TNF and obesity due to melanocortin 4 receptor deficiency: The association between obesity and periodontitis can be explained by the fact that the adipose tissue of the patients with excessive weight secretes inflammatory mediators, such as the tumor necrosis factor alpha, the interleukin 6, and the C-reactive protein, which can make the host more susceptible to inflammation.1,4,32 Therefore, patients with overweight/obesity can have higher levels of inflammation anddestruction of the periodontium, even in the presence of a normal amount of bacterial plaque, compared with patients with normal weight.