Advanced caries in a patient with a history of bariatric surgery

The rate of bariatric surgery in the United States has risen significantly in the past decade as the prevalence of extreme obesity continues to increase. Although bariatric surgery is an effective therapeutic modality for extreme obesity, it is associated with risk factors and select oral health conditions. This case study describes a patient with a significant increase in dental caries after having gastric bypass surgery. It was hypothesized that bariatric patients may be at an increased risk for caries due to the need for more frequent and prolonged meals throughout the day.

Dietary, bacterial, and salivary risk assessments were completed 5 years postsurgery. A 7-day food record was analyzed using Nutrition Calc Plus + 2.0 software and a plaque index was measured. In vitro test kits were used to evaluate the cariogenicity of the plaque as well as the quantity, quality, and buffering capacity of the patient's saliva. Clinical exams and dental radiographs were used to evaluate caries activity pre-and post-surgery.

On average, the patient typically consumed fermentable carbohydrates 5 times per day with 12% of her calories from sucrose. The plaque index and cariogenicity were high. The patient demonstrated low salivary production with poor buffering capacity and viscous saliva. The caries activity was noticeably higher postsurgery versus presurgery.

The present case study supports the hypothesis that recommended postsurgical meal patterns may place the patient at an increased risk for dental caries, particularly in the presence of other risk factors. More research is needed to further evaluate this relationship.