Influence of obesity on the outcome of non-surgical periodontal therapy - a systematic review

Abstract

Background: Obesity and periodontitis are important chronic health problems. Obesity is associated with an increased prevalence of periodontitis. Whether obesity also affects the outcome of non-surgical periodontal therapy is to date still unclear. Methods: A systematic review of studies referenced in SCOPUS, MEDLINE, PubMed, Cochrane, CINAHL, Biosis and Web of Science was performed. Titles, abstracts and finally full texts were scrutinized for possible inclusion by two independent investigators. Quality and heterogeneity of the studies were assessed and the study designs were examined. Probing pocket depth reduction was analyzed as primary surrogate parameter for therapeutic success after non-surgical periodontal therapy. Results: One-hundred-and-fifty-nine potentially qualifying studies were screened. Eight studies fulfilled the inclusion criteria and were analyzed. Three of eight studies failed to show an influence of obesity on pocket depth reduction after non-surgical therapy. The remaining five studies documented a clear negative effect on the outcome of non-surgical periodontal therapy. The finally included studies did not correspond to the highest level of quality (RCTs). Due to the heterogeneity of the data a meta-analysis was not possible. Conclusion:The literature on the effect of obesity on the treatment outcome of non-surgical periodontal therapy remains controversial. The data, however, support that obesity is not only a factor associated with poorer periodontal health but might also result in inferior response to non-surgical treatment of periodontitis.

Obesity as predictive factor of periodontal therapy clinical outcomes: A cohort study

“…A strength of this study was minimization of confounding factors through the exclusion of smokers and diabetics from the study sample, factors similarly reported in some previously published evidence (Gerber et al, ; Lakkis et al, ; Nascimento, Leite, Correa, Peres, & Demarco, ). Further strengths included the 6‐month follow‐up with no change in BMI status, which is longer than some previous studies (Al‐Zahrani & Alghamdi, ; Duzagac et al, ; Eldin, Nasr, & Hassan, ).…”

“…In particular, obese subjects had less favourable reductions in full‐mouth mean probing pocket depths and the percentage of sites presenting with probing pocket depth >4 mm at 2 months following non‐surgical periodontal therapy when compared to non‐obese individuals (Suvan et al, ). Results from prospective studies conducted to investigate the effect of obesity on periodontal therapy outcomes have provided variable results possibly due to small sample size, differing lengths of follow‐up and the presence of confounding factors such as smoking as potential sources of heterogeneity; therefore, additional evidence from larger studies is merited (Akram et al, ; Gerber et al, ; Goncalves et al, ). The aim of this study was to ascertain whether obesity is a predictor of the response to non‐surgical periodontal therapy based upon clinical periodontal assessment measured at 2 and 6 months following therapy in non‐smoker BMI obese and BMI normal individuals suffering from moderate to severe periodontitis.…”

Periodontal complications with obesity

“…For example, 1 study based analysis of the effect of obesity on response to treatment between study groups on sites with probing depths ≥4 mm following treatment no statistically significant difference was shown. 157 This study was 1 of 3, included in the review by Gerber et al, 133 which did not demonstrate a difference in periodontal clinical parameters in obese versus nonobese subjects following treatment. Five of 8 studies in this review did report poorer clinical responses to periodontal treatment in obese compared with nonobese subjects, with the comment that the effect was specifically observed in moderate-to-deep pockets.…”

“…Akram et al (2016) 131 Gerber et al (2016) 133 Nascimento et al (2016) 140 Papageorgiou et al (2015) 142…”

“…Akram et al (2016) 130,131 Gerber et al (2016) 133 Keller et al (2015) 134 Li et al (2015) 135 Martens et al (2017) 136 Martinez-Herrera et al (2017) 137 Nascimento et al (2016) 139,140 Nascimento et al (2015) 141 Papageorgiou et al…”