**5. Clinical relevance of understanding the specific effects of gender on periodontal disease**

Despite the extensive evidence from the recent past has recognized gender as an important factor in the regulation of immune responses, sex differences are still very much understudied and poorly understood in scientific research with females being under-represented in clinical disease trials. Specific exploration of sexspecific biomarkers should be considered for both the genders. Studies of multifactorial diseases demonstrate differential susceptibilities between genders encounter confounding variables, such as lifestyle, socioeconomic status, environmental exposures, and genetic polymorphisms. Hence, novel experimental models with gender differences shall be developed to understand disease pathogenesis based on gender [183, 184].

Effie Ioannidou in 2017 developed the methodological and analytical framework with the recognition of sex/gender as important determinants of disease pathogenesis. The authors aimed to present relevant sex biologic evidence to understand the plausibility of the epidemiologic data. In periodontitis pathogenesis, sex dimorphism has been implicated in the disease etiology. With the clear distinction between sex and gender, gender oral health disparities have been explained by socioeconomic factors, cultural attitudes as well as access to preventive and regular care. Economic inequality and hardship for women have resulted in limited access to oral care in some parts of the world. As a result, gender emerged as a complex socioeconomic and behavioral factor influencing oral health outcomes [185].

With the expanding knowledge regarding gender as a risk factor, we must intend to perform specific gender-based periodontal research to find better insight into the mechanisms of disease pathogenesis and mediators, so that specific gender-based tools for periodontal diagnosis, risk assessment, predictive medicine, and disease management strategies can be developed to provide optimized periodontal health care solutions to our patients.
