EC Dental Science

Background: Obesity, ranked sixth by WHO for its global health impact, leads to chronic inflammation through adipokines released from fat tissues. These compounds influence metabolism and contribute to systemic inflammation, exacerbating periodontal diseases by raising CRP levels.

Objectives: The present study aimed to investigate the correlation between indicators of obesity (Body mass index and waist circumference) and periodontal health status among undergraduate students.

Materials and Methods: A single examiner recorded the demographic data and oral health status of 1000 systemically healthy males and females aged 18 - 25 years in Hyderabad. Obesity of the study subjects was determined by calculating body mass index (BMI) and waist circumference (WC). Gingival index and the periodontitis severity and grading system adopted from the 2017 world workshop on the classification of periodontal and peri-implant diseases and conditions were used to determine the condition of periodontal health. Periodontal probing depth (PPD) and clinical attachment level (CAL) were measured. P < 0.05 is considered statistically significant.

Results: The overall mean BMI and WC among the study subjects was 25 ± 7.46 kg/m² and 79.7 ± 15.05 cm respectively. Gingivitis prevalence significantly differed by BMI (p = 0.000) and WC; older underweight individuals had mild gingivitis, while younger normal and obese subjects had moderate gingivitis. Stage 2 periodontitis was prevalent in overweight (p = 0.005) and obese (p = 0.065) subjects. Spearman correlation showed a significant, positive, and moderate to high correlation of BMI with WC, gingivitis, and periodontitis.

Conclusion: Both BMI and WC were significantly associated with periodontal status among undergraduate students in Hyderabad. Overweight and obese individuals exhibited a higher prevalence of periodontitis, highlighting the importance of oral health awareness and obesity prevention strategies.

 Keywords: Obesity; Body Mass Index; Waist Circumference; Periodontitis

1. Deshpande Neeraj Chandrahas and Mansi Rajendrakumar Amrutiya. “Obesity and oral health - Is there a link? An observational study”. Journal of Indian Society of Periodontology3 (2017): 229-233.
2. Chaffee Benjamin W and Scott J Weston. “Association between chronic periodontal disease and obesity: a systematic review and meta-analysis”. Journal of Periodontology12 (2010): 1708-1724.
3. Arumuganainar Deepavalli., et al. “Evaluation of CD44 antigen in type 2 diabetic patients with periodontitis: An immunohistochemical study”. Dental and Medical Problems2 (2024): 225-231.
4. Linden Gerry., et al. “Obesity and periodontitis in 60-70-year-old men”. Journal of Clinical Periodontology6 (2007): 461-466.
5. Ouchi Noriyuki., et al. “Adipokines in inflammation and metabolic disease”. Nature Reviews. Immunology2 (2011): 85-97.
6. Zhao Pengfei., et al. "Obesity, bone loss, and periodontitis: the interlink”. Biomolecules7 (2022): 865.
7. Cieszkowski J., et al. "Therapeutic effect of exogenous ghrelin in the healing of gingival ulcers is mediated by the release of endogenous growth hormone and insulin-like growth factor-1”. Journal of Physiology and Pharmacology4 (2017): 609-617.
8. Marruganti Crystal., et al. "Periodontitis and metabolic diseases (diabetes and obesity): tackling multimorbidity”. Periodontology 2000 (2023).
9. Kangas Sanna., et al. "Waist circumference and waist-to-height ratio are associated with periodontal pocketing—results of the health 2000 survey”. BMC Oral Health1 (2017): 48.
10. Nilsen Astrid., et al. "Periodontitis in obese adults with and without metabolic syndrome: a cross-sectional study”. BMC Oral Health1 (2023): 439.
11. Dogan Gülnihal Emrem., et al. “Salivary IL-6 and IL-10 levels in subjects with obesity and gingivitis”. American Journal of Dentistry5 (2016): 261-265.
12. Skrypnyk Maksym., et al. “Changes in the periodontium against the background of systemic vascular reactions in young individuals with obesity”. Dental and Medical Problems2 (2024): 197-207.
13. Chaffee Benjamin W and Scott J Weston. “Association between chronic periodontal disease and obesity: a systematic review and meta-analysis”. Journal of Periodontology12 (2010): 1708-1724.
14. Jimenez Monik., et al. “Prospective associations between measures of adiposity and periodontal disease”. Obesity (Silver Spring, Md.)8 (2012): 1718-1725.
15. Prpic Jelena., et al. “Association of obesity with periodontitis, tooth loss and oral hygiene in non-smoking adults”. Central European Journal of Public Health4 (2013): 196-201.
16. Pataro André Luiz., et al. “Association between severity of body mass index and periodontal condition in women”. Clinical Oral Investigations3 (2012): 727-734.
17. Morita I., et al. “Five-year incidence of periodontal disease is related to body mass index”. Journal of Dental Research2 (2011): 199-202.
18. WHO Expert Consultation. “Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies”. Lancet (London, England) 9403 (2004): 157-163.
19. “Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults”. Archives of Internal Medicine17 (1998): 1855-1867.
20. Loe H. “The gingival index, the plaque index and the retention index systems”. Journal of Periodontology6 (1967): 610-616.
21. Tonetti Maurizio S., et al. “Staging and grading of periodontitis: Framework and proposal of a new classification and case definition”. Journal of Periodontology1 (2018): S159-S172.
22. World Health Organization. "Special Issues in the Management of Obesity in Childhood and Adolescence”. Obesity: Preventing and Managing the Global Epidemic, WHO, Geneva (1998): 231-247.
23. Ritchie Hannah and Max Roser. "Obesity”. Our World in Data (2022).
24. Lim Stephen S., et al. “A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010”. Lancet (London, England)9859 (2012): 2224-2260.
25. Aucott L., et al. "Mental wellbeing related to lifestyle and risky behaviours in 18-25 year olds: evidence from north east Scotland”. International Journal of Public Health Research1 (2014): 431-440.
26. Jekielek Susan and Brett Brown. "The transition to adulthood: Characteristics of young adults ages 18 to 24 in America”. Washington, DC, The Annie E. Casey Foundation, Population Reference Bureau, and Child Trends (2005): 1-41.
27. Poobalan AS., et al. "Weight loss interventions in young people (18 to 25 Year Olds): A systematic review”. Obesity Reviews8 (2010): 580-592.
28. Bosy-Westphal Anja and Manfred J Müller. “Diagnosis of obesity based on body composition-associated health risks-Time for a change in paradigm”. Obesity Reviews2 (2021): e13190.
29. Dahiya Parveen., et al. “Obesity, periodontal and general health: Relationship and management”. Indian Journal of Endocrinology and Metabolism1 (2012): 88-93.
30. Wang Youfa., et al. “Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men”. The American Journal of Clinical Nutrition3 (2005): 555-563.
31. Yusuf Salim., et al. “Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study”. Lancet (London, England)9497 (2005): 1640-1649.
32. Peltzer Karl., et al. "Prevalence of overweight/obesity and its associated factors among university students from 22 countries”. International Journal of Environmental Research and Public Health7 (2014): 7425-7441.
33. Doddamane Dharmashree., et al. “A study to assess the periodontal status of 16-34-year-old obese individuals in colleges of Bangalore city”. Journal of Indian Society of Periodontology4 (2015): 424-428.
34. Dalla Vecchia Caroline Formolo., et al. “Overweight and obesity as risk indicators for periodontitis in adults”. Journal of Periodontology10 (2005): 1721-1728.
35. Khan Shahrukh., et al. "Prevalence of chronic periodontitis in an obese population: a preliminary study”. BMC Oral Health 15 (2015): 114.
36. Hegde Shashikanth., et al. "Obesity and its association with chronic periodontitis: a cross-sectional study”. Journal of Education and Health Promotion 8 (2019): 222.
37. Sede MA and A O Ehizele. “Relationship between obesity and oral diseases”. Nigerian Journal of Clinical Practice 6 (2014): 683-690.
38. Nascimento Gustavo G., et al. “Are obesity and overweight associated with gingivitis occurrence in Brazilian schoolchildren?”. Journal of Clinical Periodontology12 (2013): 1072-1078.
39. Pischon N., et al. “Obesity, inflammation, and periodontal disease”. Journal of Dental Research5 (2007): 400-409.
40. Gorman Andrea., et al. “Overweight and obesity predict time to periodontal disease progression in men”. Journal of Clinical Periodontology2 (2012): 107-114.
41. Pataro André Luiz., et al. “Association between severity of body mass index and periodontal condition in women”. Clinical Oral Investigations3 (2012): 727-734.
42. Morita I., et al. “Five-year incidence of periodontal disease is related to body mass index”. Journal of Dental Research2 (2011): 199-202.
43. Ekuni Daisuke., et al. “Relationship between increases in BMI and changes in periodontal status: a prospective cohort study”. Journal of Clinical Periodontology8 (2014): 772-778.
44. Mathur Lalit Kumar., et al. “Obesity and periodontitis: A clinical study”. Journal of Indian Society of Periodontology3 (2011): 240-244.
45. Saito T., et al. “Relationship between obesity, glucose tolerance, and periodontal disease in Japanese women: the Hisayama study”. Journal of Periodontal Research4 (2005): 346-353.
46. Khader Yousef Saleh., et al. “The association between periodontal disease and obesity among adults in Jordan”. Journal of Clinical Periodontology1 (2009): 18-24.
47. Al-Zahrani Mohammad S., et al. “Obesity and periodontal disease in young, middle-aged, and older adults”. Journal of Periodontology5 (2003): 610-615.
48. Reeves Anne F., et al. “Total body weight and waist circumference associated with chronic periodontitis among adolescents in the United States”. Archives of Pediatrics and Adolescent Medicine9 (2006): 894-899.
49. P Kolte Abhay., et al. “Association between anxiety, obesity and periodontal disease in smokers and non-smokers: A cross-sectional study”. Journal of Dental Research, Dental Clinics, Dental Prospects4 (2016): 234-240.
50. Haffajee Anne D and Sigmund Sidney Socransky. “Relation of body mass index, periodontitis and Tannerella forsythia”. Journal of Clinical Periodontology2 (2009): 89-99.
51. Han Dong-Hun., et al. “The association of metabolic syndrome with periodontal disease is confounded by age and smoking in a Korean population: the Shiwha-Banwol Environmental Health Study”. Journal of Clinical Periodontology 7 (2010): 609-616.
52. Hel-S Amin. "Relationship between overall and abdominal obesity and periodontal disease among young adults”. Eastern Mediterranean Health Journal4 (2010): 429-433.
53. Palle AR., et al. "Association between obesity and chronic periodontitis: a cross-sectional study”. Journal of Contemporary Dental Practice2 (2013): 168-173.
54. Jagannathachary Sunitha and Dinesh Kamaraj. “Obesity and periodontal disease”. Journal of Indian Society of Periodontology2 (2010): 96-100.