Tooth Loss: A Potential Side Effect of Obesity

By Hannah Koceja

Figure 2: Missing tooth X ray Photo taken by Theodor Negru

Stress eating, decrease in outdoor activity, and higher food insecurity - causing Americans to eat poorer quality foods - are factors heightened by the 2020 pandemic that caused the obesity rate to go over 40% in 2020.1 The obesity rate in 2020 was 42.4% for American adults, 26% higher than in 2008.1 For the past decade, the U.S. adult obesity rate has been leaning towards 40%; however, the rate did not go over 40% until after 2019.1 With obesity comes a number of health risks, such as heart disease, high blood pressure, and diabetes, but other lesser known side effects are still present and should not be neglected by the media. One such side effect being found is tooth loss. Cristiano Susin, DDS, MSD, PhD, is an associate professor in the Division of Comprehensive Oral Health and chair of UNC Chapel Hill’s Department of Periodontology since 2018. In his most recent study located in Porto Alegre, Brazil, Dr. Susin along with 6 other researchers conducted research showing that obese individuals were significantly more likely to experience tooth loss over nonobese individuals. Since 2001, Dr. Susin has aided research in the Porto Alegre study to provide evidence that a legitimate correlation between obesity and tooth loss exists; the study was finalized and then published in 2020. Obesity is thought to possibly cause periodontitis, or inflammatory gum disease, which can eventually lead to tooth loss.⁴ However, little research showing the direct connection between obesity and tooth loss has been conducted on this topic prior to Dr. Susin’s study. Research has implied that obesity can cause tooth loss but, since few studies were carried out, the obesity health risk of tooth loss was never widespread in the media. Dr. Susin and

Figure 1: Tooth loss graph regarding to sex, periodontitis, and smoking. Photo by original research journal article

his team’s research provides the evidence, which will hopefully cause more people to become aware of the hidden health detriments of obesity. Dr. Susin and his team conducted their study over 5 years and examined 1,586 individuals from ages 14-64 as a starting point. A baseline for one’s body mass index (BMI) was then calculated for each individual to determine which individuals were considered obese in this cohort study. In addition, periodontal status, smoking habits, sex, education, socioeconomic status, dental care, and number of teeth were all variables measured at the beginning, throughout, and at the end of the study.3 These factors were assessed to make the cohort study controlled and more accurate. The 5-year timespan of the study was also an adequate amount of time even when considering the long process of tooth loss. “For the study, a large population was followed for 5 years, making it extremely difficult to have more than 50% of a participation rate as a result, which is pretty much what we have. To have the study take place over 10 or 20 years seems more ideal; however, after 5 years participation goes down very precipitously,” explained Dr. Susin.2 The large starting population and 5-year timespan allowed for a sufficient number of subjects’ data to be collected even with the almost 50% participation rate (755 subjects). The results from their data then showed that 47.1% obese individuals recorded at least one tooth loss while 32.4% normalweight individuals experienced at least one tooth loss over the 5 years.3 This gives obese individuals in the study a 31% higher risk than participants who were normal-weight.3 Obese and overweight females were also significantly more likely to have a recorded tooth loss than obese and overweight males (Figure 1).3

Figure 3: Gums being examined with a periodontal measuring probe. Photo taken by Sodel Vladyslav Out of the 47.1% of obese individuals who reported having tooth loss, the types of subjects most prominently found within this percentage were females, smokers, or those who had periodontitis (Figure 1).3 These results are surprising, particularly for sex, since the data shows that females who remained normal-weight were less likely to experience tooth loss over males who remained normal-weight. Dr. Susin notes, “Males and females behave differently when it comes to dental care. For instance, females tend to have better oral hygiene because of better habits and better behaviors when it comes to teeth,” which supports the normal-weight tooth loss results but not the obese.2 This is because, as mentioned in the study, past literature has indicated that the sex differences in those who are obese may cause dissimilar side effects in chronic diseases. Varying sex hormones and different inflammatory responses between the sexes are two possible reasons mentioned for why females who remained obese reported higher tooth loss results than males of the same category, even though females are known to have better dental care.3 Although these results showed that tooth loss was more common if the subject fell into one of these categories, it is noted that individuals that did not fit into these categories and were solely obese were still found to have higher rates of tooth loss. An obese male without periodontitis who has never smoked is still more likely to experience tooth loss over his nonobese counterparts (Figure 1).3 Though the study Dr. Cristiano Susin originated in Porto Alegre, Brazil, the results found on obesity affecting tooth loss are applicable to individuals on an international level. Dr. Susin states, “Diet and lifestyles are different across the world. There will be slight differences in other studies globally, but the same trend exists. When looking at studies on this topic from other populations, you see different strengths of the association, but the results are ultimately going in the same direction. Knowing this, along with having multiple adjusted factors in our own research, it is fair to say that we are looking at a true effect that will be generalizable through multiple populations.”2 Because of this study, researchers, dentists, periodontists, and individuals can further aid others in achieving better dental care. In addition, general awareness of these results can help individuals who are obese or overweight be more conscious about how to improve their own dental health. Whether an individual is obese or overweight due to stress eating, genetic illnesses, hormonal imbalances, etc., knowing that obesity could be another factor to cause tooth loss can help them plan and prevent additional dental issues in the future.

References

1. Warren, M. Trust for America’s Health: The State of Obesity 2020: Better Policies for a Healthier America. https://www.tfah. org/report-details/state-of-obesity-2020/ (accessed February 23rd, 2021). 2. Interview with Cristiano Susin, DDS, MSD, Ph.D. 02/18/2021. 3. Vallim A.C.; Gaio E.J.; Oppermann R.V.; Rösing C.K.; Albandar J.M.; Susin C, Haas A.N. J Clin Periodontol. 2021, 48, 15 - 24. 4. Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/ periodontitis/symptoms-causes/syc-20354473 (accessed February 28th, 2021).