Relationship between bariatric surgery and periodontal status: a systematic review and meta-analysis

Background: The effects of bariatric surgery can reflect in the oral cavity and can cause alterations in oral health. This high prevalence of oral alterations in the pre and post-operative periods has been highlighted in different studies. Objectives: To investigate the effect of bariatric surgery on periodontal status through a systematic review. Methods: Electronic search was conducted in PubMed, VHL, Web of Science, Science direct, Scopus, and Cochrane databases through May 2017. Manual search, gray literature, and counter-refence of included articles were also conducted. Eligibility criteria included observational studies that reported periodontal outcomes before and after bariatric surgery. Results: Search strategy resulted in 1878 articles. Following the selection process, nine studies were included in the qualitative analysis and five in the meta-analysis. Three cross-sectional studies showed risk of bias score ranging from 5 to 6 stars, and Cohort studies scored from 6 to 9 stars out of 9 possible stars on the Newcastle -Ottawa scale. The quantitative analysis showed that clinical attachment level (MD: 0.07; C195% -0.17 to 0.31), gingival index (MD: -0.28; C195% -1.68 to 1.11), percentage of bleeding sites (MD: 0-.21; C195% -0.77 to 0.35), and pocket probing depth (MD: 0.08 CI95% -0.14 to 0.31) were not different before and after bariatric surgery. However, the plaque index was lower after than before bariatric surgery (MD: -1.29; CI 95% -2.34 to -0.24). Conclusions: Plaque index can be improved after bariatric surgery. The present systematic review investigated the association between bariatric surgery and periodontal status from cross-sectional and longitudinal studies. A systematic search strategy was developed until May 2017. The results of this systematic review allowed the conclusion that the plaque index can be improved after bariatric surgery. (Surg Obes Relat Dis 2018;14:1205-1216.) (C) 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.