Review Article

Oral Cavity and Erectile Dysfunction: A Literature Review

Akhil K Padmanabhan*

Practitioner, Researcher & Health advisor, India

Received Date: 27/08/2020; Published Date: 25/09/2020

*Corresponding author: Akhil K Padmanabhan, Practitioner, Researcher & Health advisor, India

DOI: 10.51931/OAJCS.2020.01.000003

Abstract

Sexual health is as important as the overall health. In the modern lifestyle, sexual health problems have become a common issue among the general population. Most of the disorders have unidentified etiologies which makes them difficult to treat. Erectile dysfunction is such a disorder that affects a greater population. As the connection between systemic health and oral health have been investigated over time, the link between the two have started getting clearer. Oral health has been studied to be associated with a wide range of systemic diseases. This review is an attempt to summarize the evidence and mechanisms proposed to establish the link between erectile dysfunction and oral health.

Keywords: Erectile dysfunction; Oral health; Periodontitis; Sexual disorders; Health

Introduction

Oral health is the reflection of systemic health. This relationship of oral health with the overall health have been identified and studied ever since the origin of dental medicine. Infectious disease of the oral cavity has the potential to cause damage and infection to other parts of the body as explained by focal infection theory [1]. Oral cavity is a favourable situation for several infections such as periodontitis. Periodontitis is the most common infectious and inflammatory disease of the oral cavity.  Erectile dysfunction is a sexual disorder characterized by the inability to attain and maintain an erection during sexual activity [2].  It is more common in men above 40 years of age [3]. Several factors such  as neurogenic, cavernosal, psychological, hormonal and drugs are studied to cause ED [4], however, the most commonly explained pathophysiology is vascular disease [5].

Chronic periodontitis and Erectile dysfunction share certain common risk factors [6-8]. Several studies were conducted to understand the association between these two disorders. A study by Zadik et al. [9] concluded that chronic periodontitis was found significantly higher  among men with ED than without ED. Study by Sharma et al. [10] failed to detect any association between the two. Inconsistent evidence on the relationship between the two conditions have always left us with an increased need for further studies in this area.

Pathophysiology of Erectile Dysfunction

Penile erection during sexual stimulation is achieved by the relaxation of penile arteries and smooth muscles, leading to increased blood flow to the organ. This is mediated by chemicals such as NO (Nitric Oxide) and cGMP. Cyclic GMP causes smooth muscle relaxation and increased blood flow into the corpus cavernosum, and is degraded by specific phosphodiesterase type 5 (PDE5) located around the penis [11]. When there is a blockage of blood flow to the penis due to any reason, the erection fails to happen. Sometimes the individual achieves an erection but fails to maintain it. ED is today considered to be a disease of vascular etiology [11].

Various Mechanisms by which Periodontal Disease can Cause ED

  • Micro and macrovascular changes

Endothelial dysfunction is a common manifestation of the systemic effects of periodontal diseases. This refers to various pathological conditions, such as alteration in anticoagulant and anti-inflammatory features of the endothelium, vascular growth impairment, and altered vascularremodelling. A combination of endothelial dysfunction and inflammation leads to serious disorders such as atherosclerosis. This blockage of the arteries and capillaries or smooth muscle relaxation may result in the ED [12]. Endothelial dysfunction is the most studied feature and characteristic od ED. Men with endothelial dysfunction are said to present with ED [13]. The penile vasculature is small and atherosclerosis may begin essentially in small vasculature and gradually shifts to larger vasculature. Advanced age is a strong predictor of endothelial dysfunction and ED in elderly patients [14]. Ageing males are at increased risk for ED and the cause for inflammation leading to endothelial dysfunction can be many, such as hypertension, stress, smoking and others.

  • Inflammation and inflammatory mediators

The cytokines that are commonly involved in periodontal disease are IL- 1, IL- 6and TNF- α. A significant increase in the risk for developing endothelial dysfunction resulting in ED may be associated with high levels of inflammatory mediators such as interleukin (IL)-6, IL-8, tumour necrosis factor-alpha (TNF-α), and IL-1 [15,16]. Among all the cytokines, TNF- α plays a major role in causing ED [17]. Periodontitis also induces local and systemic elevation of proinflammatory cytokines, such as TNF-α, IL-1 and IL-6 [18,19]. Furthermore, multiple studies have shown a reduction in TNF-α levels after successful periodontal treatment [20,21]. It has also been reported that, significant higher plasma levels of TNF-α were associated with moderate to severe ED [22,23] thus explaining their role in maintenance of healthy vasculature [24] (Figure 1).

  • Oxidative stress

Endothelial dysfunction due to inflammatory changes will cause release of reactive oxygen species (ROS) [25]. Increased production of ROS will increase the inactivation in nitric oxide (NO). NO is an important chemical that mediates penile erection. The damage to the antioxidant system may worsen the endothelial dysfunction. Furthermore, an animal study on rat model demonstrated that the periodontitis-induced mild systemic inflammation resulted in reduced expression and activity of endothelial Nitric Oxide synthase in penile tissues [26,27]. The effective management of ED should involve examination for all of these factors in consult with a urologist.

Figure 1: Mechanisms by which periodontitis can cause ED.

Conclusion

Oral health has several systemic associations. The relationship of periodontal diseases to ED is confirmed by short term studies, but longitudinal studies are required to establish a powerful link between the two. However, maintenance of oral hygiene and periodontal treatment has to be emphasized in patients with ED.

Conflicts of Interest

Nill

References

    1. Pizzo G, Guiglia R, Russo LL, Campisi G (2010) Dentistry and internal medicine: from the focal infection theory to the periodontal medicine concept. European journal of internal medicine 21(6): 496-502.
    2. Montague DK, Jarow JP, Broderick GA, Dmochowski RR, Heaton JP, et al. (2005) Chapter 1: The management of erectile dysfunction: An AUA update. J Urol 174: 230-239.
    3. Krane RJ, Goldstein I, Saenz de Tejada I (1989) Impotence. N Engl J Med 321: 1648-1659.
    4. Chiurlia E, D'Amico R, Ratti C, Granata AR, Romagnoli R, et al. (2005) Subclinical coronary artery atherosclerosis in patients with erectile dysfunction. J Am Coll Cardiol 46: 1503-1536.
    5. Heidelbaugh JJ (2010) Management of erectile dysfunction. Am Fam Physician 81: 305-312.
    6. Roth A, Kalter-Leibovici O, Kerbis Y, Tenenbaum-Koren E, Chen J, et al. (2003) Prevalence and risk factors for erectile dysfunction in men with diabetes, hypertension, or both diseases: A community survey among 1,412 Israeli men. Clin Cardiol 26: 25-30.
    7. Chew KK, Bremner A, Jamrozik K, Earle C, Stuckey B (2008) Male erectile dysfunction and cardiovascular disease: Is there an intimate nexus? J Sex Med 5: 928-934.
    8. Chew KK, Bremner A, Stuckey B, Earle C, Jamrozik K (2009) Is the relationship between cigarette smoking and male erectile dysfunction independent of cardiovascular disease? Findings from a population-based cross-sectional study. J Sex Med 6: 222-231.
    9. Zadik Y, Bechor R, Galor S, Justo D, Heruti RJ (2009) Erectile dysfunction might be associated with chronic periodontal disease: Two ends of the cardiovascular spectrum. J Sex Med 6: 1111-1116.
    10. Sharma A, Pradeep AR, Raju PA (2011) Association between chronic periodontitis and vasculogenic erectile dysfunction. J Periodontol 82: 1665-1659.
    11. De Tejada IS, Angulo J, Cellek S, González‐Cadavid N, Heaton J, et al. (2005) Pathophysiology of erectile dysfunction. The journal of sexual medicine 2(1): 26-39.
    12. Kirby M, Jackson G, Simonsen U (2005) Endothelial dysfunction links erectile dysfunction to heart disease. Int J Clin Pract 59: 225-229.
    13. Kaiser DR, Billups K, Mason C, Wetterling R, Lundberg JL, et al. (2004) Impaired brachial artery endothelium-dependent and −independent vasodilation in men with erectile dysfunction and no other clinical cardiovascular disease. J Am Coll Cardiol 43: 179-184.
    14. Aversa A, Bruzziches R, Francomano D, Natali M, Gareri P, et al. (2010) Endothelial dysfunction and erectile dysfunction in the aging man. Int J Urol 17: 38-47.
    15. Vlachopoulos C, Aznaouridis K, Ioakeimidis N, Rokkas K, Vasiliadou C, et al. (2006) Unfavourable endothelial and inflammatory state in erectile dysfunction patients with or without coronary artery disease. Eur Heart J 27: 2640-2648.
    16. Eaton CB, Liu YL, Mittleman MA, Miner M, Glasser DB, et al. (2007) Retrospective study of the relationship between biomarkers of atherosclerosis and erectile dysfunction in 988 men. Int J Impot Res 19: 218-225.
    17. Holm T, Aukrust P, Andreassen AK, Ueland T, Brosstad F, et al. (2000) Peripheral endothelial dysfunction in heart transplant recipients: Possible role of proinflammatory cytokines. Clin Transpl 14: 218-225.
    18. De Nardin E (2001) The role of inflammatory and immunological mediators in periodontitis and cardiovascular disease. Ann Periodontol 6: 30-40.
    19. Noack B, Genco RJ, De Nardin E (2001) Relationship between periodontal disease status, periodontal organisms, and C-reactive protein. J Periodontol 72: 1221-1227.
    20. Navarro-Sanchez AB, Faria-Almeida R, Bascones-Martinez A (2007) Effect of nonsurgical periodontal therapy on clinical and immunological response and glycaemic control in type 2 diabetic patients with moderate periodontitis. J Clin Periodontol 34: 835-843.
    21. Correa FO, Goncalves D, Figueredo CM, Gustafsson A, Orrico SR (2008) The short term effectiveness of non-surgical treatment in reducing levels of interleukin-1beta and proteases in gingival crevicular fluid from patients with type 2 diabetes mellitus and chronic periodontitis. J Periodontol 79: 2143-2150.
    22. Vlachopoulos C, Rokkas K, Ioakeimidis N, Stefanadis C (2007) Inflammation, metabolic syndrome, erectile dysfunction, and coronary artery disease: Common links. Eur Urol 52: 1590-600.
    23. Carneiro FS, Webb RC, Tostes RC (2010) Emerging role for TNF-α in erectile dysfunction. J Sex Med 7: 3823-3834.
    24. Higashi Y, Sasaki S, Nakagawa K, Matsuura H, Oshima T, et al. (2002) Endothelial function and oxidative stress in renovascular hypertension. N Engl J Med 346: 1954-1962.
    25. Cai H, Harrison DG (2000) Endothelial dysfunction in cardiovascular diseases: The role of oxidant stress. Circ Res 87: 840-844.
    26. Zuo Z, Jiang J, Jiang R, Chen F, Liu J, et al. (2011) Effect of periodontitis on erectile function and its possible mechanism. J Sex Med 8: 2598-2605.
    27. Padmanabhan Akhil (2020) Effective treatment of erectile dysfunction: What you can expect from your urologist. Bee-potent.

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