According to the CDC, periodontal disease is more common among men than women with 56.4% being affected.1 A case-control study published in April 2021 in the journal Oral Disease aimed to “compare the prevalence of chronic periodontitis between men who had semen abnormalities and those who had normozoospermia through a case-control study.”2
A total of 192 individuals participated in the case-control study. This included 63 participants with some type of semen abnormality (32.8%) and 129 participants had normozoospermia (67.2%). A self-administered questionnaire regarding socio-demographic background, lifestyle and general health was collected. Participants were asked to remain abstinent for 3to 5 days prior to semen collection. Semen was collected and analyzed for sperm concentration, sperm count and progressive and non-progressive motility. A full mouth periodontal exam was conducted, periodontal parameters included bleeding on probing (BOP), probing depth (PD), and clinical attachment loss (CAL). Periodontal disease diagnosis was based on the CDC/AAP case definitions for the surveillance of periodontitis.
Among the 192 participants, 67 (34.9%) were classified as healthy, 81 (42.2%) had mild periodontal disease, and 44 (22.9%) had moderate or severe periodontal disease. A significantly higher proportion of participants with semen abnormalities had moderate to severe periodontal disease. Participants with abnormalities related to sperm motility had a higher percentage of BOP. The results, after adjusting for confounding factors, showed participants with moderate to severe periodontal disease had a greater chance of having semen abnormalities. It is noteworthy to mention there was no significant difference was found in PD and CAL in the two groups.
Two mechanisms of action have been suggested in previous studies. One suggested mechanism is that “periodontal pathogens could penetrate the epithelial barrier of the periodontal tissue and enter the blood circulation, leading to bacteremia and bacteriospermia.” Another suggestion hypothesizes “the toxins and antigens produced by oral bacteria can induce lipopolysaccharide to activate macrophages in periodontal tissues, releasing a large number of cytokines into the circulatory system.”
Limitations mentioned by the authors of the study include lack of causal relationship, radiographs were not taken, and the participants were limited to Chinese men only. Further studies are needed to assess other population groups as well as determine a causal link.
The authors conclude by stating, “some periodontal health conditions are associated with semen parameters in men, especially semen motility. Moderate or severe periodontitis is an important factor that may be associated with the quality of male semen while more gingival bleeding is associate with poorer sperm quality.”
How will you use this knowledge to better serve your patients? If you have a patient that reveals they are having fertility issues, would you feel comfortable discussing the findings in this paper? Do you see a route to bridge the gap between reproductive healthcare providers and dental providers through this knowledge?
- Centers for Disease Control and Prevention. N.d. Oral Health. Periodontal Disease. Retrieved from https://www.cdc.gov/oralhealth/conditions/periodontal-disease.html
Tao DY, Zhu JL, Xie CY, et al. Relationship between periodontal disease and male infertility: A case-control study. Oral Dis. 2021;27(3):624-631. doi:10.1111/odi.13552