Polycystic ovarian syndrome affects as many as 5 million U.S. women. It is the most common endocrine disorder and the most common cause of female infertility. PCOS contributes to insulin resistance and in recent years there has been growing concern regarding how this long-term metabolic issue might affect oral health. In a review published in June 2020 in the journal Reproductive Sciences. The authors aimed to “discuss the relationship between PCOS, osteoporosis, and PD, and how these relationships could be impacted during aging.”1
PCOS has 5 main characteristics which include insulin resistance/type 2 diabetes, hyperandrogenism, overweight/obesity, menstrual irregularities, and infertility. A notable overlap in disease characteristic and contributing factors to the onset and progression of periodontal disease includes estrogen deficiency, obesity, and type 2 diabetes. The relationship between PCOS and osteoporosis is much clearer as the pathway and mechanism has been established.
However, the proposed relationship and mechanism between PCOS and periodontal disease is not as clear. Though this is oversimplified, and I would encourage you to refer to the figure in the study, ultimately the proposed mechanism that connects PCSO and periodontal disease is increased production of inflammatory cytokines. This inflammation could contribute to changes in periodontal tissue, such as increased collagen fiber breakdown, increased vascular permeability, and increased destruction of gingival tissues contributing to the onset or progression of periodontal disease.
The role of female sex hormones and their association with gingival inflammation is well documented. As a matter of fact, pregnancy, puberty, ovulation, and oral contraceptives are all associated with an increased risk of gingivitis. Many women with PCOS have low levels of estrogen which has been associated with increased risk of periodontal disease. Low estrogen levels contribute to an imbalance in the remodeling of periodontal tissues which could lead to tooth loss. Very few studies have been conducted to assess periodontal disease in post-menopausal women with PCOS. Therefore, aging and the role of PCOS and periodontal disease needs further studies.
Both osteoporosis and periodontal disease risks increase with age, therefore it is expected to see higher incidence in an older cohort. However, the onset of type 2 diabetes common in women with PCOS, led the authors to hypothesize that “increased risk of PD will persist into postmenopausal years for women with PCOS.”
The authors conclude by stating, “This review was aimed at identifying knowledge gaps in the relationship between PCOS, PD, and osteoporosis. Based on the available evidence, it is plausible that the risk for both PD and osteoporosis is heightened in post-menopausal women with PCOS compared to those without. Case-control and cross-sectional studies have identified possible associations linking PCOS, PD and osteoporosis; however, there is a need for longitudinal studies, with inclusion of older women with PCOS to delineate the extent of the risk.”
Do you think there is a plausible mechanism that would provide a clear relationship between periodontal disease and PCOS? Have you experienced increased incidence of periodontal disease in patients with reported PCOS? Do you consider the role of sex hormones in the gingival health of your patients?
- Young HE, Ward WE. The Relationship Between Polycystic Ovarian Syndrome, Periodontal Disease, and Osteoporosis. Reprod Sci. 2021;28(4):950-962. doi:10.1007/s43032-020-00310-7