Waistline to Gumline – Obesity and Periodontal Disease

We know that obesity is correlated to many different chronic diseases such as diabetes, high blood pressure, heart disease and kidney disease, sleep apnea, elevated cholesterol, arthritis, gastric reflux, infertility, gout and some types of cancer.    Periodontitis is a multifactorial chronic inflammatory disease associated with an imbalance in the gut microbiome community plaque biofilms and characterized by progressive destruction of the tooth-supporting apparatus. Globally, it is estimated that 740 million people are affected by its severe form. Periodontitis has been suggested to be linked to obesity and metabolic syndrome.

Obesity is a pandemic and periodontitis is the sixth most prevalent disease in the world. These two noncommunicable diseases share several risk determinants. Epidemiologic evidence from the last 2 decades has established an increase in periodontitis prevalence in obese and overweight individuals. Biologic mechanisms potentially linking obesity and periodontal disease are adiposity-associated hyperinflammation, microbial dysbiosis, altered immune response, specific genetic DNA strand sequences, and increased stress.

A state of inflammation that results from obesity may increase the host susceptibility to periodontal breakdown.  While poorly understood, an imbalance between the host’s immune and inflammatory system likely plays a significant role in both obesity and periodontitis.  Several biological effects of obesity seem to relate to the pathogenesis of periodontitis.  In particular, inflammatory cytokines – such as interleukins (IL) and tumor necrosis factor (TNF) – play a role in each disease.

Fat, or adipose tissue, is primarily responsible for regulating body energy and, under normal conditions, maintains homeostasis of energy storage and exertion.  Abnormal or excessive abdominal fat, called visceral adipose tissue, is more highly associated with adverse health conditions than excessive subcutaneous fat, and it contributes to multiple medical conditions.  Body-shape morphology, indicated by the location of visceral adipose fat deposition, has been identified as a contributor to adverse health conditions.  Proportionally more visceral adipose tissue, evident in an apple-shaped body type, increased the risk of metabolic health conditions unlike a pear-shaped body type, evidenced by excess fat below the waist.

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 are thought to increase overall inflammation in the body. This may lead to decreased immune status, which increases susceptibly to periodontal disease. The inflammation may also decrease blood flow to the gums and cause disease progression.

Both obesity and periodontal disease significantly impact an individual’s overall health. Periodontal disease (early gingivitis to advanced periodontitis) affects up to 50 percent of the U.S. adult population (age 30-70) and 90 percent of adults older than 70 years old.

Understanding the relationship between obesity and the risk factors that lead to periodontal disease is very important. With the increasing rate of child and adolescent obesity, the prevalence of periodontal disease will follow. Keys to prevention of periodontal disease are through proper oral hygiene, a balanced diet and routine dental visits.