Periodontitis and infertility: a critical narrative review with qualitative synthesis and an author-proposed translational roadmap for preconception periodontal research

Abstract

Periodontitis is a chronic dysbiotic inflammatory disease that may increase systemic inflammatory burden and expose distant organs to microbial products. Clinical and experimental studies suggest possible associations with reproductive dysfunction, but causality and the effect of periodontal treatment on fertility outcomes remain unproven. This search-informed critical narrative review qualitatively synthesizes clinical and mechanistic evidence linking periodontitis, periodontal pathogens, and fertility-related outcomes. PubMed/MEDLINE, Scopus, and Web of Science were searched from inception to 8 July 2026, and targeted Google Scholar searches were conducted through that date. Sixteen core topic-specific publications were selected for detailed narrative appraisal, while related evidence on polycystic ovary syndrome, endometriosis, adverse pregnancy outcomes, and trial methodology was used to inform the broader translational context. Direct human fertility evidence remains limited and largely observational, and clinically defined periodontitis should be distinguished from microbial detection and pathogen-specific host responses. The second half of this Review is an author-proposed, hypothesis-generating translational framework rather than a synthesis of established intervention evidence. The roadmap begins with a prospective, confounder-controlled observational study that assesses both partners and the broader oral inflammatory/infectious burden. Only if this stage supports temporality and a clinically meaningful association would feasibility and mechanistic periodontal intervention trials be justified, followed by multicenter efficacy and implementation studies. Research should move beyond cross-sectional associations toward prospective, couple-level observational studies that establish temporality, control major confounding, and quantify periodontal and broader oral inflammatory burden. If these studies support the hypothesis, staged feasibility and mechanistic intervention trials can then determine whether periodontal treatment modifies relevant biological pathways without disrupting fertility care.