title: Efficacy of non-surgical periodontal therapy in the management of chronic periodontitis among obese and non-obese patients: a systematic review and meta-analysis.
abstract: OBJECTIVE
  There is a controversy over the influence of obesity on the periodontal treatment outcome in patients with chronic periodontitis (CP). The aim of the present systematic review was to evaluate the efficacy of non-surgical periodontal therapy (NSPT) in the management of CP among obese and non-obese patients.
  
  
  METHODS
  The addressed focused question was "What is the efficacy, of NSPT with respect to clinical, radiographic, biochemical, microbiological, and patient-centered outcomes in obese as compared to non-obese chronic periodontitis patients?" Databases were searched from 1977 up to and including December 2014 using relevant key indexing terms. Unpublished data, experimental studies, letters to the editor, review articles, case reports, and commentaries were excluded. Meta-analysis of three studies was performed.
  
  
  RESULTS
  Five clinical studies were included. The total number of patients ranged between 30 and 260 individuals. The mean age of patients was between 42.5 and 48.8 years. In three studies, the clinical periodontal parameters (plaque index (PI), gingival bleeding index (GBI), periodontal pocket depth (PPD), and clinical attachment loss (CAL)) in obese and non-obese patients following NSPT was comparable. Meta-analysis of PPD and CAL among obese and non-obese subjects showed comparable outcomes (PPD P = 0.91, I (2) 67.36 %; CAL P = 0.87, I (2) 77.16 %). However, in three studies, NSPT resulted in a significantly better clinical periodontal outcome among non-obese subjects than obese subjects. The difference in the levels of serum pro-inflammatory cytokine levels (IL-1β, IL-6, TNF-α, IFN-γ, leptin, adiponectin, and CRP) among obese and non-obese patients following treatment for CP was inconsistent.
  
  
  CONCLUSIONS
  It remains unclear whether NSPT has a significantly higher impact on the clinical periodontal outcomes in obese patients than in non-obese patients with chronic periodontitis, given that the number of selected studies was relatively low and the reported findings were inconsistent.
  
  
  CONCLUSIONS
  Although the effect of obesity on the outcome of NSPT still remains unclear, nevertheless clinicians are prompted to manage obesity prior to and during periodontal treatment.
authors.affiliation: Department of Restorative Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia.|Department of Periodontology, Faculty of Dentistry, Ziauddin University, Karachi, 75600, Pakistan.
authors.forename: Zohaib
authors.initials: Z
authors.lastname: Akram
authors.affiliation: Department of Restorative Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Syarida Hasnur
authors.initials: SH
authors.lastname: Safii
authors.affiliation: Department of Restorative Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Rathna Devi
authors.initials: RD
authors.lastname: Vaithilingam
authors.affiliation: Department of Restorative Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia.
authors.forename: Nor Adinar
authors.initials: NA
authors.lastname: Baharuddin
authors.affiliation: Division of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, 14620, USA.
authors.forename: Fawad
authors.initials: F
authors.lastname: Javed
authors.affiliation: Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, PO-Box-60169, Riyadh, 11545, Saudi Arabia. fahimvohra@yahoo.com.
authors.forename: Fahim
authors.initials: F
authors.lastname: Vohra
mesh_terms: D055113:Chronic Periodontitis / Q000628:therapy*; D006801:Humans; D009765:Obesity / Q000150:complications*; D012307:Risk Factors
keywords: Cytokines; Inflammatory markers; Obese; Overweight; Periodontal therapy; Periodontitis