Evaluation of Microbial Profile in Patients with Polycystic Ovary Syndrome and Periodontal Disease: A Case-Control Study

Document Type : Original Article


Department of Periodontology, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, India


Background: Polycystic ovary syndrome (PCOS) and oral health are found to share a reciprocal link. Previous substantiating
evidences suggest that PCOS may have a confounding effect on periodontal health and may quantitatively modify
the composition of the oral microbiome. To analyze the role of PCOS as a risk factor in causing periodontal disease, we
compared and evaluated the levels of Porphyromonas gingivalis and Fusobacterium nucleatum in patients with polycystic
ovary syndrome, polycystic ovary syndrome, chronic periodontitis, polycystic ovary syndrome, and gingivitis, and
healthy controls.
Materials and Methods: In this case-control study, 40 female participants are enrolled and grouped into four groups
which included healthy female individuals, patients with PCOS, patients with PCOS and gingivitis, and patients with
PCOS and periodontitis. Periodontal examination is assessed primarily on all the participants using a UNC-15 probe.
Dental plaque is then collected using a sterile curette in one stroke and transferred into an Eppendorf tube containing
TE Buffer (Tris-EDTA buffer) solution. The level of Porphyromonas gingivalis and Fusobacterium nucleatum was
estimated by real-time polymerase chain reaction (PCR).
Results: The levels of Fusobacterium nucleatum were observed to be significantly higher in group with patients with
PCOS and periodontitis.
Conclusion: PCOS may have an impact on the composition of oral microflora causing repercussions in periodontal


  1. Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013; 98(12): 4565-4592.
  2. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004; 81(1): 19-25.
  3. Nidhi R, Padmalatha V, Nagarathna R, Amritanshu R. Prevalence of polycystic ovarian syndrome in Indian adolescents. J Pediatr Adolesc Gynecol. 2011; 24(4): 223-227.
  4. Greene GL, Gilna P, Waterfield M, Baker A, Hort Y, Shine J. Sequence and expression of human estrogen receptor complementary DNA. Science. 1986; 231(4742): 1150-1154.
  5. Mamalis A, Markopoulou C, Lagou A, Vrotsos I. Oestrogen regulates proliferation, osteoblastic differentiation, collagen synthesis and periostin gene expression in human periodontal ligament cells through oestrogen receptor beta. Arch Oral Biol. 2011; 56(5): 446- 455.
  6. Nebel D, Bratthall G, Ekblad E, Norderyd O, Nilsson BO. Estrogen regulates DNA synthesis in human gingival epithelial cells displaying strong estrogen receptor β immunoreactivity. J Periodontal Res. 2011; 46(5): 622-628.
  7. Välimaa H, Savolainen S, Soukka T, Silvoniemi P, Mäkelä S, Kujari H, et al. Estrogen receptor-beta is the predominant estrogen receptor subtype in human oral epithelium and salivary glands. J Endocrinol. 2004; 180(1): 55-62.
  8. Jönsson D, Andersson G, Ekblad E, Liang M, Bratthall G, Nilsson BO. Immunocytochemical demonstration of estrogen receptor beta in human periodontal ligament cells. Arch Oral Biol. 2004; 49(1): 85-88.
  9. Kelly CC, Lyall H, Petrie JR, Gould GW, Connell JM, Sattar N. Low grade chronic inflammation in women with polycystic ovarian syndrome. J Clin Endocrinol Metab. 2001; 86(6): 2453-2455.
  10. Ozçaka O, Nalbantsoy A, Buduneli N. Interleukin-17 and interleukin-18 levels in saliva and plasma of patients with chronic periodontitis. J Periodontal Res. 2011; 46(5): 592-598.
  11. Tanguturi SC, Nagarakanti S. Polycystic ovary syndrome and periodontal disease: underlying links- a review. Indian J Endocrinol Metab. 2018; 22(2): 267-273.
  12. Akcalı A, Bostanci N, Özçaka Ö, Öztürk-Ceyhan B, Gümüş P, Buduneli N, et al. Association between polycystic ovary syndrome, oral microbiota and systemic antibody responses. PLoS One. 2014; 9(9): e108074.
  13. Saglam E, Canakci CF, Sebin SO, Saruhan N, Ingec M, Canakci H, et al. Evaluation of oxidative status in patients with chronic periodontitis and polycystic ovary syndrome: a cross-sectional study. J Periodontol. 2018; 89(1): 76-84.
  14. Farook FF, Ng KT, MNM N, Koh WJ, Teoh WY. Association of periodontal disease and polycystic ovarian syndrome: a systematic review and meta-analysis with trial sequential analysis. Open Dent J. 2020; 13(1): 478-487.
  15. Eke PI, Page RC, Wei L, Thornton-Evans G, Genco RJ. Update of the case definitions for population-based surveillance of periodontitis. J Periodontol. 2012; 83(12): 1449-1454.
  16. Kugaji MS, Bhat KG, Joshi VM, Pujar M, Mavani PT. Simplified method of detection of Dialister invisus and Olsenella uli in oral cavity samples by polymerase chain reaction. J Adv Oral Res. 2017; 8(1-2): 47-52.
  17. Kugaji MS, Muddapur UM, Bhat KG, Joshi VM, Kumbar VM, Peram MR, et al. Quantitative evaluation of porphyromonas gingivalis in indian subjects with chronic periodontitis by real-time polymerase chain reaction. J Adv Oral Res. 2019; 10(2): 137-144.
  18. Yamaura M, Sato T, Echigo S, Takahashi N. Quantification and detection of bacteria from postoperative maxillary cyst by polymerase chain reaction. Oral Microbiol Immunol. 2005; 20(6): 333-338.
  19. Hujoel PP, White BA, García RI, Listgarten MA. The dentogingival epithelial surface area revisited. J Periodontal Res. 2001; 36(1): 48-55.
  20. D'Ercole S, Piccolomini R, Capaldo G, Catamo G, Perinetti G, Guida L. Effectiveness of ultrasonic instruments in the therapy of severe periodontitis: a comparative clinical-microbiological assessment with curettes. New Microbiol. 2006; 29(2): 101-110.
  21. Dikilitas¸ A, Karaaslan F, Yig˘It U. The association between oral hygiene behavior and gingival health status with the stage and grade of periodontitis: a cross-sectional study. J Adv Oral Res. 2020; 11(2): 156-164.
  22. Mariotti AJ. Estrogen and extracellular matrix influence human gingival fibroblast proliferation and protein production. J Periodontol. 2005; 76(8): 1391-1397.
  23. Dursun E, Akalın FA, Güncü GN, Çınar N, Aksoy DY, Tözüm TF, et al. Periodontal disease in polycystic ovary syndrome. Fertil Steril. 2011; 95(1): 320-323.
  24. Rahiminejad ME, Moaddab A, Zaryoun H, Rabiee S, Moaddab A, Khodadoustan A. Comparison of prevalence of periodontal disease in women with polycystic ovary syndrome and healthy controls. Dent Res J (Isfahan). 2015; 12(6): 507-512.
  25. Abraham-Inpijn L, Polsacheva OV, Raber-Durlacher JE. The significance of endocrine factors and microorganisms in the development of gingivitis in pregnant women. Stomatologiia (Mosk). 1996; 75(3): 15-18. Russian.
  26. Tanguturi SC, Nagarakanti S. Polycystic ovary syndrome and periodontal disease: underlying links- a review. Indian J Endocrinol Metab. 2018; 22(2): 267-273.
  27. Porwal S, Tewari S, Sharma RK, Singhal SR, Narula SC. Periodontal status and high-sensitivity C-reactive protein levels in polycystic ovary syndrome with and without medical treatment. J Periodontol. 2014; 85(10): 1380-1389.
  28. Shiau HJ, Reynolds MA. Sex differences in destructive periodontal disease: a systematic review. J Periodontol. 2010; 81(10): 1379-1389.