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Gastric bypass surgery could benefit periodontitis treatment

By Surgical Tribune
June 20, 2012

CLEVELAND, Ohio, USA: Gum disease treatment in obese patients is more effective in those who have undergone gastric bypass surgery and had fat cells from the abdomen removed, researchers from Cleveland’s Case Western Reserve University School of Dental Medicine have found. Their recent study demonstrated a significant improvement in oral health after weight reduction.

Periodontitis and obesity are both chronic health problems, and have often been found to be associated. Weight loss after bariatric surgery has been shown to decrease overall mortality and the development of new health-related conditions in morbidly obese patients.

The research team conducted a pilot study to assess whether significant weight loss would improve the response to nonsurgical periodontal therapy in obese patients. The study involved 30 obese people with chronic periodontitis. Half of the group, with an average body mass index of 39, had undergone gastric bypass surgery and had fat cells removed from the abdomen, which resulted in the loss of at least 40 percent of their excess weight for 6 months or more after surgery. The control group consisted of obese people with a BMI of 35 who had not undergone gastric bypass surgery or had fat removed.

The majority of those who had undergone surgery showed a drop in their glucose levels after the procedure, a result that bodes well for overweight people predisposed to diabetes and insulin-related problems.

For the study, all participants received nonsurgical periodontal therapy (scaling and root planing, and oral hygiene instructions for home care). Probing depth, clinical attachment level, bleeding on probing, gingival index and plaque index were measured at baseline and at four to six weeks after the periodontal treatment. While both groups showed improvement, the surgery group performed even better on the measures for periodontal attachment, bleeding, probing depth and plaque level.

"Inflammation that persists in the body can have harmful effects over time, and inflammation from gum disease can erode bone and cause tooth loss," said Nabil Bissada, chair of the department of periodontics at the Case School of Dental Medicine and lead author of the study. "It can also cause damage to the gums, allowing harmful oral bacteria to enter the bloodstream. Such bacteria have been linked to preterm birth, fetal death, heart disease, diabetes and arthritis."

The researchers postulated two hypotheses regarding the results. The first is that excessive fat cells (adipocytes) secrete more cytokines, such as TNF and IL-6, which make insulin less effective in performing its function. As a result, greater accumulation of glucose in the blood (hyperglycemia) occurs. Therefore, losing weight makes insulin more effective and improves the diabetic status. This in turn helps in the response to periodontal treatment.

The second hypothesis relates to the presence of the leptin hormone, which regulates appetite. Leptin plays a role in regulating the metabolism and is involved in the inflammatory response by increasing the production of cytokines and the C-reactive protein, which is also linked to inflammation. According to Bissada, leptin production was reduced after bariatric surgery and may be one explanation for the better outcomes of the periodontal treatment.

The researchers intend to conduct a longitudinal study to support their preliminary findings.
The study, "Response to periodontal therapy in subjects who had weight loss after bariatric surgery and obese counterparts: A pilot study", was published in the June issue of the Journal of Periodontology.

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