Oral contraceptives and the periodontium

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.

Hormone‐related events and periodontitis in women

“…However, in those years the hormones doses in OC were very high. More recent formulations have generally shown no increased risk to develop gingivitis and periodontitis in women taking them (Preshaw, ; Preshaw, Knutsen, & Mariotti, ; Taichman & Eklund, ). Our results show a tendency—even not significant—to increased odds of severe periodontitis in women with history of OC usage.…”

Periodontal bone loss and risk of epithelial ovarian cancer

“…Periodontitis and ovarian cancer share several well established etiological factors, such as OC or HT use [23, 24], and less established ovarian cancer risk factors such as smoking, coffee and alcohol use, unhealthy eating patterns and diabetes [25, 26]. Given that the risk estimates were essentially unchanged when adjusting for these factors, this is not a likely explanation for observed results.…”

Dental plaque–induced gingival conditions

“…The features of gingivitis associated with oral contraceptives in premenopausal women were similar to plaque‐induced gingivitis, except the propensity to develop frank signs of gingival inflammation in the presence of relatively small amounts of plaque in women taking these hormones. Current oral contraceptive concentrations are much lower than the original doses that were reported in these early clinical studies, and it is known that current formulations of oral contraceptive do not induce the clinical changes in gingiva that were reported with high‐dose contraceptives …”

“…Although the clinical signs of gingival inflammation that do occur may be statistically significant, the signs are not clinically significant and therefore not clinically evident to the dentist. In regard to oral contraceptives, as a result of the change to low‐dose formulations, the signs and symptoms of gingival inflammation are no longer observable . Finally, when scurvy is considered, the existence of scurvy‐influenced gingival conditions is rare and more likely to result in bleeding due to defects in collagen cross‐linkage in the gingival tissues.…”