Along with being associated with heart disease, diabetes, and even increased mortality, obesity is also associated with periodontal disease. The link between gum disease and obesity is defined as having abnormal or excessive deposition of fat in the adipose tissue and numerous studies have shown that obesity can intensify infections such as periodontal disease. Firstly, abundant fat cells produce levels of cytokines which trigger a systemic inflammatory response as well as insulin resistance. As a result, the oral cavity, which is densely populated with bacteria, becomes susceptible to gum infection, which intensifies when the infected tissues produce their own cytokines.
Obesity has been shown to modulate the host immune response resulting in increased susceptibility to various infections and exaggerated host immune responses to them, resulting in adipose tissue (adipocytes) secreting several inflammatory molecules. Over 30 years ago, a possible association between obesity and periodontitis was reported and a series of animal experiments demonstrated greater alveolar bone resorption in obese compared to non-obese rats. A recent systematic review including a meta-analysis concluded that obese and overweight/obese cases together are almost two times more likely to suffer from periodontitis independent of traditional risk factors whilst compared to normal weight controls.
An exaggerated host immune response has been reported in animal experiments, whilst clinical evidence seems to suggest that obese individuals have an increased local inflammatory response as well as possibly an altered periodontal microflora. An alternative mechanism could be the altered insulin sensitivity state found in obese individuals and this hypothesis is based on the notion that reduced insulin sensitivity coupled with increased production and accumulation of advanced glycation end- products at the gingival level in people with diabetes, can result in greater periodontal tissue destruction.
Some recent studies investigated the link between gum disease and obesity and periodontitis progression. In two studies based on the examination of 1038 USA veterans over 40 years follow-up, BMI and waist circumference-to-height ratio were all significant predictors of periodontitis progression. A recently published large prospective trial included 260 patients suffering from severe generalised periodontitis who received an intensive course of non-surgical periodontal therapy and this study was followed for up to 2 months. It found that obesity compared to normal weight was an independent predictor of worse response to non surgical periodontal therapy and the effect was nearly that of cigarettes smoking.
Key obesity prevention tactics include:
- Controlling portion size and limiting total daily calorie intake
- Regular exercise
- Regular intake of wholegrain and fibre
- Increased intake of fruits and vegetables
- Reduction of sugar, particularly through drinks
- Limiting fast food consumption
Advice on good dietary habits that help maintain both oral and general health should be included as part of routine preventive care check-ups for all patients. As research has confirmed, there is a clear link between gum disease and obesity and the ability to reduce the risk of developing periodontal disease or improving your oral health starts with your dental practitioner and yourself.
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