Abstract
Polycystic ovary syndrome (PCOS) is a hormonal disorder of women that not only is the leading cause of infertility but also shows a reciprocal link with oral health. This study aimed to investigate the hypothesis that the levels of putative periodontal pathogens in saliva and their antibody response in serum are elevated in PCOS, compared to systemic health. A total of 125 women were included in four groups; 45 women with PCOS and healthy periodontium, 35 women with PCOS and gingivitis, 25 systemically and periodontally healthy women, 20 systemically healthy women with gingivitis. Salivary levels of seven putative periodontal pathogens were analyzed by quantitative real-time polymerase chain reaction and serum antibody levels were analyzed by ELISA. In women with PCOS, salivary Porphyromonas gingivalis, Fusobacterium nucleatum, Streptococcus oralis and Tannerella forsythia levels were higher than matched systemically healthy women, particularly in the case of gingivitis. Aggregatibacter actinomycetemcomitans and Treponema denticola levels were similar among study groups. The presence of PCOS also enhanced P. gingivalis, Prevotella intermedia and S. oralis serum antibody levels, when gingivitis was also present. Gingival inflammation correlated positively with levels of the studied taxa in saliva, particularly in PCOS. The presence of P. gingivalis and F. nucleatum in saliva also exhibited a strong positive correlation with the corresponding serum antibody levels. In conclusion, as an underlying systemic endocrine condition, PCOS may quantitatively affect the composition of oral microbiota and the raised systemic response to selective members of this microbial community, exerting a confounding role in resultant gingival inflammation and periodontal health. The most consistent effect appeared to be exerted on P. gingivalis.
Highlights
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder, affecting women of reproductive age with the prevalence ranging from 6.5% to 8% according to the National Institutes of Health (NIH) criteria [1]
Mean probing depth (PD) and clinical attachment level (CAL) were below 3 mm in all the study groups, whereas plaque index (PI), bleeding on probing (BOP) and PD scores were significantly higher in the gingivitis groups, either systemically healthy or with PCOS
T. forsythia levels were higher in women with PCOS and gingivitis compared to periodontal health, but there were no differences between any of the other clinical group comparisons (Figure 1G)
Summary
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder, affecting women of reproductive age with the prevalence ranging from 6.5% to 8% according to the National Institutes of Health (NIH) criteria [1]. PCOS is characterised by chronic low-grade inflammation [5] and it is likely to be responsible for metabolic abnormalities. It was reported that certain pro-inflammatory cytokines, such as interleukin-6 (IL6), interleukin-17 (IL-17), tumor necrosis factor-a (TNF-a) were elevated in women with PCOS, compared to systemically healthy individuals [6,7]. Prolonged low-grade inflammatory state can be caused by chronic infections such as gingivitis, which is a common pathology seen in patients with PCOS [8]. There is still limited information about the composition of oral microbiota, with regards to systemic inflammatory conditions triggered by hormonal disorders, such as PCOS. Taking into consideration that periodontal diseases are chronic infections that cause a low-grade chronic systemic inflammation [11] it is plausible to consider an association with hormonal disorders, such as PCOS
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