Kaliane Rocha Soledade, Larissa Rolim Borges- Paluch, Airton Francisco de Souza, Magno Andrade dos Santos, José Carlos Barbosa Andrade Júnior, Clara Renata de Almeida Sampaio, Mônica Dourado Silva Barbosa, Isaac Suzart Gomes Filho


Current epidemiological studies have showed a growing number of obese patients worldwide. New surgical treatments for obesity that can provide consistent weight loss and effective management of associated comorbidities have been increasingly investigated. The effects of bariatric surgery include long-term benefits such as lower blood glucose levels with good management of type 2 diabetes, hyperlipidemia, metabolic syndrome, reduced risk of coronary heart disease, better quality of life and improved life expectancy. However, bariatric surgery is a procedure that implies malabsorption of nutrients and can result in nutritional deficiencies, anemia, hypocalcemia, low absorption of vitamin D and hyperparathyroidism, causing decreased bone mineral density and increased risk of osteoporosis and may play a major role in the progression and severity of periodontal disease.


Obesity, Bariatric Surgery, Periodontal Disease, Osteoporosis.

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Pandolfino JE, Krishnamoorthy B, Lee TJ. Gastrointestinal Complications of Obesity Surgery. Med Gen Med 2004;6(2):15.

Olbers T. Body Composition, Dietary Intake, and Energy Expenditure After Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Vertical Banded Gastroplasty: A Randomized Clinical Trial. Ann Surg 2006;244:715–722.

Pischon N, Heng J, Bernimoulin B, Kleber M, Willich SN, Pischon T. Obesity, Inflammation and Periodontal Disease. J Dent Res 2007;86:400-409.

Buchwald H, Avidor Y, Braunwald E, et al. Bariatric Surgery: A Systematic Review and Meta-analysis. JAMA 2004;292 (14):1724-1737.

Hague AL, Baechle M. Advanced caries in a patient with a history of bariatric surgery. Journal of Dental Hygiene 2008;82 (2):1-9.

Fundação IBGE. Pesquisa de orçamentos familiares – POF 2002-2003, Brasília Dez 2004. Disponível em ttp:// Acessado em 28 de novembro de 2008.

Francisco MC, Barella SM, Abud TG, et al. Análise radiológica das alterações gastrointestinais após cirurgia de Fobi-Capella. Radiol Brás 2007; 40 (4):235-238.

Sanches GD, Gazoni FM, Konishi RK, Guimarães HP, Vendrame LS, Lopes RD. Intensive care of postoperative patients in bariatric surgery. Revista Brasileira de Terapia Intensiva 2007;19 (2):205-209.

O’rourke P, Key T, Lyle EA, et al. Alterations in peripheral blood lymphocyte cytokine expression in obesity. British Society for Immunology. Clinical and Experimental Immunology 2006;146: 39–46.

Kongstad J, Hvidtfeldt UA, Gr?nb?k M, Stoltze K, Holmstrup P. The relation between body mass index and periodontitis in the Copenhagen City heart study. J Periodontol, 2009.

McMillan DC, Satta N, Lean M, McArdle CS. Obesity and Cancer. BMJ 2006;333:1109-1111.

Salamed JR. Bariatric Surgery: past and present. Am J Med Sci2006;331: 194-200.

Alves LFA, Gonçalves RM, Cordeiro GV, Lauria MW, Ramos AV. Beribéri Pós Bypass Gástrico: Uma Complicação Não Tão Rara. Relato de Dois Casos e Revisão da Literatura. Arq Bras Endocrinol Metab 2006;50(3):564-568.

Choban PS. Bariatric surgery for morbid obesity: why, who, when, how, where, and then what? Cleve Clin J Med. v. 69, p. 897-903, 2002.

O’brien PE, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program. A randomized trial. Ann Intern Med.2006;144:625-633.

Oria HE, Moorehead MK. Bariatric Analysis and Reportig Outcome System (BAROS) Obes Surg 1998;8: 487-499.

Papapietro KV, Emma DG, Csender AJ, et al. Effects of gastric bypass on weight, blood glucose, serum lipid levels and arterial blood pressure in obese patients. Rev Med Chile 2005;133:511-516.

Cosmo LD, Vuolo G, Piccolomine A, et al. Bariatric Surgery: early results with a multidisciplinry team. Obesity Surgery 2000;10:272-273.

Sjöström L, Narbro L, Sjöström D, et al. Effects of bariatric surgery on mortalitu in swedish obese subjects. The New England Journal of Medicine 2007;357(8):741-752.

Dallal RM, Quebbemann BB, Hunt LH, Braitman LE. Analysis of weight loss after bariatric surgery using mixed-effects linear modeling. Obes Surg. February, 2009.

National Institutes of Health: Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res. 1998;6:51S–209S.

Davies DJ, Baxter JM, Baxter JN. Nutritional deficiencies after bariatric surgery. Obesity Surgery 2007;17:1150-1558,

Wadden TA, Tsai AG. Bariatric Surgery:crossing a body mass index threshold. Annals of Internal Medicine. 2006;144(9):689-691.

Klein S. Gastrointestinal surgery for obesity: a question of life and death and expertise. Gastroenterology. 2006;130:630-631.

Genco RJ, Grossi SG, Ho A, Nishimura F, Murayama Y. A proposed model linking inflammation to obesity, diabetes and periodontal infections. J Periodontol 2005;76:2075-2084.

Segal A, Fandiño J. Bariatric surgery indications and contraindications. Rev Bras Psiquiatr 2002; 24(Supl III):68-72.

Virji A, Murr MM. Caring for patients after bariatric Surgery. American Family Physician 2006;73(8):1403-1408.

Manco M, Fernandez-Real JM, Equitani F, et al. Effect of massive weight loss on inflammatory adipocytokines and the innate immune system in morbidly obese women. The Journal of Clinical Endocrinology & Metabolism 2007;92(2):483-490.

Soares CC, Falcão MC. Nutritional approach in the different techniques of bariatric surgery. Rev Bras Nutr Clin 2007;22(1):59-64.

McCullough PA, Gallagher MJ, deJong AT, et al. Cartiorespiratory fitness and short-term complications after bariatric surgery. CHEST 2006;130 (2):516-525.

Johnson RB, Thliveris. Effect of low-protein diet on alveolar bone loss in streptozotocin-induced diabetic rats. J Periodontol 1989;264-270.

Fandiño J, Benchimol AK, Coutinho WF, Appolinário JC. Cirurgia Bariátrica: aspectos clínicos, cirúrgicos e psicológicos. Rev Psiquiatr Rio Gd Sul 2004;26 (1):47-51.

Fujioka, K. Follow-up of nutritional and metabolic problems after bariatric surgery. Diabetes Care. 2005;28:481-484.

Pugnale N, Giusti V, Suter M, et al. Bone metabolism and risk of secondary hyperparathyroidism 12 months after gastric banding in obese pre-menopausal women. International Journal of Obesity 2003;27:110-116.

Mason ME, Jalagani H, Vinik A. Metabolic complications of bariatric surgery: diagnosis and management issues. Gastroenterol Clin N Am 2005;34:25-33.

Schweitzer DH. Mineral metabolism and bone disease after surgery and ways to optimize boné health. Obesity Surgery 2007;17:1510-1516.

Berarducci A, Haines K, Murr MM. Incidence of bone loss, falls and fractures after Roux-en-Y gastric bypass for morbid obesity. Applied Nursing Research 2009;22:35-41.

Carrasco F, Ruz M, Rojas P, et al. Changes in bone mineral density, body composition and adiponectin levels in morbidly obese patients after bariatric surgery. Obes Surg 2009;19:41-46.

Kitto SC, Borradale D, Jeffrey CA, Smith JA, Villanueva EV. Bariatric surgery in Australia: Who, Why and How? ANZ J. Surg 2007;77:727-732.

Coates PS, Fernstrom JD, Madelyn HF, Schauer PR, Greenspan S. Gastric Bypass Surgery for Morbity Obesity Leads to an increase in bone turnover and a decrease in bone mass. The Journal of Clinical Endocrinology & Metabolism 2008;89(3):1061-1065.

Gasteyger C, Suler M, Gaillard RC, Giusti V. Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin suplementation. Am J Clin Nutr 2008;87:1128-1133.

Mahdy T, Atia S, Farid M, Adulaty A. Effect of Roux-em-Y gastric Bypass on bone metabolism in patients with morbid obesity. Mansoura experiences. Obes Surg 2008;18:1526-1531.

Pereira FA, Castro JAS, dos Santos JE, Foss MC, Paula FJA. Impact of marked weight loss induced by bariatric surgery on boné mineral density and remodling. Brazilian Journal of Medical and Biological Research 2007;40:509-517.

Sánchez-Hernández J. Ybarra J, Gich I, et al. Effects of bariatric surgery on vitamin D status and secundary huperparathyroidism: a prospective study. Obes Surg 2005;15:1389-1395.

Vázquez LA, Pazos F, Berrazuetta JR, et al. Effects of Changes in body weight and insulin resistence on inflamation and endothelial function in morbid obesity after bariatric surgery. The Journal of Clinical Endocrinology & Metabolism 2005;90 (1):316-322.

Diniz MFHS, Diniz MTCD, Sanches SRA, et al. Elevated serum parathormone after Roux-en-Y gastric bypass. Obesity Surgery 2004;14:1222-1226.

Wactawski-Wend J, Grossi SG, Trevisan M, et al. The role of osteopenia in oral bone loss and periodontal disease. J Periodontol 1996;Oct Sup:1076-1084.

Offenbacher S. Periodontal diseases: Pathogenesis. Ann Periodontol 1996;1:821-878.

Birkedal-Hansen H. Role of cytokines and inflamatory mediators in tissue destruction. J Periodontal Res 1993;28: 500-510.

Jeffcoat MK, Osteoporosis: a possible modifying factor in oral bone loss. J Periodontol Annals 1998;3:312-321.

Hildebold CF. Effect of vitamin D and calcium on periodontitis. J Periodontol 2005;76 (9):1576-1587.

Al-Zahrani MS, Bissada NF, Borawski EA. Obesity and periodontal disease in Young, middle-aged and older adults. J Periodontol 2003;74(5):610-615.

Iacopino AM. Relationship between nutrition and oral health. JCDA 2008;74(9):771.

Gomes-Filho IS, Passos JS, Cruz SS, et al. The association between postmenopausal osteoporosis and periodontal disease. J Periodontol 2007;78(9):1731-1740.

Mealey BL. Influence of periodontal infections on systemic health. Periodontol 2000 1999;21:197.

Hujoel PP. et al. Periodontal disease and coronary heart disease risk. JAMA 2000;284: 1406, 2000.

Herzberg MC, Meyer MW. Effects of oral flora on platelets: possible consequences in cardiovascular disease. J Periodontol 1996;67:1138-42.

Grossi SG, Genco RJ. Periodontal disease and diabetes mellitus: a two-way relationship. Ann Periodontol 1998;3:51.

Loesche WJ. Anaerobic Periodontal Infections as Risk Factors for Medical Diseases. Curr Infect Dis Rep1999;1(1):33-38.

Dasanayake AP. Poor periodontal health of the pregnant woman as a risk factor for low birth weight Ann Periodont 1998;3:202.

Offenbacher S, Katz V, Fertik G et al. Periodontal infection as a possible risk factor for preterm low birth weight. J. Periodontol 1996;67 (suppl.):1103-1113.

Scannapieco FA, Papandonatos GD, Dunfort RG. Associations between oral conditions and respiratory disease in a national sample survey population. Ann Periodontol 1998;3: 251-256.

Avenell A, Broom J, Brown TJ, et al. Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technology Assessment 2004;8(21).

Bullo M. et al. Systemic inflammation, adipose tissue tumor necrosis factor, and leptin expression. Obes Res 2003;1:525–531.

Engeli S. et al. Association between adiponectin and mediators of inflammation in obese women. Diabetes 2003;52:942–972.

Festa A. et al. The relation of body fat mass and distribution to markers of chronic inflammation. Int J Obes Relat Metab Disord 2001;25:1407–1415.

Bastard JP. et al. Elevated levels of interleukin 6 are reduced in serum and subcutaneous adipose tissue of obese women after weight loss. J Clin Endocrinol Metab 2000;85:3338–3342.

Genoleze B, Pareja JC. Does bariatric surgery cure the Metabolic Syndrome? Arq Bras Endocrinol Metab 2006;50(2):400-4007.

Field AR, 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.

Li P, He L, Sha Y, Luan Q. Relationship of metabolic syndrome to chronic periodontitis. J Periodontol 2009;80(4):541-549.

Ylölstalo P, Suomine-Taipale L, Reunanem A, Knuuttila M. Association between body weight and periodontal infection. J Clin Periodontol 2008;35:297-307.

Saito T, Shimazaki Y, Sakamoto N. Obesity and periodontitis. N Engl J Med 1998;339:482-483.

Saito T, Shimazaki Y, Koga T, Tsuzuki M, Ohshima A. Relationship between upper body obesity and periodontitis. J Dent Res 2001;80: 1631-1636.

Izumi A, Yoshihara A, Hirotomi T, Miyazaki H. The relationship between serum lipids and periodontitis in elderly no-smokers. J Periodontol 2009;80(5):740-746.

Genco RJ, Grossi SG, Ho A, Nishimura F, Murayama Y. A proposed model linking inflamation to obesity, diabetes and periodontal infections. J Periodontol 2005;76(11):2075-2084.

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.

Amano Y, Komiyama K, Makishima M. Vitamin D and periodontal disease. Journal of Oral Science 2009;51(1):11-20.

Zittermann A. Vitamin D in preventive medicine: Are we ignoring the evidence? Br J Nutr 2003;89: 552-572.

Miley DD, Garcia MN, Hildebolt CF, et al. Cross-sectional study of vitamin D and calcium supplementation effects on chronic periodontitis. J Periodontol 2009:1-12.

Liu K, Meng H, Tang X, et al. Elevated plasma calcifediol is associated with aggressive periodontitis. J Periodontol 2009:1-12.

Famili P, Cauley J, Suzuli JB, Weyant R. Longitudinal study of periodontal disease and edentulism with rates of bone loss in older women. J Periodontol 2005;76:11-15.

Gunes S, Sumer AP, Keles GC, et al. Analysis of vitamin D receptor gene polymorphisms in patients with chronic periodontitis. Indian J Med Res 2008;127:58-64.

Wang C, Zhao H, Xiao L, et al. Association between vitamin D receptor gene polymorphisms and severe chronic periodontitis in a chinese population. J Periodontol 2009;80(4):603-608.

Li S, Yang MH, Zeng CA, et al. Association of vitamin D receptor gene polymorfism in Chinese patients with generalized aggressive periodontitis. J Periodontol Res 2008;43:360-363.

Wucher H, Ciangura C, Poitou C, Czernichow S. Effects of weight loss on bone status after bariatric surgery: association between adipokines and bone markers. Obes Surg 2008;18:58-65.

Zhao LJ. Liu YJ, Liu PY, Hamilton J, Recker RR. Deng HW. Relationship of obesity eith osteoporosis. J Clin Endocrinol Metab 2007;92(5):1640-1646.

Jeffcoat M. The association between osteoporosis and oral bone loss. J Periodontol 2005(suppl);76(11):2125-2132.

Geur NC, Lewis CE, Jeffcoat MK. Osteoporosis and periodontal disease progression. Periodontology 2000 2003;32:205-210.

Henrikson PA, Periodontal disease and calcium deficiency. An experimental study in the dog. Acta Odontol Scand. 1968;Supl 50:1-132.

Nishida M, Grossi SG, Dunford RG, Ho A, Trevisan M, Genco RJ. Calcium and the risk for periodontal disease. J Periodontol 2000;71 (7)1057-1066.

Reddy MS. Oral Osteoporosis: Is There an Association Between Periodontitis and Osteoporosis? Compendium 2002;23(10 Suppl):21-28.



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