|Year : 2014 | Volume
| Issue : 4 | Page : 430-433
|Association between erectile dysfunction and chronic periodontitis: A clinical study
Ranjit Singh Uppal1, Rajat Bhandari2, Karanparkash Singh3
1 Department of Periodontology and Oral Implantology, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India
2 Department of Oral and Maxillofacial Pathology, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India
3 Department of Public Health Dentistry, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India
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|Date of Submission||22-Oct-2013|
|Date of Decision||05-Mar-2014|
|Date of Acceptance||27-May-2014|
|Date of Web Publication||10-Oct-2014|
| Abstract|| |
Background: In recent years, evidence has come forth supporting the notion that localized infectious diseases such as periodontal disease may indeed influence a number of systemic diseases. Erectile dysfunction (ED) and chronic periodontitis have common risk factors such as diabetes mellitus, cardiac diseases and smoking etc.
Aim: The aim was to evaluate the periodontal status of the subjects suffering from ED and to find association between vasculogenic ED and chronic periodontitis, if any.
Study Design: A total of 53 subjects suffering from vasculogenic ED were enrolled for the study and were divided into three groups on the basis of severity of ED.
Materials and Methods: The clinical (probing pocket depth) and radiographic parameters (alveolar bone loss) were recorded and periodontal status of three groups was evaluated, compared and an attempt was made to find an association between ED and chronic periodontitis. Karl Pearson's correlation was used to assess an association between the two conditions.
Statistical Analysis: One-way ANOVA and Scheffe's test were used to find the significant difference of chronic periodontitis with severity of ED. Karl Pearson's correlation was used to find an association between chronic periodontitis and ED.
Results: Statistically significant mean differences of 1.73 mm, 0.56 mm and 1.17 mm were recorded when comparison was made among Group I and III, Group I and II and Group II and III, respectively. Mean differences in bone loss among three groups were also statistically significant. Both the diseases were positively correlated to each other.
Conclusion: It may be concluded that chronic periodontitis and ED are associated with each other. However, further large scale studies with confounder analysis and longitudinal follow-up are warranted to explore the link between these two diseases.
Keywords: Chronic periodontitis, erectile dysfunction, systemic diseases
|How to cite this article:|
Uppal RS, Bhandari R, Singh K. Association between erectile dysfunction and chronic periodontitis: A clinical study. Indian J Dent Res 2014;25:430-3
Periodontitis is inflammation of the periodontium that is accompanied by apical migration of junctional epithelium, leading to destruction of connective tissue attachment and alveolar bone loss.  Chronic periodontitis is the most common form of destructive periodontal disease. , In recent years, evidence has come forth supporting the notion that localized infectious diseases such as periodontal disease may indeed influence a number of systemic diseases.  Associations between various systemic conditions and chronic periodontitis have been reported in the past. 
|How to cite this URL:|
Uppal RS, Bhandari R, Singh K. Association between erectile dysfunction and chronic periodontitis: A clinical study. Indian J Dent Res [serial online] 2014 [cited 2019 Sep 22];25:430-3. Available from: http://www.ijdr.in/text.asp?2014/25/4/430/142516
Erectile dysfunction (ED) is a sexual dysfunction characterized by inability to develop or maintain erection during sexual performance.  It usually occurs after age of 40 years.  A number of factors such as neurogenic, cavernosal, psychological, hormonal and drugs can cause ED,  but the most common pathophysiology is vascular disease. 
As chronic periodontitis and ED have common risk factors, ,, some studies were carried out to find out the association between these two conditions. One study by Zadik et al.  have reported that chronic periodontitis was significantly more among men with ED than without ED. Another study by Sharma et al.  failed to detect any association between the two conditions. As there is inconsistent evidence about the association between these conditions, this study was conducted to evaluate the periodontal status of the patients suffering from ED and to find an association between ED and Chronic periodontitis.
| Materials and methods|| |
Fifty-three subjects who had received a diagnosis of vasculogenic ED from out-patient departments of the hospitals in Ferozepur City, Punjab, India were selected for the study. Subjects aged between 25 and 40 years with>20 permanent teeth and who had not received periodontal therapy in last 6 months were included. Subjects with habits of alcoholism or tobacco consumption, on medication that can alter the course of any of the two diseases, suffering from systemic diseases, and aggressive periodontitis were excluded.
Clinical and radiographic parameters
- Probing pocket depth (PPD): It was measured using a UNC-15 probe as a distance from the gingival margin to base of the periodontal pocket. Six sites around the teeth were observed and mean values were calculated
- Bone loss (radiographic): Bilateral pairs of standardized posterior bitewing dental radiographs were used to detect chronic periodontitis. The distance between the cementoenamel junction (CEJ) and alveolar bone crest was measured at interproximal sites from the distal aspect of the first premolar to mesial aspect of second molars. Chronic periodontitis was defined as alveolar bone loss in at least one site in the jaw with distance of CEJ to alveolar bone crest of 6 mm or more.  A grid calibrated in millimeters was used to measure the bone loss.
Selected subjects were informed about the study design and a written informed consent was obtained from them. Subjects were divided into three groups on the basis of severity of ED.
- Group I: Subjects with mild ED
- Group II: Subjects with moderate ED
- Group III: Subjects with severe ED.
Clinical and radiographic parameters were recorded and periodontal status of three groups was evaluated, compared and an attempt was made to find an association between ED and chronic periodontitis.
Data were analyzed using SPSS version 16.0 (SPSS, Chicago, IL, USA). Descriptive statistics were obtained. One-way ANOVA test and Scheffe's test were used to find the significance difference of chronic periodontitis according to the severity of ED. Karl Pearson's correlation was used to find an association between chronic periodontitis and ED.
| Results|| |
A total of 53 subjects suffering from ED were enrolled in the study. For comparison of periodontal status of subjects and to find any association between the ED and chronic periodontitis, the subjects were categorized into three groups depending upon the severity of ED. Twenty-three subjects had mild ED, seventeen had moderate ED, and thirteen were suffering from severe ED. Data of the patients with varying severity of ED is summarized in [Table 1]. Mean PPD of 3.3 ± 0.91 mm, 3.80 ± 0.92 mm and 5.0 ± 1.31 mm was recorded for Group I, II and III, respectively. A mean difference of 0.56 mm was recorded when findings of Group I were compared with Group II, which was not statistically significant. Statistically significant difference of 1.73 mm was recorded between Group I and III. When the comparison was made among Group II and III, a statistically significant mean difference of 1.17 mm was recorded in PPD [Table 2].
|Table 2: Mean difference in PPD and bone loss according to severity of ED |
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Mean radiographic bone loss for Group I, II and III was 1.04 ± 1.50 mm, 2.41 ± l.41 mm and 3.31 ± 2.42 mm, respectively [Table 1]. A statistically significant mean difference of 1.36 mm was recorded between Group I and Group II. When comparison was made among Group I and III, a statistically significant mean difference of 2.26 mm in radiographic bone loss was recorded. It was found that comparison of Group II and III did not yield any statistically significant result.
Karl Pearson's correlation was used to assess association between ED and chronic periodontitis. It was observed that both diseases were positively correlated to each other at P = 0.000 [Table 3].
| Discussion|| |
Periodontal infection can adversely affect systemic health with manifestations such as coronary heart disease, stroke, diabetes, preterm labor, low birth weight delivery, and respiratory disease.  Systemic diseases and disorders have also been implicated as risk indicators or factors in periodontal disease.  In this study, we made an attempt to find an association between chronic periodontitis and ED based on the fact that both chronic periodontitis and ED have mutual risk factors and these risk factors result in endothelial dysfunction.
Fifty-three subjects suffering from ED were enrolled in the study and their periodontal status was evaluated. The diagnosis of chronic periodontitis was made with PPD >5 mm and radiographic evidence of bone loss. A previous study has considered only Sexual Health Inventory for Man (SHIM) questionnaire to assess ED. In our study the subjects who had already received a diagnosis vasculogenic ED were enrolled and they were categorized into three groups: Group I (with mild ED), Group II (moderate ED), and Group III (severe ED) on basis of SHIM questionnaire. The SHIM questionnaire consisted of five questions rated on a six point scale from 0 to 5, except one question on a five point scale from 1 to 5. The total score is calculated by adding all question scores together  [Table 4]. Subjects who were suffering from vasculogenic ED were enrolled and those who were having some other etiology for ED such as psychological, anatomic, drug induced etc., were excluded. As periodontal disease is a multifactorial disease, so only those subjects were selected who had ED, but no other systemic disease.
In this study, it was found that all the subjects who had ED were not suffering from chronic periodontitis. It was observed that PPD values continuously increased with increase in severity of ED, which is in accordance to a previous study.  When comparison of PPD was made among three groups, statistically significant differences were observed among Group I and III and Group II and III, respectively. These findings are in contrast to a previous study in which group comparisons yielded nonsignificant results. 
Radiographic evidence of bone loss was used as a parameter to diagnose chronic periodontitis. To the best of our knowledge, there is only one previous study on the subject in which correlation between radiographic bone loss and severity of ED was assessed. A positive correlation between the severity of ED and bone loss was found in our study, which is in accordance to a previous study.  A positive correlation between the severity of ED, PPD and bone loss was found indicating an association between ED and chronic periodontitis. Well-known contribution of periodontitis in systemic inflammation also supports the association between these two conditions. Periodontitis may result in endothelial dysfunction,  which may further lead to ED.  The possible mechanism, which may be involved is that periodontal pathogens after entering blood stream may travel to distant sites , where these stimulate release of pro inflammatory cytokines and acute phase proteins which may lead to endothelial damage causing ED. 
| Conclusion|| |
From the results of this study, it can be concluded that chronic periodontitis and ED are associated to each other. However, further large scale studies with confounder analysis and longitudinal follow-up are warranted to explore the link between these two diseases.
| References|| |
|1.||Flemmig TF. Periodontitis. Ann Periodontol 1999;4:32-8. |
|2.||Lindhe J, Ranney R, Lamster I. Consensus report: Chronic periodontitis. Ann Periodontol 1999;4:38. |
|3.||Scannapieco FA. Systemic effects of periodontal diseases. Dent Clin North Am 2005;49:533-50, vi. |
|4.||Mealy BL, Klokkevold PR. Periodontal medicine. In: Newman MG, Takei HH, Carranza FA, editors. Carranza's Clinical Periodontology. 9 th ed. Philadelphia, PA: W.B Saunders Company; 2002. p. 229-44. |
|5.||Montague DK, Jarow JP, Broderick GA, Dmochowski RR, Heaton JP, Lue TF, et al. Chapter 1: The management of erectile dysfunction: An AUA update. J Urol 2005;174:230-9. |
|6.||Krane RJ, Goldstein I, Saenz de Tejada I. Impotence. N Engl J Med 1989;321:1648-59. |
|7.||Chiurlia E, D'Amico R, Ratti C, Granata AR, Romagnoli R, Modena MG. Subclinical coronary artery atherosclerosis in patients with erectile dysfunction. J Am Coll Cardiol 2005;46:1503-6. |
|8.||Heidelbaugh JJ. Management of erectile dysfunction. Am Fam Physician 2010;81:305-12. |
|9.||Roth A, Kalter-Leibovici O, Kerbis Y, Tenenbaum-Koren E, Chen J, Sobol T, et al. Prevalence and risk factors for erectile dysfunction in men with diabetes, hypertension, or both diseases: A community survey among 1,412 Israeli men. Clin Cardiol 2003;26:25-30. |
|10.||Chew KK, Bremner A, Jamrozik K, Earle C, Stuckey B. Male erectile dysfunction and cardiovascular disease: Is there an intimate nexus? J Sex Med 2008;5:928-34. |
|11.||Chew KK, Bremner A, Stuckey B, Earle C, Jamrozik K. Is the relationship between cigarette smoking and male erectile dysfunction independent of cardiovascular disease? Findings from a population-based cross-sectional study. J Sex Med 2009;6:222-31. |
|12.||Zadik Y, Bechor R, Galor S, Justo D, Heruti RJ. Erectile dysfunction might be associated with chronic periodontal disease: Two ends of the cardiovascular spectrum. J Sex Med 2009;6:1111-6. |
|13.||Sharma A, Pradeep AR, Raju PA. Association between chronic periodontitis and vasculogenic erectile dysfunction. J Periodontol 2011;82:1665-9. |
|14.||Keller JJ, Chung SD, Lin HC. A nationwide population-based study on the association between chronic periodontitis and erectile dysfunction. J Clin Periodontol 2012;39:507-12. |
|15.||Mealey BL. Influence of periodontal infections on systemic health. Periodontol 2000 1999;21:197-209. |
|16.||Mealey BL. Periodontal implications: Medically compromised patients. Ann Periodontol 1996;1:256-321. |
|17.||Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the international index of erectile function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 1999;11:319-26. |
|18.||Higashi Y, Goto C, Jitsuiki D, Umemura T, Nishioka K, Hidaka T, et al. Periodontal infection is associated with endothelial dysfunction in healthy subjects and hypertensive patients. Hypertension 2008;51:446-53. |
|19.||Billups KL. Erectile dysfunction as an early sign of cardiovascular disease. Int J Impot Res 2005;17 Suppl 1:S19-24. |
|20.||Pallasch TJ, Wahl MJ. The focal infection theory: Appraisal and reappraisal. J Calif Dent Assoc 2000;28:194-200. |
|21.||Mattila KJ, Valle MS, Nieminen MS, Valtonen VV, Hietaniemi KL. Dental infections and coronary atherosclerosis. Atherosclerosis 1993;103:205-11. |
|22.||Ross R. Atherosclerosis - An inflammatory disease. N Engl J Med 1999;340:115-26. |
Ranjit Singh Uppal
Department of Periodontology and Oral Implantology, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4]
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