Obesity, diabetes and periodontitis – a triangular relationship?

Abstract

The global rise of obesity, both adult and childhood, has been paralleled by a rise in type 2 diabetes, a trend predicted to continue for at least the next two decades. The combined effect will create a burden of direct and co-morbidities that will strain the physical and financial resources of all countries. While it is accepted that both type 1 and type 2 diabetes are major risk factors for the development and progression of periodontal disease, there is growing evidence that obesity is both an indirect risk factor because it affects glycaemic control and a direct risk factor because secretion of pro-inflammatory agents by adipose tissue modifies the periodontal reaction to the plaque biofilm. Recent research suggests that periodontitis may adversely affect glycaemic control, which can be improved by periodontal treatment with reduced risk of diabetic co-morbidity, thereby creating a two-way relationship. Furthermore it appears possible that periodontitis may stimulate inflammatory change in adipose tissue, creating a triangular self-generating cycle of morbidity linking obesity, diabetes and periodontal disease. Dentists should recognise these interlinked risk factors and consider including an assessment of glycaemic control and adiposity, possibly by waist-to-hip ratio, when periodontitis is diagnosed and in collaboration with medical practitioners provide treatment to help reduce the development of systemic disease.

The clinical and systemic effects of periodontal treatment in diabetic and non-diabetic obese patients

“…Moreover, it has been proposed that periodontitis prompts an inflammatory alteration in adipose tissue, which is associated with obesity, DM, and periodontal sickness (4).…”

Correlation Between Obesity And Periodontitis In Vietnamese Patients

“…The prevalence of obesity is rising worryingly not only among adult but also among children in many developed and developing countries [1]. It is defined as excessive fat accumulation that can cause various health disorders [2].…”

“…Excessive adiposity can promote chronic low grade inflammation [15,16]. Obesity and its related health problems become a burden on the economy of many countries, requiring action across individual and societal levels [1].…”

“…Periodontal disease is a multifactorial disease characterised by a progressive destruction of the periodontal ligament and alveolar bone supporting the teeth [1]. Its expression and progression are complications of a complex interaction between a bacterial infection and the host response that can be modified by behavioural factors [17].…”

Estimation and Comparison of Erythrocyte and Hemoglobin Levels in Subjects with Healthy Periodontium and Chronic Periodontitis

“…As the periodontal tissues mount an immune inflammatory response to bacteria and their products, systemic challenges with these agents also induce a major vascular response offering explanatory mechanisms for the interaction between periodontal infections and a variety of systemic disorders [17,18]. Epidemiological studies have suggested that periodontal deterioration increases the risk of systemic problems such as chronic obstructive pulmonary diseases (COPDs), stroke [19], cardiovascular diseases (CVDs) [20], atherosclerosis, diabetes mellitus (DM) [21], adverse pregnancy outcomes [22]. Periodontal diseases have proved to be an independent risk factor for adverse pregnancy disorders such as preterm births, low birth weight and pre-eclampsia, after adjusting for other confounding factors [23].…”