Association of Periodontal Disease and Polycystic Ovarian Syndrome: A Systematic Review and Meta-analysis with Trial Sequential Analysis

Fathima F. Farook1, 2, *, Ka Ting Ng3, Nuzaim MNM4, Wen J. Koh5, Wan Y. Teoh6
1 Department of Preventive Dental Science, College of Dentistry, King Saud Bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
2 King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
3 Department of Anesthesiology, University of Malaya, 50603 Kuala Lumpur, Malaysia
4 Department of Obstetrics and Gynecology, University of Malaya, 50603 Kuala Lumpur, Malaysia
5 Department of Dental Health, International Medical University, 57000 Kuala Lumpur, Malaysia
6 School of Medicine,. University of Liverpool, Cedar House, Ashton Street, Liverpool, L69 3GE, United Kingdom

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Creative Commons License
© 2019 Farook et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Preventive Dental Science, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, 11426 Riyadh, Saudi Arabia; E-mail:



Several articles have suggested a potential synergistic relationship between periodontal disease and systemic inflammatory diseases, such as Polycystic Ovarian Syndrome (PCOS) and diabetes mellitus. However, the associations between periodontal disease and PCOS population remain unclear in the literature.


The primary aim of this review is to examine the associations between periodontal disease and PCOS with different scoring methods, namely clinical attachment loss, probing depth, gingival index, percentage of bleeding on probing and plaque index.


MEDLINE, EMBASE and CENTRAL were systematically searched for observational studies and case-control studies from its inception until 2nd June, 2019. Case reports, case series, non-systematic reviews and trials published as abstracts were excluded.


Four articles (614 subjects) were included for analysis. Out of 614 subjects, 329 PCOS patients were compared to 285 healthy subjects. In comparison to healthy cohort, women with PCOS had a statistically significant increase in clinical attachment loss (MD: 0.34, 95% CI: 0.13-0.55, ρ=0.002), probing depth (MD: 0.35, 95%CI: 0.21-0.48, ρ<0.001), gingival index (MD: 0.70, 95% CI: 0.70-1.11, ρ<0.001) and percentage of bleeding on probing (MD: 34.41, 95% CI: 20.23-48.59, ρ<0.001). No difference was demonstrated in plaque index (MD: 0.42, 95% CI: -0.29-1.12, ρ=0.24) for both PCOS and healthy cohort.


PCOS is significantly associated with a higher severity of the periodontal disease. This association should be emphasized during the management of PCOS patients, by including referral to dentists or periodontists for regular mechanical debridement of plaque and periodontal maintenance.

Keywords: Gingivitis, Periodontitis, Periodontal disease, Polycystic ovarian syndrome, Stein Leventhal syndrome, Polycystic ovarian disease.