To evaluate the prevalence of acute periapical abscesses (PAs) in obese patients.Integrated data of hospital patients was used. Data from the corresponding diagnosis codes for obesity and PAs was retrieved by identifying the appropriate ICD 10 codes in the database.Out of 1,874,214 hospital patients studied, 147,195 patients were classified as obese, of which 3,349 had acute PAs. The difference in prevalence of PAs between obese and average-weight patients was statistically significant (OR 4.22, 95%CI: 4.05-4.39, P< 0.0001). Adjustment for diabetes comorbidity reduced the OR to 2.55; however, the difference remained statistically significant (95%CI: 2.43-2.68, P< 0.0001). Adjustment for smoking reduced the OR to 2.63; however, the difference remained statistically significant (95%CI: 2.51- 2.87, P< 0.0001). Adjustment for periodontal disease comorbidity reduced the OR to 3.85; however, the difference remained statistically significant (95%CI: 3.70-4.01, P< 0.0001). Females were more affected than males; adults were more affected than children; and African Americans were more affected than Whites.Oral healthcare providers should be aware of the possible higher prevalence of periapical abscesses in obese patients as compared to average-weight individuals.