Adipokines and Inflammatory Biomarkers Linking Obesity and Periodontitis: A Critical Review

Background: Obesity and periodontitis change the inflammatory and adipokine profiles. The interpretation depends on the biomarker, specimen, and comparison used. This study was designed to evaluate clinical associations involving resistin, adiponectin, interleukin-6, and tumour necrosis factor-α. It also sought to assess treatment responses and implications for periodontal care.

Methods: In this critical review, clinical publications through July 2025 and molecular studies without date restriction were analysed. Observational studies, treatment reports, and randomised trials were analysed. Molecular studies were not date-restricted. Studies were analysed by study type, biomarkers, and biological specimens. The interpretation of observational associations, within-group changes, and the effects of treatment were performed separately.

Results: Obesity with poor periodontal health was associated with higher local pro-inflammatory cytokines, higher circulating resistin and leptin, and decreased adiponectin levels. The local and circulating profiles varied. Seven treatment reports described improvements in periodontal measures, but circulating adipokine levels did not consistently change. One randomised trial demonstrated lower high-sensitivity C-reactive protein levels after an intensive treatment package containing azithromycin; another found no significant between-group change in salivary resistin levels. Molecular findings remain exploratory.

Conclusions: The evidence reviewed indicates that there are relationships between adiposity, periodontitis, and host biomarkers. However, the studies reviewed offer no support for a universal biomarker pattern, use of biomarkers in practice, or prevention of cardiometabolic events. Practitioners should evaluate periodontal outcomes while the use of biomarkers demands standardisation and clinical relevance.

Keywords: Periodontitis, obesity, adipokines, inflammatory biomarkers, periodontal therapy, clinical interpretation.