The Effects of Obesity on Non Surgical Periodontal Therapy
Condition: Obese; Periodontal Disease
MeSH terms: Periodontal Diseases
Study type: Interventional

Summary: 
      The investigators' earlier study reported a high prevalence of chronic periodontitis among
      obese Malaysian adult population. Non-surgical periodontal therapy (NSPT) has been shown to
      effectively reduce microbial load and contributes to reduction in periodontal parameters and
      inflammatory burden up to 6 months post-therapy. This study will cast light on the effects of
      obesity on chronic periodontitis (CP) patients following NSPT. The objectives of the study
      were to quantify and to compare the periodontal pathogens, serum and salivary interleukins in
      obese and non obese with CP following NSPT.
    

Detailed description: 
      Obesity is a health concern, associated with complex diseases such as diabetes, hypertension
      as well as chronic periodontitis. The prevalence is estimated as 24% worldwide, 3% for South
      East Asia, and 27.2% for Malaysia. Prevalence of CP is increasing, with 10-15% reported in
      various adult populations and estimated 5-20% categorised as severe CP. In Malaysia, the
      prevalence of severe CP is estimated as 18%.

      The first paper on the relationship between obesity and periodontal disease reported that
      obese-hypertensive rats are more likely to have periodontal tissue deterioration than normal
      rats. Subsequent study reported an induction of expression of Tumour Necrosis Factor (TNF) -a
      gene in obese mice and thus proposed TNF-α represents a key mediator of obesity-linked
      insulin resistance. This was strongly supported by an extension study on human adipose
      tissue. A model was proposed linking inflammation to obesity, diabetes, and periodontal
      infection in 2005. Subsequent studies found association between obesity and increased risk
      for CP in the United States, Japanese and Jordanian adult populations.

      Adipose tissue produces a number of adipokines linked to inflammation, including adiponectin,
      interleukin (IL)-1β, IL-6, TNF-α, Monocyte Chemoattractant Protein (MCP)-1 and Macrophages
      Migrant Inhibitory Factor (MIF). Increased in circulating levels of pro-inflammatory
      cytokines such as TNF-α and IL-6 are strongly correlated with obesity, insulin resistance,
      hyperglycemia and diabetes mellitus. These cytokines also stimulate the synthesis of
      C-reactive protein (CRP) and fibrinogen by liver, as CRP is known for its role in
      inflammation, atherosclerosis and insulin resistance. In addition, these cytokines are also
      secreted from adipose tissues are involved in the pathophysiology of both obesity and
      periodontitis. Obese individuals have higher levels of circulating TNF-α and IL-6 when
      compared to normal weight individuals. This may increase the risk of destructive periodontal
      diseases development. Interestingly, studies on the immune response to periodontal pathogens
      showed that TNF-α enhanced the immune response to these pathogens.

      Periodontal health is accomplished through non-surgical periodontal therapy (NSPT), which
      includes oral hygiene education (OHE) and scaling and root planing (SRP). NSPT has been
      reported to effectively reduce microbial load and contributes to reduction in periodontal
      parameters and inflammatory burden up to 6 months post-therapy. In a general population, NSPT
      has been shown to induce a shift from a pre-dominant gram-negative to a gram-positive
      subgingival microbiota. The total bacteria count and positives sites of Porphyromonas
      gingivalis (P gingivalis) and Tannerella forsythia (T forsythia) were significant decreased
      in treated group compared to control groups. In addition, SRP has markedly reduced these
      periodontal pathogens: Porphyromonas gingivalis, Tannerella forsythia as well as Prevotella
      intermedia 24 months post NSPT.

      Molecular mechanisms between inflammatory cytokines and CP are unclear and warrant further
      studies to determine whether pro-inflammatory cytokines is the pathogenic factor linking
      obesity to periodontal infections. To date, there are not many studies that examine the
      changes in periodontal pathogen, salivary and serum interleukins levels in obese patients
      with CP following NSPT. Further prospective studies are needed to address this issue and to
      determine stronger evidence on the association between obesity, periodontal diseases and
      potential mediating factors following NSPT.
    

Intervention name(s): Non surgical periodontal therapy
Intervention type(s): Procedure
Intervention description(s): NSPT includes oral hygiene education, scaling root planing and mouth wash
Other intervention name(s): NSPT
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Care Provider)
Primary purpose: Treatment