Obese patients at higher risk of perio disease
Article Thumbnail ImageFebruary 24, 2011 -- A recent study conducted by researchers from the University of North Carolina found that dentists are interested in helping patients with serious weight issues but are afraid of offending them and appearing judgmental.
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A large number of dentists would be more willing to have such discussions if obesity were definitively linked to oral disease, the study authors noted.

Now researchers from the University of Pittsburgh have found a positive association between periodontal disease and obesity, according to data from a study to be presented next month at the International Association for Dental Research (IADR) conference in San Diego.

"The prevalence of obesity is the public health challenge of our time as it can damage quality of life, boost medical costs, and is recognized as a predisposing factor to major chronic diseases ranging from cardiovascular disease to cancer," the study authors noted.

They hypothesized that the prevalence of periodontal disease would be greater in obese individuals and used electronic health records from the University of Pittsburgh School of Dental Medicine to retrospectively identify 4,537 unique individuals (2,445 female, 2,092 male, average age 54). The patient records documented weight, height, age, sex, type 2 diabetes status, and periodontal evaluation.

Periodontal disease was classified as periodontal pocketing of 4 mm or greater. Body mass index (BMI) was calculated, and patients with a BMI of 30 or higher were classified as obese, while those with a BMI below 30 were classified as nonobese.

"Statistical analysis of the retrospective data collected established that periodontal disease is more prevalent in obese individuals," the authors noted.

Systemic condition?

Obesity might represent a systemic condition influencing onset and progression of periodontal disease through the gateway of metabolic syndrome, the proinflammatory state characterized by insulin resistance and oxidative stress, in a bidirectional relationship, the researchers added.

"Obesity is an obvious national problem and is increasingly a global problem as well, affecting societies that never before were necessarily affected by obesity," study author Pouran Famili, DMD, a professor and chair of the department of periodontics and preventive dentistry at the University of Pittsburgh School of Dental Medicine, told DrBicuspid.com. "Not much has been done about it and its relation to dental issues."

While not surprising, the findings do indicate that more research regarding the relationship between obesity and periodontal disease needs to be conducted, she added.

Positive associations are repeatedly demonstrated between prevalent periodontal disease and obesity, but establishing any physiological mechanism behind this relationship will require well-designed prospective research, Dr. Famili and her colleagues concluded.

Other studies have come to similar conclusions.

Dentists in clinical practice can expect a higher prevalence of periodontal disease among obese adults, although the evidence pointing to a direct link between obesity and periodontal disease is limited, according to a recent study in the Journal of Periodontology (December 2010, Vol. 81:12, pp. 1708-1724).

"This positive association was consistent and coherent with a biologically plausible role for obesity in the development of periodontal disease," the authors of that study concluded. "However, with few quality longitudinal studies, there is an inability to distinguish the temporal ordering of events, thus limiting the evidence that obesity is a risk factor for periodontal disease or that periodontitis might increase the risk of weight gain."

Robert Genco, DDS, PhD, a distinguished professor of oral biology and microbiology at the State University of New York at Buffalo School of Dental Medicine, has conducted similar research (Journal of Periodontology, November 2005, Vol. 76:11-s, pp. 2075-2084). He noted that while there is no new information in this new study, the findings are "confirmatory."

In addition, he said, it is possible that inflammatory cytokines produced by adipose tissue could increase the inflammatory response to periodontal bacteria.

"The dentist can better understand why obese individuals may be at greater risk for periodontal disease, let the patient know this, and encourage weight loss as part of management of periodontal disease," he concluded.