Study sheds new light on link between perio disease, ED

A growing body of research points to a link between chronic periodontal disease and erectile dysfunction (ED), and the common thread appears to be related to inflammation.

A study published in 2011 in the Journal of Periodontology found that ED and chronic periodontitis share common risk factors (December 2011, Vol. 82:12, pp. 1665-1669). In 2012, a study in the Journal of Clinical Periodontology also confirmed an association between chronic periodontitis and ED (June 2012, Vol. 39:6, pp. 507-512). And earlier this year, research published in the Journal of Sexual Medicine found that men in their 30s who had inflamed gums caused by severe periodontal disease were three times more likely to suffer from ED (March 2013, Vol. 10:3, pp. 838-843).

Now a new study in the International Journal of Impotence Research (July 4, 2013) suggests that ED is related to the damage caused by endothelial dysfunction and the systematic inflammatory changes associated with chronic periodontal disease (CPD).

"The risk of ED is related to many factors, including age, smoking, diabetes, heart disease, depression, and hypertension," wrote the study authors, from Asahikawa Medical University in Japan. "It has been discovered that CPD is associated with systemic diseases, such as MetS [metabolic syndrome], coronary heart disease, and endothelial dysfunction. As CPD and ED share common risk factors, the epidemiological and pathophysiological linkage between CPD and ED is quite possible."

For this study, the researchers distributed an interview questionnaire on CPD and ED to 300 adult men who had received a comprehensive dental exam at the hospital and dental clinics in Asahikawa. A total of 88 adult men (age range: 20-85) filled out and returned the questionnaire (response rate: 29.3%).

The CPD self-check questionnaire comprised 15 questions on symptoms, such as the following:

• When you drink water, do you feel pain in the teeth and gums?
• Do your gums feel itchy?
• Are your gums swollen and red?
• Does food get into interdental spaces easily?
• Is there blood on your toothbrush after brushing?

The answers were given numerical scores so that CPD severity could be classified into four categories based upon the respondent's total score:

• 0-9, little possibility of periodontitis
• 10-30, possibility of periodontitis
• 31-70, necessary to check it at the dentist's office
• 71 and above, considerably advance symptoms, treatment necessary

The researchers used the International Index of Erectile Function (IIEF-5) questionnaire to detect ED and assess its severity, which asks respondents about erectile function, orgasm function, sexual desire, intercourse satisfaction, and overall satisfaction. Scores above 21 represent normal erectile function, while scores at or below 21 represent ED. ED severity is classified into five categories:

• 1-7, severe ED
• 8-11, moderate ED
• 12-16, moderate to mild ED
• 17-21, mild ED
• 22 and above, no ED

After statistical analysis of the results, the researchers found no statistically significant correlation between the age of the respondents and the CPD score (p = 0.0581). However, there was a statistically significant correlation between age and ED domains (p < 0.0001) and a statistically significant correlation between the CPD score and the presence of ED (p = 0.0415).

"We assume that CPD is associated with ED just as it is associated with MetS, and that CPD might be an implication of possible ED in men," the study authors wrote. "We believe that chronic inflammation and endothelial dysfunction create a link between CPD and ED."

The study findings also suggest that oral health is important as a preventive measure against ED, they concluded.