Periodontitis is a series of chronic gum inflammation involving the destruction of the structures supporting the teeth, i.e. gingiva, periodontal ligament, cementum and alveolar bone. (Diagram 1)

Diagram 1: The Periodontal Tissues

Gum inflammation is caused by the accumulation of microorganisms present in the dental plaque.

In the initial stage of the disease or Gingivitis, inflammation is only limited to the gum. The signs observed are gum redness and swelling, bleeding on tooth brushing, changes in gum shape and pus discharge. Patients may also complain of bad breath.

Gingivitis can heal well after a few visits to the dentist and given treatment such as scaling, prophylaxis and oral hygiene instructions.

On the other hand, if gingivitis is neglected without any treatment done, the inflammation may spread to other periodontal structures leading to permanent alveolar bone loss, known as Periodontitis.

The progressive loss of the tooth-supporting structures such as alveolar bone and periodontal ligament (Diagram 2) will result in :

Unfortunately, most patients are unaware of this condition since they do not experience pain due to periodontitis, until they have a periodontal examination done at a dental clinic or inform the dentist about the symptoms.

Diagram 2: Periodontitis	Diagram 3:  Signs of periodontitis

Clinically, the dentist will carry out a basic periodontal examination, using the periodontal probe (Diagram 4) to measure the depth of a periodontal pocket. If the periodontal pocket is more than 4mm deep, it is likely to assume that periodontitis has occurred.

Diagram 4: Measuring the periodontal Pocket

Risk factors associated with periodontitis.

Local factors include conditions which encourage plaque retention , such as teeth crowding, presence of dental caries, uneven fillings surfaces and overhanging fillings.

Systemic factors are those that contribute effects to the body, example genetic factors, systemic diseases and smoking habit.

Several studies have established an association between periodontitis and systemic diseases such as diabetes mellitus, heart disease, low birth weight, premature birth and obesity.^(1,2)

Obesity and overweight is defined as “abnormal or excessive fat accumulation that presents a risk to health” (WHO 2008).

In developed countries, there is an increase in the prevalence of overweight and obesity in the population. Obesity has been identified as the main cause for chronic diseases like heart disease, diabetes mellitus, cancer and osteoarthritis.

There are several ways to measure obesity; the most commonly used is the Body Mass Index (BMI).

BMI calculation:

weight (kg)
height (m)²

The following is the BMI chart according to WHO 2008 :

Obesity associated with periodontal disease?

Studies have shown a positive correlation between obesity and the occurrence of periodontitis⁽⁴⁾ with a statistically significant association between periodontitis and obesity (odd ratio: 1.81) and overweight (odd ratio: 1.27) ⁽⁵⁾.

Nevertheless, more additional prospective studies are required to quantify the mechanisms of this association and provide sufficient evidence for guidelines on the clinical management of periodontitis in obese patients.

How does obesity cause periodontitis?

Among the contributory factors related to the occurrence of periodontitis among obese patients are:

Periodontitis has multi-factorial causes which include genetic factor, smoking habit, imbalance diet and unhealthy lifestyle (Diagram 5).

Diagram 5: Possible Mechanism Of Association Between Obesity And Periodontal Disease

How is Periodontal disease managed?

Patients who exhibit the signs and symptoms of gum disease are advised to visit a dentist for further examination. The dentist would advise on the proper care of the teeth and gums.

If periodontitis has established, patient will be referred to a Periodontal Specialist for further periodontal treatment which include:

These are some of the ways to prevent periodontitis and obesity:

References

1. Saito T, Shimazaki Y, Koga T, Tsuzuki M, Ohshima A.Relationship between upper body obesity and periodontitis. J Dent Res 2001:80:1631-1636.
2. Saito T, Shimazaki Y, Sakamoto M. Obesity and periodontitis. N Engl J Med 1998; 339:482-483.
3. WHO. Global database on body mass index. 2008. Report.
4. Dalla Vecchia, C.F., Susin, C., Rösing, C.K., Oppermann, R.V. and Albandar, J.M., 2005. Overweight and obesity as risk indicators for periodontitis in adults. Journal of Periodontology, 76(10), pp.1721-1728.
5. Suvan, J., D’Aiuto, F., Moles, D.R., Petrie, A. and Donos, N., 2011. Association between overweight/obesity and periodontitis in adults. A systematic review. Obesity Reviews, 12(5), pp.e381-e404.