Stanje obzobnih tkiv ter odziv na parodontalno zdravljenje pri pacientih s prekomerno telesno težo, ki se zdravijo z bariatričnimi kirurškimi posegi

Čolak, Dejana (author), Gašperšič, Rok (mentor), Pintar, Tadeja (comentor)

Bariatrični kirurški poseg (BP) je danes najučinkovitejša metoda zdravljenja morbidne debelosti in z njo povezanih bolezni. Debelost je znani dejavnik tveganja za slabo ustno zdravje, hkrati pa je BP dejavnik tveganja za dodatno poslabšanje ustnega zdravja. Glavni cilj raziskave je bil določiti razširjenost parodontitisa pri kandidatih za BP in korelacijo med parodontalnim zdravjem in sistemskimi stanji, povezanimi z debelostjo. Prav tako smo želeli ugotoviti učinke predoperativne parodontalne terapije na pooperativno parodontalno in sistemsko zdravje. Bolniki z morbidno debelostjo, ki so kandidati za BP v Univerzitetnem kliničnem centru v Ljubljani, so bili podvrženi celovitemu parodontalnemu kliničnemu pregledu in ovrednoteni z debelostjo povezanimi komorbiditetami in serumskimi sistemskimi biomarkerji zdravja. V naši raziskavi so kandidati za BP ovrednoteni glede prisotnosti parodontitisa in njegove povezave s spremljajočimi boleznimi, povezanimi z debelostjo (n = 79), s presnovnimi zapleti sprožena zamaščenost jeter (MAFLD, n = 30), diagnosticirano s patohistološko analizo in kakovostjo življenja, povezano z ustnim zdravjem (KŽPZUZ, n = 90). Pri 30 kandidatih za BP s parodontitisom in 20 kandidatih z gingivitisom smo izvedli parodontalno terapijo v randomiziranih kontroliranih razskavah, da bi ocenili učinkovitost nekirurške parodontalne terapije na parodontalno in sistemsko zdravje 6 mesecev po BP. Rezultati naše raziskave kažejo, da je imela več kot polovica kandidatov za BP diagnosticiran parodontitis (65%), drugi pa so kazali klinične znake gingivitisa. Parodontitis je bil povezan z večjo prevalenco arterijske hipertenzije (razmerje obetov (RO) = 3.98, p = 0.021) in višjimi ravnmi C-reaktivnega proteina v serumu (p = 0.031) pri kandidatih za BP, medtem ko sta imeli obe skupini bolnikov s parodontitisom in gingivitisom visoko prevalenco MAFLD (43 %, p = 0.41). KŽPZUZ je bil znatno poslabšan pri kandidatih za BP s parodontitisom (Spearmanov koeficient korelacije (Rho) = 0.49, p < 0.001). Parodontalna terapija pred BP lahko izboljša klinične parodontalne parametre pri bolnikih s parodontitisom (p < 0.05) in gingivitisom (p > 0.05) 6 mesecev po BP. Vendar ostajajo učinki parodontalne terapije na sistemske zdravstvene parametre bolnikov z BP 6 mesecev po operaciji vprašljivi. Splošne ugotovitve naše študije močno podpirajo zobozdravstvene preglede pred samim BP kandidatov za BP in nekirurško parodontalno terapijo kot sredstvo za preprečevanje pojava/napredovanja parodontitisa v prihodnosti. Parodontitis in parodontalna terapija lahko vplivata na sistemsko zdravje morbidno debelih in bolnikov z BP. Vendar je za popolno razumevanje teh povezav potrebnih več raziskav.

• Language: Slovenian
• Keywords: parodontitis, parodontalno zdravje, gingivitis, oralno zdravje, parodontalno zdravljenje, nekirurška parodontalno zdravljenje, bariatrični kirurški poseg, bolniki z morbidno debelostjo, bolezni povezane z debelostjo
• Work type: Doctoral dissertation
• Organization: MF - Faculty of Medicine
• Year: 2023
• PID: 20.500.12556/RUL-146140
• Publication date in RUL: 21.05.2023

Secondary language

• Language: English
• Title: Periodontal health and response to periodontal treatment in obese patients treated with bariatric surgical procedures

Abstract

The most effective long-term treatment for obesity and obesity-related comorbidities is bariatric surgery (BS). Obesity is a recognized risk factor for poor oral health, and BS may also contribute to this risk as is shown in our systematic review. The main goal of the research was to investigate periodontitis prevalence in candidates for BS and the correlation between periodontal health and obesity-related systemic conditions. We also aimed to determine the effects of preoperative periodontal therapy on post-surgery periodontal and systemic health. Patients with morbid obesity who are candidates for BS at the University Medical Center in Ljubljana, Slovenia, underwent a comprehensive periodontal clinical examination and were evaluated for obesity-related comorbidities and serum systemic health biomarkers. In our research, BS candidates were evaluated for the presence of periodontitis and its association with obesity-related comorbidities (number of patients (n) = 79), metabolic-associated fatty liver disease (MAFLD) diagnosed with pathohistological analysis (n = 30) and quality of life related to oral health (OHRQoL, n = 90). In 30 BS candidates with periodontitis and 20 candidates with gingivitis, we performed periodontal therapy in a RCT to assess the efficacy of non-surgical periodontal therapy on periodontal and systemic health 6 months after BS. Results of our research show that more than half of the BS candidates were diagnosed with periodontitis (65 %), while others displayed clinical signs of gingivitis. Periodontitis in BS candidates was associated with a higher prevalence of arterial hypertension (OR = 3.98, p = 0.021) and higher serum C-reactive protein levels (p = 0.031), while both patients with periodontitis and gingivitis had a high prevalence of MAFLD (43 %, p = 0.41). OHRQoL was significantly diminished in BS candidates with periodontitis (Rho = 0.49, p < 0.001). Pre-BS periodontal therapy can improve clinical periodontal parameters 6 months after BS in both periodontitis (p < 0.05) and gingivitis patients (p > 0.05). However, the effects of periodontal therapy on the systemic health parameters of BS patients 6-months after the surgery remain questionable. The overall findings of our study strongly support pre-BS dental examinations of BS candidates and non-surgical periodontal therapy as a means to prevent the onset/progression of periodontitis in the future. Periodontitis and periodontal therapy might have an influence on systemic health in morbidly obese and BS patients. However, more research is needed to fully understand these connections.

• Keywords: periodontitis, periodontal health, gingivitis, oral health, periodontal therapy, non-surgical periodontal therapy, bariatric surgery, patients with morbid obesity, obesity-related diseases