Obesity is classed as a Body Mass Index (BMI) score of over 30 and in the UK 29% of adults are classed as being obese. This has been increasing over the years, with physical activity reducing and increased carbohydrate diets in the Western world. 

There are some limitations using BMI to measure obesity levels, as it does not take into account bone or muscle weight or genetic make-up. 

Bariatrics is the branch of medicine that deals with the causes, prevention and treatment of obesity. The term 'bariatric' is widely used throughout the literature referring to obese patients. 'Bariatric dentistry’ presents some unique challenges in the management of these patients.

People who are obese are likely to be over the weight of a standard dental chair - which is usually around 23-26 stone. This restricts the dental surgeries these patients can access safe treatment; most of the chairs which can take higher weights are based in community or hospital dental settings (as pictured above). Patients may therefore need to travel further to access care. It is not just the dental chair weight limit that would also need to be considered. Waiting room chairs and toilets will also have maximum weight limits.

If patients are severely obese, their mobility might be impaired. This could mean they rely on wheelchairs, or are unable to manage stairs. Dental surgeries that are not accessible with wide doors or step-free could not be suitable for their care. If patients cannot leave their homes due to their physical disability, then domiciliary care needs to be considered. Helping maneuver these patients whether it be in a clinic or at their homes is a manual handling risk for staff.

People who are obese are likely to have high carbohydrate diets and therefore are at higher caries risk. This could result in a higher treatment need. Combined with some of the co-morbidities they have, as discussed below, they are also likely to also have a high periodontal risk profile too. 

When providing clinical dentistry, there are specific challenges dental professionals also encounter such as:

Patients who are obese are more likely to suffer from other co-morbidities, such as:

1. Diabetes - There is a two-way link between periodontal disease risk and diabetes. Planning patient care when patients are diabetic is important, such as not disrupting their insulin/meal routines, seeing earlier on in the morning and taking blood glucose when appropriate. 

2. Cardiovascular Disease - these patients have increased risk of angina and heart attacks. This could lead to a medical emergency at the dentist. If a patient has had a recent myocardial infarction, elective dental treatment should be postponed ideally for 3-6 months afterwards. There may be oral side-effects of anti-hypertensive drugs the patient is taking e.g. nicorandil ulceration, amlodipine induced gingival hyperplasia. 

3. Respiratory Diseases & Sleep Apnoea - Patients may have respiratory issues and obstructive sleep apnoea which can affect decisions surrounding sedation/GA, discussed below. 

They may also have impaired wound healing, psychological problems such as depression that can affect motivation, and GORD which can lead to tooth surface loss. 

If sedation or general anaesthesia are considered for the dental management of bariatric patients, pre-assessment is very important for the safe delivery of their care. 

With their co-morbidities, patients who are bariatric may not be suitable for sedation or may need to be managed in secondary care. ASA classification should be used to assess patients’ medical complexities and whether to refer on. 

If they have uncontrolled hypertension, IV sedation is not appropriate, so this should be managed with their GP or inhalation sedation may be more appropriate. Similarly, if the patient has respiratory issues, especially obstructive sleep apnoea as mentioned earlier, this compromises their airway and so IV sedation or GA should be planned with care or avoided if possible since midazolam is a respiratory depressor. 

Because bariatric patients are bigger, usual drug doses may not be effective on patients which would be something to take into consideration if giving the patient a GA. IV access could be a challenge to administer IV sedation or GA drugs. Larger blood pressure cuffs would be needed, and if treatment is planned in a theatre space, bariatric beds may need to be used. 

Dental care for patients who are bariatric presents some unique challenges, from accessibility, to clinical difficulties, to the management of associated co-morbidities. Planning dental care under sedation or general anaesthesia can be difficult to ensure it is delivered safely, so where possible, treatment under local anaesthesia is preferable.