The periodontal-female reproductive axis and infertility: a scoping review of epidemiological and mechanistic evidence

Background Periodontitis is a prevalent chronic inflammatory disease with recognized systemic implications. Its potential link to female reproductive disorders, including infertility, endometriosis, and recurrent implantation failure (RIF), has attracted growing attention, though the evidence remains heterogeneous and largely observational. This scoping review aimed to map available evidence on this relationship, identify shared biological mechanisms, and highlight gaps warranting future investigation.

Following PRISMA-ScR guidelines, four databases (PubMed/MEDLINE, Scopus, Cochrane Library (CENTRAL) and Web of Science) were searched with no date restriction, supplemented by grey literature. Two independent reviewers screened records using the PCC framework; 22 studies were included.

Eight epidemiological studies showed heterogeneous findings; prospective data suggest a possible modest reduction in fecundability associated with periodontitis, though effect sizes vary, confidence intervals are wide, and exposures were largely self-reported. Serological evidence is consistent with an association between periodontal pathogen exposure and unexplained infertility. Mechanistic studies (in vitro and animal models) suggest plausible biological pathways, but human clinical validation is lacking.

Current evidence suggests a plausible, though unconfirmed, association between periodontal disease and female reproductive disorders. Methodological heterogeneity and the absence of interventional data preclude causal conclusions. Future research should prioritize standardized exposure assessment and randomized trials evaluating periodontal treatment before assisted reproductive technologies. Similar content being viewed by others Abbreviations - aMMP-8: - Active matrix metalloproteinase-8 - APOs: - Adverse pregnancy outcomes - ART: - Assisted reproductive technologies - bEVs: - Bacterial extracellular vesicles - BMR: - Bidirectional Mendelian randomization - BMI: - Body mass index - CC: - Case-control study - CE: - Chronic endometritis - CI: - Confidence interval - COH: - Controlled ovarian hyperstimulation - CRP: - C-reactive protein - eMSCs: - Endometrial mesenchymal stem cells - EnSCs: - Endometrial stromal cells - EVs: - Extracellular vesicles - GCF: - Gingival crevicular fluid - HR: - Hazard ratio - HPO axis: - Hypothalamic–pituitary–ovarian axis - IL: - Interleukin - IVF: - In vitro fertilization - LIF: - Leukemia inhibitory factor - LPS: - Lipopolysaccharide - MeSH: - Medical Subject Headings - MMP-8: - Matrix metalloproteinase-8 - NK cells: - Natural killer cells - OMVs: - Outer membrane vesicles - OR: - Odds ratio - PC: - Prospective cohort - PCOS: - Polycystic ovary syndrome - Perio-EVs: - Periodontitis-derived extracellular vesicles - PLAP: - Placental alkaline phosphatase - PRISMA-ScR: - Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews - RIF: - Recurrent implantation failure - SR: - Systematic review - TGF-β: - Transforming growth factor beta - Th1/Th2: - T helper type 1/type 2 - TLRs: - Toll-like receptors - TNF-α: - Tumor necrosis factor alpha

The authors would like to thank the Agencia Nacional de Investigación y Desarrollo (ANID), Chile, for financial support through FONDECYT Regular Grants #1211471 and #1230932. Generative AI statement The author(s) declare that Generative AI was used in the creation of this manuscript. Some paragraphs in the Introduction and Discussion sections were revised with AI. Funding This study was funded by the Agencia Nacional de Investigación y Desarrollo (ANID), Chilean Science and Technology Ministry, through FONDECYT Regular Grants #1211471 and #1230932. The funding body had no role in the design of the study; collection, analysis, and interpretation of data; or in writing the manuscript. Author information Authors and Affiliations Corresponding authors Ethics declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. About this article Cite this article Mujica, I., Bendek, M.J., Celis, A. et al. The periodontal–female reproductive axis and infertility: a scoping review of epidemiological and mechanistic evidence. BMC Oral Health (2026). https://doi.org/10.1186/s12903-026-08685-w Received: Accepted: Published: DOI: https://doi.org/10.1186/s12903-026-08685-w