Gynaecologist & Endoscopic Surgeon

Bleeding gums and endometriosis


I had a fascinating discussion with a dentist recently in relation to gum disease (periodontal disease) and other chronic inflammatory diseases.   Several research studies have associated gum disease with other chronic inflammatory diseases such as diabetes, cardiovascular disease, rheumatoid arthritis and now possibly endometriosis.  There are various grades of severity of periodontal disease and the common symptom appears to be bleeding on brushing the teeth or when flossing.  Approximately 50% of US adults have gingivitis, 30% have some degree of periodontitis and 5-15% have severe periodontal disease. A recent report in published in Fertility and Sterility draws attention to the possible association between periodontal disease and endometriosis.  Epidemiological data were retrieved in over 4000 women and it was demonstrated that the odds of having both gingivitis and periodontitis were increased by 57% if a woman had been told she had endometriosis.  There are clearly issues in analyzing such data and the diagnosis of endometriosis for example simply related to the patient confirming they had been told they had endometriosis whether or not a formal diagnosis had been made.  These authors postulated the underlying link may be a generalized global immune disregulation.

My mind is immediately drawn to the analogy of gastric ulcers.  For many years it was thought the problem related to an excess of gastric acid. Researchers from Australia demonstrated the presence of an organism, helicobacter pylori, which could be simply eradicated with antibiotics thus resolving the problem.  This was a fabulous story where the researchers involved firstly inoculated themselves with the organism and then treated it proving the underlying pathophysiology.  These ulcers were not previously believed to have a microbial cause.  In 2005 Barry J Marshal and J Robin Warren won the Nobel prize for this discovery.

These types of reports add interesting insights and possible clues as to the aetiology of endometriosis which remains poorly understood.  If you needed another reason, continue to brush your teeth.

Michael Cooper