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

Abstract

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.

Vitamin D and Periodontitis: A Systematic Review and Meta-Analysis

“…Further, other factors such as seasonal variation [ 96 ], race and vitamin D binding protein [ 97 ] can also affect 25(OH)D levels. Likewise, periodontitis is also a relevant risk factor in these pathologies [ 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 ], and a potential mediation effect of periodontitis-vitamin D may be considered and further developed in clinical studies.…”

Comparisons of Periodontal Status between Females Referenced for Fertility Treatment and Fertile Counterparts: A Pilot Case–Control Study

“…This finding has wide implications since this group of women was seeking a successful pregnancy. Growing evidence supports a relationship between PD and female infertility related conditions, namely polycystic ovary syndrome (PCOS) [ 22 , 23 , 25 , 26 , 27 , 28 , 47 , 48 , 49 , 50 , 51 ], endometriosis [ 29 , 30 ] and obesity [ 52 , 53 , 54 , 55 , 56 ]. Furthermore, recent studies have substantiated the relationship between maternal PD as a potential risk factor of adverse pregnancy outcomes [ 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ].…”

“…Comprehensively, a diseased periodontium in women leads to a subclinical chronic inflammatory status [ 7 , 14 , 76 , 77 , 78 , 79 ] that potentiates an oxidative stress environment, and therefore impacts the endocrine system and decreases fertility [ 25 , 26 ]. Moreover, several female infertility associated conditions (such as PCOS, endometriosis and obesity) were implicated with PD [ 23 , 24 , 28 , 29 , 30 , 51 , 52 , 54 , 76 , 80 , 81 , 82 , 83 ].…”

Helicobacter pyloriinfection and micronutrient deficiency in pregnant women: a systematic review and meta-analysis

“…24 From a total of 9 points, studies with 7–9 were deemed low ROB, whereas studies with 5–6 and <5 points were considered moderate ROB and high ROB, respectively. 25 26 …”