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

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.

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

“…Steroid hormones can indirectly lead to changes in periodontal tissue [ 13 , 49 ], and the presence of estrogen and progesterone receptors has been demonstrated in the gingivae. Estrogen receptors are present in periosteal fibroblasts, fibroblasts scattered in the lamina propria, and fibroblasts and osteoblasts of the periodontal ligament [ 3 , 13 ].…”

Health Effects of Oral Contraceptives on Periodontal Disease and Gingivitis: A Cross-Sectional Questionnaire-Based Study Among Saudi Women in Jeddah

“…According to studies, the lamina propria, gingival keratinocytes, and gingival fibroblasts found in the periodontal ligament all have receptors for sex hormones, including estrogen and progesterone. 17 Therefore, periodontal tissue can be indirectly modulated by steroid hormones. In addition to encouraging an increase in tissue glycogen production and lowering keratinization of gingival epithelium, which reduces the epithelial barrier, estrogen can control collagen metabolism 8 , 9 and angiogenesis.…”

On the Role of Psychoneuroimmunology in Oral Medicine

“… 47 However, more (longitudinal) studies using sensitive methodological approaches are necessary to further elucidate the relationship between periodontitis and the HPA axis and its effector cortisol. 48 In addition, excessive or prolonged stress may be associated with more severe immune system dysregulation with regard to systemic inflammation, 19 , 24 , 49 which is thought to be the link between periodontitis and common comorbidities of periodontitis, such as coronary artery disease, osteoporosis, diabetes, and immune disorders (eg, rheumatoid arthritis). 50 , 51 , 52 …”