title: Periodontal disease and women's health.
abstract: Periodontal disease (PD) is a multifactorial inflammatory condition in which inappropriate interaction between the host immune response and specific groups of bacterial pathogens leads to destruction of connective and bone tissues supporting the tooth. Dissemination of pathogens, toxins, and immune complexes from and to periodontal lesions is at the basis of the increasingly recognized association between PD and various systemic diseases (SDs). Considering the growing attention of the medical community to "gender medicine", this review focuses on the association between PD and six systemic conditions heavily impacting women's health, with the aim of providing evidence in support of a joint effort between physicians and dentists to improve clinical management of these conditions.
  
  
  
  We considered systematic reviews, meta-analyses and narrative reviews evaluating all possible associations between periodontitis, systemic diseases and women.
  
  
  
  Gender prevalence for PD is discordant, but the literature strongly supports an association between PD and female infertility and adverse pregnancy outcomes. Moreover, PD is bidirectionally linked to several systemic diseases characterized by an established female gender bias, i.e. osteoporosis (OP), cardiovascular diseases (CVD), autoimmunity, Alzheimer's disease (AD) and cancer.
  
  
  
  Overall, the literature data reviewed here provides a strong foundation for further characterization of molecular and microbial drivers of PD and of several female-prevalent systemic diseases, highlighting the possible importance of a good oral condition in preventing or attenuating women's systemic diseases.
authors.affiliation: a IMI (International Microdentistry Institute) , Florence , Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Martelli
authors.affiliation: b Universita degli Studi di Firenze , Department of Surgery and Translational Medicine , Florence , Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Brandi
authors.affiliation: a IMI (International Microdentistry Institute) , Florence , Italy.
authors.forename: Marialaura
authors.initials: M
authors.lastname: Martelli
authors.affiliation: c AIMOP Accademia Italiana Medicina Orale e Parodontologia , Milano , Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Nobili
authors.affiliation: d University of Torino , Department of Oncology , Torino , Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Medico
authors.affiliation: a IMI (International Microdentistry Institute) , Florence , Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Martelli
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology; D005260:Female; D006801:Humans; D010024:Osteoporosis / Q000453:epidemiology; D010510:Periodontal Diseases / Q000453:epidemiology*; D010518:Periodontitis / Q000453:epidemiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D016387:Women's Health
keywords: Cancer; cardiovascular diseases; infertility; osteoporosis; periodontal disease; systemic diseases; women’s health