Dr Zohaib Akram, B.D.S. (Pak), M.D.Sc Periodontology (Malaysia) Senior Registrar, Department of Periodontology Faculty of Dentistry, Ziauddin University Research gate Profile: https://www.researchgate.net/profile/Zohaib_Akram

Obesity and Periodontitis Accumulation of superfluous amounts of fat, to a degree that may debilitate health (WHO 1997) ≥ 30 kg/m2 (WHO 1997) Initiation of destructive host response by microbial organisms Excessive inflammatory response results in tissue damage (Lindhe et al., 1983)

Proinflammatory cytokines….the culprits??? Resistin Interleukin (IL)-6

Authors’ Affiliations Effect of non-surgical periodontal therapy on clinical periodontal parameters and whole salivary resistin and interleukin-6 levels in chronic periodontitis patients with and without obesity Tariq Abduljabbar a, Fawad Javed b, Zohaib Akram c, Sergio Varela Kellesarianb, Fahim Vohra a Authors’ Affiliations a Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia b Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, NY c Department of Periodontology, Faculty of Dentistry, Ziauddin University, Karachi 75600, Pakistan   Running head: Salivary cytokines in obesity after periodontal therapy.

Research Objectives Periodontal inflammatory parameters (bleeding on probing [BOP] and PD) and whole salivary interleukin (IL-6) and resistin levels are significantly higher in obese patients with CP compared with systemically healthy individuals with CP; Nonsurgical periodontal therapy reduces BOP, PD and whole salivary IL-6 and resistin levels in CP patients with and without obesity

Trial Design and Study Settings 6-month parallel-arm, cross-sectional longitudinal non-randomised clinical trial Patients recruited from Department of Periodontology, Faculty of Dentistry, Ziauddin University

Body mass index (BMI) ≥ 30 kg/m²; Inclusion Criteria ≥ 30 years old; Body mass index (BMI) ≥ 30 kg/m²; at least 12 teeth present excluding third molars and; a diagnosis of generalized chronic periodontitis‡ Self-reported tobacco smoker; Medical condition requiring prophylactic antibiotic coverage before dental treatment; Periodontal treatment given in the last 6 months; Patients reporting the presence of systemic conditions Exclusion Criteria ‡ Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol 1999;4:1-6.

Sample Size Calculation 26 patients needed in each group to detect the difference of 0.5 mm of probing depth (PD) with 85% power and an alpha of 0.05 Study Group Group-1: obese and non-obese individuals with CP Group-2: obese and non-obese individuals without CP Interview Questionnaire Gender; age; duration of obesity; family history of obesity; oral hygiene protocols

Clinical Periodontal Examination Standardization The Kappa scores for intra-examiner reliability was 0.94 Clinical Periodontal Examination Marginal Bone Loss Picture courtesy Rocha et al. 2012

Unstimulated whole saliva sampling Saliva samples were collected using passive drooling technique into high quality polypropylene falcon tubes Measurement of resistin and IL-6 in unstimulated saliva Enzyme-linked immunosorbent assay (ELISA) kit Non-surgical periodontal therapy Full-mouth scaling and root planing Oral hygiene instructions

Statistical Analysis All statistical analyses were carried out using (SPSS, v.20.0 for Windows, IBM, Chicago, IL) Kolmogrov-Smirnov and Shapiro-Wilk tests were first performed to assess for normality of distribution of all the variables in both groups A two tailed p value of 0.05 was used as threshold for significance Group comparisons were performed using one-way analysis of variance For multiple comparisons, Bonferroni post hoc adjustment test was performed.

Table 1: General characteristics of the study population Parameters   Parameters Group-1: Patients with chronic periodontitis Group-2: Patients without chronic periodontitis Obese patients Non-obese patients n 35 34 33 Gender (Male) 32 Mean age in years (range) 39.5 (32-40) 36.3 (33-44) 37.5 (31-42) 36.2 (33-42) Mean BMI in Kg/m2 (range) 35.2 (31-38.5) 21.6 (20.5-23.2) 33.6 (30.4-38.5) 22.4 (21.8-22.6) Duration of obesity (in years) 6.1 (5-7) — 5.5 (4-6.5) Family history of obesity (%) 31.4% 11.4% 8.8% BMI, Body mass index

Table 2: Periodontal parameters at baseline and at 6-months follow-up among individuals in groups 1 and 2   Periodontal parameters Baseline 6-months follow-up Group-1: Patients with chronic periodontitis Group-2: Patients without chronic periodontitis Obese patients Non-obese patients N 35 34 33 Bleeding on probing* (range) 46.3†,‡ (38.4-66.5) 52.5§,‖ (39.3-58.1) 11.5¶ (5.7-15.2) 8.5 (6.3-12.5) 22.2# (14.2-33.4) 14.6# (12.2-20.1) (6.3-12.7) 6.4 (5.2-9.8) Probing depth ≥ 4mm (range)* 39.3** (30.5-44.1) 32.4†† (30.5-36.2) 5.5‡‡ (0-10.5) — 18.5§§ (11.2-24.4) 15.2‖‖ (12.4-20.6) 4.2 (3.6-8.4) Number of missing teeth (range) 6.2 (4-7) 6.8 (4-8) 4.5 (0-6) 4.7 (0-5) Marginal bone loss in mm (range) (2.5-6.6) 4.1 (2.2-7.4) 3.5 (2.1-5.3) 3.2 (2.4-4.8) *Percentage of sites mm: millimeters †Compared to obese and non-obese individuals in group-2 at baseline (P<0.001) ‡Compared to obese and non-obese individuals in groups 1 and 2 at 6-months follow-up (P<0.001) §Compared to obese and non-obese individuals in group-2 at baseline (P<0.001) ‖Compared to obese and non-obese individuals in groups 1 and 2 at 6-months follow-up (P<0.001) ¶Compared to obese patients in group-1 at 6-months follow-up (P<0.01) #Compared to obese and non-obese individuals in group-2 at 6-months follow-up (P<0.001) **Compared to obese individuals in group 2 at baseline (P<0.001) ††Compared to obese individuals in group-2 at baseline (P<0.001) ‡‡Compared to obese individuals in group-1 at 6-months follow-up (P<0.001) §§Compared to obese individuals in group-2 at 6-months follow-up (P<0.001) ‖‖ Compared to obese individuals in group-2 at 6-months follow-up (P<0.001).

Table 3: Whole salivary resistin and interleukin-6 levels at baseline   Periodontal parameters Baseline 6-months follow-up Group-1: Patients with chronic periodontitis Group-2: Patients without chronic periodontitis Obese patients Non-obese patients n 35 34 33 Whole salivary resistin levels in ng/ml 18.4±3.2*†‡ 20.5±5.1*†‡ 2.2±0.2§ 2.1±0.3§ 9.8±2.2‖ 8.6±0.5‖ 0.8±0.2 1.1±0.3 Whole salivary IL-6 levels in pg/ml 14.3±3.6*†‡ 15.1±0.6*†‡ 2.1±0.4§ 2.3±0.6§ 7.5±1.2‖ 5.8±2.3‖ 1.3±0.4 1.5±0.2 *Compared to obese individuals in group-2 at baseline (P<0.001) †Compared to non-obese individuals in group-2 (P<0.001) ‡Compared to obese and non-obese individuals in group-1 at 6-months follow-up (P<0.001) §Compared to obese and non-obese individuals in group-1 at 6-months follow-up (P<0.001) ‖Compared to obese and non-obese individuals in group-2 at 6-months follow-up (P<0.001).

CONCLUSION NSPT is effective in reducing periodontal inflammation in CP patients with and without obesity. CP seems to be the primary factor that influences periodontal status and expression of resistin and IL-6 levels in obese and non-obese patients; and the role of obesity itself is rather secondary.