Review of obesity and periodontitis: an epidemiological view

Article metrics


Obesity and periodontitis are among the most common non-communicable diseases, and epidemiological studies report the influence of obesity in the onset and progression of periodontitis. Data indicate that increased body mass index, waist circumference, percentage of subcutaneous body fat, and serum lipid levels are associated with increased risk to develop periodontitis. The underlying biological mechanisms of this association involve adipose tissue-derived cytokines, such as tumour necrosis factor-α and interleukin-6, which affect whole-body metabolism and contribute to the development of a low-grade systemic inflammation. Multiple studies report a positive association between these two diseases across diverse populations. Obesity does not appear to impair the success of periodontal therapy. However, currently available evidence is variable and therefore inconclusive. Despite the limited evidence about recommendations on treatment planning, oral healthcare professionals need to be aware of the complexity of obesity to counsel their patients about the importance of maintaining healthy body weight and performing good oral hygiene procedures.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1.

    Linden G J, Lyons A, Scannapieco F A. Periodontal systemic associations: review of the evidence. J Periodontol 2013; 84 (Spec Iss): S8-S19.

  2. 2.

    Smith K B, Smith M S. Obesity statistics. Prim Care 2016; 43: 121-135.

  3. 3.

    Chaffee B W, Weston S J. Association between chronic periodontal disease and obesity: a systematic review and meta-analysis. J Periodontol 2010; 81: 1708-1724.

  4. 4.

    Suvan J, D'Aiuto F, Moles D R, Petrie A, Donos N. Association between overweight/obesity and periodontitis in adults. A systematic review. Obes Rev 2011; 12: 381-404.

  5. 5.

    Saito T, Shimazaki Y, Sakamoto M. Obesity and periodontitis. N Engl J Med 1998; 339: 482-483.

  6. 6.

    Khader Y S, Bawadi H A, Haroun T F, Alomari M, Tayyem R F. The association between periodontal disease and obesity among adults in Jordan. J Clin Periodontol 2009; 36: 18-24.

  7. 7.

    Al-Zahrani M S, Bissada N F, Borawskit E A. Obesity and periodontal disease in young, middle-aged, and older adults. J Periodontol 2003; 74: 610-615.

  8. 8.

    Genco R J, Grossi S G, Ho A, Nishimura F, Murayama Y. A proposed model linking inflammation to obesity, diabetes, and periodontal infections. J Periodontol 2005; 76 (Spec Iss): 2075-2084.

  9. 9.

    Gerber F A, Sahrmann P, Schmidlin O A, Heumann C, Beer J H, Schmidlin P R. Influence of obesity on the outcome of non-surgical periodontal therapy - a systematic review. BMC Oral Health 2016; 16: 90.

  10. 10.

    World Health Organisation. Obesity: preventing and managing the global epidemic. 2000. Available at (accessed July 2019).

  11. 11.

    WHO Expert Consultation. Appropriate body mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004; 363: 157-163.

  12. 12.

    World Health Organisation. World Health Statistics 2017: Monitoring health for the SDGs. 2017. Available at (accessed July 2019).

  13. 13.

    World Health Organisation. Waist circumference and waist-hip ratio: Report of a WHO expert consultation, Geneva, December 8-11 2008. Available at (accessed July 2019).

  14. 14.

    Pischon N, Heng N, Bernimoulin J P, Kleber B M, Willich S N, Pischon T. Obesity, inflammation, and periodontal disease. J Dent Res 2007; 86: 400-409.

  15. 15.

    Ng M, Fleming T, Robinson M et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 766-781.

  16. 16.

    Ard J. Obesity in the US: what is the best role for primary care? BMJ 2015; 350: g7846.

  17. 17.

    Wang Y C, McPherson K, Marsh T, Gortmaker S L, Brown M. Health and economic burden of the projected obesity trends in the USA and the UK. Lancet 2011; 378: 815-825.

  18. 18.

    Page R C, Offenbacher S, Schroeder H E, Seymour G J, Kornman K S. Advances in the pathogenesis of periodontitis: summary of developments, clinical implications and future directions. Periodontol 2000 1997; 14: 216-248.

  19. 19.

    Van Dyke T E, Sheilesh D. Risk factors for periodontitis. J Int Acad Periodontol 2005; 2007: 3-7.

  20. 20.

    Kornman K S, Page R C, Tonetti M S. The host response to the microbial challenge in periodontitis: assembling the players. Periodontol 2000 1997; 14: 33-53.

  21. 21.

    Socransky S S, Haffajee A D. Periodontal microbial ecology. Periodontol 2000 2005; 38: 135-187.

  22. 22.

    Genco R J, Borgnakke W S. Risk factors for periodontal disease. Periodontol 2000 2013; 62: 59-94.

  23. 23.

    Salvi G E, Lawrence H P, Offenbacher S, Beck J D. Influence of risk factors on the pathogenesis of periodontitis. Periodontol 2000 1997; 14: 173-201.

  24. 24.

    Eke P I, Thornton-Evans G O, Wei L, Borgnakke W S, Dye B A, Genco R J. Periodontitis in US Adults: National Health and Nutrition Examination Survey 2009-2014. J Am Dent Assoc 2018; 149: 576-588.

  25. 25.

    Marchetti E, Monaco A, Procaccini L et al. Periodontal disease: the influence of metabolic syndrome. Nutr Metab (Lond) 2012; 9: 88.

  26. 26.

    Akram Z, Abduljabbar T, Abu Hassan M I, Javed F, Vohra F. Cytokine Profile in Chronic Periodontitis Patients with and without Obesity: A Systematic Review and Meta-Analysis. Dis Markers 2016; 2016: 4801418.

  27. 27.

    Nakamura K, Fuster J J, Walsh K. Adipokines: a link between obesity and cardiovascular disease. J Cardiol 2014; 63: 250-259.

  28. 28.

    Nokhbehsaim M, Keser S, Nogueira A V et al. Leptin effects on the regenerative capacity of human periodontal cells. Int J Endocrinol 2014; 2014: 180304.

  29. 29.

    Goncalves T E, Zimmermann G S, Figueiredo L C et al. Local and serum levels of adipokines in patients with obesity after periodontal therapy: one-year follow-up. J Clin Periodontol 2015; 42: 431-439.

  30. 30.

    Zimmermann G S, Bastos M F, Dias Goncalves T E, Chambrone L, Duarte P M. Local and Circulating Levels of Adipocytokines in Obese and Normal Weight Individuals with Chronic Periodontitis. J Periodontol 2013; 84: 624-633.

  31. 31.

    Saito T, Shimazaki Y, Koga T, Tsuzuki M, Ohshima A. Relationship between upper body obesity and periodontitis. J Dent Res 2001; 80: 1631-1636.

  32. 32.

    Saito T, Shimazaki Y, Kiyohara Y et al. Relationship between obesity, glucose tolerance, and periodontal disease in Japanese women: the Hisayama study. J Periodontal Res 2005; 40: 346-353.

  33. 33.

    Morita T, Ogawa Y, Takada K et al. Association between periodontal disease and metabolic syndrome. J Public Health Dent 2009; 69: 248-253.

  34. 34.

    Haffajee A D, Socransky S S. Relation of body mass index, periodontitis and Tannerella forsythia. J Clin Periodontol 2009; 36: 89-99.

  35. 35.

    Han D H, Lim S Y, Sun B C, Paek D M, Kim H D. Visceral fat area-defined obesity and periodontitis among Koreans. J Clin Periodontol 2010; 37: 172-179.

  36. 36.

    Dalla Vecchia C F, Susin C, Rosing C K, Oppermann R V, Albandar J M. Overweight and obesity as risk indicators for periodontitis in adults. J Periodontol 2005; 76: 1721-1728.

  37. 37.

    Linden G, Patterson C, Evans A, Kee F. Obesity and periodontitis in 60-70year-old men. J Clin Periodontol 2007; 34: 461-466.

  38. 38.

    Tonetti M S, Claffey N, European Workshop in Periodontology group C. Advances in the progression of periodontitis and proposal of definitions of a periodontitis case and disease progression for use in risk factor research. Group C consensus report of the 5th European Workshop in Periodontology. J Clin Periodontol 2005; 32 (Spec Iss): 210-213.

  39. 39.

    Saxlin T, Ylostalo P, Suominen-Taipale L, Aromaa A, Knuuttila M. Overweight and obesity weakly predict the development of periodontal infection. J Clin Periodontol 2010; 37: 1059-1067.

  40. 40.

    Gorman A, Kaye E K, Apovian C, Fung T T, Nunn M, Garcia R I. Overweight and obesity predict time to periodontal disease progression in men. J Clin Periodontol 2012; 39: 107-114.

  41. 41.

    Eke P I, Page R C, Wei L, Thornton-Evans G, Genco R J. Update of the case definitions for population-based surveillance of periodontitis. J Periodontol 2012; 83: 1449-1454.

  42. 42.

    Papapanou P N, Lindhe J, Sterrett J D, Eneroth L. Considerations on the contribution of ageing to loss of periodontal tissue support. J Clin Periodontol 1991; 18: 611-615.

  43. 43.

    Holtfreter B, Albandar J M, Dietrich T et al. Standards for reporting chronic periodontitis prevalence and severity in epidemiologic studies: Proposed standards from the Joint EU/USA Periodontal Epidemiology Working Group. J Clin Periodontol 2015; 42: 407-412.

  44. 44.

    Page R C, Eke P I. Case definitions for use in population-based surveillance of periodontitis. J Periodontol 2007; 78: 1387-1399.

  45. 45.

    Goldberg R J, McManus D D, Allison J. Greater knowledge and appreciation of commonly-used research study designs. Am J Med 2013; 126: 169.

  46. 46.

    Canadian Diabetes Association Clinical Practice Guidelines Expert C, Goldenberg R, Punthakee Z. Definition, classification and diagnosis of diabetes, prediabetes and metabolic syndrome. Can J Diabetes 2013; 37 (Spec Iss): S8-S11.

  47. 47.

    Naser K A, Gruber A, Thomson G A. The emerging pandemic of obesity and diabetes: are we doing enough to prevent a disaster? Int J Clin Pract 2006; 60: 1093-1097.

  48. 48.

    Eckel R H, Kahn S E, Ferrannini E et al. Obesity and type 2 diabetes: what can be unified and what needs to be individualized? J Clin Endocrinol Metab 2011; 96: 1654-1663.

  49. 49.

    Taylor G W, Borgnakke W S. Periodontal disease: associations with diabetes, glycaemic control and complications. Oral Dis 2008; 14: 191-203.

  50. 50.

    Mealey B L, Ocampo G L. Diabetes mellitus and periodontal disease. Periodontol 2000 2007; 44: 127-153.

  51. 51.

    Demmer R T, Jacobs D R Jr., Desvarieux M. Periodontal disease and incident type 2 diabetes: results from the First National Health and Nutrition Examination Survey and its epidemiologic follow-up study. Diabetes Care 2008; 31: 1373-1379.

  52. 52.

    Shlossman M, Knowler W C, Pettitt D J, Genco R J. Type 2 diabetes mellitus and periodontal disease. J Am Dent Assoc 1990; 121: 532-536.

  53. 53.

    Loe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care 1993; 16: 329-334.

  54. 54.

    Moura-Grec P G, Marsicano J A, Carvalho C A, Sales-Peres S H. Obesity and periodontitis: systematic review and meta-analysis. Cien Saude Colet 2014; 19: 1763-1772.

  55. 55.

    Nascimento G G, Leite F R, Do L G et al. Is weight gain associated with the incidence of periodontitis? A systematic review and meta-analysis. J Clin Periodontol 2015; 42: 495-505.

  56. 56.

    Martinez-Herrera M, Silvestre-Rangil J, Silvestre F J. Association between obesity and periodontal disease. A systematic review of epidemiological studies and controlled clinical trials. Med Oral Patol Oral Cir Bucal 2017; 22: 708-715.

  57. 57.

    Khan S, Barrington G, Bettiol S, Barnett T, Crocombe L. Is overweight/obesity a risk factor for periodontitis in young adults and adolescents?: a systematic review. Obes Rev 2018; 19: 852-883.

  58. 58.

    Lakkis D, Bissada N F, Saber A et al. Response to periodontal therapy in patients who had weight loss after bariatric surgery and obese counterparts: a pilot study. J Periodontol 2012; 83: 684-689.

  59. 59.

    Zuza E P, Barroso E M, Carrareto A L et al. The role of obesity as a modifying factor in patients undergoing non-surgical periodontal therapy. J Periodontol 2011; 82: 676-682.

  60. 60.

    Altay U, Gurgan C A, Agbaht K. Changes in inflammatory and metabolic parameters after periodontal treatment in obese and non-obese patients. J Periodontol 2013; 84: 13-23.

  61. 61.

    Nascimento G G, Leite F R, Correa M B, Peres M A, Demarco F F. Does periodontal treatment have an effect on clinical and immunological parameters of periodontal disease in obese subjects? A systematic review and meta-analysis. Clin Oral Investig 2016; 20: 639-647.

  62. 62.

    Papageorgiou S N, Reichert C, Jager A, Deschner J. Effect of overweight/obesity on response to periodontal treatment: systematic review and a meta-analysis. J Clin Periodontol 2015; 42: 247-261.

Download references

Author information

Correspondence to Silie Arboleda.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark