TNF and obesity due to melanocortin 4 receptor deficiency: The interaction between bacterial load and host response links periodontitis to DM, cardiovascular7,8 and kidney diseases,9 preterm birth, and low birth weight newborn babies.10 Although its pathophysiological mechanism is unknown, studies have suggestedthat obesity may be a risk factor for periodontitis,11,12 as first proposed by Perlstein & Bissada.13 Some studies propose that the high levels of circulating proinflammatorycytokines such as interleukin-1β (IL-1β), IL-6, tumor necrosis factor-α (TNF-α) inpatients with obesity may increase periodontal destruction.