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J Am Dent Assoc, Vol 138, No 2, 179-187. © 2007 American Dental Association

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JADA Continuing Education

Pathogenesis, medical care and dental implications

Background. The dental literature contains little information about metabolic syndrome (MetS) and its dental implications.

Types of Studies Reviewed. The authors conducted a MEDLINE search for the period 2000 through 2005, using the term "metabolic syndrome" to define its pathophysiology, medical treatment and dental implications.

Results. MetS is the co-occurrence of abdominal obesity, hyper-triglyceridemia, reduced high-density lipoprotein cholesterol levels, hypertension and impaired fasting glucose, which results from consumption of a high-calorie diet and decreased levels of physical activity superimposed on the appropriate genetic setting. Components of MetS synergistically promote the development of atherosclerosis, resulting in myocardial infarction and stroke.

Clinical Implications. Deteriorating oral health status is associated with worsening of the atherogenic profile. Tooth loss often results in chewing difficulties because of inadequate occlusive surfaces and may lead to alterations in food selection and dietary quality. This, in turn, adversely affects body composition and nutritional status, both of which are related to vascular health. Dentists should develop treatment plans that preserve and restore the dentition, thus ensuring maximum masticatory efficiency and affording patients the optimum opportunity to consume food that will not foster atherogenesis.

Key Words: Hypertension; obesity; atherosclerosis; metabolic syndrome

Abbreviations: ACE: Angiotensin-converting enzyme • BMI: Body mass index • CYP3A4: Cytochrome P450 isoform 3A4 • FDA: Food and Drug Administration • FFAs: Free fatty acids • HDL-C: High-density lipoprotein cholesterol • IR: Insulin resistance • LDL: Low-density lipoprotein • LDL-C: Low-density lipoprotein cholesterol • MetS: Metabolic syndrome • NHANES III: Third National Health and Nutrition Examination Survey • PDGF: Platelet-derived growth factor

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