1. 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:

2. 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)

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

8. 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 , Pakistan
Running head: Salivary cytokines in obesity after periodontal therapy.

9. 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

10. 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

11. 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.

12. 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

13. 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

14. 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

15. 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.

16. 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
( )
21.6
( )
33.6
( )
22.4
( )
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

17. 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†,‡
( )
52.5§,‖
( )
11.5¶
( )
8.5
( )
22.2#
( )
14.6#
( )
( )
6.4
( )
Probing depth ≥ 4mm (range)*
39.3**
( )
32.4††
( )
5.5‡‡
(0-10.5) —
18.5§§
( )
15.2‖‖
( )
4.2
( )
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)
( )
4.1
( )
3.5
( )
3.2
( )
*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).

18. 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).

19. 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.