Men in their thirties with chronic gum disease are at significantly increased risk for erectile dysfunction (ED), suggests a study by Turkish researchers.
Writing in the Journal of Sexual Medicine, the study authors say that periodontal disease should be considered as a potential cause of ED in young men, with endothelial dysfunction the most likely underlying pathogenic mechanism.
Fatih Oguz (Inonu University, Malatya) and colleagues recruited 162 men aged 30-40 years who had been referred to a urology department, of whom 80 had ED.
All the men underwent a comprehensive periodontal examination, with assessment of plaque index (PI), bleeding on probing (BoP), probing depth (PD), and clinical attachment level (CAL).
Men with and without ED were similar with regard to mean age, body mass index, household income, marital status, education status, and smoking status, Oguz et al report.
However, periodontal characteristics differed markedly between men with and without ED. Specifically, a greater proportion of men with ED had tooth sites with plaque (65.7 vs 43.7%), sites with BoP (59.8 vs 38.9%), mild periodontal disease (22.7 vs 11.9%), CAL of less than 4 mm (35.0 vs 16.1%), decayed, missing, and filled teeth (7.9 vs 4.6%), and severe periodontal disease (53.0 vs 23.0%).
Mean probing depth and clinical attachment level did not differ significantly between the groups, although both values were numerically higher in men with ED.
Finally, logistic regression analysis revealed a significant correlation between ED and the severity of CP. After adjusting for potential confounders, men with severe periodontal disease (defined as at least 15 tooth sites with 4 mm or greater probing depth and BoP) were 3.29 times more likely to suffer from ED than were men without any periodontal disease.
Oguz and coauthors note that chronic periodontitis and ED have several risk factors in common, such as ageing, smoking, diabetes mellitus, and coronary artery disease. "We excluded men with systemic disease and smokers from this study," they note.
The researchers hypothesize that chronic periodontitis predisposes men to develop ED via an increase in endothelial dysfunction. Three mechanisms could potentially mediate this pathway: reactive oxygen species leading to nitric oxide inactivation; high levels of proinflammatory mediators; and periodontal pathogens or their products.
"Though endothelial dysfunction was not assessed in this study, we measured BoP as an indicator of clinical inflammation," the authors write. "The higher level of BoP seen in the ED group in our study compared with the control group and the correlation between BoP and ED support the earlier reports that a high level of infection results in ED due to endothelial dysfunction."
Accordingly, they conclude: "Periodontal diseases must be considered in the etiology of ED in young adults."
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