In obese people, oral hygiene tends to deteriorate after bariatric surgery – often leaving irreversible damage. Find out why dentists should be involved in treating obesity early on.
Oral health deteriorates in morbidly obese people undergoing dieting in preparation for bariatric surgery as well as in patients who have already undergone the procedure. These patients have increased prevalence of caries, gingivitis and periodontitis. This is the conclusion of a study conducted by researchers at the Federal University of São Paulo (UNIFESP) in Brazil. Articles about the study were published in the Journal of Oral Rehabilitation and Clinical Oral Investigations, emphasizing the importance of a dentist’s involvement in the evaluation of bariatric patients.
The study, conducted by FAPESP researchers at the Bariatric Clinic in Piracicaba, involved 100 patients. They were divided into two groups: dietary counseling and gastroplasty. The clinic performs about 50 of such operations per month, mainly under the auspices of the SUS (Sistema Único de Saúde), Brazil’s national health service.
Questionnaires, oral examinations, saliva samples and cheek swabs were analyzed to determine dietary changes, weight loss, inflammatory markers, oral microbiota by sequencing and dental and periodontal health before the operation, as well as three and six months after the operation or start of the diet.
“The patients were asked to floss and brush their teeth three times a day, but even so their oral health deteriorated significantly. The number of caries rose, and periodontal status worsened in a short period in both groups, but particularly in the gastroplasty group”, said oral physiologist Paula Midori Castelo Ferrua, professor in the Department of Pharmaceutical Sciences at UNIFESP and last author of both articles about the studies.
Salivary markers showed impairment of acid buffering capacity, essential for maintaining pH and preventing demineralization of tooth enamel. Bacterial genome sequencing showed alterations of microbiota diversity, especially in the gastroplasty group, so that the proportion of microorganisms that cause periodontitis increased.
The diet of many patients was found to have improved, but profound dietary changes were believed to be the main cause of the deterioration in oral health, especially because more frequent daily meals were not accompanied by more frequent tooth cleaning, and more food was liquid or puréed in the first few months after surgery. “There’s less fiber in the diet and no chewing is required, so the food sticks to the enamel and biofilm forms on the tooth surface. Without chewing, less saliva is secreted and acid buffering capacity decreases”, Castelo said.
More than 300,000 bariatric surgeries were performed in Brazil between 2017 and 2022. The multidisciplinary teams responsible for these patients include physicians, physical therapists, nutritionists and psychologists. Dentists are not usually involved, although the drastic dietary changes before and after surgery pose risks to oral health.
The results of the study show that the assessment of the patient’s oral health before and after bariatric surgery is essential. The findings also suggest next steps for researchers in the field, which should be to determine the best preventive or therapeutic intervention to address oral health problems during the preoperative diet and postoperative recovery period, test proven methods such as fluoride application and reinforcing tooth brushing and flossing, and analyze financial viability and ease of implementation by SUS. “Specific oral health guidelines for people who seek treatment for morbid obesity will also be important in future”, Castelo said.
This article is based on a press release from the Fundação de Amparo à Pesquisa do Estado de São Paulo. We have linked the original publication here and in the text.
Image source: Natalia Blauth, unsplash
