studies have suggested that frequent toothbrushing is associated with a lower risk of future cardiovascular events. We sought to investigate further the relationship between toothbrushing, cardiovascular risk factors, and lifestyle behaviours.

METHODS

We analysed a cross-sectional survey including 13,761 adults aged 30 years or older without a history of cardiovascular diseases from the Korean National Health and Nutritional Examination Survey. Conventional cardiovascular risk factors (blood pressure, lipid profiles, and fasting glucose), and inflammatory markers (high-sensitivity C-reactive protein [hsCRP], and white blood cell counts [WBC]) were investigated in relation to the frequency of toothbrushing.

RESULTS

The estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk, calculated using the pooled cohort equations was 13.7%, 9.1%, and 7.3% for participants who reported toothbrushing 0-1, 2, and ≥ 3 times a day, respectively. Both conventional risk factors and inflammatory markers were significantly associated with frequent toothbrushing. However, after adjusting potential confounding factors such as age, sex, comorbidities, and lifestyle behaviours, only inflammatory markers were remained as significant factors.

CONCLUSIONS

Oral hygiene behaviours are closely linked to cardiovascular risk factors. This study suggests that reduced systemic inflammatory burden may explain the benefit of improved oral hygiene in terms of cardiovascular risk.

Exploring an Association between Body Mass Index and Oral Health-A Scoping Review

BACKGROUND

Basal metabolic index (BMI) is a unique anthropometric indicator used to define the relative amount of body fat on an individual's frame. There are many diseases and conditions associated with obesity and underweight. Recent research trials suggest that there is a significant association between oral health indicators and BMI as both are attributed to common risk factors such as dietary, genetic, socioeconomic, and lifestyle issues.

OBJECTIVES

The main objective of this review paper is to emphasize the association between BMI and oral health with available literature evidence.

METHODOLOGY

A literature search was conducted using multiple databases comprising of MEDLINE (via PubMed), EMBASE, and Web of Science. The terms used for the search were "body mass index", "periodontitis", "dental caries", and "tooth loss".

RESULTS

In total, 2839 articles were obtained from the analysis of the databases. Unrelated articles from the available full text of 1135 articles were excluded. The main reasons for excluding the articles were: they were dietary guidelines and policy statements. A total of 66 studies were finally included in the review.

CONCLUSION

The presence of dental caries, periodontitis and tooth loss may be associated with a higher BMI or obesity, whereas, improved oral health might be associated with lower BMI. Promoting general and oral health should be a hand in hand feature, as common risk factors can be embattled.

Evaluation of food and nutrient intake in a population of subjects affected by periodontal disease with different levels of bone mineral density

INTRODUCTION

Both osteoporosis and periodontitis are pathologies characterized by an imbalance in the bone tissue. Vitamin C is an important factor involved in maintaining the health of the periodontium; its deficiency causes characteristic lesions to periodontal tissues such as bleeding and redness of the gums. Among the essential minerals for the health of the periodontium we find instead calcium.Objectives of the study: The objectives of the proposed study are to study the association between the presence of osteoporosis and periodontal disease. We tried to identify the possible connections between particular dietary patterns and therefore the etiopathogenesis of periodontal disease and secondarily of osteoporosis.Materials and methods: 110 subjects were recruited in a single-center observational cross-sectional study carried through the collaboration between the University of Florence and the private institute of dentistry Excellence Dental Network based in Florence, suffering of periodontitis, 71 osteoporotic/osteopenic and 39 non-osteoporotic/osteopenic. Anamnestic data and information on eating habits were collected.

RESULTS

The population showed eating habits that do not meet the intake levels recommended by the L.A.R.N. Regarding the relationship between nutrient intake and plaque index, it appears that in the population, the higher the intake of vitamin C through food, the lower the plaque index value is. This result could reinforce the scientific evidence that there is a protective factor in the onset of periodontal disease by the consumption of vitamin C which to date is still the subject of investigation. In addition, the same type of trend would also have been observed for calcium intake, but a larger sample size would be required to make this effect significant.

CONCLUSIONS

The relationship between osteoporosis and periodontitis and the role of nutrition in influencing the evolution of these pathologies still seems to be deeply explored. However, the results obtained seem to consolidate the idea that there is a relationship between these two diseases and that eating habits play an important role in their prevention.

Real-world evidence of the impact of obesity on residual teeth in the Japanese population: A cross-sectional study

BACKGROUND

Tooth loss is associated with nutritional status and significantly affects quality of life, particularly in older individuals. To date, several studies reveal that a high BMI is associated with tooth loss. However, there is a lack of large-scale studies that examined the impact of obesity on residual teeth with respect to age and tooth positions.

OBJECTIVE

We assessed the impact of obesity on the number and position of residual teeth by age groups using large scale of Japanese database.

METHODS

This was a cross-sectional study of 706150 subjects that were included in the database that combined the data from health insurance claims and health check-up, those lacking information about BMI, HbA1c level, smoking status, and the number of residual teeth were excluded. Thus, a total of 233517 aged 20-74 years were included. Subjects were classified into 4 categories based on BMI, and the number of teeth was compared between age-groups. The percentage of subjects with residual teeth in each position was compared between groups with obesity (BMI ≥25.0 kg/m2) and non-obesity. Logistic regression analysis was performed to clarify whether obesity predicts having <24 teeth.

RESULTS

Higher BMI was associated with fewer teeth over 40s (P for trend <0.0001 when <70s). Obesity was associated with the reduction of residual teeth in the maxillary; specifically, the molars were affected over the age 30. Smoking status further affected tooth loss at positions that were not affected by obesity alone. After adjusting for age, sex, smoking status, and HbA1c ≥6.5%, obesity remained an independent predictive factor for having <24 teeth (ORs: 1.35, 95% CIs: 1.30-1.40).

CONCLUSIONS

We found that an increase in BMI was associated with a decrease in the number of residual teeth from younger ages independently of smoking status and diabetes in the large scale of Japanese database.

Relationship of BMI with the diet, physical activity and oral hygiene practices amongst the dental students

Background

Regardless of attaining adequate knowledge regarding oral hygiene, physical activity, and healthy eating habits, dental students still face oral health problems. This study was aimed to assess the association of oral hygiene habits, physical activity, and eating habits with the BMI in the dental students.

Method

This multi centric cross-sectional study was conducted from January to May 2021 in Pakistan. Three hundred and eighty-six study participants enrolled as undergraduate dental students, both males and females, were included in the study. A questionnaire used to gather data, was modified from a study conducted by Jouhar et al. Chi-square testing was used in order to assess the relationship between two categorical variables. Linear regression was performed to assess the association with putative confounders. Statistical significance was considered for p value < 0.05.

Results

Regarding brushing teeth, 57% of the underweight individuals brushed once daily, 69.8% of the healthy, 79.2% of overweight, and 48% of obese participants brushed twice. Horizontal brushing technique was performed by 50% of the underweight participants, followed by scrub technique. A soft bristled brush was frequently used by underweight (42.9%) and healthy (66%) individuals, while a medium textured bristle brush was used by overweight (62.3%) and obese (54.2%) participants. Majority of the underweight (64.3%), overweight (48.1%), and 45.8% of obese individuals had meals thrice a day, while healthy (62.3%) individuals had meals twice a day.

Conclusion

This study further intensified the contributing role of having an excessive dietary intake and sugar consumption in causing obesity and dental caries. Findings from the current study, identify a statistically significant relationship that exists between BMI levels with oral hygiene, eating habits and the physical activity.

Improved oral hygiene care and chronic kidney disease occurrence: A nationwide population-based retrospective cohort study

Oral diseases or poor oral hygiene have close connections with systemic inflammatory reaction, which is one of major mechanism in the development of chronic kidney disease (CKD). We conducted a research assuming that better oral hygiene care would be negatively related with the risk of developing new-onset CKD.From 2003 to 2004, a total of 158,495 participants from the Korean national health insurance data sharing service which provides health screening data including variables as age, sex, vascular risk factors, medication information, indicators regarding oral hygiene, and laboratory results. The diagnosis of CKD and vascular risk factors were defined according to the International Statistical Classification of Diseases and Related Health Problems codes-10th revision. The follow-up period for the study subject was until the occurrence of CKD, until death, or Dec 31, 2015.Approximately 13.3% of the participants suffered from periodontal disease, and 40.7% brushed their teeth at least three times a day. With a median of 11.6 (interquartile range 11.3-12.2) years' follow-up, the cohort included 3223 cases of incident CKD. The 10-year incidence rate for CKD was 1.80%. In multivariable analysis with adjustment for age, sex, demographics, vascular risk factors, blood pressure, and blood laboratory results, frequent tooth brushing (≥3 times a day) was negatively related to occurrence of CKD (hazard ratio: 0.90, 95% confidence interval [0.83-0.99], P  =  .043, P value for trend  =  .043).Participants with improved oral hygiene (≥3 times a day) have showed less risk of CKD. Additional interventional studies are in need to establish causative relationship between oral hygiene and risk of CKD.

Association between Findings in Oral Health Screening and Body Mass Index: A Nation-Wide Longitudinal Study

Oral diseases, such as periodontitis and dental caries, can cause systemic inflammation as well as local effects, which is an important contributing factor for obesity. We aimed to investigate the change in body mass index (BMI) according to the presence of periodontitis and oral hygiene indicators. This study enrolled 110,068 participants from the national health screening cohort in Korea from 2009–2010 who underwent an oral health checkup. As oral hygiene indicators, the presence of periodontitis, dental caries, tooth loss, and tooth brushing were assessed. We constructed a linear mixed model for BMI. BMI was repeatedly measured in the health examination until 2015. In the multivariate linear mixed model for BMI, the presence of periodontitis (β = 0.0687, standard error (SE) = 0.0225, p = 0.002), dental caries (β = 0.0735, SE = 0.0152, p < 0.001), and tooth loss (β = 0.1328, SE = 0.0175, p < 0.001) were positively associated with BMI. In contrast, frequent tooth brushing (≥3 times/day) was negatively associated with BMI (β = −0.2610, SE = 0.0306, p < 0.001). The presence of periodontitis, dental caries, and tooth loss may be associated with higher BMI, whereas frequent tooth brushing may be related to lower BMI. Better oral hygiene might be associated with lower BMI. Further study is needed to determine the effect of oral health behavior and dental disease on obesity.

Periodontal therapy on the oral health-related quality of life of obese and non-obese individuals

Oral diseases such as periodontitis can have a more negative influence on the quality of life of obese than in normal-weight patients. The objective of the present study was to assess the impact of one-stage full-mouth disinfection (OSFMD) therapy on the oral health-related quality of life (OHRQL) of obese and non-obese individuals with periodontitis. Fifty-five obese and thirty-nine non-obese patients were evaluated. The questionnaires oral impacts on daily performance (OIDP) and oral health and quality of life (OHQoL) were given to all patients at baseline and 6 months after periodontal treatment by the OSFMD protocol. For statistical analysis, Chi-square, the two-factor repeated-measures ANOVA, and correlation tests were used. At baseline, mean global OHQoL and OIDP scores were similar for both groups (p > 0.05). At 6 months, OSFMD resulted in OHQoL and OIDP global scores improvements in both groups (p < 0.05), with no significant difference between groups. The most impaired activity at baseline was eating and cleaning teeth for both groups. Periodontal parameters were associated with worse values in the OHQoL and OIDP questionnaires only in obese patients. In conclusion, OSFMD yielded similar improvements in overall OHRQL in both obese and non-obese individuals. Periodontal parameters were associated with a worse quality of life in obese patients. Periodontal treatment can be an important component to improve the OHRQL of obese individuals, and clinicians should expect similar results as those obtained with non-obese patients.

Longitudinal Associations of Toothbrushing With Obesity and Hyperglycemia

Background

Toothbrushing is a health-related lifestyle habit and has been reported to contribute not only to oral health but also to some parameters of general health; however, little research has been conducted to understand the association of the frequency and timing of toothbrushing with the development of comprehensive metabolic abnormalities, with consideration of oral health condition. In this study, using longitudinal data, we examined this association in Japanese adults, adjusting for periodontal condition.

Methods

A 5-year longitudinal study was performed with 4,537 participants between 35 and 64 years old who underwent an annual dental examination in both 2003 and 2008. Data about toothbrushing habits and metabolic abnormalities, such as obesity, hyperglycemia, diabetes, hypertension, hypertriglyceridemia, and low levels of high-density lipoprotein-cholesterol, were analyzed using Poisson regression analysis.

Results

The percentage of participants with a toothbrushing frequency ≤1 time/day was 29.4%, and that for those not brushing their teeth at night was 21.4%. The incidences of obesity and hyperglycemia after 5 years were 5.5% and 28.4%, respectively. A toothbrushing frequency ≤1 time/day was associated with development of obesity (prevalence rate ratio [PRR] 1.77; 95% confidence interval [CI], 1.12–2.80), after adjusting for periodontal condition and potential risk factors. A significant association between not brushing teeth at night and hyperglycemia (PRR 1.30; 95% CI, 1.02–1.66) was observed in participants with toothbrushing frequency of 1 time/day. No association was found between toothbrushing habits and other metabolic abnormalities.

Conclusions

This study suggests that toothbrushing habits are associated with the development of obesity and hyperglycemia.

Relationship between Obesity and Oral Health Behavior in Primary and Junior High School Students: A Cross-sectional Study

It has been reported that people who brush their teeth frequently might be more health-conscious and maintain healthier lifestyle habits. The relationship between obesity and oral health behavior in childhood is unknown, however. The aim of the present study was to fill this gap by investigating obesity and factors associated with oral health behavior in Japanese primary and junior high school students. A total of 475 primary school students (fifth-grade, age 10-11 years) and 408 junior high school students (first-grade, age 12-13 years) were included. All the participants underwent a regular health check-up and completed a self-reported questionnaire. The data thus obtained were subjected to multiple logistic regression analyses to identify the relationship between obesity and factors associated with oral health behavior. In primary school students, a dislike of physical activity was the only factor showing a significant association with obesity (p<0.05). In addition, however, tooth brushing <2 times per day and a lack of regular clinical dental care showed a significant association with obesity in junior high school students (p<0.05). The present results suggest a significant association between regular clinical dental care and tooth brushing and obesity in junior school students.

Poor Oral Hygiene and High Levels of Inflammatory Cytokines in Saliva Predict the Risk of Overweight and Obesity

The study aimed to determine if oral hygiene influences not only oral health but also potentially metabolic disorders such as overweight or obesity. Participants were 94 patients: 40 with increased body mass and 54 with normal body mass. The methods included dental examination, a questionnaire concerning hygienic habits and an assessment of selected salivary inflammatory markers. The new parameter named “cleaning index” (describing the interaction between average time of tooth brushing in minutes and its frequency per day) significantly correlated with Body Mass Index (R_Spearman = 0.300). The multivariate regression model incorporating cleaning index, approximal plaque index, receptor 1 for tumor necrosis factor-alpha (TNFα-R1) and interleukin-15 (IL-15) had a high power to predict overweight or obesity (AUC = 0.894). Patients with poor oral hygiene (approximal plaque index >40%) were more than eight times more likely to suffer from obesity than patients with good oral hygiene. Cleaning index higher than 4 decreased the odds by about 85%. Oral hygiene habits, adjusted by salivary concentrations of selected inflammatory markers may allow predicting effectively overweight or obesity risk. Early proper dental prophylaxis and treatment could lead to the better prevention of metabolic disorders.

Relationship between oral health behaviour and handgrip strength: a cross-sectional study with 7589 Korean adults

Objective: This cross-sectional study investigated the relationship between handgrip strength and oral health behaviours among Koreans.Methods: The data of 7589 individuals (3384 men and 4205 women) aged ≥19 years who participated in the Korea National Health and Nutrition Examination Survey 2014-2015 were analyzed. Oral health behaviour was assessed based on the number of daily toothbrushing sessions and the use of secondary oral-care products. The association between oral-health behaviour and handgrip strength was investigated adjusting for confounders. Multivariable logistic regression analysis was performed (α = 0.05).Results: The proportion of participants diagnosed with sarcopenia was significantly higher in the group with poor oral-health behaviours. After adjusting for confounders including age, the adjusted odds ratios and 95% confidence intervals of female participants with low handgrip strength in groups toothbrushing thrice or more per day, twice per day, and once or less per day were 1 (reference), 1.18 (0.99-1.4), and 1.24 (0.89-1.71), respectively. There were significantly more participants with low handgrip strength in the group that did not use secondary oral products for both sexes.Conclusions: Oral health behaviour is associated with handgrip strength among adults. Poor oral self-care habits may constitute a risk indicator for low muscle strength.

The association between sialolithiasis and smoking, alcohol drinking and obesity in Korea: a nested case-control study

BACKGROUND

Smoking and alcohol consumption are the most common social habits in patients with sialolithiasis. Moreover, obesity has been reported to have a significant association with poor oral hygiene, one of the causes of sialolithiasis. The purpose of this study was to evaluate the relationships among tobacco smoking, drinking alcohol, obesity and sialolithiasis in a Korean population.

METHODS

The Korean National Health Insurance Service-Health Screening Cohort, which includes patients ≥40 years old, was assessed from 2002 to 2013. A total of 947 sialolithiasis participants were matched with 3788 control subjects at a ratio of 1:4 with respect to age group, sex, income group, region of residence, hypertension, diabetes, and dyslipidemia. We analyzed the participants' previous histories of smoking (current or past smokers compared to nonsmokers) and alcohol consumption (≥ 1 time per week compared to < 1 time per week) in the sialolithiasis and control groups. Obesity was measured using body mass index (BMI, kg/m²), which was categorized as < 18.5 (underweight), ≥ 18.5 and < 23 (normal), ≥ 23 and < 25 (overweight), ≥ 25 and < 30 (obese I), and ≥ 30 (obese II). Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using conditional logistic regression analyses.

RESULTS

The rate of smoking was higher in the sialolithiasis group (32.4% [307/947]) than in the control group (29.1% [1103/3788], P = 0.047). The adjusted OR of smoking for the sialolithiasis group was 1.31 (95% CI = 1.08-1.59, P = 0.006). Alcohol consumption and obesity were not statistically significantly related to sialolithiasis.

CONCLUSION

The odds of smoking were increased in sialolithiasis patients compared with control subjects in the population ≥ 40 years of age.

Effect of Periodontitis and Toothbrushing Frequency on Obesity Onset: A Cohort Study

Background

The interplay between obesity and periodontitis has been widely examined. While obesity was reported as a risk factor for periodontitis, the inverse relationship is still little explored. Therefore, we aimed to determine whether periodontitis and toothbrushing frequency affect the onset of obesity.

Material/Methods

This cohort study included 1619 employees of a business enterprise headquartered in Tokyo, who in 2002 and 2006 underwent in prescribed annual health checks, both general and dental-specific, and who were not obese in 2002 (body mass index <25). The response variable was obesity (or absence) at 4 years, while the explanatory variables were presence/absence of periodontal pockets and toothbrushing frequency in 2002; their relationships were examined by multiple logistic regression analysis.

Results

Subjects with periodontal pockets ≥4 mm showed a significantly higher odds ratio (OR) for onset of obesity at 4 years than those without periodontal pockets [OR: 1.59, 95% CI (confidence interval): 1.08–2.35, p<0.05]. Similarly, subjects who brushed their teeth ≥3 times/day had a significantly lower obesity OR than those who brushed ≤1 time/day (OR: 0.49, 95% CI: 0.28–0.85, p<0.01).

Conclusions

The presence of periodontal pockets and toothbrushing frequency are significantly associated with the onset of obesity. Periodontal pockets ≥4 mm are associated with increased risk of obesity, while frequent toothbrushing (≥3 times/day) appears to reduce the risk of obesity.

Prevalence of risk factors for oral diseases in obese patients referred for bariatric surgery

BACKGROUND

Obesity is a risk factor for several chronic diseases, and scientific evidence suggests an association between obesity and oral diseases. In this study, the authors estimated the prevalence of risk factors for caries, dental erosion, and periodontal disease in a group of obese patients referred for bariatric surgery.

METHODS

The authors invited obese patients who were referred for bariatric surgery at a private center for treatment of obesity to participate in this study. The patients answered a questionnaire about their sociodemographic data, general and oral health histories, dietary habits, and oral health care behavior.

RESULTS

The authors evaluated a total of 255 participants; 200 (78.4%) were women, the median (interquartile range) age was 36.0 (30.0-43.0) years, and the median (interquartile range) body mass index was 39.7 (37.6-43.5) kilograms per square meter. The authors observed a high prevalence of risk factors for dental erosion; 78.4% of the participants consumed acidic foods daily, and 92.2% consumed acidic beverages daily. With respect to risk factors for caries, 38.5% of the participants reported high sucrose intake, and 59.6% preferred sweet beverages and foods with sucrose. Almost 13% of the participants reported having or having had dental mobility, and 59.6% reported having or having had gingival bleeding, suggesting a history of periodontal disease.

CONCLUSIONS

Obese patients referred for bariatric surgery are exposed to risks of experiencing oral diseases and should be evaluated by a dentist.

PRACTICAL IMPLICATIONS

Knowing the risk factors for oral diseases in obese patients is important in raising awareness about these risk factors, as well as to prevent complications in the oral cavity.