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Chronic Periodontitis and Erectile Dysfunction
3154
Letters to the Editor
Chronic Periodontitis and Erectile Dysfunction DOI: 10.1111/jsm.12292
We read the article by Oguz et al. [1] with great interest. The cited study is an interesting contribution to the literature. The relationship between erectile dysfunction (ED) and periodontal disease is explored. The cited authors conclude that an association exists between clinical periodontal parameters and ED. Further, they suggest that periodontal disease should be considered when it is sought to understand the etiology of ED in young adults. However, we suggest that these findings should be viewed with caution because some necessary data are lacking. First, the mean International Index of Erectile Function (IIEF) scores of participants were not reported. It is well known that IIEF scores can be used to grade ED severity as absent, mild, moderate, or severe [2]. Why did the authors not subdivide their group I patients in terms of the severity of ED? Had they done so, it would have been possible to draw a firm conclusion as to the existence of any correlation between ED and the presence of chronic periodontitis (CP). We would make another technical point. The possibility that some cases of ED were psychological in terms of etiology should have been explored in more detail [3]. The exclusion criteria were the presence of a systemic disease (including diabetes mellitus, heart disease, and hypertension); such conditions can affect periodontal health and ED. It was shown in the literature with a rat model that experimental model of periodontitis may cause ED [4]. Also, the authors argue that CP is an organic cause of ED, because CP may induce systemic vascular disease by triggering endothelial dysfunction, but in the study no psychological exclusion criterion was listed. It would have been possible to identify appropriate exclusion criteria had patients been asked about the presence of nocturnal erections, or had a nocturnal penile tumescence and rigidity test been performed. Mehmet Nuri Bodakçi, MD,* Namık Kemal Hatipoglu, MD,* and I˙sa Özbey, MD† *Department of Urology, Medical Faculty, Dicle University, Diyarbakir, Turkey; †Department of Urology, Medical Faculty, Atatürk University, Erzurum, Turkey Conflict of Interest: The authors report no conflicts of interest.
J Sex Med 2013;10:3151–3154
Statement of Authorship
Category 1 (a) Conception and Design Mehmet Nuri Bodakçi (b) Acquisition of Data (c) Analysis and Interpretation of Data Namık Kemal Hatipoglu
Category 2 (a) Drafting the Article (b) Revising It for Intellectual Content
Category 3 (a) Final Approval of the Completed Article I˙sa Özbey
References 1 Oguz F, Eltas A, Beytur A, Akdemir E, Uslu MO, Gunes A. Is there a relationship between chronic periodontitis and erectile dysfunction? J Sex Med 2013;10:838–43. 2 Rosen RC, Cappelleri JC, Gendrano N 3rd. The International Index of Erectile Function (IIEF): A state-of-the-science review. Int J Impot Res 2002;14:226–44. 3 Melnik T, Soares BG, Nasello AG. The effectiveness of psychological interventions for the treatment of erectile dysfunction: Systematic review and meta-analysis, including comparisons to sildenafil treatment, intracavernosal injection, and vacuum devices. J Sex Med 2008;5:2562–74. 4 Zuo Z, Jiang J, Jiang R, Chen F, Liu J, Yang H, Cheng Y Effect of periodontitis on erectile function and its possible mechanism. J Sex Med 2011;8:2598–605.
Letters to the Editor
Chronic Periodontitis and Erectile Dysfunction DOI: 10.1111/jsm.12292
We read the article by Oguz et al. [1] with great interest. The cited study is an interesting contribution to the literature. The relationship between erectile dysfunction (ED) and periodontal disease is explored. The cited authors conclude that an association exists between clinical periodontal parameters and ED. Further, they suggest that periodontal disease should be considered when it is sought to understand the etiology of ED in young adults. However, we suggest that these findings should be viewed with caution because some necessary data are lacking. First, the mean International Index of Erectile Function (IIEF) scores of participants were not reported. It is well known that IIEF scores can be used to grade ED severity as absent, mild, moderate, or severe [2]. Why did the authors not subdivide their group I patients in terms of the severity of ED? Had they done so, it would have been possible to draw a firm conclusion as to the existence of any correlation between ED and the presence of chronic periodontitis (CP). We would make another technical point. The possibility that some cases of ED were psychological in terms of etiology should have been explored in more detail [3]. The exclusion criteria were the presence of a systemic disease (including diabetes mellitus, heart disease, and hypertension); such conditions can affect periodontal health and ED. It was shown in the literature with a rat model that experimental model of periodontitis may cause ED [4]. Also, the authors argue that CP is an organic cause of ED, because CP may induce systemic vascular disease by triggering endothelial dysfunction, but in the study no psychological exclusion criterion was listed. It would have been possible to identify appropriate exclusion criteria had patients been asked about the presence of nocturnal erections, or had a nocturnal penile tumescence and rigidity test been performed. Mehmet Nuri Bodakçi, MD,* Namık Kemal Hatipoglu, MD,* and I˙sa Özbey, MD† *Department of Urology, Medical Faculty, Dicle University, Diyarbakir, Turkey; †Department of Urology, Medical Faculty, Atatürk University, Erzurum, Turkey Conflict of Interest: The authors report no conflicts of interest.
J Sex Med 2013;10:3151–3154
Statement of Authorship
Category 1 (a) Conception and Design Mehmet Nuri Bodakçi (b) Acquisition of Data (c) Analysis and Interpretation of Data Namık Kemal Hatipoglu
Category 2 (a) Drafting the Article (b) Revising It for Intellectual Content
Category 3 (a) Final Approval of the Completed Article I˙sa Özbey
References 1 Oguz F, Eltas A, Beytur A, Akdemir E, Uslu MO, Gunes A. Is there a relationship between chronic periodontitis and erectile dysfunction? J Sex Med 2013;10:838–43. 2 Rosen RC, Cappelleri JC, Gendrano N 3rd. The International Index of Erectile Function (IIEF): A state-of-the-science review. Int J Impot Res 2002;14:226–44. 3 Melnik T, Soares BG, Nasello AG. The effectiveness of psychological interventions for the treatment of erectile dysfunction: Systematic review and meta-analysis, including comparisons to sildenafil treatment, intracavernosal injection, and vacuum devices. J Sex Med 2008;5:2562–74. 4 Zuo Z, Jiang J, Jiang R, Chen F, Liu J, Yang H, Cheng Y Effect of periodontitis on erectile function and its possible mechanism. J Sex Med 2011;8:2598–605.