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Professional Position Paper

Is There a Significant Increase in the Prevalence of Periodontal Disease in Obese Adult Patients,
Compared to Non-Obese Adults with Periodontal Disease, When Using Patient BMI and
Collected Oral Hygiene Indices?

Professional Position Paper

EVBP 5500
Submitted to: Carrie Maynard

Calley Williams, Lindsay Vemb, Lydia Brouwer, Lucas Myers

July 29th 2016

Professional Position Paper

Obesity is one of the most pervasive chronic diseases. It is defined as excess adipose
tissue and has many different methods of diagnosis; BMI being the most common. Adipose
tissue secretes a number of products, including metabolites, cytokines, lipids and coagulation
factors. The excess adiposity or obesity causes increased levels of circulating fatty acids and
inflammation (Finkelstein, Trogdon, Cohen, & Dietz, 2009). Obesity increases the hosts
susceptibility by modulating the immune and inflammatory systems in a manner that predisposes
to inflammatory tissue destruction and leaves an individual at a greater risk for periodontitis,
resulting in decreased blood flow and the facilitating progression of periodontitis. (Iacopino,
2016). Obesity is a disease that affected 14,222,521 males and females over the age of 18 in
Canada in 2014 alone (Number of persons", 2016). Periodontitis is a group of conditions, all
involving inflammation of the periodontium and surrounding tooth structures. ("Periodontitis
Article | Gum Disease | Colgate Oral Care Information", 2016) It is estimated that seven out of
ten Canadians will develop gum disease at some times in their lives, and is the most common
dental problem. ("Canadian Dental Association", 2016). When ruling out other modifiable
factors such as smoking and diabetes; it is highly suspected that chronic periodontitis is directly
associated with an individuals body mass index or obesity levels.

Although there is much supporting evidence proving that obesity is linked to

periodontitis, it is difficult to prove that it alone will result in periodontal disease. There are so
many factors that can lead to periodontitis and its infections, that obesity may not be the only
factor that will increase a persons chance of getting periodontal disease. So how can one say that
strictly obesity is linked to periodontal disease? Smoking is also a large factor that is related to
periodontal disease. Even though tissues may look healthy in a smoker they are usually

Professional Position Paper

hyperplastic and damaged beyond repair by the constant heat and smoke that they are being
exposed to. In a cross-sectional study of 286 subjects those individuals that used tobacco
products when compared to those who did not, the tobacco users showed a significantly higher
prevalence in periodontal disease symptoms (Kulkarni V, 2016). Misaligned or crowded teeth as
well as many orthodontic appliances also play a big role in contributing to periodontal disease.
Any deviation in tooth morphology or insertion of appliances can attract bacteria and plaque
buildup, leading to the cascading set of events that results in chronic periodontal disease
("Periodontal Disease: Causes and Prevention", 2016). These are only a few of the reasons why
someone could have periodontal disease, however, obesity is an overlooked and unknown cause
as its process of destruction is different from the typical causes. As previously stated, smoking
affects the gingiva from physical and chemical trauma from an external object that is introduced
to the body. The misaligned or crowded teeth is a developmental or genetic cause that along with
appliances introduced to the oral cavity, results in accumulated plaque and calculus that leads to
periodontal disease ("Periodontal Disease: Causes and Prevention", 2016). Whereas obesity, in
most cases, is a modifiable factor that results in an internal chemical process leading to
periodontal disease. Due to the increasing amount of the population who are and becoming
obese, this cause is one that is not addressed and utilized in the treatment plan for periodontal
disease when it is a major influential factor.

Even though there are many other factors that can result in varying degrees of periodontal
disease, in conjunction with obesity, the bodily effects of obesity alone, in most cases, will cause
symptoms of periodontal disease (Finkelstein, Trogdon, Cohen, & Dietz, 2009). In a 26-year
study conducted by Hubert, H. B., Feinleib, M., Mcnamara, P. M., & Castelli, W. P., results

Professional Position Paper

showed that weight gain after the young adult years conveyed an increased risk of CVD in both
sexes that could not be attributed either to the initial weight or the levels of the risk factors that
may have resulted from weight gain. To combat the various cardiovascular diseases that an
obese individual may experiences, many different drugs can be prescribed to solve or lessen the
effects of the disease. One of the most common drug side effects is xerostomia; a condition that
is known to cause periodontal disease symptoms. Another study showed that when comparing
five hundred and thirty-one patients attending an adult cardiology clinic, xerostomia was the
most common side effect of those individuals taking cardiovascular drugs (K. M. Habbab, D. R.
Moles, S. R., 2010).

Obesity is a growing concern in many developed countries. As smoking is a severe cause

of periodontitis, so is obesity, and it is a growing concern today. Over seventy percent of obesity
cases are due to the lifestyle that the person is living and only thirty percent is due to genetics
(Sotwiska & Sotwiski, 2015). Without the proper balance of protein, fat, carbohydrates and
other nutrients; it is very easy to become overweight or obese. The unhealthy lifestyle of eating
out or over eating the amount of recommended carbohydrates or fats, can increase ones
susceptibly to becoming obese, especially while living a sedentary lifestyle (Sotwiska &
Sotwiski, 2015). Overeating cariogenic foods can increase ones chance of getting periodontitis
as these foods adhere to the teeth causing bacteria to become entrapped beneath the tissues for a
prolonged period of time, allowing it to attack the healthy gingiva, causing a periodontal
condition. Having a proper diet that is well balanced will reduce the risk of obesity, as well as aid
in the tissues healing, and respectively arrest periodontitis (Sotwiska & Sotwiski, 2015).

Professional Position Paper

Hypothyroidism is a decrease in thyroid hormone production which can cause slow

metabolic rate, weight gain, lethargy, intolerance to cold, dry and cool skin and puffiness of the
face (Chandna & Bathla, 2011). Since hypothyroidism changes the hormone levels in the body,
the oral cavity reacts differently than it would when the thyroid was at full function. Due to the
decrease in metabolic rate and resultant weight gain, a connection can be made between those
with a hypothyroid condition and obesity. Although it may not be a direct cause, there is a
correlation that should not be ignored. In a client with hypothyroidism the clinical oral findings
are macroglossia, dysgeusia, delayed eruption and poor periodontal health (Chandna & Bathla,
2011). Periodontal disease is highly expected in clients with hypothyroidism since most clients
are overweight, due to the decrease in metabolic rate.

The link between an individuals body mass index or obesity levels and chronic
periodontitis is unquestionable even when specific modifiable factors are eliminated. If an obese
individual is experiencing symptoms of periodontitis, a lifestyle change may be required in order
to reduce the severity of said symptoms. Whether that be from looking into solutions to
prescription drug induced symptoms such as xerostomia; watching the specific foods being
consumed that not only increase body mass but alone cause periodontal disease symptomology;
or possibly exercising to reduce to effects of other body conditions like hypothyroidism.
Regardless of the cause, the effects obesity has on the chemical processes of gingival health will
result in periodontitis.

Professional Position Paper

References
Body mass index, overweight or obese, self-reported, adult, by age group and sex (Number of
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Canadian Dental Association. (2016). Cda-adc.ca. Retrieved 12 July 2016, from
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Chandna, S. & Bathla, M. (2011). Oral manifestations of thyroid disorders and its management.
Indian Journal Of Endocrinology And Metabolism, 15(6), 113.
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Deschner J, e. (2016). The role of adipokines in periodontal infection and healing. PubMed
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Finkelstein, E., Trogdon, J., Cohen, J., & Dietz, W. (2009). Annual Medical Spending
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Hubert, H. B., Feinleib, M., Mcnamara, P. M., & Castelli, W. P. (1983). Obesity as an

independent risk factor for cardiovascular disease: A 26- year follow-up of participants in
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Retrieved 12 July 2016, from http://go.galegroup.com.dproxy.library.dc

Professional Position Paper

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