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; CI95% -0.17 to 0.31), gingival index (MD: -0.28; CI95% -1.68 to 1.11), percentage of bleeding sites (MD: -0.21; CI95% -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.