Endometriosis and Oral Health: Understanding the Possible Links

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Full transcript of the original video, lightly edited for readability.

Most women with endometriosis have been told the disease lives in the pelvic cavity the pelvis the ovaries the uterus the fallopian tubes the peritoneum and because of that every symptom outside of that box gets treated like a coincidence bleeding gums coincidence dry mouth coincidence cavities that seem to appear out of nowhere coincidence gum inflammation that gets worse around your cycle coincidence bad breath oral ulcers swollen gums periodontal disease jaw bone loss salivary changes coincidence. But here is where I'm going to challenge the entire way this disease has been explained because endometriosis is not just a pelvic disease endometriosis is a systemic inflammatory immune vascular hormonal and microbial disease that happens to produce some of its most obvious damage in the pelvis and if the disease is systemic then we should not be shocked when it starts showing up in places far outside the pelvis including the mouth and.

This is the part most people miss the mouth is not separate from the body the gums are not separate from the immune system saliva is not just spit the oral cavity is one of the most vascularized hormone sensitive bacteria rich environments in the entire body and sometimes you guys know the truth before the rest of medicine is willing to connect the dots you guys can help me prove my bench research today because if you have endometriosis or adenomyosis and your oral health has started falling apart I do not want you to immediately blame yourself I do not want you to think maybe I'm just not brushing enough I do not want you to think maybe I'm just unlucky I do not want you to think maybe this has nothing to do with my disease because there is a biological reason this can happen and once you understand the mechanism the pattern starts to make sense according to my understanding of pathology women with endometriosis have been shown to have significantly higher odds of gingivitis and severe periodontitis there's even one data set showing a 57% increased odds of periodontal disease in women with endometriosis compared to women without it the same research framework also points to overlapping inflammatory hormonal immune salivary and microbial pathways between endometriosis adenomyosis and oral disease.

So let's slow this down periodontal disease is not just bad gums periodontal disease is a chronic inflammatory breakdown of the tissue that holds your teeth in place the gum tissue becomes inflamed the periodontal ligament starts breaking down the pockets around the teeth deepen the immune system starts attacking the area and eventually the alveolar bone the jawbone that anchors your teeth can start to resorb that is not cosmetic that is not minor that is tissue destruction and what is endometriosis endometriosis is also a tissue destructive inflammatory disease it recruits immune cells it produces cytokines it triggers angiogenesis it remodels tissue it lays down fibrosis it creates pain through inflammatory and nerve related signaling it behaves like a wound that never completes the healing process.

So when I look at endometriosis and periodontal disease I do not see two random conditions I see two inflammatory battlefields using many of the same biological weapons TNF-alpha IL-1 beta IL-6 IL-8 COX-2 PGE2 reactive oxygen species VEGF r a NK l matrix remodeling bone breakdown microvascular permeability immune confusion. That is the pattern and. This is where I want women to really hear me endometriosis does not have to physically spread to your gums for endometriosis to affect your gums. That is the old mistake the connection is not that endometriosis implants itself into your mouth the connection is that endometriosis changes the biological environment of the entire body it changes inflammatory tone let's talk about.

The first mechanism inflammation in endometriosis lesions and the surrounding immune cells can produce inflammatory mediators like TNF-alpha IL-6 IL-8 COX-2 and prostaglandin E2 these molecules are not just floating around doing nothing they are instructions they tell immune cells to stay active they tell blood vessels to become more reactive they tell pain pathways to become more sensitive they tell tissue to remodel when TNF-alpha IL-6 and PGE2 are elevated in the periodontal environment they can stimulate pathways like r a NK l r a NK l is important because it tells the body to activate osteoclasts osteoclasts are the cells that break down bone in the pelvis inflammatory signaling helps lesions survive invade bleed and remodel tissue in the mouth inflammatory signaling can help drive gum destruction and jaw bone resorption same type of fire different location.

That is why some women with endometriosis may notice gums that bleed more easily inflammation that seems excessive periodontal pockets that progress faster than expected or dental problems that do not match their oral hygiene. This does not mean brushing and flossing do not matter they absolutely matter but it means the immune system may be responding to plaque in a more aggressive destructive way because the body is already inflamed. Now let's talk about hormones endometriosis is not just an estrogen disease the problem is a broken tissue environment that learns how to use estrogen as fuel and the gums are hormone sensitive the gingival tissue expresses estrogen and progesterone receptors estrogen can increase vascular permeability.

That means the tiny blood vessels in the gums can become more engorged more reactive and more prone to bleeding this is similar to why pregnancy gingivitis happens the gums become more vascular more swollen more reactive to plaque now imagine a woman with endometriosis who already has systemic inflammation hormone distortion and immune activation her gums may not respond like a normal calm tissue environment they may respond like tissue that has already been primed for overreaction then we have progesterone resistance progesterone normally has anti inflammatory and immune modulating effects it helps regulate tissue behavior but in endometriosis the body often loses proper progesterone responsiveness that matters because if progesterone signaling is not working correctly the normal brake on inflammation may be weakened.

Now add medical treatments. On top of that some women are placed on progestins oral contraceptives GnRH agonists or other hormone altering therapies these may help manage pelvic symptoms for some women but they can also affect saliva gum tissue oral microbiome balance and mucosal health GnRH agonists. For example can create a chemical menopause like state that estrogen deprivation can reduce salivary gland function less saliva means dry mouth saliva protects the teeth saliva buffers acid saliva contains antimicrobial proteins saliva helps remineralize enamel saliva mechanically washes bacteria away.

So when saliva drops the mouth becomes more acidic more bacteria friendly and more vulnerable to cavities fungal overgrowth bad breath ulcers and enamel breakdown the exact same genetic imbalances that allow endometriosis to remodel pelvic tissue also drive aggressive destruction in the oral cavity in endometriosis GATA2 is suppressed removing the tissue's natural off switch while GATA6 is abnormally activated forcing cells to become mobile and invasive this GATA2 suppression mimics severe genetic mutations known to cause extensive cavities mouth ulcers and rampant gum breakdown furthermore when suppressed Gatta 2 interacts with a specific oral inflammatory variant IL-6 dash 1 7 4 C G it acts as a massive amplifier causing an overproduction of destructive IL-6 in response to normal plaque and turning a routine immune defense into aggressive periodontitis that destroys the gums and jawbone Fusobacterium nucleatum is a major periodontal pathogen it is common in gum disease it helps build dangerous dental plaque communities it can invade epithelial cells it can manipulate immune responses it can contribute to chronic inflammation oral bacteria can enter the bloodstream through inflamed bleeding gums that can happen from brushing flossing chewing dental procedures or chronic periodontal pockets if your gums are inflamed and bleeding that barrier is no longer sealed it becomes a doorway and once bacteria enter the bloodstream they can travel research has shown how Fusobacterium is found in the pelvic cavity of women with endometriosis and how it can influence reproductive tissues I mean just putting this out there we've mapped this nearly a decade ago and something that our supplement focused on as well but that's a different discussion for a different video.

This does not mean every woman with endometriosis has an oral infection causing her disease that would be too simplistic but it does mean we have to stop pretending the mouth and pelvis are separate planets they are connected by blood they are connected by immune signaling they are connected by hormones they are connected by microbiology and they are connected by inflammation. This is the oral pelvic axis and. This is why I keep saying endometriosis is bigger than gynecology alone a gynecologist may look at the pelvis a dentist may look at the gums a rheumatologist may look at autoimmune overlap a gastroenterologist may look at the gut an endocrinologist may look at hormones but the woman is one body one system one immune network one inflammatory burden one microbial ecosystem the enemy is fragmentation the medical model chops the female body into separate departments but endometriosis follows biology and biology is connected.

So what should women do do not panic oral health must be part of your endometriosis care support the terrain early because the mouth is a window into the whole disease and that is where real answers begin.