Sex differences in oral health conditions

Dental Tribune International

Wed. 23 September 2026

save

PITTSBURGH, US: Research has found that biological sex is associated with differences in immune and inflammatory responses. These differences may contribute to variation in susceptibility to and manifestation of infectious and inflammatory diseases. A large retrospective study drawing on two major US repositories has examined whether biological sex is associated with differences in the occurrence of dental, oral and craniofacial diseases and conditions, an area where large-scale evidence remains limited. The findings corroborate previously reported sex-related differences for some conditions and provide new evidence for others.

The study analysed electronic health record data from 254,700 adults in the US National Institutes of Health All of Us research programme and approximately 4.7 million records from the BigMouth Dental Data Repository, which brings together information from US dental schools. The researchers compared the occurrence of more than 200 dental, oral and craniofacial diseases and conditions in males and females.

In the All of Us dataset, significant sex-related differences were identified for just over two-thirds of the conditions with sex-stratified data. Of these, just over half showed a female bias and just under half a male bias. Particularly strong female associations were observed for recurrent aphthous stomatitis, aphthous ulcer of the mouth and xerostomia, as well as several disorders affecting tooth development and eruption. Dental abscess, reversible pulpitis, toothache and some forms of periodontitis also showed significant female associations. The strongest male biases were found for generalised and localised moderate periodontitis, tooth loss due to local periodontal disease, and pit-and-fissure caries extending into the dentine or pulp. Oral malignancies also showed a male bias.

Analysis of the BigMouth dataset found significant sex-related differences for around two-fifths of the conditions with sex-stratified data. Almost all of these showed a female bias. Notable female associations included enamel, dentine and cementum defects, xerostomia, symptomatic apical periodontitis, symptomatic reversible pulpitis and temporomandibular disorders. The male-biased conditions were oral malignant neoplasm, generalised severe aggressive periodontitis and root caries.

However, the findings were not always consistent between the two databases. Of the 20 diagnostic terms common to both databases, eight showed opposite directions of sex bias, most notably generalised moderate and localised chronic periodontitis, as well as tooth abrasion and attrition.

The authors suggested that biological mechanisms, including differences in immune responses and hormones and sex-specific genetic factors, could contribute to some of the observed differences. However, they also pointed out that behavioural, environmental and other population-level factors may also play a role.

Recent clinical evidence also suggests that sex may modify the relationship between patient-related factors and periodontal inflammation. In that study, smoking was associated with lower bleeding on probing in males, whereas increasing age was associated with increased bleeding in females.

The study demonstrates that sex-related patterns warrant greater consideration in oral health research. The findings could ultimately support more personalised approaches to prevention, diagnosis and treatment, although the authors emphasised that studies in additional populations are needed before clinical recommendations can be made.

The study, titled “Examining electronic health records to investigate sex differences in oral diseases and conditions”, was published in the October 2026 issue of Clinical and Experimental Dental Research.