Metabolic syndrome affects more than one third of adults in the United States and increases the risk of diabetes and heart disease. It also influences oral health, particularly periodontitis, but the biological explanations for this connection remain unclear.

With a major new award from the National Institutes of Health, Sukirth Ganesan, the Dentistry Centennial Associate Professor in the Department of Periodontics, is leading a broad interdisciplinary study to better understand how metabolic health shapes the oral environment. The goal is to identify specific microbial and metabolic features in the mouth that signal health risks earlier, support prevention, and improve long‑term outcomes for patients.

This project builds on Ganesan’s earlier exploratory study, which showed that people with metabolic syndrome have oral microbial communities that look very similar to those found in individuals with periodontal disease, even when their gums appear healthy. These patients also had higher levels of inflammation in the mouth and lower levels of protective metabolites compared to people without metabolic syndrome. The findings suggest that metabolic syndrome creates an oral environment that is at greater risk for future disease, even before symptoms are visible.

The new project follows people with metabolic syndrome or obesity for two years as they undergo lifestyle, medical, or surgical interventions to improve their metabolic health. By tracking how the oral microbiome and metabolome change during that process, the team hopes to determine whether improvements in systemic health lead to meaningful improvements in the mouth.

The study has three main goals. The first is to understand how the oral microbiome shifts over time as metabolic health improves. Earlier work from Ganesan’s group identified specific strains of bacteria, including virulent forms of Porphyromonas gingivalis and Selenomonas, that were more common in people with metabolic syndrome. Monitoring these strains over time may show whether meaningful reductions occur after metabolic interventions.

The second goal is to examine how the metabolic byproducts in the mouth change. The research team will use advanced mass spectrometry methods to measure metabolites and inflammatory markers in the gingival crevicular fluid. These data may reveal whether the oral environment becomes less inflammatory when metabolic health improves.

The third goal is to identify oral biomarkers that signal broader changes in metabolic health. By linking microbial and metabolic data from the mouth with measures such as blood pressure, lipid levels, insulin resistance, and body mass index, the project aims to determine whether simple oral sampling could help track a patient’s metabolic health in the future.

“The mouth may reflect systemic health changes earlier than we currently recognize. Understanding that connection could change how we think about prevention,” Ganesan said.

Together, this work supports a growing recognition that oral health and systemic health are deeply connected. It also highlights the potential for oral health professionals to play a valuable role in early identification and prevention of systemic disease.

Ganesan explained, “Metabolic health affects far more than the body’s major organs. It also influences the microbial communities in the mouth that are essential for oral health. By understanding how these systems interact, we hope to identify early signs of risk and move toward more personalized approaches to disease prevention.”

Ganesan’s research team includes Marcelo Correia (Clinical Assistant Professor of Internal Medicine-Endocrinology and Metabolism), Shareef Dabdoub (Assistant Professor in the Division of Biostatistics and Computational Biology), Ashutosh Mangalam (Associate Professor in the Department of Pathology), Jessica Smith (Clinical Associate Professor of Surgery), Eric Taylor (Professor of Molecular Physiology and Biophysics), and Shaoping Zhang (Associate Professor of Periodontics). 

Research reported on this website is being supported by the NIH under Award Number R01 DE034679-01A1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.