ADHA Access August 2012 : Page 9

CRP. CRP can directly inhibit the bind-ing of leptin, causing leptin resistance. 6 As the resistance to leptin increases, metabolism is decreased and appetite is increased. When leptin, IL-6 and CRP are increased in an overweight individual, WKHV\VWHPLFLQÀDPPDWRU\UHVSRQVHLV higher, and more clinical attachment loss and periodontal disease result due WRWKHV\VWHPLFLQÀDPPDWRU\UHVSRQVH However, when a patient undergoes bariatric surgery, the adipose cells DUHGHFUHDVHGDQGWKHLQÀDPPDWRU\ response is decreased, systemically de-creasing the risk of diabetes and heart GLVHDVH$VWKHLQÀDPPDWRU\UHVSRQVH decreases, there is less clinical attach-ment loss and periodontal disease in the patient, which is a positive out-come for patients who have undergone bariatric surgery. Mental outlook also improves when a patient undergoes bariatric weight loss surgery. Patients who underwent bariatric surgery were more motivated to adopt health-enhancing behaviors such as diet improvement and physical exercise. A high-quality diet and an increased level of physical activity are associated with an improved periodontal health. There is a connection with increased or adequate exercise. A person who exercises may experience less SHULRGRQWDOGLVHDVHGXHWRWKHGHFUHDVHGLQÀDPPDWRU\UHVSRQVH Additionally, a person who has undergone bariatric surgery tends to have a better outlook on life. They are more likely to care about their appearance and therefore brush their teeth more often and have routine dental exams. In contrast, bariatric surgery can have a negative effect on the oral cavity. Although systemically, the cytokines in the blood serum KDYHFKDQJHGVRWKDWWKHLQÀDPPDWRU\SURFHVVLVORZHUHG&#0f;EDULDWULF surgery has direct effects on the oral cavity. These effects can include increased caries rate and tooth erosion. This is possibly due to the stomach being reduced to a capacity of between 15 and 50 mL, which requires patients to consume small frequent meals and sip liquids throughout the day. 7 If the patient consumes a diet high in carbohy-drates, and the frequency of exposure is high, then the chance of de-veloping caries is increased. Erosion can also be increased in patients who have undergone bariatric surgery because of the frequency of DFLGUHÀX[RUYRPLWLQJ&#0f;ZKLFKRFFXUVLQ&#1a;SHUFHQWRISDWLHQWV 4 Dental professionals can help prevent and treat the increased incidence of dental caries and erosion seen in patients who have had bariatric surgery. In addition, it is important to continue to evalu-ate their periodontal status. As previously stated, the incidence of periodontal disease in obese individuals may be higher because of WKHV\VWHPLFLQÀDPPDWRU\UHVSRQVH2QFHWKHSDWLHQWJHWVKHURU KLVZHLJKWXQGHUFRQWURO&#0f;WKHLQÀDPPDWRU\UHVSRQVHZLOOVWDUWWRGH -FUHDVH7KLVZLOOVLJQL¿FDQWO\LPSURYHWKHRXWFRPHRIWKHSHULRGRQWDO disease, in addition to conventional treatment. To attempt to decrease dental caries associated with the changes in diet and frequency of consumption, the patient needs to undergo nutritional counseling. Patients should be encouraged to include cariostatic food factors such as proteins, cheeses and grains in their diet. 7 $SSUR[LPDWHO\&#1a;SHUFHQWRISDWLHQWVZKRKDYHODSEDQGVXU -gery and a small percentage who have had gastric bypass surgery GHYHORSJDVWHURHVRSKDJHDOUHÀX[GLVHDVH&#0b;*(5'&#0c;&#0f;ZLWKRQH
WKLUG RIWKHVHSDWLHQWVGHYHORSLQJVHYHUHUHÀX[DQGIUHTXHQWYRPLWLQJ 4 3DWLHQWVZKRYRPLWIUHTXHQWO\EHFDXVHRI*(5'DUHPRUHOLNHO\WR develop dental caries and erosion. To combat the caries and erosion, ■ (IIHFWVRQWKH2UDO&DYLW\ ‡6\VWHPLFDOO\ ‡ /RZHUHGOHSWLQ&#0f;LQWHUOHXNLQ
DQG&
UHDFWLYHSURWHLQOHYHOV ‡ 'HFUHDVHGLQÀDPPDWRU\UHVSRQVH&#0f;ZKLFKPHDQVGHFUHDVH in clinical attachment loss ‡0HQWDO2XWORRN ‡ 'LHWLPSURYHPHQW ‡ ,QFUHDVHLQSK\VLFDOH[HUFLVH ‡$GRSWLRQRIEHWWHURUDOKHDOWKSUDFWLFHV ‡2UDOO\ ‡ ,QFUHDVHGHURVLRQGXHWRYRPLWLQJDQGJDVWULFUHÀX[ ‡ ,QFUHDVHLQFDULHVGXHWRIUHTXHQWPHDOV ■ Patient Treatment ‡(URVLRQ ‡ 5LQVHZLWKZDWHUDIWHUYRPLWLQJ&#0f;ZDLW
PLQXWHV WREUXVKDQGÀRVV ‡ 8VHRIVRGLXPÀXRULGHWRRWKSDVWHDQGÀXRULGH trays ‡'HQWDO&DULHV ‡ &DULRVWDWLFIRRGV ‡ 1XWULHQW
GHQVHIRRGV ‡ 6RGLXPÀXRULGHDQG[\OLWROSURGXFWV ‡3HULRGRQWDO'LVHDVH ‡ )RUSUHYLRXVLQFLGHQFHRISHULRGRQWDOGLVHDVH&#0f; conventional treatment is required. ‡ :LWKEDULDWULFVXUJHU\&#0f;ULVNRISHULRGRQWDOGLVHDVH is decreased. ‡+HDOWK\/LIHVW\OH ‡ 5HJXODUGHQWDOH[DPV ‡ ([HUFLVH ‡ +HDOWK\HDWLQJKDELWV VWULYH continued on page 11

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