Periodontal complications with obesity Suvan, Jean E.; Finer, Nicholas; D'Aiuto, Francesco
Periodontology 2000,
October 2018, 2018-10-00, 20181001, Volume:
78, Issue:
1
Journal Article
Peer reviewed
Open access
The purpose of this paper was to identify and summarize current evidence describing periodontal complications associated with obesity. Electronic searches supplemented with manual searches were ...carried out to identify relevant systematic reviews. Identification, screening, eligibility, and inclusion of studies were performed independently by two reviewers. A MeaSurement Tool to Assess systematic Reviews (AMSTAR) was used to assess the quality and risk of bias of the included reviews. From 430 titles and s screened, 14 systematic reviews were considered as eligible for inclusion in this meta‐review. Eight reviews reported on cross‐sectional studies investigating the association of obesity and periodontal diseases, 4 included longitudinal studies, 5 addressed response to periodontal therapy, 5 reported on studies investigating biomarkers, and only 2 were related to pediatric population samples. Systematic review summaries in the various study design domains (cross‐sectional, longitudinal and experimental) report that obese individuals are more likely to have periodontal diseases, with more severe periodontal conditions, than nonobese individuals, with cross‐sectional evidence congruent with longitudinal studies showing that obesity or weight gain increases the risk of periodontitis onset and progression. Published research on the effect of obesity on responses to periodontal therapy, or systemic or local biomarkers of inflammation, is variable and therefore inconclusive based on the evidence currently available, which suggests that overweight/obesity contributes to periodontal complications independently of other risk factors, such as age, gender, smoking, or ethnicity. This evidence supports the need for risk assessments for individual patients to facilitate personalized approaches in order to prevent and treat periodontal diseases.
Abstract
Noncommunicable diseases (NCDs) are multifactorial, long‐term, chronic conditions that represent a burden to health‐care systems worldwide as they can only be controlled rather than cured; ...hence, they require long‐term care. With the exponential increase in NCDs, the occurrence of individuals presenting with more than one chronic disease is also rapidly rising. “Multimorbidity,” defined as the presence of two or more long‐term physical or mental disorders, is now considered a worldwide epidemic, affecting around 20% of the adult population. Periodontitis, diabetes, and obesity, all chronic inflammatory diseases, are an example of multimorbidity highly relevant to dental practitioners. Over the last three decades, the three‐way relationship among the diseases has been vastly researched and accepted, with important contributions by European researchers. The interplay among periodontitis, diabetes, and obesity is sustained by shared biological mechanisms, such as systemic inflammation, insulin resistance, and metabolic dysfunction, as well as common lifestyle‐related risk factors. As such, unhealthy lifestyles were found to generally increase systemic inflammation and insulin resistance and decrease immune function, hence, eventually increasing the risk of NCDs onset and the development of multimorbidity. This narrative review of the evidence supports the need for a paradigm shift from a “single‐disease” to a “multiple‐disease” framework, characterized by an integrated multidisciplinary approach, which should include lifestyle modification interventions to successfully tackle multimorbid periodontitis and metabolic diseases (diabetes and obesity). A multidisciplinary integrated care pathway in both dental and medical settings should be considered to further tackle the global health challenge of multimorbidity.
Aim
To investigate the effect of treatment of periodontitis on systemic health outcomes, pregnancy complications, and associated quality of life.
Materials and methods
Systematic electronic searches ...were conducted to identify randomized controlled trials with minimum 6‐month follow‐up and reporting on the outcomes of interest. Qualitative and quantitative analyses were performed as deemed suitable.
Results
Meta‐analyses confirmed reductions of high‐sensitivity C‐reactive protein (hs‐CRP) 0.56 mg/L, 95% confidence interval (CI) (−0.88, −0.25), p < .001; interleukin (IL)‐6 0.48 pg/ml, 95% CI (−0.88, −0.08), p = .020, and plasma glucose 1.33 mmol/l, 95% CI (−2.41, −0.24), p = .016, and increase of flow‐mediated dilation (FMD) 0.31%, 95% CI (0.07, 0.55), p = .012 and diastolic blood pressure 0.29 mmHg, 95% CI (0.10, 0.49), p = .003 6 months after the treatment of periodontitis. A significant effect on preterm deliveries (<37 weeks) was observed 0.77 risk ratio, 95% CI (0.60, 0.98), p = .036. Limited evidence was reported on quality‐of‐life (QoL) outcomes in the included studies.
Conclusions
Treatment of periodontitis results in systemic health improvements including improvement in cardiometabolic risk, reduction in systemic inflammation and the occurrence of preterm deliveries. Further research is however warranted to confirm whether these changes are sustained over time. Further, appropriate QoL outcomes should be included in the study designs of future clinical trials.
Overweight and obesity have been suggested to be associated with periodontitis as published in studies and narrative summaries. This project presents results of a systematic review investigating the ...association between overweight or obesity (as defined by the World Health Organization) and periodontitis. Search strategy included electronic and hand searching to December 2009. Ovid MEDLINE, EMBASE, LILACS, and SIGLE were searched. RCTs, cohort, case-control and cross-sectional study designs that included measures of periodontitis and body composition were eligible. Duplicate, independent screening and data abstraction were performed. Meta-analyses were performed when appropriate. A total of 526 titles and abstracts were screened, resulting in 61 full text articles and abstracts assessed for eligibility with 33 being included. Nineteen studies provided sufficient information for inclusion in meta-analyses. Meta-analyses indicated statistically significant associations between periodontitis and body mass index (BMI) category obese OR 1.81(1.42, 2.30), overweight OR 1.27(1.06, 1.51) and obese and overweight combined OR 2.13(1.40, 3.26). In conclusion, these results support an association between BMI overweight and obesity and periodontitis although the magnitude is unclear. Additional prospective studies to further quantify, or understand the mechanisms, of this association are merited. There is insufficient evidence to provide guidelines to clinicians on the clinical management of periodontitis in overweight and obese individuals.
The impact of lifestyle factors has been increasingly studied and discussed in oral healthcare. Positive lifestyle factors are important in maintaining oral health or controlling disease, but they ...are not easy to adopt over the long term. Along with public health initiatives within communities and groups, there is a role for behavior change interventions delivered in dental practice settings to improve the periodontal health of individuals. Behavior management is now seen as a part of both prevention and therapy of periodontal diseases. This article summarizes the evidence on behavioral strategies for periodontal health to inform and assist oral healthcare professionals in implementing behavior change in their practice. In addition, strategies for education and training in communication and behavior change techniques are considered.
Aim
To systematically assess the efficacy of oral health behaviour change counselling for tobacco use cessation (TUC) and the promotion of healthy lifestyles.
Materials and Methods
Systematic ...Reviews, Randomized (RCTs), and Controlled Clinical Trials (CCTs) were identified through an electronic search of four databases complemented by manual search. Identification, screening, eligibility and inclusion of studies were performed independently by two reviewers. Quality assessment of the included publications was performed according to the AMSTAR tool for the assessment of the methodological quality of systematic reviews.
Results
A total of seven systematic reviews were included. With the exception of inadequate oral hygiene, the following unhealthy lifestyles related with periodontal diseases were investigated: tobacco use, unhealthy diets, harmful use of alcohol, physical inactivity, and stress. Brief interventions for TUC were shown to be effective when applied in the dental practice setting while evidence for dietary counselling and the promotion of other healthy lifestyles was limited or non‐existent.
Conclusions
While aiming to improve periodontal treatment outcomes and the maintenance of periodontal health current evidence suggests that tobacco use brief interventions conducted in the dental practice setting were effective thus underlining the rational for behavioural support.
In spite of the remarkable success of current preventive efforts, periodontitis remains one of the most prevalent diseases of mankind. The objective of this workshop was to review critical scientific ...evidence and develop recommendations to improve: (i) plaque control at the individual and population level (oral hygiene), (ii) control of risk factors, and (iii) delivery of preventive professional interventions.
Discussions were informed by four systematic reviews covering aspects of professional mechanical plaque control, behavioural change interventions to improve self-performed oral hygiene and to control risk factors, and assessment of the risk profile of the individual patient. Recommendations were developed and graded using a modification of the GRADE system using evidence from the systematic reviews and expert opinion.
Key messages included: (i) an appropriate periodontal diagnosis is needed before submission of individuals to professional preventive measures and determines the selection of the type of preventive care; (ii) preventive measures are not sufficient for treatment of periodontitis; (iii) repeated and individualized oral hygiene instruction and professional mechanical plaque (and calculus) removal are important components of preventive programs; (iv) behavioural interventions to improve individual oral hygiene need to set specific Goals, incorporate Planning and Self monitoring (GPS approach); (v) brief interventions for risk factor control are key components of primary and secondary periodontal prevention; (vi) the Ask, Advise, Refer (AAR) approach is the minimum standard to be used in dental settings for all subjects consuming tobacco; (vii) validated periodontal risk assessment tools stratify patients in terms of risk of disease progression and tooth loss.
Consensus was reached on specific recommendations for the public, individual dental patients and oral health care professionals with regard to best action to improve efficacy of primary and secondary preventive measures. Some have implications for public health officials, payers and educators.
Objective
To investigate periodontitis as a co‐morbidity of overweight/obesity in an age‐matched sample of periodontitis cases or periodontally healthy controls.
Methods
Participants were ...periodontally assessed using whole mouth clinical periodontal measures. Multivariable conditional logistic regression was used to calculate the odds ratio for diagnosis of periodontitis when body mass index (kg/m2), overweight (BMI 25–29.99 kg/m2, or obese BMI ≥ 30 kg/m2) were the explanatory variables. A receiver operating characteristic (ROC) curve was generated of all possible BMI (kg/m2) cut‐off points discriminating individuals for diagnosis of periodontitis.
Results
The study comprised 286 participants. BMI showed a dose–response association with increased odds (1.12 per increase of 1 kg/m2, 95% CI 1.05–1.20, p = 0.001) of being a case compared to a control independent of gender, ethnicity, smoking status and dental plaque level. Similarly overweight/obese were independently associated with increased odds of diagnosis of periodontitis for overweight (OR = 2.56, 95% CI 1.210–5.400, p = 0.014) and for obese (OR = 3.11, 95% CI 1.052–6.481, p = 0.015) compared to normal weight individuals. The ROC curve analysis confirmed diagnosis of periodontitis was 1.6 times more likely in an individual with the BMI ≥ 24.32 kg/m2.
Conclusions
Overweight/obese individuals are more likely to suffer from periodontitis compared to normal weight individuals in this case–control sample.
Treatment of periodontitis and endothelial function Tonetti, Maurizio S; D'Aiuto, Francesco; Nibali, Luigi ...
New England journal of medicine/The New England journal of medicine,
03/2007, Volume:
356, Issue:
9
Journal Article
Peer reviewed
Open access
Systemic inflammation may impair vascular function, and epidemiologic data suggest a possible link between periodontitis and cardiovascular disease.
We randomly assigned 120 patients with severe ...periodontitis to community-based periodontal care (59 patients) or intensive periodontal treatment (61). Endothelial function, as assessed by measurement of the diameter of the brachial artery during flow (flow-mediated dilatation), and inflammatory biomarkers and markers of coagulation and endothelial activation were evaluated before treatment and 1, 7, 30, 60, and 180 days after treatment.
Twenty-four hours after treatment, flow-mediated dilatation was significantly lower in the intensive-treatment group than in the control-treatment group (absolute difference, 1.4%; 95% confidence interval CI, 0.5 to 2.3; P=0.002), and levels of C-reactive protein, interleukin-6, and the endothelial-activation markers soluble E-selectin and von Willebrand factor were significantly higher (P<0.05 for all comparisons). However, flow-mediated dilatation was greater and the plasma levels of soluble E-selectin were lower in the intensive-treatment group than in the control-treatment group 60 days after therapy (absolute difference in flow-mediated dilatation, 0.9%; 95% CI, 0.1 to 1.7; P=0.02) and 180 days after therapy (difference, 2.0%; 95% CI, 1.2 to 2.8; P<0.001). The degree of improvement was associated with improvement in measures of periodontal disease (r=0.29 by Spearman rank correlation, P=0.003). There were no serious adverse effects in either of the two groups, and no cardiovascular events occurred.
Intensive periodontal treatment resulted in acute, short-term systemic inflammation and endothelial dysfunction. However, 6 months after therapy, the benefits in oral health were associated with improvement in endothelial function.
The aim of this systematic review was to assess the effect of periodontal therapy (PT) on serum levels of inflammatory markers in people with type 2 diabetes mellitus (T2DM).
A literature search was ...carried out using MEDLINE via Pubmed, EMBASE, LILACS and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Randomized-controlled trials (RCTs) and controlled clinical trials (CCTs) evaluating the effect of PT on systemic inflammatory markers were deemed eligible. Case series (CS), reports and pilot trials were excluded. Study quality was assessed using the Cochrane Collaboration's risk assessment tool. Meta-analysis was carried out using random effect methods.
The search strategy identified 3,164 potential studies of which 61 were assessed for eligibility and 9 (6 RCTs and 3 CCTs) were included in this systematic review. Three RCTs were classified by the authors as being at low risk of bias and three were "unclear" and classified as uncertain risk of bias. All CCTs were considered to be at a high risk of bias. The meta-analysis showed a statistically significant mean difference (MD) for TNF- α (-1.33 pg/ml, 95% CI: -2.10; -0.56, p<0.001) and CRP (-1.28 mg/l, 95% CI: -2.07; - 0.48, p<0.001) favoring periodontal intervention versus control.
The results of this meta-analysis support the hypothesis that PT reduces serum levels of TNF- α and CRP in T2DM individuals. The decrease of inflammatory burden has important implications for metabolic control and can, in part, explain the mechanisms linking periodontitis and increased risk for complications in people with T2DM.
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