Current oral contraceptive status and periodontitis in young adults

Oral manifestations in women using hormonal contraceptive methods: a systematic review

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.

Is the use of contraceptives associated with periodontal diseases? A systematic review and meta-analyses

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.

Periodontal complications of prescription and recreational drugs

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.

Impact of oral contraceptives on periodontal health

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.

Oral Health and Oral Contraceptive - Is it a Shadow behind Broad Day Light? A Systematic Review

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.

Matrix metalloproteinase gene polymorphisms and periodontitis susceptibility: a meta-analysis involving 6,162 individuals

We aimed to systematically investigate the potential association of matrix metalloproteinase (MMP)-9, -3, -2, and -8 gene polymorphisms with susceptibility to periodontitis using meta-analysis. A literature search in PubMed, Embase, and Web of Sciencewas conducted to obtain relevant publications. Finally a total of 16 articles with 24 case-control studies (nine on MMP-9-1562 C/T, seven on MMP-3-1171 A5/A6, four on MMP-2-753C/T, and four on MMP-8-799 C/T) were considered in this meta-analysis. The results based on 2,724 periodontitis patients and 3,438 controls showed that MMP-9-1562C/T, MMP-3-1171 A5/A6, and MMP-8-799C/T polymorphisms were associated with periodontitis susceptibility. No significant association was found between MMP-2-753 C/T and periodontitis susceptibility. Subgroup analyses suggested that the MMP-9-1562 C/T polymorphism reduced chronic periodontitis susceptibility and MMP-3-1171 A5/A6polymorphism increased chronic periodontitis susceptibility. In summary, current evidence demonstrated that MMP-9-753 C/Tpolymorphism reduced the risk of periodontitis, MMP-3-1171 5A/6A and MMP-8-799 C/Tpolymorphisms increased the risk of periodontitis, and MMP-2-753 C/T was not associated with risk of periodontitis.

Relationship between gingival inflammation and pregnancy

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.

Oral contraceptives and the periodontium

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.

Matrix metalloproteinase-1 gene polymorphisms and periodontitis susceptibility: a meta-analysis based on 11 case-control studies

Matrix metalloproteinase-1 has been implicated in periodontal disease, but the association between the most-studied Matrix metalloproteinase-1 1G-to-2G polymorphism and the risk of periodontal disease were reported with inconclusive results. Therefore, the aim of this study was to investigate the association between the Matrix metalloproteinase-1 1G-to-2G polymorphism and periodontal disease. Electronic databases search yielded 11 studies with 1447 patients and 1710 control subjects evaluated the association of the polymorphisms of Matrix metalloproteinase-1 1G-to-2G and periodontitis risk were brought into this study. The association was evaluated by odds ratio (OR) and its 95% confidence interval (CI). The overall results showed that the variant genotypes were associated with a significantly increased risk of periodontitis (OR=1.45, 95% CI=1.02-1.26 for 2G/2G vs 1G/1G, and OR=2.27, 95% CI=1.22-4.23 for 2G/2G vs 1G/2G+1G/1G). In the stratified analyses, there was a significantly increased risk for the studies of periodontitis (OR=1.59, 95% CI=1.15-2.21 for 2G/2G vs 1G/1G; OR=3.48, 95% CI=1.39-8.71 for 2G/2G vs 1G/2G+1G/1G), which remained for the studies of Asian populations. And there was a significantly increased risk of severe periodontitis (OR=2.15, 95% CI=1.35-3.43 for 2G/2G vs 1G/1G; OR=2.86, 95% CI=1.31-2.64 for 2G/2G vs 1G/2G+1G/1G; OR=1.6, 95% CI=1.12-2.39 for 1G/2G+2G/2G vs 1G/1G; OR=1.61, 95% CI=1.28-2.03 for 2G allele vs 1G allele). The current study demonstrated that the Matrix metalloproteinase-1-1607 1G-to-2G polymorphism was associated with susceptibility to periodontitis, apparently, severe periodontitis.

Clinical application of human β-defensin and CD14 gene polymorphism in evaluating the status of chronic inflammation

Background

Periodontitis is a common disease that affects the periodontal tissue supporting the teeth. This disease is attributed to multiple risk factors, including diabetes, cigarette smoking, alcohol, pathogenic microorganisms, genetics and others. Human beta-defensin-1 (hBD-1) is a cationic antimicrobial peptide with cysteine-rich ß-sheets and broad-spectrum antimicrobial activity. CD14 is a protein involved in the detection of bacterial lipopolysaccharide (LPS) and has also been associated with periodontitis. This study investigates the single nucleotide polymorphic (SNP) region, -1654(V38I), of the human beta-defensin-1 (hBD-1) gene as well as the -159 region of the CD14 gene in subjects with chronic periodontitis.

Methods

Blood samples from periodontally healthy subjects and periodontitis patients were obtained. DNA was extracted from the blood and was used to perform restriction digest at the polymorphic G1654A site of DEFB1 with the enzyme HincII. The polymorphic site 159TT of CD14 was digested with the enzyme AvaII. Enzyme-linked immunosorbent assay (ELISA) was performed on soluble samples to determine the protein expressions.

Results

The control and patient groups expressed 35% and 38% 1654 A/A genotype of DEFB1, respectively. The A allele frequency of the control group was 40%, while the patient blood group was 54%. The mean hBD-1 protein levels of the control and patient samples were 102.83 pg/mL and 252.09 pg/mL, respectively. The genotype distribution of CD14 in healthy subjects was 16% for C/C, 26% for T/T and 58% for C/T. The genotype frequencies of CD14 in periodontitis patients were 10% for C/C, 43% for T/T and 47% for C/T. The CD14 protein expression determined by ELISA showed a mean protein level of the control samples at 76.28ng/mL and the patient blood samples at 179.27ng/mL with a p value of 0.001.

Our study demonstrated that patients suffering from chronic periodontitis present more commonly with the 1654A/A genotype on the DEFB1 gene and the 159T/T genotype on the CD14 gene.

Conclusions

This study purely investigated the association between periodontitis and one polymorphic site on both DEFB1 and CD14 gene, with the purpose of expanding knowledge for the future development in diagnostic markers or therapeutic interventions to combat this disease.

Influence of combined oral contraceptives on the periodontal condition

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.

Change of periodontal disease status during and after pregnancy

BACKGROUND

This study explored whether there is any change of periodontal disease status during and after pregnancy. We also examined whether the change is different between females with a history of gestational diabetes mellitus (GDM) and females without GDM during pregnancy.

METHODS

A follow-up study was conducted at Woman's Hospital, Baton Rouge, Louisiana. Thirty-nine females who were previously enrolled in a case-control study during pregnancy were followed an average of 22 months postpartum. Periodontal status was assessed through dental examinations performed both during and after pregnancy. Clinical periodontal parameters included bleeding on probing (BOP), mean probing depth (PD), and mean clinical attachment level (CAL). Periodontitis was defined as the presence of ≥1 sites exhibiting PD ≥4 mm or CAL ≥4 mm. We used generalized estimating equation analysis to examine the change of periodontal status.

RESULTS

Mean number and percentage of sites with BOP decreased from 10.7 ± 11.6 (mean ± SD) and 6.5% ± 7.0% during pregnancy to 7.1 ± 8.8 and 4.3% ± 5.3% at 22 months postpartum (P <0.05), respectively. Mean levels of PD and CAL decreased from 1.8 ± 0.4 mm and 1.9 ± 0.3 mm to 1.6 ± 0.3 mm and 1.6 ± 0.3 mm (P <0.01), respectively. The prevalence of periodontitis decreased from 66.7% to 33.3% (P <0.01, adjusted risk ratio = 2.1, 95% confidence interval = 1.3 to 3.4). There was no difference in the change of periodontal status between females with GDM and females without GDM during pregnancy.

CONCLUSIONS

Pregnancy may be associated with an increased risk of periodontal disease. The association is not different between females with GDM and females without GDM during pregnancy.

Depot medroxyprogesterone acetate use and periodontal health in 15- to 44-year-old US females

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.

Relationship between soy and isoflavone intake and periodontal disease: the Freshmen in Dietetic Courses Study II

Background

Much research has shown that soy products inhibited various diseases. However, no published studies have examined the effects of consumption of soy and isoflavones on periodontal disease. The aim of this study was to investigate whether soy and isoflavone intake is associated with the prevalence of periodontal disease.

Methods

The subjects were 3956 Japanese female students, aged 18 to 22 years, who were taking a dietetic course. Periodontal disease was defined as present when a subject reported diagnosis of the disorder by a dentist. Information on dietary factors was collected using a validated diet history questionnaire. Logistic regression analysis was used to estimate the odds ratios and their confidence intervals of periodontal disease. Adjustment was made for cigarette smoking, toothbrushing frequency, region of residence, and body mass index.

Results

The prevalence of periodontal disease was 8.0%. Intake of total soy product and tofu was independently associated with a decreased prevalence of periodontal disease; multivariate odds ratios in comparison of the highest with the lowest quintile were 0.68 and 0.68, respectively (95% confidence intervals = 0.47–0.97 and 0.47–0.98, P for trend = 0.01 and 0.004, respectively). A significant inverse dose-response relationship between the intake of isoflavones and the prevalence of periodontal disease was observed, although the difference in the adjusted odds ratio between the extreme quintiles was of borderline significance (P for trend = 0.04). There were no measurable dose-response relationships between consumption of tofu products, fermented soybeans, boiled soybeans, miso, or miso soup and the prevalence of periodontal disease.

Conclusion

Our findings suggest that soy and isoflavone intake may decrease the likelihood of periodontal disease. Further investigations with objective measures for periodontal disease are needed to confirm our findings.