Association between periodontal flap surgery for periodontitis and vasculogenic erectile dysfunction in Koreans. The National Health Insurance Service-National Sample Cohort and medical checkup data from to were used to evaluate the association between periodontal surgery for the treatment of periodontitis PSTP and vasculogenic erectile dysfunction VED. Bivariate and multivariate logistic regression analyses were applied to a longitudinal retrospective database to assess the association between PSTP and VED while adjusting for the potential confounding effects of sociodemographic factors age, household income, insurance status, health status, residence area, and smoking status and comorbidities diabetes mellitus, angina pectoris, cerebral infarction, and myocardial infarction.
Subjects with a history of periodontal flap surgery had a significantly higher risk of VED, after adjusting for potential confounding factors. Further studies are required to identify the key mechanisms underlying the association between severe periodontal disease and VED. Chronic periodontitis; Cohort studies; Erectile dysfunction; Periodontal diseases; Retrospective studies.
Periodontal disease PD is a chronic bacterial inflammatory disease [ 1 ]. In particular, severe chronic PD can affect almost every periodontal structure, including the cementum, gingiva, and periodontal ligament, and is characterized by the slow-to-rapid but irreversible progression of destruction of the supporting bone, as indicated by more than 5 mm of clinical attachment loss [ 2 ]. Sexual dysfunction in males refers to a persistent inability to maintain a sufficient erection or achieve sexual intercourse without an aid [ 4 ].
When such a state lasts for more than Lee jae hwang wife sexual dysfunction months, it is generally referred to as erectile dysfunction ED [ 5 ]. The overall prevalence of ED in Korea was reported to be While PD and vasculogenic erectile dysfunction VED are considered inflammatory infectious diseases that share the same proinflammatory cytokines and chemokines in the vascular endothelium, controversy still exists about the of common pathways and mechanisms between these different diseases [ 9 ].
In addition, the results of case-control and cohort studies that have assessed the association between periodontal surgery for the treatment of periodontitis PSTP and VED have been ambiguous and inconsistent due to the use of vague PD definitions, small samples, and the presence of various confounding factors [ 10 ].
The Korean population in was We extracted data on 1, people, who represented 2. The researchers were blinded to the patients' identities, and a unique random number was allocated to each individual. Subjects in the representative random population samples who died between and were automatically disqualified from inclusion in the NHIS-NSC database, while newborn representative subjects were added. Figure 1 shows a flowchart for the inclusion and exclusion of participants in the current study.
The total recruited sample consisted of 7, patients who had undergone periodontal flap surgery the PSTP group andcontrol participants the non-PSTP group.
Among the patients who had been treated with periodontal surgery between andthose who were diagnosed with VED by a urologist at a private or general hospital were included in this cohort study. The following comorbidities were considered to be present if they were diagnosed by a medical doctor between and All statistical data were analyzed using SAS version 9.
Table 1 Baseline characteristics of the study population Characteristics No. PSTP corresponded to 7, 2. National Health "Lee jae hwang wife sexual dysfunction" Service. In addition, 2, patients 0. Table 3 presents the results of the multivariate logistic analysis, adjusting for sociodemographic factors and comorbidities to investigate the association between PSTP and VED.
Smoking showed an OR of 1. Cerebral infarction OR, 1. In the multivariate regression analysis conducted to identify risk or modifying factors in PSTP, including sociodemographic factors, smoking status, and comorbidities, the OR for VED was 1. These results are consistent with those of Lee et al. This contrasts with previous studies of the prevalence of PD and VED that showed an increased prevalence among elderly subjects and those with a lower standard of living [ 1213 ].
These discrepancies might be explained by the reduced accessibility of dental services among that Lee jae hwang wife sexual dysfunction, and by the limitations of the current study, which included only patients who visited clinics to be diagnosed and treated for severe PD and VED [ 14 ].
Therefore, periodontal pathogens that chronically infect the periodontal pocket could explain the association between PSTP and systemic endothelial dysfunction [ 16 ].
A gene-level analysis found associations indicating that mutual genetic factors play important pathological roles in both inflammatory diseases, with 2 linkage regions at human chromosome 9p Their data are supported by the strong association between PD and VED, which share the same inflammatory reaction mechanism [ 22 ].
In addition, treatment of chronic PD has been prospectively validated to reduce the risk of endothelial dysfunction at 6 months therapy [ 23 ]. PD and VED share multiple common risk factors and pathophysiological pathways, such as older age, smoking, obesity, chronic glucocorticoid therapy, and immunological diseases [ 24 ]. Therefore, smoking cessation, reducing obesity, and avoiding other common risk factors are safe and effective means of reducing the incidence of both diseases.
Some studies have also suggested that the incidence of periodontal inflammation can be reduced by taking statins hydroxymethylglutaryl-CoA reductase inhibitorswhich are the major lipid-lowering agents and one of the drugs prescribed for reducing the risk of cardiovascular disease and VED, although these results are controversial [ 25 ].
In particular, one cohort study of statins found beneficial effects in middle-aged men [ 26 ]. Although a healthy vascular endothelium protects against damage and exhibits anti-inflammatory and antioxidant properties, low concentrations of chronic PD-induced inflammatory cytokines and oxidative stress that accumulate in the penile endothelium can cause VED [ 28 ].
Moreover, since the penile artery has a small arterial branch, it is considered to be vulnerable to the accumulation of inflammatory products [ 29 ]. Our study had several limitations. First, its observational cohort design meant that it was not possible to conclude definitively that severe PD had an adverse effect on Lee jae hwang wife sexual dysfunction erection.
Second, this study did not analyze dental records such as full probing charts or intraoral radiographs, which restricted the ability to diagnose the severity and the follow-up period of PD [ 30 ].
Third, the severity and the follow-up period of VED and other investigated comorbidities were not assessed because of insufficient medical records.
Finally, the severity and follow-up status of smoking were also not assessed because of limitations in the national health examination database. Therefore, future cohort studies should be designed to assess the severity and the follow-up period of PD, smoking status, and accompanying comorbidities, including VED. Despite these limitations, this well-controlled longitudinal cohort study that included smoking status found that PSTP was closely related to VED, as PD is known to be a risk or modifying factor for cardiovascular disease and diabetes mellitus [ 22 ].
Therefore, when a patient is diagnosed with a severe form of PD requiring periodontal flap surgery, improvement of the periodontal environment through appropriate periodontal treatment should be considered an effective intervention to reduce or reverse the prevalence of VED, including serious endothelial dysfunction. This retrospective longitudinal cohort analysis found significant and positive associations between PSTP and the surveyed comorbidities. Further studies are required to identify the key mechanisms underlying the association between severe PD and VED.
This study was supported by a student research grant from Yonsei University, College of Dentistry in and Wonkwang University in
Lee jae hwang wife sexual dysfunction potential conflict of interest relevant to this article was reported.