Obesity and periodontal disease: A narrative review on current evidence and putative molecular links

Background: Obesity represents one of the main health problems worldwide and is considered a risk factor for several diseases, including periodontitis, which is a microbially-associated inflammatory disease affecting the tooth-supporting structures. Objective: The aim of this review was to report the current direct and indirect evidence concerning the possible association between obesity and periodontitis and their putative molecular links. Methods: A literature search was conducted between January 1999 and September 2019, in PubMed/MEDLINE and Science Direct databases, using pertinent keyword combined by Boolean operators. Through a multi-step screening process (literature search; articles title and abstract evaluation and full-text reading), studies fitting inclusion/exclusion criteria were considered for the review. Results: 35 studies were included in the present review (17 observational studies; 7 systematic reviews; 11 systematic reviews with meta-analysis), focusing on the direct and indirect evidence of the possible association between obesity and periodontitis and their potential etiopathogenic molecular links Conclusion: Although the majority of the studies reported a positive association between obesity and periodontitis, the heterogeneity of the classification criteria and of the clinical parameters employed in the studies for both obesity and periodontitis evaluation, complicated the comparison of the results, thus considered inconclusive. Although several putative molecular pathogenic links between obesity and periodontitis have been highlighted, further studies, with longer follow-ups and with homogeneous clinical criteria, are needed to better understand the putative relation between obesity and periodontal disease.