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Rojo MG, Lloret MRP, Gironés JG. Oral manifestations in women using hormonal contraceptive methods: a systematic review. Clin Oral Investig 2024; 28:184. [PMID: 38427087 PMCID: PMC10907424 DOI: 10.1007/s00784-024-05573-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES To investigate the oral manifestations in women of reproductive age using hormonal contraceptive methods. MATERIALS AND METHODS This review is based on the PRISMA statement. A literature search incorporated observational studies from the last 21 years. An investigative question was formulated using the PICO model, studies were selected, and a quality analysis was performed using the modified STROBE guidelines. A bibliometric analysis was performed, and the data were examined. RESULTS Thirteen articles were included, with the majority evaluating periodontal status. Others analyzed factors such as the presence of alveolar osteitis, oral candidiasis, and salivary microbiome dysbiosis. Ten articles were deemed to have a low risk of bias. CONCLUSIONS Hormonal contraceptives may increase the risk of alveolar osteitis following tooth extraction and increase the presence of the Candida species in the oral cavity. They also affect the periodontium, such as the frequent development of gingivitis, but do not lead to changes in the salivary microbiome. CLINICAL RELEVANCE The increasing number of women using hormonal contraceptives and the knowledge that these contraceptives can produce oral cavity alterations underscore the need to evaluate the oral manifestations found in these women.
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Affiliation(s)
- Marta García Rojo
- Gerodontology and Special Care Dentistry Unit, Faculty of Medicine, IMIB-Arrixaca, Morales Meseguer Hospital, University of Murcia, Murcia, 30008, Spain
| | - Miguel Ramón Pecci Lloret
- Gerodontology and Special Care Dentistry Unit, Faculty of Medicine, IMIB-Arrixaca, Morales Meseguer Hospital, University of Murcia, Murcia, 30008, Spain.
| | - Julia Guerrero Gironés
- Gerodontology and Special Care Dentistry Unit, Faculty of Medicine, IMIB-Arrixaca, Morales Meseguer Hospital, University of Murcia, Murcia, 30008, Spain
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AlGhamdi SA, Altowairqi K, Altowairqi YG, Alkharobi H, Alfayez E, Mansouri R, Aljahdali B, Badahdah A, Alqarni NM, Qumusan GS, Alrafiah A. Health Effects of Oral Contraceptives on Periodontal Disease and Gingivitis: A Cross-Sectional Questionnaire-Based Study Among Saudi Women in Jeddah. Clin Cosmet Investig Dent 2023; 15:237-244. [PMID: 37881241 PMCID: PMC10595954 DOI: 10.2147/ccide.s431814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023] Open
Abstract
Background Sex hormones strongly influence the health and ailment of the oral cavity. For instance, a woman's oral health is influenced by her menstrual cycle, menopause, pregnancy, and usage of oral contraceptives. The use of various therapeutic medication results in intraoral alterations. Oral contraceptive pills (OCPs) are among the drugs that produce intraoral alterations. The study's objective was to evaluate attitudes and oral health conditions of Saudi women's utilizing OCPs in Jeddah, Saudi Arabia. Methods A cross-sectional questionnaire-based study was conducted among Saudi women in Jeddah, Saudi Arabia. The self-administered questionnaire was made and sent to women to evaluate the attitude and oral health condition of women utilizing OCPs. The women using OCPs were asked to self-administer 17 questions to evaluate attitudes and oral health conditions. The questionnaire had multiple-choice questions and was consisted of four sections. Results The number of participants who used contraceptives was 125 (35.9%) women; of them, only 94 (75.2%) used oral contraceptives. The duration of using oral contraceptives mainly was 1-5 years (39.4%), then > 5 years (34.0%), and <1 year (26.6%). Of the 94 women, 34 (36.2%) had gingival diseases, 23 (24.5%) treated their gums; and 13 (13.8%) cleaned their gums at a dental clinic regularly. Times of teeth brushing per day were one time in 32 women (34%), twice in 47 women (50.0%), and three times in 15 (16.0%). Of the 94 women, 4 (4.3%) were smoking, 24 (25.5%) took medication other than OCPs, and 16 (17.02%) had chronic diseases. Common oral complications noticed by participants were gum bleeding after brushing (51.6%), dental caries (25.5%), and oral ulcers (10.6%). Conclusion Females on OCPs had a high rate of gingival bleeding, dental caries, and oral ulcers. OCPs users had poor periodontal and gingival health. Establishing an oral hygiene program was necessary to treat gingival and periodontal inflammation that exacerbated by OCPs.
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Affiliation(s)
- Samar Abdullah AlGhamdi
- Department of Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khaled Altowairqi
- Department of Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Yazan Ghazi Altowairqi
- Department of Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hanaa Alkharobi
- Department of Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Eman Alfayez
- Department of Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rowaina Mansouri
- Department of Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Bushra Aljahdali
- Department of Periodontology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Arwa Badahdah
- Department of Periodontology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | | | - Aziza Alrafiah
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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Castro MML, Ferreira MKM, Prazeres IEE, de Oliveira Nunes PB, Magno MB, Rösing CK, Maia LC, Lima RR. Is the use of contraceptives associated with periodontal diseases? A systematic review and meta-analyses. BMC WOMENS HEALTH 2021; 21:48. [PMID: 33526027 PMCID: PMC7852091 DOI: 10.1186/s12905-021-01180-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/13/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Previous studies indicated an impact of hormonal contraceptive use on oral health. This systematic review aimed to investigate the evidence supporting the impact of the use of hormonal contraceptives and periodontal diseases. METHODS This study is based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and based on the PECO acrostic. Inclusion criteria comprised observational studies including women (P), which evaluated hormonal contraceptive users (E) and hormonal contraceptive non-users (C), to verify the association between this hormonal therapy and the periodontal diseases (O). Searches were performed on 5 databases: PubMed, Scopus, Web of Science, Cochrane Library, LILACS and grey literature (OpenGrey and Google Scholar). After the selection process, the included studies were evaluated qualitatively. Moreover, quantitative data were analyzed in two meta-analyses for clinical attachment loss (CAL) and probing depth (PD). Finally, the level of certainty was measured with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) tool between periodontal clinical parameters. RESULTS 18 articles were eligible for the qualitative synthesis and 7 of them were selected for quantitative analysis. Hence, 15 of the eligible articles reported an association between the use of hormonal contraceptives and severity of periodontal disease. However, 6 articles demonstrated high risk of bias and were excluded from quantitative synthesis. The meta-analysis showed a statistically significant difference for CAL (MD 0.24 [0.09, 0.40]; p = 0.002), but in PD (MD 0.05 [- 0.05, 0.15]; p = 0.33) such difference was not identified. A very low level of evidence was found between the clinical parameters. CONCLUSIONS The use of hormonal contraceptives may be associated to severity of periodontal diseases. However, the quantitative analysis points to an inconclusive outcome due to the high level of heterogeneity. The association is biologically plausible, however additional studies are warranted to better elucidate the clinical significance of this possible association.
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Affiliation(s)
- Micaele Maria Lopes Castro
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Augusto Corrêa street, n 1, Guamá, Belém, PA, 66075-110, Brazil
| | - Maria Karolina Martins Ferreira
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Augusto Corrêa street, n 1, Guamá, Belém, PA, 66075-110, Brazil
| | - Iasmin Encaua Essashika Prazeres
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Augusto Corrêa street, n 1, Guamá, Belém, PA, 66075-110, Brazil
| | - Paula Beatriz de Oliveira Nunes
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Augusto Corrêa street, n 1, Guamá, Belém, PA, 66075-110, Brazil
| | - Marcela Baraúna Magno
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cassiano Kuchenbecker Rösing
- Department of Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Rodrigues Lima
- Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Federal University of Pará, Augusto Corrêa street, n 1, Guamá, Belém, PA, 66075-110, Brazil.
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Relationship between the Oral and Vaginal Microbiota of South African Adolescents with High Prevalence of Bacterial Vaginosis. Microorganisms 2020; 8:microorganisms8071004. [PMID: 32635588 PMCID: PMC7409319 DOI: 10.3390/microorganisms8071004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/18/2020] [Accepted: 06/28/2020] [Indexed: 01/01/2023] Open
Abstract
Bacterial vaginosis (BV) and periodontal disease (PD) are characterised as bacterial dysbioses. Both are associated with an increased risk of poor pregnancy outcomes, yet it is unknown whether PD and BV are related. We characterised the oral microbiota of young South African females with a high prevalence of BV and investigated the association between oral communities and vaginal microbiota. DNA was extracted from vaginal lateral wall, saliva and supragingival plaque samples from 94 adolescent females (aged 15–19 years). 16S rRNA gene sequencing of the V4 hypervariable region was performed for analysis of the oral and vaginal microbiota and BV status was determined by Nugent scoring. The core oral microbiota was predominately comprised of Firmicutes followed by Proteobacteria and Bacteroidetes. The salivary microbiota of participants with BV was more diverse than those with lactobacillus-dominated communities (p = 0.030). PD-associated bacterial species, including Prevotella intermedia and Porphyromonas endodontalis were enriched in the supragingival microbiota of women with non-optimal vaginal communities compared to those with Lactobacillus-dominant communities, while Pseudomonas aeruginosa and Prevotella intermedia were enriched in the saliva of women with non-optimal vaginal microbiota. These data suggest a relationship between oral and vaginal dysbiosis, warranting further investigation into whether they are casually related.
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Hughes FJ, Bartold PM. Periodontal complications of prescription and recreational drugs. Periodontol 2000 2019; 78:47-58. [PMID: 30198137 DOI: 10.1111/prd.12230] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Drug use for both therapeutic and recreational purposes is very widespread in most societies. The range of drugs used, the variations in response to these drugs and other health and behavioral confounders mean that drug use may be an important contributor to individualized periodontal diagnoses. In this narrative review, we review the main reported effects of drugs on the periodontal tissues and periodontal disease processes. Although some of the more common adverse drug reactions on periodontal tissues are well described, in many other cases the evidence for these drug effects is quite limited and based on small case series or isolated reports. Prescription drugs are responsible for a range of effects, including drug-induced gingival overgrowth and increased gingival bleeding, and influence periodontal inflammation and periodontal breakdown. The effects of recreational drugs on the periodontal tissues is less well researched, perhaps for the obvious reason that assembling large cohorts of recreational drug users presents particular challenges. Use of nearly all of these substances is associated with poorer periodontal and dental health, although there is almost certainly a large degree of behavioral confounding in these findings. Overall, further studies of adverse drug reactions on the periodontal tissues are required as this continues to be an important and increasing factor in periodontal health determination.
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Affiliation(s)
| | - P Mark Bartold
- Periodontology, University of Adelaide, Adelaide, SA, Australia
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Prachi S, Jitender S, Rahul C, Jitendra K, Priyanka M, Disha S. Impact of oral contraceptives on periodontal health. Afr Health Sci 2019; 19:1795-1800. [PMID: 31149010 PMCID: PMC6531981 DOI: 10.4314/ahs.v19i1.56] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Oral contraceptives pills (OCPs) are common and a convenient form of contraception. The use of hormonal contraceptives by women has been considered to influence gingival and periodontal disease progression. Aim This study was conducted to assess the effect of oral contraceptive pills on the periodontal health. Materials and method A cross-sectional comparative study was conducted among 200 females aged 18 years and above of Jaipur city. The study subjects were divided into two groups i.e. contraceptive users and non-contraceptive users, each group consisted 100 females. Data was collected using Modified WHO Performa (1997). Periodontal status was examined using Community Periodontal Index (CPI) and Loss of Attachment (LOA). Chi-square test and one sample t-test was used for statistical analysis and P value was set (p< 0.05) as significant. Results Mean CPI score in subjects and non-contraceptive users was 2.34+ 0.81 and 1.16+ 0.89 respectively. Mean LOA score in each group was 0.28+ 0.45 and 0.19+ 0.50 respectively. Conclusion Oral Contraceptive pills had adverse effects on periodontal health.
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Ali I, Patthi B, Singla A, Gupta R, Dhama K, Niraj LK, Kumar JK, Prasad M. Oral Health and Oral Contraceptive - Is it a Shadow behind Broad Day Light? A Systematic Review. J Clin Diagn Res 2016; 10:ZE01-ZE06. [PMID: 28050520 DOI: 10.7860/jcdr/2016/19439.8790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 06/01/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Oral contraceptives are one of the risk factors for gingival disease. Oral contraceptives can affect the proliferation of cell, growth and differentiation of tissues in the periodontium. Nowadays recent research has suggested that the newer generation oral contraceptives have less influence on gingival diseases. AIM The purpose of this study was to systematically review the effect of oral contraceptives on periodontium. MATERIALS AND METHODS A literature review was performed; PubMed, PubMed Central and Cochrane Library, Embase, Google Scholar were searched from 1970 up to December 2015 to identify appropriate studies. RESULTS Out of the total 94 titles appeared 13 articles fulfilled the criteria and were selected for the review. Two articles which were hand searched and one article which was through e-mail was also included. The hormones progesterone and estrogen have direct impact on immune system of the body and thus, affect the pattern and rate of collagen production in the gingiva. Furthermore, the review also shows that longer duration usage of oral contraceptive could lead to poorer oral hygiene status, gingival inflammation and increased susceptibility to periodontal disease. CONCLUSION There are relatively few studies evaluating the effect of oral contraceptives on periodontium. It was found that oral contraceptives have a marked effect on periodontium. The gingival changes after use of oral contraceptives are pronounced in the first few months and with the passage of time these changes get enhanced.
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Affiliation(s)
- Irfan Ali
- Tutor, Department of Public Health Dentistry, D.J. College of Dental Sciences and Research , Ghaziabad, Uttar Pradesh, India
| | - Basavaraj Patthi
- Professor and Head, Department of Public Health Dentistry, D.J. College of Dental Sciences and Research , Ghaziabad, Uttar Pradesh, India
| | - Ashish Singla
- Reader, Department of Public Health Dentistry, D.J. College of Dental Sciences and Research , Ghaziabad, Uttar Pradesh, India
| | - Ritu Gupta
- Senior Lecturer, Department of Public Health Dentistry, D.J. College of Dental Sciences and Research , Ghaziabad, Uttar Pradesh, India
| | - Kuldeep Dhama
- Tutor, Department of Public Health Dentistry, D.J. College of Dental Sciences and Research , Ghaziabad, Uttar Pradesh, India
| | - Lav Kumar Niraj
- Tutor, Department of Public Health Dentistry, D.J. College of Dental Sciences and Research , Ghaziabad, Uttar Pradesh, India
| | - Jishnu Krishna Kumar
- Tutor, Department of Public Health Dentistry, D.J. College of Dental Sciences and Research , Ghaziabad, Uttar Pradesh, India
| | - Monika Prasad
- Tutor, Department of Public Health Dentistry, D.J. College of Dental Sciences and Research , Ghaziabad, Uttar Pradesh, India
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Algate K, Haynes DR, Bartold PM, Crotti TN, Cantley MD. The effects of tumour necrosis factor-α on bone cells involved in periodontal alveolar bone loss; osteoclasts, osteoblasts and osteocytes. J Periodontal Res 2015; 51:549-66. [DOI: 10.1111/jre.12339] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2015] [Indexed: 12/22/2022]
Affiliation(s)
- K. Algate
- Discipline of Anatomy and Pathology; University of Adelaide; Adelaide SA Australia
| | - D. R. Haynes
- Discipline of Anatomy and Pathology; University of Adelaide; Adelaide SA Australia
| | - P. M. Bartold
- School of Dentistry; University of Adelaide; Adelaide SA Australia
| | - T. N. Crotti
- Discipline of Anatomy and Pathology; University of Adelaide; Adelaide SA Australia
| | - M. D. Cantley
- Discipline of Anatomy and Pathology; University of Adelaide; Adelaide SA Australia
- Myeloma Research Laboratory; University of Adelaide; Adelaide SA Australia
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Relationship between gingival inflammation and pregnancy. Mediators Inflamm 2015; 2015:623427. [PMID: 25873767 PMCID: PMC4385665 DOI: 10.1155/2015/623427] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 08/28/2014] [Indexed: 01/09/2023] Open
Abstract
An increase in the prevalence and severity of gingival inflammation during pregnancy has been reported since the 1960s. Though the etiology is not fully known, it is believed that increasing plasma sex steroid hormone levels during pregnancy have a dramatic effect on the periodontium. Current works of research have shown that estrogen and progesterone increasing during pregnancy are supposed to be responsible for gingivitis progression. This review is focused not only on epidemiological studies, but also on the effects of progesterone and estrogen on the change of subgingival microbiota and immunologic physiological mediators in periodontal tissue (gingiva and periodontal ligament), which provides current information about the effects of pregnancy on gingival inflammation.
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Risk factors of periodontal disease: review of the literature. Int J Dent 2014; 2014:182513. [PMID: 24963294 PMCID: PMC4055151 DOI: 10.1155/2014/182513] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 04/07/2014] [Indexed: 01/15/2023] Open
Abstract
Objectives. This paper aims to review the evidence on the potential roles of modifiable and nonmodifiable risk factors associated with periodontal disease. Data. Original articles that reported on the risk factors for periodontal disease were included. Sources. MEDLINE (1980 to Jan 2014), PubMed (using medical subject headings), and Google Scholar were searched using the following terms in different combinations: "periodontal disease," "periodontitis," "risk factors," and "causal." This was supplemented by hand-searching in peer-reviewed journals and cross-referenced with the articles accessed. Conclusions. It is important to understand the etiological factors and the pathogenesis of periodontal disease to recognize and appreciate the associated risk factors. As periodontal disease is multifactorial, effective disease management requires a clear understanding of all the associated risk factors.
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Abstract
Oral contraceptives are a safe and effective means of contraception for millions of women worldwide. The first formulations of these drugs contained much higher doses of estrogens and progestins than those available today, and these were associated with an unacceptably high rate of unwanted effects including serious cardiovascular events. In addition, a number of case reports and clinical studies suggested that use of the first generation oral contraceptives was also associated with an increased risk for gingival and/or periodontal disease. Unfortunately, many of these early studies suffered from significant methodological flaws which throw their findings into question. Nonetheless, these studies provided the basis for a perception among the dental profession that oral contraceptives increase the risk for gingivitis and/or periodontitis. Realisation that the adverse events profile of oral contraceptives was dose dependant led to the development of the modern low dose formulations that are in use today. There have been far fewer studies to investigate whether modern oral contraceptives have any impact on the periodontium compared to studies of the early contraceptive formulations, but the quality of the more recent research is undoubtedly better. Following extensive review of the relevant literature and consideration of the historical perspective, the best available evidence strongly supports that oral contraceptives no longer place users at any increased risk for gingivitis or periodontitis. Oral contraceptives should not be viewed as a risk factor for gingival or periodontal disease.
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MESH Headings
- Contraceptives, Oral/therapeutic use
- Contraceptives, Oral, Hormonal/adverse effects
- Contraceptives, Oral, Hormonal/history
- Contraceptives, Oral, Hormonal/therapeutic use
- Dose-Response Relationship, Drug
- Estrogens/pharmacology
- Female
- Gingivitis/chemically induced
- History, 20th Century
- History, 21st Century
- Humans
- Periodontitis/chemically induced
- Periodontium/drug effects
- Progestins/pharmacology
- Risk Factors
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Abstract
During pregnancy profound perturbations in innate and adaptive immunity impact the clinical course of a number of infectious diseases, including those affecting periodontal tissues. Conversely, it has been suggested that periodontal infections may increase the risk of adverse pregnancy outcomes. In this review, a summary of the literature associated with the bidirectional relationship between pregnancy and periodontal disease as well as the possible mechanisms behind this interaction were examined.
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Figuero E, Carrillo-de-Albornoz A, Martín C, Tobías A, Herrera D. Effect of pregnancy on gingival inflammation in systemically healthy women: a systematic review. J Clin Periodontol 2013; 40:457-73. [PMID: 23557432 DOI: 10.1111/jcpe.12053] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 11/14/2012] [Accepted: 11/30/2012] [Indexed: 11/29/2022]
Abstract
AIM To obtain an overall quantitative estimate of the association between pregnancy and gingival inflammation. MATERIAL AND METHODS Medline and EMBASE databases were searched through August 2011. Prospective cohort or cross-sectional studies assessing the effect of pregnancy on gingival inflammation evaluated by the gingival index (GI) and/or bleeding on probing were included. Meta-analyses were performed if possible. RESULTS Forty-four articles representing 33 studies (14 cohort and 19 cross-sectional) were included. Meta-analyses, performed whenever possible, revealed (1) a significantly lower GI in pregnant women in the first term compared with those in their second or third term of pregnancy; (2) a lower mean GI score in post-partum women compared with women in their second [WMD = 0.143; 95% CI (0.031; 0.255); p = 0.012] or third term [WMD = 0.256; 95% CI (0.151; 0.360); p < 0.001] of pregnancy, when considering cohort studies; (3) Non-pregnant women had lower mean GI values than women in their second or third term of pregnancy. Small changes in plaque levels were reported. CONCLUSION Despite the limited number of studies included in the meta-analyses, the present systematic review confirms the existence of a significant increase in GI throughout pregnancy and between pregnant versus post-partum or non-pregnant women, without a concomitant increase in plaque levels.
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Affiliation(s)
- Elena Figuero
- Section of Graduate Periodontology, University Complutense, Madrid, Spain.
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15
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Increased PELP1 expression in rat periodontal ligament tissue in response to estrogens treatment. J Mol Histol 2013; 44:347-56. [DOI: 10.1007/s10735-013-9490-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 02/04/2013] [Indexed: 01/21/2023]
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Domingues RS, Ferraz BFR, Greghi SLA, Rezende MLRD, Passanezi E, Sant'Ana ACP. Influence of combined oral contraceptives on the periodontal condition. J Appl Oral Sci 2012; 20:253-9. [PMID: 22666846 PMCID: PMC3894772 DOI: 10.1590/s1678-77572012000200022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Accepted: 01/01/2011] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED Most studies investigating the impact of oral contraceptives have been performed some years ago, when the level of sexual hormones was greater than the actual formulations. OBJECTIVE The aim of this study was to evaluate the effects of current combined oral contraceptives (COC) on periodontal tissues, correlating the clinical parameters examined with the total duration of continuous oral contraceptive intake. MATERIAL AND METHODS Twenty-five women (19-35 years old) taking combined oral contraceptives for at least 1 year were included in the test group. The control group was composed by 25 patients at the same age range reporting no use of hormone-based contraceptive methods. Clinical parameters investigated included pocket probing depth (PD), clinical attachment level (CAL), sulcular bleeding index (SBI) and plaque index (Pl.I). Data were statistically evaluated by unpaired t test, Pearson's correlation test and Spearman's correlation test. RESULTS The test group showed increased PD (2.228±0.011 x 2.154±0.012; p<0.0001) and SBI (0.229±0.006 x 0.148±0.005, p<0.0001) than controls. No significant differences between groups were found in CAL (0.435±0.01 x 0.412±0.01; p=0.11). The control group showed greater Pl.I than the test group (0.206±0.007 x 0.303±0.008; p<0.0001). No correlation between the duration of oral contraceptive intake, age and periodontal parameters was observed. CONCLUSIONS These findings suggest that the use of currently available combined oral contraceptives can influence the periodontal conditions of the patients, independently of the level of plaque accumulation or total duration of medication intake, resulting in increased gingival inflammation.
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Affiliation(s)
- Roberta Santos Domingues
- Division of Periodontology, Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
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Taichman LS, Sohn W, Kolenic G, Sowers M. Depot medroxyprogesterone acetate use and periodontal health in 15- to 44-year-old US females. J Periodontol 2012; 83:1008-17. [PMID: 22309173 DOI: 10.1902/jop.2012.110534] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND It has been suggested that progestins may have an inflammatory component and/or increase in prostaglandin synthesis. Thus, extended progestin use may be associated with higher risk of periodontal diseases. This study investigates the association between depot medroxyprogesterone acetate (DMPA) injectable contraception and the prevalence of periodontal diseases among US premenopausal females. METHODS Data for this cross-sectional analysis comes from the 1999 to 2004 National Health and Nutrition Examination Surveys. This analysis includes 4,460 US females (15 to 44 years of age) with complete DMPA usage and periodontal status data. RESULTS Current and past DMPA use was 4.1% and 12.0%, respectively. The prevalence of gingivitis was 53.9% for females who reported having used DMPA compared with 46.1% for DMPA never-users. Females taking DMPA were more likely to be young, single, and non-white, have a history of smoking, have lower levels of education and income, and have ≥1 live births and were less likely to visit the dentist. Using logistic regression, DMPA use was associated with an increased risk of gingivitis (odds ratio [OR] =1.7; 95% confidence interval [CI] = 1.09 to 1.67) and periodontitis (DMPA, OR = 1.49; 95% CI = 1.01 to 2.22) after adjusting for age, race, education, poverty income ratio, dental care use, and smoking status. A significant interaction between smoking status and DMPA use was also found (P = 0.029). CONCLUSIONS This study suggests that DMPA use may be associated with periodontal diseases. Additional investigation is warranted as a result of the disproportionate usage of DMPA among low-income populations who are at an increased risk for poor dental health.
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Affiliation(s)
- L Susan Taichman
- Department of Periodontics and Oral Medicine, Room 3345, University of Michigan School of Dentistry, 1011 N. University Ave., Ann Arbor, MI 48109-1078, USA.
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Gunson MJ, Arnett GW, Formby B, Falzone C, Mathur R, Alexander C. Oral contraceptive pill use and abnormal menstrual cycles in women with severe condylar resorption: A case for low serum 17β-estradiol as a major factor in progressive condylar resorption. Am J Orthod Dentofacial Orthop 2009; 136:772-9. [DOI: 10.1016/j.ajodo.2009.07.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 07/01/2009] [Accepted: 07/01/2009] [Indexed: 10/20/2022]
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Meurman JH, Tarkkila L, Tiitinen A. The menopause and oral health. Maturitas 2009; 63:56-62. [PMID: 19324502 DOI: 10.1016/j.maturitas.2009.02.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 02/15/2009] [Accepted: 02/19/2009] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To review the literature about oral symptoms and signs at the menopause with an emphasis on hormone replacement therapy (HRT). To give practical guidelines for women and their physicians in menopause-related oral health problems. METHODS The PubMed and Cochrane databases was searched until mid January 2009 with key words such as "menopause", "menopausal complaints", "postmenopausal complaints" and "oral diseases", "oral discomfort", "dental health", "dental diseases", "saliva", "burning mouth syndrome", "dry mouth", "xerostomia". Because of a scarcity of controlled studies no systematic review could be conducted. RESULTS Oral discomfort is found in many menopausal women in addition to more general climacteric complaints. The principal peri- and postmenopausal symptoms are dry mouth and burning mouth (glossodynia) which, in turn, may increase the occurrence of oral mucosal and dental diseases, such as candidiasis. The mechanisms of hormone-related oral symptoms and signs are not known although oestrogen receptors, for example, have been detected in the oral mucosa and salivary glands. In principle, the histology of oral and vaginal mucosa is very similar and thus their symptoms might share a common cause. Yet, hormone replacement therapy use does not necessarily prevent or help women with oral symptoms. CONCLUSION Properly controlled long-term randomized studies are needed to assess the effect of HRT on oral discomfort. Future gene profiling could identify women who may or may not benefit from HRT with regard to oral symptoms.
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Abstract
The purpose of this article is to review the current literature on the association between maternal periodontal disease and poor pregnancy and neonatal outcomes and outline the role nurses can play in improving the oral health of pregnant women. Maternal periodontal disease is linked to preterm birth, low birthweight, and preterm low birthweight, but treatment of periodontal disease during pregnancy has been shown to be safe and effective. Nurses, nurse practitioners, and nurse-midwives are in a position to educate pregnant women on the benefits of good oral health and identify and refer women who are in need of dental care for treatment.
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Mullally BH, Coulter WA, Hutchinson JD, Clarke HA. Current oral contraceptive status and periodontitis in young adults. J Periodontol 2007; 78:1031-6. [PMID: 17539716 DOI: 10.1902/jop.2007.060163] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study was to investigate the influence of current hormonal contraceptive medication on periodontal health in young females. METHODS Fifty women aged 20 to 35 years (mean +/- SD: 29.7 +/- 4.7 years) had a comprehensive periodontal examination. Current and previous contraceptive pill use was assessed by a questionnaire. Periodontal assessment included plaque index, gingival index, probing depth, and attachment level at six sites per tooth. The periodontal health of current pill users was compared to that of women not taking the pill. RESULTS Forty-two percent of subjects were taking the contraceptive pill at the time of periodontal examination. Current pill users had deeper mean probing depths compared to non-users (3.3 mm versus 2.7 mm; P = 0.006) and more severe attachment loss (2.6 mm versus 1.7 mm; P = 0.015). Pill users had more sites with bleeding on probing (44.0% versus 31.1%; P = 0.017). CONCLUSION Current users of oral contraceptives had poorer periodontal health.
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Affiliation(s)
- Brian H Mullally
- Department of Restorative Dentistry, Queens University Belfast, Belfast, Northern Ireland.
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Güncü GN, Tözüm TF, Cağlayan F. Effects of endogenous sex hormones on the periodontium--review of literature. Aust Dent J 2005; 50:138-45. [PMID: 16238210 DOI: 10.1111/j.1834-7819.2005.tb00352.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hormones are specific regulatory molecules that have potent effects on the major determinants of the development and the integrity of the skeleton and oral cavity including periodontal tissues. It is clear that periodontal manifestations occur when an imbalance of these steroid hormones take place. The authors conducted a Medline search up to 2004 and in addition, a manual search was also performed including bibliographies of relevant papers, review articles and books. This review focuses on the effects of endogenous sex hormones on the periodontium and the goal was to inform and update practitioners' knowledge about the impact of these hormones on periodontal status. In addition, this review article will analyze how these hormones influence the periodontium at different life stages such as puberty, menstruation, pregnancy, menopause and post-menopause. Moreover, the effects of contraceptives and hormone replacement therapies on the periodontium will be discussed. It is clear that endogenous sex steroid hormones play significant roles in modulating the periodontal tissue responses. A better understanding of the periodontal changes to varying hormonal levels throughout life can help the dental practitioner in diagnosis and treatment.
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Affiliation(s)
- G N Güncü
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
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Taichman LS, Eklund SA. Oral contraceptives and periodontal diseases: rethinking the association based upon analysis of National Health and Nutrition Examination Survey data. J Periodontol 2005; 76:1374-85. [PMID: 16101372 DOI: 10.1902/jop.2005.76.8.1374] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Historic evidence suggests that use of high-dose combined oral contraceptives (OCs) (containing >50 microg of estrogen and>or=1mg progestin) places women at increased risk for periodontal diseases. Since the mid-1970s, OC formulations have dramatically changed. This study investigated the association between OC use and periodontal diseases among 4,930 National Health and Nutrition Examination Survey (NHANES) I and 5,001 NHANES III premenopausal U.S. women, aged 17 to 50 years, before and after the reduction of hormone levels in OCs. METHODS Data for this cross-sectional study came from the first (NHANES I, 1971 to 1974) and third (NHANES III, 1988 to 1994) NHANES studies. RESULTS The prevalence of OC use in the U.S. premenopausal female population in NHANES I was 22% and in NHANES III, 20%. Using multivariable logistic regression, a protective association between current OC use and gingivitis was suggestive but not significant in both NHANES I (odds ratio [OR]=0.65; 95% con- fidence interval [CI]: 0.42 to 1.01) and NHANES III (OR=0.80; 95% CI: 0.61 to 1.02) surveys. Current OC use was also associated with a decreased risk of periodontal disease in NHANES I (OR=0.36; 95% CI: 0.13 to 0.96) and a non-significant association in NHANES III (OR=0.73; 95% CI: 0.50 to 1.07). CONCLUSION This analysis failed to validate the theory that earlier high- or current low-dose OC use is associated with increased levels of gingivitis or periodontitis and suggests an important reexamination of the perceived association between OC use and periodontal diseases.
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Affiliation(s)
- L Susan Taichman
- Department of Periodontics, Prevention, and Geriatrics, University of Michigan Dental School, Ann Arbor, MI, USA.
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Haytaç MC, Cetin T, Seydaoglu G. The effects of ovulation induction during infertility treatment on gingival inflammation. J Periodontol 2004; 75:805-10. [PMID: 15295945 DOI: 10.1902/jop.2004.75.6.805] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Ovulation induction is the most common method of infertility treatment in which the ovaries are stimulated to produce multiple follicles. The aim of this study was to assess the effects of three drug protocols of ovulation induction: clomiphene citrate (CC) alone, CC combined with follicle stimulating hormone (FSH), and CC combined with human menopausal gonadotropin (HMG) on the gingival tissues of women who were undergoing infertility treatment. METHODS Study population was composed of 18 women using CC for three menstrual cycles or less and 16 women using CC for more than three cycles; 21 women using CC-FSH; and 24 women using CC-HMG who had at least four cycles of CC alone the previous year. All subjects were clinically examined for plaque levels (plaque index), gingival inflammation (gingival index), bleeding on probing, and gingival crevicular fluid volume. The results were compared with a control group of 20 women matched for age, educational and professional level, and oral habits and who had never used ovulation drugs. RESULTS Despite similar plaque levels (P>0.05), women using CC for more than three cycles and combined protocols of CC-FSH and CC-HMG had higher levels of gingival inflammation (P<0.01, P<0.001 and P<0.001, respectively), bleeding (P<0.001), and GCF volume (P<0.001) when compared to the control group and to the users of CC for three cycles or less. CONCLUSIONS The results of this study have shown that ovulation induction, which is the most common method in the management of infertility, exacerbates gingival inflammation, bleeding, and GCF volume and that the duration of the usage of these drugs is strongly associated with the severity of gingival inflammation.
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Affiliation(s)
- M Cenk Haytaç
- Cukurova University, Faculty of Dentistry, Department of Periodontology, Balcali/Adana, Turkey.
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Abstract
BACKGROUND Fluctuation in estrogen/progesterone levels has been shown to affect the periodontium. The effects of pregnancy, prepuberty, and oral contraceptives on gingival health has been studied extensively, with gingival scores reported to be higher, in most instances, than in controls. Fluctuation in steroid sex hormone is also noticeable through women's menstrual cycle. Many women report an increase in gingival inflammation and discomfort associated with their menstrual cycle, most commonly around the menses period. However, this well-known phenomenon has never been studied. The purpose of this longitudinal, prospective study was to compare the periodontal status of premenopausal women at different times during their menstrual cycle. METHODS Eighteen premenopausal women, enrolled in our maintenance program, were recruited. Clinical examination was performed before the recall visit at three different time points in their menstrual cycle: ovulation (OV), premenstruation (PM), and menstruation (M). Plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL) were examined around the Ramfjord index teeth. Analysis of variance, with Scheffe modification, was used to determine differences between the menstrual time points. RESULTS Several women in this study reported appreciable oral symptoms just before or during menses. Mean PI (0.85 +/- 0.06) was almost identical at all time points. Despite this, GI was significantly higher (P = 0.0245) in OV (0.54 +/- 0.07) and in PM (0.5 +/- 0.08) than in M (0.38 +/- 0.07). Mean patient's PD (2.22 +/- 0.08 mm) and CAL (2.92 +/- 0.15 mm) was not significantly different between examinations. CONCLUSIONS We observed changes in gingival scores during the menstrual cycles of periodontally healthy women. These changes need to be addressed when analyzing data from epidemiological and treatment studies in premenopausal women.
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Affiliation(s)
- Eli E Machtei
- Unit of Periodontology, Department of Maxillofacial Surgery, Rambam Medical Center, Haifa, Israel
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Güngörmüş M, Akgül HM, Yilmaz AB, Dağistanli S, Erciyas K. Generalized gingival hyperplasia occurring during pregnancy. J Int Med Res 2002; 30:353-5. [PMID: 12166356 DOI: 10.1177/147323000203000320] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In this report, we present a case of generalized gingival hyperplasia related to pregnancy causing chewing, speaking, breathing and cosmetic problems. The patient was a 26-year-old woman in the fourth month of her second pregnancy, with generalized gingival hyperplasia affecting both buccal and lingual aspects of the maxilla and mandible. The hyperplastic tissues, together with mobile teeth, were excised completely; no recurrence was observed for the remainder of the pregnancy. Hormonal changes occurring during pregnancy have long been known to be associated with generalized gingival hyperplasia. Pregnancy does not cause the condition, but altered tissue metabolism in pregnancy accentuates the response to local irritants. This case was of clinical interest because of the extent of tissue proliferation, with the teeth in both the upper and lower jaw completely submerged.
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Affiliation(s)
- M Güngörmüş
- Department of Oral and Maxillofacial Surgery, Atatürk University, Erzurum, Turkey.
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Abstract
Oral contraceptives (OC) have historically been considered a risk factor for gingival diseases. We set out to investigate this premise further, given that, over recent years, hormone concentrations in OC have been substantially reduced. Using a prospective, split-mouth, experimental gingivitis model, pre-menopausal women either taking (n 14) or not taking (n = 16) OC refrained from all oral hygiene practices in one maxillary (test) quadrant while continuing to perform normal oral hygiene activities in the contralateral (control) quadrant. Mean increases in plaque index (PI), gingival index (GI), and gingival crevicular fluid (GCF) volume from days 0 to 21 were significant in test quadrants (P < 0.05) but did not differ regardless of whether subjects received OC (P > 0.05). PI, GI, and GCF volume did not vary in control quadrants over the course of the study (P > 0.05). Analysis of these data suggests that current OC formulations do not affect the inflammatory response of the gingiva to dental plaque.
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Affiliation(s)
- P M Preshaw
- University of Newcastle upon Tyne, The Dental School, UK
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