|Year : 2017 | Volume
| Issue : 4 | Page : 323-326
Relationship of obesity with periodontitis among patients attending a dental college in Chennai: A cross-sectional survey
Delfin Lovelina Francis1, B Kumara Raja1, Chitraa R Chandran2
1 Department of Public Health Dentistry, Tagore Dental College and Hospital, Chennai, Tamil Nadu, India
2 Department of Periodontics, Tagore Dental College and Hospital, Chennai, Tamil Nadu, India
|Date of Web Publication||13-Dec-2017|
B Kumara Raja
Tagore Dental College and Hospital, Chennai - 600 127, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Introduction: Periodontal disease is a global public health issue, and it has been suggested to be an associated risk factor for obesity. However, the studies addressing these relationships were sparse. Aim: This study aims to determine whether there was a relationship between body mass index (BMI) and periodontal disease. Materials and Methods: This cross-sectional study was carried out on 400 individuals who were randomly selected from the outpatient department of a dental college in Chennai. The community periodontal index (CPI) was used to assess periodontal status. Participants with a CPI score (CPI 0–2) were considered as nonperiodontitis group and those with a CPI score (CPI 3–4) were considered to have periodontitis. Statistical analysis was performed using Chi-square test and logistic regression analysis was used to estimate the association between BMI and periodontitis. P < 0.05 was considered as statistically significant. Results: The prevalence of periodontitis was 29.2% with a mean BMI score of 22.45 ± 05.27. Logistic regression analysis revealed a 30% increased risk for periodontitis per 1-kg/m2 increase in BMI (adjusted odds ratio, 1.30; 95% confidence interval, 1.08–1.27; P < 0.05). Conclusion: Periodontal disease was associated with increased BMI establishing a link between obesity and periodontitis.
Keywords: Body mass index, obesity, periodontitis
|How to cite this article:|
Francis DL, Raja B K, Chandran CR. Relationship of obesity with periodontitis among patients attending a dental college in Chennai: A cross-sectional survey. J Indian Assoc Public Health Dent 2017;15:323-6
| Introduction|| |
Obesity is increasing at an alarming rate throughout the world making it a major public health concern in both developing and developed countries. Obesity is a complex and multi-factorial disease resulting from excessive storage of fat, occurs due to the interaction of social, behavioral, cultural, psychological, metabolic, and genetic factors among the population. Various health consequences associated with obesity are diabetes mellitus, hypertension, heart disease like coronary artery disease, cerebrovascular disease such as hemorrhagic and ischemic stroke, metabolic syndrome like insulin resistance, some cancers such as cancer of esophagus, thyroid, kidney, uterus, colon and breast, and psychosocial problems. Besides these risk factors, obesity has also been suggested to be a risk factor for periodontitis which is a disease of the supporting structures of the teeth resulting from the interaction between pathogenic bacteria and the host immune response. It has been believed that adverse effect of obesity on the periodontium may be mediated through pro-inflammatory cytokines such as interleukins (IL-1, IL-6 and tumor necrosis factor-α), adipokines (leptin, adiponectin, resistin, and plasminogen activator inhibitors-1), and several other bioactive substances like reactive oxygen species, which may affect the periodontal tissues directly. Therefore, these findings indicate the adipose tissue secretes several cytokines and hormones that are involved in inflammatory processes, suggesting similar pathways are involved in the pathophysiology of obesity and periodontitis.
Although some studies ,, have shown an association between obesity and periodontal disease in different populations, there have been only few studies documented in literature, in this part of southern India. Hence, an attempt was made to explore the relationship between obesity and periodontitis among the patients attending outpatient department of a dental college in Chennai.
| Materials and Method|| |
A cross-sectional study was conducted among participants attending Outpatient Department of a Dental College in Chennai. The study was approved by the Institutional Review Board and Ethics Committee and study subjects were recruited in October 2016. A written informed consent was obtained from all participants who fulfilled the inclusion and exclusion criteria after explaining the study protocol. This study was carried out in accordance with the world medical association, declaration of Helsinki guidelines.
A pilot study was conducted among 50 participants aged 20 years and above, in which 45% of study individuals showed the presence of periodontal disease (community periodontal index [CPI] 3–4). Hence, the sample size was calculated by keeping an alpha error of 1.96, power for the study as 80%, and difference to be detected as 10%. Thus, a sample size of 377 study individuals was required with 95% confidence interval, and finally, it was rounded off to 400 study participants. The participants aged between 20 and 60 years, with a minimum of 20 teeth were included and participants with systemic diseases and conditions, past periodontal treatment with 6 months before examination, previous history of antibiotic therapy, physically and mentally challenged participants and pregnant women and lactating mothers were excluded from the study.
A structured questionnaire was prepared to collect information regarding demographic and sociodemographic data. The variables such as age, gender, level of education, smoking, and alcohol were included as covariates since they were identified as periodontal disease risk factors. All participants answered the questionnaire and underwent biometric measurements for height and weight and clinical measurements for periodontal status.
The height of the study participants was measured in centimeters, then converted to meters and weight was measured in kilograms using a mechanical scale. These measurements were recorded by a separate investigator, who was also blinded to CPI scores. According to the criteria given by the World Health Organization (WHO) the study individuals were grouped into four strata as: underweight (body mass index [BMI] <18.5 kg/m 2), normal weight (BMI 18.5–24.9 kg/m 2), overweight (BMI 25–29.9 kg/m 2), and obese (BMI >30 kg/m 2).
To assess periodontal status, the WHO CPI was used and recorded under five scores: score 0 (healthy), score 1 (bleeding), score 2 (calculus), score 3 (shallow periodontal pockets), and score 4 (deep periodontal pockets). All oral examinations were performed by a single examiner who was trained and calibrated for measuring CPI in the department of public health dentistry and examiner was blinded to BMI measurements. Intraexaminer reliability for periodontal status assessment was weighed using Cohen's kappa statistics which showed a good intraexaminer agreement (0.74).
The statistical package for social science version 19 (SPSS Inc., Chicago, IL, USA) was used for data processing and analysis. Frequency distributions were used for categorical variables and mean and standard deviation for continuous variables. Chi-square tests were used to find the association between various demographic factors with periodontitis. Binary logistic regression analysis was carried out to determine the relationship between obesity and periodontal disease. The dependent variable for the logistic regression analysis was categorized into nonperiodontitis (CPI 0-2) and periodontitis group (CPI 3-4). Then nonperiodontitis was entered as 0 and periodontitis group as 1. BMI is taken as an independent variable and entered in continuous scale. Both adjusted and crude odds ratio were calculated for assessing the influence of an independent variable on the periodontal status with 95% confidence intervals. A significance value of P < 0.05 was accepted as statistically significant.
| Results|| |
A total of 400 study individuals were enrolled for the study with a mean age of 38.51 ± 08.14 years, among which 219 (54.8%) were males and 181 (45.2%) were females. The mean BMI was 22.45 ± 05.27 and the overall prevalence of periodontal disease was 29.2%.
A CPI score of 2 (bleeding and calculus) was recorded for majority (34.2%) of the study participants. More than half of the study participants had a normal weight (56.3%), whereas (23.7%) of the study participants recorded to be overweight and only (5.5%) were seen to be obese [Table 1].
|Table 1: Distribution of participants based on periodontal status and body mass index|
Click here to view
A statistically significant association was found between BMI and periodontitis (0.00001*) with 27.6% and 15.2% of overweight and obese study participants showing the presence of periodontitis [Table 2]. A statistically significant difference was found for age, gender, level of education, smoking, and alcohol between the groups [Table 3]. Individuals had an increased risk of periodontitis by 30% for each 1 kg/m 2 increase in BMI (Adjusted odds ratio, 1.30; 95% confidence interval, 1.08–1.27; P < 0.05) [Table 4].
| Discussion|| |
An increased prevalence of obesity has been observed in recent years and is one of the fastest growing health-related problems in the world. Overweight and obesity have been suggested to be associated with periodontitis, because obesity may have some effects on systemic health by affecting the host susceptibility to periodontitis due to inflammatory mediators.
BMI was used as a biometric measurement for measuring obesity hence it is an indicator for overall adiposity, and it was computed from weight in kilograms divided by square height in meters. The WHO had also documented that BMI provides the most useful population-level measure of overweight and obesity as it is the same for both sexes and all ages of adults, hence, BMI was used as a tool to measure obesity in this study.
The CPI was taken to assess the level of periodontitis because WHO in its third edition of oral health basic methods has reported that “The most useful information on periodontal diseases would be obtained by including gingival bleeding, the presence of calculus and periodontal pocket depth measurements.” The overall prevalence of periodontitis in the present study was 29.2% but Bhardwaj et al. and Kumar et al. had reported a higher prevalence rate. Several factors, such as poor oral hygiene, diet, socioeconomic status, low access to dental health services had attributed to progression of periodontal disease in their studies.
A high prevalence of bleeding and calculus was observed in the present study and it is in accordance with previous studies.,, Our study also showed an increased risk of periodontitis by 30% for each 1 kg/m 2 increase in BMI, and it is in accordance with studies reported by Ekuni, Salekzamani et al. and Hypponen et al.
One of the main limitations of this study was data collection was confined to a single center, which might affect the generalizability of the study. Hence, studies with multicenter approach are recommended in future. Since a cross-sectional design was adopted, it limits the ability to identify causality between obesity and periodontal disease, therefore, longitudinal study design will be required to explore cause and effect relationships in this regard. Necessary steps should be taken by the oral health-care professionals, to arrange dental screening camps among the vulnerable groups for early detection of periodontal disease and recognize patients at risk to advocate promotion of healthy nutritional habits and physical activity to prevent the progression of obesity and periodontal disease.
| Conclusion|| |
The results of the present study show a higher BMI could be a potential risk factor for periodontitis establishing a link between obesity and periodontitis.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Al-Zahrani MS, Bissada NF, Borawskit EA. Obesity and periodontal disease in young, middle-aged, and older adults. J Periodontol 2003;74:610-5.
Moura-Grec PG, Marsicano JA, Carvalho CA, Sales-Peres SH. Obesity and periodontitis: Systematic review and meta-analysis. Cien Saude Colet 2014;19:1763-72.
Amrutiya MR, Deshpande N. Role of obesity in chronic periodontal disease – A literature review. J Dent Oral Disord 2016;2:1012.
Dahiya P, Kamal R, Gupta R. Obesity, periodontal and general health: Relationship and management. Indian J Endocrinol Metab 2012;16:88-93.
Jagannathachary S, Kamaraj D. Obesity and periodontal disease. J Indian Soc Periodontol 2010;14:96-100.
] [Full text]
Mathur LK, Manohar B, Shankarapillai R, Pandya D. Obesity and periodontitis: A clinical study. J Indian Soc Periodontol 2011;15:240-4.
] [Full text]
Palle AR, Reddy CM, Shankar BS, Gelli V, Sudhakar J, Reddy KK, et al.
Association between obesity and chronic periodontitis: A cross-sectional study. J Contemp Dent Pract 2013;14:168-73.
Kumar S, Dagli RJ, Dhanni C, Duraiswamy P. Relationship of body mass index with periodontal health status of green marble mine laborers in Kesariyaji, India. Braz Oral Res 2009;23:365-9.
Khan S, Saub R, Vaithilingam RD, Safii SH, Vethakkan SR, Baharuddin NA, et al.
Prevalence of chronic periodontitis in an obese population: A preliminary study. BMC Oral Health 2015;15:114.
Aykroyd WR, Mayer J. Food and nutrition terminology. In: WHO Doc NUT/68.6. Geneva: WHO; 1968. p. 667.
World Health Organization. Community periodontal index. In: Oral Health Surveys: Basic Methods. 4th
ed. Geneva: WHO; 1999. p. 1-66.
Beltrán-Aguilar ED, Eke PI, Thornton-Evans G, Petersen PE. Recording and surveillance systems for periodontal diseases. Periodontol 2000 2012;60:40-53.
Bhardwaj VK, Sharma D, Jhingta P, Fotedar S, Sahore M, Manchanda K, et al.
Assessment of relationship between body mass index and periodontal status among state government employees in Shimla, Himachal Pradesh. J Int Soc Prev Community Dent 2013;3:77-80.
Ojima M, Hanioka T, Tanaka K, Inoshita E, Aoyama H. Relationship between smoking status and periodontal conditions: Findings from national databases in japan. J Periodontal Res 2006;41:573-9.
Ekuni D, Yamamoto T, Koyama R, Tsuneishi M, Naito K, Tobe K, et al.
Relationship between body mass index and periodontitis in young Japanese adults. J Periodontal Res 2008;43:417-21.
Salekzamani Y, Shirmohammadi A, Rahbar M, Shakouri SK, Nayebi F. Association between human body composition and periodontal disease. ISRN Dent 2011;2011:863847.
Hypponen E, Power C, Smith GD. Prenatal growth, BMI, and risk of type 2 diabetes by early midlife. Diabetes Care 2003;26:2512-7.
[Table 1], [Table 2], [Table 3], [Table 4]