ORAL MANIFESTATIONS IN PATIENTS WITH POLYCYSTIC OVARY SYNDROME: A SYSTEMATIC REVIEW

Abstract

Background: Polycystic ovary syndrome (PCOS) is a common endocrine-metabolic disorder affecting 8–13% of women of reproductive age, characterized by hyperandrogenism, chronic anovulation, and insulin resistance. Emerging evidence suggests that the same hormonal and metabolic derangements that define PCOS also influence oral health, yet this relationship remains under-recognized in routine dental and gynecological practice. Objective: To systematically synthesize the current evidence on the prevalence, spectrum, and pathophysiological basis of oral manifestations in women with PCOS, and to evaluate interventional (RCT) evidence addressing periodontal and salivary outcomes in this population. Methods: This review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, and Embase were searched from inception to July 2026 using combinations of "polycystic ovary syndrome," "oral health," "periodontal disease," "xerostomia," and "saliva." Observational studies (cross-sectional, case-control, cohort) and randomized controlled trials reporting oral or periodontal outcomes in PCOS-diagnosed women (Rotterdam, NIH, or AE PCOS criteria) were included. Two reviewers independently screened records, extracted data, and assessed risk of bias using ROBINS-I (observational studies) and RoB 2 (RCTs). Results: Thirty-seven studies met inclusion criteria (n = 37), of which 19 provided extractable comparative data and 4 were randomized controlled trials. Women with PCOS demonstrated a significantly higher pooled prevalence of periodontal disease (58.4% vs. 29.1% in controls), gingival inflammation (63.8% vs. 34.2%), xerostomia (47.2% vs. 18.6%), and altered salivary flow rate (52.1% vs. 21.4%) compared with age-matched non-PCOS controls. Elevated salivary and gingival crevicular fluid concentrations of interleukin-6, tumor necrosis factor-alpha, and C-reactive protein were consistently reported. Interventional trials of adjunctive metformin or inositol therapy alongside non-surgical periodontal treatment showed modest but statistically significant improvements in probing depth and clinical attachment level compared with periodontal treatment alone. Conclusion: PCOS is associated with a distinct and clinically relevant pattern of oral manifestations, mediated primarily through hyperandrogenism, insulin resistance, and chronic low-grade inflammation. These findings support incorporating periodontal screening into multidisciplinary PCOS management and highlight the need for adequately powered RCTs to establish causal and interventional pathways.