|Year : 2015 | Volume
| Issue : 4 | Page : 424-428
A study to assess the periodontal status of 16-34-year-old obese individuals in Colleges of Bangalore City
Dharmashree Doddamane1, Vijayakumar Nanjundappa2, Karim Virjee3
1 Department of Public Health Dentistry, Maharana Pratap College of Dentistry and Research Centre, Gwalior, Madhya Pradesh, India
2 Department of Public Health Dentistry, Dr. Syamala Reddy Dental College Hospital and Research Centre, Bengaluru, Karnataka, India
3 Department of Public Health Dentistry, Oxford Dental College Hospital and Research Centre, Bengaluru, Karnataka, India
|Date of Submission||22-Oct-2013|
|Date of Acceptance||16-Mar-2015|
|Date of Web Publication||11-Aug-2015|
Department of Public Health Dentistry, Maharana Pratap College of Dentistry and Research Centre, Putalighar Road, Gwalior 474 006, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: The prevalence of obesity has increased substantially over the past decades. Age, genetic factors, activity level, body weight, eating habits, medications, and hereditary factors are some of the causes of obesity. It is a risk factor for several chronic health conditions, as well as being associated with increased mortality. Obesity has also been associated with oral diseases, particularly with periodontal disease. Objective: The objective was to assess the periodontal status of obese and nonobese young individuals in colleges of Bangalore city. Materials and Methods: A cross-sectional study was undertaken to assess the periodontal status of 16-34-year-old obese individuals in colleges of Bangalore City. The students and staff of preuniversity and Degree Colleges of Bangalore City aged below 35 years were considered in the study. Data regarding demographic factors, oral hygiene habits, and dental visits were collected through a questionnaire. Periodontal status was examined using community periodontal index (CPI). Subjects were examined for weight and height as well as periodontal status. Results: It was observed that pocket 4-5 mm (CPI Code 3) is significantly higher among obese when compared to nonobese with P < 0.001 and loss of attachment 4-5 mm (Loss of Attachment Code 1) is significantly higher in obese when compared to nonobese with P < 0.001. Conclusion: The results described earlier and related research indicate that obesity may have potential for periodontal disease among young and/or those lacking oral health care.
Keywords: Body mass index, nonobese, obesity, periodontal status
|How to cite this article:|
Doddamane D, Nanjundappa V, Virjee K. A study to assess the periodontal status of 16-34-year-old obese individuals in Colleges of Bangalore City
. J Indian Soc Periodontol 2015;19:424-8
|How to cite this URL:|
Doddamane D, Nanjundappa V, Virjee K. A study to assess the periodontal status of 16-34-year-old obese individuals in Colleges of Bangalore City
. J Indian Soc Periodontol [serial online] 2015 [cited 2019 Dec 12];19:424-8. Available from: http://www.jisponline.com/text.asp?2015/19/4/424/157881
| Introduction|| |
Globally, the prevalence of chronic, noncommunicable disease is increasing at an alarming rate. Propelling the upsurge in cases of diabetes and hypertension is the growing prevalence of overweight and obesity which have, during the past decade, joined underweight, malnutrition, and infectious diseases as major health problems threatening the developing world.  Obesity is a serious risk concerning millions of people all over the world and has now even been ranked as a serious risk comparable to other chronic diseases. 
Obesity may be defined as an abnormal growth of the adipose tissue due to an enlargement of fat cell size (hypertrophic obesity) or increase in fat cell number (hyperplastic obesity) or a combination of both; expressed in terms of body mass index (BMI). Obesity results when there is an imbalance between energy intake and energy expenditure. Age, genetic factors, activity level, body weight, eating habits, medications, and hereditary factors are some of the causes of obesity.  It is a risk factor for several chronic health conditions, as well as being associated with increased mortality. Hypertension, diabetes, elevated cholesterol, fatty liver, metabolic syndrome, cancer, degenerated arthritis, gallstones, heart attacks, strokes, sleep disorders, depression are some of the complications of obesity. 
The global epidemic of obesity has alarmed all those who are concerned with community, national and international health. Abundance and widespread availability of processed and ready-to-eat high calorie-dense foods coupled with physical inactivity and stresses of modern life have contributed to this global health problem. National and international health agencies are grappling to formulate health policies that can prevent and avert this avalanche. , Today more than 1.1 billion adults worldwide are overweight, and 312 million of them are obese. According to the international obesity task force, at least 155 million children worldwide are obese. This task force and the WHO have revised the prevalence as -1.7 billion people overweight worldwide.  Prevalence of obesity in India ranges from 10% to 50%.  Based on prevalence data from National Health and Nutrition Examination Survey, the combined prevalence of overweight and obesity is currently more than 152 million, with projected to increase to more than 211 million in 2050. 
Obesity is also associated with oral diseases, particularly with periodontal disease. Periodontal disease is one of the common chronic diseases and is commonly defined as a condition where the tissue supporting the teeth is destroyed. The disease is slow to progress and has been defined in adolescents as the presence of loss of tissue attachment of 3 mm or more on one or more teeth.  Obesity has several harmful biological effects that might be related to the pathogenesis of periodontitis. In fact, the adipose tissue secretes several cytokines and hormones that are involved in inflammatory processes, suggesting that similar pathways are involved in the pathophysiology of obesity and periodontitis. According to current knowledge, the adverse effects of obesity on the periodontium might be mediated through impaired glucose tolerance, dyslipidaemia or through increased levels of various bioactive substances secreted by adipose tissue. A number of epidemiological studies have examined the association between obesity and periodontitis.  Although obesity is in its infancy in India compared to western countries, nevertheless it needs to be tackled aggressively before it assumes serious proportions.  The purpose of the present study was to assess the periodontal status of obese young individuals in colleges of Bangalore City and to compare their periodontal status with nonobese of those colleges.
| Materials and Methods|| |
The students and staff of preuniversity and Degree Colleges of Bangalore City aged below 35 years were included in the study. List of colleges of preuniversity and degree colleges were obtained from the respective authority. There are 432 preuniversity colleges and 342 degree colleges present in Bangalore City. Of 774 colleges, by systematic random sampling, 70 colleges were selected. In each college, one section of a class was selected for the study. All the students of that particular section and the staff aged below 35 years present on the day of the survey were included in the study.
In each selected college, all the students present in the selected class and the staff present on the day of study were examined to know their weight and height. Weighing machine and measuring tape were used to measure weight and height respectively.
Data regarding demographic factors, oral hygiene habits and dental visits were collected through a questionnaire. Periodontal status was examined using community periodontal index (CPI). Of the total subjects, obese individuals were identified using BMI and nonobese subjects were selected, one above and two below in the register. Available data on the prevalence of obesity in India suggest that the prevalence ranged between 10% and 50%. Hence 1:3 ratio sample of obese and nonobese was considered. BMI classification given by WHO/IASO/IOTF, 2000 was used to identify obese individuals. All the students and staff were examined in order not to discriminate between obese and nonobese.
Body mass index classification for Asian population
Body mass index <18.5 - underweight.
Body mass index was calculated by dividing weight (kg) by height (m) square. Examination was done using a mouth mirror and CPI probe in natural light.
- 18.5-22.9 - normal weight
- 23.0-24.9 - overweight
- 25.0-29.9 - obese class I
- ≥30.0 - obese class II.
- Those who were absent on the day of study
- Colleges that did not permit to conduct a study
- Subjects other than one above and two below the obese in the register
- Subjects who refused to be part of the study
- Subjects with systemic diseases.
| Statistical Methods|| |
Results on continuous measurements are presented on mean ± standard deviation (Min-Max) and results on categorical measurements are presented in Number (%). Significance is assessed at 5% level of significance. Chi-square/Fisher exact test has been used to find the significance of study parameters on the categorical scale between two or more groups. 95% Confidence Interval has been computed to find the significant features. The Statistical software namely SPSS 15.0, Stata 8.0, MedCalc 9.0.1, and Systat 11.0, SPSS Inc. Chicago were used for the analysis of the data.
| Results|| |
Age distribution and gender distribution are shown in [Table 1] and [Table 2], respectively, where 44% were males, and 56% were females. BMI distribution is shown in [Table 3]. 298 subjects were obese out of 2243 subjects.
Obese and nonobese subjects were randomly selected in a ratio of 1:3. Of 2243, 1190 were included in the study and their periodontal status was compared. Nonobese group was younger than an obese group which was significant at P < 0.001 [Table 4]. There was no difference found in gender distribution [Table 5]. Oral hygiene practice among obese and nonobese was presented in [Table 6]. CPI scores among obese and nonobese are given in [Table 7]. Subjects with bleeding on probing and calculus detected during probing were significantly higher among nonobese when compared to obese with P < 0.001. Comparison of loss of attachment (LOA) scores among obese and nonobese subjects is given in [Table 8]. LOA 0-3 mm (LOA Code 0) was higher in nonobese when compared to obese (P < 0.001). LOA 4-5 mm (LOA Code 1) was higher in obese when compared to nonobese (P < 0.001). Comparison of mean sextants among obese and nonobese is illustrated in [Table 9]. Mean number of sextants of CPI Code 1 was higher among nonobese when compared to obese with P < 0.001. Mean number of sextants of CPI Code 2 was higher among obese when compared to nonobese (P < 0.001). Mean number of sextants of CPI Code 3 was suggestively significant among obese when compared to nonobese (P < 0.084). Mean sextants of LOA among obese and nonobese are illustrated in [Table 10]. Mean number of sextants of LOA Code 0 was higher among nonobese when compared to obese (P < 0.001). Mean number of sextants of LOA Code 1 was higher among obese when compared to nonobese with (P < 0.001).
| Discussion|| |
In the present study, BMI classification given by WHO/IASO/IOTF 2000 was considered whereas other studies have considered BMI classification for Europeans. For south Asians BMI cut off for obese to be considered was 25 whereas BMI cut off for European obese was ≥30.
In the present study, it was found that the nonobese group was younger when compared to the obese group which was significant. In another study  conducted by Anne et al., it was found that the interaction between age and weight and age and waist circumference was significant. A study  conducted by Linden et al., among 60-70-year-old men, it was found that there was no significant difference in the age of the men and the BMI.
In the present study, there was no statistically significant difference among obese and nonobese when gender distribution was considered. In another study  conducted by Saito et al., it was found that BMI and waist-hip ratio was higher in females than males. A study  conducted by Ekuni et al., observed, no significant difference in gender between periodontitis cases and controls.
There was no significant difference found when method of brushing and frequency of cleaning were considered among obese and nonobese. The frequency of changing toothbrush more regularly was statistically significant among nonobese when compared to obese. This could be due to the increased level of confidence and greater attention paid to personal hygiene by nonobese individuals. When prior visit was considered, in the present study, number of subjects who did not visit were more among obese than nonobese.
A study  conducted by Saito et al., observed significant relationship between oral hygiene and Obesity. A study  conducted by Linden et al., among 60-70-year-old men, it was observed that there were less regular dental attendance and less frequent tooth brushing among obese and all these factors have been associated with an increased risk of periodontitis. In the present study also we found that nonobese subjects changed their toothbrush more regularly than obese. A study  conducted by Saito et al., observed that the oral hygiene had a slightly negative association with periodontitis. A study  conducted by Pekka Ylostalo et al., observed that obese subjects who brushed their teeth once a day were more when compared to nonobese. In the present study also we found that obese subjects who brushed their teeth once a day were more when compared to nonobese. A study  conducted by Al-Zaharani et al., observed that periodontal disease prevalence was more among subjects who had never visited a dental office. In the present study also, subjects who had not visited dental office were more among obese than nonobese.
As no studies have been done as in the present study to compare CPI and LOA scores, they are just reported.
It has been reported that the prevalence of periodontal disease was 76% higher among young obese (BMI ≥30 kg/m 2 ) individuals aged 18-34 year  and that weight is associated with increased risk of periodontitis among those aged 17-21 years.  In an another study  of Japanese university students aged 18-24 years, a higher BMI was associated with increased risk of periodontitis. In the present study, we have found that Mean number of sextants of CPI Code 3 is suggestively significant (P = 0.084+) among obese when compared to nonobese. Mean number of sextants of LOA Code 1 is statistically significant among obese when compared to nonobese (P < 0.001).
Saito et al.  used community periodontal index of treatment needs and reported a strong association between BMI and periodontal disease in Japanese group. In another study  the same authors studied the relationship between upper body obesity, BMI, and periodontitis in healthy dentate Japanese adults and found that the subjects with high upper body obesity or high total body fat had significantly increased adjusted risk of periodontitis.
A study  conducted by Saito et al., found nonsignificant association between obesity and attachment loss. A study  conducted by Wood et al., found a significant association between periodontal attachment loss and obesity. In the present study, we have found that subjects with mean number of sextants with LOA Code 1 were more among obese when compared to nonobese with P < 0.001.
This study had some limitations
As the design of this study limited the interpretation of causal relationships, prospective cohort studies may provide information beyond what we present here.
The roles of genetics, or other factors (e.g., smoking, nutrition, stress levels, alcohol consumption, etc.), which have been shown to affect the prevalence of periodontitis, were not considered in our study.
The use of representative teeth may underestimate the prevalence while overestimating the severity of periodontitis.
Our study does not address any mechanisms of how obesity may have an adverse effect on the periodontium.
| Conclusion|| |
The results described earlier and related research indicates that obese individuals may have a potential for periodontal disease. Medical and Dental professionals should develop interdisciplinary approaches for identifying and treating early signs of oral disease among young obese individuals. It may be useful for BMI evaluations to be included on a regular basis during general and oral health examinations.
| References|| |
Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world - A growing challenge. N Engl J Med 2007;356:213-5.
Sheiham A, Watt RG. The common risk factor approach: A rational basis for promoting oral health. Community Dent Oral Epidemiol 2000;28:399-406.
Park K. Epidemiology of chronic noncommunicable diseases and conditions. In: Park K, editor. Park's Text Book of Preventive and Social Medicine. 19 th
ed. Jabalpur: Banarsidas Bhanot; 2007. p. 332-6.
Yajnik CS. Obesity epidemic in India: Intrauterine origins? Proc Nutr Soc 2004;63:387-96.
Griffiths PL, Bentley ME. The nutrition transition is underway in India. J Nutr 2001;131:2692-700.
Chopra M, Galbraith S, Darnton-Hill I. A global response to a global problem: The epidemic of overnutrition. Bull World Health Organ 2002;80:952-8.
Mohan V, Deepa R. Obesity and abdominal obesity in Asian Indians. Indian J Med Res 2006;123:593-6.
Douglass CW, Shanmugham JR. Primary care, the dental profession, and the prevalence of chronic diseases in the United States. Dent Clin North Am 2012;56:699-730.
Reeves AF, Rees JM, Schiff M, Hujoel P. Total body weight and waist circumference associated with chronic periodontitis among adolescents in the United States. Arch Pediatr Adolesc Med 2006;160:894-9.
Ylöstalo P, Suominen-Taipale L, Reunanen A, Knuuttila M. Association between body weight and periodontal infection. J Clin Periodontol 2008;35:297-304.
Linden G, Patterson C, Evans A, Kee F. Obesity and periodontitis in 60-70-year-old men. J Clin Periodontol 2007;34:461-6.
Saito T, Shimazaki Y, Koga T, Tsuzuki M, Ohshima A. Relationship between upper body obesity and periodontitis. J Dent Res 2001;80:1631-6.
Ekuni D, Yamamoto T, Koyama R, Tsuneishi M, Naito K, Tobe K. Relationship between body mass index and periodontitis in young Japanese adults. J Periodontal Res 2008;43:417-21.
Al-Zahrani MS, Bissada NF, Borawskit EA. Obesity and periodontal disease in young, middle-aged, and older adults. J Periodontol 2003;74:610-5.
Saito T, Shimazaki Y, Sakamoto M. Obesity and periodontitis. N Engl J Med 1998;339:482-3.
Saito T, Shimazaki Y, Kiyohara Y, Kato I, Kubo M, Iida M, et al.
Relationship between obesity, glucose tolerance, and periodontal disease in Japanese women: the Hisayama study. J Periodontal Res 2005;40:346-53.
Wood N, Johnson RB, Streckfus CF. Comparison of body composition and periodontal disease using nutritional assessment techniques: Third National Health and Nutrition Examination Survey (NHANES III). J Clin Periodontol 2003;30:321-7.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]