Obesity is a central issue in today’s healthcare discussion, with the Centers for Disease Control and Prevention reporting that more than a third of adults in the United States struggle with it. These patients are at risk of heart disease, stroke, type 2 diabetes, and even some cancers. Yet obesity also plays a role in oral care, so dentists need to mind it as well.
“Obesity has an impact on our periodontal health,” said Lisa Mallonee, BSDH, MPH, RD, LD. “Adipocytes—fat cells—produce a heightened inflammatory response. And what we need to know is that inflammation in the mouth can be an indicator that your body as a whole is in an inflamed state.”
Increased body mass index correlates with increased pocket depths as well, according to Mallonee, who is an associate professor at the Caruth School of Dental Hygiene at the Texas A&M Health Science Center. Obese patients may present with more bleeding points and more clinical attachment loss. And diet plays a role in all of these factors.
“One of the things that I always say, and an easy way to relate oral health and obesity together, is making the connection that the same foods/beverages that contribute to caries risk are essentially the same factors that put weight on our bodies,” Mallonee said. “You cannot talk about what causes a cavity with your patients without including diet as a component.”
Mallonee encourages dentists and dental hygienists to discuss eating habits with their patients, even though it might not be a comfortable conversation. That’s why she typically starts these talks with the etiology of caries. By indirectly addressing the role that diet plays in caries, dental professionals can help patients make changes in their diets to improve their oral health and, potentially, lose weight too.
“Sugar-sweetened beverages contribute to weight gain. Just cutting back on them can, in turn, have a benefit of weight loss,” Mallonee said. “That’s just one way that indirectly we’re helping with the fattening of America, by having conversations with our patients about things other than brushing and flossing.”
Dental professionals should focus on sugar intake in particular, Mallonee said, as it impacts caries development as well as heart disease. According to the American Heart Association, 801,000 people die of heart disease in the United States each year, and it is the number one killer of women in the country.
Patients who are trying to lose weight aren’t necessarily free from risks to their oral health yet, however. Patients who have had bariatric surgery, Mallonee notes, may have acid reflux, which can lead to increased demineralization. Many fad diets can lead to xerostomia, which in turn encourages demineralization and subsequent tooth decay. Hard and soft tissues also may be impacted by nutrient deficiencies.
“People are overfed, but they’re undernourished,” Mallonee said. “So just having conversations with them about dietary habits and their side effects can make them aware of how they’re impacting not just their overall health but their oral health as well.”
Programs like First Lady Michelle Obama’s “Let’s Move!” aim to promote awareness and encourage physical fitness to combat the obesity epidemic in the United States, and many consumers are making an effort to eat healthier foods. Yet they’re fighting against the marketing prowess of many food and beverage companies, Mallonee said.
“The numbers are rising. There are more overweight people than underweight people in the world. It’s getting worse,” Mallonee said. “And what we see is that this generation of kids is going to die at a younger age than their parents if poor lifestyle habits and patterns of dietary choices continue.”
In January, the National Maternal and Child Oral Health Resource Center at Georgetown University in collaboration with several groups including the ADA, the American Dental Hygienists’ Association, the American Academy of Pediatric Dentistry, and the Santa Fe Group were awarded hundreds of thousands of dollars by the Robert Wood Johnson Foundation to identify evidence-based approaches that can be utilized by oral health professionals in reducing childhood obesity while improving children’s oral health.
“We’re looking at childhood obesity and what we as the dental health profession can actually do to address it in our practices and how we can work together not only with the children (under age 12) who are our patients, but also with their parents,” Mallonee said.
Some nations are employing a more aggressive strategy. Mexico saw its 2013 tax on sugary beverages slash consumption by 12%. England will impose a similar levy on soft-drink producers and importers based on the amount of sugar in their products beginning in 2018. Some municipalities in the United States have considered similar approaches.
“I don’t know if taxing is the way to go, or if it’s having more programmatic support nationally as well as at the state and local level,” Mallonee said. “Perhaps putting more programs in place that promote behavior change would help individuals increase their activity levels and make healthier choices for weight control. Incentive programs in the workplace and more funding dollars for community level programs are a few examples.”
In the meanwhile, dentists can turn to research for more information, which in turn can help them communicate obesity’s risks to oral health to their patients, improving the state of their teeth as well as the rest of their bodies.
“There’s ample evidence-based information regarding the impact of obesity on periodontal health,” Mallonee said. “We should always provide information supported by research, so when making recommendations, turn to the literature. Relate the research regarding obesity to your patient population in simplified terms using language they can understand. Practically apply your findings to educate and tailor recommendations on an individual patient-by-patient basis.”
Related Articles
Food Guidelines Include New 10% Limit on Sugar
More Evidence Connects Gum and Heart Disease
Great Britain Imposes Sugar Levy on Soft-Drink Companies
