Research has found significant connections between periodontitis and systemic health issues like heart disease, diabetes, and even Alzheimer’s disease. But while studies of periodontitis and levels of testosterone have suggested a relationship, they have been less conclusive.
An international team of researchers recently reviewed 8 studies that investigated testosterone and chronic periodontitis. Sergio V. Kellesarian of the department of general dentistry at the Eastman Institute for Oral Health, University of Rochester, shared his insights from that work.
Q: What prompted the research into the connection between testosterone and chronic periodontitis?
A: In the past 30 years, bidirectional linkages between chronic periodontitis and several systemic conditions such as atherosclerosis, myocardial infarction, and diabetes mellitus have been reported extensively. Likewise, the relationship between female sex hormones (estrogens) and periodontal disease in women during puberty, pregnancy, and menopause or in women taking oral contraceptives has been widely reported.
However, the relationship between chronic periodontitis and men’s reproductive health has been overlooked and scarcely reported. Therefore, we conducted searches using indexed databases to assess the link between periodontal diseases and men’s reproductive health conditions, such as erectile dysfunction, male infertility, and low testosterone levels.
Q: What do you think accounts for the range of results in your review, from negative and positive associations between testosterone and chronic periodontitis to no significant association at all?
A: Certainly, several factors may have biased the results of the included studies accounting for the range of results. For example, different factors might influence testosterone levels, including aging, genetics, and comorbidities such as glycemic levels and obesity.
Among the included studies we noticed that the participants’ ages varied significantly. One study analyzed testosterone levels in men between 19 and 21 years old. Another study assessed testosterone levels in patients aged between 66 and 95 years old.
Moreover, it is pertinent to mention that around 50% of the studies included did not adjust the results for confounder’s factors, such as smoking and obesity. Therefore, we recommend additional prospective studies including stringent confounder assessment, larger samples, longer periods of time, and different ethnicities.
Q: It seems that 6 of the 8 studies suggested some relationship between low testosterone and more chronic periodontitis. What could be driving this connection, and how could awareness of this connection improve periodontal treatment?
A: The negative effects of testosterone deficiency in bone metabolism have been related to increased levels of pro-inflammatory cytokines, such as interleukin-6, and enhanced osteoclastic activity. Results from approximately 65% of the studies included reported a positive correlation between testosterone levels (saliva, gingiva, and/or serum) and chronic periodontitis.
A possible explanation for these findings is related to an exacerbated response in the periodontal tissue by immune-endocrine interactions and a hormonal modulation of fibroblast. It has been also proposed that testosterone could affect the gingival stromal cell response to inflammatory challenges by downregulation of proinflammatory cytokines production. Nevertheless, more studies are needed to establish the link between both conditions.
It’s fair to conclude that the relationship between low testosterone levels and chronic periodontitis remains debatable, and further longitudinal studies are needed. However, it is imperative for general physicians and oral healthcare providers to be aware of the fact that chronic periodontitis can influence men’s reproductive health, including erectile function and fertility.
We recommend that an evaluation of patients’ medical history should be considered as an integral component of comprehensive dental examinations. Moreover, patients exhibiting low testosterone levels in bodily fluids should be referred to oral health care providers for a dental examination and treatment. Such regimens may also help improve the overall quality of life of patients.
Q: Finally, could testosterone or estrogen play a role in women’s oral health?
A: We speculate that the different phases of a woman’s life (puberty, menses, pregnancy, and menopause) and the sex steroid hormone production might influence oral health. In this context, currently we are studying the impact of female reproductive health and oral inflammatory conditions.
The study, “Low Testosterone Levels in Body Fluids Are Associated With Chronic Periodontitis: A Reality or a Myth?” was published by the American Journal of Men’s Health.