Periodontal therapy both surgical and nonsurgical has been shown to decrease circulating inflammatory cytokines in patients with periodontitis.93-95 Two recent meta-analyses concluded there was no difference in clinical periodontal parameters after periodontal therapy between obese and normal weight patients, indicating nonsurgical periodontal therapy can be effective in reducing clinical signs of periodontal disease in obese patients.96,97 Furthermore, obese subjects did demonstrate an overall reduction in systemic inflammatory burden after periodontal therapy, although most studies demonstrated overall significantly higher levels of pro-inflammatory cytokines at baseline in obese patients when compared with their non-obese counterparts.97 Elevated adipokine levels seen in obesity have been indicated in altered or impaired periodontal healing in obese patients98 but these meta-analyses indicate obese patients do receive benefit from periodontal therapy and this benefit may have a systemic effect as well. Furthermore, even in instances where clinical outcomes of therapy are similar, obese patients have been shown to have a different immunologic and cytokine responses which may affect the longevity of maintenance of the results of therapy.99 Based upon these findings, adjunctive use of antibiotics, decreased maintenance intervals, and/or periodontal surgical therapy may be advantageous in obese patients whose increased inflammatory burden may make controlling periodontal disease progression more challenging.
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