In recent years it has been observed that both periodontal disease and erectile dysfunction are associated with cardiovascular diseases, and with risk factors for both, including smoking and diabetes mellitus; however, it has never been studied whether there could be a direct association between periodontal disease and erectile dysfunction.
In recent years, several studies have attempted to establish such a connection, which could stem from the existence of pathophysiological factors in common. Periodontitis could provoke a situation of systemic inflammation, which in turn would produce a dysfunction in the endothelium of the blood vessels, which, just as it can affect the cardiovascular system, could affect the cavernous vessels of the penis.
The first study was conducted in 2009 by Zadik et al. in the Journal of Sexual Medicine. In a sample of 305 patients, they observed that the 70 who had erectile dysfunction had a significantly higher prevalence of periodontitis than those who did not. In 2011 Sharma et al. presented a study in the Journal of Periodontology in which they found a relationship, but not a significant one.
In 2012, Keller et al. presented an association study in a large population in Taiwan in the Journal of Clinical Periodontology. Adjusting for confounding characteristics in their study, such as obesity, alcohol abuse, sociodemographic characteristics, etc., they concluded that patients with erectile dysfunction were 3.25 times more likely to have previous periodontitis. They advise dentists to inform patients of the possible association between periodontitis and erectile dysfunction.
In 2013, a study was conducted between the Department of Urology and the Department of Periodontology at Inonu University in Turkey. In that study they included 80 adults with erectile dysfunction and 82 adults without erectile dysfunction, all aged between 30 and 40 years. Their level of education, economic status and body mass index were similar. They observed a highly significant association between erectile dysfunction and periodontal disease. Patients with periodontal disease were 3.29 times more likely to develop erectile dysfunction than the control group. The percentages of high probing sites and periodontal attachment losses were higher in the ED group than in the control group. They concluded that there was a high association between chronic periodontitis and erectile dysfunction in adults aged 30-40 years. They recommended in their study that it might be beneficial to consider periodontal disease as a causative clinical condition of erectile dysfunction in such patients.
This same group has presented in 2014 a randomized controlled study in the Journal of Clinical Periodontology in which, their premise was that if there was a suspicion that periodontal disease might be a causative agent of erectile dysfunction, what if it is treated, what are going to be the effects of such treatment in terms of improvement of erectile dysfunction. Of the 120 patients they recruited with moderate or advanced periodontal disease, they treated half of them perionontally, and the other 60 did not receive any periodontal treatment. They observed that at 3 months there was an improvement in the ¨International Erectile Dysfunction Index” parameters only in the periodontally treated patients. These findings are very important and suggest, always with due caution, because more randomized controlled studies are needed, that periodontal treatment may provide additional benefits to erectile dysfunction.
Finally, also in this year, in 2014, two more studies have been conducted, but in this case of association. One of them, has been conducted in Japan, also obtaining a significant correlation between periodontal disease and erectile dysfunction in 300 adults. But the most interesting is the one carried out by Tsao CW and collaborators in Taiwan on 5105 patients with erectile dysfunction and 10210 control patients. After adjusting for co-morbidity factors, they have observed that patients with erectile dysfunction are more likely to be diagnosed with previous periodontitis than controls. The association is especially stronger in populations younger than 30 years and older than 60 years, with a probability of having erectile dysfunction twice as high as those without periodontal disease.
All these studies suggest that erectile dysfunction is related to damage caused by endothelial dysfunction and inflammatory changes associated with periodontitis. In this sense, it would be important to suggest to urologists that dental health is important as a preventive measure for the treatment of erectile dysfunction.