The Effect of Elevated Ovarian Hormones on Periodontal Health

Abstract

The most common oral manifestation of elevated levels of ovarian hormones, as seen in pregnancy or oral contraceptive usage, is an increase in gingival inflammation with an accompanying increase in gingival exudate. This gingivitis can be avoided or at least minimized by establishing low plaque levels at the beginning of pregnancy or the beginning of oral contraceptive therapy. It would appear that bacteria are not solely responsible for the gingivitis seen during these times, nor are the ovarian hormones solely responsible for the condition. Data from numerous studies suggest that the ovarian hormones alter the microenvironment of the oral bacteria so as to promote their growth and shifts in their populations. The present article reviews the current state of knowledge concerning the relationship of gingivitis to elevated levels of ovarian hormones, and describes the role that these hormones may play in the gingivitis associated with pregnancy or oral contraceptive usage.

Inflammation Mediators Related to Periodontal Disease and Pregnancy Outcomes: A Call for Quality of Antenatal Care While Promising Evidences Are Emerging

“…The underlying mechanism for this enhanced inflammatory response during pregnancy is the elevated level of progesterone and estrogen, amplifying the gingival inflammation (Zachariasen, 1992;Raber-Durlacher, Leene, Palmer-Bouva, Raber &Abraham-Inpijn, 1993). The severity of the response is directly attributed to the levels of these hormones (Steinberg, Hilton, Iida, Iada, & Samelson, 2013) and associated to increased vascular permeability, decline of the immune system, and changes on the composition of supra and subgingival microbiota (Carrillo-de-Albornoz et al, 2010).…”

Does Pregnancy or Use of Contraceptives Influence Adult Facial Changes?

“…The increase in length of the anterior cranial base, length of the posterior facial height and mandible inclination as well as the decrease in mandibular prognathism and soft tissue thickness below the nose were significant in females only. Increased production of growth [9] and ovarian hormones [10] is observed during pregnancy, and it is well known that hyperplasia of the gingivae is common during pregnancy [7].…”

“…Contraceptive pills basically mimic the hormonal levels of pregnancy, as they trigger high circulating levels of estrogens and progestins [10]. From experimental studies of adult animals we know that the administration of high doses of 17 beta-estradiol (E2), similar to those in late pregnancy, stimulates bone formation [1].…”

“…Die Längenzunahme der vorderen Schädelbasis, die Länge der hinteren Gesichtshöhe und die mandibuläre Inklination sowie die Abnahme der mandibulären Prognathie und der Weichteildicke unterhalb der Nase waren nur bei den weiblichen Probanden signifikant. Während der Schwangerschaft sind erhöhte Blutwerte für Wachstums-und Ovarialhormone [9,10] vorzufinden. Des Weiteren sind schwangerschaftsinduzierte Hyperplasien der Gingiva bekannt [7].…”

Ultrastructural Evaluation of Gingival Glycosaminoglycans in Ovariectomized Rats: Effects of Steroid Hormone Therapy

“…An increase of gingivitis, periodontal disease, tooth loss and dry mouth has been reported [1] and hormone replacement seems to be associated with decreased levels of several indicators of severity of oral disease as compared with estrogen-insufficient women [2,3] . It also is known that elevated levels of ovarian hormones, as seen in pregnancy or oral contraceptive usage, can lead to an increase of gingival inflammation with an accompanying increase in gingival exudates [4] . Sex hormones are considered to be a risk factor for periodontal disease because they can facilitate the proliferation of specific periodontal microorganisms, alter the saliva composition as well as the gingival immune response and the local blood supply [5] .…”