The Dual Effects of Bariatric Surgery on Oral Health: Periodontal Improvement versus Dental Erosion—A Retrospective Self-Controlled Study

The Dual Effects of Bariatric Surgery on Oral Health: Periodontal Improvement versus Dental Erosion—A Retrospective Self-Controlled Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Dual Effects of Bariatric Surgery on Oral Health: Periodontal Improvement versus Dental Erosion—A Retrospective Self-Controlled Study WenJun Zhao, Kai Ma This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8600321/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Obesity shares a bidirectional pathophysiological relationship with periodontitis, primarily driven by chronic inflammation. While bariatric surgery (BS) effectively reduces systemic inflammatory load, the resulting anatomical and dietary changes may adversely affect dental hard tissues. This study aimed to retrospectively evaluate the dual effects of BS on periodontal health and dental hard tissues. Methods This single-center, retrospective, self-controlled study enrolled patients who underwent bariatric surgery (Roux-en-Y Gastric Bypass [LRYGB] or Sleeve Gastrectomy [LSG]) between January 2018 and December 2022. Clinical data, including Body Mass Index (BMI), C-reactive protein (CRP), periodontal parameters (Bleeding on Probing [BOP], Probing Depth [PD], Clinical Attachment Loss [CAL]), and dental hard tissue indices (Decayed, Missing, and Filled Teeth [DMFT]; Basic Erosive Wear Examination [BEWE]), were collected at baseline (pre-operative) and 12 months post-operative. Paired t-tests or Wilcoxon signed-rank tests were used for analysis. Results A total of 156 patients were included. At 12 months post-surgery, mean BMI decreased significantly (38.5 ± 4.2 kg/m² vs. 26.8 ± 3.5 kg/m², P < 0.001), accompanied by a marked reduction in serum CRP. Periodontal inflammation improved significantly, with BOP% decreasing from 45.2% ± 15.3% to 26.8% ± 12.1% ( P < 0.001). Conversely, dental health showed signs of deterioration: the DMFT index increased (8.4 ± 3.2 vs. 9.1 ± 3.5, P = 0.032), and the risk of high-grade enamel erosion (BEWE score ≥ 2) increased by 2.4-fold. Multivariate regression identified post-operative Gastroesophageal Reflux Disease (GERD) symptoms as an independent predictor of dental erosion (OR = 3.12). Conclusion Bariatric surgery yields significant periodontal benefits via the attenuation of systemic inflammation; however, it concurrently poses a substantial risk for dental erosion and caries due to increased acidic exposure. Integrated multidisciplinary care addressing oral hygiene and acid management is recommended for bariatric patients. Bariatric surgery Obesity Periodontitis Dental erosion Retrospective study 1. Introduction 1.1 Background Obesity has reached pandemic proportions globally and is a well-established risk factor for cardiovascular disease, type 2 diabetes mellitus, and chronic inflammatory conditions( 1 ). Oral health, an integral component of systemic well-being, is intricately linked to obesity. Extensive epidemiological evidence identifies obesity as an independent risk factor for periodontitis( 2 ). The underlying mechanism involves the secretion of pro-inflammatory cytokines—such as tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6)—by adipose tissue. These cytokines exacerbate the host’s immune response to bacterial biofilms, accelerating periodontal tissue destruction( 3 ). 1.2 The Clinical Dilemma Bariatric surgery (BS) is currently the most effective intervention for severe obesity and its metabolic comorbidities( 4 ). The rapid post-surgical reduction in fat mass and the consequent improvement in metabolic profiles theoretically benefit periodontal health by reducing the systemic inflammatory burden. However, the anatomical alterations induced by surgery—particularly the impairment of the lower esophageal sphincter—frequently lead to Gastroesophageal Reflux Disease (GERD)( 5 ). Furthermore, the post-operative dietary regimen (characterized by “frequent small meals”) and potential vomiting episodes expose the oral cavity to acidic substances for prolonged periods. This environment is conducive to dental erosion and caries, creating a potential conflict between soft tissue (periodontal) improvement and hard tissue (dental) deterioration. 1.3 Objectives Current literature presents conflicting views regarding the net effect of bariatric surgery on oral health( 6 ), with few studies simultaneously evaluating the dichotomy between periodontal benefits and dental risks. This retrospective, self-controlled study aims to systematically assess the impact of bariatric surgery on both periodontal status and dental hard tissues over a 12-month period and to analyze the systemic and local factors driving these changes. 2. Materials and Methods 2.1 Study Design and Ethical Statement This was a single-center, retrospective, self-controlled study conducted at Shanxi Bethune Hospital. The requirement for informed consent was waived due to the retrospective nature of the analysis. 2.2 Study Population Data Source : We performed a cross-referenced search of the Bariatric Surgery Database and the Electronic Medical Records (EMR) of the Department of Stomatology, covering the period from January 2018 to December 2022. Inclusion Criteria 1. Aged 18–65 years. 2. Clinical diagnosis of morbid obesity (BMI ≥ 32.5 kg/m², according to Chinese guidelines). 3. Underwent laparoscopic Roux-en-Y Gastric Bypass (LRYGB) or Laparoscopic Sleeve Gastrectomy (LSG). 4. Possessed complete oral examination records at baseline (within 1 month pre-surgery) and at the 12-month follow-up (± 3 months). Exclusion Criteria 1. Received active periodontal therapy (scaling and root planing or periodontal surgery) during the study period. 2. History of orthodontic treatment or severe tooth wear prior to surgery. 3. Systemic diseases affecting bone metabolism (e.g., hyperthyroidism, long-term glucocorticoid use). 4. Pregnancy or lactation. 2.3 Variables and Data Collection Demographic and Clinical Data : Gender, age, smoking history, alcohol consumption, and type of surgery. Metabolic Indicators Height, weight (to calculate BMI), fasting blood glucose (FBG), Glycated Hemoglobin (HbA1c), and high-sensitivity C-reactive protein (hs-CRP). Periodontal Health Indicators : * Bleeding on Probing (BOP %) : The percentage of sites bleeding upon probing, reflecting gingival inflammatory activity. * Probing Depth (PD) : The mean distance from the gingival margin to the bottom of the sulcus/pocket. * Clinical Attachment Loss (CAL) : The distance from the cementoenamel junction to the bottom of the sulcus/pocket, indicating irreversible tissue destruction. Dental Hard Tissue Indicators : * DMFT Index : The sum of Decayed, Missing, and Filled teeth. * BEWE Score : The Basic Erosive Wear Examination score was utilized to grade erosion severity (0 = No wear; 1 = Initial loss of surface texture; 2 = Distinct defect, hard tissue loss 50%). A cumulative score was calculated. Reflux Assessment Since objective pH monitoring was unavailable in this retrospective cohort, the presence of reflux symptoms (heartburn or regurgitation ≥ 3 times per week) and the prescription of proton pump inhibitors (PPIs) were used as surrogate markers for GERD. 2.4 Statistical Analysis Statistical analysis was performed using SPSS version 26.0 (IBM Corp., Armonk, N.Y., USA). Normality of data distribution was tested using the Shapiro-Wilk test. Normally distributed continuous variables were expressed as mean ± standard deviation (SD) and compared using paired t -tests. Non-normally distributed data were presented as medians (interquartile range) and analyzed using the Wilcoxon signed-rank test. Categorical variables were compared using the Chi-square test or McNemar’s test. Multivariate linear and logistic regression analyses were conducted to identify independent predictors of periodontal improvement and dental erosion. A P -value < 0.05 was considered statistically significant. 3. Results 3.1 Baseline Characteristics A total of 156 patients met the inclusion criteria. The cohort consisted of 112 females (71.8%) and 44 males (28.2%), with a mean age of 35.4 ± 8.6 years. The majority of patients underwent Laparoscopic Sleeve Gastrectomy (LSG, n = 118, 75.6%), while 38 patients (24.4%) underwent Roux-en-Y Gastric Bypass (LRYGB). Baseline demographic and clinical characteristics are detailed in Table 1 . Table 1 Baseline Demographic and Clinical Characteristics of the Study Population (N = 156) Variable Value Age (years) 35.4 ± 8.6 Gender, n (%) Female 112 (71.8%) Male 44 (28.2%) Type of Surgery, n (%) Laparoscopic Sleeve Gastrectomy (LSG) 118 (75.6%) Roux-en-Y Gastric Bypass (LRYGB) 38 (24.4%) Smoking History, n (%) 22 (14.1%) Pre-operative BMI (kg/m²) 38.5 ± 4.2 Pre-operative hs-CRP (mg/L) 8.5 ± 3.2 3.2 Metabolic and Anthropometric Changes At the 12-month follow-up, patients achieved significant weight loss. Mean BMI decreased from 38.5 ± 4.2 kg/m² to 26.8 ± 3.5 kg/m² ( P < 0.001). Concurrently, the systemic inflammatory marker hs-CRP dropped significantly from 8.5 ± 3.2 mg/L to 2.1 ± 1.1 mg/L ( P < 0.001). Glycemic control also improved, with HbA1c levels decreasing from 6.8 ± 1.2% to 5.4 ± 0.6% ( P < 0.001). See Table 2 . Table 2 Comparison of Metabolic Parameters Pre- and Post-Surgery Parameter Pre-Operative (Baseline) Post-Operative (12 Months) P -Value BMI (kg/m²) 38.5 ± 4.2 26.8 ± 3.5 < 0.001* Weight (kg) 105.4 ± 15.6 73.2 ± 11.3 < 0.001* hs-CRP (mg/L) 8.5 ± 3.2 2.1 ± 1.1 < 0.001* Fasting Blood Glucose (mmol/L) 6.2 ± 1.8 5.1 ± 0.7 < 0.001* HbA1c (%) 6.8 ± 1.2 5.4 ± 0.6 < 0.001* Note: Data presented as Mean ± SD; indicates paired t-test.* 3.3 Changes in Periodontal Health (The “Improvement” Effect) Significant improvements in periodontal status were observed at the 12-month follow-up. BOP% decreased from 45.2% ± 15.3% to 26.8% ± 12.1% ( P < 0.001). Mean Probing Depth (PD) reduced from 3.2 ± 0.6 mm to 2.8 ± 0.5 mm ( P < 0.001). While CAL showed a slight trend towards improvement, the difference was not statistically significant ( P = 0.062), indicating that while inflammation subsided, the regeneration of lost attachment was limited within the 12-month window. Correlation analysis revealed that the magnitude of CRP reduction was positively correlated with the reduction in BOP% (r = 0.34, P = 0.002). 3.4 Changes in Dental Hard Tissue Health (The “Deterioration” Effect) In contrast to periodontal improvements, dental hard tissue health deteriorated. The DMFT index increased significantly from 8.4 ± 3.2 to 9.1 ± 3.5 ( P = 0.032). The prevalence of high-risk erosion (BEWE cumulative score ≥ 2) rose from 15.4% (24/156) at baseline to 36.5% (57/156) at 12 months ( P < 0.001). Subgroup analysis indicated that patients who underwent LSG had a significantly higher incidence of new erosion compared to the LRYGB group (41.5% vs. 21.1%, P = 0.018). See Table 3 . Table 3 Comparison of Oral Health Parameters Pre- and Post-Surgery Oral Health Parameter Pre-Operative Post-Operative (12 Months) P -Value Periodontal Parameters BOP % 45.2 ± 15.3 26.8 ± 12.1 < 0.001* PD (mm) 3.2 ± 0.6 2.8 ± 0.5 < 0.001* CAL (mm) 3.5 ± 0.8 3.4 ± 0.7 0.062 Hard Tissue Parameters DMFT Index 8.4 ± 3.2 9.1 ± 3.5 0.032* BEWE Score (Cumulative) Low Risk (0–1) 132 (84.6%) 99 (63.5%) < 0.001† High Risk (≥ 2) 24 (15.4%) 57 (36.5%) Note: Continuous data presented as Mean ± SD (paired t-test); Categorical data presented as n (%). † indicates McNemar’s Test. 3.5 Predictors of Oral Health Outcomes Multivariate regression analysis was performed to identify factors associated with clinical changes. As shown in Table 4 , a greater reduction in post-operative CRP was an independent protective factor for periodontal bleeding (OR = 0.65, 95% CI: 0.50–0.85). Conversely, the presence of frequent post-operative reflux symptoms (≥ 3 times/week) was identified as a strong independent risk factor for the progression of dental erosion (OR = 3.12, 95% CI: 1.85–5.24). Table 4 Multivariate Analysis of Factors Influencing Post-Surgical Oral Health Changes Dependent Variable Predictive Factor Odds Ratio (OR) 95% Confidence Interval P -Value Improvement in BOP Reduction in hs-CRP 0.65 0.50–0.85 0.002 (Binary Logistic) Smoking History 1.80 0.92–3.52 0.085 Progression of Dental Erosion Post-op GERD Symptoms 3.12 1.85–5.24 < 0.001 (Binary Logistic) Surgery Type (LSG vs LRYGB) 1.45 0.98–2.14 0.061 Post-op Dietary Frequency (meals/day) 1.20 0.95–1.51 0.120 4. Discussion 4.1 The Metabolic-Periodontal Link: Anti-Inflammatory Benefits The results of this retrospective study confirm the “anti-inflammatory” of bariatric surgery on periodontal tissues. The significant reduction in BOP and PD paralleled the decrease in serum CRP and BMI. This strongly supports the hypothesis that obesity-induced systemic inflammation exacerbates periodontitis. Adipose tissue acts as an endocrine organ secreting adipokines; the rapid reduction in fat mass following surgery decreases circulating levels of TNF-α and IL-6, thereby mitigating the host’s hyper-inflammatory response to periodontopathogens. Our findings align with Arboleda et al.(7), who demonstrated similar improvements in periodontal indices following surgical weight loss. 4.2 The Acidic Challenge: Impact on Dental Hard Tissues While periodontal health improved, our study revealed a concerning trend toward the deterioration of dental hard tissues. The increase in DMFT and BEWE scores highlights a significant environmental shift in the oral cavity post-surgery. This duality is crucial for clinical understanding. 1. Anatomical and Physiological Factors: The increased prevalence of dental erosion is likely driven by GERD. Although both LRYGB and LSG carry a risk of reflux, our subgroup analysis indicated a higher erosion risk in the LSG group. This may be attributed to the technical elimination of the lower esophageal sphincter mechanism and the tubular shape of the gastric sleeve, which increases intragastric pressure. Frequent exposure of teeth to gastric acid (pH < 1.5) causes irreversible demineralization of enamel. 2. Behavioral and Dietary Factors: Post-surgery, patients adhere to a diet of frequent liquid or semi-solid meals. This eating pattern, combined with a potential reduction in mechanical oral hygiene due to post-operative nausea or psychological factors, increases the substrate availability for cariogenic bacteria and prolongs the acidic challenge on tooth surfaces. 4.3 Clinical Implications and Multidisciplinary Care The “dual effect” observed in this study underscores a critical gap in current bariatric care pathways. While patients are monitored for nutritional deficiencies and surgical complications, oral health is often overlooked. Pre-operative Counseling: Patients should be informed about the potential risk of dental erosion and caries. Post-operative Management: Routine dental check-ups should be mandated. Patients presenting with GERD symptoms should be monitored closely for enamel wear. Preventive Strategies: We recommend the use of high-fluoride toothpastes (5000 ppm) and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) pastes to enhance remineralization. Furthermore, patients should be advised to rinse with water or baking soda solution immediately after a reflux episode rather than brushing immediately, as brushing softened enamel can cause abrasion. 4.4 Limitations This study has several limitations inherent to its retrospective design. First, data on oral hygiene habits (brushing frequency, flossing) were self-reported and potentially inconsistent in the EMR. Second, the diagnosis of GERD was based on symptoms and PPI usage rather than objective pH-metry or endoscopy. Third, the 12-month follow-up may be insufficient to capture long-term periodontal regeneration or severe tooth wear; extended studies are warranted. 5. Conclusion Bariatric surgery exerts a dual influence on oral health. It significantly ameliorates periodontal inflammation through the reduction of systemic obesity-related inflammation. However, it concurrently increases the risk of dental erosion and caries, driven largely by post-operative gastroesophageal reflux and altered dietary habits. These findings suggest that oral health monitoring must be integrated into the multidisciplinary management of bariatric surgery patients to mitigate the detrimental effects of acid exposure while maximizing the metabolic and periodontal benefits. Declarations Human Ethics and Consent to Participate This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board (IRB) and Ethics Committee of Shanxi Bethune Hospital. Because of the retrospective nature of the study, the requirement for informed patient consent was waived by the Ethics Committee. All patient data were anonymized and de-identified prior to analysis to protect privacy. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Author Contribution Kai Ma and WenJun Zhao conceived and designed the study. WenJun Zhao collected the data and performed the statistical analysis. Kai Ma and WenJun Zhao wrote the main manuscript text. All authors reviewed the manuscript. References Bhupathiraju SN, Hu FB. Epidemiology of Obesity and Diabetes and Their Cardiovascular Complications. Circ Res. 2016;118(11):1723–35. Martinez-Herrera M, Silvestre-Rangil J, Silvestre FJ. Association between obesity and periodontal disease. A systematic review of epidemiological studies and controlled clinical trials. Med Oral Patol Oral Cir Bucal. 2017;22(6):e708–15. Martínez-García M, Hernández-Lemus E. Periodontal Inflammation and Systemic Diseases: An Overview. Front Physiol. 2021;12:709438. Cornejo-Pareja I, Clemente-Postigo M, Tinahones FJ. Metabolic and Endocrine Consequences of Bariatric Surgery. Front Endocrinol (Lausanne). 2019;10:626. Naik RD, Choksi YA, Vaezi MF. Impact of Weight Loss Surgery on Esophageal Physiology. Gastroenterol Hepatol (N Y). 2015;11(12):801–9. Sindi H, Almuzaini S, Mubarak A, Hakeem FF, Campus G, Fadel HT, et al. Oral Health in Individuals After Bariatric Surgery: A Systematic Scoping Review. Obes Surg. 2025;35(5):1878–99. Arboleda S, Pianeta R, Vargas M, Lafaurie GI, Aldana-Parra F, Chaux CF. Impact of bariatric surgery on periodontal status in an obese cohort at one year of follow-up. Med Int (Lond). 2021;1(2):4. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 20 Feb, 2026 Reviews received at journal 18 Feb, 2026 Reviewers agreed at journal 18 Feb, 2026 Reviewers agreed at journal 13 Feb, 2026 Reviewers agreed at journal 13 Feb, 2026 Reviewers invited by journal 11 Feb, 2026 Editor invited by journal 22 Jan, 2026 Editor assigned by journal 21 Jan, 2026 Submission checks completed at journal 21 Jan, 2026 First submitted to journal 14 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8600321","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":590768067,"identity":"e28030eb-c717-464a-bd3d-e28d88c1d2be","order_by":0,"name":"WenJun Zhao","email":"","orcid":"","institution":"Shanxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"WenJun","middleName":"","lastName":"Zhao","suffix":""},{"id":590768068,"identity":"203ce459-e4f3-4b07-ba9d-69a75dc2a9d1","order_by":1,"name":"Kai Ma","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYFACNgaGhAobO8b2BqjAAaK0nElLZu6BKSVKC2PLYcb2GQlEatFtP5b44WFDGjPvzOfPpG62Mcjx3Uhg/FyAR4vZmbTDEok7bPgkZ+cYG+e2MRhL3khglp6BT8uB9AaJxDNpzIazcxgfA7UkbriRwMbMg0/L+efNPxLbDjPuv3n8wWGglnrCWm6kHZMAaWmcwWAIsiXBgLCWZ2kWoEBm7AH6JeechOHMMw+bpfE7LM345g9wVB5/Jp1TZiPPdzz54Gd8WtCBBBAzNpCgYRSMglEwCkYBNgAAFRFSqNtFS/IAAAAASUVORK5CYII=","orcid":"","institution":"Shanxi Medical University","correspondingAuthor":true,"prefix":"","firstName":"Kai","middleName":"","lastName":"Ma","suffix":""}],"badges":[],"createdAt":"2026-01-14 09:53:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8600321/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8600321/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103503869,"identity":"ff9d07e3-2970-4b28-a9f7-135580c11268","added_by":"auto","created_at":"2026-02-26 13:03:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1006677,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8600321/v1/c0c22958-07d1-497e-ba83-853a06efa076.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Dual Effects of Bariatric Surgery on Oral Health: Periodontal Improvement versus Dental Erosion—A Retrospective Self-Controlled Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003e\u003cspan\u003e\u003cstrong\u003e1.1 Background\u003c/strong\u003e Obesity has reached pandemic proportions globally and is a well-established risk factor for cardiovascular disease, type 2 diabetes mellitus, and chronic inflammatory conditions(\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e). Oral health, an integral component of systemic well-being, is intricately linked to obesity. Extensive epidemiological evidence identifies obesity as an independent risk factor for periodontitis(\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e). The underlying mechanism involves the secretion of pro-inflammatory cytokines\u0026mdash;such as tumor necrosis factor-alpha (TNF-\u0026alpha;) and interleukin-6 (IL-6)\u0026mdash;by adipose tissue. These cytokines exacerbate the host\u0026rsquo;s immune response to bacterial biofilms, accelerating periodontal tissue destruction(\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003cstrong\u003e1.2 The Clinical Dilemma\u003c/strong\u003e Bariatric surgery (BS) is currently the most effective intervention for severe obesity and its metabolic comorbidities(\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e). The rapid post-surgical reduction in fat mass and the consequent improvement in metabolic profiles theoretically benefit periodontal health by reducing the systemic inflammatory burden. However, the anatomical alterations induced by surgery\u0026mdash;particularly the impairment of the lower esophageal sphincter\u0026mdash;frequently lead to Gastroesophageal Reflux Disease (GERD)(\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e). Furthermore, the post-operative dietary regimen (characterized by \u0026ldquo;frequent small meals\u0026rdquo;) and potential vomiting episodes expose the oral cavity to acidic substances for prolonged periods. This environment is conducive to dental erosion and caries, creating a potential conflict between soft tissue (periodontal) improvement and hard tissue (dental) deterioration.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003cstrong\u003e1.3 Objectives\u003c/strong\u003e Current literature presents conflicting views regarding the net effect of bariatric surgery on oral health(\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e), with few studies simultaneously evaluating the dichotomy between periodontal benefits and dental risks. This retrospective, self-controlled study aims to systematically assess the impact of bariatric surgery on both periodontal status and dental hard tissues over a 12-month period and to analyze the systemic and local factors driving these changes.\u003cbr\u003e\u003c/span\u003e\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003e\u003cb\u003e2.1 Study Design and Ethical Statement\u003c/b\u003e This was a single-center, retrospective, self-controlled study conducted at Shanxi Bethune Hospital. The requirement for informed consent was waived due to the retrospective nature of the analysis.\u003c/p\u003e\u003cp\u003e\u003cb\u003e2.2 Study Population Data Source\u003c/b\u003e: We performed a cross-referenced search of the Bariatric Surgery Database and the Electronic Medical Records (EMR) of the Department of Stomatology, covering the period from January 2018 to December 2022.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eInclusion Criteria\u003c/strong\u003e \u003cp\u003e1. Aged 18\u0026ndash;65 years. 2. Clinical diagnosis of morbid obesity (BMI\u0026thinsp;\u0026ge;\u0026thinsp;32.5 kg/m\u0026sup2;, according to Chinese guidelines). 3. Underwent laparoscopic Roux-en-Y Gastric Bypass (LRYGB) or Laparoscopic Sleeve Gastrectomy (LSG). 4. Possessed complete oral examination records at baseline (within 1 month pre-surgery) and at the 12-month follow-up (\u0026plusmn;\u0026thinsp;3 months).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eExclusion Criteria\u003c/strong\u003e \u003cp\u003e1. Received active periodontal therapy (scaling and root planing or periodontal surgery) during the study period. 2. History of orthodontic treatment or severe tooth wear prior to surgery. 3. Systemic diseases affecting bone metabolism (e.g., hyperthyroidism, long-term glucocorticoid use). 4. Pregnancy or lactation.\u003c/p\u003e \u003cp\u003e \u003cb\u003e2.3 Variables and Data Collection Demographic and Clinical Data\u003c/b\u003e: Gender, age, smoking history, alcohol consumption, and type of surgery.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMetabolic Indicators\u003c/strong\u003e \u003cp\u003eHeight, weight (to calculate BMI), fasting blood glucose (FBG), Glycated Hemoglobin (HbA1c), and high-sensitivity C-reactive protein (hs-CRP).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePeriodontal Health Indicators\u003c/b\u003e: * \u003cb\u003eBleeding on Probing (BOP %)\u003c/b\u003e: The percentage of sites bleeding upon probing, reflecting gingival inflammatory activity. * \u003cb\u003eProbing Depth (PD)\u003c/b\u003e: The mean distance from the gingival margin to the bottom of the sulcus/pocket. * \u003cb\u003eClinical Attachment Loss (CAL)\u003c/b\u003e: The distance from the cementoenamel junction to the bottom of the sulcus/pocket, indicating irreversible tissue destruction.\u003c/p\u003e \u003cp\u003e \u003cb\u003eDental Hard Tissue Indicators\u003c/b\u003e: * \u003cb\u003eDMFT Index\u003c/b\u003e: The sum of Decayed, Missing, and Filled teeth. * \u003cb\u003eBEWE Score\u003c/b\u003e: The Basic Erosive Wear Examination score was utilized to grade erosion severity (0\u0026thinsp;=\u0026thinsp;No wear; 1\u0026thinsp;=\u0026thinsp;Initial loss of surface texture; 2\u0026thinsp;=\u0026thinsp;Distinct defect, hard tissue loss\u0026thinsp;\u0026lt;\u0026thinsp;50%; 3\u0026thinsp;=\u0026thinsp;Hard tissue loss\u0026thinsp;\u0026gt;\u0026thinsp;50%). A cumulative score was calculated.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eReflux Assessment\u003c/strong\u003e \u003cp\u003eSince objective pH monitoring was unavailable in this retrospective cohort, the presence of reflux symptoms (heartburn or regurgitation\u0026thinsp;\u0026ge;\u0026thinsp;3 times per week) and the prescription of proton pump inhibitors (PPIs) were used as surrogate markers for GERD.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e2.4 Statistical Analysis\u003c/b\u003e Statistical analysis was performed using SPSS version 26.0 (IBM Corp., Armonk, N.Y., USA). Normality of data distribution was tested using the Shapiro-Wilk test. Normally distributed continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) and compared using paired \u003cem\u003et\u003c/em\u003e-tests. Non-normally distributed data were presented as medians (interquartile range) and analyzed using the Wilcoxon signed-rank test. Categorical variables were compared using the Chi-square test or McNemar\u0026rsquo;s test. Multivariate linear and logistic regression analyses were conducted to identify independent predictors of periodontal improvement and dental erosion. A \u003cem\u003eP\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e "},{"header":"3. Results","content":"\u003cp\u003e \u003cb\u003e3.1 Baseline Characteristics\u003c/b\u003e A total of 156 patients met the inclusion criteria. The cohort consisted of 112 females (71.8%) and 44 males (28.2%), with a mean age of 35.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.6 years. The majority of patients underwent Laparoscopic Sleeve Gastrectomy (LSG, n\u0026thinsp;=\u0026thinsp;118, 75.6%), while 38 patients (24.4%) underwent Roux-en-Y Gastric Bypass (LRYGB). Baseline demographic and clinical characteristics are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Demographic and Clinical Characteristics of the Study Population (N\u0026thinsp;=\u0026thinsp;156)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112 (71.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (28.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of Surgery, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaparoscopic Sleeve Gastrectomy (LSG)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118 (75.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRoux-en-Y Gastric Bypass (LRYGB)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (24.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmoking History, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePre-operative BMI (kg/m\u0026sup2;)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePre-operative hs-CRP (mg/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e3.2 Metabolic and Anthropometric Changes\u003c/b\u003e At the 12-month follow-up, patients achieved significant weight loss. Mean BMI decreased from 38.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 kg/m\u0026sup2; to 26.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5 kg/m\u0026sup2; (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Concurrently, the systemic inflammatory marker hs-CRP dropped significantly from 8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 mg/L to 2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 mg/L (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Glycemic control also improved, with HbA1c levels decreasing from 6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2% to 5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6% (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). See Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Metabolic Parameters Pre- and Post-Surgery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-Operative\u003c/p\u003e \u003cp\u003e(Baseline)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-Operative\u003c/p\u003e \u003cp\u003e(12 Months)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI (kg/m\u0026sup2;)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e38.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e26.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWeight (kg)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e105.4\u0026thinsp;\u0026plusmn;\u0026thinsp;15.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e73.2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ehs-CRP (mg/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFasting Blood Glucose (mmol/L)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHbA1c (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eNote: Data presented as Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD;\u003c/em\u003e indicates paired t-test.*\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e3.3 Changes in Periodontal Health (The \u0026ldquo;Improvement\u0026rdquo; Effect)\u003c/b\u003e Significant improvements in periodontal status were observed at the 12-month follow-up. BOP% decreased from 45.2% \u0026plusmn; 15.3% to 26.8% \u0026plusmn; 12.1% (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Mean Probing Depth (PD) reduced from 3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 mm to 2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5 mm (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). While CAL showed a slight trend towards improvement, the difference was not statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.062), indicating that while inflammation subsided, the regeneration of lost attachment was limited within the 12-month window. Correlation analysis revealed that the magnitude of CRP reduction was positively correlated with the reduction in BOP% (r\u0026thinsp;=\u0026thinsp;0.34, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e \u003cp\u003e \u003cb\u003e3.4 Changes in Dental Hard Tissue Health (The \u0026ldquo;Deterioration\u0026rdquo; Effect)\u003c/b\u003e In contrast to periodontal improvements, dental hard tissue health deteriorated. The DMFT index increased significantly from 8.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 to 9.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.032). The prevalence of high-risk erosion (BEWE cumulative score\u0026thinsp;\u0026ge;\u0026thinsp;2) rose from 15.4% (24/156) at baseline to 36.5% (57/156) at 12 months (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Subgroup analysis indicated that patients who underwent LSG had a significantly higher incidence of new erosion compared to the LRYGB group (41.5% vs. 21.1%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.018). See Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Oral Health Parameters Pre- and Post-Surgery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral Health Parameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-Operative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-Operative\u003c/p\u003e \u003cp\u003e(12 Months)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontal Parameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBOP %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.2\u0026thinsp;\u0026plusmn;\u0026thinsp;15.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePD (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCAL (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHard Tissue Parameters\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDMFT Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.032*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBEWE Score (Cumulative)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow Risk (0\u0026ndash;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e132 (84.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99 (63.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh Risk (\u0026ge;\u0026thinsp;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (15.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (36.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eNote: Continuous data presented as Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (paired t-test); Categorical data presented as n (%). \u0026dagger; indicates McNemar\u0026rsquo;s Test.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e3.5 Predictors of Oral Health Outcomes\u003c/b\u003e Multivariate regression analysis was performed to identify factors associated with clinical changes. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, a greater reduction in post-operative CRP was an independent protective factor for periodontal bleeding (OR\u0026thinsp;=\u0026thinsp;0.65, 95% CI: 0.50\u0026ndash;0.85). Conversely, the presence of frequent post-operative reflux symptoms (\u0026ge;\u0026thinsp;3 times/week) was identified as a strong independent risk factor for the progression of dental erosion (OR\u0026thinsp;=\u0026thinsp;3.12, 95% CI: 1.85\u0026ndash;5.24).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate Analysis of Factors Influencing Post-Surgical Oral Health Changes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDependent Variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePredictive Factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003cp\u003e(OR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% Confidence Interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImprovement in BOP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReduction in hs-CRP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.50\u0026ndash;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Binary Logistic)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmoking History\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.92\u0026ndash;3.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProgression of Dental Erosion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-op GERD Symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.85\u0026ndash;5.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Binary Logistic)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgery Type (LSG vs LRYGB)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.98\u0026ndash;2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-op Dietary Frequency (meals/day)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.95\u0026ndash;1.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e\u003cstrong\u003e4.1 The Metabolic-Periodontal Link: Anti-Inflammatory Benefits\u003c/strong\u003e The results of this retrospective study confirm the \u0026ldquo;anti-inflammatory\u0026rdquo; of bariatric surgery on periodontal tissues. The significant reduction in BOP and PD paralleled the decrease in serum CRP and BMI. This strongly supports the hypothesis that obesity-induced systemic inflammation exacerbates periodontitis. Adipose tissue acts as an endocrine organ secreting adipokines; the rapid reduction in fat mass following surgery decreases circulating levels of TNF-\u0026alpha; and IL-6, thereby mitigating the host\u0026rsquo;s hyper-inflammatory response to periodontopathogens. Our findings align with Arboleda et al.(7), who demonstrated similar improvements in periodontal indices following surgical weight loss.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2 The Acidic Challenge: Impact on Dental Hard Tissues\u003c/strong\u003e While periodontal health improved, our study revealed a concerning trend toward the deterioration of dental hard tissues. The increase in DMFT and BEWE scores highlights a significant environmental shift in the oral cavity post-surgery. This duality is crucial for clinical understanding. 1. \u003cstrong\u003eAnatomical and Physiological Factors:\u003c/strong\u003e The increased prevalence of dental erosion is likely driven by GERD. Although both LRYGB and LSG carry a risk of reflux, our subgroup analysis indicated a higher erosion risk in the LSG group. This may be attributed to the technical elimination of the lower esophageal sphincter mechanism and the tubular shape of the gastric sleeve, which increases intragastric pressure. Frequent exposure of teeth to gastric acid (pH \u0026lt; 1.5) causes irreversible demineralization of enamel. 2. \u003cstrong\u003eBehavioral and Dietary Factors:\u003c/strong\u003e Post-surgery, patients adhere to a diet of frequent liquid or semi-solid meals. This eating pattern, combined with a potential reduction in mechanical oral hygiene due to post-operative nausea or psychological factors, increases the substrate availability for cariogenic bacteria and prolongs the acidic challenge on tooth surfaces.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.3 Clinical Implications and Multidisciplinary Care\u003c/strong\u003e The \u0026ldquo;dual effect\u0026rdquo; observed in this study underscores a critical gap in current bariatric care pathways. While patients are monitored for nutritional deficiencies and surgical complications, oral health is often overlooked. \u003cstrong\u003ePre-operative Counseling:\u003c/strong\u003e Patients should be informed about the potential risk of dental erosion and caries. \u003cstrong\u003ePost-operative Management:\u003c/strong\u003e Routine dental check-ups should be mandated. Patients presenting with GERD symptoms should be monitored closely for enamel wear. \u003cstrong\u003ePreventive Strategies:\u003c/strong\u003e We recommend the use of high-fluoride toothpastes (5000 ppm) and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) pastes to enhance remineralization. Furthermore, patients should be advised to rinse with water or baking soda solution immediately after a reflux episode rather than brushing immediately, as brushing softened enamel can cause abrasion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.4 Limitations\u003c/strong\u003e This study has several limitations inherent to its retrospective design. First, data on oral hygiene habits (brushing frequency, flossing) were self-reported and potentially inconsistent in the EMR. Second, the diagnosis of GERD was based on symptoms and PPI usage rather than objective pH-metry or endoscopy. Third, the 12-month follow-up may be insufficient to capture long-term periodontal regeneration or severe tooth wear; extended studies are warranted.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eBariatric surgery exerts a dual influence on oral health. It significantly ameliorates periodontal inflammation through the reduction of systemic obesity-related inflammation. However, it concurrently increases the risk of dental erosion and caries, driven largely by post-operative gastroesophageal reflux and altered dietary habits. These findings suggest that oral health monitoring must be integrated into the multidisciplinary management of bariatric surgery patients to mitigate the detrimental effects of acid exposure while maximizing the metabolic and periodontal benefits.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eHuman Ethics and Consent to Participate\u003c/h2\u003e \u003cp\u003e This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board (IRB) and Ethics Committee of Shanxi Bethune Hospital. Because of the retrospective nature of the study, the requirement for informed patient consent was waived by the Ethics Committee. All patient data were anonymized and de-identified prior to analysis to protect privacy.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eKai Ma and WenJun Zhao conceived and designed the study. WenJun Zhao collected the data and performed the statistical analysis. Kai Ma and WenJun Zhao wrote the main manuscript text. All authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBhupathiraju SN, Hu FB. Epidemiology of Obesity and Diabetes and Their Cardiovascular Complications. Circ Res. 2016;118(11):1723\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartinez-Herrera M, Silvestre-Rangil J, Silvestre FJ. Association between obesity and periodontal disease. A systematic review of epidemiological studies and controlled clinical trials. Med Oral Patol Oral Cir Bucal. 2017;22(6):e708\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMart\u0026iacute;nez-Garc\u0026iacute;a M, Hern\u0026aacute;ndez-Lemus E. Periodontal Inflammation and Systemic Diseases: An Overview. Front Physiol. 2021;12:709438.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCornejo-Pareja I, Clemente-Postigo M, Tinahones FJ. Metabolic and Endocrine Consequences of Bariatric Surgery. Front Endocrinol (Lausanne). 2019;10:626.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaik RD, Choksi YA, Vaezi MF. Impact of Weight Loss Surgery on Esophageal Physiology. Gastroenterol Hepatol (N Y). 2015;11(12):801\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSindi H, Almuzaini S, Mubarak A, Hakeem FF, Campus G, Fadel HT, et al. Oral Health in Individuals After Bariatric Surgery: A Systematic Scoping Review. Obes Surg. 2025;35(5):1878\u0026ndash;99.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArboleda S, Pianeta R, Vargas M, Lafaurie GI, Aldana-Parra F, Chaux CF. Impact of bariatric surgery on periodontal status in an obese cohort at one year of follow-up. Med Int (Lond). 2021;1(2):4.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Bariatric surgery, Obesity, Periodontitis, Dental erosion, Retrospective study","lastPublishedDoi":"10.21203/rs.3.rs-8600321/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8600321/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eObesity shares a bidirectional pathophysiological relationship with periodontitis, primarily driven by chronic inflammation. While bariatric surgery (BS) effectively reduces systemic inflammatory load, the resulting anatomical and dietary changes may adversely affect dental hard tissues. This study aimed to retrospectively evaluate the dual effects of BS on periodontal health and dental hard tissues.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis single-center, retrospective, self-controlled study enrolled patients who underwent bariatric surgery (Roux-en-Y Gastric Bypass [LRYGB] or Sleeve Gastrectomy [LSG]) between January 2018 and December 2022. Clinical data, including Body Mass Index (BMI), C-reactive protein (CRP), periodontal parameters (Bleeding on Probing [BOP], Probing Depth [PD], Clinical Attachment Loss [CAL]), and dental hard tissue indices (Decayed, Missing, and Filled Teeth [DMFT]; Basic Erosive Wear Examination [BEWE]), were collected at baseline (pre-operative) and 12 months post-operative. Paired t-tests or Wilcoxon signed-rank tests were used for analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 156 patients were included. At 12 months post-surgery, mean BMI decreased significantly (38.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 kg/m\u0026sup2; vs. 26.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5 kg/m\u0026sup2;, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), accompanied by a marked reduction in serum CRP. Periodontal inflammation improved significantly, with BOP% decreasing from 45.2% \u0026plusmn; 15.3% to 26.8% \u0026plusmn; 12.1% (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Conversely, dental health showed signs of deterioration: the DMFT index increased (8.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 vs. 9.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.032), and the risk of high-grade enamel erosion (BEWE score\u0026thinsp;\u0026ge;\u0026thinsp;2) increased by 2.4-fold. Multivariate regression identified post-operative Gastroesophageal Reflux Disease (GERD) symptoms as an independent predictor of dental erosion (OR\u0026thinsp;=\u0026thinsp;3.12).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eBariatric surgery yields significant periodontal benefits via the attenuation of systemic inflammation; however, it concurrently poses a substantial risk for dental erosion and caries due to increased acidic exposure. Integrated multidisciplinary care addressing oral hygiene and acid management is recommended for bariatric patients.\u003c/p\u003e","manuscriptTitle":"The Dual Effects of Bariatric Surgery on Oral Health: Periodontal Improvement versus Dental Erosion—A Retrospective Self-Controlled Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-16 12:44:16","doi":"10.21203/rs.3.rs-8600321/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-20T07:12:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-19T02:11:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"199493435474292300589713765889423409344","date":"2026-02-19T01:54:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"79516762111511640889418514006289604346","date":"2026-02-13T09:18:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180907462181229101443413706644282015487","date":"2026-02-13T08:10:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-11T07:30:04+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-22T05:00:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-21T12:16:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-21T12:10:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2026-01-14T09:42:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e2dbe320-2a76-4286-8d9b-19d04b72ceed","owner":[],"postedDate":"February 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T12:44:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-16 12:44:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8600321","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8600321","identity":"rs-8600321","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}