Clinical and microbiological evaluation of non-surgical periodontal therapy in obese and non-obese individuals with periodontitis: a 9-month prospective longitudinal study

Abstract

Objective: Obesity is a chronic disease that negatively affects an individual's general and oral health. The present study aimed to compare the clinical and microbiological effects of non-surgical periodontal therapy with the full mouth disinfection (FMD) protocol on obese and non-obese individuals at 9 months post-therapy. Methodology: This clinical study was first submitted and approved by the Ethics Committee. Fifty-five obese patients and 39 nonobese patients with periodontitis were evaluated. The full-mouth periodontal clinical parameters, clinical attachment level (CAL), probing depth (PD), gingival index (GI), and plaque index (PI), were monitored at baseline, 3, 6, and 9 months after periodontal treatment with full mouth disinfection (FMD) protocol. The mean count of Tannerella forsythia, Porphyromonas gingivalis, Treponema Denticola, and Aggregatibacter actinomycetemcomitans was determined by quantitative polymerase chain reaction on subgingival biofilm samples. Demographic data were assessed by Chi-square test. For clinical and microbiological parameters, two-factor repeated-measures ANOVA was used. Results: In both groups, periodontal therapy using the one-stage full-mouth disinfection protocol significantly improved CAL, PD, GI, and PI (p<0.05). Obese and non-obese patients equally responded to non-surgical periodontal therapy (p>0.05). Microbial count found no major differences (p>0.05) between obese and non-obese individuals who had undergone non-surgical periodontal therapy. Conclusions: Obesity did not affect the clinical and microbiological outcomes of non-surgical periodontal therapy.

What Are the Clinical and Systemic Results of Periodontitis Treatment in Obese Individuals?

“…More recently, other studies with obese and non-obese individuals demonstrated that obesity status does not impact clinical periodontal outcomes after non-surgical therapy [ 68 , 71 ••, 72 ••, 73 , 84 ••, 85 ]. Those studies demonstrated that periodontal treatment led to a significant improvement in periodontal conditions in both groups in a short term [ 68 , 71 ••, 72 ••, 85 ], 6-month [ 73 ], and 9-month [ 84 ••] follow-up post-therapy (Table 1 ). Conversely, Martinez-Herrera et al [ 70 ••] found a significant difference in the extension of teeth with PD ≥ 4 mm after treatment in 3 months post-therapy when obese was compared to non-obese individuals.…”

Subgingival microbiota in overweight and obese young adults with no destructive periodontal disease

“…12,[18][19][20][21] Conversely, other studies with obese middle-aged individuals have failed to find differences in the frequency and levels of periodontal pathogens between obese and non-obese individuals. 22,23 In some parts of the Western world, the overall rates of cardiovascular diseases have been decreasing, except among young adult populations which have shown alarmingly high rates. 24 It is unsettling that one of the main reasons for that is the increasing incidence in overweight (OW) and obesity (OB) among them, which is causally related to various aspects of modern lifestyle.…”

“…Studies have also demonstrated significant correlations between these pathogens and parameters of obesity such as BMI and waist circumference (WC) in adolescents and middle‐aged individuals with chronic periodontitis 12,18–21 . Conversely, other studies with obese middle‐aged individuals have failed to find differences in the frequency and levels of periodontal pathogens between obese and non‐obese individuals 22,23 …”

Effect of Overweight and Obesity on Periodontal Treatment Intensity

“…Due to its association with impaired immunity and healing (Anderson and Hamm 2014), obesity is thought to adversely affect periodontal treatment success. However, a review of nonsurgical treatment interventions conducted through 2015 (Gerber et al 2016) and more recent studies (Peralta et al 2020; Suvan et al 2020; Zuza et al 2020) show inconclusive results. Several investigators found that improvements in pocket depth or number of teeth with attachment loss were less pronounced after nonsurgical treatment in obese patients compared to nonobese individuals (Offenbacher et al 2009; Suvan et al 2014; Bouaziz et al 2015; Goncalves et al 2015;Suvan et al 2020), while others reported no significant difference in clinical periodontal outcomes (Al-Zahrani and Alghmadi 2012; Altay et al 2013; Peralta et al 2020; Zuza et al 2020).…”

“…However, a review of nonsurgical treatment interventions conducted through 2015 (Gerber et al 2016) and more recent studies (Peralta et al 2020; Suvan et al 2020; Zuza et al 2020) show inconclusive results. Several investigators found that improvements in pocket depth or number of teeth with attachment loss were less pronounced after nonsurgical treatment in obese patients compared to nonobese individuals (Offenbacher et al 2009; Suvan et al 2014; Bouaziz et al 2015; Goncalves et al 2015;Suvan et al 2020), while others reported no significant difference in clinical periodontal outcomes (Al-Zahrani and Alghmadi 2012; Altay et al 2013; Peralta et al 2020; Zuza et al 2020). These controlled studies have limitations such as a focus on nonsurgical root planing and scaling or disinfectant only, as well as small sample sizes, and they rarely had follow-up times more than several weeks or months.…”