Erectile dysfunction (ED), the inability to achieve or sustain an erection, is believed to affect more than 18 million American men. Gum disease – periodontal infection that can lead to tooth loss – is also very common. The connection between the two isn’t clear, although Chinese researchers who reviewed five studies published between 2009 and 2014, which included data on 213,000 men, concluded that ED is more common in men with gum disease. All five studies found that ED was more than twice as common among men being treated for chronic periodontitis – an advanced form of gum disease – than in those with no gum problems. This was particularly true of men who were under 40 or older than 59. (The researchers controlled for diabetes, which they noted can increase the risk of gum disease and also affect sexual function.) One of the studies included in the review found that treating periodontitis led to improved erectile function in those with ED.
Research suggests that the bacteria that cause gum infections can also lead to or worsen atherosclerosis, the arterial disease associated with heart attacks and strokes. ED has been more directly linked to cardiovascular disease and is considered an early warning of existing or future heart problems.
According to the American Heart Association (AHA), there is no definitive proof that gum disease causes heart disease or stroke or that treating gum disease reduces the risk of either. The AHA does note that risks for gum disease – including smoking, aging and diabetes – also increase the risk of heart disease. And it acknowledges that many observational studies have noted associations between gum disease and cardiovascular disease. Analyses and observational studies cannot prove cause and effect – they can only show that an association exists.
Current thinking holds that ED often stems from problems with the inner lining of blood vessels that slow blood flow to the penis and also to the heart. Beyond that, both ED and heart disease have many of the same risk factors including diabetes, smoking, high blood pressure, high alcohol consumption, high cholesterol, aging, obesity and low testosterone levels.
There are many other causes and potential contributors to ED which are unrelated to heart disease. These include depression and other mental health problems, some prescription medications, and sleep disorders (such as sleep apnea). Even distance bike riding with old style narrow bike seats can cause ED by compressing nerves and blood vessels in the perineum.
At this point the link between ED and periodontal disease isn’t well understood, although Zhigang Zhao, senior author of the Chinese review, said that treatment for periodontitis might help reduce the risk of ED.
Andrew Weil, M.D.
Zhigang Zhao et al, “Chronic periodontitis and the risk of erectile dysfunction: a systematic review and meta-analysis.” International Journal of Impotence Research,” November 10, 2016, doi:10.1038/ijir.2016.43