Background: Obesity has reached epidemic patterns and constitutes a serious public health problem due to comorbidities and the impact on life quality of affected individuals. Bariatric surgery appears as one of the most recommended treatments; however much has been known about the effects of this intervention on the functional performance of the organism as a whole. Objective: To characterize the oral health of adults submitted to bariatric surgery, before and after the intervention, with emphasis on the performance of masticatory function. Methods: A prospective observational cohort study conducted in a public reference service to the treatment of obesity in the city of Recife, State of Pernambuco. The data were obtained during the first half of 2011, through interview, intraoral physical examination and evaluation of masticatory function. Statistical treatment adopted was a CI of 95% and the chi-square test. The collection was conducted in three stages, with initial assessment in the preoperative and follow-up at 60 and 180 days. Results: The sample consisted of 20 volunteers, aged between 23 and 58 years and mean BMI of 43.2 ± 2.8. When compared the pre-operative to the control periods, there were significant differences for variables with decreased tendency towards spontaneous gingival bleeding and increased tooth hypersensitivity and tooth mobility ( p < 0.05). Regarding the masticatory function, we found significant differences for most of the variables investigated, except in the coordination of movements and breathing during this function. Conclusion: The performance of masticatory function shows differences in pre- and postoperative periods for bariatric surgery.
The World Health Organization (WHO) defines obesity as a chronic, non-transferable disease, characterized by excessive accumulation of adipose tissue around the body that often causes damage to health [
Gastrointestinal surgery for obesity, also called Bariatric Surgery (BS) is an option for people with morbid obesity and who cannot lose weight by traditional methods or suffer from health problems related to obesity, since its moderate condition [
In this context, the feeding behavior and nutrition of the patient undergoing this type of intervention have been associated with masticatory ability. From the surgical intervention, individuals who previously tended to eat faster [
However few studies address the teeth health conditions and supporting structures of patients submitted to bariatric surgery for this purpose [
Considering what was mentioned above, the present study aims at characterizing the oral health of adults submitted to bariatric surgery, before and after the intervention, with emphasis on the improvement in the performance of masticatory function.
This was an observational, prospective cohort study with descriptive analytical data analysis and, considering a confidence interval (CI) of 95%. The study was conducted at a public reference service for treatment of obesity in Recife, northeastern Brazil, where the sample represented 66.7% of patients submitted to bariatric surgery.
The inclusion criteria were: patients over 18 years of age, indicated for surgical treatment for morbid obesity, over a period of up to thirty days before the surgery and that proposed to control after 60 and 180 days of the initial assessment. For undergoing the remaining stages of the study, from the first examination, the volunteer had to meet the hospital discharge with normal feeding authorized (except in quantity).
Exclusion criteria included the record or report of mood disorders (dysthymic severe) or mental disorders, patients with neuromotor disorders or other systemic disorders, congenital or genetic with repercussions on the masticatory efficiency.
Data collection occurred between April and June of 2011 (1st and 2nd phases: initial assessment and control at 60 days) and in October and November 2011 (3rd phase: corresponding to the control at 180 days) by the signing of a Consent Letter (head of department) and the Consent Statement by the research participants. Academic students from the courses of Dentistry and Speech Therapy have participated to study, as well as one dentist and one speech pathologist previously calibrated.
Face to face interview with intraoral physical examination and evaluation of masticatory function (with filming, auscultation and palpation) were the sampling tool, applied in the normal referral service under artificial light, with volunteers sit in room granted for this purpose. Apple and bread were used to analyze the masticatory performance being recorded the information on a form specific for the study, with adaptations of the MBGR myofunctional evaluation protocol [
The statistical analysis was performed using SPSS 18. Continuous variables were presented as mean ± standard deviation and chi-square test and the categorical variables in the form of relative frequency.
No conflict of interest, the study was approved by the Research Ethics Committee (REC) of the Federal University of Pernambuco, UFPE, under the protocol number 259/09 and started after signing the Letter of Consent by the responsible regarding the investigated service and signing the informed consent by the study volunteers.
ResultsThis sample consisted of 20 volunteers, aged between 23 and 58 years, with average age of 39 years and standard deviation 3.6. Volunteers had an average family income under U$600.
The socio-demographic characteristics of the patients involving in this study were summarized in
These adults have a mean number of permanent teeth remaining of 23.2. Overlooking the mean DMFT, we obtained: 9.1, 9.1 and 9.9 and the respective standard deviations for the initial examination and the controls with 60 and 180 days: 1.3, 1.3 and 1.4, with differences only for the missing or extracted components. Concerning to the malocclusions, four patients had posterior crossbite and two patients with deep overbite, all female.
Variables | N (%) |
---|---|
Volunteers Female Male | 20 (100) 17 (85) 3 (15) |
Level of education Completed secondary education Incomplete primary education Complete higher education at university | 10 (50) 8 (40) 2 (10) |
Degree of obesity III [Body Mass Index ≥ 40 Kg/m2] II [Body Mass Index 35 to 39.9 Kg/m2] | 13 (65) 7 (35) |
Oral characteristics | Stage of the study (evaluation) | ||
---|---|---|---|
Preoperative N (%) | 60 days N (%) | 180 days N (%) | |
Gingival bleeding | 13 (65%) | 12 (60%) | 7 (35%)* |
Halitosis | 14 (70%) | 14 (70%) | 13 (65%) |
Tooth mobility | 6 (30%) | 7 (35%) | 11 (55%)* |
Malocclusion | 6 (30%) | 6 (30%) | 6 (30%) |
Dentin hypersensitivity | 5 (25%) | 5 (25%) | 9 (45%)* |
CI of 95% and the chi-square test *p < 0.05.
Variables | Preoperative N (%) | After bariatric surgery | |
---|---|---|---|
60 days | 180 days | ||
Preferred food consistency Solid Paste Liquid | 12 (60%) 4 (20%) 4 (20%) | 4 (20%) 6 (30%) 10 (50%) | 6 (30%)* 6 (30%)* 8 (40%)* |
Masticatory preference side Both Right Left | 7 (35%) 4 (20%) 9 (45%) | 12 (60%) 3 (15%) 5 (25%) | 10 (50%)* 1 (5%)* 9 (45%) |
Presence of chocking Yes No | 7 (35%) 13 (65%) | 4 (20%) 16 (80%) | 4 (20%)* 16 (80%) |
Chewing with mouth open Yes No | 7 (35%) 13 (65%) | 5 (25%) 15 (75%) | 5 (25%) 15 (75%) |
Chewing speed Slow Regular/Normal Fast | 4 (20%) 6 (30%) 10 (50%) | 10 (50%) 9 (45%) 1 (5%) | 8 (40%)* 8 (40%) 4 (20%)* |
Pain when chewing Yes No | 4 (20%) 16 (80%) | 4 (20%) 16 (80%) | 6 (30%) 14 (70%) |
Difficult to open or close the mouth Yes No | 5 (25%) 15 (75%) | 5 (25%) 15 (75%) | 5 (25%) 15 (75%) |
Coordination of movements Yes No | 10 (50%) 10 (50%) | 10 (50%) 10 (50%) | 8 (40%) 12 (60%) |
Breathing during mastication Yes No | 8 (40%) 12 (60%) | 4 (20%) 16 (80%) | 5 (25%)* 15 (75%) |
CI of 95% and the chi-square test *p < 0.05.
According to the chi-square test, there was significant difference (p < 0.05) between baseline and postoperative period for most of variables, except: chewing with mouth open, pain when chewing, difficult to open or close the mouth and coordination of movements.
The evaluated individuals were referred to a public health center for treatment in dentistry and speech therapy, according to the observed needs.
The present study shows the side effects of bariatric surgery in the oral health conditions and masticatory performance in patients with morbid obesity. Women (85%) represented the group that most undergoes this type of treatment, fact based on the demand for improvements in life quality and aesthetic reasons, imposed by society [
The current scenario of obesity as a public health problem worldwide has encouraged surgical alternatives for individuals with difficulties in adjusting the most common treatment programs. In this context, despite the high rates of bariatric surgery, studies on the implications of this intervention are scarce, particularly in the functional performance of the organism. It is known that the parameters for a better life quality of obese individuals un-
dergoing this type of intervention are directly related to the prevention and treatment of possible side effects [
According to the study of Heling et al. [
Thus, there was increased DMFT after surgery (9.9 mean value for control of 180 days), a characteristic also found in surveys of Hague and Baechle [
Regarding the evaluation of the variable spontaneous gingival bleeding, there was reduction in this index, considering the fact that after the CB there is reduction in the levels of C-reactive protein by decreased BMI and consequent reduction of adipose tissue. The adipose tissue, acting as a reservoir of inflammatory mediators, leads to increased probability of the host inflammatory response in periodontal disease. Also, one can explain these data by the reduction of medication use for co-morbidities [
The increased tooth mobility can be explained by the vitamin D deficiency observed in the postoperative CB, which usually leads to development of bone metabolic diseases such as osteoporosis. Osteoporosis influences the bone loss, leading to tooth loss [
With reference to the variables dentin hypersensitivity, malocclusion and halitosis among obese individuals, little is established in comparative terms by the lack of studies more targeted to the subject and with such methodology. However, it is known that the gastroesophageal reflux results in dental erosion and consequently hypersensitivity could be established [
In this present study, the mean of DMFT index increased after the bariatric surgery. According to the study of Östberg et al. [
Sánchez-Ayala, Campanha and Garcia [
Although the association between bariatric surgery and oral health conditions presents a strong foundation in literature, besides the data obtained in this study, no protocol related to bariatric surgery includes, effectively, the dental surgeon in the multidisciplinary team or even indicates dental evaluations prior to the procedure. The results of this present study do not necessarily generalize. A pilot study is a requisite initial step. It’s necessary a larger, ensuing hypothesis testing study. Even considering the limitations of this present study, the results point to the need to adequate oral health care for the obese patient in the planning, especially when there being need for a surgical intervention.
Despite the beneficial effects of bariatric surgery on general health status, negative effects reflect on the oral health status and performance of masticatory function. Therefore, it becomes necessary to integrate the dental surgeon in the multidisciplinary team, monitoring of these patients pre- and postoperatively.