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.
Highlights
Polycystic ovary syndrome (PCOS) is a complex endocrine, reproductive and metabolic condition, with a worldwide prevalence ranging 5–15% [1]
The overall results reveal that females with periodontitis have, on average, 46% more risk to be diagnosed with PCOS (RR [95% confidence intervals (CI)]: 1.46 [1.29–1.66], p < 0.0001, I2 = 0.0%), with complete homogeneity among the included studies (Figure 3)
Subgroup analysis was performed and women with PCOS had greater clinical attachment loss (CAL) levels than women without PCOS (MD [95% CI]: 0.51 [0.12–0.89] p < 0.01) (Figure 6)
Summary
Polycystic ovary syndrome (PCOS) is a complex endocrine, reproductive and metabolic condition, with a worldwide prevalence ranging 5–15% [1]. PCOS is characterized by polycystic ovaries, hyperandrogenism with impaired gonadotropin secretory activity, hyperinsulinemia, hypothalamic–pituitary–ovarian (HPO) axis changes, and ovulatory and menstrual dysfunction [2,3,4,5,6,7,8]. PCOS is accompanied by psychological alterations, such as anxiety, depression and poor quality of life [9]. The pathogenesis of PCOS remains to be fully understood due to its multifactorial profile. The proinflammatory state has been one of the most investigated for the PCOS link with periodontitis
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