Influence of Roux‐en‐Y Gastric Bypass Surgery on Vitamin C, Myeloperoxidase, and Oral Clinical Manifestations

Abstract

Background Bariatric surgery influences the intake and absorption of nutrients, which, when associated with vomiting, can damage the oral cavity. The serum concentrations of vitamin C and myeloperoxidase (MPO) and oral clinical manifestations were examined in patients 2 years after Roux‐en‐Y gastric bypass (RYGB). Methods Clinical prospective study with control group (CG; n = 26), assessed only once, and the bariatric group (BG; n = 26), assessed in the basal period and at 12 and 24 months after surgery. The mean ages in the CG and BG were 37.8 ± 1.51 and 39.6 ± 1.93 years, respectively, and their body mass indices were 22.07 ± 0.29 and 45.62 ± 1.46 kg/m2, respectively. Results At 12 months after surgery, increased episodes of vomiting (P < .001) and dental hypersensitivity (P = .012) were observed, with a reduction in the saliva‐buffering capacity of 21.3% ± 2.9% (P = .004). At 24 months after RYGB, a significant reduction in serum vitamin C was detected (32.9% ± 5.3%, P < .001), and MPO values were higher than in the basal period (P = .032). With regard to oral hygiene habits, 92.3% of patients reported frequent tooth brushing and 96.1% used fluoride, which were similar across the 2 years. However, dental hypersensitivity (P = .048) was significantly increased than baseline. Conclusions The results demonstrated that vitamin C deficiency and increased vomiting after gastric bypass for morbid obesity may contribute to increased periodontal disease. The fact that it is impossible to determine which factor or factors (diet, poor compliance with supplementation, vomiting, poor oral hygiene) contributed to the dental problems in these patients is a shortcoming of the report.

Perceived oral health in patients after bariatric surgery using oral health‐related quality of life measures

“…Sales‐Peres et al () evaluated if periodontal disease and periopathogens were influenced by gastric bypass operation, and their findings showed an increased periodontal disease in the study group. This was in accordance with the findings of Marsicano et al () and Netto et al (), where a small difference in increased dental pocket depth in individuals that have undergone bariatric surgery was demonstrated, compared with obese patients who had not undergone bariatric surgery. Netto et al () also reported that vitamin C deficiency and increased vomiting after surgery might be an explanation to increased periodontal disease postoperative in the study group.…”

“…This was in accordance with the findings of Marsicano et al () and Netto et al (), where a small difference in increased dental pocket depth in individuals that have undergone bariatric surgery was demonstrated, compared with obese patients who had not undergone bariatric surgery. Netto et al () also reported that vitamin C deficiency and increased vomiting after surgery might be an explanation to increased periodontal disease postoperative in the study group. A cohort study (de Moura‐Grec et al, ) evaluated oral health conditions before and 6 months after bariatric surgery, and the results showed that systemic conditions could improve but oral health conditions deteriorated because of increased periodontal disease and decayed teeth.…”

“…Binge eating disorder (Dawes et al, ) and vomiting are other reported side effects (Barbosa et al, ), which can lead to a variety of potential dental problems. Also periodontal disease seems to be more common in individuals that have undergone bariatric surgery and may be related to nutritional deficiency secondary to the surgery (de Moura‐Grec et al, ; Netto et al, ). The material available about oral health and postbariatric surgery is limited and sometimes contradictory.…”

Iron bioavailability from commercially available iron supplements

“…In one study postoperative gastric bypass patients given 100 mg FeSO 4 tablets as an oral challenge absorbed inadequate amounts of iron as measured by change in serum iron concentration [44]; altered gut physiology after bariatric surgery may not allow for iron absorption from FeSO 4 tablets. Furthermore, several studies have also documented low vitamin C levels in patients after bypass procedures [45,46], therefore liquid iron preparations with added ascorbate -such as Spatone Apple ® and Iron Vital F ® (which also has other micronutrients) -may be helpful in this population.…”

Iron Deficiency and Bariatric Surgery

“…Thus, a significant reduction in serum vitamin C after 24 months after Roux-en-Y BS has been described [77]. Nevertheless other authors have not reported such a deficiency, so it remains controversial [33].…”