ORIGINAL RESEARCH

ERECTILE DYSFUNCTION

Effect of Edentulism and Oral Quality of Life on Sexual Functions in

Men: A Cohort Prospective Study
Hasan Turgut, PhD,1,2 and Sedanur Turgut, PhD3

ABSTRACT

Introduction: Edentulism has a serious impact on quality of life (QoL), and changes in QoL can affect sexual
functioning.
Aim: To assess the correlation between oral health-related quality of life (OHQoL) and sexual function in
edentulous men.
Methods: A total of 148 men (18e70 years) with incomplete natural dentition completed the International
Index of Erectile Function (IIEF) and Oral Health Impact Profile (OHIP-14) at 4 time points: before (T0),
during (T1), 4 weeks after (T2), and 1 year (T3) after dental treatment. KruskaleWallis, Friedman, and
Spearman’s rank correlation tests were used for statistical analyses (significance at P < .05).
Results: IIEF total scores differed significantly between the time points (P < .001), with medians and inter-
quartile ranges (IQR) of 46 (7), 42 (8), 49 (6), and 52 (5) at T0, T1, T2, and T3, respectively. The highest rate of
sexual dysfunction was detected at T1 (42.2%) and the lowest at T3 (26.6%). IIEF domain scores also decreased
at T1 and increased at T2 and T3 compared with T0 (P < .05). Median (IQR) OHIP-14 scores were 26.0 (8),
28.0 (8), 20.0 (6), and 18.0 (5), respectively (P < .001). OHIP score was significantly correlated with IIEF
domain scores (P < .05) and there were strong negative correlations between OHIP and total IIEF scores at T0
(r ¼ 0.737), T1 (r ¼ 0.802), T2 (r ¼ 0.831), and T3 (r ¼ 0.722) (P ¼ <.001 for all).
Main Outcome Measure: Changes and correlations in IEFF and OHIP-14 scores; SD and ED prevalances at
T0; T1; T2 and T3 periods.
Clinical Implications: Sexual functions was significantly correlate with OHQoL; thus patients with ED should
also be examined in terms of toothlessness.
Conclusion: OHQoL was significantly associated with sexual function in men. However, correcting the problem
of edentulism improved OHQoL and sexual function, with the best results observed after 1-year follow-up. H
Turgut, S Turgut. Effect of Edentulism and Oral Quality of Life on Sexual Functions in Men: A Cohort
Prospective Study. Sex Med 2021;9:100305.
Copyright
2020, The Authors. Published by Elsevier Inc. on behalf of the International Society for Sexual Medicine.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Key Words: Edentulism; IEFF; Quality of Life; OHIP; Sexual Function

INTRODUCTION encompasses a range of problems related to sexual desire, arousal,

Sexuality is a complex process affected by medical, social, orgasm, or pain.2 The prevalence of SD ranges from 20% to
psychological, economical, and other factors, and is closely 75% in men and increases with age.3 The National Institutes of
related with quality of life.1 The term sexual dysfunction (SD) Health described erectile dysfunction (ED) as the consistent or
recurrent inability to attain and/or maintain adequate penile
erection.4 ED often has a serious impact on quality of life,
Received September 25, 2020. Accepted December 13, 2020. intimate relationships, and overall self-esteem.5 The Interna-
1
Avrasya University, Faculty of Health Sciences, Trabzon, Turkey; tional Index of Erectile Function (IIEF) is the gold standard self-
2
Department of Urology, Medikalpark Karadeniz Hospital, Trabzon, Turkey; report questionnaire used for evaluating erectile function in
clinical trials for the approval of ED treatments.6,7 It has been
3
Karadeniz Technical University, Faculty of Dentistry, Trabzon, Turkey
Copyright ª 2020, The Authors. Published by Elsevier Inc. on behalf of reported that ED becomes more common with age and affects up
the International Society for Sexual Medicine. This is an open access to 1 in 3 men during their lives.8 Although the exact mechanism
article under the CC BY-NC-ND license (http://creativecommons.org/
licenses/by-nc-nd/4.0/). has not been well defined, there is clearly a link with mental
https://doi.org/10.1016/j.esxm.2020.100305 health; ED can occur in the presence of psychological problems,

Sex Med 2021;9:100305 1

2 Turgut and Turgut

and patients may experience psychological distress as a result of Institutional ethics board approval (no:2018/538) was obtained
ED.5 A decline in sexual function has been associated with an before initiation of this study and informed consent was obtained
overall decrease in quality of life, and several physiological causes from all participants. Sample size calculation was performed us-
of ED have also been identified.9,10 Epidemiological reports ing the G*Power 3.1.9.2 program. It was calculated in accor-
suggest a role of lifestyle factors, but there is insufficient evidence dance with the previous article.22 Based on an alpha level of 0.05,
that treating the underlying risk factors and coexistent disorders beta error of 0.20, and effect size ¼ 0.27, the total required
with diet or stress management reduces ED.9 sample size was calculated as 125. With a possible dropout rate of
The World Health Organization described edentulism as a 20%, we determined that at least 148 patients.
major public health issue worldwide that substantially influences A total of 148 men aged 18e70 years years who had
both general and oral health status.11 In accordance with various incomplete (presence of 1e20 natural teeth) or no natural
studies, tooth loss and edentulism can impact a person’s general dentition with no teeth replaced and were scheduled for dental
health in several ways.12,13 Individuals need a minimum number treatment in the prosthodontics department participated in the
of natural teeth for sufficient dental function without prosthetic study. Only the patients planned to make fixed prostheses
replacements, a state referred to as functional dentition.14 People (implant or natural teeth supported) were evaluated. The par-
can chew more foods when they have more than 20 teeth, and ticipants were selected from these edentulous patients who have
functional dentition is defined as the presence of 21 or more not previously applied to the any clinic for SD treatment and
teeth.15 Previous research has shown that adults who are eden- have not taken any medication. Exclusion criteria were the
tulous or have fewer natural teeth have lower quality diets.16 The presence of cardiovascular disease, alcoholism, smoking, or
treatment of edentulism is also disturbing and can affect patients’ obesity, antidepressant drug use, and uncontrolled diabetes or
quality of life. hypertension. Data were collected using questionnaires admin-
Oral health is a state of the oral tissues that contributes to istered in face-to-face interviews in a room separate from the
overall physical, psychological, and social well-being by allowing clinic. All patients completed 2 different questionnaires for 4
individuals to eat, talk, and socialize without discomfort, pain, or time points: T0, before prosthodontic treatment; T1, during
distress.17 Oral health-related quality of life (OHQoL) is influ- dental treatments (4 weeks after the dental treatments started);
enced by an individual’s ability to chew effectively, speak clearly, T2, 4 weeks after, and T3, 1 year after delivery of their new
and present an acceptably esthetic smile and facial appearance, dentures and completion of the dental treatment. No additional
without pain or halitosis.18 The Oral Health Impact Profile treatment was applied to the patients for sexual functions before
(OHIP) questionnaire is commonly used to determine the and after the dental procedures.
OHQoL and is available in different versions and translations.19
Edentulism has been shown to affect OHQoL and is increasing Questionnaires
slowly at a rate of approximately 1% per year in most
countries.20 International Index of Erectile Function
The Turkish version of the IIEF-15 was used to assess male
Toothlessness can result in body image issues, adverse psy- sexual function. It consists of 15 items evaluating the domains of
chological and social impacts, and poor nutrition, all of which are erectile function (questions 1e5 and 15), intercourse satisfaction
known to affect sexual performance. Demographic and socio- (questions 6e8), orgasmic function (questions 9, 10), sexual
economic factors are strongly associated with the prevalence of desire (questions 11, 12), and overall satisfaction (questions 13,
edentulism among adults.21 Moreover, these factors are also 14). Each response is rated on a scale of 0e5 or 1e5, with lower
associated with the prevalence of SD in men. However, there is a values corresponding to higher symptom burden. Patients were
lack of data in the literature about the link between toothlessness, asked to consider which response was most applicable to them
oral health, and sexual function. Therefore, this study aimed to over the last 4 weeks while answering each question. For the 5
assess the relationship between OHQoL and SD in edentulous IIEF domains, maximum possible scores are 30 for erectile
men before, during, and after (6 months and 1 year) dental function, 10 for orgasmic function, sexual desire, and overall
treatment. The hypotheses tested in the present study were 1) satisfaction and 15 for intercourse satisfaction, while minimum
there is a significant relationship between sexual function and possible scores are 0 for intercourse satisfaction and orgasmic
OHQoL and 2) the prevalence of ED will decrease after function, 1 for erectile function, and 2 for sexual desire and
completing dental treatments. overall satisfaction.22 Total IIEF score ranges from 5 to 75, with
higher results indicating better sexual function. Previous studies
determined a cutoff score of 43 for SD.23,24 In addition, a cutoff
MATERIALS AND METHODS
score of 25 in the erectile function domain is optimal for
Subjects differentiating men with and without ED. Based on this score,
This prospective cohort study was carried out in the depart- ED was classified into 4 subgroups: none (26e30), mild
ment of prosthodontics of Karadeniz Technical University and (22e25), mild to moderate (17e21), moderate (11e16), and
the urology department of Medicalpark Trabzon Hospital. severe (5e10).25

Sex Med 2021;9:100305

Edentulism, Oral QoL, and Sexual Functions in Men 3

Table 1. Sociodemographic characteristics of the study population moderate (0.5  r < 0.7), strong (0.7  r < 0.9), and very
Variables N % strong (r  0.9).26

Age (year)
18e35 52 35 RESULTS
35e45 32 22
45e70 64 43
Sociodemographic characteristics of the study population are
Duration of marriage (year) presented in Table 1. The mean age was 40.4 ± 10.6. (min: 24;
<10 45 30 max: 67) years. Natural dentition was incomplete (fewer than 20
10e20 48 32 teeth) in 81% of the patients and the other 19% were fully
>20 55 38 edentulous (no natural teeth). The patients’ median scores with
Educational status interquartile ranges (IQR) and mean and standard deviation
Primary level or lower 71 48 values for the IIEF domains (erectile function, orgasmic func-
High school 50 34 tion, sexual desire, intercourse satisfaction, and overall satisfac-
University 27 18 tion) are shown in Table 2. All domains showed statistically
Employment status significant differences across the time points (P < .001). The
Unemployed 32 21 distribution of patients with no ED and mild, mild to moderate,
Employed 94 63 and moderate ED as per erectile function scores was 19%,
Retired 16 16 34.1%, 35.4%, and 11.6% at, respectively, T0; 6.1%, 27.2%,
Perceived income level 48.3%, and 18.4% at T1; 25.2%, 40.2%, 30.3%, and 5.4% at
Poor 21 14 T2; and 38.8%, 39.4%, 17.7%, and 4.1% at T3. None of the
Moderate 127 86
patients had severe ED.
Teeth loss
Incomplete natural dentition 120 81 The mean total scores of the IIEF for T0, T1, T2, and T3 were
No natural dentition 28 19 46.5 ± 5.1 (range, 34e60); 41.6 ± 4.7 (range, 29e52),
49.0 ± 5.1 (range, 34e62), and 51.1 ± 4.3 (range, 38e64),
respectively (Table 3). Total IIEF scores also differed significantly
across the time points (P < .001). Median and IQR values for
Oral Health Impact Profile total IIEF score at T0, T1, T2, and T3 were 46.0 (7), 42.0 (8), 49
The Turkish version of the Oral Health Impact Profile (6), and 52.0 (5), respectively. Based on the total IIEF score
(OHIP-14) was used to evaluate OHQoL.25 This questionnaire cutoff of 43, 38.4% of the men had SD at T0, 42.2% at T1,
is a self-administered short-version of the original questionnaire 30.3% at T2, and 26.6% at T3. All IIEF domain scores and IIEF
and includes 14 questions in 7 domains: functional limitation, total score decreased at T1 compared with T0 and followed by
physical pain, psychological discomfort, physical disability, psy- significant increases at T2 and T3, representing improved sexual
chological disability, social disability, and handicap. The patients function.
were asked how often they had experienced the impact of that
Mean OHIP scores at T0, T1, T2, and T3 were 25.7 ± 3.7
factor in the last 4 weeks using a 5-point Likert-type scale (0:
(range 11e41), 27.7 ± 4.4 (range 12e44), 19.1 ± 3.6 (range
never, 1: hardly ever, 2: occasionally, 3: fairly often, and 4: very
8e31), and 17.3 ± 3.9 (range 7e31) points (Table 3). OHIP-
often). Domain scores range from 0 to 8 and are summed to
14 scores also differed significantly across the time points
obtain a total score between 0 and 56, with higher scores indi-
(P < .001), with median and IQR values of 26.0 (8), 28.0 (8),
cating lower OHQoL.18 The questionnaire was administered at
20.0 (6), 18.0 (5), respectively. OHIP-14 score increased
T0, T1, T2, and T3 as described previously.
significantly during dental treatments (T1), representing a decline
in OHQoL. However, OHIP scores decreased significantly at T2
Statistical Analysis and T3 (P < .001).
All statistical analyses were made using IBM SPSS Statistics Correlations between total OHIP scores and IIEF total and
version 20.0 (IBM Corp., Armonk, NY). Normal distribution domain scores are presented in Table 4. The analysis showed that
was analyzed by using KolmogoroveSmirnov test and histogram. OHIP score correlated with all IIEF domains (P < .05). For total
When the data were not normally distributed, the Wilcoxon IIEF and OHIP scores, negative correlations were detected at T0
signed rank test was applied to test for statistical significance (r ¼ 0.737, P < .001), T1 (r ¼ 0.802, P < .001), T2
differences. (r ¼ 0.831, P < .001), and T3 (r ¼ 0.722, P < .001).
Spearman’s rank correlation test was used to analyze the
relationship between two quantitative variables (nonnormal dis-
tribution for at least one variable). Data analyses were evaluated DISCUSSION
at a significance level of P < .05 and correlations were inter- This prospective clinical study aimed to determine the impact
preted as very weak (negligible) (r < 0.3), weak (0.3  r < 0.5), of toothlessness and oral quality of life on sexual function in

Sex Med 2021;9:100305

 4
Table 2. International Index of Erectile Function domain scores before (T0), during (T1), 4 weeks after (T2), and 1 year (T3) after dental treatment
IIEF domains T0 (mean ± SD) median [IQR] T1 (mean ± SD); median [IQR] T2 (mean ± SD); median [IQR] T3 (mean ± SD); median [IQR]

Erectile function (21.8 ± 3.6); (20.3 ± 3.4); (22.8 ± 4.2); (25.2 ± 3.4);
22.0 [5]a 20.0 [5]b 22.0 [5]c 25.0 [5]d
Orgasmic function (6.4 ± 1.6); (5.7 ± 1.7); (6.8 ± 1.7); (6.9 ± 2.0);
6.0 [1]a 6.0 [2]b 7.0 [2]c 7.0 [1]d
Sexual desire (5.3 ± 0.7); (5.1 ± 1.9); (5.8 ± 1.6); (5.9 ± 1.9);
5.0 [1]a 5.0 [2]b 6.0 [2]c 6.0 [1]d
Sexual satisfaction (7.2 ± 0.8); (6.2 ± 1.7); (8.1 ± 2.1); (7.4 ± 1.7);
7.0 [2]a 6.0 [2]b 8.0 [2]c 7.0 [2]d
General satisfaction (5.7 ± 1.1); (4.8 ± 0.6); (6.0 ± 1.2); (6.1 ± 1.8);
5.0 [2]a 5.0 [1]b 6.0 [2]c 6.0 [2]d
Different superscript letters shows the significant median of differences between the columns (T0; T1; T2; T3) horizontally. The significance level is P < .05.

Table 3. Total Oral Health Impact Profile (OHIP-14) and International Index of Erectile Function (IIEF) total scores before (T0), during (T1), 4 weeks after (T2), and 1 year (T3) after
dental treatment
OHIP-14 domains T0 (mean ± SD) median [IQR] T1 (mean ± SD) median [IQR] T2 (mean ± SD) median [IQR] T3 (mean ± SD) median [IQR]

OHIP-14 (25.7 ± 3.7); (27.7 ± 4.4); (19.1 ± 3.6); (17.3 ± 3.9);

26.0 [8]a 28.0 [8]b 20.0 [6]c 18.0 [5]d
IEFF (46.5 ± 5.1); (41.6 ± 4.7); (49.0 ± 5.1); (51.1 ± 4.3);
46.0 [7]a 42.0 [8]b 49.0 [6]c 52.0 [5]d
Sex Med 2021;9:100305

Different superscript letters shows the significant differences between the columns (T0; T1; T2; T3) horizontally. The significance level is P < .05.

Turgut and Turgut

Edentulism, Oral QoL, and Sexual Functions in Men 5

men. Our results demonstrated significant correlations between

<.001
<.001
<.001
<.001
<.001
<.001
OHIP scores and IIEF total and domain scores, thereby sup-

P
porting the first study hypothesis that sexual function and
OHQoL are associated. The patients’ erectile function, orgasmic
function, sexual desire, intercourse satisfaction, and overall
satisfaction improved as their OHQoL improved in the present
study.

0.896

0.694
0.626
0.704

0.744
0.722
Table 4. Correlation between OHIP-14 and IIEF domain and total scores before (T0), during (T1), 4 weeks after (T2), and 1 year (T3) after dental treatment
T3

Edentulism can directly cause functional, physical, psycho-

r

logical, and social disability, as well as a diminished sense of well-

being,27 all of which can impact patients’ general health in
various ways. Lifestyle modifications such as increased physical
.002 activity, adequate calorie intake, and healthy nutrition have been
<.001
<.001
<.001

<.001
<.001
associated with improvement in erectile function in the general
male population.28 Some researchers have reported a strong
P

positive correlation between sexual function and health-related

quality of life.10,22e30 Desire and satisfaction involve not only
physical sexual function but also an individual’s social and
emotional sexual experiences. Therefore, interpersonal, psycho-
0.802

0.632
0.831

0.612

0.701
0.521

logical, social, and cultural factors should be addressed as well

T2

when investigating possible reasons for ED.28

r

Previous studies showed that men with functional dentition

(21 or more natural teeth) ate more servings of fruit and vege-
tables and had higher a/b-carotene intake compared to eden-
tulous men.31e33 Denture wearers may also have difficulty
<.001
<.001
<.001
<.001
<.001
<.001

chewing, resulting in a poor diet.31 Diet quality, food intake, and

P

serum nutrient levels are generally lower among denture wearers

than patients with complete or partial natural dentition.15,32
Only adults who have well-fitting dentures exhibited similar
P: The value of statistical significance; r: correlation coefficient. The significance level is P < .05.

nutrient intake and dietary quality to those with natural teeth.33

0.802

Esposito et al34 evaluated the effect of diet on ED. Their ran-

0.668
0.490
0.646
0.856
0.469

domized study demonstrated lower risk of ED when the in-

T1

IIEF ¼ International Index of Erectile Function; OHIP-14 ¼ Oral Health Impact Profile.

dividuals consumed a diet rich in vegetables, fruit, and whole

grains.
In accordance with the results of our study, the lowest IIEF
scores and highest OHIP scores were found at T1, which was
<.001
<.001

<.001
.018
.021
.011

during dental treatment. Undergoing dental treatments for

P

incomplete dentition can cause oral discomfort and pain, thereby

reducing OHQoL.13,27 The decrease in IIEF scores during
treatment may be related to previously reported observations that
dental rehabilitation can have a tremendous impact on patients.
However, after completion of treatment and delivery of the new
0.682
0.462
0.785

0.752
0.737

0.516
OHIP

dentition, OHIP scores decreased and IIEF scores increased. In

T0

our image-conscious world, dentures restore a sense of normality

and enhance the patient’s ability to interact socially. It is reported
that patients’ adaptation to new dentures can last up to a year.35
Similarly, the best scores for sexual function and OHQoL were
General satisfaction

observed 1 year after completing dental treatment and showed a

Sexual satisfaction
Orgasmic function
Erectile function

significant improvement over pretreatment levels.

Sexual desire

In accordance with total IIEF scores in the present study, SD

Total score

was detected in 38.4% at T0, 42.2% for T1, 30.3% at T2, and
26.6% at T3. The highest prevalence of ED was seen at T1
(48.3% mild to moderate and 18.4% moderate) whereas the
IIEF

lowest was seen at T3 (17% mild to moderate and 4.1%

Sex Med 2021;9:100305

6 Turgut and Turgut

moderate). The ED prevalence was lower at T2 and T3 than at general health status of the individual, the presence of diabetes
T0, supporting the second study hypothesis that the prevalence mellitus, cardiovascular problems, obesity, psychiatric/psycho-
of ED would decrease after completion of dental treatments. Our logical disorders, and sociodemographic conditions. Several
results point to a strong relationship between lower OHQoL and cross-sectional and longitudinal studies showed these associa-
higher prevalence of ED. Among healthy men, ED has been tions. So, the patients meeting any of these criteria were excluded
reported at rates of 20e80%.36 In fact, the results of the present to prevent the risk factors’ effect on the results. This study reveals
study were not surprising, considering the increased social, psy- that edentulousness, which affects the quality of life of in-
chological, and esthetic problems men face when coping with dividuals, may also be a criterion that will affect SD. Further
mastication and speech impairments result from the chronic research will be beneficial to elucidate the mechanism underlying
nature of edentulism, and these factors can also affect SD. these findings.
Lifestyle and diet are recognized as the main factors affecting the A limitation of this study was that all of the included men
production of vascular NO and erectile function.27 Lifestyle were from the same region. A similar analysis can be conducted
habits that decrease low-grade inflammation may have a role in with large samples from different regions and populations. A
reducing the burden of SD.29 Moreover, emotional stress and quasi-experimental design method was used without a control
depression may cause ED without any vascular dysfunction. group in this study. It was a single-arm intervention and each
Researchers have also evaluated the effect of infectious peri- patient serve as his own control. In addition, the sample of the
odontitis on ED. This oral disease causes the loss of both study included only patients who presented to the dental hospital
attachment of the periodontal ligament and the bony support of for treatment. The patients included in the study were edentu-
the tooth, and is generally responsible for tooth loss. Authors lous for at least 4 weeks. However, some patients may have
have reported a strong relationship between ED and periodon- longer periods of toothlessness before applying, and these dura-
titis, noting that this oral disease may induce systemic vascular tions of edentulism may also have effect on the results. Further
diseases.36e39 Zadik et al40 showed that chronic periodontitis studies should also evaluate SD and its determining factors in
was more common among men with ED and suggested a rela- men who do not present to the hospital but need prosthodontic
tionship between the two disorders. Similarly, Sharma et al41 treatment.
reported the highest chronic periodontitis prevalence among
patients with ED. In the present study, the patients were eval-
uated before and after periodontal treatment to rule out the CONCLUSIONS
possible effects of periodontitis on ED. Within the limitations of the present study, the following
Although the studies assessing the role of lifestyle changes in conclusions were reached:
ED are limited by their small sample sizes, the European Asso- 1. Sexual function and OHQoL were significantly correlated in
ciation of Urology recently stated that “lifestyle changes and risk men.
factor modification must precede or accompany ED treatment”, 2. OHIP scores increased significantly during dental treatments
with a level 1b, grade A evidence rating. Therefore, promoting (T1) and decreased after completion of the dental treatments
healthful living or primary prevention can lessen the burden of (T2 and T3) compared to before treatment (T0).
non-communicable diseases such as SD.27 Although SD and 3. Total IIEF scores differed significantly between T0, T1, T2,
poor oral health are not life-threatening conditions, they still and T3. IIEF domain and total scores decreased at T1, then
have an impact on individual well-being. Heydecke et al42 have increased at T2 and T3, showing improved sexual function.
also evaluated the impact of prostheses on social and sexual ac- 4. ED prevalence was highest at T1, during dental treatment,
tivities in edentulous adults for 2 months after treatment. The and lowest at T3, 1 year after completion of dental treatment.
authors also reported that edentulism has a negative impact on
social and sexual life. The analysis of the present study showed Corresponding Author: Hasan Turgut, PhD, Department of
moderate to strong correlations between OHQoL and sexual Urology, Medikalpark Karadeniz Hospital, Trabzon, Turkey.
function in men. The results suggest that improving oral health Tel: þ905059345825; Fax: þ904622297074; E-mail: drha-
by eliminating patients’ dental deficiencies may have positive [email protected]
effects on quality of life and sexual function in men and reduce
Conflicts of Interest: The authors report no conflicts of interest.
the prevalence of ED. Restoration of the esthetic, oral function,
and phonation of the men in our study due to their new den- Funding: None.
tures, and the subsequent increase in their quality of life may
explain the improvement in sexual function. Undoubtedly, this
study not to aim to cure the SD in men; but to reveal the fre-
STATEMENT OF AUTHORSHIP
quency of SD in edentulous patients and also to see the effect of Hasan Turgut: Conceptualization, Investigation, Writing -
improving the oral health with prosthesis on SD in men. It’s Original Draft, Writing - Review & Editing, Funding Acquisi-
known that risk factor categories associated with SD include tion, Resources, Supervision; Sedanur Turgut:

Sex Med 2021;9:100305

Edentulism, Oral QoL, and Sexual Functions in Men 7

Conceptualization, Methodology, Investigation, Writing - 17. Sischo L, Broder HL. Oral health-related quality of life: what,
Original Draft, Writing - Review & Editing, Resources, why, how, and future implications. J Dent Res 2011;90:1264-
Supervision. 1270.
18. John MT, Patrick DL, Slade GD. The German version of the oral
health ımpact profile: translation and psychometric properties.
REFERENCES Eur J Oral Sci 2002;110:425-433.
1. Derogatis LR, Burnett AL. The epidemiology of sexual dys-
functions. J Sex Med 2008;5:289-300. 19. Roumanas ED. The social solution-Denture esthetics, pho-
netics and function. J Prosthodont 2009;18:112-115.
2. Park JH, Ovbiagele B, Feng W. Stroke and sexual dysfunction
-a narrative review. J Neurol Sci 2015;350:7-13. 20. Ervin RB, Dye BA. Centers for Disease Control and Prevention,
National Number of natural and prosthetic teeth impact
3. Dusenbury W, Johansen P, Mosack V, et al. Determinants of nutrient intakes of older adults in the United States. Ger-
sexual function and dysfunction in men and women with odontology 2012;29:e693-e702.
stroke: a systematic review. Int J Clin Pract 2017;71:1296-
1299. 21. Cappelleri JC, Rosen RC, Smith MD, et al. Diagnostic evalua-
tion of the erectile function domain of the international index
4. Heıdelbaugh JJ. Management of erectile dysfunction. Am Fam of erectile function. Urology 1999;54:346-351.
Physician 2010;81:305-312.
22. Esposito K, Giugliano F, Di Palo C, et al. Effect of lifestyle
5. Montague DK, Jarow JP, Broderick GA, et al. Chapter 1: the changes on erectile dysfunction in obese men: a randomized
management of erectile dysfunction: an AUA update. J Urol controlled trial. JAMA 2004;291:2978-2984.
2005;174:230-239.
23. Rosen RC, Cappelleri JC, Gendrano N. The international index
6. Althof SE. Quality of life and erectile dysfunction. Urology of erectile function (IIEF): a state-of-the-science review. Int J
2002;59:803-810. Impot Res 2002;14:226-244.
7. Ghanem H, Shamloul R. An evidence-based perspective to 24. Rosen RC, Riley A, Wagner G, et al. The international index of
commonly performed erectile dysfunction investigations. erectile function (IIEF): a multidimensional scale for assess-
J Sex Med 2008;5:1582-1589. ment of erectile dysfunction. Urology 1997;49:822-830.
8. Nicolosi A, Glasser DB, Kim SC, et al; for the GSSAB In- 25. Mumcu G, Inanç N, Ergun T, et al. Oral health related quality of
vestigators’ Group. Sexual behavior and dysfunction and help- life is affected by disease activity in Behçet’s disease. Oral Dis
seeking patterns in adults aged 40e80 years in the urban 2006;12:145-151.
population of Asian countries. BJU Int 2005;95:609-614.
26. Hinkle D, Wiersma W, Jurs S. Applied statistics for the
9. Rosen RC, Wing R, Schneider S, et al. Epidemiology of erectile behavioral sciences. 5 ed. Boston, MA: Houghton Mifflin;
dysfunction: the role of medical comorbidities and lifestyle 2003.
factors. Urol Clin North Am 2005;32:403-417. 27. Szentpetery AG, John M, Slade GD, et al. Problems reported
10. Esposito K, Ciotola M, Giugliano F, et al. Effects of intensive by patients before and after prosthodontic treatment. Int J
lifestyle changes on erectile dysfunction in men. J Sex Med Prosthodont 2005;18:124-131.
2009;6:243-250. 28. Maiorino M, Bellastella G, Esposito K. Lifestyle modifications
11. McGrath C, Bedi R. Measuring the impact of oral health on and erectile dysfunction: what can be expected? Asian J
quality of life in Britain using OHQoL-UK(W)((c)). J Public Androl 2015;17:5-10.
Health Dent 2003;63:73-77. 29. Hannan JL, Maio MT, Komolova M, et al. Beneficial impact of
12. Brunello DL, Mandikos MN. Constructions faults, age and exercise and obesity interventions on erectile function and its
relative medical health: factors associated with complaints in risk factors. J Sex Med 2009;6:254-261.
complete denture patients. J Prosthet Dent 1998;79:545- 30. Chew KK, Bremner A, Stuckey B, et al. Alcohol consumption
554. and male erectile dysfunction: an unfounded reputation for
13. Baran I, Nalcaci R. Self-reported problems before and after risk? J Sex Med 2009;6:1386-1394.
prosthodontic treatments according to newly created Turkish 31. Hildebrandt GH, Dominguez BL, Schork MA, et al. Functional
version of oral health impact profile. Arch Gerontol Geriatr units, chewing, swallowing, and food avoidance among the
2011;53:e99-e105. elderly. J Prosthet Dent 1997;77:588-595.
14. Sheiham A, Steele JG, Marcenes Wet, et al. The impact of oral 32. Sheiham A, Steele J. Does the condition of the mouth and
health on stated ability to eat certain foods; National Diet and teeth affect the ability to eat certain foods, nutrient and di-
Nutrition Survey of Older People in Great Britain. Ger- etary intake and nutritional status amongst older people?
odontology 1999;16:11-20. Public Health Nutr 2001;4:797-803.
15. Sahyoun NR, Chien-Lung L, Krall E. Nutritional status of the 33. Marshall TA, Warren JJ, Hand JS, et al. Oral health, nutrient
older adult is associated with dentition status. J Am Diet intake and dietary quality in the very old. J Am Dent Assoc
Assoc 2003;103:61-66. 2002;133:1369-1379.
16. John MT, Hujoel P, Miglioretti DL, et al. Dimensions of oral- 34. Esposito K, Giugliano F, De Sio M, et al. Dietary factors in
health-related quality of life. J Dent Res 2004;83:956-960. erectile dysfunction. Int J Impot Res 2006;18:370-374.

Sex Med 2021;9:100305

8 Turgut and Turgut

35. John MT, Slade G, Szentpetery A, et al. Oral health-related 39. Keller JJ, Chung S-D, Lin H-C. A nationwide populationbased
quality of life in patients treated with fixed, removable, and study on the association between chronic periodontitis and
complete dentures 1 month and 6 to 12 after treatment. Int J erectile dysfunction. J Clin Periodontol 2012;39:507-512.
Prosthodont 2004;7:503-511. 40. Zadik Y, Bechor R, Galor S, et al. Erectile dysfunction might be
36. Neto AF, Rodrigues MA, Fittipaldi JA, et al. The epidemiology associated with chronic periodontal disease: two ends of the
of erectile dysfunction and its correlates in men chronic renal cardiovascular spectrum. J Sex Med 2009;6:1111-1116.
failure on hemodialysis in Londrina. Int J Impot Res 2002; 41. Sharma A, Pradeep AR, Raju PA. Association between chronic
14:19-26. periodontitis and vasculogenic erectile dysfunction.
37. Johannes CB, Araujo AB, Feldman HA, et al. Incidence of J Periodontol 2011;82:1665-1669.
erectile dysfunction in men 40 to 69 years old: longitudinal 42. Heydecke G, Thomason M, Lund J, et al. The impact of con-
results from the Massachusetts male aging study. J Urol ventional and implant supported prostheses on social and
2000;163:460-463. sexual activities in edentulous adults. Results from a ran-
38. Peng S. Chronic periodontal disease may be a sign for erec- domized trial 2 months after treatment. J Dent 2005;
tiledysfunction in men. Med Hypotheses 2009;73:854-865. 33:649-657.

Sex Med 2021;9:100305