Current Oral Health Reports

, Volume 4, Issue 2, pp 51–58 | Cite as

Epidemiological Evidences for the Association of Obesity and Metabolic Disorders with Oral Diseases

  • Michiko Furuta
  • Yoshihisa YamashitaEmail author
Oral Disease and Nutrition (F Nishimura, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Oral Disease and Nutrition


Purpose of Review

Obesity is the underlying cause of many chronic diseases and affects overall health. Obesity and obesity-related metabolic disorders, particularly, metabolic syndrome and diabetes, have been recognized to be associated with oral diseases. This review describes the recent evidence from epidemiological studies investigating the effect of obesity and metabolic disorders on oral diseases, including dental caries and periodontal disease in adults.

Recent Findings

Longitudinal studies indicate the direction of association that obesity and diabetes affect periodontal disease. Interpretation of causal relationships between metabolic syndrome and periodontal disease remains limited because of the small number of prospective evidence. Longitudinal studies investigating dental caries have not been performed.


Further exploration of the effect of metabolic syndrome on periodontal disease, and that of obesity and metabolic disorders on dental caries in longitudinal studies, is warranted.


Dental caries Diabetes Metabolic syndrome Obesity Periodontal disease 



This study was supported by the Grants-in-Aid for Scientific Research (16H05850 and 26861832) from the Ministry of Education, Science, Sports, and Culture of Japan, Tokyo, Japan.

Compliance with Ethical Standards

Conflict of Interest

M Furuta and Y Yamashita declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640–5. doi: 10.1161/circulationaha.109.192644.CrossRefPubMedGoogle Scholar
  2. 2.
    Mensah GA, Mokdad AH, Ford E, Narayan KM, Giles WH, Vinicor F, et al. Obesity, metabolic syndrome, and type 2 diabetes: emerging epidemics and their cardiovascular implications. Cardiol Clin. 2004;22(4):485–504. doi: 10.1016/j.ccl.2004.06.005.CrossRefPubMedGoogle Scholar
  3. 3.
    Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care. 1994;17(9):961–9.CrossRefPubMedGoogle Scholar
  4. 4.
    World Health Organization. Fact sheet; obesity and overweight. 2016. Accessed December 2 2016.
  5. 5.
    International Diabetes Federation. IDF worldwide definition of the metabolic syndrome. Accessed December 2 2016.
  6. 6.
    World Health Organization. Fact sheet: diabetes. Accessed December 2 2016.
  7. 7.
    Kidambi S, Patel SB. Diabetes mellitus: considerations for dentistry. J Am Dent Assoc. 2008;139 Suppl:8s-18s.Google Scholar
  8. 8.
    World Health Organization. Oral health. 2012. Accessed December 2 2016.
  9. 9.
    Solomon CG, Manson JE. Obesity and mortality: a review of the epidemiologic data. Am J Clin Nutr. 1997;66(4 Suppl):1044s–50s.PubMedGoogle Scholar
  10. 10.
    Al-Zahrani MS, Bissada NF, Borawskit EA. Obesity and periodontal disease in young, middle-aged, and older adults. J Periodontol. 2003;74(5):610–5. doi: 10.1902/jop.2003.74.5.610.CrossRefPubMedGoogle Scholar
  11. 11.
    Wood N, Johnson RB, Streckfus CF. Comparison of body composition and periodontal disease using nutritional assessment techniques: Third National Health and Nutrition Examination Survey (NHANES III). J Clin Periodontol. 2003;30(4):321–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Genco RJ, Grossi SG, Ho A, Nishimura F, Murayama Y. A proposed model linking inflammation to obesity, diabetes, and periodontal infections. J Periodontol. 2005;76(11 Suppl):2075–84. doi: 10.1902/jop.2005.76.11-S.2075.CrossRefPubMedGoogle Scholar
  13. 13.
    Shimazaki Y, Egami Y, Matsubara T, Koike G, Akifusa S, Jingu S, et al. Relationship between obesity and physical fitness and periodontitis. J Periodontol. 2010;81(8):1124–31. doi: 10.1902/jop.2010.100017.CrossRefPubMedGoogle Scholar
  14. 14.
    Saito T, Shimazaki Y, Kiyohara Y, Kato I, Kubo M, Iida M, et al. Relationship between obesity, glucose tolerance, and periodontal disease in Japanese women: the Hisayama study. J Periodontal Res. 2005;40(4):346–53. doi: 10.1111/j.1600-0765.2005.00813.x.CrossRefPubMedGoogle Scholar
  15. 15.
    Ylöstalo P, Suominen-Taipale L, Reunanen A, Knuuttila M. Association between body weight and periodontal infection. J Clin Periodontol. 2008;35(4):297–304. doi: 10.1111/j.1600-051X.2008.01203.x.CrossRefPubMedGoogle Scholar
  16. 16.
    Nishida N, Tanaka M, Hayashi N, Nagata H, Takeshita T, Nakayama K, et al. Determination of smoking and obesity as periodontitis risks using the classification and regression tree method. J Periodontol. 2005;76(6):923–8. doi: 10.1902/jop.2005.76.6.923.CrossRefPubMedGoogle Scholar
  17. 17.
    Kongstad J, Hvidtfeldt UA, Gronbaek M, Stoltze K, Holmstrup P. The relationship between body mass index and periodontitis in the Copenhagen City Heart Study. J Periodontol. 2009;80(8):1246–53. doi: 10.1902/jop.2009.080559.CrossRefPubMedGoogle Scholar
  18. 18.
    Ekuni D, Yamamoto T, Koyama R, Tsuneishi M, Naito K, Tobe K. Relationship between body mass index and periodontitis in young Japanese adults. J Periodontal Res. 2008;43(4):417–21.CrossRefPubMedGoogle Scholar
  19. 19.
    Benguigui C, Bongard V, Ruidavets JB, Sixou M, Chamontin B, Ferrieres J, et al. Evaluation of oral health related to body mass index. Oral Dis. 2012;18(8):748–55. doi: 10.1111/j.1601-0825.2012.01940.x.CrossRefPubMedGoogle Scholar
  20. 20.
    Kim YS, Kim JH. Body mass index and oral health status in Korean adults: the Fifth Korea National Health and Nutrition Examination Survey. Int J Dent Hyg. 2016; doi: 10.1111/idh.12207.Google Scholar
  21. 21.
    Yamashita JM, Moura-Grec PG, Freitas AR, Sales-Peres A, Groppo FC, Ceneviva R, et al. Assessment of oral conditions and quality of life in morbid obese and normal weight individuals: a cross-sectional study. PLoS One. 2015;10(7):e0129687. doi: 10.1371/journal.pone.0129687.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Suvan JE, Petrie A, Nibali L, Darbar U, Rakmanee T, Donos N, et al. Association between overweight/obesity and increased risk of periodontitis. J Clin Periodontol. 2015; doi: 10.1111/jcpe.12421.Google Scholar
  23. 23.
    Gorman A, Kaye EK, Apovian C, Fung TT, Nunn M, Garcia RI. Overweight and obesity predict time to periodontal disease progression in men. J Clin Periodontol. 2012;39(2):107–14. doi: 10.1111/j.1600-051X.2011.01824.x.CrossRefPubMedGoogle Scholar
  24. 24.
    Gorman A, Kaye EK, Nunn M, Garcia RI. Changes in body weight and adiposity predict periodontitis progression in men. J Dent Res. 2012;91(10):921–6. doi: 10.1177/0022034512457372.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Jimenez M, Hu FB, Marino M, Li Y, Joshipura KJ. Prospective associations between measures of adiposity and periodontal disease. Obesity (Silver Spring, Md). 2012;20(8):1718–25. doi: 10.1038/oby.2011.291.CrossRefGoogle Scholar
  26. 26.
    Linden G, Patterson C, Evans A, Kee F. Obesity and periodontitis in 60–70-year-old men. J Clin Periodontol. 2007;34(6):461–6. doi: 10.1111/j.1600-051X.2007.01075.x.CrossRefPubMedGoogle Scholar
  27. 27.
    Morita I, Okamoto Y, Yoshii S, Nakagaki H, Mizuno K, Sheiham A, et al. Five-year incidence of periodontal disease is related to body mass index. J Dent Res. 2011;90(2):199–202. doi: 10.1177/0022034510382548.CrossRefPubMedGoogle Scholar
  28. 28.
    Ekuni D, Mizutani S, Kojima A, Tomofuji T, Irie K, Azuma T, et al. Relationship between increases in BMI and changes in periodontal status: a prospective cohort study. J Clin Periodontol. 2014;41(8):772–8. doi: 10.1111/jcpe.12273.CrossRefPubMedGoogle Scholar
  29. 29.
    Nascimento GG, Peres KG, Mittinty MN, Mejia GC, Silva DA, Gonzalez-Chica D, et al. Obesity and periodontal outcomes: a population-based cohort study in Brazil. J Periodontol. 2016:1–17. doi: 10.1902/jop.2016.160361.
  30. 30.
    Gaio EJ, Haas AN, Rosing CK, Oppermann RV, Albandar JM, Susin C. Effect of obesity on periodontal attachment loss progression: a 5-year population-based prospective study. J Clin Periodontol. 2016;43(7):557–65. doi: 10.1111/jcpe.12544.CrossRefPubMedGoogle Scholar
  31. 31.
    •• Nascimento GG, Leite FR, Do LG, Peres KG, Correa MB, Demarco FF, et al. Is weight gain associated with the incidence of periodontitis? A systematic review and meta-analysis. J Clin Periodontol. 2015;42(6):495–505. doi: 10.1111/jcpe.12417. This article reviews the studies investigating the effect of weight gain on periodontal disease CrossRefPubMedGoogle Scholar
  32. 32.
    Falagas ME, Kompoti M. Obesity and infection. Lancet Infect Dis. 2006;6(7):438–46. doi: 10.1016/s1473-3099(06)70523-0.CrossRefPubMedGoogle Scholar
  33. 33.
    Isakson P, Hammarstedt A, Gustafson B, Smith U. Impaired preadipocyte differentiation in human abdominal obesity: role of Wnt, tumor necrosis factor-alpha, and inflammation. Diabetes. 2009;58(7):1550–7. doi: 10.2337/db08-1770.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Van Kaer L, Parekh VV, Wu L. Invariant natural killer T cells as sensors and managers of inflammation. Trends Immunol. 2013;34(2):50–8. doi: 10.1016/ Scholar
  35. 35.
    Hegde V, Dhurandhar NV. Microbes and obesity—interrelationship between infection, adipose tissue and the immune system. Clin Microbiol Infect : Official Publ Eur Soc Clin Microbiol Infect Dis. 2013;19(4):314–20. doi: 10.1111/1469-0691.12157.CrossRefGoogle Scholar
  36. 36.
    Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15(7):539–53. doi: 10.1002/(sici)1096-9136(199807)15:7>539::aid-dia668>;2-s.
  37. 37.
    Balkau B, Charles MA. Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Diabet Med. 1999;16(5):442–3.CrossRefPubMedGoogle Scholar
  38. 38.
    Einhorn D, Reaven GM, Cobin RH, Ford E, Ganda OP, Handelsman Y, et al. American College of Endocrinology position statement on the insulin resistance syndrome. Endocr Pract : Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2003;9(3):237–52.Google Scholar
  39. 39.
    Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 2001. 285(19):2486–97.Google Scholar
  40. 40.
    Alberti KG, Zimmet P, Shaw J. Metabolic syndrome—a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med. 2006;23(5):469–80. doi: 10.1111/j.1464-5491.2006.01858.x.CrossRefPubMedGoogle Scholar
  41. 41.
    Grundy SM, Brewer Jr HB, Cleeman JI, Smith Jr SC, Lenfant C. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation. 2004;109(3):433–8. doi: 10.1161/01.cir.0000111245.75752.c6.CrossRefPubMedGoogle Scholar
  42. 42.
    Timonen P, Niskanen M, Suominen-Taipale L, Jula A, Knuuttila M, Ylostalo P. Metabolic syndrome, periodontal infection, and dental caries. J Dent Res. 2010;89(10):1068–73. doi: 10.1177/0022034510376542.CrossRefPubMedGoogle Scholar
  43. 43.
    Shimazaki Y, Saito T, Yonemoto K, Kiyohara Y, Iida M, Yamashita Y. Relationship of metabolic syndrome to periodontal disease in Japanese women: the Hisayama Study. J Dent Res. 2007;86(3):271–5.CrossRefPubMedGoogle Scholar
  44. 44.
    D’Aiuto F, Sabbah W, Netuveli G, Donos N, Hingorani AD, Deanfield J, et al. Association of the metabolic syndrome with severe periodontitis in a large U.S. population-based survey. J Clin Endocrinol Metab. 2008;93(10):3989–94. doi: 10.1210/jc.2007-2522.CrossRefPubMedGoogle Scholar
  45. 45.
    Andriankaja OM, Sreenivasa S, Dunford R, DeNardin E. Association between metabolic syndrome and periodontal disease. Aust Dent J. 2010;55(3):252–9. doi: 10.1111/j.1834-7819.2010.01231.x.CrossRefPubMedGoogle Scholar
  46. 46.
    Fukui N, Shimazaki Y, Shinagawa T, Yamashita Y. Periodontal status and metabolic syndrome in middle-aged Japanese. J Periodontol. 2012; doi: 10.1902/jop.2012.110605.PubMedGoogle Scholar
  47. 47.
    Tu YK, D’Aiuto F, Lin HJ, Chen YW, Chien KL. Relationship between metabolic syndrome and diagnoses of periodontal diseases among participants in a large Taiwanese cohort. J Clin Periodontol. 2013;40(11):994–1000. doi: 10.1111/jcpe.12157.CrossRefPubMedGoogle Scholar
  48. 48.
    LaMonte MJ, Williams AM, Genco RJ, Andrews CA, Hovey KM, Millen AE, et al. Association between metabolic syndrome and periodontal disease measures in postmenopausal women: the Buffalo OsteoPerio study. J Periodontol. 2014;85(11):1489–501. doi: 10.1902/jop.2014.140185.CrossRefPubMedGoogle Scholar
  49. 49.
    • Iwasaki M, Sato M, Minagawa K, Manz MC, Yoshihara A, Miyazaki H. Longitudinal relationship between metabolic syndrome and periodontal disease among Japanese adults aged ≥70 years: the Niigata Study. J Periodontol. 2015;86(4):491–8. doi: 10.1902/jop.2015.140398. This article provides evidence for longitudinal association between MetS and periodontal disease.CrossRefPubMedGoogle Scholar
  50. 50.
    Kushiyama M, Shimazaki Y, Yamashita Y. Relationship between metabolic syndrome and periodontal disease in Japanese adults. J Periodontol. 2009;80(10):1610–5. doi: 10.1902/jop.2009.090218.CrossRefPubMedGoogle Scholar
  51. 51.
    Kwon YE, Ha JE, Paik DI, Jin BH, Bae KH. The relationship between periodontitis and metabolic syndrome among a Korean nationally representative sample of adults. J Clin Periodontol. 2011;38(9):781–6. doi: 10.1111/j.1600-051X.2011.01756.x.CrossRefPubMedGoogle Scholar
  52. 52.
    Benguigui C, Bongard V, Ruidavets JB, Chamontin B, Sixou M, Ferrieres J, et al. Metabolic syndrome, insulin resistance, and periodontitis: a cross-sectional study in a middle-aged French population. J Clin Periodontol. 2010;37(7):601–8. doi: 10.1111/j.1600-051X.2010.01571.x.CrossRefPubMedGoogle Scholar
  53. 53.
    Han DH, Lim SY, Sun BC, Paek D, Kim HD. The association of metabolic syndrome with periodontal disease is confounded by age and smoking in a Korean population: the Shiwha-Banwol Environmental Health Study. J Clin Periodontol. 2010;37(7):609–16. doi: 10.1111/j.1600-051X.2010.01580.x.CrossRefPubMedGoogle Scholar
  54. 54.
    Furuta M, Shimazaki Y, Takeshita T, Shibata Y, Akifusa S, Eshima N, et al. Gender differences in the association between metabolic syndrome and periodontal disease: the Hisayama Study. J Clin Periodontol. 2013;40(8):743–52. doi: 10.1111/jcpe.12119. CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Kikui M, Kokubo Y, Ono T, Kida M, Kosaka T, Yamamoto M, et al. Relationship between metabolic syndrome components and periodontal disease in a Japanese general population: the Suita Study. J Atheroscler Thromb. 2016; doi: 10.5551/jat.33761.PubMedGoogle Scholar
  56. 56.
    Morita T, Ogawa Y, Takada K, Nishinoue N, Sasaki Y, Motohashi M, et al. Association between periodontal disease and metabolic syndrome. J Public Health Dent. 2009;69(4):248–53. doi: 10.1111/j.1752-7325.2009.00130.x.CrossRefPubMedGoogle Scholar
  57. 57.
    Minagawa K, Iwasaki M, Ogawa H, Yoshihara A, Miyazaki H. Relationship between metabolic syndrome and periodontitis in 80-year-old Japanese subjects. J Periodontal Res. 2015;50(2):173–9. doi: 10.1111/jre.12190.CrossRefPubMedGoogle Scholar
  58. 58.
    Lee KS, Kim EK, Kim JW, Choi YH, Mechant AT, Song KB, et al. The relationship between metabolic conditions and prevalence of periodontal disease in rural Korean elderly. Arch Gerontol Geriatr. 2014;58(1):125–9. doi: 10.1016/j.archger.2013.08.011.CrossRefPubMedGoogle Scholar
  59. 59.
    Hotamisligil GS. Inflammation and metabolic disorders. Nature. 2006;444(7121):860–7. doi: 10.1038/nature05485.CrossRefPubMedGoogle Scholar
  60. 60.
    Ishikawa S, Kayaba K, Gotoh T, Nakamura Y, Kajii E. Metabolic syndrome and C-reactive protein in the general population: JMS Cohort Study. Circ J. 2007;71(1):26–31.CrossRefPubMedGoogle Scholar
  61. 61.
    Fredriksson MI, Figueredo CM, Gustafsson A, Bergstrom KG, Asman BE. Effect of periodontitis and smoking on blood leukocytes and acute-phase proteins. J Periodontol. 1999;70(11):1355–60. doi: 10.1902/jop.1999.70.11.1355.CrossRefPubMedGoogle Scholar
  62. 62.
    Noack B, Genco RJ, Trevisan M, Grossi S, Zambon JJ, De Nardin E. Periodontal infections contribute to elevated systemic C-reactive protein level. J Periodontol. 2001;72(9):1221–7. doi: 10.1902/jop.2000.72.9.1221.CrossRefPubMedGoogle Scholar
  63. 63.
    Chavarry NG, Vettore MV, Sansone C, Sheiham A. The relationship between diabetes mellitus and destructive periodontal disease: a meta-analysis. Oral Health Prev Dent. 2009;7(2):107–27.PubMedGoogle Scholar
  64. 64.
    Lim SG, Han K, Kim HA, Pyo SW, Cho YS, Kim KS, et al. Association between insulin resistance and periodontitis in Korean adults. J Clin Periodontol. 2014;41(2):121–30. doi: 10.1111/jcpe.12196.CrossRefPubMedGoogle Scholar
  65. 65.
    Levine RS. Obesity, diabetes and periodontitis—a triangular relationship? Br Dent J. 2013;215(1):35–9. doi: 10.1038/sj.bdj.2013.627.CrossRefPubMedGoogle Scholar
  66. 66.
    Taylor GW. Bidirectional interrelationships between diabetes and periodontal diseases: an epidemiologic perspective. Ann Periodontol. 2001;6(1):99–112. doi: 10.1902/annals.2001.6.1.99.CrossRefPubMedGoogle Scholar
  67. 67.
    Novaes Jr AB, Gutierrez FG, Novaes AB. Periodontal disease progression in type II non-insulin-dependent diabetes mellitus patients (NIDDM). Part I—probing pocket depth and clinical attachment. Braz Dent J. 1996;7(2):65–73.PubMedGoogle Scholar
  68. 68.
    Taylor GW, Burt BA, Becker MP, Genco RJ, Shlossman M, Knowler WC, et al. Non-insulin dependent diabetes mellitus and alveolar bone loss progression over 2 years. J Periodontol. 1998;69(1):76–83. doi: 10.1902/jop.1998.69.1.76.CrossRefPubMedGoogle Scholar
  69. 69.
    Cullinan MP, Ford PJ, Seymour GJ. Periodontal disease and systemic health: current status. Aust Dent J. 2009;54(Suppl 1):S62–9. doi: 10.1111/j.1834-7819.2009.01144.x.CrossRefPubMedGoogle Scholar
  70. 70.
    Ostberg AL, Bengtsson C, Lissner L, Hakeberg M. Oral health and obesity indicators. BMC Oral Health. 2012;12:50. doi: 10.1186/1472-6831-12-50.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Cao X, Wang D, Zhou J, Yuan H, Chen Z. Relationship between dental caries and metabolic syndrome among 13 998 middle-aged urban Chinese. J Diabetes. 2016; doi: 10.1111/1753-0407.12424.Google Scholar
  72. 72.
    Ojima M, Amano A, Kurata S. Relationship between decayed teeth and metabolic syndrome: data from 4716 middle-aged male Japanese employees. J Epidemiol. 2015;25(3):204–11. doi: 10.2188/jea.JE20140132.CrossRefPubMedGoogle Scholar
  73. 73.
    Jawed M, Shahid SM, Qader SA, Azhar A. Dental caries in diabetes mellitus: role of salivary flow rate and minerals. J Diabetes Complicat. 2011;25(3):183–6. doi: 10.1016/j.jdiacomp.2010.07.001.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and DevelopmentKyushu University Faculty of Dental ScienceFukuokaJapan

Personalised recommendations