Sex hormones may explain higher risk of gum disease in men

To establish better management and risk assessment models for periodontal disease, Harlan Shiau, DDS, DMedSc, assistant professor, and Mark Reynolds, DDS, PhD, MA, professor at the Dental School, have published the first comprehensive review of gender differences in the development and progression of the destructive periodontal disease.

In a review paper in the Journal of Periodontology, the authors examine evidence for a biologic basis for a sexual dimorphism, or the differences in susceptibility, to periodontal disease between men and women. They conclude that sex steroids exert effects on multiple ways on the immune system regulation of inflammation. They also conclude that the root of the difference may be genetic.

"Differential gene regulation, particularly in sex steroid-responsive genes, could likely play a part in the observed sexual dimorphism of destructive periodontal disease," said Shiau.

"We think it is a plausible explanation," he added. The observation of men "having worse gum disease than women" was generally accepted by dental clinicians previously, says Shiau, "but we wondered if the traditional explanations were adequate. This study provides health care professionals with important comparative data for estimating gender-related differences in risk for destructive periodontal disease."

Prior to the current review paper, the researchers conducted a systematic review of published population studies on the prevalence of periodontal disease. In their analysis they established that men, indeed, have a greater prevalence of periodontal disease than women globally.

Shiau and Reynolds explored potential biologic explanations by drawing from the extensive body of literature in autoimmune disease research, where there also exists sexual dimorphism in disease prevalence.

"Also, we considered the competing hypothesis that the environment explains the dimorphism, such as the observation that men have worse oral hygiene and compliance than women. However, there exist population studies, which control for potential co-variants, like these, and have still yielded significant gender effects." Shiau explains.

"The innate immune response plays a considerable role in the pathogenesis of periodontal disease. The literature seems to indicate that a 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," says Shiau.