Women are less likely than men to get periodontal disease!
Most studies about gum disease report that men are more likely to have aggressive periodontitis. But, women may be just slightly more likely to develop late onset chronic periodontitis.
Dental implants last longer in women
A study in 2015 found that dental implants were more likely to fail in men than women. The researchers don’t know why, but maybe it ties back to the first fact – that women are less likely to have gum disease! Dental implants placed in patients with a history of periodontal disease are more likely to fail, especially if the periodontal disease is untreated.
Estrogen, the primary female hormone, is tied to gum disease.
Periodontal disease manifests at different times throughout a woman’s life, due to shifts in hormones.
Hormonal changes in puberty, pregnancy, menstrual cycles, and menopause can affect the blood supply to the gums and cause an exaggerated response to irritants from plaque. Gums may become red, tender, swollen and likely to bleed easily during chewing or tooth brushing.
Although not exclusive, many systemic diseases are more frequent in women compared to men. In particular, gender differences have been already proven in disorders associated with immune and cardiovascular systems, neurodevelopment and cancers.
Women who had gum disease have a 14% increased risk of breast cancer
compared to women who didn’t have gum disease. The percentage jumps to over 30% if the woman smokes, or has smoked in the past 20 years.
Post-menopausal women who suffer from osteoporosis are 86% more likely to also develop periodontal disease.
The National Osteoporosis Foundation estimates nearly 54 million Americans have it or the pre-condition for it (low bone mass), and that one in two women over age 50 will break a bone due to the condition. Researchers have connected osteoporosis to loss of bone in the jaw. This is because osteoporosis working in connection with gum disease will make the bone loss of the mouth much more severe. When the jaw bone deteriorates, the teeth fall out, which is a symptom associated with advanced gum disease.
Gum disease may trigger Rheumatoid Arthritis.
Rheumatoid Arthritis is an autoimmune disease that women are 2 to 3 times more likely to have than men.
A study presented back in 2018 at the Annual European Congress of Rheumatology theorized that Gum disease may be a key initiator of rheumatoid arthritis related autoimmunity. In the study, individuals at risk for RA were nearly twice as likely to have gum disease.
The antibodies associated with RA are present in the body before the disease exhibits any signs. This suggests that the antibodies don’t start in the joints affected by RA, but rather come from somewhere else in the body and then find their way into the joints. The specific antibodies associated with RA are a response to an enzyme created by the oral bacteria that triggers gum disease (P. gingivalis).
Thus, having gum disease can lead to earlier onset, faster progression and greater severity of RA, including increased damage to bone and cartilage.
Lupus is significantly associated with periodontal disease.
Similar to gum disease, lupus is an inflammatory disease that causes your body’s immune system to attack your own tissues. Anyone can develop lupus, but it affects women more often than men. In fact, 9 in 10 people with lupus are women. One study published in 2019 linked higher lupus disease activity to bacteria originating from periodontal disease. Additional studies have also indicated lupus may lead to a higher risk of gum disease. However, it’s also possible that gum disease may lead to the development of lupus!
Periodontal disease and the oral-systemic connection in women also has serious implications for fertility and pregnancy.
Women with gum disease are at seven times greater risk of preterm birth or low birth weight.
Researchers have linked periodontitis to a risk for pre-term delivery (PTD) and premature and low-birth-weight (PLBW) babies. Studies indicate that the infection present in the oral cavity gets into the blood stream and can target the fetus. When they cross the placenta, the bacteria create toxicity in the womb and cause early delivery.
Pregnant women with periodontal disease are more likely to experience preeclampsia.
Preeclampsia is a pregnancy-specific disease which is characterized by hypertension and increased levels of protein in the urine. Proteins should remain in the blood, so finding increased levels in urine could be a sign of kidney damage. This disease occurs in about 2-8 % of pregnancies and is among the major causes of maternal and neonatal mortality and morbidity throughout the world. Several epidemiological studies have found an association between periodontal disease and preeclampsia.
Gum Disease can make it harder for women to become pregnant
Chronic periodontitis is gaining awareness as a key contributor to systemic wellness. The time to conception is another aspect of systemic health that is impacted by gum disease. Multiple studies across different races demonstrated that women with chronic periodontitis took longer to become pregnant.
The possible biological explanation is that periodontitis causes a systemic inflammation, which could: a) prevent ovulation; b) prevent implantation of the embryo or does not sustain its implantation.
Women with gum disease are nearly 50% more likely to develop Polycystic Ovarian Syndrome (PCOS).
PCOS females have 28% more risk towards periodontal disease, and females with gum disease have 46% more risk to have PCOS. PCOS females with PD had higher gum bleeding, periodontal pocket depth and clinical attachment loss than non-PCOS females with PD
Women without gum disease live longer!
Women with periodontal disease have a 12% higher risk of premature death from any cause![7] Another study found that women with cardiovascular disease and periodontal disease has a 17% higher mortality rate than women without periodontal disease.
Many classic studies about gum disease didn’t include women!
After the unethical experiments during WW2, there was a need for laws to protect human subjects and women were not allowed to participate in clinical trials. It was commonly thought there was “no difference” and that including females might create “unnecessary hormonal noise.”
In 1986, the National Institute of Health (NIH) encouraged but did not require the inclusion of women in clinical studies. The Office of Research on Women’s Health, the Revitalization Act law in 1993 outlining the inclusion of women and minorities, as well as an NIH policy in 2015 requiring studies to justify single-sex research protocols, that women were routinely included in clinical studies.
However, we now know that men are significantly more likely harbor periodontal pathogens in saliva and beneath the gums. There are also sex-specific differences in the bacteria in the gut microbiome and sex chromosomes play a role in the immune response.