Download Oral Effects Associated With Obesity and Bariatric Surgery

CONTINUING EDUCATION
Course Number: 181
Oral Effects Associated
With Obesity
and Bariatric Surgery
Authored by Alison L. Glascoe, DDS, MS; Ronald S. Brown, DDS, MS; Derrick K. Eiland, DDS;
and Cheryl E. Fryer, DDS, MS, MA
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CONTINUING EDUCATION
obesity as a calculation of the ratio of body weight (kg) by the
square of height (m2).5,6 This calculation is also known as the
Body Mass Index (BMI).5,6 A person having a BMI > 30 kg/m2 is
considered obese.5,7,8
Oral Effects Associated
With Obesity
and Bariatric Surgery
Systemic and Oral Factors Associated With Obesity
Obesity is associated with and is considered a risk factor for
many systemic chronic conditions such as diabetes, chronic kidney disease, cardiovascular disease, high blood pressure, stroke,
arthritis, respiratory complications such as sleep apnea syndrome, and various forms of cancer.9,10 Many of these conditions, such as cardiovascular disease, secondary to
atherosclerosis, stroke, high blood pressure, diabetes, and cancers are leading causes of death in most developed countries.
Obesity is associated with psychosocial problems such as lack
of self-esteem and a sense of lacking personal strength.5
Obesity has also been associated with significant oral health
problems such as periodontal disease, caries, and xerostomia.1,9,11-15 Dental caries may develop secondary to xerostomia
(ie, dry mouth). Xerostomia can increase one’s risk for caries formation since there is a reduction in the amount of saliva present
in the mouth. Saliva contains enzymes, buffering agents, and
antibodies which protect the teeth against bacterial decay.16
Many obese patients suffer from sleep apnea.5 When one has
sleep apnea, one stops breathing during periods of time while
sleeping. Sleep apnea has secondary medical manifestations
such as hypertension, cancer, and congestive heart disease.5 Xerostomia is highly associated with sleep apnea.
Effective Date: 01/01/2015 Expiration Date: 01/01/2018
Learning Objectives: After reading this article, the individual will learn:
(1) the current state of the medical and dental literature regarding
obesity, and (2) the bariatric surgical treatments for obesity and the
positive and negative outcomes from bariatric surgical treatment.
About the Authors
Dr. Glascoe is an associate professor in the department of preventive services at Howard University College of Dentistry in Washington, DC. She is a
Diplomate of the American Board of Periodontology
and maintains a private practice in periodontics in
Baltimore. She can be reached via e-mail at the address [email protected].
Dr. Brown is a professor in the department of clinical dentistry at Howard
University College of Dentistry and a clinical associate professor in the department of otolaryngology at Georgetown University Medical Center, Washington, DC. He can be reached at [email protected].
Dr. Eiland is a native of Washington, DC, and graduated from Howard
University College of Dentistry. He is an active member of the American
Academy of Oral Medicine. He has had a long-term private practice in
Washington, DC, and is presently an assistant professor within the oral
diagnosis section of the department of comprehensive dentistry of Howard
University College of Dentistry. He can be reached at [email protected].
Dental Treatment and the Obese Patient
Treating the obese patient population in a conventional dental
primary care setting is often very challenging and risky. For example, providing and achieving profound dental anesthesia,
which is a basic essential for rendering restorative treatment
against most carious lesions, and providing sedation are often
difficult when treating the obese patient.17,18 Besides the challenges practitioners face when trying to render dental care to
the obese dental patient, many dental practitioners endure
physical challenges associated with treating the obese patient
population. For example, most standard dental chairs are
equipped to take a static load of approximately 300 pounds (lbs)
but may not be able to lift or recline at this load.17 Bariatric dental chairs are available and able to withstand a static load of approximately 1,000 lbs, but the cost is typically 4 times the cost
of a standard dental unit.17
Dr. Fryer is on faculty at Howard University College of Dentistry, where
she serves as director of faculty development and director of the Caries
Management Clinic for third-year dental students. She can be reached at
[email protected].
Disclosure: The authors report no disclosures.
A
ccording to the National Health and Nutrition Examination (NHANES) 2007 to 2008, it is estimated that 9
million Americans (approximately 32.2% of the adult
male and approximately 35.5% of the adult female population)
are obese.1,2 Obesity has become more problematic as lifestyles
have become more sedentary. Obesity has become a major public health concern worldwide.1-3 The World Health Organization (WHO) has estimated that more than one billion people
worldwide are overweight or obese.1,4 The WHO has classified
Bariatric Surgical Techniques
There are many reasons to motivate the obese patient to make
lifestyle changes in order to lose weight. There are many op-
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CONTINUING EDUCATION
Oral Effects Associated With Obesity and Bariatric Surgery
tions for weight loss that include dieting, physical exercise,
pharmacologic adjuncts, and surgical intervention.9,19-21
Bariatric surgery is an intervention that is a successful option
both clinically and cost-effectively for those who are moderately
to severely obese.9 One of the many benefits of weight loss as a
result of surgical intervention is a significant reduction in mortality and a reduction in the development of co-morbidities
such as diabetes and cardiovascular disease.9
Bariatric surgery for weight loss is only recommended for
those who have been unsuccessful in using nonsurgical methods for weight loss. Currently, there are 3 main bariatric surgical
techniques.22,23 The gastric band is a procedure that involves
placing a silicone ring around the stomach.22,24 This ring divides the stomach into 2 compartments: a small one above that
will store small quantities of food, creating the sensation of satiety, and a larger area below where normal digestion will
occur.22,24 The misuse biliopancreatic procedure involves removing three fourths of the stomach and shortening the intestine.22,23 This procedure results in reducing the absorption of
nutrients.22,23 The final surgical option is called gastric bypass
Roux-en-Y procedure.22 Currently, this is the most commonly
performed bariatric surgical procedure. This procedure involves
stapling the stomach to create a small pouch, thereby reducing
the amount of food that can be consumed.22,25 A part of the
small intestine is diverted, delaying the mixing of food with gastric juices.22,25 This technique entails a combination of malabsorptive and restrictive procedures. With the Roux-en-Y
technique, the gastric capacity is reduced. A restrictive ring is
placed, segmenting the duodenum (the first section of the small
intestine) and the jejunum (the middle section of the small intestine). This segmentation or exclusion of the digestive system
ultimately results in a decrease in the amount of food digested
and in the quality of ingested nutrients.5,26,27
tential positive outcomes of bariatric surgery that affect systemic
health include a reduction in sleep apnea, a decrease in systolic
and diastolic blood pressures, a reduction in the risk for coronary
artery disease, a reduction in total cholesterol, a reduction in the
risk for diabetes, changes in plasmatic hormones related to ovulation, and a reduction in systemic inflammation.9,22,31
Adverse Effects of Bariatric Surgery
Despite the potential for many positive outcomes, adverse effects or complications of bariatric surgery may also frequently
occur. Some factors that may influence the results of bariatric
surgery include the age of the patient. In general, the elderly
tend to develop more postoperative surgical complications,
which doctors and researchers attribute to a lower functional
reserve of this population. In addition, the elderly tend to have
more metabolic diseases such as diabetes that contribute to less
favorable outcomes.22,32
Adverse effects and manifestations following bariatric surgical procedures include changes associated with the following:
gastro-esophageal, respiratory, cardiovascular, endocrine, and
psychological.22,33 Some common gastro-esophageal complications include regurgitation, gastric ulcers, chronic vomiting, reflux, diarrhea, anemia, dehydration, and an increased risk for
gastro-esophageal cancers.22 Previously, mortality figures were
considerably higher than at present. In a study of 6,118 patients
undergoing bariatric surgery, there were 18 deaths recorded
within 30 days of the surgery.34 Currently, mortality rates secondary to bariatric surgery are less than 1%.35,36
The oral cavity is an integral part of the human digestive
system, and thus one would expect that anything that affects
the other components of the digestive system would potentially
affect the oral cavity. High acidic levels in the mouth are an essential contributing factor for the development of dental
caries.22,37,38 Dental plaque found in the oral cavity is composed of cariogenic bacteria.20 These bacteria metabolize carbohydrates or sugars. A by-product of this metabolism is the
formation of organic acids such as lactic acid, which dissolves
away the mineral content of tooth structure resulting in the formation of dental caries.3,22 High acidic levels in the mouth not
only contribute to caries formation but are also an essential contributing factor for the development of tooth erosion.37-39 Tooth
erosion is defined as the chemical dissolution of dental tissues
by a chemical process (acid or chelating agents) without the bacterial involvement.22,40 The presence of dental caries and tooth
erosion often result in hypersensitivity to external stimuli.
There are 3 main sources of acid in the oral cavity: (1) bacterial
fermentation of the carbohydrates, specifically sugar, that are
consumed from foods and beverages; (2) foods with high intrin-
Positive Outcomes of Bariatric Surgery
There are several potential positive outcomes as a result of
bariatric surgery. Some are associated with improving the psychological and emotional health of the patient. Examples would
include an increase in the quality of life, weight loss, an improvement in self-esteem, emotional stability, and greater satisfaction with one’s body image and in relationships.1,28,29
Researchers have also noted an increase in patients chewing
their food more completely but doing so more slowly following
bariatric surgery, which may be related to an increase in metabolic energy.30 This would also potentially optimize the digestive process.30
There are also significant changes that occur in systemic
health following bariatric surgery. Examples of some of the po-
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CONTINUING EDUCATION
Oral Effects Associated With Obesity and Bariatric Surgery
sic levels of acid; and (3) gastric acid.37,41-43 Gastric acids may
be introduced into the oral cavity secondary to vomiting,
chronic reflux, and regurgitation, which all are frequent occurrences following gastric bypass surgery.
Treatment options for dental caries and tooth erosion include a team approach involving all members of the dental
team: dentists, hygienists, dental assistants, and administrative
support workers. All on the dental team can play a part in patient education and motivation. This would include motivating
the patient to adhere to a strict recall regimen. In addition, patient education and dietary or nutritional counseling need to be
reinforced by all team members. These patients would benefit
from fluoride supplementation provided both in the dental office and at home. In addition, clinicians should consider using
fluoride-releasing restorative materials and dental adhesives
whenever possible.44
Post-bariatric surgery, patients are also at an increased risk
for nutritional and mineral deficiencies secondary to poor absorption of nutrients by the stomach and intestine. Examples
include an increased risk for iron, zinc, copper, vitamin A, vitamin B12, vitamin C, vitamin D, vitamin E, vitamin K, calcium,
and folic acid deficiencies.15,22,33,45 An iron deficiency increases
one’s risk for developing anemia. A vitamin B12 deficiency may
result in oral burning and neuropathy.46 A vitamin E deficiency
can result in neuromuscular problems, anemia, and impairment of the immune response.47,48 Such deficiencies, including
folic acid deficiency, may also result in anemia, which would
decrease healing secondary to periodontal therapy.30
Nutritional deficiencies such as vitamin C or ascorbic acid
deficiency can impair the formation and subsequent repair of
collagen.27 Collagen is the predominant component of the skin,
gingiva, and the attachment apparatus: periodontal ligament,
cementum, and bone. Collagen maintenance is therefore of utmost importance for periodontal health. A deficiency in ascorbic acid may affect the ability of the periodontium to regenerate
and repair. It may also result in an increase in gingival bleeding,
reduction in tissue tone (ie, the development of a more friable
gingival tissue), hemorrhage in the periodontal ligament, osteoporosis of the alveolar bone, and tooth mobility, all of which increase the risk for periodontal disease.4
There are 2 main forms of periodontal disease. The most
common is the plaque-induced gingival disease called gingivitis, which is a reversible form of periodontal disease. Gingivitis
is characterized by bleeding gingival tissues and is not associated with moderate to severe alveolar bone loss (ie, periodontal
pocketing and gingival attachment loss). The second most common form of periodontal disease is periodontitis. Periodontitis
is a destructive, irreversible inflammatory process that results
in atrophy or loss of the underlying bone and connective tissue
support around the teeth.46,49 Patients with periodontal disease
frequently complain of bleeding and painful gums, hypersensitive teeth, and mobile teeth. For those at risk for developing periodontal disease, patient education and motivation, monitoring
the patient during frequent recall dental appointments, and aggressively treating any site showing signs of active periodontal
disease are ways to reduce the risk for periodontal disease.
A vitamin D deficiency is another potential outcome of
bariatric surgery. Vitamin D is essential to maintain normal calcium metabolism, and is necessary for healthy bone growth.5,50
When vitamin D levels are deficient, calcium absorption becomes insufficient, which may result in secondary hyperparathyroidism.5 As a result of this process, the body removes
calcium from bone and reabsorbs it from the kidneys in an effort to re-establish homeostasis.5 Patients who are deficient in
vitamin D are at an increased risk for developing osteoporosis.
Osteoporosis is characterized by loss of trabecular bone and
thinning of the cortical bone, leading to an increased risk of
fractures.5 Osteoporosis may affect the mandible and maxilla.
A reduction in bone density of the mandible and maxilla may
increase one’s risk for periodontal disease and potentially be a
contraindication for the placement of dental implants.5,26 Osteoporosis may also result in alveolar bone loss.5
Methods to be used to reduce the risk for the development of
nutritional deficiencies include frequent monitoring of these patients and counseling by physicians and nutritionists; however,
once a nutritional deficiency has been diagnosed, the patient
must receive nutritional and mineral supplementation.51,52
Another consideration for the dental patient following
bariatric surgery is associated with the prescription and administration of certain drugs. Following bariatric surgery, patients
may be at an increased risk for kidney disease. Local anesthetics
and medications may be metabolized by the kidneys, thus these
(including tetracycline) should be avoided in those with kidney
disease. Additionally, local anesthetics act on renal function by
self-regulating blood flow and the glomerular filtration rate.5
Care must also be heeded for those at risk of gastric ulcers
secondary to bariatric surgery, particularly when prescribing
medications such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) in the management of pain control. Aspirin, NSAIDs, and oral bisphosphonates (bisphsophonates are
often used in the treatment for osteoporosis) must be avoided
in patients with gastric ulcers and those who have had bariatric
surgery.5 Patients who have had bariatric surgery are at an increased risk for the development of gastric ulcers around the
connections between the stomach and the intestine where areas
have been segmented or reduced.53
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Oral Effects Associated With Obesity and Bariatric Surgery
2nd ed. Oxford, England: Wiley-Blackwell; 2008.
17. Levine R. Obesity and oral disease—a challenge for dentistry. Br Dent J.
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18. Reilly D, Boyle CA, Craig DC. Obesity and dentistry: a growing problem. Br Dent J.
2009;207:171-175.
19. Lau DC, Douketis JD, Morrison KM, et al; Obesity Canada Clinical Practice Guidelines
Expert Panel. 2006 Canadian clinical practice guidelines on the management and
prevention of obesity in adults and children [summary]. CMAJ. 2007;176:S1-S13.
20. Hussain SS, Bloom SR. The pharmacological treatment and management of obesity.
Postgrad Med. 2011;123:34-44.
21. Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness
of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13:1-190, 215-357, iii-iv.
22. Barbosa CS, Barbério GS, Marques VR, et al. Dental manifestations in bariatric patients: review of literature. J Appl Oral Sci. 2009;17(suppl):1-4.
23. Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of
obesity. Ann Intern Med. 2005;142:547-559.
24. Cunneen SA. Review of meta-analytic comparisons of bariatric surgery with a focus
on laparoscopic adjustable gastric banding. Surg Obes Relat Dis. 2008;4(suppl
3):S47-S55.
25. Jones KB Jr, Afram JD, Benotti PN, et al. Open versus laparoscopic Roux-en-Y gastric
bypass: a comparative study of over 25,000 open cases and the major laparoscopic
bariatric reported series. Obes Surg. 2006;16:721-727.
26. Marsicano JA, Grec PG, Belarmino LB, et al. Interfaces between bariatric surgery and
oral health: a longitudinal survey. Acta Cir Bras. 2011;26(suppl 2):79-83.
27. Netto BD, Moreira EA, Patiño JS, et al. Influence of Roux-en-Y gastric bypass surgery
on vitamin C, myeloperoxidase, and oral clinical manifestations: a 2-year follow-up
study. Nutr Clin Pract. 2012;27:114-121.
28. Wang A, Powell A. The effects of obesity surgery on bone metabolism: what orthopedic surgeons need to know. Am J Orthop (Belle Mead NJ). 2009;38:77-79.
29. Pataky Z, Carrard I, Golay A. Psychological factors and weight loss in bariatric surgery.
Curr Opin Gastroenterol. 2011;27:167-173.
30. Huether SM, McCance KL. Understanding Pathophysiology. 3rd ed. St. Louis, MO:
Mosby; 2004.
31. Maciel Santos ME, Rocha NS, Laureano Filho JR, et al. Obstructive sleep apnea-hypopnea syndrome—the role of bariatric and maxillofacial surgeries. Obes Surg.
2009;19:796-801.
32. Fatima J, Houghton SG, Iqbal CW, et al. Bariatric surgery at the extremes of age. J
Gastrointest Surg. 2006;10:1392-1396.
33. Mango VL, Frishman WH. Physiologic, psychologic, and metabolic consequences of
bariatric surgery. Cardiol Rev. 2006;14:232-237.
34. Smith MD, Patterson E, Wahed AS, et al. Thirty-day mortality after bariatric surgery:
independently adjudicated causes of death in the longitudinal assessment of
bariatric surgery. Obes Surg. 2011;21:1687-1692.
35. Vines L, Schiesser M. Gastric bypass: current results and different techniques. Dig
Surg. 2014;31:33-39.
36. Musella M, Milone M, Gaudioso D, et al. A decade of bariatric surgery. What have
we learned? Outcome in 520 patients from a single institution. Int J Surg.
2014;12(suppl 1):S183-S188.
37. Heling I, Sgan-Cohen HD, Itzhaki M, et al. Dental complications following gastric restrictive bariatric surgery. Obes Surg. 2006;16:1131-1134.
38. Borgström MK, Edwardsson S, Svensäter G, et al. Acid formation in sucrose-exposed
dental plaque in relation to caries incidence in schoolchildren. Clin Oral Investig.
2000;4:9-12.
39. Zero DT, Lussi A. Erosion—chemical and biological factors of importance to the dental practitioner. Int Dent J. 2005;55(4 suppl 1):285-290.
40. Magalhães AC, Wiegand A, Rios D, et al. Insights into preventive measures for dental
erosion. J Appl Oral Sci. 2009;17:75-86.
41. Newbrun E. Sugar and dental caries: a review of human studies. Science.
1982;217:418-423.
42. Lussi A, Jaeggi T, Zero D. The role of diet in the aetiology of dental erosion. Caries
Res. 2004;38(suppl 1):34-44.
43. Ali DA, Brown RS, Rodriguez LO, et al. Dental erosion caused by silent gastroesophageal reflux disease. J Am Dent Assoc. 2002;133:734-737.
44. Dionysopoulos D, Koliniotou-Koumpia E, Helvatzoglou-Antoniades M, et al. Fluoride
release and recharge abilities of contemporary fluoride-containing restorative materials and dental adhesives. Dent Mater J. 2013;32:296-304.
45. Song A, Fernstrom MH. Nutritional and psychological considerations after bariatric
surgery. Aesthet Surg J. 2008;28:195-199.
46. Brown RS, Glascoe A, Feimster T, et al. Vitamins and the treatment of oral and dental
diseases. Dent Today. 2010;29:51-57.
47. Brigelius-Flohé R, Traber MG. Vitamin E: function and metabolism. FASEB J.
1999;13:1145-1155.
CONCLUSION
As obesity increases in America, dentists will be challenged to
render safe dental care to the obese patient population. Dentists
should partner with other health professionals to educate and
promote healthier lifestyle practices. Many chronic inflammatory systemic diseases, such as diabetes and cardiovascular disease, are not only risk factors for obesity but for oral diseases
such as periodontitis. Obesity is also a risk factor for xerostomia
and dental caries. These oral diseases and conditions impact
dental practices on a daily basis. As more patients seek surgical
intervention for the treatment of obesity, dentists should also
expect to see some of the potential adverse effects of bariatric
surgery affect their practices as well. These include an increase
in the presentation of caries, tooth erosion, periodontal disease,
oral burning, and alveolar bone loss. Obesity and bariatric surgery might also influence how dentistry is practiced in regards
to medications clinicians use daily such as local anesthesia, and
what is prescribed for pain management, because many in this
patient population have the potential for kidney disease and
gastric ulcers following bariatric surgery.
References
1. Pataro AL, Costa FO, Cortelli SC, et al. Influence of obesity and bariatric surgery on
the periodontal condition. J Periodontol. 2012;83:257-266.
2. Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US
adults, 1999-2008. JAMA. 2010;303:235-241.
3. Haenle MM, Brockmann SO, Kron M, et al. Overweight, physical activity, tobacco and
alcohol consumption in a cross-sectional random sample of German adults. BMC
Public Health. 2006;6:233.
4. World Health Organization. The World Health Organization warns of the rising threat
of heart disease and stroke as overweight and obesity rapidly increase [press release]. September 22, 2005. who.int/mediacentre/news/releases/2005/pr44/en.
Accessed October 10, 2014.
5. Moura-Grec PG, Assis VH, Cannabrava VP, et al. Systemic consequences of bariatric
surgery and its repercussions on oral health. Arq Bras Cir Dig. 2012;25:173-177.
6. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:i-xii, 1-253.
7. Balsa JA, Botella-Carretero JI, Peromingo R, et al. Role of calcium malabsorption in
the development of secondary hyperparathyroidism after biliopancreatic diversion. J
Endocrinol Invest. 2008;31:845-850.
8. Ferreira VA, Magalhães R. Obesesidade e pobreza: o aparente paradox [dissertacao].
Escola Nacional de Saude Publica, 2003. ensp.unl.pt/dispositivos-deapoio/cdi/cdi/sector-de-publicacoes/revista/2000-2008/pdfs/2-06-2006.pdf. Accessed on October 24, 2014.
9. Lakkis D, Bissada NF, Saber A, et al. Response to periodontal therapy in patients
who had weight loss after bariatric surgery and obese counterparts: a pilot study. J
Periodontol. 2012;83:684-689.
10. Field AE, Coakley EH, Must A, et al. Impact of overweight on the risk of developing
common chronic diseases during a 10-year period. Arch Intern Med.
2001;161:1581-1586.
11. Perlstein MI, Bissada NF. Influence of obesity and hypertension on the severity of
periodontitis in rats. Oral Surg Oral Med Oral Pathol. 1977;43:707-719.
12. Marsicano JA, Sales-Peres A, Ceneviva R, et al. Evaluation of oral health status and
salivary flow rate in obese patients after bariatric surgery. Eur J Dent. 2012;6:191-197.
13. Mathus-Vliegen EM, Nikkel D, Brand HS. Oral aspects of obesity. Int Dent J.
2007;57:249-256.
14. Saito T, Shimazaki Y, Kiyohara Y, et al. Relationship between obesity, glucose tolerance, and periodontal disease in Japanese women: the Hisayama study. J Periodontal Res. 2005;40:346-353.
15. Palle AR, Reddy CM, Shankar BS, et al. Association between obesity and chronic
periodontitis: a cross-sectional study. J Contemp Dent Pract. 2013;14:168-173.
16. Fejerskov O, Kidd E, eds. Dental Caries: The Disease and Its Clinical Management.
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48. National Institutes of Health, Office of Dietary Supplements. Vitamin E Fact Sheet
for Health Professonals. ods.od.nih.gov/factsheets/VitaminE-HealthProfessional. Accessed October 20, 2014.
49. Laurence B, Glascoe A, McIntosh C, et al. Periodontal Disease and Systemic Health
for Medical Students. Washington, DC: MedEdPORTAL Publications; 2013. mededportal.org/publication/9468. Accessed October 20, 2014.
50. Staud R. Vitamin D: more than just affecting calcium and bone. Curr Rheumatol Rep.
2005;7:356-364.
51. Malinowski SS. Nutritional and metabolic complications of bariatric surgery. Am J
Med Sci. 2006;331:219-225.
52. Pech N, Meyer F, Lippert H, et al. Complications, reoperations, and nutrient deficiencies two years after sleeve gastrectomy. J Obes. 2012;2012:828737.
53. Scheffel O, Daskalakis M, Weiner RA. Two important criteria for reducing the risk of
postoperative ulcers at the gastrojejunostomy site after gastric bypass: patient compliance and type of gastric bypass. Obes Facts. 2011;4(suppl 1):39-41.
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Oral Effects Associated With Obesity and Bariatric Surgery
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POST EXAMINATION QUESTIONS
4. Obesity is associated with which oral condition?
a. Xerostomia.
b. Pulpitis.
c. Root fracture.
d. Avulsion.
1. In order to be classified as being obese, the Body Mass
Index must be > ____.
a. 10%.
b. 30%.
c. 50%.
d. 90%.
5. A standard dental chair is equipped to handle a static load
of approximately how many pounds (lbs)?
a. 200 lbs.
b. 300 lbs.
c. 500 lbs.
d. 1,000 lbs.
2. It is estimated that there are more than how many obese
people worldwide?
a. 500,000.
b. 1,000,000.
c. 750,000,000.
d. 1,000,000,000.
6. A bariatric dental chair is equipped to handle a static load
of approximately how many pounds?
a. 200 lbs.
b. 300 lbs.
c. 500 lbs.
d. 1,000 lbs.
3. Obesity is a risk factor for which of the following?
a. Pregnancy.
b. Cardiovascular disease.
c. Skin cancer.
d. Asthma.
7. What is the most common bariatric surgical procedure
done today?
a. Misuse biliopancreatic procedure.
b. Gastric bypass Roux-en-Y procedure.
c. Gastric band.
d. None of the above.
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CONTINUING EDUCATION
Oral Effects Associated With Obesity and Bariatric Surgery
8. Providing and achieving profound dental anesthesia and
providing sedation are often difficult when treating the obese
patient.
a. True.
b. False.
9. What is a common nutritional or mineral deficiency
encountered by patients post bariatric surgery?
a. Vitamin C.
b. Echinacea.
c. Fluoride.
d. None of the above.
10. For those at risk for developing gastric ulcers, what
medication(s) should be avoided?
a. Amoxicillin.
b. Aspirin.
c. Azithromycin.
d. None of the above.
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CONTINUING EDUCATION
Oral Effects Associated With Obesity and Bariatric Surgery
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