Obesity and periodontitis are both common health concerns that have given rise to considerable economic and societal burden worldwide. There are established negative relationships between bone metabolism and obesity, obesity and diabetes mellitus (DM), and DM and periodontitis, to name a few, with osteoporosis being considered a long-term complication of obesity. In the oral cavity, bone metabolic disorders primarily display as increased risks for periodontitis and alveolar bone loss. Obesity-driven alveolar bone loss and mandibular osteoporosis have been observed in animal models without inoculation of periodontopathogens. Clinical reports have also indicated a possible association between obesity and periodontitis.
Authors and Year (Report Nature) |
Aim and Objective | Studies Included and Disease Definition | No. of Participants (Grand Total and Range in Parenthesis) and Outcome of MA | Quality Assessment | Subgroup Analysis (I); Sensitivity Analysis (II); and Publication Bias Assessment (III) |
Summary |
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Chaffee et al. 2010 [12] (SR and MA) |
To compile the evidence concerning relationship between obesity and periodontal disease. | 70/28 studies included for SR/MA. Obesity definition: BMI or WHR Periodontal disease definition—up to 18 different selected clinical criteria with top 3 as: (1) CPI = 4; (2) CPI ≥ 3; (3) ≥1 site with CAL ≥ 3 mm and PPD ≥ 4 mm. |
70,855 (96–13,665) participants; ORs, or MD of CAL between obese and non-obese groups. | Using a specific scale design by the authors. 13, 7, and 8 studies were rated with high, medium, or low quality of evidence, respectively. | (I) Yes. Based on study characteristics. (II) Attempted. Exclusion of any single study only slightly altered the outcome. (III) Limited bias detected. |
A positive association between periodontal disease and obesity. Overall OR: 1.35, 95% CI (1.23, 1.47). Obese patients were prone to show greater mean CAL. Summary MD = 0.58 mm; 95% CI (0.40, 0.74). |
Suvan et al. 2011 [13] (SR and MA) |
To systematically review the evidence investigating the association between obesity and periodontitis. | 33/19 studies included for SR/MA. Obesity definition: BMI, WHR, WC, or body fat%. Periodontal disease definition—up to 16 different selected clinical criteria, with top 3 criteria are: (1) CPI ≥ 3; (2) > 4 teeth with minimum one site with CAL ≥ 3 mm and PPD ≥4 mm; (3) ≥ 1 site with CAL ≥3 mm and PD ≥ 4 mm. |
39,777 (96–13,665) participants; pooled estimates of ORs. | Newcastle-Ottawa Quality Assessment Scale (N-OQAS) [24]. | (I) Yes. Based on BMI categories. (II) Not reported. (III) Not reported. | Significant associations between periodontitis and obesity (OR: 1.81, 95% CI (1.42, 2.30]), or overweight (OR: 1.27, 95% CI (1.06, 1.51]), and obese and overweight combined (OR: 2.13, 95% CI (1.40, 3.26]). Results suggested a positive association of BMI categories, obese and overweight with presence of periodontitis, although the magnitude appeared unclear. |
de Moura-Grec et al. 2014 [14] (SR and MA) |
To systematically review the studies regarding association between overweight/ obesity and periodontitis. | 31/22 studies included for SR/MA. Obesity definition: BMI or WC. Periodontal disease definition—up to 16 different selected clinical criteria, with top 3 as: (1) PPD ≥ 4 mm; (2) CPI ≥ 3; (3) PPD ≥ 5 mm. |
69,089 (79–13,665) participants; ORs, MD in BMI between periodontitis and periodontally healthy group. | Not reported. | (I) Not reported. (II) Not reported. (III) Not reported. |
Obesity and overweight showed an increased odds for periodontitis (OR: 1.3, 95% CI (1.25, 1.35)). Participants with periodontitis had higher BMI compared to periodontally healthy participants. MD: 2.74 kg/m2 (95% CI (2.70, 2.79]). |
Keller et al. 2015 [20] (SR) |
To longitudinally examine the association between obesity and periodontitis. | 13 studies included for SR. Obesity definition: BMI or WC. Periodontal disease definition—7 clinical outcomes: PPD, CAL, ABL, PI, GI, CPI, BOP, and FMBS with thresholds not reported. |
44,758 (46–36,910) participants; NA. | Not reported. | (I) Not reported. (II) Not reported. (III) Not reported. | Suggests overweight, obesity, weight gain, and increased waist circumference could be considered as risk factors for development of periodontitis. |
Li et al. 2015 [15] (SR and MA) |
To investigate the association between anthropometric measurements and periodontal diseases in children and adolescents. | 16/5 studies included for SR/MA. Obesity definition: BMI or WC. Periodontal disease definition—3 clinical criteria: (1) either two sites between adjacent teeth with CAL ≥4 mm, or at least two such sites with PPD ≥ 5 mm; (2) ≥1 sites with CAL ≥ 3 mm and PPD ≥ 3 mm; (3) ≥ 1 bleeding site. |
589(87–164) participants; ORs. | Strengthening the Reporting of Observational studies in epidemiology (STROBE) checklist [25]. | (I) Yes, based on different periodontal markers. (II) Not reported. (III) No substantial bias detected. |
Reported positive association between obesity and presence of subgingival calculus (OR: 3.07, 95% CI (1.10, 8.62]), visible Plaque Index (OR: 4.75; 95% CI (2.42, 9.34]), BOP (OR: 5.41; 95% CI (2.75, 10.63]), and risk of PPD > 4 mm (OR: 14.15; 95% CI (5.10, 39.25]) in children and adolescents. Concluded that obesity is associated with some signs of periodontal disease in children and adolescents. |
Nascimento et al. 2015 [16] (SR and MA) |
To systematically review the effect of weight gain on incidence of periodontitis. | Both 5 studies included for SR and MA. Obesity definition: BMI or WC. Periodontal disease and progression definition— 3 sets of clinical criteria: (1) PPD ≥ 4 mm; (2) ABL ≥ 40% or PPD or CAL ≥ 5 mm; (3) self-reported periodontal disease. |
42,158 (224–36,910) participants; RRs. | N-OQAS | (I) Yes, based on obese status. (II) Attempted. Omission of any single study did not alter the findings. (III) No substantial bias detected. |
Results showed overweight (RR: 1.13, 95% CI (1.06, 1.20]) and those participants who became obese (RR: 1.33, 95% CI (1.21, 1.47]) had a significant higher risk to develop periodontitis. |
Nascimento et al. 2016 [17] (SR and MA) |
To examine the bidirectional association of tooth loss and obesity. | 25/16 studies included for SR/MA. Obesity definition: BMI. Periodontal disease and progression manifestation: number of teeth lost. |
42,430 (186–16,416) participants; ORs. | The Critical Appraisal Checklist (Joanna Briggs Institute [26]). | (I) Yes, based on tooth loss or edentulism. (II) Attempted. Omission of any single study did not alter the findings. (III) Presence of a small-study effect when any tooth loss was considered as an exposure. | Results indicated obese individuals had higher odds of having any tooth loss (OR: 1.49, 95% CI (1.20, 1.86)) or being edentulous (OR: 1.25, 95% CI (1.10, 1.42]), respectively. Individual with any tooth loss had higher odds (OR: 1.41, 95% CI [1.11, 1.79]) for obesity; similar for edentulous participants (OR: 1.60, 95% CI: (1.29, 2.00)). Suggested bidirectional association between tooth loss and obesity. |
Martens et al. 2017 [18] (SR and MA) |
To investigate the association between overweight/ obesity and periodontal disease in children and/or adolescents. | 12/7 studies included for SR/MA. Obesity definition: BMI, WHR, WC, or body fat%, and skinfold thickness. Periodontal disease definition: ≥ 1 site with CAL≥ 3 mm and PPD ≥ 3 mm. |
1983 (87–1204) participants; ORs. | Downs and Black checklist [27]. | (I) Not reported. (II) Attempted. Omission of any single study did not alter the findings. (III) No evidence of publication bias detected. |
Significant association between periodontal disease and obesity in children (OR: 1.46, 95% CI (1.20, 1.77]). |
Martinez-Herrera et al. 2017 [21] (SR) |
To systematically review the association between obesity and periodontal disease. | 28 studies included for SR. Obesity definition: BMI, WC, WHR, or body fat%. Periodontal disease definition—7 clinical outcomes: PPD, CAL, PI, BOP, ABL, CPI and GI with thresholds not reported. |
102,221 (91–36,910) participants; NA. | Not reported. | (I) Not reported. (II) Not reported. (III) Not reported. |
All studies except two articles described an association between obesity and periodontal disease. |
Khan et al. 2018 [22] (SR) |
To investigate if overweight or obese is risk factor for periodontitis in adolescents and young adults. | 25 studies included for SR. Obesity definition: BMI, WC, WHR, or body fat%. Periodontal disease definition—up to 17 different selected clinical criteria, with top 2 as: (1) CPI ≥ 3; (2) ≥ 1 sites with PPD ≥ 4 mm. |
51,597 (55–17,660) participants; NA. | N-OQAS | (I) Not reported. (II) Not reported. (III) Not reported. | Suggested evidence available indicating obesity was associated with periodontitis in adolescents and young adults. |
Foratori-Junior et al. 2022 [19] (SR and MA) |
To generate pooled evidence for the association between excess weight and periodontitis during pregnancy. | Both 11 studies included for SR and MA. Obesity definition: BMI. Periodontal disease definition—up to 8 different selected clinical criteria, with top 3 as: (1) ≥ 2 interproximal CAL ≥ 4 mm on different teeth; (2) ≥ 2 interproximal sites with CAL ≥ 3 mm or PPD ≥ 4 mm (on different teeth), or one site with PPD ≥ 5 mm; (3) interproximal CAL ≥ 2 on nonadjacent teeth or buccal or oral CAL ≥ 3 mm with PPD > 3 mm detectable on ≥ 2 teeth. |
2152 (50–682) participants; RRs. |
N-OQAS | (I) Not reported. (II) Not reported. (III) No evidence of publication bias detected. | Positive association between overweight/obesity and periodontitis during pregnancy (RR: 2.21, 95% CI (1.53, 3.17]). |