Obesity and Oral Diseases in Adult Patients

The management and treatment of obesity is outlined in clinical guidelines from American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE), European Association for the Study of Obesity (EASO) and others. The cornerstone is life-style modification programs aiming to reduce energy intake and increase physical activity, often referred to as conservative treatment. In recent years, pharmacological management to achieve weight loss is increasingly used as effective drugs become available. Conservative treatment generally targets to induce long-term weight loss of 5-10%. The obesity treatment has wider objectives than weight loss alone by also including treatment of obesity-related comorbidities like diabetes mellitus, hypertension, dyslipidemia, and obstructive sleep apnea with the ultimate goals of improving quality of life, working ability and reduce mortality.

Bariatric surgery is considered an effective and safe intervention for the treatment of obesity. Consistent with international consensus gastrointestinal surgery might be recommended for patients with extreme obesity (BMI ≥ 40 kg/m2) as well as for those with BMI ≥ 35 kg/m2 with significant comorbidities. The surgical procedures are usually performed laparoscopically, and includes sleeve gastrectomy, Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch.

Benefits of bariatric surgeries include significant weight loss, improved and remission of obesity-related comorbidities such as type 2 diabetes, hyperlipidemia, hypertension, cardiovascular disease, obstructive sleep apnea, anxiety, depression, and improved quality of life. Gastro esophageal reflux and vomiting in addition to increased intake of food and drinks have been reported as potential side effects. All these side effects are considered risk factors for the occurrence of dental caries and dental erosion, which may lead to decreased function and pain. Periodontitis is also reported to be more frequent in individuals who have undergone bariatric surgery probably related to nutritional deficiency secondary to the surgery.

Periodontitis is a widespread chronic, inflammatory disease of the gingival tissues and alveolar bone triggered by oral biofilms. Since 2010, periodontitis is cited to be the sixth most prevalent chronic condition globally. The high prevalence of moderate/severe periodontitis may be attributed to multiple factors such as lifestyle, genetics, and medical care. Current knowledge recognizes adipose tissue as an endocrine organ in which adipocytes play an important role as inflammatory modulators, producing anti- and pro-inflammatory cytokines which regulate oral and systemic inflammation. In obese individuals, an imbalance may result in an increased expression of pro-inflammatory and reduction of anti-inflammatory adipokines, leading to the establishment of a chronic inflammatory status.

Available data on obesity and oral diseases as well as the influence of non-surgical and surgical interventions on oral health are scarce, and several reports have published conflicting and inconsistent results. The main objectives of the present research project are to explore the association between obesity and oral diseases and assess how weight changes following non-surgical and surgical interventions may affect the cariological and periodontal health status.