Chronic periodontal disease (PD) may be a risk factor for erectile dysfunction (ED), a new review suggests.

Sergio Varela Kellesarian, DDS, of Eastman Institute for Oral Health in Rochester, NY, and colleagues identified 9 studies published from 2009 to 2015 that assessed ED and oral health. Two were randomized controlled trials and the remainder cross-sectional studies. The number of participants ranged from 53 to 513,258, with ages ranging from 20 to 85 years.

All studies reported a positive and statistically significant relationship between PD and ED, according to results published online in the American Journal of Men’s Health. Researchers reported odds ratios in 4 studies, with odds of ED ranging from 1.5–3.4 times higher in men with PD.

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Regarding how PD might contribute to ED, the investigators cited hypotheses such as increased production of reactive oxygen species in tissues that reduce the bioavailability of nitric oxide, promoting endothelial dysfunction. In an animal model, mild systemic inflammation associated with PD reduced nitric oxide synthase activity in penile tissue.

Andrological examination “should include comprehensive oral evaluation, and physicians detecting erectile dysfunction should refer the patient to a dentist for further evaluation and treatment,” Dr Varela Kellesarian told Renal & Urology News.

A few of the studies suggested that nonsurgical periodontal treatments can reduce inflammation in ED patients. Chronic PD weakens the supporting structures of teeth, such as the cememtum, gingiva, periodontal ligament, and alveolar bone.

More well-designed, controlled, and longitudinal studies are needed, however. More than half of the included studies did not account for tobacco and alcohol use, and a fifth did not adjust for diabetes or heart disease. Smoking, alcohol, uncontrolled diabetes, and coronary heart disease, are risk factors for both ED and PD. In addition, the researchers noted that the 9 studies in their review were conducted in Asia and the Middle East for relatively short period of times and with relatively small study samples, limiting generalizability.

Future studies should establish ED diagnosis with medical and psychological exam, nocturnal penile rigidity test, and Doppler ultrasound. ED diagnosis in many of the studies was made using less ideal methods such as the International Index of Erectile Function or Sexual Health Inventory for Men.

In a separate meta-analysis and review published recently in the Journal of Clinical Periodontology (2016;43;206-215), investigators reported finding an association between chronic periodontitis and ED. The study, which included 4 studies involving 38,111 cases and 174,807 controls, showed that periodontitis was associated with a significant 3-fold increased odds of ED.


  1. Varela Kellesarian S, Varela Kellesarian T, Ros Malignaggi V, et al. Association Between Periodontal Disease and Erectile Dysfunction: A Systematic Review. Am Journ Men’s Health. doi:10.1177/1557988316639050. 
  2. Wang Q, Kang J, Cai X, Wu Y, Zhao L. The Association Between chronic periodontitis and vasculogenic erectile dysfunction: a systematic review and meta-analysis. J Clin Periodontol. 2016 Mar;43(3):206-15. doi:10.1111/jcpe.12512.