Obese Clinical Trial
Official title:
The Effects of Obesity on Non Surgical Periodontal Therapy
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.
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.
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Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Single Blind (Caregiver), Primary Purpose: Treatment
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