More and more folks are becoming aware of the fact there is an association between obesity and oral health. It may be hard to see because obesity normally causes lots of different problems and some of them are attributed to bad habits. Besides, it’s not like dental issues are restricted to a certain group of people only. They happen to everyone, independent of age and sex.
That said, people with a higher body mass index (BMI) are more likely to experience serious tooth pathologies than those with a normal BMI. Below, you are going to find out more information about this phenomenon and how to prevent it with the right measures in place. Let’s go.
What is Body Mass Index (BMI)?
The term body mass index is an indicator employed to calculate where on the weight range a person falls. Developed by the World Health Organization (WHO), it takes two measures, height and weight, to identify the proportion of existing body fat.
The formula reads the following: BMI = kg/m2. Normal weight is considered to be one that lies anywhere between 18.5 and 24.9. Ranges below 18.5 are regarded as underweight and those above 25 up to 29.9 are believed to be overweight. Individuals who happen to have a BMI of 30 or higher are considered obese and need to take measures to up their health status.
Now, it is worth mentioning these ranges are different in Singapore since some Asian communities have a higher tendency to develop diabetes mellitus and cardiovascular diseases than Caucasians. For this reason, the figures have been modified to offer a more realistic picture in terms of good and bad physical condition.
Another piece of information to take into account is that the body mass index is a relative indicator of health problems since everybody is exposed to different social-economic and lifestyle factors1. Plus, people who lift weights and build loads of muscle are generally heavier, yet they don’t run a higher risk of developing chronic disease. It’s quite the opposite actually for they don’t have so much body fat as people who don’t work out. Of course, it is all strongly individual.
And lastly, the body mass index calculations should not be applied to (obese) children. It serves to estimate healthy weight ranges for adults only. You can calculate your BMI here. If the numbers are on the higher end of the spectrum, you should think about improving your quality of life.
Obesity and Oral Health in Adults and Children
Now, as you know, obesity is a huge problem around the globe. To put it in numbers, in 2016 solely, it affected 650 million adults, the WHO reports2. Children are also impacted. A total of 38.2 million children under the age of 5 were either obese or overweight in 2019. According to scientists, obesity reflects on periodontal health3 but it is not clear yet how it happens and for what reasons.
For example, a small study with 100 participants organised in two groups reported that there is a prevalence of periodontitis among obese individuals with a mean BMI of 30 or higher. It is safe to say the difference was statistically significant. (P < 0.031 for clinical attachment level (CAL); P < 0.05 for pocket probing depth (PPD); P < 0.05 for gingival index (GI)) However, it should be taken into account that cross-sectional study designs are a bit restrictive and unable to provide a definitive cause and effect relationship.
The participants were selected based on the number of teeth that were naturally occurring in their oral cavities. That is, each one had to have at least 6 teeth in their mouth to be eligible. They were all aged 18 or above. Both gingivitis and periodontitis were part of the criteria.
In another study, the same implications for oral health were observed. It counted on logistic regression analysis to calculate the associations and pick up the right kind of information. It was executed among the general population in Sweden. Younger adults were excluded from the trial. Only middle-aged and elderly women were in. A statistically significant correlation was detected between obesity and the number of teeth (fewer than 20 in some of the participants). Part of the risk factors was the waist-to-hip ratio.
As well as this, the study looked into the socioeconomic status of the participants as they believe there is an association between socio economic status, public health, and normal weight4.
And here is an interesting systematic review and meta-analysis from Plymouth which takes a peek at childhood obesity. A cross-sectional study on 4-6 year-old children revealed that there was no significant relationship between obesity and dental caries (tooth decay)5. That was quite surprising and needs to be researched more. There were a total of 347 participants.
Obesity and Waist Circumference
What is worse is obesity impacts different parts of the body. For example, having too much fat around the waist is a problem on its own.
The general rule of thumb is waist circumference should be as follows: less than 80 cm for women and less than 95 cm for men. For those of you who are familiar with the imperial system, that’s less than 35 inches for women and less than 40 inches for men. Measuring more than that is a common risk factor for disease and it may eventually act on your oral health.
Why is it so important to keep a slim waist circumference? The bigger your belly, the more fat you carry around it. Although visceral fat is supposed to keep your organs in good condition, it is not okay to have too much of it. The reason for this is simple. Visceral fat tends to make more inflammatory chemicals than fat that is found in other areas. These chemicals affect the entire body and can lead to heart disease and type 2 diabetes mellitus.
What is the Relationship Between Oral Health and General Health?
Entire colonies of bacteria, mostly harmless, take shelter inside your mouth where they have the time of their lives. However, under certain circumstances, these guys can find their way into the bloodstream and travel to places you don’t want them to access, like your heart and lungs.
Let’s take for instance periodontal disease. It happens when the bacteria in the oral cavity begins to infect the surrounding tissue. Some of the symptoms it creates are swelling, bad breath, and bleeding. If left unattended for too long, it can cause the gum disease and the gums to pull away from the teeth, weakening the structures, and promoting tooth loss.
Not only does oral health deteriorate but there is a direct impact on general health. It is known that there is an association between periodontal disease and cardiovascular diseases. But that’s not all. Respiratory diseases, dementia, insulin resistance, mortality, stroke, and high blood pressure are linked too. As was made evident earlier, the difference is statistically significant in some cases. In fact, overweight is linked to more mortality on a global scale than underweight. This stems from the fact there are more obese people on the planet than underweight.
And back to oral hygiene and risk factors. When you undergo different dental procedures, the bad bacteria that have taken hold of your gums might enter the bloodstream and reach the heart, leading to endocarditis, inflammation to the heart. And that’s just a small visualisation of what might happen. The possibilities are quite a few depending on where the germs will hit.
All in all, you want to maintain your teeth and gums in good condition to prevent oral hygiene from interfering with your general health, and vice versa. After all, obesity is one of the risk factors for periodontitis and gingivitis and is a huge public health problem. The more information is obtained, the more evidence there is to prove it.
What Medical Conditions Affect Oral Health?
Unfortunately, there are a lot of health conditions that have a negative on oral and dental health.
Common medical conditions affecting dental health
- Osteoporosis. In case you don’t know, osteoporosis is a disease affecting the bones, making them weaker and more prone to breakage. On one hand, it is this very intimidating fact of losing bone density that can contribute to oral health problems like tooth loss. On the other hand, certain medications prescribed to treat the condition may damage the bones of the jaw in the long run. Although that risk is relatively small, it still exists.
- HIV/AIDS. People who have AIDS often complain about dry mouth. Along with that, they may experience oral warts, canker sores, bone loss, and gingivitis. Patients happen to be more prone to dental caries, oral candidiasis, fever blisters, and hairy leucoplakia. (There seems to be an association between obesity and dental caries too.)
- Insulin resistance. The main problem with health conditions of this calibre is elevated blood sugar levels. If they are not in the accepted ranges, white blood cells become weak and blood vessels thicken. White blood cells are the ones responsible for the body’s defence mechanisms against bacterial infections. Like we said before, the mouth is infested with bacteria which co-exist in perfect balance. When the balance is broken, a number of problems might arise. Now, when blood vessels thicken, the transportation of nutrients in and waste out of the system becomes sluggish, as a result of which the body can no longer fight off infections as adequately as before. This generates a higher risk of periodontal disease.
- Eating disorders. Without a shadow of a doubt, dietary habits consistently play an important role in one’s oral health status. The foods that we eat change the environment in the mouth. A diet lacking key nutrients might lead to nutritional deficiencies which can then affect the production of saliva, sturdiness or the enamel, and other things. Mental conditions like bulimia nervosa that involve frequent vomiting help to eat away at the teeth. According to recent information, there may be an association with dental caries as well. However, there is not enough evidence to back this up.
- Arthritis. People suffering from rheumatoid arthritis typically experience lots of pain on the daily, which may interfere with their brushing and flossing rituals. Numerous problems can arise from this.
- Alzheimer's disease. It is a brain disorder that affects one’s cognitive abilities and memory. As the disease progresses, patients are unable to carry out small jobs or take proper care of themselves. As a result of that oral hygiene declines6. This in turn could cause some dental pathologies.
Does Obesity Increase the Risk of Infection?
A study found an association between obesity and a greater predisposition towards infections7. It started back in 1997 and was completed in 2016. Almost 40,000 Swedish adults took part in it. Each subject registered their BMI by themselves while the infections they had throughout that time ineterval were collected from the Swedish National Patient Register.
The results of the study depicted 27,675 infections. In other words, during the 19-year period, 32% of the participants developed at least one infection that would have to be addressed by a physician.
Compared to normal body weight individuals from the same study group, both obese men and women were found to suffer an increased risk of any infection, hazard ratio (HR) ranging from 1.22 to 1.25.
When it comes to the type of infections, the numbers go like this. There was an increased number of skin infection events in both genders, while bigger prevalence of urinary tract infections, gastrointestinal tract infections, and sepsis were noticeable among obese females only.
What kind of Problems are Linked to being Overweight and Obese?
Being overweight comes with a lot of potential problems and if you're obese that can make things a lot worse. Here are some of the things that can be caused or made worse by obesity:
- Sleep apnoea
- Type 2 diabetes mellitus
- Heart disease
- High blood pressure
- Certain types of cancer
- Kidney disease
- Fatty liver disease
- Metabolic syndrome
BMI and Oral Health
Because of the aforementioned factors, body mass index (BMI) can highly reflect on oral hygiene and health. A study including Saudi adults showed that participants with a higher BMI were also more likely to experience oral soft tissue variations, periodontal pocket, and DMFT (decayed, missing and filled teeth).
According to NCBI, there seems to be a correlation between more caries lesions and a high BMI but no gender-specific differences have been found. Obesity and dental caries are observed quite often to be ignored.
What Can You Do to Boost Your Oral Health Status and Decrease Dental Caries Incidents?
There are plenty of things you can do to get your teeth in tiptop shape. The process is complex and affects several different steps.
- For starters, you should brush and floss after every meal (ideally) or twice a day at the very minimum. Also, use mouthwash. This will keep plaque out of the way, creating a nice and clean environment for your teeth and gums.
- Second, you should try to incorporate more healthy foods and snacks into your diet because this is the secret to less plaque. Increase your veggie intake. Remember to eat more protein and cut down on sugars, coffee and carbonated drinks if you consume any of that. If possible, quit smoking because that takes a toll as well.
- Third, watch your general health. Show up at all your annual physical check-ups and do blood tests and other screening as ordered by your doctor. You don’t want to miss a health problem and let it get out of hand. It can have a direct effect on your oral health. Test yourself for any deficiencies and make sure to replenish them if you find out any.
- Take your medication exactly how it was advised and don’t experiment with drugs. If you have a condition that requires you to take antibiotics before a certain manipulation, don’t forget to talk to your physician about it.
- Last but not least, make it a point to go to the dentist regularly. Schedule a dental examination every 7-8 months so you know you are doing everything you can to keep that smile nice and shiny. This involves filling cavities, treating cracks and chips, and subjecting yourself to regular cleanings, etc. Don’t leave it to chance and don’t be lazy. All your efforts will pay off in the future. Oral health is an ongoing process that practically persists until you die.
Information to Divulge to Your Dentist Before You Have Any Dental Work Done
Overweight and obesity aren’t the only things to worry when it comes to teeth. Here are the things you should bring up to your dentist before you undergo any treatment.
- You have haemophilia
- You are allergic to a drug, food, or anything else
- You have cardiovascular disease
- You’re taking medication
- You’re suffering from asthma
- You have epilepsy or another health condition
- You are on blood thinners
- You are on antidepressants
- You are pregnant
- You’re taking bisphosphonates
- You have kidney disease
- You’ve been diagnosed with diabetes type 1 or type 2 (insulin resistance)
- You have HIV
Bottom Line of BMI and Oral Cavity Health
After so many years of research and study on the effects of obesity on oral health, there is no doubt now that these two things are correlated. When healthy weight is not present, it gradually starts to act on your pearly whites. Not only is there an association between obesity and dental caries prevalence but there seems to be one between obesity and other dental issues.
The takeaway from this post is that you have to monitor your weight by implementing a healthier diet and a decent amount of physical activity to ensure that both your body and teeth are in good shape. This is a public health issue occurring to both children and adults. And it has to be taken care of. It doesn’t hurt to make trips to your dentist once a year to get those cleanings and fix other issues.
- 1. https://link.springer.com/article/10.1186/1472-6831-12-50
- 2. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
- 3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803880/
- 4. https://pubmed.ncbi.nlm.nih.gov/30667187/
- 5. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-51...
- 6. https://pubmed.ncbi.nlm.nih.gov/20043813/
- 7. https://academic.oup.com/ije/article/48/6/1783/5530734