Evaluation of oral health related to body mass index

Association between Periodontal Disease and Obesity: Umbrella Review

Objective: Determine the association between periodontal disease (PD) and obesity through an umbrella review. Materials and Methods: A search for information until March 2024 was carried out in the following electronic databases: PubMed, Cochrane library, Scopus, SciELO, Web of Science, Google Scholar, Proquest Dissertations and Theses, and OpenGrey. We included studies that were systematic reviews (SR) with or without meta-analysis, without time or language restrictions, that evaluated primary studies that associated PD with obesity. Literary or narrative reviews, rapid reviews, intervention studies, observational studies, preclinical and basic research, summaries, comments, case reports, protocols, personal opinions, letters, and posters were excluded. The AMSTAR-2 tool was used to determine the quality and overall confidence of the included studies. Results: The preliminary search yielded a total of 419 articles, discarding those that did not meet the selection criteria, leaving only 14 articles. All studies reported that PD was associated with obesity, with an OR and RR ranging from 1.1 to 1.46 and 1.64 to 2.21, respectively. Conclusions: Based on the results and conclusions of the SR with a high overall confidence level, PD is associated with obesity.

The Healthy Eating Index and oral health among adults: a cross-sectional study from an Iranian RaNCD cohort data

This study was conducted to investigate the association between decayed, missing, and filled teeth (DMFT) index and nutritional status measured by Healthy Eating Index 2015 (HEI-2015), in Iranian adults. In this cross-sectional study, data from the Ravansar non-communicable diseases cohort study were analyzed. DMFT index was employed as a measurement of oral health. The HEI-2015 score was calculated based on data obtained from Food Frequency Questionnaire and categorized into quartiles. Linear regression models were used to assess the association between HEI-2015 and DMFT. From total of 7549 participants with the mean age of 45.65 ± 7.70, 3741 of them were female (49.56%). The mean of DMFT in the highest quartile of HEI-2015 was lower than the lowest quartile (12.64 ± 7.04 vs. 14.29 ± 7.54, P < 0.001). The mean of DMFT in subject who had higher socioeconomic status (SES (was significantly lower than those with low SES (P < 0.001). The mean of DMFT in the lowest quartile of HEI-2015 was significantly lower than in the highest quartile, after adjusting for confounding variables (ß = - 0.11, 95% CI - 0.54, - 0.30). The increasing dairy intake (β = - 0.08, 95% CI - 0.13, - 0.03) was associated with decreasing DMFT score and increasing refined grains (β = 0.20, 95% CI 0.02, 0.35) and sodium (β = 0.07, 95% CI 0.02, 0.12) intake was significantly associated with increasing DMFT score. A healthy diet was associated with a decrease in DMFT score in the studied population. Following a healthy diet is recommended for oral health.

Obesity and periodontitis: A systematic review and updated meta-analysis

BACKGROUND

A previous 2014 meta-analysis reported a positive association between obesity and periodontitis. It was considered necessary to update the recently published papers and to analyse subgroups on important clinical variables that could affect the association between obesity and periodontitis. Therefore, we updated the latest studies and attempted to derive more refined results.

METHODS

All observational studies were eligible for inclusion. The Newcastle-Ottawa scale was used to qualitatively evaluate the risk of bias. Subgroup analyses were conducted for patients aged 18-34, 35-54, and 55+ years and the countries (European countries, USA, Brazil, Japan, Korea, and other Asian countries).

RESULTS

Thirty-seven full-text articles were included. Obesity conferred increased odds of periodontal disease with an odds ratio (1.35, 95% CI: 1.05-1.75). In the subgroup analysis by age, the odds ratio was the highest in the 18-34 years group (2.21, 95% CI: 1.26-3.89). In the subgroup analysis by country, European countries had the highest odds ratio (2.46, 95% CI: 1.11-5.46).

CONCLUSION

Despite the differences in degree, a positive association between obesity and periodontitis was found regardless of country or age. Therefore, medical professionals should try to prevent periodontitis by controlling patient weights, and more studies should be conducted to determine the association between obesity and oral health.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, identifier CRD42022301343.

Association between obesity and traumatic dental injuries in pre-school children-A case-control study

BACKGROUND/AIM

Obese children are more prone to accidents due to poorer motor skills which increase the likelihood of falls and the occurrence of traumatic dental injuries (TDIs). The aim of this study was to determine the association between overweight/obesity and TDI in pre-school children.

MATERIAL AND METHODS

The case group was formed by children with TDI identified during a clinical examination (n = 262). Each pre-school child identified as a case was matched by a peer of the same age, gender and pre-school but without TDI to form the control group (n = 262). TDI was evaluated using the criteria proposed by Andreasen. The weight and height of the children were measured for the calculation of the body mass index which was plotted on the growth curve established by the World Health Organization. Socio-demographic variables were collected through questionnaires sent to the parents/guardians. Data analysis involved the determination of frequency distribution, the chi-square test and logistic regression analysis.

RESULTS

The sample was composed of 253 children in each group. Among the children in the case group, 15.4% (n = 39) were overweight and 15.8% (n = 40) were obese. In the control group, 13.8% (n = 35) were overweight and 8.3% (n = 21) were obese. Children with trauma were more likely to be obese than children without trauma (OR = 2.05; 95%CI: 1.14 to 3.67; p = .016). In contrast, TDI was not associated with being overweight. A greater odds of TDI was also associated with an open bite (OR = 3.61; 95% CI: 1.64 to 7.96; p = .001) and accentuated overjet (OR = 2.19; 95% CI: 1.37 to 3.50; p = .001).

CONCLUSIONS

Pre-school children with a history of dental trauma were more likely to be obese than those without a history of dental trauma whereas being overweight was not associated with TDI.

The relationship between body mass index and stage/grade of periodontitis: a retrospective study

OBJECTIVES

Possible impact of obesity on stage and grade of periodontitis has never been investigated before. This study aimed to examine the association between body mass index (BMI) and stage/grade of periodontitis per the current classification of periodontal diseases.

MATERIAL AND METHODS

A total of 142 patients (82 males/60 females) were included in this study. "2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions" was taken as basis to characterize the stage/grade of periodontitis. Age, gender, smoking status, and frequency of tooth brushing, and medical data of the patients including hypertension, hyperlipidemia, BMI, and diabetes mellitus were obtained from the patient's hospital records. Obesity was assessed by BMI using the "World Health Organization" criteria. For estimating the association between BMI and periodontitis, logistic regression analysis was utilized.

RESULTS

BMI was statistically associated with clinical attachment loss (CAL), probing pocket depth (PPD), Plaque index (PI), stage and grade of periodontitis, and number of remaining teeth (p < 0.001, p < 0.05, p < 0.05, p < 0.05, p < 0.001, respectively). According to the multiple regression analysis results, those with BMI 25-29.9 were found to be at risk of being stage III-IV 3.977 times (95% CI: 1.831-8.640, p < 0.001) higher than those with BMI < 25, and similarly, those with BMI ≥ 30 were found to be at risk of being stage III-IV 4.062 times (95% CI: 1.315-12.549, p = 0.015) higher than those with BMI < 25. No relationship was found between obesity and grade of periodontitis according to multivariate analysis.

CONCLUSIONS

BMI increases the likelihood of stage III and stage IV periodontitis; however, it does not have an impact on the grade of periodontitis.

CLINICAL RELEVANCE

It seems that obesity is related to the severity of periodontitis.

Predictors of Limited Access to Dental Health Care Among NYC Taxi/FHV Drivers

Taxi and for-hire vehicle (FHV) drivers are a largely immigrant, low-income occupational group at increased cardiovascular disease (CVD) risk. Poor dental health is a CVD risk factor, and dental care access is an unexamined taxi/FHV driver CVD risk factor. A cross-sectional survey was administered to 422 taxi/FHV drivers (2016-2017) to identify predictors of access to dental health care among drivers. One-third (n = 128, 30.3%) reported needing dental care/tests/treatment within the past six months, and nearly one-half (n = 61, 48%) were delayed/unable to obtain care. Only 57.6% (n = 241) had past-year dental cleanings. Not having enough money to cover household expenses was a significant predictor of being delayed/unable to obtain needed dental care/tests/treatment in the prior six months (0.5 OR; 95% CI, 0.28-0.89; p < .05). Lack of dental insurance coverage (2.72 OR; 95% CI, 1.60-4.63; p < .001) or lack of primary care provider (2.72 OR; 95% CI, 1.60-4.63; p < .001) were associated with lack of past-year dental cleaning. Seventeen percent of drivers with Medicaid were unaware of their dental coverage, which was associated with both inability to access needed dental care/tests/treatment in the past 6 months (p = .026) and no past-year dental cleaning (p < .001). Limited understanding of dental coverage was associated with both an inability to access needed dental care/tests/treatment in the past 6 months (p = .028) and lack of past-year dental cleaning (p = .014). Our findings can inform targeted intervention development to increase taxi/FHV driver dental care access/uptake, potentially improving their CVD risk.

Association between clinical measures of gingival inflammation and obesity in adults: systematic review and meta-analyses

OBJECTIVE

This study aimed to systematically review the literature about the association between clinical measures of gingival inflammation and obesity in adults.

MATERIAL AND METHODS

Searches for studies were performed in five databases (Medline-PubMed, Scopus, Web of Science, Cochrane Library, and Embase) to compile studies of any design that evaluated the association between clinical measures of gingival inflammation and obesity in adults. Selection of studies, data extraction and risk of bias analysis were performed independently by two reviewers, and a third researcher was involved to resolve disagreements. Meta-analyses were performed for measures of gingival inflammation as compared to body mass index (BMI). Independent analyses were performed for studies involving periodontitis, gingivitis, and population-based/studies that did not provide a periodontal diagnosis. Standard mean deviation (SMD) and its 95% confidence interval (95%CI) were estimated.

RESULTS

Ninety studies were included (cross-sectional/clinical trials [n=82], case-control [n=3], cohorts [n=5]). Most of the studies demonstrated no significant difference in the measures of gingival inflammation regardless of the comparison performed. However, meta-analysis showed that among individuals with periodontitis, significantly higher levels of gingival inflammation are observed in those with obesity (n of individuals=240) when compared to those who were not obese (n of individuals=574) (SMD:0.26; 95%CI:0.07-0.44). When considering population-based/those studies that did not provide periodontal diagnosis, significantly higher measures of gingival inflammation were observed in the groups with higher BMI.

CONCLUSIONS

Within the limitations of the present study, it was concluded that higher measures of gingival inflammation may be expected for those with higher BMI.

CLINICAL RELEVANCE

Clinicians must be aware that higher measures of gingival inflammation may be expected for individuals with higher BMI. However, there is a necessity for further longitudinal studies regarding the association between obesity and gingival inflammation.

Plasmid encoding microRNA-200c ameliorates periodontitis and systemic inflammation in obese mice

The present study was conducted to characterize microRNA-200c (miR-200c) and its regulators in adipogenic differentiation, obesity, and periodontitis in obese subjects (PiOSs), and to determine the therapeutic efficacy of plasmid DNA encoding miR-200c as a treatment for PiOSs. We report that highly expressed miR-200c in gingival tissues was downregulated in diet-induced obese (DIO) mice and during adipogenic differentiation of human bone marrow mesenchymal stromal cells (hBMSCs). Local injection of Porphyromonas gingivalis lipopolysaccharide (Pg-LPS) in the maxilla interdental gingiva of DIO mice reduced miR-200c in gingival and adipose tissues and induced periodontal inflammation associated with systemic elevation of interleukin-6 (IL-6) and impaired glucose tolerance. The inhibitory functions of Pg-LPS and IL-6 on miR-200c and their effectiveness on Zeb1 were confirmed in vitro. Injection of naked plasmid DNA encoding miR-200c into the gingiva effectively rescued miR-200c downregulation, prevented periodontal and systemic inflammation, and alleviated the impaired glucose metabolism in obese mice with LPS-induced periodontitis. Increased circulating exosomal miR-200c and its function on suppressing proinflammatory cytokines and adipogenesis explained the mechanism(s) of gingival application of miR-200c in attenuating systemic inflammation in PiOSs. These results demonstrated that miR-200c reduced by Pg-LPS and IL-6 in periodontitis and obesity might lead to the pathogenesis of PiOSs, and upregulation of miR-200c in the gingiva presents a therapeutic approach for PiOSs.

Competing interplay between systemic and periodontal inflammation: obesity overrides the impact of oral periphery

Objectives

We aimed at investigating whether the interaction between the local inflammation, periodontitis, and obesity is independently associated with systemic inflammation.

Methods

From the population-based Study of Health in Pomerania, 3366 participants, without (2366) and with (1000) obesity, were studied for the association of periodontitis, measured as probing depth (PD) and plaque together with body mass index (BMI) on C-reactive protein (CRP). Quantile regression was used to evaluate the association between periodontal, anthropometric, and inflammatory variables (outcomes).

Results

The overall prevalence of obesity in this adult population was 31.4% in men and 28.1% in women. Both PD and plaque were positively associated with CRP, revealing an increasing impact across the CRP concentration distribution. Adjusting the regression of CRP or fibrinogen on PD for waist circumference attenuated but did not abolish the PD coefficients. Dental plaque was similarly associated with these interrelations. Association between PD and a dental plaque was different among participants with low-, medium-, or high-risk CRP concentrations.

Conclusion

Local and systemic sources of inflammation contribute to blood levels of inflammatory markers. The respective contributions depend on the relative rate in each of the inflammation-inducing risks and are dominated by adiposity.

Clinical relevance

Keeping systemic inflammation low in order to prevent age-related disease sequelae.

Electronic supplementary material

The online version of this article (10.1007/s00784-020-03514-y) contains supplementary material, which is available to authorized users.

Oral Health, Diet, and Frailty at Baseline of the Canadian Longitudinal Study on Aging

OBJECTIVES

Poor diet due to poor oral health was proposed as a potential mediator of the association between poor oral health and frailty. This study explores the cross-sectional associations between poor oral health, poor diet, and frailty in Canadian adults, aged 45 to 85 years, and then tests whether the expected oral health-frailty association is changed by taking into account the pathway through poor diet.

DESIGN

Cross-sectional study.

SETTING

The baseline wave of the Canadian Longitudinal Study on Aging, a nationally representative population study.

PARTICIPANTS

Data from 28 738 community-dwelling participants, aged 45 to 85 years.

MEASUREMENTS

We characterized poor oral health (cumulative count of 24 items of oral health problems), poor diet (scale of poor food consumption from 7 healthy foods groups), and frailty (cumulative frailty index of 76 items). Regression-based path analyses were used to investigate associations between poor oral health, poor diet, and frailty, adjusted for age group, sex, income, smoking, living alone, education, physical activity, social support, and dental visit.

RESULTS

Poorer oral health was associated with low income, smoking, low physical activity, low social support, and no dental visit. There were associations between poorer oral health and poorer diet (effect size β adjusted = .40; 95% confidence interval [CI] = .20-.61) and between poorer oral health and increased frailty (β adjusted = .85; 95% CI = .68-1.02). The indirect effect through the path of poor diet was approximately 0.01 (95% CI = 0.01-0.02) (ie, explaining ∼1% of the effect of poor oral health on frailty).

CONCLUSIONS

Poor oral health was associated with poor diet and frailty. Each additional oral health problem was associated with an increase of approximately 1 frailty index point, even after full adjustment for poor diet. The indirect effect of poor oral health through poor diet was modest. Though poor oral health was associated with poorer diet quality, a more direct effect of poor oral health on increasing frailty may be indicated. J Am Geriatr Soc 68:959-966, 2020.

Self-perceived oral health among institutionalized older adults in Taubate, Brazil

PURPOSE/AIM

To assess self-perception of oral health among institutionalized older adults in Taubate, Brazil.

METHOD AND MATERIALS

Demographics, oral, and systemic health data were collected from a sample of 89 institutionalized older adults. The Geriatric Oral Health Assessment Index (GOHAI) was applied to assess their self-perception of oral health. A linear regression model using GOHAI scores and considering age, BMI, gender, race, dry mouth, denture status, number of teeth, number of comorbid conditions, and number of medications as independent variables was generated.

RESULTS

Fifty-five percent were male, with an average age of 75.9 years (±9.1), 43.8% identified as mixed race, and 42.7% as white. The average BMI was 23.9 (±3.8), the average number of comorbid condition was 1.8 (±1.4), and the average number of daily medications was 6.2 (±3.6). The average number of teeth was 3.9 (±7.4), and 57.3% of the participants reported dry mouth sensation; 8.9% presented oral lesions, with denture stomatitis as the most common oral lesion (5.6%). The average GOHAI score was 31.1 (±3.7). Regression analysis showed a negative correlation between BMI and GOHAI scores (P = .032, R²  = 7.2%).

CONCLUSIONS

Self-perception of oral health was good and negatively correlated with BMI.

Association of dietary habits with restorative dental treatment need and BMI among Finnish conscripts: a cross-sectional epidemiological study

OBJECTIVE

Processed foods and fatty, sugary snacking products, such as fizzy drinks and desserts, have become more popular, causing a desire to replace meals with snacks worldwide. High-sugar and fat-rich food components have been reported to be associated with increased level of dental caries as well as underweight and overweight. The aim of the present cross-sectional population-based study was to analyse the eating behaviours of young, healthy Finnish males in association with oral health and BMI, considering self-reported and residential background factors.

DESIGN

Cross-sectional study.

SETTING

Finnish Defence Forces, Finland.

PARTICIPANTS

The used clinical data were gathered from 13 564 Finnish conscripts born in the beginning of the 1990s through clinical check-ups. In addition, about 8700 of the conscripts answered a computer-assisted questionnaire ('Oral Health of the Conscripts 2011' data) about their background information and health habits.

RESULTS

There was distinct variation in dietary patterns. Eating breakfast, regular physical exercise and daily tooth brushing all decreased the odds for restorative dental treatment need (decayed teeth), whereas smoking and drinking fizzy drinks for quenching thirst increased it. Eating breakfast and dinner were each associated with lower BMI, but smoking increased the odds for higher BMI (≥25 kg/m2).

CONCLUSIONS

Regular, proper meals and especially eating breakfast decreased the odds for both dental caries and high BMI (≥25 kg/m2).

Fewer teeth are a risk factor for being underweight in community-dwelling Japanese aged 40 years and older: The Yamagata (Takahata) Study

OBJECTIVE

The aim of the present study was to investigate comprehensively, the risk factors for underweight in cross-sectional study in the general population of Japan.

METHODS

The survey population was the general population of individuals aged >40 years in Takahata town, Japan in 2005. A postal survey in the form of a self-administered questionnaire was distributed, and 6084 individuals were entered into the final statistical analysis. The self-administered questionnaire contained items regarding lifestyle, oral health status, socio-economic status and dietary intake. To examine the independent relationships between an underweight status and several parameters, a multivariate logistic regression analysis was used to estimate adjusted odds ratios (ORs).

RESULTS

The number of teeth, age, alcohol consumption, hypertension, spousal status, smoking habit, appetite, body weight at 20 years of age, habit of going out and physical activity were independently associated with an underweight status compared with the normal weight group. Individuals with fewer than 10 teeth were especially more likely to be underweight than individuals with more than 20 teeth (OR = 1.956, 95% CI = 1.261-3.035).

CONCLUSION

This study showed an independent association between the number of teeth and an underweight status, indicating that fewer teeth can increase the risk of being underweight.

Is there a relationship between obesity and tooth loss and edentulism? A systematic review and meta-analysis

This study conducted a systematic review to assess the bi-directional association between tooth loss/edentulism and obesity. Electronic searches were performed in four different databases. Observational studies that tested associations between tooth loss/edentulism and obesity as either exposures or outcomes were included. Additionally, meta-analyses, funnel plots and sensitivity analyses were conducted to synthesize the evidence. A total of 549 articles were identified in the electronic database search. Out of which, 16 studies were included within the meta-analyses: 75% considered tooth loss/edentulism as exposure and obesity as outcome, whereas 25% alternatively considered obesity as exposure and tooth loss/edentulism as outcome. Pooled estimates showed that obese individuals had 1.49 (95%CI 1.20-1.86) and 1.25 (95%CI 1.10-1.42) times higher odds of having any tooth loss and edentulism, respectively. Alternatively, when tooth loss or edentulism were considered as exposures, individuals with any tooth loss had 1.41 (95%CI 1.11-1.79) times higher odds for obesity, while edentates had even higher odds (OR 1.60; 95%CI 1.29-2.00). The results indicate a bi-directional association between tooth loss and obesity. Considering that all selected studies were of cross-sectional study design limiting inferences on temporality, longitudinal prospective studies are required to test the causal relationship between tooth loss/edentulism and obesity or vice a versa. © 2016 World Obesity.

Tooth loss and metabolic syndrome in middle-aged Japanese adults

AIM

Metabolic syndrome is associated with periodontal disease and dental caries; however, little attention has been given to the association between metabolic syndrome and tooth loss, which is the endpoint of these two diseases. This study examined this association in middle-aged adults over a 5-year period.

METHODS

A retrospective study was performed in 2107 participants (1718 males and 389 females) aged 35-60 years who underwent annual dental check-ups, to evaluate tooth loss and metabolic components, including obesity, elevated triglycerides, blood pressure, fasting glucose, and reduced high-density lipoprotein. Logistic regression analysis was performed to evaluate the association between metabolic syndrome (≥3 components) at the baseline examination and tooth loss.

RESULTS

Over a 5-year period, 10.8% of the participants lost at least one tooth. Compared to those with no metabolic components, participants with ≥3 components had an increased risk of tooth loss (odds ratio = 1.54; 95% confidence interval: 1.01-2.37), adjusting for age, gender, dental caries experience, attachment loss, oral hygiene status, number of teeth, tooth brushing frequency, smoking, and occupational status.

CONCLUSIONS

Metabolic syndrome was associated with the incidence of tooth loss among middle-aged adults.

Poor Oral Health and Diet in Relation to Weight Loss, Stable Underweight, and Obesity in Community-Dwelling Older Adults: A Cross-Sectional Study From the JAGES 2010 Project

BACKGROUND

Involuntary weight loss and underweight increase the risks of mortality and disability in older people. However, the association and interaction of poor oral health and dietary intake with body mass index (BMI) have not been elucidated.

METHODS

Data were analyzed for 96 794 respondents aged >65 years who were randomly selected from 31 Japanese municipalities in the Japan Gerontological Evaluation Study. Weight loss was defined as ≥2-3 kg of loss over the preceding 6 months. BMI was evaluated in respondents without weight loss. Multiple logistic regression analysis was performed with weight loss, underweight, and obesity as dependent variables and having fewer teeth (<20) and infrequent food intake as independent variables, with adjustment for potential confounders.

RESULTS

Weight loss was associated with having fewer teeth (men: odds ratio [OR] 1.3; 95% confidence interval [CI], 1.2-1.3; women: OR 1.2; 95% CI, 1.1-1.3) and infrequent fruit/vegetable intake (men: OR 1.1; 95% CI, 1.1-1.2; women: OR 1.4; 95% CI, 1.3-1.5) and fish/meat intake (OR 1.2; 95% CI, 1.1-1.3 for both sexes). No interaction was observed between having fewer teeth and food intake. Obesity was associated with the same factors: having fewer teeth (ORs 1.2 and 1.3 for men and women, respectively) and infrequent intake of fruit/vegetables (ORs 1.1 and 1.2 for men and women, respectively) and fish/meat (OR 1.1 for both sexes). Infrequent fruit/vegetable intake showed a higher OR for underweight in women with fewer teeth than for others.

CONCLUSIONS

Having fewer teeth and infrequent food intake were associated with both weight loss and obesity. A significant interaction was observed in the associations of having fewer teeth and infrequent food intake with underweight in women.

Host response, obesity, and oral health

Proper food choices are part of preventing or reducing the risk of dental caries and periodontal disease. A significant association has been proven between oral diseases and the incidence of systemic diseases. Obesity, just like smoking, is one of the major risk factors for oral disease and is a serious social problem that has reached epidemic proportions in many developed countries. The results of studies on periodontitis confirm the relationship between the values of body mass index (BMI) and the prevalence of periodontal diseases. Adipose tissue is an active endocrine organ and it performs many important functions in the body, such as thermal isolation and protection, storage, and secretion. Many cytokines are secreted proportionally to the amount of fat present and are actively involved in the metabolism of the whole system, including the functioning of the immune system. Therefore, obesity may alter the response of the host to the antigens derived from bacterial plaque, and thus cause disturbances in the inflammatory response in the course of periodontal disease.

Are overweight/obese children at risk of traumatic dental injuries? A meta-analysis of observational studies

BACKGROUND/AIM

Observational studies which investigated the association between overweight/obesity and traumatic dental injuries (TDI) reported contrasting results. Thus, this meta-analysis was designed to investigate such an association with the highest possible levels of internal and external validities.

MATERIAL AND METHODS

A comprehensive literature search was performed through PubMed, ISI Web of Science, Cochrane Library, Scopus, Google scholar to ensure generalizability. Eligible studies reported clear case and control definitions, exposure assessment. Where possible, odds ratio (OR) adjusted for covariates was extracted. Study quality was assessed through Newcastle-Ottawa Scale (NOS). Only fair-to-good quality studies with NOS scores ≥4 were selected. The method to assess the pooled OR was based on the level of between-study heterogeneity, estimated through the Cochran's Q. Reliability of the pooled OR was improved by controlling for publication bias, sensitivity analysis to study inclusion, and subgroup analyses according to tooth type (permanent vs primary teeth) and country where the study was performed (Brazilian studies vs studies from other countries).

RESULTS

Seventeen studies were selected from America, Asia, and Europe, their NOS scores ranged between 4 and 8. Overall, there were almost 28,000 patients, 7400 of them with TDI. The level of publication bias was minimal, and no adjustment was necessary. Between-study heterogeneity was high, and the random-effects method was used to assess the pooled OR, which resulted 1.30 (95% confidence interval, 1.11-1.53; P < 0.05). Sensitivity and subgroup analyses corroborated this estimate.

CONCLUSION

The choice to increase internal and external validity levels decreased the precision of the pooled OR (i.e., confidence intervals were relatively wide). The statistically significant overweight/obesity-TDI association, together with the so-called counterfactual condition (i.e., TDI prevalence was higher among overweight/obese children than among lean children), suggests that causal association between these two conditions is plausible.

Beta-diversity metrics of the upper digestive tract microbiome are associated with body mass index

OBJECTIVE

Studies of the fecal microbiome have implicated the gut microbiota in obesity, but few studies have examined the microbial diversity at other sites. The association between obesity and the upper gastrointestinal (UGI) microbial diversity was explored.

METHODS

The UGI microbiome of 659 healthy Chinese adults with a measured body mass index (BMI) range of 15.0 to 35.7 was characterized using the 16S rRNA gene DNA microarray (HOMIM).

RESULTS

In multivariate-adjusted models, alpha diversity was not associated with BMI. However, beta diversity, assessed by principal coordinate vectors generated from an unweighted UniFrac distance matrix of pairwise comparisons, was associated with BMI (third and fourth vectors, P = 0.01 and P = 0.03, respectively). Moreover, beta diversity, assessed by cluster membership (three clusters), was also associated with BMI; individuals in the first cluster [median BMI 22.35, odds ratio (OR) = 0.48, 95% confidence interval (CI) = 0.05-4.34] and second cluster [median BMI 22.55, OR = 0.26, 95% CI = 0.09-0.75] were significantly less likely to be obese (BMI ≥ 27.5) than those in the third cluster (median BMI 23.59).

CONCLUSIONS

A beta-diversity metric of the UGI microbiome is associated with a four fold difference in obesity risk in this Asian population. Future studies should address whether the UGI microbiome plays a causal role in obesity.

Association between periodontal disease and overweight and obesity: a systematic review

BACKGROUND

Periodontitis and obesity are among the most common chronic disorders affecting the world's populations, and recent reviews suggest a potential link between overweight/obesity and periodontitis. However, because of the scarcity of prospective evidence, previous reviews were primarily based on cross-sectional studies, with only a few longitudinal or intervention studies included. This study's objective is to examine the time-dependent association between obesity and periodontitis and how weight changes may affect the development of periodontitis in the general population. Therefore, longitudinal and experimental studies that assessed the association among overweight, obesity, weight gain, waist circumference, and periodontitis are reviewed.

METHODS

Intervention and longitudinal studies with overweight or obesity as exposure and periodontitis as outcome were searched through the platforms PubMed/Medline and Web of Knowledge.

RESULTS

Eight longitudinal and five intervention studies were included. Two of the longitudinal studies found a direct association between degree of overweight at baseline and subsequent risk of developing periodontitis, and a further three studies found a direct association between obesity and development of periodontitis among adults. Two intervention studies on the influence of obesity on periodontal treatment effects found that the response to non-surgical periodontal treatment was better among lean than obese patients; the remaining three studies did not report treatment differences between obese and lean participants. Among the eight longitudinal studies, one study adjusted for C-reactive protein (CRP) and biologic markers of inflammation such as CRP, interleukin-6, and tumor necrosis factor-α, and inflammation markers were analyzed separately in three of the five intervention studies.

CONCLUSION

This systematic review suggests that overweight, obesity, weight gain, and increased waist circumference may be risk factors for development of periodontitis or worsening of periodontal measures.

Pocket depth and bleeding on probing and their associations with dental, lifestyle, socioeconomic and blood variables: a cross-sectional, multicenter feasibility study of the German National Cohort

Background

To investigate the periodontal disease status in a multi-center cross-sectional study in Germany. Associations of dental, socio-economic, blood and biomedical variables with periodontal outcome parameters were evaluated.

Methods

From 4 different centers N = 311 persons were included, drawn randomly from the registration offices. Maximal pocket depth (PD) was used as primary indicator for periodontitis. It was classified as: no/mild ≤3 mm, moderate 4-5 mm, severe ≥6 mm. Associations between socioeconomic (household income, education), lifestyle, and biomedical factors and PD or bleeding on probing (BOP) per site (“Yes”/”No”) was analyzed with logistic regression analysis.

Results

Mean age of subjects was 46.4 (range 20–77) years. A significantly higher risk of deeper pockets for smokers (OR = 2.4, current vs. never smoker) or persons with higher BMI (OR = 1.6, BMI increase by 5) was found. Severity of periodontitis was significantly associated with caries lesions (p = 0.01), bridges (p < .0001), crowns (p < .0001), leukocytes (p = 0.04), HbA1c (p < .0001) and MCV (p = 0.04). PD was positively correlated with BOP. No significant associations with BOP were found in regression analysis.

Conclusions

Earlier findings for BMI and smoking with severity of PD were confirmed. Dental variables might be influenced by potential confounding factors e.g. dental hygiene. For blood parameters interactions with unknown systemic diseases may exist.

Is obesity a possible modifier of periodontal disease as a chronic inflammatory process? A case-control study

BACKGROUND AND OBJECTIVE

This cross-sectional case-control study was conducted to provide a comparative evaluation of clinical periodontal measurements, together with serum levels of certain bioactive peptides and inflammatory cytokines, in relation to obesity. For this purpose, clinical periodontal measurements and the levels of serum leptin, adiponectin, interleukin-6 (IL-6), C-reactive protein and soluble intercellular adhesion molecule-1 of obese female individuals and their nonobese counterparts were compared.

MATERIAL AND METHODS

Sixty obese (body mass index (BMI) > 30) and 31 nonobese (BMI < 30) female subjects were recruited for the present study. Before any periodontal intervention, serum samples were obtained and full-mouth clinical periodontal measurements were recorded at six sites per tooth. ELISA was used for the biochemical analysis. Data were tested statistically.

RESULTS

Clinical attachment level was significantly higher in the obese group compared with the nonobese control group (p < 0.05). Serum levels of leptin and IL-6 were significantly higher in the obese group (p < 0.05). BMI correlated with the serum levels of inflammatory molecules (p < 0.05), but not with clinical periodontal parameters, in the obese group.

CONCLUSION

In conclusion, obesity does not seem to have a prominent effect on clinical periodontal parameters but it does have many correlations with circulating inflammatory molecules. As suggested in the literature, increased levels of leptin and IL-6 in the obese group might be one explanation for a possible relationship between obesity and periodontal disease. A prospective study is warranted to clarify, in greater detail, the effects of obesity on periodontal health.

Orosomucoid, a new biomarker in the association between obesity and periodontitis

Epidemiological data indicate an association between periodontitis and obesity. The biological mechanisms of this relationship remain unclear. A cross-sectional study was conducted to evaluate the relationship between periodontitis and the common systemic inflammatory markers in 32 morbidly obese patients recruited in a Clinical Nutrition department. Periodontal condition was evaluated using pocket depth (PD) measurement, a classical clinical marker of ongoing periodontitis. Major periodontal risk factors were recorded (age, gender, diabetes and smoking status), as well as plasma levels of inflammatory markers (CRP, orosomucoid, IL-6) and adipokines (adiponectin, leptin). All patients included in the sample exhibited evidence of periodontitis, 16 of whom were diagnosed as having severe disease. Adjusted logistic regression analysis indicated that the severity of periodontitis was associated with the plasma level of orosomucoid (p<0.04) after adjustment for age, gender and smoking. Our study thus suggests that the severity of periodontitis, in morbidly obese patients, is associated with the increase of orosomucoid levels.

Prevalence and severity of periodontitis in Indonesian patients with rheumatoid arthritis

BACKGROUND

Patients with rheumatoid arthritis (RA) may have more prevalent and severe periodontitis than healthy controls. Periodontitis may increase the systemic inflammation in RA. The aim of this study is to assess periodontitis prevalence and severity and its potential association with systemic inflammation in Indonesian patients with RA.

METHODS

A full-mouth periodontal examination including probing depth, gingival recession, plaque index, and bleeding on probing was performed in 75 Indonesians with RA and 75 age-, sex-, and smoking-matched Indonesian controls. A validated questionnaire was used to assess smoking, body mass index, education, and medical conditions. In addition, in all participants, the use of drugs was noted, and erythrocyte sedimentation rates and serum levels of high-sensitivity C-reactive protein (hsCRP), rheumatoid factor, and anti-citrullinated protein antibodies were measured. Differences in periodontitis prevalence and 12 measures of periodontitis severity between patients with RA and controls were analyzed using univariate analyses.

RESULTS

No significant differences in periodontitis prevalence and 11 measures of periodontitis severity between patients with RA and controls were observed. Conversely, patients with RA had a significantly lower surface area of healthy pocket epithelium versus controls (P = 0.008), and a tendency toward higher hsCRP levels was observed in patients with RA with severe periodontitis compared with patients with RA with no mild or moderate periodontitis (P = 0.063). It has to be noted that all patients with RA were on anti-inflammatory drugs, whereas none of the controls used such drugs.

CONCLUSION

Prevalence and severity of periodontitis in Indonesian patients with RA is comparable to controls but with less healthy pocket epithelium than in controls and a tendency toward a higher inflammatory state in patients with RA and severe periodontitis.