Considerations in the treatment of individuals with obesity and periodontitis

Two common non-communicable diseases, obesity and periodontitis, are responsible for and affected by systemic inflammation, sharing common risk factors and mechanistic pathways. Periodontitis is an irreversible immune-mediated inflammatory disease of hard and soft tissue supporting teeth. If left untreated, periodontitis can lead to tooth loss, affecting food choices and healthy eating, therefore affecting overall health. Obesity is an independent predictive factor for worsened periodontal inflammation, increased onset, progression, severity, and recurrence of infection, as well as delayed wound healing. Thus, managing obesity and associated metabolic dysfunctions may improve periodontal therapy outcomes. The chronic inflammatory state of obesity impairs immune regulation exacerbating the inflammatory gingival tissue destruction of periodontitis, which can also systemically contribute to inflammatory mediators. Furthermore, bariatric surgeons and dietitians should educate patients with obesity regarding the risk of elevated caries, xerostomia, and periodontitis risk from acid reflux and frequent food intake. Non-dental healthcare professionals should recognise periodontal disease signs to prompt dental referral when warranted. Asking patients about recent dental visits promotes patient involvement in cross-discipline dialogue to enhance patient care coordination between medicine and dentistry. This article discusses the association between these two diseases, the challenges of achieving optimal periodontal treatment outcomes, and the clinical strategies to enhance holistic care. It also explores oral health considerations in dietary and surgical interventions in the treatment of obesity.