Sex differences in destructive periodontal disease: exploring the biologic basis

Epidemiologic studies provide broad-based evidence that men are at greater risk for developing destructive periodontal disease than women, even after adjusting for behavioral and environmental factors, such as oral hygiene practice and smoking. What requires clarification, however, is whether sex-specific differences in immune function provide a plausible biologic basis for a sexual dimorphism in susceptibility to destructive periodontal disease. This review examines evidence that might provide an underlying biologic basis for a sexual dimorphism in the prevalence and severity of destructive periodontal disease.

A narrative review of the literature related to sexual dimorphism in pathogen-mediated inflammatory diseases and immune response was retrieved from searches of computerized databases (MEDLINE, PubMed, and SCOPUS).

Sex steroids exert profound effects on multiple immunologic parameters regulating both the amplification and resolution of inflammation. Strong evidence exists for sexual dimorphisms in immune function, involving both innate and acquired immunity. Injury and infection have been associated with higher levels of inflammatory cytokines, including interleukin-1β and tumor necrosis factor-α, in men than women, paralleling observed sex-specific differences in periodontitis.

Differential gene regulation, particularly in sex steroid-responsive genes, may contribute to a sexual dimorphism in susceptibility to destructive periodontal disease.