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

Tong, Ching; Wang, Yu‐Hsun; Yu, Hui-Chieh; Chang, Yu‐Chao

doi:10.1089/jwh.2018.7648

Cited by 12 publications

(19 citation statements)

References 31 publications

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“…Out of these 19 articles which were subjected to full paper review eligibility, 7 articles were excluded as they did not address the research questions ( Supplementary Table S1 ). As a result, a final number of 12 case-control studies [ 14 , 15 , 16 , 17 , 18 , 19 , 21 , 22 , 33 , 34 , 35 , 36 ] met all of the inclusion and exclusion criteria and were included for qualitative synthesis ( Figure 1 ). Interexaminer reliability at the full-text screening was considered very substantial (kappa score = 1.00).…”

Section: Resultsmentioning

confidence: 99%

“…These studies were published between 2011 and 2020. The sample sizes ranged from 40 [ 35 ] to 48.820 participants [ 18 ] per study. A total of 49.965 participants were included in this review, comprising 768 PCOS female individuals without PD, 613 PCOS female individuals with PD, 24.152 female patients with PD and 24.445 healthy controls.…”

Section: Resultsmentioning

confidence: 99%

“…To investigate the likelihood of PCOS female individuals to have PD, three studies were included [ 15 , 18 , 21 ], in a total of 49,046 participants. The overall results reveal that PCOS individuals have on average 28% more risk to develop periodontitis (RR [95% CI]: 1.28 [1.06–1.55], p < 0.0001, I 2 = 43.0%) with moderate heterogeneity, revealing some variation among the included studies ( Figure 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Comprehensively, the link between PD and PCOS is based on the chronic subclinical inflamed status of both conditions [ 18 , 37 ]. In other words, a persistent subclinical inflammation triggers the synthesis of a panel of proinflammatory markers (such as C-Reactive Protein (CRP), tumor necrosis factor-α, interleukin (IL)-6, IL-17, and matrix metalloproteinase-9) [ 36 , 38 , 39 ], and potentiates an oxidative stress environment (through local oxidant status-like myeloperoxidase and nitric oxide) [ 14 , 17 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…Over the last decade, cross-sectional evidence has suggested that PCOS patients may be more prone to develop periodontitis [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ] and with higher local levels of OS [ 14 , 17 ]. Also, a randomized clinical trial showed that nonsurgical periodontal therapy together with myo-inositol therapy contributed to a higher decrease of systemic inflammatory levels compared with myo-inositol solely in women with PCOS and periodontitis [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

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

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2020

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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.

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