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    The Association Between Obesity and Periodontitis

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    Obesity, therefore, is a chronic metabolic ailment that predisposes various types of disorders which include arterial hypertension, diabetes mellitus among other risk factors. However, the most common ailment that is closely linked to obesity is the susceptibility to periodontitis (Suvan, et al., 2015). Periodontitis refers to an infectious disease that is accompanied by an inflammatory syndrome of tooth-supporting edifices which emerge as a result of the interface between pathogenic bacteria and the host of the immune response. When the host immune response is subjected into activation for the purpose of protection, there is an eventual destruction of tissues during the process of synthesis and release of cytokines, metalloproteinases and proinflammatory mediators.

    According to Nascimiento, et al. (2014), periodontal disease is amongst the 10 most rampant chronic ailments that have been mentioned to affect the world’s demographics through impoverishment (Suvan, et al., 2015). Various researches have been done recently to back up the argument that was put forward by Nascimiento, et al. (2014), on the existing relationship between obesity and periodontitis and other related disorders. This association emerged as a result of the recent studies on the relationship between periodontal disease and obesity which have affirmed that there are several aspects that are still unclear hence leaving a gap in the study (Suvan, et al., 2015). However, the adipose tissue plays the role of secreting proinflammatory cytokines and hormones that are famously known as adipocytokines which have the potentiality to induce inflammatory processes and oxidative anxiety syndromes therefore ending up producing a similar pathophysiology between the two ailments. Initial experiments on the association between obesity and periodontal disease were at first encountered in animals as experimental control mechanisms in 1977 by Perlstein and Bissada (Herrera, et al., 2017).

    Thereafter, it was extended to human beings in 1998 under the control of Saito et al. where several hypotheses were observed to be on the high to understand that obesity is a risk factor for periodontitis following various epidemiological studies that followed the initial study.

    The Effects of Obesity on Periodontal Tissues

    Persons who are known to experience obesity have enhanced tendencies to illustrate an increased rate of circulation of pro-inflammatory cytokines interleukin (IL)-6 and tumor necrosis factor alpha (TNF-alfa, components that are secreted from the adipose tissue which are eventually incorporated in the pathophysiology of both victims of periodontitis and obesity (Herrera, et al., 2017). According to Altay et al., (2013), serum among these cytokines tend to decrease when persons experiencing the same diseases exhibit tremendous weight loss. Severities of the effects of obesity conditions to periodontium can be mitigated by administering impaired glucose tolerance, causing dyslipidemia, causing inflammatory cytokines and adipokines, for instance, the TNF-alfa, IL-6 and adiponectin and leptin among other elements. Studies suggest that when the rate of concentration of TNF-alfa is high, there is an automated aggravation of pre-existent periodontal disease as it is encountered through the inspiration of fibroblasts that promote the synthesis of enzymes that are entitled with degrading properties that quicken the stimulation of osteoclasts, facets that are judged with the responsibility of activating bone resorption. One of the latest researches on the relationship between obesity and periodontitis was conducted in Japan and analysis were done by Saito et al. and Nassar et al. on 241 Japanese nationalities and findings illustrated the first association of obesity and periodontal disease in humans (Herrera, et al., 2017).

    Furthermore, the analysis affirmed that patterns of distribution of fat demonstrate a crucial role in the association between the two diseases. An extent of the same research by Saito et al. indicated that obesity has a close association with deep periodontal pockets, a condition that is independent of glucose tolerance status. According to an analysis by Genco, et al., on National Health and Nutritional Survey (NHNS) data, they reported that BMI is positively related to the sternness of periodontal loss of attachment. In addition, they reported that this mutuality is regulated by insulin resistance by the metabolic functions in relation to obesity and periodontitis. Following the fact that there is a gap existing in studies that attempted to address this matter, research has endlessly worked on it and several findings towards curbing the gap have deemed claims on adipose-tissue-derived cytokines and hormones to play a big role in revealing facts concerning this matter (Herrera, et al., 2017).

    Assessment of Risks that are related to Obesity and Periodontal Disease

    There is a concern that obesity stands second after smoking as a risk factor for inflammatory facets that destruct tissues in periodontal disease. This is evidenced by the fact that obese persons have increased clinical attachment devastation and increased deeper periodontal pockets (Herrera, et al., 2017). This appears as a result of a fueled inflammation by cytokines that accept inflammability therefore making obesity to be in the forefront and having the tendency of increasing the chance of destructive periodontal disease by a substantial rate of about 35 percent.

    Pathophysiology of Obesity and Periodontal Disease

    The two disorders, obesity and periodontitis are caused primarily by inflammations. This is according to the concern that fats in human beings secrete 12 different kinds of cytokines that are inflammatory in nature with TNL-alfa in inclusion (Winning, et al., 2015). These inflammatory cytokines have the potential to cause alteration on the metabolic mechanism of the cytokines in the bodies of the individuals therefore causing low-grade systematic inflammation. Findings from the various studies indicated that for each unit increase in BMI, there is a 5% projection in the evolution loss in alveolar bone. On the other hand, each increase in waist circumference by a centimeter results to a 1 to 2% increase in the progression which compels the depth in the loss of clinical attachment (Winning, et al., 2015). This case justifies the information that the disease becomes rampant among individuals who have high risks of cardiometabolic illness in comparison to those persons who have a healthy weight.

    Recommended Medication for Periodontal Disease

    At past, periodontitis was addressed through the use of scaling and root planning with the aid of ultrasonic scalers. Scaling and root planning was the most preferable method of treating periodontitis due to its affordability and the easiest method of eliminating microbial deposits which tend to favor optimal periodontal health among patients of the disease. In connection to this form of medication, there exist other treatment methods that are recommendable for treating periodontitis (Virto, et al., 2018). This includes non-surgical adjunctive treatment of periodontal treatment, for example, the use of lasers and other locally delivered controlled-release microbials which have the ability to embrace the reduction in pocket depths. These products include tetracycline, chlorhexidine, chip and minocycline among other medicinal substances (Akram, et al., 2016).

    Medication of Obesity

    The major aim of treating obesity is achieving the recommended healthy weight that does not encourage the susceptibility of diseases which are prevalent in obesity including periodontitis. This treatment concerns much of physical activities than the use of medicinal substances (Akram, et al., 2016). This includes the attendance of weight loss programs which has been termed to be the most beneficial activity to be considered by obese individuals towards their healthy living. The second activity that should be observed towards the treatment of obesity is the proper consideration of eating habits and diet by patients who are experiencing obesity. Finally, consideration of sedentary lifestyles should also be factored in as an important treatment for obesity.

    Methodology

    For this literature review, PubMed, ESCOhost, and Wiley online library searches were utilized to obtain the articles needed using the keywords: obesity, periodontal disease, inflammation, and periodontitis. The initial search contributed hundreds of articles and then was minimized to literature that was within five years old, peer-reviewed, and full-text articles. The methodology for the articles is as follows. In Akram et al., (2016) meta-analysis of three studies were performed to compare results of non-surgical periodontal therapy on obese and non-obese patients. Five clinical studies were included with several patients ranging from 30 to 260 and the age ranged from 42.5 to 48.8 years of age. Plaque index, clinical attachment loss, gingival bleeding index, and periodontal pocket depth were all measured. The number of studies selected, and findings made the study less reliable.

    The results did depict a more desirable outcome for non-obese patients, but the levels of serum pro-inflammatory cytokine levels following treatment for both obese and non-obese patients was unpredictable. Keller et al., (2015) included eight longitudinal and five intervention studies to assess the association of obesity and periodontitis. This systematic review on longitudinal studies allowed for sufficient time unlike prior reviews on cross-sectional studies. This was a reliable review based on the amount of studies involved and suggested obesity has a close correlation with the development of periodontal disease or increased severity of periodontitis. Martinez et al., (2017) utilized 28 articles that incorporated controlled clinical trials and observational studies that obtained quality data and assessments. The literature search for these articles were collected through PubMed-Medline and Embase. It concurred that there is relation between obesity and periodontal disease but needed further longitudinal studies to grasp the significance of the biological process. Suvan et al., (2015) inquired by the means of a clinical case control study of 286 individuals to associate the two disorders by utilizing periodontal measurements and calculated body mass index. The study concluded that obese individuals raised their odds of having periodontitis. Virto et al., (2018) used an experimental study of melatonin therapy for periodontitis on rats rather than human subjects. The study proceeded with obese and non-obese rats and were randomly selected for treatment with periodontal debridement, no treatment, chlorhexidine or melatonin.

    The study resulted that melatonin did have a significant affect of reduction of bone loss and exerted protective anti-inflammatory effect with the therapy of melatonin. Winning et al., (2015) researched the connection between periodontal disease pathogens and levels of systemic inflammation measured by C-reactive protein. The clinical analysis included 518 men with age ranging from 60 to 70 years of age. Periodontal assessment and body mass index were obtained as well as real time C-reactive protein. Smoking was a factor which was not excluded but men taking statins were excluded. Discussion The vast amount of literature and studies obtained on obesity and periodontal disease suggested that they both go hand in hand with each other and obesity itself has been acknowledged as a considerable risk factor for periodontal disease. It is important to keep patients in tune with what is happening with their oral health and how it impacts their overall health, but also how their overall health impacts their oral health. The body should be seen as a whole and not divided.

    Collaboration between an individual’s primary care doctor and dentist is key factor for that person’s overall health. Not many individuals think about how obesity and periodontal health are related, but when you consider obesity as distinguished by a chronic subclinical inflammation and periodontitis being a chronic inflammatory disease it becomes clear of the link between the two.

    Conclusion

    This systematic review illustrates that obesity is among the primary contributing risk factors for the development of periodontitis alongside factors such as age, gender, ethnicity and race. The progression of periodontal disease is compelled by inflammation that is related to obesity. This inflammatory response is secreted by the adipose tissue which is a producer of increasing gingival inflammation and contributes to the spread of bacteria.

    Furthermore, it is evident that the progression of periodontal disease increases the likelihood that the production of pro-inflammatory cytokines enhances the tendency for the development of various metabolic ailments such as obesity. However, men have been found to be much more vulnerable to periodontitis disease than women. On the other hand, women have an increased gingivitis inflammation which increases their vulnerability to periodontitis. This disease can be treated by scaling and root planning therapy, the use of lasers and other microbials. Obesity can be managed through consideration of a proper healthy diet and observance of exercises and physical activities.

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