THE prevalence of obesity has increased substantially over the past decades in most industrialised countries. Obesity is a systemic disease that predisposes someone to a variety of comorbidities and complications that affect overall health.

Being overweight increases the likelihood of a patient having associated health and social problems, which may affect dental services and dental management. Cross-sectional studies suggest that obesity is also associated with oral diseases, particularly periodontal disease.

Periodontal disease is a chronic bacterial infection that affects the tissues surrounding the teeth as well as the bone supporting the teeth. These are composed of the gingiva, the periodontal ligament, the cementum, and the alveolar bone.

HOW DOES OBESITY AFFECT PERIODONTAL DISEASE?

Overweight and obese adults have long been considered to be at high risk for many chronic inflammatory disease and conditions such as cardiovascular disease, diabetes and arthritis. Likewise, obesity appears to be an independent risk factor for the development of periodontal disease, even after controlling other risk factors such as smoking, age and other medical problems. A recent study (Khader YS, et al J Clin Periodontol 2009;36(1):18-24) showed that overweight individuals had double the incidence of periodontitis, while obese individuals had triple the incidence.

Fat cells were once thought of as having limited function energy storage. It is now known that fat cells produce many chemical signals and hormones. Many of these substances, like leptin, are thought to increase overall inflammation in the body. This may lead to decreased immune status, which increases susceptibility to periodontal disease. The inflammation may also decrease blood flow to the gums and cause disease progression.

It is thought that this association, in part, could also be due to lifestyle characteristics that make individuals more prone to both obesity and periodontal disease.

Leptin is the best-known substance secreted from adipose tissue. It plays an important role in regulating energy intake and energy expenditure, including appetite and metabolism. It is similar in some action to insulin. Most patients suffering from obesity have leptin resistance. It has been reported that leptin is present within healthy and marginally inflamed gingiva and decreased in concentration as the adjacent probing depth increases. Thus, leptin may play an important role in the development of periodontitis.

Plasminogen Activator Inhibitor-1 (PAI-1): PAI-1 is another adipokine that generates agglutination of the blood and raises the risk of ischemic vascular disease and gingival inflammation. PAI-1 may decrease blood flow in the periodontium of obese patients and promotes development of periodontitis.

TREATMENT OF PERIODONTAL DISEASE

The goal of treatment for periodontal disease is to stop the progression of the disease, improve the health of surrounding gums, and if indicated, to restore the supporting structures — bone, gum tissue and ligaments. Thorough cleaning, removing tartar and plaque and scraping the deep pockets free of infected tissue are the basic steps.

Surgery is sometimes needed for repairing deep pockets or reshaping the bone and/or surrounding tooth structures. Oral or topical antibiotics are sometimes needed. Maintenance of proper oral hygiene is essential for long-term success.

PREVENTION OF PERIODONTAL DISEASE

Correct tooth brushing, mouth cleansing and flossing are the best defences against periodontal disease. The American Dental Association recommends brushing teeth twice daily, in the morning and before bedtime, using fluoride toothpaste and a soft-bristled toothbrush. It is important to clean all sides of the teeth and also brush the tongue. Replacing the toothbrush every one to three months is recommended. Flossing daily is important to remove bacteria and particles of food stuck between teeth.

Quitting smoking and chewing tobacco is one of the best ways to decrease risk of developing periodontal disease. Tobacco users are six times more likely to develop gum disease.

Diet is very important for overall health, including dental health. Eating a low-fat, reduced sodium, balanced diet of whole grains, vegetables and fruits is recommended. Limiting the time sugar is in contact with the teeth is advised. Avoiding sugary beverages (sodas, fruit juices, sweetened tea) and candies (especially ones that stick to the teeth like taffy), is helpful. Eating sugary foods in-between meals and before bed is also discouraged. Regular dental visits are recommended for teeth cleaning and inspection.

Dr Sharon Robinson DDS has offices at the Dental Place Cosmetix Spa located at Shop #5, Winchester Business Centre, 15 Hope Road, Kingston 10. Dr Robinson is an adjunct lecturer at the University of Technology, Jamaica, School of Oral Health Sciences. She may be contacted at 630-4710 or visit the website www.dentalplace4u.com