Impact of Medical and Surgical Obesity Treatment on Dental Caries: A 2-Year Prospective Cohort Study

Abstract

The objective was to study the long-term effects on oral health of bariatric surgery compared with medical treatment of obesity. Swedish females with morbid obesity (n = 66;18-35 years at baseline) were followed prospectively from before obesity treatment until two years after treatment. The main response variable was dental caries registered according to the ICDAS-II system. Possible confounding caused by sociodemographic characteristics, general health, oral health habits and oral hygiene was controlled for. The statistical methods included Chi-square tests, Student’s t-tests, one-way ANOVA, Wilcoxon’s non-parametric tests and linear regression models. In the surgically treated patients (n = 40), a significant increase over time in enamel caries (mean increase 4.13 tooth surfaces ICDAS1-2), dentine caries (mean increase 2.18 tooth surfaces ICDAS3-6), and total caries (mean increase 6.30 tooth surfaces ICDAS1-6) was registered (all p < 0.001), which was not seen in the medically treated patients (n=26). However, the difference between the treatment groups (surgical or medical) was only statistically significant for enamel caries (crude β 4.89, p=0.003) and total caries (crude β 6.53, p<0.001). The relationships were stable and independent of differences in confounders as socioeconomy, general health and oral health behaviors. In conclusion, two years after obesity treatment, a significant increase in dental caries was registered in the surgically treated but not in the medically treated women. The dental service should intensify its preventive efforts in individuals undergoing obesity treatment.

Effect of an Oral Health Promotion Program on Gastroplasty Patients: A Randomized Clinical Trial

“…The present study is in line with research that also recommends periodic prophylaxis to help improve the oral hygiene status of patients undergoing bariatric surgery, which results in the prevention of oral diseases such as periodontitis, thus greatly improving the patient’s quality of life 20 .…”

“…After six and 12 months, the incidence of caries was significantly lower among members of the IG compared to those in the CG, both in enamel and dentin. A previous study, in which there was no dental intervention, reported a significant increase in dental caries over time following gastroplasty 20 .…”

“…The bariatric diet, combined with inadequate oral hygiene, may result in an increase in carious lesions, because, with reduced gastric capacity, there is a medical recommendation to increase the frequency of food and liquid intake throughout the day 20 . Furthermore, hyposalivation, common in gastroplasty patients in the first months after surgery, is accompanied by an increase in cariogenic microorganisms, such as Lactobacillus and Streptococcus mutans , increasing the risk of caries, especially in the first six months 7 .…”

“…The repercussion of bariatric surgery complications on oral health has not been adequately reported in the few longitudinal studies found in the literature 20 , which justifies the need for further research providing information to promote the oral health of these patients and healthcare protocols with educational-preventive guidelines 8 .…”