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Periodontitis is a common condition which, according to recent research, may be associated with infertility. This may be due to a number of factors such as periodontal-specific bacteria and widepread inflammation in the body resulting from the disease.

Periodontitis - what is it?

Periodontitis is a very common condition, known colloquially as 'gum disease', where the gums and deeper tooth-supporting structures become inflamed. This inflammatory response (redness, swelling, and bleeding during tooth-brushing) is the way your body reacts to specific bacteria which have remained on the teeth and, although part of the body’s natural defense system, it can, unfortunately, lead to serious damage. If not treated, the inflammation can extend to below the gums and along the roots of the teeth, resulting in the periodontal ligaments and supporting bone eventually being destroyed. In the long run, this can mean wobbly teeth that may ultimately fall out.

Infertility - what is it?

The main symptom of infertility is being unable to conceive. It affects around 15% of the couples worldwide and may be due to numerous factors; indeed around 30% of cases of infertility are unexplained. An inability to conceive within one year (or within 6 months for women over than 35 years) or the incapacity to continue pregnancy until a live birth is the clinical definition of infertility.

In society, the woman is often regarded as holding the key to any infertility however men also have a role to play: data suggests that as many as half of all cases may be due to the male. This statistic would suggest it is wholly inappropriate for the root of infertility to solely lay with the woman.

Periodontitis and infertility — what's the connection? 

Little has been made as to the effect of periodontal disease on reproductive function and research is still in its infancy. In recent years researchers have focused upon the role of periodontitis in infertility and whether oral health status plays any part.

Emerging research suggests that there may indeed be a correlation between periodontal disease and a woman’s chance of conception and effectiveness of infertility treatment.

It is hypothesized that periodontal status impacts upon fertility by virtue of its defining characteristic - inflammation. Chronic inflammation can become systemic and prevent ovulation and implantation, and the waste products produced by the periodontal bacteria are able to pass through the placenta to the baby and cause fetal toxicity. The presence of bacteria and its metabolic toxic by-products (bacteremia and endotoxemia) in the bloodstream, alongside immune system responses such as increased cytokines (which play a key role in general immunity and inflammation) can all affect reproductive outcomes.

Periodontal-specific bacteria also associated with infertility

There are five key bacteria that are associated with periodontal disease:

  • Porphyromonas ginigvalis

  • Tannerela forsynthia,

  • Prevotella intermedia,

  • Aggregatibacter actinimucentemcomitans, and

  • Treponema denticola.

Porphyromonas gingivalis has been found in saliva and increased antibodies (produced as a result of exposure to that bacteria) worsens the likelihood of successful conception among young women. Research also indicates an increased risk of not becoming pregnant in the presence of a high number of P. gingivalis antibodies, alongside periodontal disease indicators.

Another study argued that the time it took women to conceive was extended by two months when periodontal disease was present; alongside other expected risk factors for infertility such as age, smoking, and obesity. Research suggested that that periodontal disease played the same role as obesity in terms of length of time it took a woman to conceive — each periodontal disease and obesity delayed conception by two months.  

What's the connection between periodontitis and infertility treatment?

Those suffering from infertility have different treatment options available to them such as hormone treatment and assisted reproductive therapy (ART), including in-vitro fertilization. These treatments are proposed depending on what is deemed to be the causal factor in their infertility.

Fertility drugs increase hormones linked to various periodontal problems

Generally, a woman will use medications to stimulate ovulation (such as clomiphene citrate) for six menstrual cycles before pursuing additional treatments, also designed to stimulate ovulation (such as follicle stimulating hormones or human menopausal gonadotropin).  Couples may also decide to explore more invasive treatment options, such as IVF. Research has shown that these fertility medications increase the levels of female sex hormones like estrogen and progesterone, which in turn have been linked to various periodontal issues.

For example, it has been observed that women who have taken fertility drugs for more than three menstrual cycles have increased levels of gum inflammation and bleeding in comparison with those not using such drug therapy.

It is hypothesized that increased levels of estrogen and progesterone may promote the growth of periodontal bacteria in plaque.

Another study found that increased estrogen and progesterone affected the growth of Prevotella intermedia.

In vitro fertilization (IVF) medications and periodontitis

Medications, similar to those listed have been found in one study to cause inflammation to the gums as well as increasing bleeding. They also found a negative correlation (direct inverse relationship) between the number of retrieved follicles before IVF and the number of transferred embryos after IVF and concluded that the hormone medications given before IVF affected both the mothers' periodontal status and in turn the outcome of IVF.  

How periodontal disease affects male infertility?

It is thought that anything up to half of infertility cases can be located in the male. 

Studies have shown periodontal disease to be associated with reduced sperm quality. It can also lead to increases in bacterial concentration in ejaculate which is a condition believed to decrease male fertility. Findings from research also suggest that the inflammatory cytokines associated with chronic periodontitis lead to global inflammation in the body which causes sperm to die and lower sperm count.

Additionally, researchers have undertaken meta-analyses (where they evaluate a number of completed studies) and a link was found between male infertility and various dental infections, like cavities, chronic periodontitis, and necrotic pulp.

It is also suggested by other research that once dental procedures to address periodontal issues have been completed, there appears to be an improvement in sperm motility. In addition, other factors affecting sperm health (morphology, motility, and density) show significant improvement once dental treatment has been carried out.

How can you minimize the impact of periodontal issues on fertility and infertility treatment?

While a dental hygienist cannot directly assist with infertility issues, as part of a multi-disciplinary team, dental professionals can help patients who are going through treatment for infertility. In order to be able to assist, it is important for dental practitioners to be aware of how fertility treatments can affect the mouth.

Thorough oral hygiene for both men and women during fertility treatments as well as during pregnancy is crucial.

It is recommended to have a dental exam before commencing any fertility treatment to ensure there are no dental factors that might hinder the process and to have one dental examination during pregnancy, preferably during the three-six month stage.

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