Proposed Mechanisms of Interaction between Periodontal Disease and Obesity

Numerous recent studies have demonstrated associations between periodontal disease prevalence and/or progression and obesity status.40-44 A recent systematic review demonstrated odds ratio (OR) associations between periodontitis and body mass index (BMI) category obese of 1.81 (1.47, 2.30), between periodontitis and BMI category overweight of 1.23 (1.06, 1.51), and between periodontitis and obese and overweight 2.13 (1.40, 3.26).1 In younger age groups, but not older cohorts, overall and abdominal obesity demonstrated an association with prevalence of periodontal disease (when measured through attachment loss ≥3 mm, probing depth ≥4 mm, and alveolar bone loss).45,46 This may be related to increasing inflammatory burden from cumulative exposure to various diseases, conditions, and environmental exposures that occur with aging, the extraction of periodontally affected teeth in older adults, and/or the immunological effects of exposure to periodontal pathogens in a naïve environment. Periodontal therapy in patients with metabolic syndrome—which is a clustering of risk factors including: atherogenic dyslipidemia, elevated blood pressure, obesity, elevated serum glucose levels, a prothrombotic state, and a proinflammatory state has been shown to reduce systemic markers of inflammation at 9 months post-treatment.47 The mechanism for an association between obesity and periodontitis has been suggested to involve the proinflammatory state that exists in obese patients, which results in insulin resistance and oxidative stress;43,48-54 others have implicated additional factors which may govern this interaction (Figure 3).

Figure 3. Infectobesity? The proposed multifactorial interaction between obesity and periodontal disease.102

Diagram showing the proposed multifactorial interaction between obesity and periodontal disease