Dental Health Deteriorates Before and After Weight Loss Surgery

People on a diet to prepare for weight loss surgery and patients who have undergone the procedure saw their oral health deteriorate as caries, gingivitis, and periodontitis have increased.

A study conducted by researchers at the Federal University of São Paulo (UNIFESP) in Brazil, the findings of which were published in the Journal of Oral Rehabilitation and Clinical Oral Investigations, emphasizes the importance of including a dentist in the assessment of patients who undergo weight loss surgery.

The study followed 100 patients with obesity divided into two groups — those receiving dietary counseling and those undergoing gastroplasty, a minimally invasive surgery in which a suturing device is inserted in the throat and down to the stomach to place sutures that make the stomach smaller.

Researchers analyzed questionnaires, oral examinations, saliva samples, and cheek swabs to determine dietary changes, weight loss, inflammatory markers, oral microbiota by sequencing, and dental and periodontal health before the surgery as well as three and six months after the procedure or start of the diet.

The patients were asked to floss and brush their teeth three times a day, but 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, a professor in the Department of Pharmaceutical Sciences at UNIFESP and last author of both articles.

The study found that the participants had impaired acid buffering capacity, essential for maintaining pH and preventing demineralization of tooth enamel. Moreover, the patients, especially in the gastroplasty group, had altered microbiota diversity, which led to an increased proportion of microorganisms that cause periodontitis.

Although the diet of many patients improved, scientists think that profound dietary changes are the main cause of the deterioration in oral health, especially because more frequent daily meals were not accompanied by more frequent tooth cleaning. Additionally, 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."

- Professor Paula Midori Castelo Ferrua

How can you improve your dental health?

The Centers for Disease Control and Prevention (CDC) recommends maintaining oral health by:

• Brushing twice a day with fluoride toothpaste.
• Visiting the dentist regularly.
• Drinking fluoridated water.
• Avoiding all tobacco products and limiting alcohol.
• Limiting sugary drinks and snacks.
• Working with your doctor to monitor your A1C levels if you have diabetes.
• Talking to your dentists about applying dental sealants.
• Flossing your teeth daily.
• Getting regular and emergency dental care while pregnant.

The authors say the findings underline the need for oral health guidelines for people with morbid obesity who seek weight loss surgery.