Sir, I read with interest the article Obesity and dentistry: a growing problem (BDJ 2009; 207: 171–175). This was timely for me as I also attended a clinical presentation by Professor Goran Dahloff at the FDI World Dental Congress in Singapore in September, entitled Lifestyle and obesity - the link to general disease and oral health.

Adipose tissue is loose connective tissue composed of cells called adipocytes and secretes adipokines in amounts proportional to the amounts of adipose tissue present. Adipokines affect the metabolism of the body and are thought to contribute to low grade systemic and vascular inflammation due to accumulation of gram negative bacteria and inflammatory mediators. Increasing body fat may stimulate a hyper inflammatory response as noted in periodontal disease. Obesity may have the potential for transforming the host's immunity and inflammatory system, causing the patient to be more at risk to the effects of microbial plaque.

Obesity is also associated with type 2 diabetes mellitus which results from inadequate insulin secretion to sustain normal metabolism and obese patients require more insulin to achieve this. The cytokine TNF, secreted by adipose tissue, is assumed to be critical in the pathogenesis of non-insulin dependent diabetes mellitus and in insulin resistance. Patients with type 2 diabetes are known to be prone to periodontal disease and obesity is also a risk factor for this and periodontitis.

I believe that obesity could therefore present dentistry with an opportunity to contribute to public health. Preventive interventions with a focus on children would be the key to health before obesity can cause the many medical conditions mentioned in the BDJ paper: hypertension, cardiovascular disease, diabetes mellitus, sleep breathing disorder, cancer, fatty liver disease, gall bladder disease, gastro-oesophageal reflux disease, osteoarthritis and reproductive problems. Dental professionals in primary dental care are well placed and could be central in children's obesity services in Primary Care Trusts Healthy Weight Healthy Lives clinical pathways. Similarly, a reverse process could take place with obese children with dental caries referred to primary dental care by both health and non-healthcare professionals such as school nursing teams, community paediatricians, dieticians, psychologists, paediatricians, healthy schools teams, school sports co-ordinators and secondary care clinicians.