Association between obesity and its determinants with chronic periodontitis: A cross-sectional study

Clinical Study on the Implications of Immunological Markers in the Diagnosis of Periodontitis in People with Diabetes Mellitus

The basic idea from which the working hypothesis for this study started is the fact that the only systemic disease today that is clearly linked to periodontal disease by biochemical mechanisms is diabetes mellitus, as well as the clinical finding that diabetes causes a number of specific periodontal changes. Highlighting the biochemical markers of inflammation during periodontal disease in patients diagnosed with type 2 diabetes is the main aim of the study. To achieve this objective, we used the human ELISA kit from Boster Biological Technology Co., Ltd. (Pleasanton, CA, USA), for the detection of IL-1β, IL-4, IL-8 and TNF-α. The data analysis shows that plasma levels of these cytokines are associated with the progression of periodontitis. In conclusion, we can state that the involvement of immunological markers is evident in the pathogenesis of periodontal disease.

Association between Periodontal Disease and Obesity: Umbrella Review

Objective: Determine the association between periodontal disease (PD) and obesity through an umbrella review. Materials and Methods: A search for information until March 2024 was carried out in the following electronic databases: PubMed, Cochrane library, Scopus, SciELO, Web of Science, Google Scholar, Proquest Dissertations and Theses, and OpenGrey. We included studies that were systematic reviews (SR) with or without meta-analysis, without time or language restrictions, that evaluated primary studies that associated PD with obesity. Literary or narrative reviews, rapid reviews, intervention studies, observational studies, preclinical and basic research, summaries, comments, case reports, protocols, personal opinions, letters, and posters were excluded. The AMSTAR-2 tool was used to determine the quality and overall confidence of the included studies. Results: The preliminary search yielded a total of 419 articles, discarding those that did not meet the selection criteria, leaving only 14 articles. All studies reported that PD was associated with obesity, with an OR and RR ranging from 1.1 to 1.46 and 1.64 to 2.21, respectively. Conclusions: Based on the results and conclusions of the SR with a high overall confidence level, PD is associated with obesity.

The relationship between obesity and oral-health status in North African adults: A comparative study

INTRODUCTION

The strength of the association between obesity and oral health is still indecisive.

OBJECTIVE

The objectives of the study were to compare some oral-health data between two groups involving obese (OG) and normal weight (NWG) participants and determine the influencing factors of the periodontal probing depth (PPD).

METHODS

This was a cross-sectional study including 67 Tunisian adults [OG (n = 33, body mass index (BMI) > 30 kg/m2 ), NWG (n = 34, BMI: 18.5-25.0 kg/m2 )]. The plaque level was recorded using the plaque index (PI). Gingival index (GI) was used to evaluate gingival inflammation. The depths of the sulci/pockets were probed using a periodontal probe. Stimulated saliva was collected for 5 min, and salivary flow rate (SFR) was determined. Salivary baseline pH (SBpH) was measured. A multivariable regression analysis was performed between PPD and some independent variables [i.e. obesity status, age, sex, socioeconomic status, systemic diseases and PI data].

RESULTS

The OG and NWG were age- and sex-matched and included comparable percentages of participants with systemic diseases (27.3 vs. 29.4%, respectively). The OG included a higher percentage of participants having a low socioeconomic status (87.9 vs. 64.7%, respectively). Compared with the NWG, the OG: (i) had comparable values of daily toothbrushing frequency, PI, GI and tooth mobility, (ii) included comparable percentages of irregular brushers, of participants with periodontitis, PI classes [0-1]and [1-2]; and GI classes [0-1], [1-2] and [2, 3]; (iii) had a higher PPD (2.02 ± 0.41 vs. 2.35 ± 0.22 mm, respectively), (iv) had lower SBpH (7.59 ± 0.21 vs. 7.45 ± 0.22, respectively) and SFR (1.98 ± 0.28 vs. 1.60 ± 0.32 mL/mn, respectively) and (v) included a higher percentage of participants having a PI class [2, 3] (67.6 vs. 87.9%, respectively). The multivariable regression analysis revealed that only obesity status, age and PI classes influenced the PPD, altogether explained 29.62% of the PPD variance.

CONCLUSION

Obesity poses a risk for oral health, and obese adults had altered PPD and lower BSpH and SFR. Dentists should make obese patients aware of the health risks of obesity in an attempt to reduce the potential oral complications associated with this epidemic.

Visceral adipose tissue increases the risk of periodontal disease: Results from the 2011-2014 National Health and Nutrition Examination Survey and Mendelian randomization analysis

AIM

This study aimed to investigate the relationship and potential causal effect of visceral adipose tissue (VAT) on periodontal disease (PD). Despite prior research on this, there has been no definitive conclusion. Therefore, this study aimed to provide additional insight into these associations.

MATERIALS AND METHODS

This study used data from the National Health and Nutrition Examination Survey 2011-2014 to examine the association between VAT and PD in a cross-sectional study design. Various analytical methods were employed, such as multivariable logistic regression, restricted cubic spline analysis, and p-value for trend. Additionally, two-sample Mendelian randomization (MR) analysis was performed to evaluate the potential causal effect of VAT on PD risk. These methods enabled us to evaluate the association between VAT and PD and to establish whether VAT could be a causal factor in PD development.

RESULTS

The study examined a sample of 3535 participants, and the findings suggested that higher VAT levels were associated with an increased risk of PD. In addition, multivariable regression analysis conducted in six models revealed a statistically significant association between VAT and PD risk. Restricted cubic spline analysis showed an inverted U-shaped association between VAT and PD, with a turning point at 733 g of VAT. Finally, a two-sample MR analysis provided evidence for a potential causal relationship between VAT and PD risk, with an odds ratio of 1.16 (95% confidence interval: 1.02-1.33, p = .027) per kg increase in genetically predicted VAT.

CONCLUSIONS

The results of this study suggest that there is a significant association between VAT and PD and that VAT could be a potential causal factor in PD risk. Our results also suggest that although there is a potential link between VAT levels and PD risk, the effect size is modest. Therefore, interventions designed to reduce VAT levels should not be considered a primary strategy for PD risk reduction but could be one of many strategies used in a comprehensive approach to PD risk management.

Association between Body Mass Index and Severity of Periodontal Disease among Adult South Indian Population: A Cross-sectional Study

Background

Periodontal disease is one of the top six chronic noncommunicable diseases (NCDs) and is recognized as a severe global public health problem. This study aimed to assess the association between various levels of body mass index (BMI) and periodontal disease severity in Indian adults.

Material and Methods

The study was designed as a hospital-based cross-sectional study involving 212 participants aged between 18 and 65. A questionnaire assessed by an investigator was used to assess oral health-associated risky behavior and demographical factors. Participants were also assessed using full-mouth clinical periodontal and anthropometric measurements. The mean number of sites with pocket probing depth (PPD) ≥4 mm and the presence of periodontal disease were used as outcome measures. Bivariate analysis and multiple logistic regressions were performed.

Results

The overall proportion of participants with periodontal disease was 50%, that is, sites with PPD ≥4 mm (n = 106). Multivariate analysis showed that BMI (odds ratio (OR) = 0.77, 95% confidence interval (CI): 0.43, 1.37) was not associated with periodontal disease, but smoking (OR = 3.90, 95% CI: 1.63, 5.89), alcohol consumption (OR = 1.24, 95% CI: 0.72, 2.13), age (OR = 2.51, 95% CI: 1.08, 5.84), and diabetic mellitus (OR = 1.69, 95% CI: 0.92, 3) were positively associated with periodontal disease.

Conclusion

A positive association was found between smoking, alcohol consumption, age, gender, history of diabetic mellitus, and periodontal disease. No significant association exists between obesity and periodontal disease in South Indian adults.

Evaluation of Pentraxin 3 and Serum Amyloid A in the Gingival Crevicular Fluid of Patients with Periodontal Disease and Obesity

BACKGROUND

Pentraxin 3 (PTX3) is associated with periodontal tissue inflammation, a condition that precedes alveolar bone resorption. It is also elevated in obese tissues and is a useful biomarker of proinflammatory status. Serum amyloid A (SAA) is a proinflammatory and lipolytic adipokine. Adipocytes strongly express SAA, which suggests that it may have a significant role in the production of free fatty acids and local and systemic inflammation.

MATERIALS AND METHODS

We statistically analyzed the gingival crevicular fluid (GCF) values of PTX3 and SAA in patients with periodontal disease, who were diagnosed with obesity, and compared them with the values of inflammatory markers from patients diagnosed with one of the diseases and with healthy patients.

RESULTS

The patients with obesity and periodontitis had significantly higher levels of PTX3 and SAA than the patients diagnosed with either obesity or periodontitis.

CONCLUSIONS

These two markers are involved in the association between the two pathologies, as evidenced by the correlations between these levels and some clinical parameters.

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.

Is Obesity a Risk Factor for Periodontal Disease in Adults? A Systematic Review

There is inconclusive evidence about the link between the severity and prevalence of periodontitis in obese adults. Therefore, this systematic review aims to explore the possibility of significant evidence on the association between obesity and periodontitis and to determine the necessity to consider obesity as a risk factor for periodontitis. We followed the PRISMA protocol, and studies that met the eligibility criteria were included in this review. The risk of bias in individual studies was also evaluated. This review included 15 observational studies (9 cross-sectional studies, 2 case-control, and 4 cohort studies). The total study subjects from these studies were 6603 (males = 3432; females = 3171). Most studies showed a significant association between obesity and periodontitis. Among these studies, a few showed obese females to be at a higher risk, and one study found no association between obesity and periodontal disease at all. Based on the evidence obtained from this review, the body mass index (BMI) should be routinely assessed in patients to assess the risk for periodontal disease and to offer personalized management of periodontitis. Based on the findings of this review, we recommend the need to initiate awareness among clinicians and implement dental hygiene care prevention measures for obese patients.

Masulili SL, Kusdhany LS, Prahasanti C, Soedarsono N. Obesity correlated to a higher risk of acquiring periodontitis: a cross-sectional study

Background: The present study aimed to investigate the correlation between obesity and periodontitis, among other risk factors for periodontitis.  

Methods:  In total, 262 Indonesian male and female subjects were analysed for body mass index (BMI), oral hygiene, plaque index, and clinically evaluated periodontitis. Statistical analysis was performed using Spearman tests and Pearson chi-square tests to estimate the correlation between BMI and periodontitis. Multivariate binary logistic analysis was conducted between covariate and periodontitis. P<0.05 was considered as statistically significant.  

Results: The prevalence of obesity was 48.47%. There were positive correlations between BMI and periodontal status for healthy-mild periodontitis, moderate, and severe periodontitis respectively. BMI and periodontitis crude odds ratio (OR) = 2.31 (95% CI 1.41-3.78); p < 0.05, adjusted OR of BMI among other variables, was 1.88 (95%CI 1.05-3.37); p < 0.05. Exploration of the ROC curve found a BMI cut off point of 24.785 kg/m2. 

Conclusion: Obesity by BMI measurement of ≥ 25kg/m2 correlated to a higher risk of acquiring periodontitis compared to normal-weight individuals.

Do cytokines associate periodontitis with metabolic disorders? An overview of current documents

Periodontitis is an oral chronic inflammatory condition affecting the adult population worldwide. Many microorganisms act as an initiator for induction of inflammatory immune responses, which participate in the destruction of connective tissue surrounding the teeth and thereby result in tooth loss. Cytokines may have indispensable roles in its pathogenesis through enhancing inflammatory and immune responses. Cytokines can affect functions of some cells of different tissues, such as the cells of the pancreas, liver, and adipose tissues. There is evidence that periodontitis is associated with metabolic disorders, like liver cirrhosis, obesity, and diabetes mellitus. Hence, this review was focused on determining how cytokines can participate in the correlation of periodontitis with metabolic disorders.

Periodontitis regulates renal impairment in obese mice via TGF-β/Smad pathway

OBJECTIVE

To determine the impact of periodontitis on renal impairment induced by obesity.

METHODS

Periodontitis and obesity models were induced using silk ligatures with bacteria and high-fat diet, respectively. Indicators of renal function were compared. Renal tubular epithelial cells (RTECs) were treated with lipopolysaccharides from periodontal pathogens in a high-fat environment to induce cell models of periodontitis and obesity. The transforming growth factor-β/mothers against decapentaplegic homolog (Smad) (TGF-β/Smad) pathway was evaluated both in vivo and in vitro. The indicators of renal function, renal pathological changes, and serum inflammatory cytokines were measured. The viability/apoptosis of RTECs and the expression of inflammatory cytokines were determined.

RESULTS

Periodontitis resulted in an increase in TGF-β/Smad activity in the kidney of obese mice. Moreover, the activity of RTECs was also increased in vitro. Downregulation of TGF-β led to reduced TGF-β, p-Smad2, p-Smad3, and Smad7 levels in kidney tissue and RTECs, ameliorated renal function indicators and renal pathological changes, increased viability and apoptosis of RTECs, and decreased levels of inflammatory cytokines.

CONCLUSION

Periodontitis regulates renal impairment via the TGF-β/Smad pathway in obese mice.

The Association between Nutritional Alterations and Oral Lesions in a Pediatric Population: An Epidemiological Study

The oral conditions of an individual are the result of different factors, including the subject's genotype, oral hygiene habits, the type of diet, and lifestyle, such as smoking. Nutrition in the first years of life can affect dental health for a long time. To prevent mouth diseases, it is also important to eliminate unfavorable eating behaviour and to amplify protective ones. Eating habits, especially in pediatric age, are an easily modifiable and controllable factor, and diet, in addition to influencing the health of the oral cavity, plays a fundamental role in systemic health. Indeed, a sugar-rich diet can lead to conditions, such as diabetes, being overweight, and obesity. The present research was an epidemiological study, with the aim of highlighting some of the associations between nutrition and oral health. In particular, we studied those lesions of hard and soft tissues that are diagnosed most frequently by dentists: caries, enamel hypoplasia, periodontal disease, and aphotoxic lesions and their associations with nutritional deficiencies and excesses including proteins, vitamin A, vitamin D, B vitamins, and iron and calcium minerals. To perform this study, we recruited 70 patients from the pediatric and orthodontic clinics, aged between 3 and 15 years (y), with mean age of 10.4 y.o. The study was conducted by providing a questionnaire to pediatric patients' (supported from their parents or guardians) on individual eating habits, followed by an accurate oral cavity specialistic examination. The nutritional data were processed by using Grana Padano Observatory (OGP) software, freely provided online by the OPG. The statistical tests performed were the chi-square (χ²) for independence, and Cramér's V test was used to evaluate the associations between eating habits and oral pathologies. The results showed that certain nutritional vitamin deficiencies and nutritional excesses were associated with definite oral pathologies.

Effect of obesity on risk and severity of periodontitis: a cross-sectional study

Background: The present study aimed to investigate the correlation between obesity and periodontitis, among other risk factors for periodontitis.   Methods:  In total, 262 Indonesian male and female subjects were analysed for body mass index (BMI), oral hygiene, plaque index, and clinically evaluated periodontitis. Statistical analysis was performed using Spearman tests and Pearson chi-square tests to estimate the correlation between BMI and periodontitis. Multivariate binary logistic analysis was conducted between covariate and periodontitis. P<0.05 was considered as statistically significant.   Results: The prevalence of obesity was 48.47%. There were positive correlations between BMI and periodontal status for healthy-mild periodontitis, moderate, and severe periodontitis respectively. BMI and periodontitis crude odds ratio (OR) = 2.31 (95% CI 1.41-3.78); p < 0.05, adjusted OR of BMI among other variables, was 1.88 (95%CI 1.05-3.37); p < 0.05. Exploration of the ROC curve found a BMI cut off point of 24.785 kg/m2.  Conclusion: Obesity by BMI measurement of ≥ 25kg/m2 correlated to a higher risk of acquiring periodontitis compared to normal-weight individuals.

Association between clinical measures of gingival inflammation and obesity in adults: systematic review and meta-analyses

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.

Application value of combination therapy of periodontal curettage and root planing on moderate-to-severe chronic periodontitis in patients with type 2 diabetes

Background

Our study attempted to observe the value of periodontal curettage combined with root planing on moderate-to-severe chronic periodontitis in patients with type 2 diabetes.

Methods

There involved 72 patients with type 2 diabetes mellitus complicated with moderate-to-severe chronic periodontitis who were diagnosed and treated in our hospital from January 2019 to December 2019. The patients enrolled were randomly divided into four groups using a computer-generated table: root planing and periodontal curettage combined group (n = 18), root planning group (n = 18), periodontal curettage group (n = 18) and cleansing group (n = 18). Blood glucose, plaque index (PI), gingival index (GI), probing depth (PD), attachment loss (AL), serum levels of inflammatory factors (Tumor Necrosis Factor Alpha [TNF- α] and hypersensitive C-reactive protein [hs-CRP]) were observed before and after treatment. The collecting dates were analyzed by the chi-square χ 2 test, repeated measurement analysis of variance, or t-test according to different data types and research objectives.

Results

Before treatment, there was no significant difference in PI, GI, PD and AL among the four groups (P> 0.05), while after 3-month treatment, the levels of PI, GI, PD and AL in the combined group were lower than those in the root planing group, periodontal curettage group and cleansing group, with both root planing group and periodontal curettage group significantly lower than cleansing group (P< 0.05). The fasting blood glucose, 2-h postprandial blood glucose and glycosylated hemoglobin in the combined group, root planing group, periodontal curettage group and cleansing group were significantly lower than those before treatment (P < 0.05). Before treatment, there was no significant difference in TNF- α and hs-CRP among the four groups (P> 0.05), but the levels of TNF- α and hs-CRP in the four groups decreased significantly after 3-month treatment (P< 0.05). The levels of TNF- α and hs-CRP in the combined group were lower than those in the root planing group, periodontal curettage group and cleansing group, and those in the root planing group and periodontal curettage group were significantly lower than those in the cleansing group (P< 0.05).

Conclusion

The combination therapy of periodontal curettage and root planing exerted beneficial effects on moderate-to-severe chronic periodontitis in patients with type 2 diabetes mellitus, which holds the potential to maintain the level of blood glucose and improve the quality of life of the patients.

The relationship between periodontal status and rheumatoid arthritis - systematic review

There have been numerous publications investigating the relationship between periodontitis (PD) and rheumatoid arthritis (RA) so far.

This publication presents the common risk factors for the development of PD and RA. The major impact of the pathological bacterial factor and cigarette smoking with chronic inflammation playing the key role in both diseases has been confirmed by numerous studies in various populations over the years. More research focuses nowadays also on the role of improper diet and obesity. Pathophysiological pathways, such as increased concentration of proinflammatory cytokines, indirectly affecting the cardiovascular complications and coagulation disorders, which has an impact on function disorders of tissue metalloproteinase inhibitors and the plasminogen activation system, were also researched.

This systematic review of current literature has shown numerous discrepancies in previous analyses and the need for further detailed research on the relationship between periodontal status and RA.