“The link between periodontitis and systemic disease plays a major role for men”

Looking ahead, Prof. James Deschner, whose field of study concerns links between periodontitis and systemic health, anticipates clearer evidence regarding possible causal relationships between periodontal disease and male-specific systemic disease. (Image: EFP)

Prof. Deschner, could you briefly explain why the link between periodontal disease and general health is relevant for men?
The link between periodontitis and systemic disease plays a major role for men because men often have more pronounced risk factors for periodontitis, such as lower health awareness, poorer oral hygiene habits, unhealthy diets and higher smoking rates. Certain diseases associated with periodontitis also occur only in men, such as erectile dysfunction and prostate cancer.

Recent analyses suggest that men with periodontitis are two to three times more likely to experience erectile dysfunction. From a scientific standpoint, how robust is the evidence supporting this association, and what are the key insights we have about the relationship between these two conditions?
The evidence for the link between periodontitis and erectile dysfunction is increasingly robust, although the underlying studies are heterogeneous and have important limitations. For example, most studies used self-administered questionnaires to assess erectile dysfunction, which are not as reliable as objective diagnostic methods such as Doppler ultrasound.

It may be that the association between periodontitis and erectile dysfunction is based solely on shared risk factors such as age and smoking. Such risk factors increase the risk of periodontitis as well as of erectile dysfunction. However, whether periodontitis itself increases the risk of this condition, for example via bacteria and inflammatory molecules, requires further research.

Nevertheless, at least two studies have already shown that treatment of periodontitis can improve erectile dysfunction, although only questionnaires were used to assess erectile dysfunction in these studies. Hypothetically, it could also be that erectile dysfunction contributes to the development and progression of periodontitis. It is conceivable that erectile dysfunction could lead to increased stress and anxiety and reduced social activity, which in turn could be associated with an inadequate immune response and neglected oral hygiene. This would then be a case of bidirectional causality. In summary, although the association between periodontitis and erectile dysfunction has been consistently observed, the causality has not yet been fully clarified.

There is also emerging evidence on periodontitis, sperm quality and prostate cancer. What does current research suggest on connections in these areas, and how cautiously should clinicians interpret these findings?
Some studies suggest that periodontitis is also associated with lower sperm concentration and motility, as well as with abnormal morphology. However, this is a relatively unexplored area of research, and although there is some evidence to support this link, the results are not yet conclusive. Regarding prostate cancer, several meta-analyses suggest a possible link between periodontitis and an increased risk of prostate cancer. However, these findings should be interpreted with caution because further research is needed to understand the underlying mechanisms. Shared risk factors for periodontitis and prostate cancer could play an important role in this association.

Severe periodontal disease affects more than one billion people worldwide. In your view, why is periodontitis still so under-recognised as a public health problem, especially among men?
Periodontitis is often under-estimated as a public health problem owing to several factors. First, many people are unaware of the far-reaching health effects of poor oral hygiene. Second, the symptoms of early-stage periodontitis are often painless, so those affected may not seek treatment until the disease has already progressed. In men, this problem is exacerbated by a lack of health awareness and a tendency to neglect preventive check-ups. Men are generally less likely to visit the dentist regularly and are more prone to risk factors such as smoking and poor diet. There is also stigma around discussing intimate health issues, which can contribute to symptoms going unreported and to reluctance to seek help—for both oral and systemic conditions.

In response to these challenges, the European Federation of Periodontology has made it a priority to strengthen public awareness of the disease. It has launched many public campaigns and awareness-raising initiatives aimed at improving knowledge, promoting prevention, and encouraging early diagnosis and treatment. A key priority is raising public understanding of how periodontitis is linked to various systemic diseases through dedicated campaigns.

What are the best practices for dental professionals when approaching sensitive topics such as erectile dysfunction or fertility with male patients? Specifically, when and how should these conversations be initiated to ensure patient comfort and trust and support effective communication?
Sensitive topics such as erectile dysfunction or fertility can easily be woven into the general education of patients about the association between periodontitis and systemic disease. This in turn gives patients the opportunity to ask about such sensitive topics more easily and in a more natural way. Dentists should discuss such sensitive topics with male patients with empathy, openness and discretion. It is important to create a non-judgemental environment where patients feel comfortable discussing their concerns. These conversations should take place after trust has been established.

“Periodontitis is often under-estimated as a public health problem.”

Looking ahead, how do you think that the growing evidence on the link between oral and overall health will change healthcare guidelines and routine dental care for men over the next decade?
This is an exciting question. New associations between periodontitis and systemic disease will likely be discovered. However, it will be even more exciting to see whether further periodontitis treatment studies can provide even more evidence of the direct influence of periodontitis on systemic disease. In other words, in the future, it will probably become even clearer that periodontitis not only occurs in conjunction with many systemic diseases owing to common risk factors, but that there is also a causal relationship. This would then lead to even more cooperation between dentistry and medicine than has been the case to date.

More joint consensus papers will likely be published on how patients with periodontal disease and certain systemic diseases should be treated in an interdisciplinary manner, and on how adequate prevention, diagnosis, therapy and aftercare of periodontal disease could prevent, delay or mitigate systemic disease. Ideally, the findings on causal relationships between periodontitis and systemic disease will also lead to greater motivation among the male population to improve oral hygiene and visit the dentist regularly. Dentistry could play an even greater role in the treatment of infertility if future studies further confirm the suspected causal link between periodontitis and erectile dysfunction and sperm concentration and quality.