Short-Term Changes in Salivary IL-6, TNF-α, and Periodontal Inflammation Following Sleeve Gastrectomy in Patients with Obesity: A Randomized Controlled Pilot Study

Background: Obesity and periodontitis share inflammatory pathways. This pilot randomized controlled trial evaluated salivary IL-6 and TNF-α and periodontal changes after sleeve gastrectomy (SG) versus non-surgical management (NSG). Methods: Thirty-two adults with obesity and stage I–III periodontitis were randomized to SG (n = 18) or NSG (n = 14) and assessed at baseline, 3 months, and 6 months. Primary outcomes were salivary IL-6 and TNF-α; secondary outcomes were PI, BOP, PPD, and CAL. Results: At 6 months, SG participants had lower BMI than NSG participants (32.20 ± 3.90 vs. 42.10 ± 4.30 kg/m2; p = 0.0001). Primary cytokine outcomes also favored SG: IL-6 was 3.72 ± 1.08 vs. 6.34 ± 1.37 pg/mL and TNF-α was 5.11 ± 1.29 vs. 7.71 ± 1.68 pg/mL (both p = 0.0001). PI and BOP were lower in SG than NSG (38.60 ± 9.80% vs. 60.80 ± 10.40% and 20.80 ± 7.40% vs. 39.70 ± 9.10%; both p = 0.0001), while PPD was modestly lower (2.89 ± 0.43 vs. 3.31 ± 0.46 mm; p = 0.017) and CAL was not significantly different (p = 0.15). Conclusions: These preliminary pilot findings suggest parallel reductions in salivary inflammatory markers and plaque-related/gingival-inflammatory indices after SG, but behavioral confounding, complete-case analysis, short follow-up, and absent significant CAL gain preclude causal or regenerative conclusions.