Impact of Oral Contraceptives on Periodontal Health

Hamnah Tirmizi


1st Year BDS, Islamabad Medical and Dental College

Introduction

Oral contraceptives pills (OCPs) are one of the most common and convenient forms of contraception used very frequently by women around the world.1 Recent surveys indicate that injectable agents and contraceptive pills elevate the levels of progesterone and estrogen hormones in the body. These raised levels are linked to periodontal diseases and decreased bone mineral density.2 Oral contraceptive use influences a woman’s periodontal health by causing a biological effect on the periodontal microbiology, by altering gingival cell function and vasculature, the local immune system and thus resulting in the inflammation process. Estrogen and progesterone have been most strongly linked to such diseases as hormonal disturbances directly influence the physiology of the host organisms in the oral cavity. Moreover, patients taking OCs had a higher number of positive cultures for the fungal infection Candida. If left untreated, periodontal infections may adversely affect pregnancy outcomes as they influence placental membranes too. A case study by 203 gynecologists, concluded that long term use of OCs caused gingival changes amongst women and one of the root causes of this was linked to lack of knowledge and awareness regarding
Figure 1; oral contraceptive induced changes in gums
the effects of their long term use of OC. Use of OCs also causes drug induced gingivitis. This can cause pain, spontaneous bleeding, and colour and volume growth changes of the gums.6 Oral Contraceptive users are also more at risk of getting mild to extensive gingivitis, and gingival bleeding and hyperplastic gingivitis.1
Figure 2; progression of periodontal disease

Effects of using OCS

A study was conducted which showed that oral contraceptive (OC) users showed a statistically significant increase in the prevalence of severe periodontitis as compared to those who didn’t. They had much deeper probing depths (≥5 mm), higher gingival index scores and clinical attachment loss, ≥2 and ≥5 than non OC users respectively.

Solutions and Alternatives

While condoms are the most common contraceptive method amongst people, it is followed by the use of the contraceptive pills, making it a popular method of choice.8 Since the middle of the last century ,OC pills have been used as a form of contraceptive method and by 2019, over 150 million people of reproductive age were preferring it over other methods of contraception.9 By minimizing plaque levels at the beginning of oral contraceptive therapy ,gingival inflammation and exudate can be minimized if not completely avoided.10 It was also observed that although long term usage of OCs causes periodontitis , women that used injectable contraceptives and implants were still more prone to a more severe type of gingivitis, relatively.7,5 Scientists are also working on making an oral contraceptive pill for men called Dimethandrolone Undecanoate which is well tolerated and has not caused any periodontitis or gum related disease as of yet. Doctors are also working on reducing the levels of estrogen and progestin in new OCs to reduce their adverse effects on users.5 More research and studies should be conducted for a better understanding of the relationship between the use of OCs and periodontal health amongst its users and solutions and healthy alternate methods should be discovered.

Role of Dentists

Dentists should be well informed about the use of OCs and their influence on oral health, and should always ask their patient if they are using any, and what form of contraception before treating them. If patients come with severe periodontitis, the dentist must inform them about the long term consequences of using oral contraceptive pills which may have caused, or triggered this condition. Alternative methods of contraception should be suggested to such patients.

  1. Prachi S, Jitender S, Rahul C, Jitendra K, Priyanka M, Disha S. Impact of oral contraceptives on periodontal health. African health sciences. 2019 Apr 23; 19(1):1795-800.
  2. Brusca MI, Rosa A, Albaina O, Moragues MD, Verdugo F, Pontón J. The impact of oral contraceptives on women's periodontal health and the subgingival occurrence of aggressive periodontopathogens and Candida species. Journal of periodontology. 2010 Jul; 81(7):1010-8..
  3. Kulkarni S, Zope S, Suragimath G, Varma S, Kale A. female sex hormones and periodontal health: assessment of knowledge and awareness among women of western maharashtra. Annals of Dental Specialty Vol. 2022 Oct;10(4):50.
  4. Al-Qahtani A, Altuwaijri SM, Tulbah H, Al-Fouzan A, Abu-Shaheen A. Gynecologists’ Knowledge of the Association Between Periodontal Health and Female Sex Hormones. Cureus. 2019 Apr 20; 11(4).
  5. Ahmad Haerian-Ardakani DD, Moeintaghavi A, Talebi-Ardakani MR, Sohrabi K, Bahmani S, Dargahi M. The association between current low-dose oral contraceptive pills and periodontal health: a matched-case-control study. The Journal of Contemporary Dental Practice. 2010 May 1; 11(3):33-40.
  6. Kis E, Lazăr A, Lazăr L. Drug-Induced Changes in the Gingival Tissue.
  7. Saini R. Periodontal Status of Women on Hormonal Contraceptives Visiting Maternal Child Health and Family Planning Clinic and Youth Clinic at Kenyatta National Hospital (Doctoral dissertation, University of Nairobi).
  8. Kaufman AY. An oral contraceptive as an etiologic factor in producing hyperplastic gingivitis and a neoplasm of the pregnancy tumor type. Oral Surgery, Oral Medicine, Oral Pathology. 1969 Nov 1; 28(5):666-70.
  9. Cameron NA, Blyler CA, Bello NA. Oral Contraceptive Pills and Hypertension: AReview of Current Evidence and Recommendations. Hypertension. 2023 May; 80(5):924-35.
  10. Zachariasen RD. The effect of elevated ovarian hormones on periodontal health: oral contraceptives and pregnancy. Women &health. 1993 Jun 28; 20(2):21-30
  11. Thirumalai A, Ceponis J, Amory JK, Swerdloff R, Surampudi V,Liu PY, Bremner WJ, Harvey E, Blithe DL, Lee MS, Hull L. Effects of 28 days of oral dimethandrolone undecanoate in healthy men: a prototype male pill. The Journal of Clinical Endocrinology & Metabolism. 2019 Feb; 104(2):423-32.


Volume 5
2023


An Official Publication of Student Spectrum at
Islamabad Medical & Dental College


Address of Correspondence

Hamnah Tirmizi