Periodontal Status among women with Polycystic Ovary Syndrome based on medical treatment: A Cross-sectional study

Periodontal Status among women with Polycystic Ovary Syndrome based on medical treatment: A Cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Periodontal Status among women with Polycystic Ovary Syndrome based on medical treatment: A Cross-sectional study Jagadeeswara Rao Sukhabogi, Dolar Doshi, Marzia Shamila Iqbal, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8665838/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Medications for polycystic ovary syndrome (PCOS) are primarily prescribed to manage hormonal imbalances and associated symptoms. However, both the condition itself and certain medications used for its management may have indirect effects that influence periodontal health. This study evaluated the periodontal status of women with PCOS by examining the dichotomous status of medical treatment, whether treatment has been initiated or not. Material and methods A self-administered questionnaire was used to collect demographic information, including age, marital status, treatment status, type of medication used for PCOS, reasons for seeking medical care, and duration of medication use. Clinical examination was conducted to assess periodontal status. Results Participants receiving medication demonstrated significantly lower mean scores for bleeding on probing, shallow periodontal pockets, and deep pockets compared to non-users. Binary logistic regression analysis showed that age, marital status, gingival bleeding, and the presence of shallow and deep pockets were negatively associated with PCOS medication use. Conclusion As growing evidence highlights the potential relationship between PCOS medication and periodontal health, future research should focus on long-term studies that assess periodontal outcomes over extended periods following the initiation of PCOS treatment. PCOS medication cross-sectional study periodontal pockets Introduction Polycystic ovary syndrome (PCOS), first described by Stein and Leventhal, is among the most commonly diagnosed endocrinopathies in women of reproductive age, with significant negative effects on metabolic, psychological, and cardiovascular functions ( 1 , 2 ). Although the exact etiology of PCOS remains incompletely understood, it is characterized by a complex array of symptoms. These include menstrual irregularities (such as oligomenorrhea or amenorrhea), chronic anovulation or oligo-ovulation, and hyperandrogenism—manifesting as hirsutism, acne, or androgenic alopecia. Additionally, some women may experience obesity, insulin resistance, and abnormal lipid profiles ( 3 , 4 ). The global prevalence of PCOS is estimated at 8%–13%; in India, the rate is 11.34%, which is slightly higher than in China (10.01%) and Eastern regions (7.82%) but lower than in Central (14.24%) and Western (13.35%) regions ( 5 , 6 ). Evidence suggests that PCOS is associated not only with metabolic syndrome and infertility but also with an increased risk of periodontitis ( 3 , 7 , 8 ). Although the mechanisms linking PCOS to periodontal disease are not yet fully defined, several studies suggest that PCOS may alter the composition of the oral microflora. Additionally, the hormonal and metabolic disturbances seen in PCOS may increase susceptibility to periodontal disease ( 8 – 11 ). Elevated serum levels of inflammatory markers, including C-reactive protein and proinflammatory cytokines such as TNF-α, IL-1, IL-6, and IL-17, have been reported in individuals with PCOS. These markers are also elevated in patients with periodontal disease, possibly due to oxidative stress, which may serve as a mechanistic link between the two conditions ( 3 , 11 ). Multiple studies have identified the involvement of TNF-α, IL-1, IL-6, and IL-17 in the development of insulin resistance, a hallmark of PCOS. These inflammatory mediators activate signaling pathways that impair insulin signaling ( 2 , 3 , 8 , 9 , 12 ). In women with PCOS, compensatory hyperinsulinemia contributes to androgen-dependent ovarian dysfunction. Given these interactions, periodontal disease may exacerbate the clinical characteristics of PCOS ( 3 , 4 ). Currently, limited research specifically addresses the direct impact of PCOS medications on periodontal diseases. Although such medications are primarily intended to correct hormonal imbalances and alleviate associated symptoms, they are not designed to treat oral health conditions such as periodontitis. Nonetheless, PCOS itself and certain medications used in its management may exert indirect effects on periodontal health. Drugs such as anti-androgens and insulin sensitizers may confer benefits to gingival tissues by reducing inflammation related to hormonal imbalances ( 14 , 15 ). While these findings suggest possible connections between PCOS medications and improved periodontal outcomes, further research is necessary to establish a definitive causal relationship. Previous studies have indicated a possible relationship between PCOS and periodontitis, suggesting that PCOS may have an impact on the periodontium ( 8 , 9 , 12 ). However, these investigations have not accounted for the medical treatment status, duration of therapy, or the specific types of medications used to manage the syndrome. To address this gap, the present study aims to assess the periodontal status of women with PCOS by examining the dichotomous condition of medical treatment, whether treatment has been initiated or not ( 14 ). Material and methods Women diagnosed with PCOS and attending the Department of Obstetrics and Gynecology at a private general hospital were included in this cross-sectional study. Participants between 18 and 45 years of age were enrolled only after providing written informed consent and indicating their willingness to participate. Ethical Considerations Ethical approval for the study was granted by the Ethical Committee of Osmania Medical College (IEC-BHR/OMC/M.NO (05)/P-64). Study procedures involving living human participants were followed per guidelines laid by the institutional and/or national research committees and the Declaration of Helsinki and its later amendments. Confidentiality and anonymity were maintained for all participants. Women were excluded if they smoked, were pregnant, had received systemic antibiotic treatment within the past three years, or had undergone periodontal therapy within the previous six months. The study was conducted over a three-month period (September to December). The sample size was calculated based on a reported prevalence of periodontitis (56.3%) among women with PCOS, as documented in a cross-sectional study by Venkataraman H et al ( 16 ). Using a precision level of 6% (d) and a 95% confidence interval, the minimum required sample size was determined to be 378. The survey tool consisted of a self-administered questionnaire that collected demographic information, including age, marital status, treatment status, type of medication used for PCOS management (Oral contraceptives, Clomiphene citrate, Anti Diabetics and any other), reasons for seeking medical care, and duration of medication use. In addition, a trained and calibrated dentist conducted clinical oral examinations to assess periodontal status using the World Health Organization's Oral Health Assessment Form for Adults ( 17 ). Data were analyzed using the Statistical Package for the Social Sciences Version 26.0. Categorical variables were summarized as frequencies and percentages, while continuous variables were presented as means and standard deviations. The Kruskal-Wallis test was used for multiple group comparisons. Binary logistic regression analysis was conducted to examine associations between medication use and other variables. A p value of ≤ 0.05 was considered statistically significant. Results The study sample included 378 participants. Most were between 18 and 31 years of age (87.6%), while 12.4% were between 32 and 45 years. The majority of participants were married, and over two-thirds (73.5%) reported using various medications to manage PCOS. As shown in Table 1 , the most frequently reported medication type was unspecified (39.9%), followed by Clomiphene citrate (38.8%) and oral contraceptives (16.2%). Table 1 Demographics characteristics of study participants Variables Frequency (n) Percentage (%) Age 18–31 yrs 331 87.6 32–45 yrs 47 12.4 Marital status Married 247 65.3 Unmarried 131 34.7 Medication for PCOS Yes 278 73.5 No 100 26.5 If yes Type of medication Oral contraceptives 45 16.2 Clomiphene citrate 108 38.8 Anti Diabetics 14 5.1 Any other 111 39.9 Duration of treatment 5 year 44 15.8 Reason for treatment Reproductive aspect 162 58.3 Metabolic aspect 116 41.7 Nearly half of the participants (51.1%) had been receiving treatment for one to five years. Among those on medication, 58.3% reported using it primarily for reproductive reasons. Significant associations were observed between medication use (users vs. non-users) and several variables, including age, marital status, gingival bleeding, and the presence of periodontal pockets (Table 2 ). Participants receiving medication demonstrated significantly lower mean scores for bleeding on probing, shallow pockets, and deep pockets compared to those not on medication (Table 3 ). Table 2 Association between medication use and demographic variables Variables Medication use p value Yes No Age 18–31 yrs 231 100 0.000* 32–45 yrs 47 0 Marital status Unmarried 43 57 0.000* Married 204 74 Gingival bleeding Present 119 95 0.000* Absent 159 5 Shallow pocket Present 17 62 0.000* Absent 261 38 Deep pocket Present 0 10 0.000* Absent 270 90 Table 3 Mean comparison of periodontal status among PCOS participants based on medication status Variables Medication status p value Yes No Bleeding on probing 5.99 ± 9.681 22.85 ± 8.483 0.000* Shallow pockets 0.36 ± 1.417 3.96 ± 3.671 0.000* Deep pockets 0.00±.000 0.32 ± 1.062 0.000* *p ≤ 0.05 was considered significant Binary logistic regression analysis indicated that age, marital status, gingival bleeding, and the presence of shallow and deep periodontal pockets were negatively associated with medication use for PCOS (Table 4 ). Table 4 Binary logistic regression Variable B S. E Exp(B) p value Constant 2.361 0.394 10.598 0.000* Age 1.204 1.104 5.873 0.000* Marital status -1.550 0.346 0.212 0.000* Gingival Bleeding -2.074 0.506 0.127 0.000* Shallow periodontal pockets -2.792 0.385 0.061 0.000* Deep periodontal pockets -1.754 0.152 0.099 0.000* *p ≤ 0.05 was considered significant Discussion PCOS induces a range of inflammatory disturbances that increase susceptibility to periodontitis. The interplay of hormonal imbalances, metabolic dysregulation, and microbial dysbiosis contributes to the multifactorial breakdown of periodontal tissues ( 3 ). Although an extensive body of literature ( 4 – 13 ) explores the effect of PCOS on periodontitis, relatively little attention has been given to the potential benefits of PCOS pharmacotherapy on periodontal health. Medications prescribed for PCOS primarily target these dysregulated biological pathways and may consequently improve periodontal status, as reflected in the findings of the present study. A large proportion of participants reported the use of unspecified medications, followed by Clomiphene citrate and oral contraceptives. Most participants were undergoing medical treatment and exhibited lower levels of bleeding on probing and fewer shallow periodontal pockets compared to those not receiving treatment. Notably, none of the participants on medication presented with deep periodontal pockets. The binary logistic regression analysis further revealed an inverse relationship between medication use and the presence of gingival bleeding, shallow periodontal pockets, and deep periodontal pockets. These results suggest that individuals receiving pharmacological treatment for PCOS were less likely to exhibit signs of periodontal disease, indicating a potential protective effect of such medications on periodontal health. Participants on medication were more likely to be unmarried or single. This trend may reflect a greater capacity among single individuals to prioritize self-care, including adherence to prescribed treatments and the maintenance of overall health. Lifestyle differences, such as fewer family responsibilities or an increased personal focus on well-being, may also contribute to this association. Evidence suggests that PCOS medications help correct hormonal imbalances and reduce the expression of pro-inflammatory cytokines, thereby promoting better periodontal health 14,15 . Antidiabetic drugs, in particular, exert beneficial effects on tissue insulin resistance, helping to decrease oxidative stress and inflammation in the periodontium. Agents such as metformin have also been shown to improve endothelial function, potentially enhancing gingival microcirculation and supporting tissue healing ( 15 ). In addition to their direct effects on periodontal tissues, PCOS medications may exert indirect benefits by improving mental health. PCOS is frequently associated with psychological conditions such as anxiety, depression, and stress-related disorders, which can negatively influence oral hygiene practices. These mental health challenges often result in inadequate plaque control and an elevated risk of periodontal disease. Studies have shown that individuals with depression may have reduced motivation for self-care, including oral hygiene. However, medications such as oral contraceptives can alleviate mood disturbances, reduce anxiety, and enhance emotional well-being in individuals with PCOS. These improvements may, in turn, lead to better oral hygiene practices and contribute to improved periodontal status. This study possesses several strengths. The large sample size (n = 378) enhances the statistical power of the findings. To the best of our knowledge, this is the first study to investigate the impact of PCOS pharmacotherapy on periodontitis while also offering insights into the systemic connections between metabolic disorders and oral health. Furthermore, standardized tools were employed for clinical examination, specifically the World Health Organization's Oral Health Assessment Form. Ethical rigor was maintained throughout the study, and binary logistic regression was used to identify significant predictors while controlling for confounders. However, several limitations must be acknowledged. One key limitation is the variability in patient adherence to PCOS medication, which may have introduced inconsistencies in the results. Additionally, reliance on self-reported medication data could lead to recall bias. Some participants may also have been engaged in other forms of treatment, such as lifestyle modifications, that could influence periodontal outcomes. Additionally, important confounding factors such as oral hygiene practices and socioeconomic status were not considered, limiting the comprehensiveness of the analysis. Finally, the heterogeneity of PCOS phenotypes—particularly differences between insulin-resistant and non-insulin-resistant individuals—may result in variable responses to treatment, thereby limiting the generalizability of the findings. In conclusion, as the body of evidence linking PCOS medication and periodontal health continues to grow, future research should focus on long-term studies that monitor periodontal health over extended durations following the initiation of treatment. Such studies will be essential in establishing causal relationships and evaluating the sustained impact of pharmacotherapy. Additionally, comparative analyses of different PCOS treatment modalities, such as metformin, inositol, and oral contraceptives, will be critical in determining the most effective strategies for supporting periodontal health. Declarations Author Contribution Author Contributions Conceptualization: Sukhabogi JS, Doshi D ,Funding acquisition: None. Methodology: M S Iqbal. Writing – original draft, Writing – review & editing: Jummala S. Data Availability All the data is in the supplementary file References Dharuman S, Ajith Kumar S, Kanakasabapathy Balaji S, Vishwanath U, Parthasarathy Parameshwari R, Santhanakrishnan M. Evaluation of Levels of Advanced Oxidative Protein Products in Patients with Polycystic Ovary Syndrome with and without Chronic Periodontitis: A Cross-Sectional Study. Int J Fertil Steril. 2022;16(1):55–9. Pavankumar S, Yellarthi PK, Jn S, Boyapati R, Damera TK. Evaluation of periodontal status in women with polycystic ovary syndrome versus healthy women: A cross-sectional study. J Yeungnam Med Sci. 2023;40(Suppl):S17–22. Wendland N, Opydo-Szymaczek J, Formanowicz D, Blacha A, Jarzabek-Bielecka G, KMizgier M. Association between metabolic and hormonal profile, proinflammatory cytokines in saliva and gingival health in adolescent females with polycystic ovary syndrome. BMC Oral Health. 2021;21(1):193. Tanguturi SC, Nagarakanti S. Polycystic Ovary Syndrome and Periodontal disease: Underlying Links- A Review. Indian J Endocrinol Metab. 2018;22(2):267–73. https:// Bharali MD, Rajendran R, Goswami J, Singal K, Rajendran V. Prevalence of Polycystic Ovarian Syndrome in India: A Systematic Review and Meta-Analysis. Cureus. 2022;14(12):e32351. Kellesarian SV, Malignaggi VR, Kellesarian TV, Al-Kheraif AA, Alwageet MM, Malmstrom H, Romanos GE, Javed F. Association between periodontal disease and polycystic ovary syndrome: a systematic review. Int J Impot Res. 2017;29(3):89–95. Dou Y, Xin J, Zhou P, Tang J, Xie H, Fan W, Zhang Z, Wu D. Bidirectional association between polycystic ovary syndrome and periodontal diseases. Front Endocrinol (Lausanne). 2023;14:1008675. Ozcaka O, Ceyhan BO, Akcali A, Bicakci N, Lappin DF, Buduneli N. Is there an interaction between polycystic ovary syndrome and gingival inflammation? J Periodontol. 2012;83(12):1529–37. Akcalı A, Bostanci N, Ozcaka O, Ozturk-Ceyhan B, Gumus P, Buduneli N, Belibasakis GN. Association between polycystic ovary syndrome, oral microbiota and systemic antibody responses. PLoS ONE. 2014;9(9):e108074. Rahiminejad ME, Moaddab A, Zaryoun H, Rabiee S, Moaddab A, Khodadoustan AK. Comparison of prevalence of periodontal disease in women with polycystic ovary syndrome and healthy controls. Dent Res J. 2015;12:507–12. Marquez-Arrico CF, Silvestre-Rangil J, Gutierrez-Castillo L, Martinez-Herrera M, Silvestre FJ, Rocha M. Association between Periodontal Diseases and Polycystic Ovary Syndrome: A Systematic Review. J Clin Med. 2020;9(5):1586. Dursun E, Akalın FA, Guncu GN, Cinar N, Aksoy DY, Tozum TF, Kilinc K, Yildiz BO. Periodontal disease in polycystic ovary syndrome. Fertil Steril. 2011;95(1):320–3. Porwal S, Tewari S, Sharma RK, Singhal SR, Narula SC. Periodontal status and high sensitivity C-reactive protein levels in polycystic ovary syndrome with and without medical treatment. J Periodontol. 2014;85(10):1380–9. Dunaif A. Drug insight: insulin-sensitizing drugs in the treatment of polycystic ovary syndrome-a reappraisal. Nat Clin Pract Endocrinol Metab. 2008;4(5):272–83. Venkataraman H, Peter MR, Sreedhar S, Suresh R, Vyloppillil R, Sreelakshmi MR. Prevalence of periodontal disease in patients with polycystic ovary syndrome in a tertiary centre at Kerala: A cross-sectional study. J Datta Meghe Inst Med Sci Univ. 2022;17:898–903. World Health Organization. Oral health surveys: basic methods. 5th ed. Geneva: World Health Organization; 2013. Greenwood EA, Pasch LA, Cedars MI, et al. Insulin resistance is associated with depression risk in polycystic ovary syndrome. Fertil Steril. 2018;110(1):27–34. Erensoy H, Niafar M, Ghafarzadeh S, Aghamohammadzadeh N, Nader ND. A pilot trial of metformin for insulin resistance and mood disturbances in adolescent and adult women with polycystic ovary syndrome. Gynecol Endocrinol. 2019;35(1):72–5. Additional Declarations No competing interests reported. Supplementary Files Supplementary.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8665838","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":589087009,"identity":"a8ed97ac-d78c-4e77-99ec-3949eb54903b","order_by":0,"name":"Jagadeeswara Rao Sukhabogi","email":"","orcid":"","institution":"Government Dental College and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jagadeeswara","middleName":"Rao","lastName":"Sukhabogi","suffix":""},{"id":589087010,"identity":"16a9482b-f2ee-4759-b31b-6564fd16648a","order_by":1,"name":"Dolar Doshi","email":"","orcid":"","institution":"Government Dental College and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Dolar","middleName":"","lastName":"Doshi","suffix":""},{"id":589087011,"identity":"dfa57217-392f-4a05-b5eb-ef2cea3bf224","order_by":2,"name":"Marzia Shamila Iqbal","email":"","orcid":"","institution":"Government Dental College and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Marzia","middleName":"Shamila","lastName":"Iqbal","suffix":""},{"id":589087012,"identity":"7bd764f1-fb70-41c4-a039-f6005ba937ae","order_by":3,"name":"Sasikala Jummala","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYJCCgw0MFkDq8MEHQJKHj0gtEkDqWLIBSAsbMVoYIVp4zEAkA0Et8u3HHx6cUSMhz8B4xqzya46dDBsD88NHN/BoMTiTY3BwwzEJwwaGY2W3ZbclAx3GZmycg08LQw7DwQdsEkDHHd52W3IbM1ALD5s0Pi3y/c8fHHzwT8K+geGAWbHktnrCWhhuJBgc3NgmkdjAcMSM8eO2w4S1GNx4Y3BwZp9EchswkKUZtx3nYWMm4Bf5/vTHH3u+2dj2Sxw++PHntmp7fvbmh4/xOgwG2CQOMDDzgFjMxCgHA/4GBsYfRKseBaNgFIyCkQQAy+pLgn+84c4AAAAASUVORK5CYII=","orcid":"","institution":"Government Dental College and Hospital","correspondingAuthor":true,"prefix":"","firstName":"Sasikala","middleName":"","lastName":"Jummala","suffix":""}],"badges":[],"createdAt":"2026-01-22 06:10:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8665838/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8665838/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105741574,"identity":"24ced198-d29a-4317-b937-97e31072cb55","added_by":"auto","created_at":"2026-03-30 13:13:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":552381,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8665838/v1/6a15e828-a74d-41b5-aa9d-33b488e5cae9.pdf"},{"id":102541786,"identity":"d0e94c8e-84e1-44f6-8021-276388e6abfe","added_by":"auto","created_at":"2026-02-12 19:21:49","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":14711,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementary.docx","url":"https://assets-eu.researchsquare.com/files/rs-8665838/v1/b24f011dd2f54712ae856b0d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Periodontal Status among women with Polycystic Ovary Syndrome based on medical treatment: A Cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePolycystic ovary syndrome (PCOS), first described by Stein and Leventhal, is among the most commonly diagnosed endocrinopathies in women of reproductive age, with significant negative effects on metabolic, psychological, and cardiovascular functions (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Although the exact etiology of PCOS remains incompletely understood, it is characterized by a complex array of symptoms. These include menstrual irregularities (such as oligomenorrhea or amenorrhea), chronic anovulation or oligo-ovulation, and hyperandrogenism\u0026mdash;manifesting as hirsutism, acne, or androgenic alopecia. Additionally, some women may experience obesity, insulin resistance, and abnormal lipid profiles (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The global prevalence of PCOS is estimated at 8%\u0026ndash;13%; in India, the rate is 11.34%, which is slightly higher than in China (10.01%) and Eastern regions (7.82%) but lower than in Central (14.24%) and Western (13.35%) regions (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Evidence suggests that PCOS is associated not only with metabolic syndrome and infertility but also with an increased risk of periodontitis (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Although the mechanisms linking PCOS to periodontal disease are not yet fully defined, several studies suggest that PCOS may alter the composition of the oral microflora. Additionally, the hormonal and metabolic disturbances seen in PCOS may increase susceptibility to periodontal disease (\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Elevated serum levels of inflammatory markers, including C-reactive protein and proinflammatory cytokines such as TNF-α, IL-1, IL-6, and IL-17, have been reported in individuals with PCOS. These markers are also elevated in patients with periodontal disease, possibly due to oxidative stress, which may serve as a mechanistic link between the two conditions (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Multiple studies have identified the involvement of TNF-α, IL-1, IL-6, and IL-17 in the development of insulin resistance, a hallmark of PCOS. These inflammatory mediators activate signaling pathways that impair insulin signaling (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In women with PCOS, compensatory hyperinsulinemia contributes to androgen-dependent ovarian dysfunction. Given these interactions, periodontal disease may exacerbate the clinical characteristics of PCOS (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Currently, limited research specifically addresses the direct impact of PCOS medications on periodontal diseases. Although such medications are primarily intended to correct hormonal imbalances and alleviate associated symptoms, they are not designed to treat oral health conditions such as periodontitis. Nonetheless, PCOS itself and certain medications used in its management may exert indirect effects on periodontal health. Drugs such as anti-androgens and insulin sensitizers may confer benefits to gingival tissues by reducing inflammation related to hormonal imbalances (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). While these findings suggest possible connections between PCOS medications and improved periodontal outcomes, further research is necessary to establish a definitive causal relationship.\u003c/p\u003e \u003cp\u003ePrevious studies have indicated a possible relationship between PCOS and periodontitis, suggesting that PCOS may have an impact on the periodontium (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). However, these investigations have not accounted for the medical treatment status, duration of therapy, or the specific types of medications used to manage the syndrome. To address this gap, the present study aims to assess the periodontal status of women with PCOS by examining the dichotomous condition of medical treatment, whether treatment has been initiated or not (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003eWomen diagnosed with PCOS and attending the Department of Obstetrics and Gynecology at a private general hospital were included in this cross-sectional study. Participants between 18 and 45 years of age were enrolled only after providing written informed consent and indicating their willingness to participate.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003eEthical approval\u003c/strong\u003e for the study was granted by the Ethical Committee of Osmania Medical College (IEC-BHR/OMC/M.NO (05)/P-64). Study procedures involving living human participants were followed per guidelines laid by the institutional and/or national research committees and the Declaration of Helsinki and its later amendments. Confidentiality and anonymity were maintained for all participants.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eWomen were excluded if they smoked, were pregnant, had received systemic antibiotic treatment within the past three years, or had undergone periodontal therapy within the previous six months.\u003c/p\u003e \u003cp\u003eThe study was conducted over a three-month period (September to December). The sample size was calculated based on a reported prevalence of periodontitis (56.3%) among women with PCOS, as documented in a cross-sectional study by Venkataraman H et al (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Using a precision level of 6% (d) and a 95% confidence interval, the minimum required sample size was determined to be 378.\u003c/p\u003e \u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1770923990.png\" style=\"width: 96px;\"\u003e\u003c/p\u003e\u003cp\u003eThe survey tool consisted of a self-administered questionnaire that collected demographic information, including age, marital status, treatment status, type of medication used for PCOS management (Oral contraceptives, Clomiphene citrate, Anti Diabetics and any other), reasons for seeking medical care, and duration of medication use. In addition, a trained and calibrated dentist conducted clinical oral examinations to assess periodontal status using the World Health Organization's Oral Health Assessment Form for Adults (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eData were analyzed using the Statistical Package for the Social Sciences Version 26.0. Categorical variables were summarized as frequencies and percentages, while continuous variables were presented as means and standard deviations. The Kruskal-Wallis test was used for multiple group comparisons. Binary logistic regression analysis was conducted to examine associations between medication use and other variables. A p value of \u0026le;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study sample included 378 participants. Most were between 18 and 31 years of age (87.6%), while 12.4% were between 32 and 45 years. The majority of participants were married, and over two-thirds (73.5%) reported using various medications to manage PCOS. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the most frequently reported medication type was unspecified (39.9%), followed by Clomiphene citrate (38.8%) and oral contraceptives (16.2%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics characteristics of study participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;31 yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e331\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32\u0026ndash;45 yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMedication for PCOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eIf yes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eType of medication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOral contraceptives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClomiphene citrate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnti Diabetics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAny other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDuration of treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eReason for treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReproductive aspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMetabolic aspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNearly half of the participants (51.1%) had been receiving treatment for one to five years. Among those on medication, 58.3% reported using it primarily for reproductive reasons. Significant associations were observed between medication use (users vs. non-users) and several variables, including age, marital status, gingival bleeding, and the presence of periodontal pockets (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Participants receiving medication demonstrated significantly lower mean scores for bleeding on probing, shallow pockets, and deep pockets compared to those not on medication (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between medication use and demographic variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMedication use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;31 yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32\u0026ndash;45 yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGingival bleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eShallow pocket\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDeep pocket\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e270\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean comparison of periodontal status among PCOS participants based on medication status\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMedication status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleeding on probing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.99\u0026thinsp;\u0026plusmn;\u0026thinsp;9.681\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e22.85\u0026thinsp;\u0026plusmn;\u0026thinsp;8.483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShallow pockets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.36\u0026thinsp;\u0026plusmn;\u0026thinsp;1.417\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.96\u0026thinsp;\u0026plusmn;\u0026thinsp;3.671\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeep pockets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.00\u0026plusmn;.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003e*p\u0026thinsp;\u0026le;\u0026thinsp;0.05 was considered significant\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBinary logistic regression analysis indicated that age, marital status, gingival bleeding, and the presence of shallow and deep periodontal pockets were negatively associated with medication use for PCOS (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBinary logistic regression\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eS. E\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExp(B)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.394\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.598\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.873\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.550\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGingival Bleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-2.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShallow periodontal pockets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-2.792\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeep periodontal pockets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003e*p\u0026thinsp;\u0026le;\u0026thinsp;0.05 was considered significant\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePCOS induces a range of inflammatory disturbances that increase susceptibility to periodontitis. The interplay of hormonal imbalances, metabolic dysregulation, and microbial dysbiosis contributes to the multifactorial breakdown of periodontal tissues (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Although an extensive body of literature (\u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) explores the effect of PCOS on periodontitis, relatively little attention has been given to the potential benefits of PCOS pharmacotherapy on periodontal health.\u003c/p\u003e \u003cp\u003eMedications prescribed for PCOS primarily target these dysregulated biological pathways and may consequently improve periodontal status, as reflected in the findings of the present study. A large proportion of participants reported the use of unspecified medications, followed by Clomiphene citrate and oral contraceptives.\u003c/p\u003e \u003cp\u003eMost participants were undergoing medical treatment and exhibited lower levels of bleeding on probing and fewer shallow periodontal pockets compared to those not receiving treatment. Notably, none of the participants on medication presented with deep periodontal pockets. The binary logistic regression analysis further revealed an inverse relationship between medication use and the presence of gingival bleeding, shallow periodontal pockets, and deep periodontal pockets. These results suggest that individuals receiving pharmacological treatment for PCOS were less likely to exhibit signs of periodontal disease, indicating a potential protective effect of such medications on periodontal health.\u003c/p\u003e \u003cp\u003eParticipants on medication were more likely to be unmarried or single. This trend may reflect a greater capacity among single individuals to prioritize self-care, including adherence to prescribed treatments and the maintenance of overall health. Lifestyle differences, such as fewer family responsibilities or an increased personal focus on well-being, may also contribute to this association.\u003c/p\u003e \u003cp\u003eEvidence suggests that PCOS medications help correct hormonal imbalances and reduce the expression of pro-inflammatory cytokines, thereby promoting better periodontal health \u003csup\u003e14,15\u003c/sup\u003e. Antidiabetic drugs, in particular, exert beneficial effects on tissue insulin resistance, helping to decrease oxidative stress and inflammation in the periodontium. Agents such as metformin have also been shown to improve endothelial function, potentially enhancing gingival microcirculation and supporting tissue healing (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition to their direct effects on periodontal tissues, PCOS medications may exert indirect benefits by improving mental health. PCOS is frequently associated with psychological conditions such as anxiety, depression, and stress-related disorders, which can negatively influence oral hygiene practices. These mental health challenges often result in inadequate plaque control and an elevated risk of periodontal disease. Studies have shown that individuals with depression may have reduced motivation for self-care, including oral hygiene. However, medications such as oral contraceptives can alleviate mood disturbances, reduce anxiety, and enhance emotional well-being in individuals with PCOS. These improvements may, in turn, lead to better oral hygiene practices and contribute to improved periodontal status.\u003c/p\u003e \u003cp\u003eThis study possesses several strengths. The large sample size (n\u0026thinsp;=\u0026thinsp;378) enhances the statistical power of the findings. To the best of our knowledge, this is the first study to investigate the impact of PCOS pharmacotherapy on periodontitis while also offering insights into the systemic connections between metabolic disorders and oral health. Furthermore, standardized tools were employed for clinical examination, specifically the World Health Organization's Oral Health Assessment Form. Ethical rigor was maintained throughout the study, and binary logistic regression was used to identify significant predictors while controlling for confounders. However, several limitations must be acknowledged. One key limitation is the variability in patient adherence to PCOS medication, which may have introduced inconsistencies in the results. Additionally, reliance on self-reported medication data could lead to recall bias. Some participants may also have been engaged in other forms of treatment, such as lifestyle modifications, that could influence periodontal outcomes. Additionally, important confounding factors such as oral hygiene practices and socioeconomic status were not considered, limiting the comprehensiveness of the analysis. Finally, the heterogeneity of PCOS phenotypes\u0026mdash;particularly differences between insulin-resistant and non-insulin-resistant individuals\u0026mdash;may result in variable responses to treatment, thereby limiting the generalizability of the findings.\u003c/p\u003e \u003cp\u003eIn conclusion, as the body of evidence linking PCOS medication and periodontal health continues to grow, future research should focus on long-term studies that monitor periodontal health over extended durations following the initiation of treatment. Such studies will be essential in establishing causal relationships and evaluating the sustained impact of pharmacotherapy. Additionally, comparative analyses of different PCOS treatment modalities, such as metformin, inositol, and oral contraceptives, will be critical in determining the most effective strategies for supporting periodontal health.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor Contributions Conceptualization: Sukhabogi JS, Doshi D ,Funding acquisition: None. Methodology: M S Iqbal. Writing \u0026ndash; original draft, Writing \u0026ndash; review \u0026amp; editing: Jummala S.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll the data is in the supplementary file\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDharuman S, Ajith Kumar S, Kanakasabapathy Balaji S, Vishwanath U, Parthasarathy Parameshwari R, Santhanakrishnan M. Evaluation of Levels of Advanced Oxidative Protein Products in Patients with Polycystic Ovary Syndrome with and without Chronic Periodontitis: A Cross-Sectional Study. Int J Fertil Steril. 2022;16(1):55\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePavankumar S, Yellarthi PK, Jn S, Boyapati R, Damera TK. Evaluation of periodontal status in women with polycystic ovary syndrome versus healthy women: A cross-sectional study. J Yeungnam Med Sci. 2023;40(Suppl):S17\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWendland N, Opydo-Szymaczek J, Formanowicz D, Blacha A, Jarzabek-Bielecka G, KMizgier M. Association between metabolic and hormonal profile, proinflammatory cytokines in saliva and gingival health in adolescent females with polycystic ovary syndrome. BMC Oral Health. 2021;21(1):193.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTanguturi SC, Nagarakanti S. Polycystic Ovary Syndrome and Periodontal disease: Underlying Links- A Review. Indian J Endocrinol Metab. 2018;22(2):267\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ehttps://\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003c/span\u003e\u003cspan address=\"http://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBharali MD, Rajendran R, Goswami J, Singal K, Rajendran V. Prevalence of Polycystic Ovarian Syndrome in India: A Systematic Review and Meta-Analysis. Cureus. 2022;14(12):e32351.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKellesarian SV, Malignaggi VR, Kellesarian TV, Al-Kheraif AA, Alwageet MM, Malmstrom H, Romanos GE, Javed F. Association between periodontal disease and polycystic ovary syndrome: a systematic review. Int J Impot Res. 2017;29(3):89\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDou Y, Xin J, Zhou P, Tang J, Xie H, Fan W, Zhang Z, Wu D. Bidirectional association between polycystic ovary syndrome and periodontal diseases. Front Endocrinol (Lausanne). 2023;14:1008675.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOzcaka O, Ceyhan BO, Akcali A, Bicakci N, Lappin DF, Buduneli N. Is there an interaction between polycystic ovary syndrome and gingival inflammation? J Periodontol. 2012;83(12):1529\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkcalı A, Bostanci N, Ozcaka O, Ozturk-Ceyhan B, Gumus P, Buduneli N, Belibasakis GN. Association between polycystic ovary syndrome, oral microbiota and systemic antibody responses. PLoS ONE. 2014;9(9):e108074.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRahiminejad ME, Moaddab A, Zaryoun H, Rabiee S, Moaddab A, Khodadoustan AK. Comparison of prevalence of periodontal disease in women with polycystic ovary syndrome and healthy controls. Dent Res J. 2015;12:507\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarquez-Arrico CF, Silvestre-Rangil J, Gutierrez-Castillo L, Martinez-Herrera M, Silvestre FJ, Rocha M. Association between Periodontal Diseases and Polycystic Ovary Syndrome: A Systematic Review. J Clin Med. 2020;9(5):1586.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDursun E, Akalın FA, Guncu GN, Cinar N, Aksoy DY, Tozum TF, Kilinc K, Yildiz BO. Periodontal disease in polycystic ovary syndrome. Fertil Steril. 2011;95(1):320\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePorwal S, Tewari S, Sharma RK, Singhal SR, Narula SC. Periodontal status and high sensitivity C-reactive protein levels in polycystic ovary syndrome with and without medical treatment. J Periodontol. 2014;85(10):1380\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDunaif A. Drug insight: insulin-sensitizing drugs in the treatment of polycystic ovary syndrome-a reappraisal. Nat Clin Pract Endocrinol Metab. 2008;4(5):272\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVenkataraman H, Peter MR, Sreedhar S, Suresh R, Vyloppillil R, Sreelakshmi MR. Prevalence of periodontal disease in patients with polycystic ovary syndrome in a tertiary centre at Kerala: A cross-sectional study. J Datta Meghe Inst Med Sci Univ. 2022;17:898\u0026ndash;903.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Oral health surveys: basic methods. 5th ed. Geneva: World Health Organization; 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreenwood EA, Pasch LA, Cedars MI, et al. Insulin resistance is associated with depression risk in polycystic ovary syndrome. Fertil Steril. 2018;110(1):27\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErensoy H, Niafar M, Ghafarzadeh S, Aghamohammadzadeh N, Nader ND. A pilot trial of metformin for insulin resistance and mood disturbances in adolescent and adult women with polycystic ovary syndrome. Gynecol Endocrinol. 2019;35(1):72\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"PCOS medication, cross-sectional study, periodontal pockets","lastPublishedDoi":"10.21203/rs.3.rs-8665838/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8665838/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMedications for polycystic ovary syndrome (PCOS) are primarily prescribed to manage hormonal imbalances and associated symptoms. However, both the condition itself and certain medications used for its management may have indirect effects that influence periodontal health. This study evaluated the periodontal status of women with PCOS by examining the dichotomous status of medical treatment, whether treatment has been initiated or not.\u003c/p\u003e\u003ch2\u003eMaterial and methods\u003c/h2\u003e \u003cp\u003eA self-administered questionnaire was used to collect demographic information, including age, marital status, treatment status, type of medication used for PCOS, reasons for seeking medical care, and duration of medication use. Clinical examination was conducted to assess periodontal status.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eParticipants receiving medication demonstrated significantly lower mean scores for bleeding on probing, shallow periodontal pockets, and deep pockets compared to non-users. Binary logistic regression analysis showed that age, marital status, gingival bleeding, and the presence of shallow and deep pockets were negatively associated with PCOS medication use.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAs growing evidence highlights the potential relationship between PCOS medication and periodontal health, future research should focus on long-term studies that assess periodontal outcomes over extended periods following the initiation of PCOS treatment.\u003c/p\u003e","manuscriptTitle":"Periodontal Status among women with Polycystic Ovary Syndrome based on medical treatment: A Cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-12 19:21:44","doi":"10.21203/rs.3.rs-8665838/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"09d232ba-0106-4d99-a105-12b958743285","owner":[],"postedDate":"February 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T13:11:52+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-12 19:21:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8665838","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8665838","identity":"rs-8665838","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}