The Ribbon Box: Oral Health and Fertility FAQs Answered

Can oral health affect fertility? Here’s what a dentist wants you to know was originally published on The Ribbon Box, and is shared here with permission.

Can a tooth infection cause infertility? Can oral health affect fertility overall? Is there a link between gum disease and pregnancy complications?

Today, I’m sitting down together with The Ribbon Box to help answer these questions, and more.

What do we mean by the phrase ‘the mouth-body connection’?

Simply put, the mouth is connected to the body and therefore what happens in the mouth does not stay in the mouth. Instead what happens in the mouth affects what happens in the body. 

Dentistry, and therefore the oral cavity, was separated from medicine over 100 years ago and since then, little has been done to reconnect the two and the value that most people place on dental health is unfortunately low. 

But we shouldn’t ignore the mouth! It is the beginning of the digestive system, it is a passageway into our bodies, it is connected to our circulatory and nervous system, and is the way in which we communicate with others.

The mouth affects the body in several ways. Harmful bacteria from an unbalanced oral microbiome can enter our circulatory system through gum tissue, causing issues like heart disease, dementia, cancer, and infertility. Inflammation in the mouth can lead to chronic inflammation elsewhere, such as arthritis, endometriosis, and gut issues. Tooth abscesses and periodontal disease can damage the heart, leading to heart attacks and strokes. Airway and breathing issues can also stress the heart, leading to neurodegeneration, including Alzheimer’s and dementia.

On a microscopic level, when our immune system detects an oral infection, it releases the enzyme MMP-8 to create pathways for immune cells, allowing them to reach and eliminate the infection. 

However, this process destroys collagen in our gum tissues, making them leaky. This allows pathogens to enter our circulatory system and travel to other organs, causing further issues. Healthy gums act as a barrier, much like our skin and gut lining. Ever heard of a leaky gut? It’s the same process! Leaky gums can lead to a leaky gut, and vice versa.

Can oral health affect fertility?

Yes, oral health absolutely affects fertility, in both men and women. This occurs in two ways; oral inflammation leading to wider inflammation in the body, and oral pathogenic bacteria directly affecting the reproductive system. 

In fact, having a chronic, severe infection with Fusobacterium nucleatum, a very common oral microbe, could increase infertility risk by three times, and oral inflammation could have a similar impact as obesity on fertility.  

It is important to note that it takes two when it comes to fertility, it is not just a woman’s issue – guys, you also need to be aware that in 50% of infertility cases, the problem might be you!

In men

Oral bacteria can travel to your reproductive system and affect your sperm. This bacteria can reduce the number of sperm present as well as sperm motility, and could even unfavorably change the shape of your sperm, making it less likely to penetrate the egg. 

Also, men with gum disease are three times more likely to experience erectile dysfunction than those with healthy gums. This is thought to be because Porphyromonous gingivalis bacteria in the mouth inhibit arginine production, which is a precursor to nitric oxide. Nitric oxide is directly responsible for dilating the penile artery to achieve an erection.

In women

Oral health affects female fertility in a number of ways, from the ability to ovulate and ability to conceive, to the ability to carry the baby to term, and even certain maternal health outcomes. 

Looking at preconception specifically, oral inflammation and bacteria increase your risk of acquiring PCOS by 46%, and is also linked to endometriosis which can make it more difficult to conceive.

The chronic inflammation that can happen after an oral infection could also lead to inflammation inside your uterus, which may impact embryo implantation.

Can a tooth infection cause infertility?

It is unlikely that a tooth infection will cause infertility but it certainly will contribute to temporary infertility in both males and females. 

Tooth infections are also known as dental abscesses and occur when a tooth has become infected and turned necrotic (died). The tooth excretes toxins from its roots into the surrounding bone and this forms an infection called an abscess. Abscesses are filled with bacteria and inflammation and both of these contribute to temporary infertility in females and males. 

In men, bacteria from tooth and gum infections can infect the sperm and kill them off, reducing their number.

Could gum disease affect time to conception?

Yes! Gum disease has been shown to increase time to conception by 2 months, and occurs as a result of inflammation. 

As we’ve mentioned, the chronic systemic inflammation that occurs as a result of gum disease could both impede ovulation and create an unfavorable environment for an embryo to implant. 

For men, the bacteria in the mouth from gum disease can infect sperm and cause bacteriospermia (literally- ‘bacteria in the sperm’) bacteria will kill the sperm, reducing the overall count, and change the shape of the sperm which impedes their motility.

What’s the gum disease endometriosis connection?

The gum disease endometriosis connection is becoming increasingly clear as scientists uncover new mechanisms of disease origin and pathogenesis, leading to successful treatments for this painful, fertility-impacting condition. 

In oral health, chronic inflammation from gum disease and Fusobacterium nucleatum infection exacerbates endometriosis. Chronic oral inflammation heightens the body’s inflammatory response, worsening the condition. 

New research suggests that Fusobacterium nucleatum infection could even be a cause of endometriosis, too. A study published in June 2023 found that 64% of women with endometriosis had a Fusobacterium nucleatum infection in the endometrium. 

Antibiotics, combined with periodontal therapy if a Fusobacterium nucleatum gum infection is present, could treat Fusobacterium nucleatum-induced endometriosis.

Can gum disease also impact fertility treatments or IVF outcomes?

In a word – yes. The bacteria and inflammation from gum disease can impact fertility treatment outcomes, and can even decrease the effectiveness of IVF treatments.

As we’ve suggested, when the mouth is infected and inflamed, this inflammation is not isolated. It can spread to the uterus and create an unfavorable environment for embryo implantation, which is a key part of the IVF process post-embryo transfer. 

If a successful implantation does occur and an oral infection is still present, oral bacteria and inflammation could affect blood flow to the embryo, and restrict blood flow to the baby.

Can having IVF affect your teeth?

Yes, we know that hormones given during IVF treatments may contribute to oral inflammation. 

The inflammation caused by these hormones causes an increased release of MMP-8 leading to receding gums, and, ultimately, movement of oral bacteria into the maternal bloodstream. 

An increase in pregnancy hormones, whether originating from IVF or pregnancy, is what causes bleeding gums commonly seen with pregnancy.

In fact, bleeding gums are often a first sign of pregnancy that many women might miss!

Can poor oral hygiene affect pregnancy?

Looking at pregnancy, Fusobacterium nucleatum could lead to premature labor, and research shows that when this bacterium exists in combination with Porphyromonous gingivalis, a mother’s risk of acquiring gestational diabetes and preeclampsia more than doubles. 

All dental treatments (minus dental fluoride application) that are aimed at disease prevention and at trying to eliminate infection are safe and should be performed prior to and/or during pregnancy. 

It is more important to eliminate any pathogens that could migrate to the uterus and harm the baby. It is also important to keep inflammation down so that it does not contribute to gestational conditions for the mother. 

Use products that are chemical and fluoride-free and that are gentle on your mouth’s microbiome.

Is there a link between gum disease and pregnancy complications?

Absolutely. As we’ve mentioned above, the same bacteria that we have been talking about, Porphyromonous gingivalis and Fusobacterium nucleatum are linked to an increased risk of pre-eclampsia, gestational diabetes, c-section delivery, and preterm birth. 

The correlation with preterm birth is outstanding, Gum disease during pregnancy increases risk of a preterm delivery by up to six times.

The good news is there’s a lot we can do to treat gum disease, and there’s a lot you can do at home to maintain good hygiene too – we’ll get into this below!

What steps can we take to improve our oral health, before we start trying to conceive?

If you’re able to plan ahead for a family, the best time to focus on oral health is before trying to conceive. Start by visiting your dentist for an exam and saliva test to check for bacteria like Pg or Fn, which can negatively impact fertility. The good news is, if these bacteria are present, treatment is simple and quick. Both partners should be tested and treated, as oral bacteria are transmissible – just like you can catch strep throat, you can pass an infection through intimacy or even sharing drinks.

Your dentist will also check for gum disease by measuring gum pockets for bone loss and bleeding (a sign of chronic infection). If found, treatment can reduce inflammation and stop the disease. It’s also a good idea to have a 3D x-ray for abscesses and bitewing x-rays to check for cavities. It’s always best to complete any treatment before pregnancy, but if that’s not possible, get these tests done as soon as you can. Oral infections don’t stay in the mouth, so early treatment ensures both you and your baby stay healthy. Ideally, wait three months after treatment before trying to conceive to support the best quality egg.

Once you get a clean bill of health, maintaining good oral hygiene is key. Use an electric toothbrush 2-3 times a day for 2 minutes, a gentle, non-alcoholic mouthwash, a tongue scraper, and floss twice daily.