Obesity prevention and intervention in dental practice

Inflammation as a link between periodontal disease and obesity

Nutrition plays a critical role in the homeostatic balance, maintenance of health, and longevity. There is a close link between inflammatory diseases and nutritional health. Obesity is a severe pathological process with grave implications on several organ systems and disease processes, including type 2 diabetes, cardiovascular disease, osteoarthritis, and rheumatoid arthritis. The impact of obesity on periodontal inflammation has not been fully understood; the association between nutritional balance and periodontal inflammation is much less explored. This review is focused on the potential mechanistic links between periodontal diseases and obesity and common inflammatory activity pathways that can be pharmacologically targeted.

Socioeconomic inequality in the provision of health advice in dental setting in England, Wales and Northern Ireland

OBJECTIVE

To assess socioeconomic inequalities in health advice provided in dental setting.

METHODS

Data were from the Adult Dental Health Survey, 2009 of England, Wales and Northern Ireland. Index of Multiple Deprivation, occupational classification and education were used to assess differences in advice on diet, oral hygiene and dental visits using logistic regression.

RESULTS

The analysis included 6279 participants with complete data. There were significant socioeconomic inequalities in all health advice provided in dental setting. Those with a higher level of education had significant odds ratios of 1.36 (1.06-1.75), 1.40 (1.15-1.70), and 1.82 (1.47-2.25) for having advice on diet, dental visits and oral hygiene, respectively compared to those with lower education.

CONCLUSION

Inequalities in health advice in the dental setting resemble inequalities in oral health. This implies that those who are most likely to need behaviour-related advice do not receive it. Health policies should address the underpinning causes of inequalities in health advice.

PRACTICE IMPLICATIONS

Growing evidence supports the importance of health advice given in dental practice. More time and greater resources should be allocated for comprehensive health advice particularly to the socially disadvantaged to reduce inequalities and subsequently promoting health-related behaviours.

Paediatric dentists' identification and management of underweight and overweight children

Introduction

Dental caries and obesity are growing challenges for the NHS. Dentists are in the unique position of being able to identify both conditions and intervene, following UK government strategy of 'making every contact count'.

Aims

Identify specialists in paediatric dentistry's (SPD) current practice regarding diagnosis and management of underweight or overweight/obese children presenting to dental services.

Materials and methods

An online survey was emailed to the UK SPD group. Questions investigated whether height, weight or body mass index (BMI) were measured, actions taken, and dentists' feelings regarding their role.

Results

49/118 (42%) SPDs responded. All felt they had a responsibility to identify underweight or overweight/obese children. Around a quarter (26%) measured BMI 'always' or 'often', while 37% did not measure BMI. Only 41% of SPDs who measured BMI took action more than twice in a year. Most commonly (90%) the child's GP was informed.

Conclusions

SPDs were supportive of the identification of underweight or overweight/obese children. However, many felt uncertain about BMI interpretation. Thus, few routinely measured BMI or acted on abnormal results. SPDs would benefit from training, alongside development of a local protocol, regarding BMI calculation and interpretation.

County-level correlation between adult obesity rates and prevalence of dentists

BACKGROUND

Investigators of previous studies regarding the correlation between area-level health care resources and obesity have not examined the association between the prevalence of dentists and rates of adult obesity. The authors conducted a study to address that knowledge gap.

METHODS

Using data compiled in the Robert Wood Johnson County Health Rankings and Roadmaps database, the authors conducted multivariable analyses of the relationship between the prevalence of dentists (from the 2011 Health Resources and Services Administration Area Resource File) and rates of obesity within counties. The authors controlled for prevalence of primary care providers, measures of the built environment (for example, number of recreational facilities per 10,000 population, the percentage of restaurants serving fast food) and county-level sociodemographic and economic factors.

RESULTS

When the authors conducted a multivariable analysis adjusted for state-level fixed effects, they found that having one additional dentist per 10,000 population was associated significantly with a 1-percentage point reduction in the rate of obesity (P < .001). This effect was significantly larger in counties in which 25 percent of children or more (versus less than 25 percent of children) lived in poverty and in counties that had more primary care physicians per 10,000 population (P ≤ .009).

CONCLUSIONS

The association between the prevalence of dentists and obesity, even after adjusting for primary care resources and sociodemographic factors, was evident. Although these data could not be used to assess causality, given the strength of the ecological, cross-sectional association, additional research involving person-level, longitudinal data is warranted.

PRACTICAL IMPLICATIONS

The correlation between the prevalence of dentists and obesity rates highlights the potential for dental professionals, as well as other primary care providers, to provide meaningful health education and support for improved nutritional behaviors, although the increased obesity rates in counties with fewer dentists per capita present challenges.

Type 2 diabetes risk screening in dental practice settings: a pilot study

BACKGROUND

Dental surgeries are highlighted in the 2012 NICE guidance Preventing type 2 diabetes: risk identification and interventions for individuals at high risk as a suitable setting in which to encourage people to have a type 2 diabetes risk assessment.

AIM

To assess the feasibility of implementing a type 2 diabetes risk screening pathway in dental settings using the NICE guidance tool.

METHOD

The study was carried out over two weeks in June 2013. The validated tool in the NICE guidance was used to determine risk. This included a questionnaire and BMI measurement used to determine a risk score. Patients were rated low, increased, moderate or high risk. All patients were given written advice on healthy lifestyle. Patients who were moderate or high risk were referred to their general medical practitioners for further investigation. Participating dental teams were asked to nominate a member who would be responsible for overseeing the screening and training the other team members.

RESULTS

A total of 166 patients took part in the pilot (58% male, 75% aged 49 years or younger and 77% were from BME groups). Twenty-six low risk patients (15.7%), 61 increased risk patients (36.7%), 49 moderate-risk patients (29.5%) and 30 high-risk patients (18.1%) were identified during the pilot. Fifteen of the 49 patients (30.6%) identified as moderate-risk and 6 of the 30 high-risk patients (20%) had visited their GP to discuss their type 2 diabetes risk in response to the screening.

CONCLUSION

The pilot suggests that people at risk of developing type 2 diabetes could be identified in primary, community and secondary dental care settings. The main challenges facing dental staff were time constraints, limited manpower and the low number of patients who visited their GP for further advice.

Weighing in on pediatric obesity: Weight screening at the dental visit

BACKGROUND AND OVERVIEW

Pediatric obesity is a public health concern requiring an interprofessional approach to care. Weight screening in the dental office can promote healthy behaviors to improve weight and oral health status and reduce systemic and oral health risks.

CONCLUSIONS

Oral health care professionals can perform weight screenings quickly. Routine weight screening of pediatric patients and early intervention through education and referral of patients to a registered dietitian nutritionist and a physician for more in-depth evaluation may help reduce disease risk.

PRACTICAL IMPLICATIONS

Oral health care professionals can measure a patient's height and weight and can easily calculate body mass index percentile according to a patient's age and sex to detect weight status that does not fall within the normal range. Oral health care professionals should refer patients who are underweight, overweight, or obese to a registered dietitian nutritionist and the patient's physician for follow-up.

Obesity and its association with comorbidities and hospital charges among patients hospitalized for dental conditions

AIM

The aim of the present study was to examine the impact of obesity on hospitalization charges and comorbid burden following hospitalization due to dental conditions.

METHODS

The Nationwide Inpatient Sample for 2004-2010 was used. All hospitalizations due to dental conditions were selected. The prevalence of obesity was estimated among these hospitalizations. Multivariable linear regression models were used to examine the impact of obesity on outcomes.

RESULTS

A total of 11 965 hospitalizations were attributed to dental conditions; 5.6% were related to obesity. The proportion of those who were obese increased over the study period (ranging from 3.7% in 2004 to 7.3% in 2010). The mean age of those who were obese was 45 years (compared to 38.7 years for those who were not obese). Close to 41% of those who were obese were males (compared to 51% who were not obese). Whites comprised 62.4% of those who were obese (compared to 59.2% of those who were not obese). Those who were obese had a higher comorbid burden compared to those who were not obese (83.5% of those who were obese had at least one comorbid condition, whereas 56.4% of those who were not obese had at least one comorbid condition). Those who were obese had higher hospitalization charges ($US2225 more, P = 0.0001).

CONCLUSIONS

Obesity is associated with high comorbid burden and hospital charges among patients hospitalized due to dental conditions.