Relationship between increases in BMI and changes in periodontal status: a prospective cohort study

Interlinked Pathways: Exploring the Bidirectional Impacts of Periodontitis and Metabolic Syndrome

Metabolic syndrome (MBS) and periodontitis are distinct conditions with overlapping and unique risk factors. Periodontitis is a chronic destructive disease of the periodontium, driven by alterations in the host immune-inflammatory response to virulent periodontal pathogens. MBS is characterized by various abnormalities, including visceral abdominal obesity, dyslipidemia (low high-density lipoprotein (HDL) and high triglyceride (TG) levels), hypertension, and hyperglycemia. These factors collectively increase the risk of atherosclerotic cardiovascular disease (CVD) and diabetes. Several pro-inflammatory mediators are involved in the pathogenesis of periodontitis and MBS, and the deleterious bidirectional effects of these mediators exacerbate the severity and progression of both conditions. This comprehensive review focuses on the intricate relationship between MBS and periodontitis. Specifically, it explores the pathophysiological mechanisms of each disease component of MBS and its impact on periodontitis, and vice versa.

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 relationship between obesity and oral-health status in North African adults: A comparative study

INTRODUCTION

The strength of the association between obesity and oral health is still indecisive.

OBJECTIVE

The objectives of the study were to compare some oral-health data between two groups involving obese (OG) and normal weight (NWG) participants and determine the influencing factors of the periodontal probing depth (PPD).

METHODS

This was a cross-sectional study including 67 Tunisian adults [OG (n = 33, body mass index (BMI) > 30 kg/m2 ), NWG (n = 34, BMI: 18.5-25.0 kg/m2 )]. The plaque level was recorded using the plaque index (PI). Gingival index (GI) was used to evaluate gingival inflammation. The depths of the sulci/pockets were probed using a periodontal probe. Stimulated saliva was collected for 5 min, and salivary flow rate (SFR) was determined. Salivary baseline pH (SBpH) was measured. A multivariable regression analysis was performed between PPD and some independent variables [i.e. obesity status, age, sex, socioeconomic status, systemic diseases and PI data].

RESULTS

The OG and NWG were age- and sex-matched and included comparable percentages of participants with systemic diseases (27.3 vs. 29.4%, respectively). The OG included a higher percentage of participants having a low socioeconomic status (87.9 vs. 64.7%, respectively). Compared with the NWG, the OG: (i) had comparable values of daily toothbrushing frequency, PI, GI and tooth mobility, (ii) included comparable percentages of irregular brushers, of participants with periodontitis, PI classes [0-1]and [1-2]; and GI classes [0-1], [1-2] and [2, 3]; (iii) had a higher PPD (2.02 ± 0.41 vs. 2.35 ± 0.22 mm, respectively), (iv) had lower SBpH (7.59 ± 0.21 vs. 7.45 ± 0.22, respectively) and SFR (1.98 ± 0.28 vs. 1.60 ± 0.32 mL/mn, respectively) and (v) included a higher percentage of participants having a PI class [2, 3] (67.6 vs. 87.9%, respectively). The multivariable regression analysis revealed that only obesity status, age and PI classes influenced the PPD, altogether explained 29.62% of the PPD variance.

CONCLUSION

Obesity poses a risk for oral health, and obese adults had altered PPD and lower BSpH and SFR. Dentists should make obese patients aware of the health risks of obesity in an attempt to reduce the potential oral complications associated with this epidemic.

Periodontal Disease and Its Association with Metabolic Syndrome-A Comprehensive Review

Periodontal disease is a complex and progressive chronic inflammatory condition that leads to the loss of alveolar bone and teeth. It has been associated with various systemic diseases, including diabetes mellitus and obesity, among others. Some of these conditions are part of the metabolic syndrome cluster, a group of interconnected systemic diseases that significantly raise the risk of cardiovascular diseases, diabetes mellitus, and stroke. The metabolic syndrome cluster encompasses central obesity, dyslipidemia, insulin resistance, and hypertension. In this review, our objective is to investigate the correlation between periodontal disease and the components and outcomes of the metabolic syndrome cluster. By doing so, we aim to gain insights into the fundamental mechanisms that link each systemic condition with the metabolic syndrome. This deeper understanding of the interplay between these conditions and periodontal disease can pave the way for more effective treatments that take into account the broader impact of managing periodontal disease on the comprehensive treatment of systemic diseases, and vice versa.

Saliva biomarkers in oral disease

Saliva is a versatile biofluid that contains a wide variety of biomarkers reflecting both physiologic and pathophysiologic states. Saliva collection is noninvasive and highly applicable for tests requiring serial sampling. Furthermore, advances in test accuracy, sensitivity and precision for saliva has improved diagnostic performance as well as the identification of novel markers especially in oral disease processes. These include dental caries, periodontitis, oral squamous cell carcinoma (OSCC) and Sjögren's syndrome (SS). Numerous growth factors, enzymes, interleukins and cytokines have been identified and are the subject of much research investigation. This review highlights current procedures for successful determination of saliva biomarkers including preanalytical factors associated with sampling, storage and pretreatment as well as subsequent analysis. Moreover, it provides an overview of the diagnostic applications of these salivary biomarkers in common oral diseases.

Association between C-Reactive protein and periodontitis in an obese population from the NHANES 2009-2010

BACKGROUND

Various data have been obtained on the relationship between body mass index (BMI) and C-reactive protein (CRP) and periodontitis. The aim of this study was to determine whether CRP/BMI are associated with periodontitis using data from the National Health and Nutrition Examination Survey (NHANES) database.

METHODS

A cross-sectional analysis of data from 3602 participants in the 2009-2010 NHANES cycle was performed. The definition of periodontitis was used to divide participants into four groups according to the criteria of Eke. Correlations between CRP/BMI and periodontitis were tested for statistical significance by means of descriptive statistics, multivariate regression, and subgroup-stratified analyses, with and without adjustments for confounders (such as age and sex).

RESULTS

There were no statistically significant differences (p > 0.05) regarding BMI and the development of periodontitis. After adjustment for age, sex, race, marital status, annual family income, alcohol consumption, hypertension, smoking, chronic pulmonary disease, cardiovascular disease, diabetes, flossing, and arthritis, CRP correlated significantly with the development of periodontitis in the subgroups stratified by obesity, with an odds ratio (OR) of 1.2 (95% CI, 1.0 to 1.5).

CONCLUSION

Through data analysis, we found an association between CRP levels and periodontitis prevalence in the American population, although this association was only present in the obese population. While there are several hypotheses about the underlying mechanism, further studies are needed to validate these findings.

Incarceration exposure and women's oral health experiences during pregnancy

RATIONALE

Prior research has documented an association between incarceration and poor oral health outcomes. Likewise, recent scholarship has also detailed that women exposed to incarceration either directly or vicariously through a partner during pregnancy incur worse health outcomes. However, no previous research has assessed the connection between incarceration exposure and oral health during pregnancy.

OBJECTIVE

The current study assesses the link between maternal incarceration exposure and oral health during pregnancy.

METHODS

Data are from the Pregnancy Risk Assessment Monitoring System (PRAMS) from years 2016-2019 (N = 60,342). Logistic regression was used to assess the relationship between incarceration and oral health.

RESULTS

Women exposed to incarceration exhibited worse oral health outcomes in the form of being more likely to report not knowing the importance of oral care, not having an oral health discussion with a provider, not getting a teeth cleaning, as well as being likely to report needing to see a dental provider, having visited a dental provider for a problem during pregnancy, and having more unmet dental care needs.

CONCLUSIONS

These findings add to a burgeoning literature that demonstrates a woman's prenatal exposure to incarceration poses risk for overall health and wellbeing. Given the influence of both incarceration exposure and oral health during pregnancy for maternal and infant health, the findings suggest that coordination between criminal justice, public health, and oral health experts can develop programmatic efforts that expand access to oral health care and improve oral health literacy among incarceration-exposed pregnant women.

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.

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.

Association between obesity and chronic periodontitis: A nationwide population-based cohort study in Taiwan

ABSTRACT

Previous studies have suggested that obesity might be associated with chronic periodontitis (CP); however, no clear conclusions have been reached so far. In this retrospective cohort study, we aimed to investigate the association between obesity and CP by using a large population-based dataset in Taiwan.A population-based retrospective cohort study was conducted using the Longitudinal Health Insurance Database 2010 (LHID2010) derived from the National Health Insurance Research database in Taiwan, from 2000 to 2013. Obesity and non-obesity groups were matched with sex, age, urbanization level, socioeconomic status, and the related comorbidities by using the propensity score method at a 1:2 ratio.An obese cohort (n = 4140) and a non-obese cohort (n = 8280) were included in this study, with an average age of 41.7 ± 13.8 years and 42.0 ± 14.0 years, respectively. The risk of CP for the patients with obesity was 1.12-fold compared with those without obesity (hazard ratio, 1.12; 95% confidence interval, 1.01-1.25). In the subgroup analysis according to age and sex, the hazard ratio of CP were 1.98 (95% confidence interval, 1.22-3.22) in the subgroup of age equal to or older than 65 years. The risk of CP showed no difference between obesity and non-obesity groups in both sex.This population-based cohort study demonstrated that obesity was associated with the development of CP in Taiwan.

Prevalence of periodontitis in obese patients in Bahrain: a cross-sectional study

Background

Adult obesity has been associated with various systemic diseases and is an increasing problem in Bahrain. Recent evidence indicates a correlation between adult obesity and periodontitis. Hence the aim of this study was to assess the prevalence of periodontitis in overweight/obese adults in Bahrain and to determine the factors associated with periodontitis in these obese adults.

Method

This cross-sectional study was conducted in overweight subjects attending Ministry of Health (MOH) Nutrition Clinics at primary health centers in Bahrain. After obtaining the institutional ethics approval, the demographic and anthropometric data, including Body Mass Index (BMI) and waist circumference (WC) using World Health Organization (WHO) thresholds for severity of obesity, were recorded. Periodontal status was measured using the Community Periodontal Index (CPI) and the extent and severity of periodontal disease were categorized according to the number of sextants with CPI codes 3 and 4.

Results

A total of 372 participated with a mean age 44.0 (± 10.5) years for males, and 42.5 (± 11.2) years for females. Periodontitis was present in 361 (97%) of participants. Hypertension and diabetes were the most prevalent co-morbidities at 23.4% and 16% respectively. Mean WC was significantly greater in males at 114 cm (± 15.6) compared to females 109.5 cm (± 12.5) (p < 0.001). BMI was not associated with severity or extent of periodontitis but WC was weakly correlated in males but not in females (Spearman rho =  + 0.2, p < 0.05). In the logistic regression model using overall WC to predict the severity of periodontitis, the adjusted OR was 1.02 (95% CI 1.00–1.04) and for age it was 1.05 (95% CI 1.00–1.07).

Conclusion

The prevalence of periodontitis was high in this sample of overweight Bahrainis. BMI was not correlated with periodontitis but WC had a weak positive correlation. Implementation of periodontal health screening as a routine part of a nutrition clinic program is recommended.

Analysis of Healthy Lifestyle Habits and Oral Health in a Patient Sample at the Dental Hospital of the University of Barcelona

The association between general health and oral health has been studied over recent years. In order to evaluate the lifestyle and the presence of healthy habits, a descriptive observational study was conducted from December 2018 to April 2019 with 230 patients, aged from 18 to 65 years old, that attended the Dental Hospital of the University of Barcelona for the first time. A total of 230 participants were considered, 98 (43%) were men and 132 (57%) were women, with a mean age of 37 years old. Our hypothesis was that patients with healthy habits had a better oral status in comparison with patients with bad lifestyle habits. No statistically significant results were found regarding oral hygiene between gender, smokers and patients with systemic pathology. Regarding a healthy lifestyle (High adherence to dietary intake), no statistically significant results were found. No significant differences were found regarding physical activity between male and female patients. Our hypothesis wasn't confirmed; therefore, we cannot conclude that patients with healthy habits have better oral status in comparison with patients with bad lifestyle habits. Consequently, more prospective longitudinal studies should be carried out.

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.

Association of periodontal pocket area with type 2 diabetes and obesity: a cross-sectional study

INTRODUCTION

The aim was to investigate the relationship of full-mouth inflammatory parameters of periodontal disease with diabetes and obesity.

RESEARCH DESIGN AND METHODS

This cross-sectional study conducted diabetes-related examinations and calculated periodontal inflamed and epithelial surface area (PISA and PESA) of 71 Japanese patients with type 2 diabetes. Multiple linear regression analyses were performed to evaluate associations between PISA or PESA and diabetes and obesity parameters.

RESULTS

Median value of body mass index (BMI), hemoglobin A1c (HbA1c) level, fasting plasma glucose (FPG) level, and visceral fat area (VFA) were 25.7 kg/m2, 9.1%, 151 mg/L, and 93.3 cm2, respectively. PISA and PESA were significantly associated with HbA1c after adjusting for age, sex, BMI, smoking status, and full-mouth plaque control level (PISA: coefficient=38.1, 95% CI 8.85 to 67.29, p=0.001; PESA: coefficient=66.89, 95% CI 21.44 to 112.34, p=0.005). PISA was also significantly associated with the highest FPG tertile (>175 mg/dL) after adjusting for confounders (coefficient=167.0, 95% CI 48.60 to 285.4, p=0.006). PISA and PESA were not significantly associated with BMI or VFA.

CONCLUSION

PISA was associated with FPG and HbA1c, but not with obesity parameters, independent from confounders such as full-mouth plaque control level in patients with type 2 diabetes.

Relationship between Obesity and Oral Health Behavior in Primary and Junior High School Students: A Cross-sectional Study

It has been reported that people who brush their teeth frequently might be more health-conscious and maintain healthier lifestyle habits. The relationship between obesity and oral health behavior in childhood is unknown, however. The aim of the present study was to fill this gap by investigating obesity and factors associated with oral health behavior in Japanese primary and junior high school students. A total of 475 primary school students (fifth-grade, age 10-11 years) and 408 junior high school students (first-grade, age 12-13 years) were included. All the participants underwent a regular health check-up and completed a self-reported questionnaire. The data thus obtained were subjected to multiple logistic regression analyses to identify the relationship between obesity and factors associated with oral health behavior. In primary school students, a dislike of physical activity was the only factor showing a significant association with obesity (p<0.05). In addition, however, tooth brushing <2 times per day and a lack of regular clinical dental care showed a significant association with obesity in junior high school students (p<0.05). The present results suggest a significant association between regular clinical dental care and tooth brushing and obesity in junior school students.

Association between Sleep Quality and Duration and Periodontal Disease among University Students: A Cross-Sectional Study

The purpose of this cross-sectional study was to investigate the association between sleep quality and duration, and periodontal disease among a group of young Japanese university students. First-year students (n = 1934) at Okayama University who voluntarily underwent oral health examinations were included in the analysis. Sleep quality and duration were assessed by the Japanese version of the Pittsburgh Sleep Quality Index. Dentists examined Oral Hygiene Index-Simplified (OHI-S), probing pocket depth (PPD), and percentage of sites with bleeding on probing (BOP). Periodontal disease was defined as presence of PPD ≥ 4 mm and BOP ≥ 30%. Overall, 283 (14.6%) students had periodontal disease. Poor sleep quality was observed among 372 (19.2%) students. Mean (± standard deviation) sleep duration was 7.1 ± 1.1 (hours/night). In the logistic regression analysis, periodontal disease was significantly associated with OHI-S (odds ratio [OR]: 2.30, 95% confident interval [CI]: 1.83-2.90; p < 0.001), but not sleep quality (OR: 1.09, 95% CI: 0.79-1.53; p = 0.577) or sleep duration (OR: 0.98, CI: 0.87-1.10; p = 0.717). In conclusion, sleep quality and duration were not associated with periodontal disease among this group of young Japanese university students.

Prevalence of Periodontal Disease among Obese Young Adult Population in Saudi Arabia-A Cross-Sectional Study

Background and objectives: We aimed to assess the prevalence of periodontal disease among obese young adults in Saudi Arabia and to analyze the association between different body mass indexes and the severity of periodontal disease. Materials and methods: This descriptive cross-sectional study consisted of 307 obese patients aged 18-39 years, with body mass index (BMI) ≥30. Demographic variables for periodontal disease, anthropometric parameters such as BMI along with clinical parameters such as oral hygiene index-simplified, community periodontal index (CPI) score and loss of attachment (LOA), were assessed. Multivariate binary logistic regression analysis was used to identify the predictors for chronic periodontitis in obese young adults between 18-40 years of age. Results: The majority of the participants (71.3%) had periodontal disease. Obese and extremely obese patients together showed a statistically significant difference in the age group of 21-30 years in terms of CPI score for inflammation (p < 0.05) and LOA (p < 0.001). Logistic regression analysis showed age (OR: 3.180; 95%CL: 1.337-7.561; p <.001), occasional dental visit (OR: 5.965; 95%CL: 3.130-11.368; p < 0.001), smoking >10 cigarettes (OR: 11.868; 95%CL: 3.588-39.254; p < 0.001) and poor oral hygiene status (OR: 17.250; 95%CL: 6.958-42.764; p < 0.001) were associated with a significantly higher risk of having periodontal disease. Conclusions: This study showed a high prevalence of periodontal disease in obese patients among the Saudi Arabian population.

Relationship of Salivary Microbiome with the Worsening of the Periodontal Health Status in Young Adults: A 3-Year Cohort Study

The purpose of this prospective cohort study was to investigate the influence of the salivary microbiome on the worsening of the periodontal health status among Japanese young adults. We assessed the data of systemically healthy and non-smoking young (18-22 years) university students (n = 457) from Okayama University at baseline (2013) and follow-up (2016). The worsening group was defined based on an increase in the percentage of bleeding on probing (%BOP) or an increase in probing pocket depth (PPD) from <4 mm to ≥4 mm. Unstimulated saliva samples were randomly collected from 69 students for microbiome analysis at follow-up. The salivary microbiome was assessed through 16S rRNA metagenomic sequencing. The type of community in the salivary microbiome clustered by statistical analysis and diversity was not significantly associated with the worsening of the periodontal health status in cases of increasing %BOP and PPD (p > 0.05). The prevalence of some species was significantly higher in the worsening group than in the non-worsening group (p < 0.05) in both cases. The worsening of the periodontal health status was associated with some species, but not the type of community and diversity in the salivary microbiome among Japanese young adults.

Periodontitis increases the risk of respiratory disease mortality in older patients

Evidence for an association between periodontitis and respiratory disease in the older patients is limited. Additionally, little information exists regarding the role of potential effect modifiers. The aim of this study is to examine whether periodontitis increases the risk of respiratory disease mortality in older patients. Between January 2010 and December 2014, 1385 patients aged 75 years and above who underwent radiographic examination in the largest dental hospital in Shanghai, China were included in this retrospective cohort study. The dental examination was made with the panoramic radiographs. Demographic information and comorbid health conditions were collected from local health authorities. Participant follow up was continued until either the occurrence of mortality, or the end of the study on December 31, 2018. Cox proportional hazards regression and competing risk hazard models were performed to examine the association between periodontitis and respiratory disease mortality. We found that periodontitis was associated with total respiratory disease mortality. Compared with healthy participants, the hazards ratio and 95% confidence interval for total respiratory disease mortality in patients with severe periodontitis was 2.72(1.04,7.11) after adjusting for relevant confounding variables. With increasing severity of periodontitis, risks for chronic obstructive pulmonary disease (COPD) mortality also increased significantly (P = .038). Smokers and participants with body mass index (BMI) < 25 kg/m² were at increased risk. Loss of teeth was not associated with either total respiratory disease or COPD mortality. Although the present study cannot ascertain causal association, it provides substantial evidence that poor periodontal health is associated with respiratory disease in the older patients, particularly in smokers and patients with BMI < 25 kg/m².

Influence of Occupational Stress and Coping Style on Periodontitis among Japanese Workers: A Cross-Sectional Study

The aim of this cross-sectional study was to evaluate the association between the influence of occupational stress and coping style on periodontitis among Japanese workers. The study sample included 738 workers (age range: 19-65 years) at a manufacturing company in Kagawa Prefecture, Japan. To analyze occupational stress and coping style, all participants answered a self-report questionnaire composed of items on their work environment and oral health behavior. Oral examinations were performed by calibrated dentists. Among all workers, 492 (66.7%) workers were diagnosed with periodontitis, and 50 (6.8%) were diagnosed with a high stress-low coping condition. Significant differences (p < 0.05) were observed between the periodontitis and non-periodontitis groups in terms of age, gender, body mass index, smoking status, daily alcohol drinking, monthly overtime work, worker type, and stress-coping style. Logistic regression analysis showed that a high stress-low coping condition was associated with an increased risk of periodontitis (odds ratio: 2.79, 95% confidence interval: 1.05-7.43, p = 0.039). These findings suggest that a high stress-low coping condition is associated with periodontitis among the 19-65 years of age group of Japanese workers.

The level of salivary lactate dehydrogenase as an indicator of the association between gingivitis and related factors in Japanese university students

The aim of this study was to investigate the association between the presence of gingivitis estimated using the salivary level of lactate dehydrogenase (LD) and related factors in young Japanese adults. Data from 1,915 participants (21.4 ± 2.5 years) were analyzed. Unstimulated saliva was collected from each participant and the salivary LD level was evaluated using a commercially available test kit with an integer scale ranging from 1 to 10. Gingivitis was defined as the LD level of ≥8. The number of permanent teeth, the simplified oral hygiene index (OHI-S), the presence of partially erupted molars and body mass index were recorded. Additionally, participants answered a questionnaire. The percentage of male participants, the number of permanent teeth, the OHI-S and the presence of partially erupted molars were higher, whereas the proportion receiving dental check-ups was lower in the gingivitis group (n = 88, 4.6%) than in the healthy group. Logistic regression analysis showed that gingivitis was significantly associated with OHI-S (OR: 2.68, 95% CI: 1.94-3.69) and receiving dental checkups (OR: 0.31, 95% CI: 0.10-0.99). The present findings indicated that the OHI-S and receiving dental checkups were significantly associated with gingivitis, as assessed by the salivary LD level, in this cohort.

Awareness of Clenching and Underweight are Risk Factors for Onset of Crowding in Young Adults: A Prospective 3-Year Cohort Study

Bruxism is a parafunctional activity that can seriously affect quality of life. Although bruxism induces many problems in the oral and maxillofacial area, whether it contributes to the onset of malocclusion remains unclear. The purpose of this prospective cohort study was to investigate the association between the onset of malocclusion and awareness of clenching during the daytime in young adults. Among 1,092 Okayama University students who underwent normal occlusion at baseline, we analysed 238 who had undergone a dental examination and had complete data after 3 years (2013⁻2016). We also performed subgroup analysis to focus on the association between awake bruxism and the onset of crowding (n = 216). Odds ratios (ORs) were calculated using multivariate logistic regression analyses. The incidences of malocclusion and crowding were 53.8% and 44.5%, respectively. In multivariate logistic regression, awareness of clenching was a risk factor for crowding (OR: 3.63; 95% confidence interval [CI]: 1.08⁻12.17). Moreover, underweight (body mass index < 18.5 kg/m²) was related to the onset of malocclusion (OR: 2.34; 95%CI: 1.11⁻4.92) and crowding (OR: 2.52, 95%CI: 1.25⁻5.76). These results suggest that awareness of clenching during the daytime and underweight are risk factors for the onset of crowding in young adults.

Stress-related hormones in association with periodontal condition in adolescents-results of the epidemiologic LIFE Child study

OBJECTIVES

The aim of this study was to investigate the associations between blood levels of stress-related hormones and early signs of periodontal disease in children and adolescents.

MATERIALS AND METHODS

Within the LIFE (Leipzig research center for civilization diseases) Child study, 498 adolescents (10 to 18 years) were included. Early signs of periodontal inflammation were measured by probing depth (PD) at six index teeth (16, 11, 26, 36, 31, 46). Blood levels of stress-related hormones (cortisol, dehydroepiandosterone-sulfate [DHEA-S]) and, additionally interleukine-6 (IL-6) were measured. Socioeconomic status, oral hygiene, orthodontic appliances, and nutritional status, recorded by body-mass-index-standard-deviation-score (BMI-SDS), were considered as confounding factors. Additionally, in 98 participants, an oral chairside active matrix metalloproteinase-8 (aMMP-8) test was performed. Statistical tests are the Mann-Whitney U tests, chi-squared tests and multivariate logistic regression model.

RESULTS

IL-6, BMI-SDS as well as positive aMMP-8 test result were significantly associated with maximum PD > 3 mm (p < 0.05). However, no statistically significant associations between stress-related hormones (cortisol and DHEA-S) and presence of maximum PD > 3 mm were found (p > 0.05). Higher DHEA-S and BMI were associated with positive aMMP-8 result, even after adjusting for age and gender (p = 0.027, p_adj = 0.026).

CONCLUSION

The results reveal no associations between PD and stress-related hormones cortisol and DHEA-S. aMMP-8 test result might be associated with DHEA-S level. Nutritional status seems to influence periodontal disease in adolescents.

CLINICAL RELEVANCE

DHEA-S and BMI-SDS show associations with early signs of periodontal disease in adolescents aged 10 to 18 years. This association should be confirmed by the investigation of high-risk groups.

Type D personality and periodontal disease in university students: A prospective cohort study

The purpose of this prospective cohort study was to investigate whether Type D personality was related to periodontal disease in Japanese university students. Among students ( n = 600) who were interested in receiving oral health examinations, logistic regression analysis showed that the risk of developing periodontal disease during a 3-year period was associated with body mass index ⩾ 25 (odds ratio: 2.543; 95% confidence interval: 1.297-4.989; p = 0.007) and Type D personality (odds ratio: 1.473; 95% confidence interval: 1.027-2.111; p = 0.035). In this short-term prospective cohort study, a significant association between periodontal disease and Type D personality was observed in Japanese university students.

Body fat rather than body mass index is associated with gingivitis - A southern Brazilian cross-sectional study

BACKGROUND

This cross-sectional study aimed to evaluate the association between body mass index (BMI) and body fat with gingivitis in 613 adults of Porto Alegre, Brazil.

METHODS

Individuals with at least four teeth were included in this study. They were identified through a multi-stage probability sampling, considering the city distribution of sex and age. Structured interviews were conducted by trained researchers in order to collect sociodemographic characteristics, behavioral habits, and systemic impaired conditions. Visible plaque and modified gingival index were assessed by a trained and calibrated examiner. Additionally, weight, height, and body fat percentage were measured. Body fat percentage was determined by bioelectrical-impedance analysis using a portable electrical micro-current monitor. The median sites with marginal bleeding was 20%, and used as a cutoff point for gingivitis. Crude and adjusted prevalence ratio by mean Poisson regression with robust variance were calculated. Two multivariable models were performed in order to associate both independent and dependent variables.

RESULTS

In the multivariable analysis that included BMI, no significant association with gingivitis was detected. On the other hand, the multivariable model that included body fat showed that very high body fat category (PR 1.22; 95% CI: 1.01 to 1.49) was significantly associated with higher marginal gingival bleeding.

CONCLUSION

Very high body fat category rather than BMI was significantly associated with higher positive marginal gingival bleeding in adults.

Association between obesity and periodontal disease. A systematic review of epidemiological studies and controlled clinical trials

Background

Obesity is a very prevalent chronic disease worldwide and has been suggested to increase susceptibility of periodontitis. The aim of this paper was to provide a systematic review of the association between obesity and periodontal disease, and to determine the possible mechanisms underlying in this relationship.

Material and Methods

A literature search was carried out in the databases PubMed-Medline and Embase. Controlled clinical trials and observational studies identifying periodontal and body composition parameters were selected. Each article was subjected to data extraction and quality assessment.

Results

A total of 284 articles were identified, of which 64 were preselected and 28 were finally included in the review. All the studies described an association between obesity and periodontal disease, except two articles that reported no such association. Obesity is characterized by a chronic subclinical inflammation that could exacerbate other chronic inflammatory disorders like as periodontitis.

Conclusions

The association between obesity and periodontitis was consistent with a compelling pattern of increased risk of periodontitis in overweight or obese individuals. Although the underlying pathophysiological mechanism remains unclear, it has been pointed out that the development of insulin resistance as a consequence of a chronic inflammatory state and oxidative stress could be implicated in the association between obesity and periodontitis. Further prospective longitudinal studies are needed to define the magnitude of this association and to elucidate the causal biological mechanisms.

Key words:Periodontal disease, periodontitis, periodontal infection, obesity, abdominal obesity.

Nutritional approaches for managing obesity-associated metabolic diseases

Obesity is an ongoing pandemic and serves as a causal factor of a wide spectrum of metabolic diseases including diabetes, fatty liver disease, and cardiovascular disease. Much evidence has demonstrated that nutrient overload/overnutrition initiates or exacerbates inflammatory responses in tissues/organs involved in the regulation of systemic metabolic homeostasis. This obesity-associated inflammation is usually at a low-grade and viewed as metabolic inflammation. When it exists continuously, inflammation inappropriately alters metabolic pathways and impairs insulin signaling cascades in peripheral tissues/organs such as adipose tissue, the liver and skeletal muscles, resulting in local fat deposition and insulin resistance and systemic metabolic dysregulation. In addition, inflammatory mediators, e.g., proinflammatory cytokines, and excessive nutrients, e.g., glucose and fatty acids, act together to aggravate local insulin resistance and form a vicious cycle to further disturb the local metabolic pathways and exacerbate systemic metabolic dysregulation. Owing to the critical role of nutrient metabolism in controlling the initiation and progression of inflammation and insulin resistance, nutritional approaches have been implicated as effective tools for managing obesity and obesity-associated metabolic diseases. Based on the mounting evidence generated from both basic and clinical research, nutritional approaches are commonly used for suppressing inflammation, improving insulin sensitivity, and/or decreasing fat deposition. Consequently, the combined effects are responsible for improvement of systemic insulin sensitivity and metabolic homeostasis.

Gender Differences in Periodontal Status and Oral Hygiene of Non-Diabetic and Type 2 Diabetic Patients

BACKGROUND

This study investigated gender dependent differences by the comparison of periodontal status and oral hygiene between diabetic patients and non-diabetic subjects.

METHODS

517 mostly obese subjects (171 non-diabetic, 205 type 2 diabetic with oral and 141 with insulin therapy; mean: 59 years) completed an oral hygiene questionnaire and had a clinical examination, including periodontal screening and recording (PSR), percentage of bleeding teeth (PBT), probing pocket depth (PD), gingivitis index (GI), and number of teeth (Tn). Main parameters were "periodontitis" and "oral hygiene behaviour", each defined by 5 sub-parameters. For a comparison of all results, each sub-parameter was set 0.2. The "low performance index" (LoP) was the sum of significantly worse sub-parameters in the compared groups (maximum of low performing = 1.0).

RESULTS

Gender comparison: In non-diabetic and diabetic patients with oral medication, males performed worse (LoP: periodontitis 0.6 - 0.8; oral hygiene 0.4 - 0.6). The male insulin group performed worse oral hygiene (LoP: 0.4) than females with insulin therapy, whereas the periodontal status showed no difference. Diabetic and non-diabetic groups: Females: Diabetic groups performed worse than non-diabetics (LoP: periodontitis 0.2 - 1.0; oral hygiene 0.4). Insulin patients had worse periodontal status and showed no difference in oral hygiene when compared to diabetic patients with oral medication (LoP: 0.2). Males: Diabetic group with oral medication had worse periodontal status than non-diabetics (LoP: 0.6).

CONCLUSIONS

The periodontal status was mainly due to oral hygiene behaviour, which was worse in men. Apparently behaviour and not diabetes is the major determinant of periodontitis. Men apparently need much more advise than women.

Relationship Between Prehypertension/Hypertension and Periodontal Disease: A Prospective Cohort Study

BACKGROUND

Most cross-sectional studies have found a significant positive relationship between periodontal disease and prehypertension/hypertension. However, these studies had limitations and there are few prospective cohort studies in young adults. The purpose of this prospective cohort study was to investigate whether periodontal disease was related to prehypertension/hypertension in Japanese university students.

METHODS

Students (n = 2,588), who underwent health examinations before entering university and before graduation, were included in the analysis. The association between periodontal disease such as the percentage of bleeding on probing (BOP) and community periodontal index (CPI) scores, and change in blood pressure status was determined.

RESULTS

At the reexamination, the numbers of participants with prehypertension (systolic blood pressure 120-139mm Hg or diastolic blood pressure 80-89mm Hg) and hypertension (≥140/90mm Hg) were 882 (34.1%) and 109 (4.2%), respectively. In a logistic regression model, the risk of hypertension was significantly associated with male (odds ratio (OR): 6.31; 95% confidence interval (CI): 2.63-15.13; P < 0.001), no habitual physical activity at baseline (OR: 2.90; 95% CI: 1.56-5.38; P < 0.01) and periodontal disease defined as the presence of both probing pocket depth (PPD) ≥ 4mm and BOP ≥ 30% at baseline (OR: 2.74; 95% CI: 1.19-6.29; P = 0.02) in participants with prehypertension at baseline. On the other hand, the risk of prehypertension was not associated with presence of periodontal disease (OR: 0.93; 95% CI: 0.51-1.70; P = 0.82).

CONCLUSION

In the short-term prospective cohort study, a significant association between presence of periodontal disease and hypertension was observed in Japanese university students.

Self-efficacy and progression of periodontal disease: a prospective cohort study

AIM

The purpose of this longitudinal study was to investigate whether self-efficacy scale for self-care (SESS) was related to changes in oral health behaviours and progression of periodontal disease in Japanese university students.

MATERIAL AND METHODS

Students (n = 533) who were interested in receiving oral health examinations before entering the university and before graduation were included in the analysis. Self-efficacy was assessed using SESS, which uses three subscales: self-efficacy for brushing of the teeth (SE-BR), for dentist consultations (SE-DC) and for dietary habits. The informations about oral health behaviours were also collected. For all participants, oral hygiene instructions was performed at baseline. After 3 years, the oral health behaviours and the periodontal condition were re-assessed.

RESULTS

The progression of periodontal disease was related to low baseline SE-BR. Logistic regression analysis showed that progression of periodontal disease risk during a 3-year period was associated with low baseline SE-BR (OR: 1.516; 95% CI: 1.010-2.275; p < 0.05). The increase in the score of SE-DC was related to the increase in regular dental checkups (p < 0.05).

CONCLUSION

Low SESS was associated with progression of periodontal disease and improvement of oral health behaviours in university students who received oral hygiene instructions at baseline.

Change of periodontal inflammatory indicators through a 4-week weight control intervention including caloric restriction and exercise training in young Koreans: a pilot study

BACKGROUND

Recent cross-sectional studies indicate that obesity is a risk factor for periodontal disease. Exercise training in high fat mice or rats can inhibit gingival inflammation effectively. The objective of this human intervention study was to investigate whether short-term weight control could affect periodontal indexes and serum and gingival crevicular fluid (GCF) biomarkers in young Koreans.

METHODS

Forty-one obese volunteers (body mass index (BMI) > 25.0) and 12 normal weight subjects (18.5 ≤ BMI ≤ 23.0) participated in a four-week weight control program to analyze the changes in anthropometric criteria, the concentrations of C-reactive protein (CRP), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides in serum, gingival index, bleeding on probing, periodontal biomarkers in GCF, and dental plaque index at the first and the 27th days.

RESULTS

The means of obesity measures decreased significantly more in the obese group (BMI 2.53 ± 0.96, waist-to-hip ratio (WHR) 4.88 ± 1.58 %, LDL 35.85 ± 21.74 mgdL(-1)) than in the normal weight group (BMI 0.78 ± 0.72, WHR 2.00 ± 0.95 %, LDL 15.58 ± 18.07 mgdL(-1)). While the obese group showed significant decreases in the biomarkers in GCF (IL-1β 58.38 ± 65.55 pgmL(-1), MMP-8 4.19 ± 5.61 ngmL(-1), MMP-9 3.36 ± 6.30 ngmL(-1)), the mean changes for the normal weight group (IL-1β 10.07 ± 21.08 pgmL(-1), MMP-8 1.49 ± 4.61 ngmL(-1), MMP-9 -1.52 ± 9.71 ngmL(-1)) were not statistically significant. Anthropometric measures and the amounts of GCF biomarkers had weak positive correlations (0.242 ≤ r ≤ 0.340), and LDL in serum correlated with MMP-8 (r = 0.332) and IL-1β (r = 0.342) in the obese group. Stepwise multiple linear regression analysis in the obese group showed that the relationship between the amount of IL-1β in GCF and predictor variables including LDL and BMI was highly significant and accounted for 19.1 % of the variance in IL-1β in GCF.

CONCLUSIONS

In periodontally healthy subjects, weight control could reduce the amounts of MMP-8, MMP-9, and IL-1β in GCF of the obese subjects. Further studies with periodontally unhealthy and obese people are needed to identify the mechanism of decreases in inflammation biomarkers in GCF through weight control.

TRIAL REGISTRATION

ISRCTN86753073 (2015.08.14).

Is weight gain associated with the incidence of periodontitis? A systematic review and meta-analysis

AIM

This study aimed to conduct a systematic review assessing the effects of weight gain on the incidence of periodontitis in adults.

METHODS

Electronic searches in four databases were performed up to and including February 2015. Only prospective longitudinal studies assessing the association between weight gain and the incidence of periodontitis in adults were eligible to be included in this study. All studies should state a clear description of nutritional status (Body Mass Index; Waist Circumference) as well as the case definition of periodontitis. Pooled relative risks (RR) for becoming overweight and obese on the incidence of periodontitis were estimated by meta-analysis. Quality was assessed with the Newcastle-Ottawa scale for cohort studies.

RESULTS

Five articles were included in this review and meta-analysis with 42,198 subjects enrolled. Subjects who became overweight and obese presented higher risk to develop new cases of periodontitis (RR 1.13; 95%CI 1.06-1.20 and RR 1.33 95%CI 1.21-1.47 respectively) compared with counterparts who stayed in normal weight.

CONCLUSIONS

A clear positive association between weight gain and new cases of periodontitis was found. However, these results are originated from limited evidence. Thus, more studies with longitudinal prospective design are needed.

The impact of masticatory ability as evaluated by salivary flow rates on obesity in Japanese: The Toon health study

OBJECTIVE

This study examined the associations of masticatory ability evaluated by chewing-gum-stimulated salivary flow rate with anthropometric indices among a general Japanese population.

METHODS

In total, 921 Japanese men and women aged 30-79 years participated in this cross-sectional study. Saliva production was stimulated by 5 min of gum chewing, then collected; salivary flow rate was calculated as g/min. Overweight, abdominal obesity in terms of waist circumference (WC), and waist-hip ratio (WHR), and elevated skinfold thickness statuses were determined.

RESULTS

The multivariable odds ratio and 95% confidence intervals of overweight, abdominal obesity (WC, WHR), and elevated skinfold thickness status for highest vs. lowest quartile of salivary flow rate were 0.59 (0.37-0.95, P for trend = 0.02), 0.65 (0.43-0.98, P = 0.03), 0.54 (0.35-0.83, P < 0.01), and 0.61 (0.39-0.96, P < 0.01), respectively. The linear trends of multivariable-adjusted means of BMI, WC, WHR, and skinfold thickness according to quartiles of salivary flow rate did not vary after stratification by overweight status.

CONCLUSIONS

Higher stimulated salivary flow rate, a surrogate marker for mastication ability, was associated with lower prevalence of overweight, abdominal obesity (whether WC- or WHR-defined), and elevated skinfold thickness among the general Japanese population.

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.