Is There a Bidirectional Association between Polycystic Ovarian Syndrome and Periodontitis? A Systematic Review and Meta-analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Protocol
2.2. Focused Question and Eligibility Criteria
- “Does PCOS have an effect on the healthy periodontium?”
- “Does PCOS influence periodontal clinical characteristics of Periodontitis?
- “Does Periodontitis influence clinical characteristics of PCOS?”
- Female patients without PD (Patients-P); PCOS (Exposure-I); No PCOS (Comparison-C); periodontal probing depth (PPD), clinical attachment loss (CAL), bleeding on probing (BoP) levels (Outcome-O)
- Female patients with PD (Patients-P); PCOS (Exposure-I); No PCOS (Comparison-C); PPD, CAL, BoP levels (Outcome-O)
- Female patients with PD (Patients-P); PCOS (Exposure-I); No PCOS (Comparison-C); endocrine outcomes (Ferriman–Gallwey score, free androgen index, dehydroepiandrosterone sulfate (DHEAS), free testosterone and total testosterone levels); glycemic (fasting blood insulin, fasting blood glucose, homeostatic model assessment (HOMA-IR)); and physical (waist-to-hip ratio (WHR)) outcomes - O
2.3. Search Strategy
2.4. Study Processs
2.5. Risk of Bias (RoB) in Individual Studies
2.6. Statistical Analysis
2.7. Strength of Recommendation
3. Results
3.1. Characteristics of Included Studies
3.2. Methodological Quality
3.3. Methodological Quality
3.3.1. Bidirectional Association between Polycystic Ovarian Syndrome and Periodontitis
3.3.2. PCOS Effect on the Gingival Inflammation
3.3.3. PCOS effect on Periodontal Structure Loss
3.3.4. Additional Analyses
4. Discussion
4.1. Summary of Main Findings and Quality of The Evidence
4.2. Strengths and Potential Limitations
4.3. Interpretation and Clinical Implications
4.4. Research Implications
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Authors (Year) | Country | Funding | Number of Subjects | PCOS | PCOS–PD | PD | H | Mean Age ± SD (PCOS/PCOS–PD/PD/H) | Exclusion Criteria | PD Diagnostic Criteria | PCOS Criteria |
---|---|---|---|---|---|---|---|---|---|---|---|
Porwal et al. (2014) | India | None | 126 | 85 | 0 | 0 | 41 | 23.50 ± 2.67/NA/NA/22.9 ± 4.7 | Thyroid dysfunction, hyperprolactinemia, and androgen-secreting tumors to avoid misdiagnosis of PCOS; chronic inflammatory disease; smoking and alcohol habits; Systemic ATB within 3 months; periodontal treatment within 6 months; and AgP diagnosis | Page and Eke 2012 | Rotterdam Criteria |
Akcali et al. 2014 | Turkey | IADR | 125 | 80 | 0 | 0 | 45 | 25.6 ± 5.2/NA/NA/26.1 ± 4.7 | Hyperandrogenism, DM, hyperprolactemia, congenital adrenal hyperplasia, thyroid disorders, Cushing syndrome, HTA, hepatic or renal dysfunction; BMI > 30 kg/m2; CVD; medications (e.g., oral contraceptive agents, steroid hormones, insulin-sensitizing drugs and ATB or ant-inflammatory); periodontal status within the last 6 months | Armitage 1999 | Rotterdam Criteria |
Hameed et al. 2017 | India | None | 80 | 20 | 20 | 20 | 20 | NA | Smoking habits; pregnant women; periodontal therapy at the previous 3 months; anti-inflammatory or ATB therapy during the last 3 months; contraceptives or hormonal drugs or medications for PCOS; systemic diseases (e.g., DM, HTA, CVD) which could affect periodontal health | AAP 1999 | Rotterdam Criteria |
Saglam et al. 2017 | India | None | 88 | 22 | 22 | 22 | 22 | 27.6 ± 4.0/28.6 ± 4.5/28.2 ± 4.3/27.8 ± 3.9 | Cushing syndrome, non-classic congenital adrenal hyperplasia, hyperprolactinemia, thyroid dysfunction, and androgen-secreting tumors | Page and Eke 2012 | Rotterdam Criteria |
Tong et al. 2019 | Taiwan | None | 48820 | 304 | 441 | 23969 | 24106 | NA | Endocrine disorders (e.g., Cushing syndrome, non-classic congenital adrenal hyperplasia, hyperprolactinemia, thyroid dysfunction and androgen-secreting tumors) | ICD-9-CM code: 523.4 | ICD-9-CM code: 256.4X |
Saljoughi et al. 2020 | Iran | Arak University of Medical Sciences | 110 | 25 | 30 | 23 | 32 | 45.3 ± 3.0/45.2 ± 3.2/45.3 ± 3.1/45.5 ± 3.3 | Interfering drugs (e.g., ATB, oral contraceptives, antihypertensive, and DM drugs); infection in the last 6 months; systemic diseases (e.g., thyroid disorders, hyperprolactinemia, DM, HTA, malignancies, osteoporosis); obesity and overweight; smoking and alcohol habits, and pregnant women | Armitage 1999 | Rotterdam Criteria |
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Machado, V.; Escalda, C.; Proença, L.; Mendes, J.J.; Botelho, J. Is There a Bidirectional Association between Polycystic Ovarian Syndrome and Periodontitis? A Systematic Review and Meta-analysis. J. Clin. Med. 2020, 9, 1961. https://doi.org/10.3390/jcm9061961
Machado V, Escalda C, Proença L, Mendes JJ, Botelho J. Is There a Bidirectional Association between Polycystic Ovarian Syndrome and Periodontitis? A Systematic Review and Meta-analysis. Journal of Clinical Medicine. 2020; 9(6):1961. https://doi.org/10.3390/jcm9061961
Chicago/Turabian StyleMachado, Vanessa, Cláudia Escalda, Luís Proença, José João Mendes, and João Botelho. 2020. "Is There a Bidirectional Association between Polycystic Ovarian Syndrome and Periodontitis? A Systematic Review and Meta-analysis" Journal of Clinical Medicine 9, no. 6: 1961. https://doi.org/10.3390/jcm9061961