Comparison of prevalence of periodontal disease in women with polycystic ovary syndrome and healthy controls

A Potential Link Between Oral Microbiota and Female Reproductive Health

Oral cavity dysbiosis is associated with numerous inflammatory diseases, including diabetes, inflammatory bowel diseases, and periodontal disease. Changes in the oral microenvironment lead to bidirectional interactions between pathogens and individual host systems, which may induce systemic inflammation. There is increasing evidence linking the condition of the oral cavity with the most common causes of female infertility, such as polycystic ovary syndrome and endometriosis, as well as gestational complications, e.g., low birth weight, preterm delivery, and miscarriages. This review highlights the composition of the female oral microbiome in relation to infertility-related disorders, such as endometriosis and polycystic ovary syndrome, and provides a comprehensive overview of the current state of knowledge on the relationship between a dysbiotic oral microbiome, pregnancy, and its impact on the female reproductive tract.

Impact of body mass index and polycystic ovary syndrome (PCOS) subtypes on periodontal health in Chinese women with PCOS and periodontitis

BACKGROUND

This study aimed to investigate the impact of body mass index (BMI) and Polycystic Ovary Syndrome (PCOS) subtypes on periodontal parameters in Chinese women with PCOS and periodontitis.

METHOD

We conducted a retrospective case-control study analyzing data from 88 women with PCOS and 82 healthy controls. Participants were categorized by BMI (<24.0 kg/m2and ≥24.0 kg/m2) and PCOS subtypes. We compared periodontal parameters [including probing depth (PD), gingival bleeding index (GBI)] and reproductive hormone-related parameters.

RESULTS

Women with PCOS and periodontitis had a significantly higher GBI (2.71 ± 0.53) compared to controls (2.25 ± 0.41, p < 0.0001). Among patients with BMI <24.0 kg/m2, those with PCOS had a younger age [25.00(5.00) vs. 26.00(6.00) years, p < 0.05], lower PD [3.24(0.55) mm vs. 3.43 (0.48) mm, p < 0.01], and higher GBI [2.63(0.76) vs. 2.23(0.55), p < 0.0001]. For BMI ≥24.0 kg/m2, PCOS patients had a higher GBI [2.91(0.36) vs. 2.38(0.59), p < 0.01] but a lower percentage of severe periodontal disease (p < 0.05).

CONCLUSION

PCOS could potentially worsen gingival inflammation among women already suffering from periodontitis, and a higher BMI might further intensify this correlation.

Prevalence of co-morbidities among periodontitis and non-periodontitis Indian patients

Periodontitis being an immuno-inflammatory disease can act as an aggravating factor for various systemic diseases. Therefore, it is of interest to document the prevalence of comorbidities among periodontitis and non-periodontitis Indian patients. 680 patients were enrolled, categorized into non-periodontitis group (Group A) and periodontitis group (Group B). Each group was again sub-grouped into comorbidities and non-co-morbidities. Periodontitis patients were found to have significantly more co-morbidities than non-periodontitis patients. Osteoporosis and obesity showed statistically higher levels in periodontitis patients. Hypertension, diabetes mellitus, cardiovascular diseases, and COVID-19 infection showed higher prevalence in periodontitis group, though the difference was statistically non-significant.

[Polycystic ovary syndrome is positively correlated with periodontitis: a prospective study]

OBJECTIVE

To explore the correlation between polycystic ovary syndrome (PCOS) and periodontitis in light of cytokines levels, sex hormone levels and metabolism-related indicators and their changes during progression of the two diseases.

METHODS

Twenty healthy subjects and 40 patients diagnosed with PCOS underwent full-mouth periodontal examinations to obtain full-mouth plaque score (FMPS), gingival bleeding index of probing (BOP), probing depth (PD), and clinical attachment level (CAL). The participants were divided into Group A without periodontitis or PCOS (n=15), Group B with PCOS but without periodontitis (n=28), Group C with periodontitis but without PCOS (n=5), and Group D with both diseases (n=12). Serum levels of luteinizing hormone/follicle stimulating hormone (LH/FSH), testosterone, prolactin, progesterone and estradiol, and the levels of interleukin 6 (IL-6), IL-17A, tumor necrosis factor α and matrix metalloproteinase 8 (MMP-8) in both serum and saliva samples were measured at the time of enrolment and at 3 and 6 months after enrolment and compared among the 4 groups.

RESULTS

Serum MMP-8 level was significantly higher in Group B than in Group A (P<0.05). Salivary MMP-8 level was significantly higher in Group D than in Group B (P<0.05). Salivary MMP-8, LH, and LH/FSH levels and serum and salivary IL-6 and progesterone levels all tended to increase in the 6 months after enrollment (OR>1, P<0.05). During the follow-up period, serum IL-6 levels differed significantly between the non-PCOS groups (A and C) and PCOS groups (B and D)(P<0.05); serum IL-6 and salivary MMP-8 levels differed significantly between the non-periodontitis groups (A and B) and periodontitis groups (C and D)(P<0.05). Spearman correlation analysis indicated positive correlations of LH and LH/FSH with PD (P<0.05); testosterone and LH/FSH were positively correlated with serum MMP-8 levels (P<0.05), and PD, BOP and FMPS were positively correlated with salivary MMP-8 levels (P<0.01).

CONCLUSION

There is a correlation between PCOS and periodontitis, and their progression is accompanied by changes in serum and salivary levels of pro-inflammatory cytokines and serum sex hormones.

Impact of Polycystic Ovary Syndrome on Periodontal Status of Women of Adolescent and Adult Age Groups: A Cross-Sectional Study

OBJECTIVE

Polycystic ovary syndrome (PCOS) is identified as the most common endocrine disorder in reproductive-aged women, and symptoms of PCOS appear during the early pubertal age. There is a gap in knowledge in recognizing the status of gingival inflammation/periodontal destruction and high-sensitivity C-reactive protein levels (hsCRP) in adolescents versus adults with PCOS. This study aimed to observe the impact of PCOS on periodontal status and systemic inflammation in adolescents and compared them with adults with PCOS.

METHODS

A total of 100 newly diagnosed female subjects with PCOS were enrolled into two groups: adolescents (11-19 years, n = 50) and adult females (20-40 years, n = 50). Periodontal parameters, anthropometric parameters, PCOS phenotype, hirsutism score, and serum hsCRP levels were recorded.

RESULTS

High levels of mean hsCRP, gingival index, and bleeding on probing % were observed in adolescent and adult PCOS groups, though nonsignificant between the groups (p > 0.05). Significantly more sites with probing pocket depth 3-4 mm, higher mean clinical attachment level (CAL) and sites with CAL 1-2 mm, and high frequency of patients (n = 11) with periodontitis (stage 1) were observed in adults with PCOS compared to adolescents (p ≤ 0.05). Similar and predominant prevalence of PCOS phenotype A (66%) and moderate hirsutism (46% adolescents vs. 58% adults) were observed in both groups.

CONCLUSION

Similar levels of hsCRP and periodontal inflammation were found in adolescents and adults with PCOS. More periodontal tissue destruction was observed in adults with PCOS as compared to adolescents with PCOS.

Causal relationship between PCOS and related sex hormones with oral inflammatory diseases: a bidirectional Mendelian randomization study

Background

Observational studies have identified a strong association between polycystic ovary syndrome (PCOS) and hormone levels related to oral inflammatory diseases. To better understand the relationship between them, we conducted an analysis using a two-sample Mendelian randomization (MR) approach.

Methods

We gathered summary statistical data from previously published genome-wide association studies (GWAS) on PCOS and three sex hormones (AMH, Estradiol, LH) along with four oral inflammatory diseases (painful gums, loose teeth, mouth ulcers, and toothache). We selected single nucleotide polymorphisms (SNPs) as instrumental variables and employed four types of MR analysis methods to evaluate causal relationships between exposure and outcome. Finally, the robustness of our results was further validated through sensitivity tests and reverse MR.

Results

We observed that PCOS could increase the risk of mouth ulcers (ORIVW= 1.0013, 95%CI: 1.0001-1.0025, PIVW = 0.0278), painful gums (ORIVW= 1.0015, 95%CI:1.0003-1.0027, PIVW = 0.0163), and loose teeth (ORIVW= 1.0014, 95%CI: 1.0001-1.0027, PIVW = 0.0328). Moreover, LH was also found to increase the risk of mouth ulcers (ORIVW= 1.0031, 95%CI: 0.0001-1.0062, PIVW = 0.0457). MR-Egger regression, weighted mode, and WE indicated similar results. Additionally, we discovered no causal link between PCOS and toothache (PIVW>0.05), LH and painful gums, loose teeth, or toothache (PIVW>0.05), or AMH and Estradiol level with any of the four oral diseases (PIVW>0.05).

Conclusion

Our research provides new insights and references for exploring the effects of PCOS and related hormones on oral inflammatory lesions. For patients with PCOS, especially those with elevated LH levels, early intervention measures should be taken to prevent the occurrence of oral inflammatory diseases.

Evaluation of periodontal status in women with polycystic ovary syndrome versus healthy women: a cross-sectional study

BACKGROUND

Polycystic ovary syndrome (PCOS) affects approximately 4% to 12% of females of reproductive age. Previous studies have shown an association between systemic and periodontal diseases. This study aimed to compare the prevalence of periodontal disease in women with PCOS and healthy women.

METHODS

A total of 196 women aged 17 to 45 years were included in this study. Oral hygiene index-simplified (OHI-S), gingival index (GI), community periodontal index (CPI), and loss of attachment (LA) were assessed. Individuals who smoked, were pregnant, had any systemic disease (such as type 1 or type 2 diabetes mellitus, cardiovascular disease, malignancy, osteoporosis, and thyroid dysfunction), had a history of systemic antibiotic use in the past three months, or received any periodontal intervention in the past 6 months of screening were excluded. Student t-test was used to analyze the data. A p-value of <0.05 was considered statistically significant.

RESULTS

Despite similar OHI-S scores (p=0.972) in the two groups, women with PCOS had significantly higher GI, CPI, and LA scores than healthy women (p<0.001).

CONCLUSION

Periodontal disease was more prevalent in women with PCOS than in healthy women. This finding may be due to the synergistic effects of PCOS and periodontitis on proinflammatory cytokines. PCOS may have an effect on periodontal disease, and vice versa. Hence, education on periodontal health and early detection and intervention for periodontal diseases is of paramount importance in patients with PCOS.

Risk of Periodontal Diseases in Women With Polycystic Ovary Syndrome: An Overview

Polycystic ovary syndrome (PCOS) is the most prevalent condition seen in reproductive-aged women, which has a negative impact on their health system. There is a serious concern for women having PCOS that they may experience long-term metabolic conditions. PCOS also has a negative impact on periodontium components such as gingiva, periodontal ligament (PDL), and alveolar bone. It has been said that there may be a bidirectional link between PCOS and periodontal diseases. Moreover, PCOS and periodontal disorders both have common risk factors. Periodontal diseases are exacerbated by systemic low-grade inflammation, including obesity, constant immunological imbalance, and oxidative stress caused by PCOS. On the other hand, periodontal diseases can also increase the risk of causing PCOS. According to recent data, women with PCOS may be more likely to suffer from periodontal diseases. A PubMed and Google Scholar search was conducted for literature relating to PCOS and its relationship with different comorbidities which also included periodontal disorders. Analyses were performed, and data was synthesized and assembled in a presentable form. Therefore, the focus of this review will be on the relationship between PCOS and periodontal disorders, as well as the risk factors for both. However, in order to establish a more distinct and solid link, more studies with a large sample size need to be done.

Comparative Assessment of Periodontal Status in Subjects with and without Polycystic Ovary Syndrome and its Correlation with Body Mass Index: A Cross-Sectional Study

New avenues for research have opened, which assess the influence of systemic disease on periodontium and vice versa. To find the correlation between polycystic ovary syndrome (PCOS) and periodontium by assessing clinical parameters [plaque index (PI), probing depth, periodontal disease index (PDI)] and the anthropological parameter [body mass index (BMI)] and to find the correlation between body mass index and periodontal disease index in subjects with and without PCOS. Sixty females comprising 30 with PCOS and 30 without PCOS were selected. Clinical, anthropological, and radiological assessment was done. Double blinding was incorporated. There was a statistically highly significant difference in mean age, mean PI, and mean PDI (P < 0.001) in PCOS group when compared to those without PCOS group by unpaired t-test for inter-group analysis. A statistically significant difference was found in mean probing depth and mean BMI (P < 0.05) in PCOS group when compared to those without PCOS group by unpaired t-test for inter-group analysis. No statistically significant correlation was found between mean PDI and mean BMI in PCOS and non-PCOS group subjects using Spearman's rank correlation. Women suffering from PCOS may be at a heightened risk for developing periodontal disease as our study re-establishes this association with respect to some periodontal parameters. With such a result, general practitioners/gynecologists can be encouraged to refer cases of PCOS to periodontists for early detection, prevention of periodontal disease, and maintenance of periodontal health.

Evaluation of Microbial Profile in Patients with Polycystic Ovary Syndrome and Periodontal Disease: A Case-Control Study

BACKGROUND

Polycystic ovary syndrome (PCOS) and oral health are found to share a reciprocal link. Previous substantiating evidences suggest that PCOS may have a confounding effect on periodontal health and may quantitatively modify the composition of the oral microbiome. To analyze the role of PCOS as a risk factor in causing periodontal disease, we compared and evaluated the levels of Porphyromonas gingivalis and Fusobacterium nucleatum in patients with polycystic ovary syndrome, polycystic ovary syndrome, chronic periodontitis, polycystic ovary syndrome, and gingivitis, and healthy controls.

MATERIALS AND METHODS

In this case-control study, 40 female participants are enrolled and grouped into four groups which included healthy female individuals, patients with PCOS, patients with PCOS and gingivitis, and patients with PCOS and periodontitis. Periodontal examination is assessed primarily on all the participants using a UNC-15 probe. Dental plaque is then collected using a sterile curette in one stroke and transferred into an Eppendorf tube containing TE Buffer (Tris-EDTA buffer) solution. The level of Porphyromonas gingivalis and Fusobacterium nucleatum nucleatum was estimated by real-time polymerase chain reaction (PCR).

RESULTS

The levels of Fusobacterium nucleatum were observed to be significantly higher in group with patients with PCOS and periodontitis.

CONCLUSION

PCOS may have an impact on the composition of oral microflora causing repercussions in periodontal health.

Bidirectional association between polycystic ovary syndrome and periodontal diseases

Polycystic ovary syndrome (PCOS) and periodontal disease (PDD) share common risk factors. The bidirectional interaction between PCOS and PDD has been reported, but until now, the underlying molecular mechanisms remain unclear. Endocrine disorders including hyperandrogenism (HA) and insulin resistance (IR) in PCOS disturb the oral microbial composition and increase the abundance of periodontal pathogens. Additionally, PCOS has a detrimental effect on the periodontal supportive tissues, including gingiva, periodontal ligament, and alveolar bone. Systemic low-grade inflammation status, especially obesity, persistent immune imbalance, and oxidative stress induced by PCOS exacerbate the progression of PDD. Simultaneously, PDD might increase the risk of PCOS through disturbing the gut microbiota composition and inducing low-grade inflammation and oxidative stress. In addition, genetic or epigenetic predisposition and lower socioeconomic status are the common risk factors for both diseases. In this review, we will present the latest evidence of the bidirectional association between PCOS and PDD from epidemiological, mechanistic, and interventional studies. A deep understanding on their bidirectional association will be beneficial to provide novel strategies for the treatment of PCOS and PDD.

Salivary microbiome differences in prepubertal children with and without adrenal androgen excess

BACKGROUND

Premature adrenarche is a condition of childhood adrenal androgen excess (AAE) in the absence of gonadotropin-dependent puberty, and has been linked to insulin resistance and progression to metabolic syndrome. Microbial dysbiosis is associated with progression of inflammatory states and chronic diseases. Here, we aimed to examine the salivary microbiomes of children with AAE and assess the relationship with adrenal androgens and metabolic parameters.

METHODS

In a prospective cross-sectional study of children with AAE and healthy controls, adrenal and metabolic parameters were characterized and salivary microbiome was profiled using V3-V4 16S rDNA gene amplicon sequencing.

RESULTS

There was increased α-diversity in AAE (5 M, 15 F) compared to controls (3 M, 8 F), with positive correlation of 11OHA4, 11KA4, testosterone, androstenedione, DHEA, and DHEAS. Subanalyses showed increased α-diversity in both overweight/obese AAE and normal weight AAE compared to normal weight controls. Genus Peptostreptococcus, Veillonella, and Streptococcus salivarius were increased in normal weight AAE. Genus Prevotella, Abiotrophia, and Neisseria were increased in overweight/obese AAE.

CONCLUSION

These pilot data demonstrate differences in salivary microbiome profiles of children with and without AAE. Further studies are needed to assess the causal relationships between adrenal androgens, metabolic dysfunction, and salivary microbiome composition.

IMPACT

This study is the first to report the salivary microbiome of prepubertal children with adrenal androgen excess (AAE). α-Diversity is increased in the salivary microbiome of children with AAE independent of weight status, and in this study cohort several serum androgens are positively associated with α-diversity. Several taxa that have been associated with periodontal disease and inflammation are found to be significantly increased in AAE.

Association between metabolic and hormonal profile, proinflammatory cytokines in saliva and gingival health in adolescent females with polycystic ovary syndrome

Background

Research studies indicate that polycystic ovary syndrome (PCOS) may increase susceptibility to periodontal disease. The mechanisms that link both conditions are not entirely understood. Thus, the study aimed to investigate the impact of hormonal and metabolic disturbances on the gingival health and salivary levels of tumor necrosis factor (TNF-α), interleukin 1β (IL1-β), and interleukin 6 (IL-6) in adolescent girls with PCOS.

Methods

Thirty-one patients with PCOS and twenty-eight healthy age-mates (as the control group) were enrolled in the study. Individuals with PCOS underwent blood tests for the determination of hormonal and metabolic parameters. Saliva samples were collected to measure salivary testosterone and proinflammatory cytokines in both studied groups. Calibrated dentist assessed oral hygiene and gingival health of all subjects.

Results

Salivary testosterone was significantly higher in the study group (p = 0.0007). The groups did not differ significantly concerning periodontal parameters. Patients with PCOS revealed higher levels of salivary cytokines (p < 0.0001). Gingival index (GI) and the percentage of sites bleeding upon probing (BOP%) were positively correlated with the plaque index (PI) in both groups (r_s ≥ 0.60, p < 0.001), and negatively correlated with salivary testosterone level in the PCOS group (r_s = − 0.44, p = 0.0138 and r_s = − 0.37, p = 0.0424, respectively). BOP% was also positively correlated with body mass index (BMI) in the control group (r_s = 0.40, p = 0.0368) and index of insulin resistance (HOMA-IR) in the study group (r_s = 0.48, p = 0.0068). Salivary testosterone was positively correlated with TNF-α in the control group (r_s = 0.41, p = 0.0321), while in the study group, total testosterone (TT) was positively correlated with IL-6 (r_s = 0.37, p = 0.0400) and free androgen index (FAI) with TNF-α (r_s = 0.36, p = 0.0491).

Conclusions

Gingival health of the examined population was associated primarily with oral hygiene and, to a lesser extent, with the hormonal and metabolic profile. Despite similar periodontal parameters in the both studied groups, patients with PCOS revealed significantly higher levels of proinflammatory cytokines in saliva, which might be the manifestation of the systemic low-grade inflammation associated with PCOS.

Subgingival microflora in adolescent females with polycystic ovary syndrome and its association with oral hygiene, gingivitis, and selected metabolic and hormonal parameters

OBJECTIVES

Research studies suggest that polycystic ovary syndrome (PCOS) may influence the composition of the oral microflora in women. This study aimed to investigate factors affecting the number of selected periopathogens in a young cohort of females with PCOS and to assess the association between oral hygiene, subgingival microbiome, gingival health, and metabolic and hormonal parameters.

MATERIALS AND METHODS

Thirty-two subjects with PCOS and twenty-three healthy controls aged 15-19 years were examined periodontally by a calibrated dentist. A real-time PCR method was used for the identification of 9 subgingival microorganisms. Subjects with PCOS underwent blood tests for determination of FSH, LH, total testosterone, DHEA-S, estradiol, SHBG, fasting glucose, fasting insulin, and lipid profile.

RESULTS

Gingival index (GI), the proportion of bleeding sites (BOP%), probing depth (PD), and plaque index (PLI) did not differ significantly between cases and healthy age-mates. The control group had significantly higher levels of Peptostreptococcus micros and substantially greater percentage of subjects infected by Treponema denticola. Capnocytophaga gingivalis count was positively correlated with the level of estradiol, while the concentration of HDL-C was negatively correlated with the number of Aggregatibacter actinomycetemcomitans and orange complex bacteria.

CONCLUSIONS

PCOS in young patients was not associated with higher pathogenicity of subgingival biofilms.

CLINICAL RELEVANCE

Further studies are needed to explain the relationship between hormonal and metabolic abnormalities, subgingival microflora, and periodontal health in patients with PCOS.

The Relationship Between Polycystic Ovarian Syndrome, Periodontal Disease, and Osteoporosis

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder to affect women in their reproductive years. There has been growing concern that women with PCOS may suffer from long-term metabolic consequences due to the high degree of insulin resistance that is often present in PCOS. However, few longitudinal studies exist in this area and there is a paucity of data on whether women with PCOS are at risk of other chronic diseases as they age. Specifically, current evidence suggests that reproductive-age women with PCOS may be at increased risk for both osteoporosis and periodontal disease (PD)-both these chronic diseases can have serious implications for health and quality of life. However, few studies have addressed how risk factors for osteoporosis and PD may be altered by aging in PCOS. The PCOS phenotype of women beyond reproductive years is poorly understood, and it is not known whether the metabolic profile of older women with PCOS results in an increased risk of osteoporosis and PD. The objective of this review is to discuss the relationships between PCOS, osteoporosis, and PD, and how these relationships could be impacted during aging. The long-term goal of this review is to provide direction for future research that is needed to more clearly elucidate these relationships and eventually provide a basis for evidence-based health recommendations.

Is There a Bidirectional Association between Polycystic Ovarian Syndrome and Periodontitis? A Systematic Review and Meta-analysis

Polycystic ovary syndrome (PCOS) has reproductive and metabolic properties that may be linked to periodontitis (PD). This study aimed to update and render a robust critical assessment on all evidence linking PCOS and PD, and appraising a hypothetical bidirectional association. Five databases (PubMed, Scholar, EMBASE, Web of Science and CENTRAL) were searched up to May 2020. Case-control and cohort studies on the association of PCOS and PD were included. The risk of bias of observational studies was assessed through the Newcastle-Ottawa Scale (NOS). Random effects meta-analyses of standardized mean difference (SMD) and risk ratio (RR) were performed. We followed Strength of Recommendation Taxonomy (SORT) to appraise the strength and quality of the evidence. Twelve case-controls fulfilled the inclusion criteria (876 with PCOS and 48170 healthy controls), all scored as having a low risk of bias. Meta-analysis revealed that PCOS females have 28% more risk towards PD, and PD females have 46% more risk to have PCOS. PCOS females with PD had higher gum bleeding, periodontal pocket depth and clinical attachment loss than non-PCOS females with PD. Populations with undefined periodontal status contribute to underestimated results. On the basis of the available evidence, it is possible to assume a bidirectional link between PCOS and PD. That is, PCOS increases by 28% the risk of having PD and in the same fashion, PD increases by 46% the risk of having PCOS. Furthermore, women with PCOS were associated with worsening clinical characteristics and inflammation of PD. These findings suggest that PCOS and PD may be linked. Hence, further prospective and clinical trial studies with nonsurgical periodontal therapy are necessary to clarify the existence of an increased risk of PCOS in women with PD and vice-versa.

Association between Periodontal Diseases and Polycystic Ovary Syndrome: A Systematic Review

Background: A convergent association between polycystic ovary syndrome (PCOS) and periodontal disease, in particular chronic periodontitis (CP), has recently been proposed. The underlying molecular mechanisms of this association are not fully understood, though it is thought that chronic inflammation is responsible. Therefore, the aim of this study was to evaluate the association between periodontal disease—gingivitis and CP—and PCOS. Materials and Methods: The PICO (Participants, Intervention, Control, and Outcomes) question was as follows: “Is there an association between PCOS and CP?” A systematic review of three databases—PubMed, Embase and Scopus—was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Original studies in human cohorts carried out in the last 10 years and including a control group were eligible for inclusion. Letters to the editor, case reports, and reviews were not considered. Results: Ten articles met all the selection criteria and provided a positive answer to the PICO question. Our review of these articles revealed an association between CP and PCOS, since periodontal parameters were altered more frequently in patients with these conditions than in healthy young women. This altered periodontal response in PCOS was associated with a proinflammatory status that seemed to increase susceptibility to periodontal disease. Conclusion: Patients with PCOS appear to be more susceptible to developing periodontal diseases than women without the pathology.

Evaluation of periodontal status in different phenotypes of polycystic ovary syndrome in untreated patients of early reproductive age: A case-control study

AIM

A few studies demonstrated an increased risk of periodontal disease in patients with polycystic ovary syndrome (PCOS). The aim of this study was to evaluate the periodontal status in women of reproductive age who were recently diagnosed with different phenotypes of PCOS.

METHODS

This prospectively designed cross-sectional case-control study included 116 consecutive subjects with PCOS and 90 healthy volunteers, aged between 18 and 24, who were admitted to the gynecology polyclinic between April 2018 and December 2018. All subjects of PCOS diagnosed using the Rotterdam criteria were subdivided into four phenotypes based on clinical, biochemical and ultrasonographic parameters according to the guidelines of the National Institutes of Health. The same dentist investigated periodontal parameters including plaque index, gingival index, bleeding on probing (%), probing depth, clinical attachment loss and the decayed, missing, filled teeth index.

RESULTS

Probing depth, a periodontal parameter, was higher in all sub-phenotypes of the PCOS group compared to the control group. There was no difference in other periodontal parameters.

CONCLUSION

Periodontal probing depth, which is an important parameter in the diagnosis of periodontal diseases, was higher in all phenotypic subgroups of PCOS in early reproductive age.

Association of Periodontal Disease and Polycystic Ovarian Syndrome: A Systematic Review and Meta-analysis with Trial Sequential Analysis

Introduction:

Several articles have suggested a potential synergistic relationship between periodontal disease and systemic inflammatory diseases, such as Polycystic Ovarian Syndrome (PCOS) and diabetes mellitus. However, the associations between periodontal disease and PCOS population remain unclear in the literature.

Objective:

The primary aim of this review is to examine the associations between periodontal disease and PCOS with different scoring methods, namely clinical attachment loss, probing depth, gingival index, percentage of bleeding on probing and plaque index.

Methods:

MEDLINE, EMBASE and CENTRAL were systematically searched for observational studies and case-control studies from its inception until 2nd June, 2019. Case reports, case series, non-systematic reviews and trials published as abstracts were excluded.

Results:

Four articles (614 subjects) were included for analysis. Out of 614 subjects, 329 PCOS patients were compared to 285 healthy subjects. In comparison to healthy cohort, women with PCOS had a statistically significant increase in clinical attachment loss (MD: 0.34, 95% CI: 0.13-0.55, ρ=0.002), probing depth (MD: 0.35, 95%CI: 0.21-0.48, ρ<0.001), gingival index (MD: 0.70, 95% CI: 0.70-1.11, ρ<0.001) and percentage of bleeding on probing (MD: 34.41, 95% CI: 20.23-48.59, ρ<0.001). No difference was demonstrated in plaque index (MD: 0.42, 95% CI: -0.29-1.12, ρ=0.24) for both PCOS and healthy cohort.

Conclusion:

PCOS is significantly associated with a higher severity of the periodontal disease. This association should be emphasized during the management of PCOS patients, by including referral to dentists or periodontists for regular mechanical debridement of plaque and periodontal maintenance.

Gingival crevicular fluid levels of visfatin in patients with chronic periodontitis and polycystic ovary syndrome

Objective

Recently, the association between periodontal diseases and polycystic ovary syndrome (PCOS) has been established, and it has been revealed that visfatin levels increase in chronic periodontitis (CP) and PCOS. However, there was no study comparing the mean visfatin levels between advanced CP and PCOS. Therefore, the probable role of visfatin linking these diseases remains unknown, and this study was conducted to address this gap.

Methods

In this age- and weight-matched case-control study (cases with PCOS disease and controls without it), 110 female participants were divided into 4 groups based on clinical findings. The 1st group participants had both PCOS and advanced CP (n=30), 2nd group participants had only PCOS (n=25), 3rd group participants had only advanced CP (n=23), and 4th group comprised of healthy participants (n=32). Enzyme-linked immunosorbent assay was used to investigate visfatin levels in the gingival crevicular fluid (GCF). Data were collected and analyzed using Stata software (version 11).

Results

The results revealed the significant effect of both PCOS and advanced CP on visfatin levels in the GCF (P<0.05).

Conclusion

According to the results of this study, the visfatin level in the GCF could be the probable link of association between PCOS and advanced CP.

Evaluation of oxidative status in patients with chronic periodontitis and polycystic ovary syndrome: A cross-sectional study

BACKGROUND

In patients with polycystic ovary syndrome (PCOS), chronic periodontitis (CP) contributed to increased oxidative stress (OS), owing to an increase in serum and salivary 8-hydroxy-2'-deoxyguanosine (8-OHdG) and malondialdehyde (MDA) levels and a decrease in serum total antioxidant status (TAS) levels. The aim of the present study is to investigate salivary and serum 8-OHdG and MDA levels as well as total antioxidant status (TAS) in females with CP and PCOS compared with healthy females.

METHODS

Four groups, each consisting of 22 individuals, were: 1) women with both PCOS and CP (PCOSCP); 2) systemically healthy women with CP; 3) periodontally healthy women with PCOS (PCOSPH); and 4) periodontally and systemically healthy women (PH). Demographic and clinical periodontal parameters were measured. Oxidative parameters were evaluated in serum and salivary samples.

RESULTS

Salivary 8-OHdG levels in the PCOSCP and CP groups were statistically higher than those in both the PCOSPH and the PH groups (P < 0.05). There was no statistical difference between the PCOSCP, CP, and PCOSPH groups with regard to salivary MDA and TAS levels (P > 0.05). Highest serum 8-OHdG and MDA levels and lowest serum TAS levels were seen in the PCOSCP group (P < 0.05). Serum 8-OHdG and MDA levels in the PCOSPH group were higher than those in both systemically healthy groups (PH and CP) (P < 0.05). Salivary TAS levels were highest (P < 0.05) in the PH group. There was no statistical difference between the CP and PCOSPH groups, but serum TAS levels were lower than those in the PH group (P < 0.05).

CONCLUSIONS

CP, which led to an increase in serum and salivary 8-OHdG and MDA levels and a decrease in serum TAS levels in patients with PCOS, contributed to increased OS. This effect was more prominent in serum levels than in salivary levels.

Increased Risk of Polycystic Ovary Syndrome in Taiwanese Women with Chronic Periodontitis: A Nationwide Population-Based Retrospective Cohort Study

Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women of reproductive age. Both hormonal and inflammatory influences are assumed to affect periodontal tissues. Previous studies have shown that PCOS patients could have higher prevalence of gingival inflammation. However, the relationship between PCOS and chronic periodontitis (CP) is not clear. Materials and Methods: In this study, we evaluated the risk of PCOS from CP exposure in a nationwide population-based retrospective cohort study in Taiwan. We studied the claims data of Taiwanese population from 2001 to 2012. The 24,410 female patients with CP were identified from the National Health Insurance Database. The 24,410 controls were selected with randomly frequency matched by age, sex, and index year from the general population. The risk of PCOS was analyzed by Cox proportional hazards regression models, including sex, age, and comorbidities. Results: In this study, 24,410 female patients with CP (mean age: 35.14 ± 8.81 years) and 24,410 controls (mean age: 35.14 ± 8.8 years) were observed for 8.89 and 8.85 years, respectively. A total of 441 cases of PCOS were identified in CP cohort and 304 cases in non-CP cohort. Multivariate Cox regression analysis indicated that the incidence rate of PCOS was significantly higher in CP cohort than those in non-CP cohort (adjusted hazard ratio: 1.44, 95% confidence interval: 1.24-1.67). Conclusions: Taken together, this nationwide retrospective cohort study demonstrated that the risk of PCOS was significantly higher in female patients with CP than those without CP in Taiwan.

Polycystic Ovary Syndrome and Periodontal disease: Underlying Links- A Review

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age, which negatively affects various health systems. There is an extensive literature regarding the association of PCOS and other systemic conditions such as diabetes mellitus, cardiovascular disease, and psychological disorders. However, there is a lack of literature in associating PCOS and periodontal disease. Hence, PubMed search was done for various articles related to PCOS and its association with other comorbidities, including periodontal diseases. Analysis was done and data were synthesized and compiled in a sequential and presentable paradigm. This literature review of the pathophysiological mechanisms linking the two diseases suggests a positive relation between the two comorbidities. However, multicenter studies, with larger sample sizes, are to be conducted to establish a clearer and stronger association.

Association between periodontal disease and polycystic ovary syndrome: a systematic review

The purpose of the present study was to review systematically the association between periodontal diseases (PDs) and polycystic ovary syndrome (PCOS). To address the focused question, 'Is there a relationship between PD and PCOS?' indexed databases were searched up to October 2016 without time or language restrictions using different combinations of the following key words: PCOS, ovarian cysts, PD, periodontitis, gingival diseases and gingivitis. Letters to the Editor, commentaries, historic reviews, case-report, unpublished articles and animal/experimental studies were excluded. Seven case-control studies were included. The number of study participants ranged between 52 and 196 females aged between 15 and 45 years. In three and three studies, proinflammatory cytokines were assessed in gingival crevicular fluid and saliva samples, respectively. In one study, salivary microbes were investigated. All studies reported that a positive association exists between PD and PCOS. In conclusion, there is a positive association between PD and PCOS; however, further well-designed longitudinal controlled clinical trials are needed in this regard. It is recommended that physicians should refer patients with PCOS to oral health-care providers for comprehensive oral evaluation and treatment.

The Salivary Microbiome in Polycystic Ovary Syndrome (PCOS) and Its Association with Disease-Related Parameters: A Pilot Study

Background: Polycystic ovary syndrome (PCOS) is a common female endocrine condition of unclear etiology characterized by hyperandrogenism, oligo/amenorrhoea, and polycystic ovarian morphology. PCOS is often complicated by infertility, overweight/obesity, insulin resistance, and low-grade inflammation. The gut microbiome is known to contribute to several of these conditions. Recently, an association between stool and saliva microbiome community profiles was shown, making saliva a possible convenient, non-invasive sample type for detecting gut microbiome changes in systemic disease. In this study, we describe the saliva microbiome of PCOS patients and the association of microbiome features with PCOS-related parameters.

Methods: 16S rRNA gene amplicon sequencing was performed on saliva samples from 24 PCOS patients and 20 healthy controls. Data processing and microbiome analyses were conducted in mothur and QIIME. All study subjects were characterized regarding reproductive, metabolic, and inflammatory parameters.

Results: PCOS patients showed a decrease in bacteria from the phylum Actinobacteria and a borderline significant shift in bacterial community composition in unweighted UniFrac analysis. No differences between patients and controls were found in alpha diversity, weighted UniFrac analysis, or on other taxonomic levels. We found no association of saliva alpha diversity, beta diversity, or taxonomic composition with serum testosterone, oligo/amenorrhoea, overweight, insulin resistance, inflammatory markers, age, or diet.

Conclusions: In this pilot study, patients with PCOS showed a reduced salivary relative abundance of Actinobacteria. Reproductive and metabolic components of the syndrome were not associated with saliva microbiome parameters, indicating that the majority of between-subject variation in saliva microbiome profiles remains to be explained.