Gastric bypass and gastric sleeve – caries risks

Nearly 5,000 bariatric surgeries are performed in Sweden every year – surgical interventions to treat obesity. The most common operations are gastric sleeve, in which the stomach is converted into a narrow tube, and gastric bypass, in which a small stomach pouch is created to which the small intestine is connected.

– It is an excellent treatment for morbid obesity, as it increases the quality of life and reduces the risk of a number of consequences. But at the same time, there are certain other consequences that are important to be aware of so that you can take action against them, says Negin Tagat, PhD, at the Department of Dentistry at Sahlgrenska Academy, University of Gothenburg.

Gastric bypass and gastric banding with caries

She has it in her thesis Studied oral health in obese people, that is, a body mass index greater than 40 (or more than 35 with obesity-related diseases such as diabetes), and how it is affected by different types of obesity treatment. The study included 118 people who were followed before and up to two years after treatment. One group received so-called medical treatment. This includes advice on lifestyle changes, nutritional therapy, physical activity support and possibly medication for weight loss. The other group underwent surgery.

Before treatment, it was generally considered that the higher the BMI, the greater the risk of developing cavities. For those with a BMI of 45 and above, the risk of developing cavities was doubled.

– We also saw that they went to the dentist less often, and that their last visit was more often an emergency visit.

Adverse consequences of obesity surgery

After two years of treatment, an interesting difference was seen. In the group that underwent surgery, the number of caries lesions on the tooth surface increased compared to what it was before surgery. In the group that received medical treatment, their numbers decreased after two years of treatment. Even when it came to deeper damage to the tooth’s bone, the same pattern was seen.

– Those who have undergone surgical treatment can also suffer from a range of symptoms from the mouth, and we have seen that almost everyone suffers from poor oral health, says Negin Taghat.

The difference remained even after taking into account the socioeconomic differences between the two groups. For example, low educational level was more common in the group that underwent surgery.

However, this did not affect the results in the statistical analyses, and the differences in caries remained between the two groups.

Couldn’t there be other differences between those who choose surgery over medical treatment, in terms of motivation to maintain a routine for example?

– It is certainly possible that there are differences that we have not considered, which could be the subject of further studies. You also need to go further and look at the reasons why it seems like that, it’s not something that fits with this thesis. What we have done is map your oral health before and after obesity treatment.

How can this knowledge be used?

-Staff in both dental and health care encounter these patient groups in their daily work. There are many people in Sweden who have surgeries every year, and this trend is on the rise. Hence it is important for staff to be aware so that they can act preventively and impart knowledge to patients. Today, it is not routine to tell people who are going to undergo these operations about how they will affect their oral health, and it is important to communicate with them.