Post-surgical serum ferritin levels and tooth loss

A study evaluating the levels of serum ferritin before and after bariatric surgery and assessing whether there is a relation with tooth loss, reported that there was no significant difference regarding the serum ferritin levels between dentate (having a tooth-like or serrated edge) and edentulous (lacking teeth) patients prior to Roux-en-Y gastric bypass. However, after surgery the serum ferritin levels were higher in edentulous patients (prosthesis users) when compared to the pre-surgical levels, and the post-surgical levels presented significant difference regarding the dentate patients.

Ferritin is an intracellular protein responsible for fixing, storage and releasing of iron. Consequently, it is the main protein involved in the regulation and availability of iron ion. The researchers concluded that rehabilitated patients in postoperative period showed better levels of serum ferritin after surgical intervention.

The study, ‘Presence of Serum Ferritin before and after Bariatric Surgery: Analysis in Dentate and Edentulous Patients’, published in PlosOne, was undertaken by authors from the University of São Paulo, Bauru, São Paulo, the University of State of São Paulo, Botucatu, São Paulo, the University of São Paulo, São Paulo, and the State University of Campinas, Campinas, São Paulo, Brazil.

Following a pilot study (n=10), 50 patients were included in the study and oral health maintenance was evaluated in both dentate (n=29, 18 females) and edentulous patients (n=21, 17 females) during the post-operative period. Furthermore, prosthesis of the edentulous patients were analysed to make sure there still were in appropriate conditions.

Outcomes

The average weight loss after three months of the intervention was 33% for the group of dentate and 31% for the group of edentulous that were rehabilitated with total dental prosthesis and/or removable partial prosthesis.

The researchers report that in the preoperative period, there was no significant difference in the levels of serum ferritin between dentate and edentulous patients. However after bariatric surgery, there was an increase regarding serum ferritin levels in edentulous individuals, yet denture users (total dental prosthesis and/or removable partial prosthesis). This result presented a significant difference compared to the group of dentate patients.

Concerning the tooth loss, all partially or totally edentulous patients had molar loss, and 80% of these patients had lost premolars pre-surgically. The authors report that this reduces masticatory efficiency, harming the nutrition and, consequently, the surgery outcome of these patients.

According to the data, it was expected that the preoperative levels of serum ferritin were altered due to the nutritional deficiency presented by all patients, once obesity causes a general chronic inflammation associated to an inadequate food intake.

All patients of this study had nutritional attendance before and after bariatric surgery however, after the procedure, all of them were likely to develop altered frequency and quantities patterns of feeding and deficient absorption due to the surgery performed.

In this study only the dentate group preserved altered levels of ferritin. The group of edentulous patients, who had recently been rehabilitated with dental prosthesis, began to show normal levels of serum ferritin. This occurrence may be explained by the improvement in masticatory function of these patients. Consequently, they started to chew meat, fish and nutritive food that were not likely to be chewed before. Even with the reduction of the gastroesophageal tract, the prosthesis users started to chew better, resulting in an increase of ferritin levels.

The researchers also found that prosthetic rehabilitation of these patients started to contribute to food digestion and nutritive food choice, improving the nutritional status in general, especially as concerns the serum ferritin levels.

“These findings highlight that morbid obese patients who were candidates to bariatric surgery as well as patients that have already undergone this surgical procedure require follow-ups with dentists in order to be fully treated,” the authors concluded. “It may improve not only the results of this kind of surgery, but also the quality of life of these patients.”