{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T11:04:47Z","timestamp":1791198287357,"version":"4.1.0"},"reference-count":44,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T00:00:00Z","timestamp":1745539200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background: Periodontal disease (PD) and polycystic ovary syndrome (PCOS) are two prevalent conditions that have been independently associated with systemic inflammation and hormonal dysregulation. Emerging evidence suggests a potential bidirectional relationship between these conditions, but the nature and strength of this association remain unclear. Objective: This systematic review aimed to evaluate and synthesize the existing evidence on the association between periodontal disease and polycystic ovary syndrome, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methods: A comprehensive literature search was conducted in multiple databases, including PubMed, Scopus, and Web of Science, from 1990 to 2025. Studies investigating the association between PD and PCOS in terms of prevalence, severity, and shared pathophysiological mechanisms were included. Two independent reviewers screened studies for eligibility, extracted data, and assessed methodological quality using validated tools. Discrepancies were resolved through consensus. Meta-analysis was conducted where appropriate. Results: A total of nine studies were included. Most studies reported a higher prevalence and severity of periodontal disease among women with PCOS compared to controls. Shared mechanisms, including systemic inflammation, insulin resistance, and hormonal dysregulation, were frequently proposed as underlying factors. However, heterogeneity in study designs, diagnostic criteria, and confounding adjustments limited the comparability of findings. Conclusions: This systematic review supports a potential association between periodontal disease and polycystic ovary syndrome, likely mediated by common inflammatory and metabolic pathways. However, the evidence is limited by heterogeneity and methodological biases. Further well-designed longitudinal studies are needed to clarify causal relationships and explore the clinical implications of integrating periodontal health management into PCOS care.<\/jats:p>","DOI":"10.3390\/dj13050188","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T08:57:47Z","timestamp":1745571467000},"page":"188","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The Association Between Periodontal Disease and Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"13","author":[{"given":"Vincenzo","family":"Bitonti","sequence":"first","affiliation":[{"name":"UOC Odontostomatologia e Chirurgia Orale, AUSL Modena, 41122 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiziana","family":"Perri","sequence":"additional","affiliation":[{"name":"UO Ginecologia e Ostetricia Ospedale SS Annunziata, AUSL Ferrara, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Cigni","sequence":"additional","affiliation":[{"name":"UOC Odontostomatologia e Chirurgia Orale, AUSL Modena, 41122 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Familiari","sequence":"additional","affiliation":[{"name":"UOC Odontostomatologia e Chirurgia Orale, AUSL Modena, 41122 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Vazzana","sequence":"additional","affiliation":[{"name":"UOC Odontostomatologia e Chirurgia Orale, AUSL Modena, 41122 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rocco","family":"Franco","sequence":"additional","affiliation":[{"name":"UOC Odontostomatologia e Chirurgia Orale, AUSL Modena, 41122 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,25]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"Polycystic ovary syndrome","volume":"10","author":"Teede","year":"2024","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_2","first-page":"55","article-title":"Evaluation of Levels of Advanced Oxidative Protein Products in Patients with Polycystic Ovary Syndrome with and without Chronic Periodontitis: A Cross-Sectional Study","volume":"16","author":"Dharuman","year":"2022","journal-title":"Int. J. Fertil. Steril."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1007\/s12602-024-10223-5","article-title":"Gut Microbiota and Polycystic Ovary Syndrome (PCOS): Understanding the Pathogenesis and the Role of Probiotics as a Therapeutic Strategy","volume":"16","author":"Salehi","year":"2024","journal-title":"Probiotics Antimicrob. Proteins"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Bianchi, S., Bernardi, S., Mattei, A., Cristiano, L., Mancini, L., Torge, D., Varvara, G., Macchiarelli, G., and Marchetti, E. (2022). Morphological and Biological Evaluations of Human Periodontal Ligament Fibroblasts in Contact with Different Bovine Bone Grafts Treated with Low-Temperature Deproteinisation Protocol. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23095273"},{"key":"ref_5","first-page":"248","article-title":"Evaluation of Microbial Profile in Patients with Polycystic Ovary Syndrome and Periodontal Disease: A Case-Control Study","volume":"17","author":"Joseph","year":"2023","journal-title":"Int. J. Fertil. Steril."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1001\/jama.2021.23769","article-title":"Diagnosis and Treatment of Polycystic Ovary Syndrome","volume":"327","author":"Huddleston","year":"2022","journal-title":"JAMA"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1136\/gutjnl-2015-309897","article-title":"Periodontitis Induced by Porphyromonas Gingivalis Drives Periodontal Microbiota Dysbiosis and Insulin Resistance via an Impaired Adaptive Immune Response","volume":"66","author":"Garidou","year":"2017","journal-title":"Gut"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/s00774-021-01302-6","article-title":"Bone Markers and Bone Mineral Density Associates with Periodontitis in Females with Poly-Cystic Ovarian Syndrome","volume":"40","author":"Zia","year":"2022","journal-title":"J. Bone Miner. Metab."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Rathi, N., and Reche, A. (2023). Risk of Periodontal Diseases in Women With Polycystic Ovary Syndrome: An Overview. Cureus, 15.","DOI":"10.7759\/cureus.47169"},{"key":"ref_10","first-page":"74","article-title":"Metabolic Syndrome: Contemporary Views and Danger in Pregnancy","volume":"77","author":"Davydova","year":"2019","journal-title":"Ukr. J. Perinatol. Pediatr."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Wu, P., Zhang, X., Zhou, P., Zhang, W., Li, D., Lv, M., and Liao, X. (2021). Assessment of Bidirectional Relationships Between Polycystic Ovary Syndrome and Periodontitis: Insights From a Mendelian Randomization Analysis. Front. Genet., 12.","DOI":"10.3389\/fgene.2021.644101"},{"key":"ref_12","first-page":"274","article-title":"Effect of Cyproterone Acetate\/Ethinyl Estradiol Combination on Periodontal Status and High-Sensitivity C-Reactive Protein Levels in Women with Polycystic Ovary Syndrome: A Cross-Sectional Study","volume":"55","author":"Singhal","year":"2024","journal-title":"Quintessence Int."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Merfea, M., Cimpean, S.I., Chiorean, R.S., Antoniac, A., Delean, A.G., Badea, I.C., and Badea, M.E. (2024). Comparative Assessment of Push-Out Bond Strength and Dentinal Tubule Penetration of Different Calcium-Silicate-Based Endodontic Sealers. Dent. J., 12.","DOI":"10.3390\/dj12120397"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Mashyakhy, M., and Adawi, H.A. (2024). Fracture Resistance and Initial Penetration Time of a Novel Zirconia Crown Design for Simplifying Future Endodontic Treatment: An In Vitro Study. Dent. J., 12.","DOI":"10.3390\/dj12120385"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1111\/jog.14179","article-title":"Evaluation of Periodontal Status in Different Phenotypes of Polycystic Ovary Syndrome in Untreated Patients of Early Reproductive Age: A Case\u2013Control Study","volume":"46","author":"Telatar","year":"2020","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3249","DOI":"10.1007\/s00784-018-2741-2","article-title":"Influence of Polycystic Ovary Syndrome on the Periodontal Health of Indian Women Visiting a Secondary Health Care Centre","volume":"23","author":"Varadan","year":"2019","journal-title":"Clin. Oral. Investig."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Klimenko, E.S., Igumnov, I.A., Markova, D.P., Belkova, N.L., and Suturina, L.V. (2022). Does Salivary Microbiome Reflect the Functional Activity Profile of Oral Microbiota?. Russ. Open Med. J., 11.","DOI":"10.15275\/rusomj.2022.0120"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Machado, V., Escalda, C., Proen\u00e7a, L., Mendes, J.J., and Botelho, J. (2020). Is There a Bidirectional Association between Polycystic Ovarian Syndrome and Periodontitis? A Systematic Review and Meta-Analysis. J. Clin. Med., 9.","DOI":"10.3390\/jcm9061961"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Zhang, H., and Lin, X. (2024). Research Progress on the Potential Correlation between Polycystic Ovary Syndrome and Periodontal Disease. J. Int. Med. Res., 52.","DOI":"10.1177\/03000605241300096"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.jclinepi.2010.09.011","article-title":"GRADE Guidelines: A New Series of Articles in the Journal of Clinical Epidemiology","volume":"64","author":"Guyatt","year":"2011","journal-title":"J. Clin. Epidemiol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Liu, X., Wang, F., Wang, X., and Luan, Q. (2024). Impact of Body Mass Index and Polycystic Ovary Syndrome (PCOS) Subtypes on Periodontal Health in Chinese Women with PCOS and Periodontitis. Gynecol. Endocrinol., 40.","DOI":"10.1080\/09513590.2024.2405097"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1007\/s00784-020-03456-5","article-title":"Subgingival Microflora in Adolescent Females with Polycystic Ovary Syndrome and Its Association with Oral Hygiene, Gingivitis, and Selected Metabolic and Hormonal Parameters","volume":"25","author":"Wendland","year":"2021","journal-title":"Clin. Oral. Investig."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.fertnstert.2010.07.1052","article-title":"Periodontal Disease in Polycystic Ovary Syndrome","volume":"95","author":"Dursun","year":"2011","journal-title":"Fertil. Steril."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Akcal\u0131, A., Bostanci, N., \u00d6z\u00e7aka, \u00d6., \u00d6zt\u00fcrk-Ceyhan, B., G\u00fcm\u00fc\u015f, P., Buduneli, N., and Belibasakis, G.N. (2014). Association between Polycystic Ovary Syndrome, Oral Microbiota and Systemic Antibody Responses. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0108074"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"798","DOI":"10.4103\/ijcm.ijcm_1012_22","article-title":"Comparative Assessment of Periodontal Status in Subjects with and without Polycystic Ovary Syndrome and Its Correlation with Body Mass Index: A Cross-Sectional Study","volume":"48","author":"Mariam","year":"2023","journal-title":"Indian J. Community Med."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Wendland, N., Opydo-Szymaczek, J., Formanowicz, D., Blacha, A., Jarz\u0105bek-Bielecka, G., and Mizgier, M. (2021). Association between Metabolic and Hormonal Profile, Proinflammatory Cytokines in Saliva and Gingival Health in Adolescent Females with Polycystic Ovary Syndrome. BMC Oral. Health, 21.","DOI":"10.1186\/s12903-021-01553-9"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Rahiminejad, M., Moaddab, A., Zaryoun, H., Rabiee, S., Moaddab, A., and Khodadoustan, A. (2015). Comparison of Prevalence of Periodontal Disease in Women with Polycystic Ovary Syndrome and Healthy Controls. Dent. Res. J., 12.","DOI":"10.4103\/1735-3327.170547"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"S17","DOI":"10.12701\/jyms.2023.00143","article-title":"Evaluation of Periodontal Status in Women with Polycystic Ovary Syndrome versus Healthy Women: A Cross-Sectional Study","volume":"40","author":"Pavankumar","year":"2023","journal-title":"J. Yeungnam Med. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"M\u00e1rquez-Arrico, C.F., Silvestre, F.J., Fern\u00e1ndez-Reyes, M., L\u00f3pez-Dom\u00e8nech, S., Hermenejildo, J., Abad-Jim\u00e9nez, Z., Silvestre-Rangil, J., Fern\u00e1ndez-Collazo, P., Morillas, C., and Montiel-Company, J.M. (2024). Gingival Inflammation and Leukocyte\u2013Endothelium Cell Interactions in Women with Polycystic Ovary Syndrome. J. Periodontol.","DOI":"10.1002\/JPER.24-0148"},{"key":"ref_30","first-page":"1315","article-title":"Polycystic Ovarian Syndrome: Its Impact on Periodontal Disease","volume":"14","author":"Rajesh","year":"2020","journal-title":"Indian J. Forensic Med. Toxicol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1159\/000536223","article-title":"Impact of Polycystic Ovary Syndrome on Periodontal Status of Women of Adolescent and Adult Age Groups: A Cross-Sectional Study","volume":"33","author":"Jaglan","year":"2024","journal-title":"Med. Princ. Pract."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Galbraith, A., and Abubakr, N.H. (2024). Evaluation of the Effects of Thermal Aging on the Surface Roughness of Novel Tooth-Colored Restorative Materials. Dent. J., 12.","DOI":"10.3390\/dj12120390"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Qasim, S.S.B., Akbar, A.A., Sadeqi, H.A., and Baig, M.R. (2024). Surface Characterization of Bone-Level and Tissue-Level PEEK and Titanium Dental Implant Scan Bodies After Repeated Autoclave Sterilization Cycles. Dent. J., 12.","DOI":"10.3390\/dj12120392"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"506","DOI":"10.19256\/d.cadmos.07.2022.04","article-title":"Perio-Fertility: The State of the Art","volume":"90","author":"Ortu","year":"2022","journal-title":"Dent. Cadmos"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Sologova, D., Diachkova, E., Sologova, S., Smolyarchuk, E., Margaryan, A., Grigorevskikh, E., Petruk, P., Tumanova, E., Svitich, O., and Tarasenko, S. (2024). The Efficacy of Er:YAG Laser in the Extraction of Impacted Third Molars: A Randomized Clinical Trial. Dent. J., 12.","DOI":"10.3390\/dj12120388"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Shimatsu, M., Kawashima, S., and Suzuki, M. (2024). Evaluating Craniofacial Morphology Ratios as Predictors of Obstructive Sleep Apnea Severity in Non-Obese Adult Males. Dent. J., 12.","DOI":"10.3390\/dj12120374"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Hristozova, M., Dimitrova, M., and Zlatev, S. (2024). Bilateral Symmetry in the Aesthetic Area Achieved by Digital Smile Design on 3D Virtual Patient and Conventional Diagnostic Wax-Up\u2014A Comparative Study. Dent. J., 12.","DOI":"10.3390\/dj12120373"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Papadopoulou, E., Kouri, M., Andreou, A., Diamanti, S., Georgaki, M., Katoumas, K., Damaskos, S., Vardas, E., Piperi, E., and Nikitakis, N.G. (2024). Challenges in Differential Diagnosis of Diffuse Gingival Enlargement: Report of Two Representative Cases and Literature Review. Dent. J., 12.","DOI":"10.3390\/dj12120403"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Sachelarie, L., Cristea, R., Burlui, E., and Hurjui, L.L. (2024). Laser Technology in Dentistry: From Clinical Applications to Future Innovations. Dent. J., 12.","DOI":"10.3390\/dj12120420"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"M\u00e1rquez-Arrico, C.F., Silvestre-Rangil, J., Guti\u00e9rrez-Castillo, L., Martinez-Herrera, M., Silvestre, F.J., and Rocha, M. (2020). Association between Periodontal Diseases and Polycystic Ovary Syndrome: A Systematic Review. J. Clin. Med., 9.","DOI":"10.3390\/jcm9051586"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Di Spirito, F., Pisano, M., Di Palo, M.P., Salzano, F., Rupe, A., Fiorino, A., and Rengo, C. (2024). Potential Impact of Microbial Variations After Peri-Implantitis Treatment on Peri-Implant Clinical, Radiographic, and Crevicular Parameters: A Systematic Review. Dent. J., 12.","DOI":"10.3390\/dj12120414"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Bung\u0103u, T.C., Moca, A.E., Ciavoi, G., Romanul, I.M., Vaida, L.L., and Buha\u0219, C.L. (2024). Usage and Preferences of Orthodontic Mini-Implants Among Romanian Practitioners: A Survey Study. Dent. J., 12.","DOI":"10.3390\/dj12120400"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Wang, Y., Millstein, P., Lu, K.Y.-F., Lee, J.D., and Lee, S.J. (2024). Changes in Occlusal Contacts upon the Cementation of Zirconia Crowns with Different Cement Spacers. Dent. J., 12.","DOI":"10.3390\/dj12120377"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1038\/ijir.2017.7","article-title":"Association between Periodontal Disease and Polycystic Ovary Syndrome: A Systematic Review","volume":"29","author":"Kellesarian","year":"2017","journal-title":"Int. J. Impot. Res."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/13\/5\/188\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:21:37Z","timestamp":1760030497000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/13\/5\/188"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,25]]},"references-count":44,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["dj13050188"],"URL":"https:\/\/doi.org\/10.3390\/dj13050188","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,25]]}}}