Host response, obesity, and oral health

Body mass index and dental caries in New Zealand pre-school children: A population-based study

AIM

Pre-school dental caries is a significant public health problem and may be associated with the growth and nutritional status of children. This study aimed to investigate the association between body mass index (BMI) and early childhood caries (ECC) among pre-school children.

METHODS

This population-based retrospective study involves all 5-year-old children who resided in northern New Zealand and received school entry dental examinations between 1 January 2014 and 31 December 2015. ECC status was determined with the decayed missing filled teeth (dmft) score obtained from a routinely collected regional dental data set. Objectively measured BMI information was obtained from the 'Before School Check' (B4SC) Programme. Logistic regression analyses were used to assess the association between BMI and the occurrence of ECC (dmft score ≥ 1). Ethnic subgroup analyses were also conducted.

RESULTS

Of the 27 333 children involved in this analysis, 11 173 (40.9%) had ECC with a mean dmft score of 1.85, and 3948 (14.4%) were overweight and 2964 (10.8%) were obese at school entry. The prevalence of ECC was higher in overweight and obese children but in subgroup analyses by ethnicity, this positive association was observed in European children only (adjusted odds ratio for overweight children compared to normal weight children: 1.16; 95% CI: 1.02, 1.32 and adjusted odds ratio for obese children: 1.20; 95% CI: 1.00, 1.45).

CONCLUSION

ECC is highly prevalent in New Zealand children and associated with higher BMI in children of European ethnicity.

Oral health of overweight and obese children and adolescents: a comparative study with a multivariate analysis of risk indicators

PURPOSE

The aim of this study was to investigate the oral health status of overweight and obese children compared to normal weight children and to explore the effect of risk indicators, including stress, on the oral health of the children.

METHODS

For this cross-sectional study, 7-15-year-old children were enrolled: divided into a group of overweight and obese and a group of normal weight children. Parent-reported questionnaires were used to for data collection demographic data, children's medical and developmental history, brushing frequency and dietary habits. Participants' state and trait anxiety levels were evaluated using STAIC questionnaires while saliva cortisol was measured as a biomarker of stress. Dental Caries (DMFT/dmft), periodontal health (plaque index-PI and gingival index-GI), saliva flow rate and buffer capacity were recorded at the dental clinic by two calibrated examiners. Student's t-test, Pearson's r and Fisher's exact test were used for bivariate associations and backward stepwise multivariate regression analysis for each oral health outcome was performed (P ≤ 0.05).

RESULTS

Overweight and obese children had significantly higher DMFT (3.92 ± 4.69 vs. 1.30 ± 2.49, P < 0.001), PI (0.9 ± 0.5 vs. 0.45 ± 0.52, P < 0,001) and GI (0.38 ± 0.39 vs. 0.18 ± 0.47, P < 0,001), salivary cortisol AUC (128.3 ± 55.5 vs. 99.4 ± 35.7, P = 0.004), lower saliva flow rate and decreased "high" saliva buffer capacity. There were no differences for the STAIC measures between the groups. Child's weight affected periodontal parameters but not dental caries, when controlling for other risk indicators.

CONCLUSION

Oral status of overweight and obese children was worse compared to normal weight children and this did not correlate to stress variables.

High-resolution taxonomic examination of the oral microbiome after oil pulling with standardized sunflower seed oil and healthy participants: a pilot study

OBJECTIVES

We aimed at the high-resolution examination of the oral microbiome depending on oil pulling, compared it with saline pulling, and analyzed whether the method is capable of reducing the overall microbial burden of the oral cavity.

MATERIALS AND METHODS

The study was a cohort study with three healthy subjects. Oil pulling samples, saline pulling samples, and saliva samples were microscoped and cultured under microaerophilic and anaerobic conditions; colony-forming units were counted; and cultivated bacteria were identified employing MALDI-TOF MS. The oral microbiomes (saliva) and the microbiota incorporated in oil and saline pulling samples were determined in toto by using 16S rDNA next-generation sequencing (NGS) and bioinformatics.

RESULTS

Microscopy revealed that oral epithelial cells are ensheathed with distinct oil droplets during oil pulling. Oil pulling induced a higher production of saliva and the oil/saliva emulsion contained more bacteria than saline pulling samples. Oil pulling resulted in a significant and transient reduction of the overall microbial burden in comparison to saliva examined prior to and after pulling. Both oil and saline pulling samples mirrored the individual oral microbiomes in saliva.

CONCLUSIONS

Within the limitations of this pilot study, it might be concluded that oil pulling is able to reduce the overall microbial burden of the oral cavity transiently and the microbiota in oil pulling samples are representative to the oral microbiome.

CLINICAL RELEVANCE

Within the limitations of this pilot study, it might be concluded that oil pulling can be considered as an enlargement of standard oral hygiene techniques since it has the characteristic of an oral massage, enwrapping epithelial cells carrying bacteria in oil vesicles and reaching almost all unique habitats in oral cavity.

Relationship between periodontitis and subclinical risk indicators for chronic non-communicable diseases

In view of the epidemiological relevance of periodontal disease and chronic noncommunicable diseases, the study aimed to evaluate the relationship between them through subclinical indicators of systemic risk in a population group with healthy habits, including alcohol and tobacco abstinence. A complete periodontal examination of six sites per tooth was performed in a sample of 420 participants from the Advento study (Sao Paulo), submitted to anthropometric and laboratory evaluation. Periodontitis was defined and classified based on the Community Periodontal Index score 3 (periodontal pocket = 4-5 mm) and score 4 (periodontal pocket ≥ 6 mm). The prevalence of mild/moderate and severe periodontitis was 20% and 8.2%, respectively. Both categories of periodontal disease had significantly higher levels of triglycerides, C-reactive protein, calcium score, and calcium percentile, whereas blood glucose after tolerance test was significantly higher among people with severe periodontitis and HDL-c levels were lower (p < 0.05). Young adults with severe periodontitis had significantly higher prevalence of obesity, pre-diabetes, hypertension, and metabolic syndrome. Besides these conditions, the older adults with severe periodontitis had significantly higher prevalence of dyslipidemia and subclinical atherosclerosis. The group with periodontitis had also a higher coronary heart disease risk based on the PROCAM score (p < 0.05). The results indicated associations of periodontitis with several systemic indicators for chronic noncommunicable diseases, and highlighted the need for multiprofessional measures in the whole care of patients.

Association between Dental Caries and Obesity in Children and Young People: A Narrative Review

OBJECTIVES

To explore the association between obesity and dental caries in children and adolescents. Furthermore, to consider the possible reasons behind this relationship.

METHODS

A database search for papers published between January 2015 and May 2018, inclusive, addressing the association between obesity and dental caries was conducted. A review and critical appraisal of all included studies was performed.

RESULTS

Twenty-six studies were included in this review from different populations worldwide. Eight studies assessed the primary dentition, nine studies were conducted on permanent dentition, and remaining nine studies on both dentitions. The results regarding the association between obesity and dental caries were conflicting and inconsistent. Nine studies concluded that there was no relationship between obesity and dental caries. A positive association was reported in five studies, while the inverse association was reported in eleven studies. Studies included in this review had significant variations in methodology and the investigated cofactors. Possible explanations of the controversial association between obesity and dental caries are discussed in this review.

CONCLUSION

Both obesity and dental caries are multifactorial diseases, and their association is far more complex that can be explained by a single common risk factor, presenting evidence for the complexity of this association.

Interaction between beta-3 adrenergic receptor genotype and environmental factors on periodontal progression

OBJECTIVES

The purpose of this longitudinal study was to evaluate the relationship between beta-3 adrenergic receptor polymorphism and environmental factors such as smoking on periodontal disease by considering effect modification.

MATERIALS AND METHODS

A total of 294 subjects who participated in all follow-up surveys over the 6-year study period were analysed. After dividing subjects into tertiles according to the number of years exposed to smoking, we conducted Poisson regression analysis to compare the incidence rate ratio (IRR) for periodontal disease events during the 6-year study period with beta-3 adrenergic receptor genotype (1: Arg allele carriers, 2: Arg allele non-carriers) for each tertile adjusted for other four variables.

RESULTS

The number of years exposed to smoking (mean ± standard deviation) for the 1st, 2nd and 3rd tertiles was 0 ± 0, 20.1 ± 9.1 and 45.3 ± 7.7 years, respectively. The IRRs ± SE were 0.89 ± 0.08 (p = 0.218) for the 1st tertile, 1.93 ± 0.36 (p < 0.001) for the 2nd tertile and 2.56 ± 0.23 (p < 0.001) for the 3rd tertile.

CONCLUSION

There was a clear dose-response relationship between beta-3 adrenergic receptor genotype and periodontal disease progression based on the number of years exposed to smoking.

Salivary fingerprint of simple obesity

BACKGROUND

The nature of a link between poor oral health and obesity is not fully understood. It is also unclear if saliva contributes to it and whether the properties of saliva change as a result of an increase in body mass or rather as a consequence of obesity-associated comorbidities. This pilot study was undertaken in an attempt to determine if salivary biomarkers can identify obesity per se.

METHODS

Whole mixed saliva was analysed for 16 soluble parameters covering 4 categories (inflammation, oxidative stress, endothelial dysfunction, adipokines). In the discovery group, 19 obese and 25 non-obese women matched for age, with similar hygiene habits, with no comorbidities and not taking any medication known to affect saliva secretion were analysed. In the validation group, a cohort of no-preselected 81 individuals (34 obese) were analysed.

RESULTS

Individuals with obesity had significantly higher salivary concentrations of several cytokines and adipokines, of which TNF-R1, serpin A12 and PAI-1 were identified as parameters discriminating between obese and non-obese subjects with the highest sensitivity and specificity.

CONCLUSIONS

Obesity per se leads to distinct changes in the concentration of several parameters in saliva. These findings may have diagnostic implications for distinguishing the effects of obesity and obesity-linked comorbidities on oral health.

Suppression of Gingival NK Cells in Precancerous and Cancerous Stages of Pancreatic Cancer in KC and BLT-Humanized Mice

The aim of our studies is to determine the dynamics of natural killer (NK) cell modulation in gingivae in precancerous and cancerous stages of pancreatic and oral cancers in P48+/Cre;LSL-KRASG12D (KC) mice carrying a pancreas-specific oncogenic Kras mutation and BLT-humanized mice. Wild type and KC mice fed with control diet (CD) or high-fat calorie diet (HFCD), and the pancreatic and oral tumor-bearing humanized BLT (hu-BLT) mice were used to determine precancerous and cancer induced changes in numbers and function of gingival NK cells. Increased numbers of PanIN lesions and the greatest score of inflammation in pancreas of KC mice fed with CD and HFCD co-related with significant decline in percentages of circulating and gingival NK cells, lack of DX5+ NK expansion and increased secretion of IFN-γ and IL-6 after culture. At the malignant stage of pancreatic cancer, hu-BLT tumor-bearing mice had the lowest secretion of IFN-γ from cells dissociated from the gingival tissues as compared to those from non-tumor-bearing mice. Injection of NK cells into tumor-bearing mice increased IFN-γ secretion, and the secretion was similar or higher than those obtained by gingival cells from non-tumor-bearing hu-BLT control mice. The highest increase in IFN-γ secretion was observed when tumor-bearing mice were fed with AJ2 probiotic bacteria and injected with the NK cells. Along with an increase in secretion of IFN-γ, injection of NK cells in the presence and absence of feeding with AJ2 in pancreatic tumor-bearing mice increased percentages of CD45+ and CD3+ T cells in oral gingival cells. Similar results were observed with oral tumors. In conclusion, these results indicated that oral cavity may mirror systemic disease and provide a rationale for why cancer patients may be prone to suffer from diverse oral pathologies.

Influence of obesity on the outcome of non-surgical periodontal therapy - a systematic review

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.