Periodontal Disease: Sex Matters

As a practicing dentist, I sometimes notice trends and tendencies in my patients before research comes out to confirm it. Years before the term “oral-systemic health” was a widely accepted term, I noticed that my oldest, healthiest patients had teeth and gums as healthy as their grandchildren’s.

And as oral-systemic research expands to include genetics and immunity, I’m now seeing research that confirms another of my clinical observations: When it comes to gum disease, men and women are affected differently.

Typically, men have more visual signs of periodontal disease:

“Men are at greater risk for developing destructive periodontal disease than women due to heightened innate immune response in men compared to women, as well as potential differences in regulation of amplification and termination of inflammation, provide a sound biologic basis for sex differences in periodontal disease progression.”

Women, on the other hand, typically have a greater impact from hormones and lifestyle factors on oral biofilm that might not necessarily be visible to the eye.

“About three-quarters of periodontal office visits are made by women, even though women tend to take better care of their teeth than men. Female hormones affect the gums, and women are particularly susceptible to periodontal problems:

  • Before menstruation
  • Pregnancy
  • Oral contraceptives
  • Menopause

As a dentist, I can tell you that, on the whole, women take better care of themselves intra-orally. However, women appear to have a greater impact from oral biofilm/inflammation due to stress and subsequent cortisol production—which, as we know, can feed some of the most virulent oral pathogens.

A 2013 study in the British Journal of Health Psychology noted that

“Interpersonal conflict, marital stress, and single or divorced marital status are more robustly associated with poor health outcomes in women than in men. Higher IL-6 may represent one pathway through which less positive relationships are associated with greater health risk in women.”

Also, elevated Il-6 has been shown to elevate the impact of oral biofilm, especially in women.

As we know, periodontal disease is not as cut-and-dry as bleeding gums and pocketing. A person can have healthy looking gums but still have a very high bioburden of harmful pathogens. This silent infection can have grave impacts systemically—in the absence of traditional signs of periodontal disease—triggering both bacterial spread and inducing inflammation at distant sites, potentially resulting in inflammatory diseases such as Alzheimer’s disease and cardiovascular diseases.

These relationships are not linear—stress/cortisol, genetics, diet, and sleep disorders play confounding roles. It’s never been more important to pay attention to both lifestyle and genetic triggers, especially for women.