Effect of Treatment of Periodontitis on Incretin Axis in Obese and Nonobese Individuals: A Cohort Study

Abstract

Context Periodontitis confers an increased risk of developing type 2 diabetes and, in patients with obesity, it might interfere with the incretin axis. The effect of periodontal treatment on glucoregulatory hormones remains unknown. Objective To evaluate the effect of periodontal treatment on incretin axis in obese and lean non-diabetic individuals. Setting King's College Dental Hospital and Institute, London, UK. Participants and Methods The metabolic profile of obese and BMI-normal individuals affected by periodontitis was studied at baseline, 2 and 6 months after intensive periodontal treatment, by measuring plasma insulin, glucagon, GLP-1 and GIP and markers of systemic inflammation and oxidative stress. Main Outcome Measure(s) Circulating levels of incretins and inflammatory markers. Results At baseline, periodontal parameters were worse for obese than non-obese; this was accompanied by higher levels of circulating hs-CRP, insulin and GLP-1. The response to periodontal treatment was less favourable in the obese group, without significant variations of hs-CRP or malondialdehyde. Gluco-regulatory hormones changed differently after treatment: while insulin and glucagon did not vary at 2 and 6 months, GLP-1 and GIP significantly increased at 6 months in both groups. In particular, GLP-1 increased more rapidly in obese participants, while the increase of GIP followed similar trends across visits in both groups. Conclusions Nonsurgical treatment of periodontitis is associated with increased GLP-1 and GIP levels in non-obese and obese patients; changes in GLP-1 were more rapid in obese participants. This might have positive implications for the metabolic risk of these individuals.

What Are the Clinical and Systemic Results of Periodontitis Treatment in Obese Individuals?

“…Those differences were detected in the final percent of PD > 4 mm, percent of PD > 5 mm, and percent of full-mouth bleeding (Table 1 ). Another study by Suvan et al [ 15 ••] demonstrated at 6 months that, although a significant reduction in mean PD and percent of BOP is detected in comparison with baseline, those parameters were significantly higher in obese compared to non-obese with similar mean CAL and percent of BOP in the baseline (Table 1 ).…”

“…Periodontitis is not only associated with periodontal tissue breakdown but also associated with systemic diseases, such as cardiovascular disease and other metabolic diseases [ 3 , 4 ]. Additionally, individuals with obesity have been identified as having worse periodontal conditions in different populations [ 11 , 12 •, 13 , 14 , 15 ••]. Women may present greater prevalence of periodontitis and poorer periodontal parameters compared to non-obese women [ 14 , 15 ••].…”

“…Additionally, individuals with obesity have been identified as having worse periodontal conditions in different populations [ 11 , 12 •, 13 , 14 , 15 ••]. Women may present greater prevalence of periodontitis and poorer periodontal parameters compared to non-obese women [ 14 , 15 ••]. However, the association between periodontitis and obesity may not be influenced by gender [ 59 ].…”

“…Obese patients with periodontitis compared to non-obese with periodontitis may present significantly higher mean periodontal probing depth (PD), probably indicating worse inflammatory clinical aspects and greater challenge for treatment [ 15 ••]. Furthermore, the link between obesity and periodontitis may start early in life, as demonstrated in a meta-analysis that shows that obese children and adolescents have a higher chance of 1.46 of developing periodontitis [ 58 ].…”

“…Hypertrophic or hyperplastic adipose tissue, present in excessive weight gain, can recruit inflammatory cells and induce exacerbated synthesis of pro-inflammatory adipokines/cytokines [ 8 – 10 ]. As a consequence, the resulting hyper-inflammatory state could impair periodontal response to bacterial challenge [ 2 ], leading to a higher chance of periodontitis in obese individuals [ 11 , 12 •, 13 , 14 , 15 ••]. Thus, this current review aims to explore recent literature, published within the past 5 years, to understand what the impact of obesity on periodontal treatment outcomes are and to find out whether periodontal treatment can improve systemic biomarkers in obese individuals.…”