Obesity means accumulation of excess fat in the body especially around the abdomen. Obesity leads to several health conditions including heart disease, diabetes, high blood pressure etc.
There is usually a chronic state of inflammation in obese persons. This may play a role in development of insulin resistance and result in poor oral health. Obesity ranks second in importance to smoking as the strongest risk factor for inflammatory periodontal tissue destruction.
Obesity and periodontal disease
The first report connecting obesity and periodontal disease appeared in 1977 among laboratory rats. It was noted that under healthy oral conditions, obesity per se does not promote pathologic periodontal changes. The periodontal changes and severe damage is seen in response to bacterial plaque accumulation.
Human reports first came in 1998 among Japanese adults. Studies show that increasing body mass index (BMI) and waist to hip ratio was associated with increasing risk of periodontitis.
Body fat and periodontal disease
Data from the Third National Health and Nutrition Examination Survey (NHANES) also shows that there is a significant association between measures of body fat like BMI and waist to hip ratio and periodontal disease especially among young adults. The association is not very strong among middle-aged or older adults.
Periodontal measures among obese individuals
The various periodontal measures that were seen among obese individuals include:-
- average periodontal attachment loss
- average pocket depth
- average gingival bleeding index
- average calculus index
BMI and TNF alpha
There have been recent studies that reveal the presence of tumor necrosis factor alpha (TNF alpha), an inflammation marker, in the gingival crevice fluid among those with a high BMI.
High BMI may be contributing to increased reservoir of inflammation inducing cytokines in the body fat tissues. These may be increasing the inflammatory response in people with periodontal disease.
Obesity and diabetes in relation to periodontitis
Obesity and diabetes both are associated conditions. They are caused by high calorie and high fat diets. High levels of blood sugar, inflammation and insulin resistance contributes to inflammation and periodontitis.
Diabetes is associated with intake of foods with a high glycemic index (GI). Foods like fibre rich foods are considered to be healthy and these require adequate chewing. These foods are good for oral and gum health as well as for prevention of diabetes and obesity.
Evaluation of the NHANES III study also showed that people with fewer than 28 teeth took less amounts of fibre rich foods like carrots, tossed salads, and dietary fibers. The study showed that subjects with diabetes and insulin resistance had more severe periodontitis than those without these diseases.
Obesity in dentistry
Because of the recognized importance of obesity in oral health, dentists and oral hygienists usually emphasize on obesity prevention and management. This is more important because, studies as well as the NHANES data reveal that a large proportion of men who had a moderate risk of experiencing a cardiovascular or heart event (e.g. a heart attack) within 10 years, had not seen a physician in the previous 12 months, but had seen a dentist.