|
 
 |
| LETTER TO EDITOR |
|
| Year : 2017 | Volume
: 5
| Issue : 1 | Page : 35-37 |
|
Obesity and oral health disorders: Concealed penalties!!
Ujwala R Newadkar
Department of Oral Medicine and Radiology, ACPM Dental College, Dhule, Maharashtra, India
| Date of Web Publication | 13-Jul-2017 |
Correspondence Address:
Ujwala R Newadkar
Department of Oral Medicine and Radiology, ACPM Dental College, Dhule - 424 003, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/sjo.sjo_2_17
How to cite this article:
Newadkar UR. Obesity and oral health disorders: Concealed penalties!!. Saudi J Obesity 2017;5:35-7 |
In 2014, over 600 million adults worldwide, 18 years and older, were obese.[1] Just like smoking, it is one of the major risk factors for oral disease and is a serious social problem that has reached epidemic proportions in many developed as well as developing countries.[2] Relationship between oral health and obesity may go two ways: oral infectious diseases (caries, periodontitis, periapical lesions such as granulomas, and periapical abscesses) impact the functional ability to eat, leading to changes in diet displacing nutrient-dense foods and favoring softer foods rich in sugars and saturated fats, finally promoting conditions such as obesity.[3],[4] The literature shows the existence of an association between biological and anthropometric indices defining overweight and obesity, and poor conditions of the oral cavity. The correlation is manifested by an increased frequency of oral dryness, numerous carietic defects, and periodontitis. However, despite many years of studies, determining a direct causal relationship between obesity and condition of the oral cavity remains unsuccessful. The association may still be coincidental.[5] This brief review summarizes impact of obesity on the oral health.
The relationship between changes in nutrition worldwide with increased overweight and obesity on the oral health status has been highlighted.[6] This article tries to focus concisely on the possible role of obesity as a potential contributor to periodontal disease, dental decay, and vice versa. A systematic review on obesity, periodontal disease, and dental caries was performed in the electronic databases of the Medline/PubMed, LILACS, and the Web of Science between 2005 and 2015.
Studies on the association between diseases and the periodontium and obesity have been conducted for years. Risk factors of periodontium diseases include: gender, addictions (tobacco smoking and alcohol consumption), diabetes, obesity, osteoporosis, and vitamin D deficiency, as well as stress, immunological factors: interleukin-1 (IL-1), tumor necrosis factor (TNF-α), and genetic factors.[7],[8] A positive correlation has been found between the presence of periodontal disease and obesity in adults aged 17 to 21 years.[9] It has been shown that the prevalence of periodontal disease in obese young people aged 18 to 34 years is approximately 76%, significantly higher as compared with those of the same age with normal body weight.[10] Lissner et al. conducted a study determining the level of adipocytokines TNF-α and IL-6 in people with normal body weight and in obese patients with chronic periodontitis. Cytokine levels were determined in blood serum and periodontal pocket fluid. It was demonstrated that periodontitis influences mostly the level of resistin and adiponectin produced by adipocytes, and both obesity and periodontitis cause an increased leptin level. Moreover, obesity also causes an increased TNF-α level.[11] Prpić et al.[12] studied a correlation between obesity [measured by body mass index (BMI)] and general condition of the oral cavity, in a group of men and women aged 31 to 60 years. The study demonstrated that obese subjects’ oral cavities were in poorer condition. This manifested itself by a higher number of lost teeth, an increased number of carietic defects, and an intensity of periodontium diseases.
Obesity is an element of metabolic syndrome, constituting an important risk factor of arterial atheromatosis. Other components of the syndrome are hypertension, hyperglycemia or pharmacologically controlled type 2 diabetes, and dyslipidemia. Presence of three of the above-mentioned criteria is necessary for the diagnosis of metabolic syndrome.[13] The study by Rousseau et al. on children of both sexes, aged 8 to 10 years, with a diagnosed metabolic syndrome, demonstrated increased TNF-α level in periodontal pocket fluid and bleeding gums. Those factors were particularly strong in obese boys with arterial hypertension and dyslipidemia.[14] Sarlati et al., conducted a study on the relationship between obesity and periodontal status in a sample of young Iranian adults and found that the overall and abdominal obesity were associated with the extent of periodontal disease and hence prevention and management of obesity may be an additional factor for improving periodontal health.[15]
The findings of two systematic reviews with meta-analysis subordinate obesity with sugar intake with dental decay. Increased dental caries has long been associated with increased sugar consumption. Dental caries does not develop in the absence of sugar. Thus, dental caries has become a surrogate marker for sugar intake. The current controversy relating obesity to sugar consumption has migrated to the level of affecting public policy despite the weakness of supporting data. A recent systematic review concluded that unrestricted intake sugar experimentally increases body weight by only 0.8 kg. It was also concluded that studies involving isocaloric substitution of other carbohydrates for sugar had no effect on body weight. These data can hardly be considered as an evidence that obesity is caused by sugar consumption.[16]
The main link in the etiological chain of dental caries is obviously cariogenic microorganisms from dental plaque, mainly Streptococcus mutans group, in combination with carbohydrate diet. The passage of time is required, so that the demineralizing action of the acid, which is a product of sugar metabolism by bacteria, can injure the hard tissue structure of the tooth. Various additional parameters should also be included, of which the most important are dietary habits and socioeconomic and demographic factors. The study by Modéer et al.[17] on a group of youths, with BMI as a measure of obesity, demonstrated that obese individuals had a significantly higher number of carietic defects, and the stimulated saliva flow was 1.2 ml/min, whereas in a group of children with normal body weight, the corresponding value was 2.0 ml/min. Another study confirming the existence of a correlation between obesity and caries was completed by Costa et al.[18] on a group of children from families with low income, with a mean age of 6 years. Over 50% of the study participants had caries, and 25% of these children were obese. However, the level of family wealth was the strongest factor in determining the existence of caries. Bailleul-Forestier et al.,[19] identified a higher decayed, missing and filled teeth index (DMFT) in obese patients (mean 6.9) compared to those nonobese (4.3).
Obesity has a negative impact on both general health and the health of the oral cavity. Promoting healthy eating behavior and appropriate physical activity are fundamental elements of modern prophylaxis of periodontal and teeth diseases and prevention or reduction of obesity. Dental professionals can have a positive impact in treatment outcomes by recognizing patients at risk for obesity and multidisciplinary approach can be given.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, Brauer M et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015;386:2287-323.  |
| 2. | Słotwińska SM, Słotwiński R. Host response, obesity, and oral health. Cent Eur J Immunol 2015;40:201-5. |
| 3. | Touger-Decker R, Mobley CC. Position of American Dietetic Association: oral health and nutrition. J Am Diet Assoc 2007;107:1418-28. |
| 4. | Thompson FE, McNeel TS, Dowling EC, Midthune D, Morrissette M, Zeruto CA. Interrelationships of added sugars intake, socioeconomic status, and race/ethnicity in adults in the United States: National Health Interview Survey, 2005. J Am Diet Assoc 2009;109:1376-83. |
| 5. | Walis M, Kłosek S. The role of obesity in modifying the course of periodontal diseases. Prog Health Sci 2014;4:195-9. |
| 6. | Enwonwu CO. Global nutrition transition challenges oral health. Compend Contin Educ Dent 2010;31:98-9. |
| 7. | Genco RJ, Borgnakke WS. Risk factors for periodontal disease. Periodontol 2000 2013;62:59-94. |
| 8. | Palle AR, Reddy CM, Shankar BS, Gelli V, Sudhakar J, Reddy KK. Association between obesity and chronic periodontitis: a cross-sectional study. J Contemp Dent Pract 2013;14:168-73. |
| 9. | Reeves AF, Rees JM, Schiff M, Hujoel P. Total body weight and waist circumference associated with chronic periodontitis among adolescents in the United States. Arch Pediatr Adolesc Med 2006;160:894-9. |
| 10. | Al-Zahrani MS, Bissada NF, Borawskit EA. Obesity and periodontal disease in young, middle-aged, and older adults. J Periodontol 2003;74:610-5. |
| 11. | Lissner L, Visscher TL, Rissanen A, Heitmann BL. Monitoring the obesity epidemic into the 21st century—weighing the evidence. Obes Facts 2013;6:561-5. |
| 12. | Prpić J, Kuis D, Pezelj-Ribarić S. Obesity and oral health-is there an association? Coll Antropol 2012;36:755-9. |
| 13. | Szczeklik A. Chorobywewnętrzne. Stan wiedzynarok 2013. Kraków: Med Prakt; 2013. p. 1283-4 (Polish). |
| 14. | Ka K, Rousseau MC, Lambert M, Tremblay A, Tran SD, Henderson M et al. Metabolic syndrome and gingival inflammation in Caucasian children with a family history of obesity. J Clin Periodontol 2013;40:986-93. |
| 15. | Sarlati F, Akhondi N, Ettehad T, Neyestani T, Kamali Z. Relationship between obesity and periodontal status in sample of young Iranian adults. Int Dent J 2008;58:36-40. |
| 16. | Goodson JM, Tavares M, Wang X, Niederman R, Cugini M, Hasturk H et al. Obesity and dental decay: inference on the role of dietary sugar. PLoS One 2013;8:e74461. |
| 17. | Modéer T, Blomberg CC, Wondimu B, Julihn A, Marcus C. Association between obesity, flow rate of whole saliva and dental caries in adolescents. Obesity 2010;18:2367-73. |
| 18. | Costa LR, Daher A, Queiroz MG. Early childhood caries and body mass index in young children from low income families. Int J Environ Res Public Health 2013;10:867-78. |
| 19. | Bailleul-Forestier I, Lopes K, Souames M, Azoguy-Levy S, Frelut ML, Boy-Lefevre ML. Caries experience in a severely obese adolescent population. Int J Paediatr Dent 2007;17:358-63. |
|
Search Pubmed for