Periodontitis and erectile dysfunction

Iveta Ramonaite, Dental Tribune International

Mon. 4. April 2022

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GRANADA, Spain: A study led by researchers from the University of Granada has recently reported that men with periodontitis who are also diagnosed with erectile dysfunction (ED) are almost four times more likely to suffer a major adverse cardiovascular event, including cerebral infarction and cardiovascular death. The pathologies were found to occur approximately four years after the sexual dysfunction had been diagnosed.

According to the researchers, approximately 24% of the male population suffer from ED, which they say is a “multifactorial pathology described as the repeated or continuous inability to achieve and maintain a sufficient penile erection to complete a satisfactory sexual intercourse”. The National Institute of Diabetes and Digestive and Kidney Diseases states on its website that ED affects about 30 million men in the US. According to researchers from King’s College London, 322 million men worldwide will be affected by ED by 2025.

The research on the link between ED and periodontitis was initiated in 2017 and was a collaboration between the urology unit of the Hospital Universitario Cliníco San Cecilio (San Cecilio clinical university hospital) in Granada and the periodontics and implantology research group of the University of Granada.

Dr Antonio Magán-Fernández. (Image: Antonio Magán-Fernández)

“The idea came after noting the rising interest in the potential relationship between these two diseases, which are of great interest in public health owing to their prevalence,” corresponding author Dr Antonio Magán-Fernández, assistant professor in the Faculty of Dentistry at the university, told Dental Tribune International (DTI).

“We found that patients with ED presented worse periodontal condition and also that patients with periodontitis had an odds ratio of 2.17 of presenting ED. This hypothesis led us to design and conduct a study to determine whether the joint presence of periodontitis and ED could have had any effect on the incidence of severe cardiovascular events,” he continued.

The present epidemiological study involved 158 male patients who attended the urology service and were diagnosed with ED according to the International Index of Erectile Function. The researchers collected information on the participants’ socio-demographic characteristics and gathered data related to their periodontal health at baseline, including pocket probing depth, clinical attachment loss, bleeding on probing, plaque index and the number of teeth. According to the researchers, the participants experienced major adverse cardiovascular events both before the study was carried out and during the follow-up time.

After analysing the findings, the data showed that patients with periodontitis and ED were approximately four times more at risk of suffering major adverse cardiovascular events after a mean follow-up of 4.2 years. The pathologies included cerebral infarction, non-fatal myocardial infarction, sudden cardiac arrest, heart failure, acute coronary syndrome, coronary artery bypass grafting and percutaneous coronary intervention, pathologies that could be life-threatening in middle-aged men.

“Our results suggest that penile blood vessels would be first affected by atherosclerosis owing to their smaller size and that ED may act as an early sign of cardiovascular disease,” Dr Magán-Fernández noted.

Study implications

Commenting on the relationship between ED and periodontal disease, Dr Magán-Fernández told DTI that ED could be triggered by atheroma plaques in the penile vascular system. “Periodontitis could contribute to this atheroma plaque formation, as described in the scientific literature, through plaque colonisation of periodontal pathogens or through the systemic dissemination of pro-inflammatory mediators from the periodontal sites in the mouth,” he explained.

The researcher noted that, every year, more evidence of the systemic repercussions of periodontitis is reported, and that dentists play a great role in the management of systemic conditions. He stated: “Oral health may affect not only the survival of teeth and the healing of oral pathologies but also the general health of patients. Greater awareness of these topics is needed since the dentist is able to provide preventive medical advice about potentially life-threatening diseases such as severe cardiovascular outcomes that could be related to periodontitis.”

The study, titled “Patients with periodontitis and erectile dysfunction suffer a greater incidence of major adverse cardiovascular events: A prospective study in a Spanish population”, was published online on 10 December 2021 in the Journal of Periodontology, ahead of inclusion in an issue.