Obesity is the fastest growing health-related problem in the world.1 A common metabolic and nutritional disorder, obesity is a complex multifactorial chronic disease that develops from an interaction of genotype and the environment.1 Overweight and obese adults have long been considered to be at high risk for many chronic inflammatory diseases and conditions such as cardiovascular disease, diabetes and arthritis.3 It has been suggested that obesity contributes to an overall systemic inflammatory state through its effect on metabolic and immune parameters, thereby increasing suscept­ibility to periodontal disease.*5

In recent years, the evidence linking obesity to increased incidence and severity of periodontal disease has grown.6“‘ In general, data indicate that increased body mass index, waist circumference (abdominal obesity), serum lipid levels and percentage of subcutaneous body fat are associated with increased risk for periodontitis. After adjusting for confounding factors such as smoking, age and systemic conditions, the risk association appears to be linear. For instance, more bleeding on probing, deeper periodontal pockets and more bone loss were noticed in individuals with higher indicators of obesity.9 The most recent study” provides what is perhaps the most compelling evidence to date for a significant association between obesity and increased prevalence, severity and extent of periodontal disease. In this study, overweight individuals had double the incidence of periodontitis while obese individuals had triple the incidence of periodontitis, thus demonstrating, for the first time, a dose-response relationship.

The underlying biological mechanisms for the association of obesity and periodontitis most likely involve adipose tissue-derived cytokines and hormones. Fat tissue produces a vast amount of cytokines and hormones, collectively called adipokines, which may modulate periodontitis.15 Obesity increases the host’s susceptibility by modulating the immune and inflammatory systems in a manner that predisposes to inflammatory tissue destruction and leaves an individual at greater risk of periodontitis.7 Additionally, increased amounts of adipokines from visceral fat may induce agglutination of blood in the microvasculature, decreasing blood flow to the gingiva in obese people and facilitating the progression of periodontitis.

Despite the accumulating evidence for significant associations, it is still unclear whether obesity truly precedes peri­odontitis. Prospective cohort studies will be needed to address this issue. This association could be, at least in part, due to common lifestyle characteristics that make subjects more prone to both obesity and periodontal disease.

However, maintaining a normal body weight, eating a well-balanced diet and engaging in physical activity have been shown to reduce the severity of periodontrtis.310 Thus, all health professionals, including the dental team, can provide an important service to patients with obesity by educating them about the risk of periodontal disease and the importance of proper oral hygiene. *

References:

1. Haenle MM. Brockmann 50. Kron M, Berlling U. Mason RA. Sieinbach G. and others. Overweight, physical activity, tobacco and alcohol con­sumption in a cross-sectional random sample of German adults. BMC Public Health 2006; 6:233-37.

2. Dennison EM. Syddall HE. Aihie Sayer A. Martin HJ, Cooper C; Hertfordshire Cohort Study Group. Lipid profile, obesity and bone mineral
density: the Hertfordshire Cohort Study. QJM 2007. 100(5):297-303 Epub 2007 Apr 19.

3. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Expert Panel on the Identification, Evaluation and Treatment of Overweight Adults, Am J Clin Nutr 1998; 68(41:899-917.

4. Genco RJ. Grossi SG, Ho A. Nishimura F, Murayama Y. A proposed model linking inflammation to obesity, diabetes, and periodontal infections.
1 Periodontal 2005; 76(11 Suppl) 2075-S4

5. Van DykeTE. Inflammation and periodontal disease, a reappraisal J Periodontal 2008; 79(8 Suppl):1501-02

6. Cutler CW, Shinedling EA. Nunn M, Jotwani R. Kim BO, Nares S, and other. Association between periodontitis and hyperlipidemia: cause or
effect’ J Periodontal 1399; 70(12): 1429-3d

7. Iacopino AM, Cutler CW. Pathophysiological relationships between periodontitis and systemic disease1 recent concepts involving serum lipids.
J Periodontal 2000, 71(81:1375-84,

8. Saito T. Shimazaki Y, Koga T. Tsuzuki M. Ohshima A. Relationship between upper body obesity and periodontitis. J Dent to 2001;
80(71:1631-36.

9. Wood N. Johnson RB, Sireddus CT. Comparison of body composition and periodontal disease using nutritional assessment techniques: Third
National Health and Nutrition Examination Survey (NHANES III). J Cln Periodontal 2003; 30(4):321-27.

10. Al-Zahrani MS, Bissada NF. Borawskit EA. Obesity and periodontal disease in young, middle-aged, and older adults J Periodontal 2003;
74(5):610-15.

11. SaitoT, Shimazaki Y, Kiyohara Y, Kalo I, KuboM. Iida M, and other. Relationship between obesity, glucose tolerance, and periodontal disease
in Japanese women: the Hisayma study. J. Periodontal Res 2005; 40(4):346-53,

12. Khader YS, Bawadi HA. Haroun TF. Alomari M. Tayyem RF. The association between periodontal disease and obesity among adults in Jordan.
J Cln Periodontal 2009; 36(1):18-24. Epub 2O0B Nov 19.

Dr. lacopino is dean and professor of restorative dentistry and director of the International! Centre for Oral-Systemic Health, faculty of dentistry, University of Manitoba, Winnipeg, Manitoba, EsnaiUkkC0pittO@tc.umanitobQ.ca