Oral health deteriorates before and after bariatric surgery, study shows

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Oral health deteriorates in morbidly obese people on a diet in preparation for bariatric (weight-loss) surgery and patients who have undergone the procedure, with increasing caries, gingivitis and periodontitis. This is the conclusion of a study conducted by researchers at the Federal University of São Paulo (UNIFESP) in Brazil.

Articles on the study are published in the Journal of Oral Rehabilitation and Clinical Oral Investigations.

The study followed 100 patients divided into two groups (dietary counselling and gastroplasty). Questionnaires, oral examinations, saliva samples and cheek swabs were analysed to determine dietary changes, weight loss, inflammatory markers, oral microbiota by sequencing, and dental and periodontal health before the operation, as well as three and six months after the operation or start of the diet.

“The patients were asked to floss and brush their teeth three times a day, but even so their oral health deteriorated significantly,” last author Professor Paula Midori Castelo Ferrua said.

“The number of caries rose, and periodontal status worsened in a short period in both groups, but particularly in the gastroplasty group.”

Salivary markers showed impairment of acid buffering capacity, essential for maintaining pH and preventing demineralisation of tooth enamel. Bacterial genome sequencing showed alterations of microbiota diversity, especially in the gastroplasty group, so that the proportion of microorganisms that cause periodontitis increased.

The diet of many patients was found to have improved, but profound dietary changes were believed to be the main cause of the deterioration in oral health, especially because more frequent daily meals were not accompanied by more frequent tooth cleaning, and more food was liquid or puréed in the first few months after surgery.

“There’s less fibre in the diet and no chewing is required, so the food sticks to the enamel and biofilm forms on the tooth surface,” Professor Castelo said. 

“Without chewing, less saliva is secreted and acid buffering capacity decreases.”

The results of the study show that assessing the patient’s oral health before and after bariatric surgery is essential. 

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