TNF and periodontal disorder: The plausible association between BMI and CAL could be attributed to increased production of adipokines that alter the balance between pro-inflammatory cytokines (IL-1, IL-6, TNF-α, etc.)and anti-inflammatory cytokines (visfatin, leptin, resistin, and adiponectin) thereby shifting the immune response against periodontal pathogens which ultimately leads to increased susceptibility to periodontal disease [21].