The Influence of Oral Contraceptive Therapy on the Periodontium—Duration of Drug Therapy

Abstract

The participants in this study were 151 women; 49 of these had been taking oral contraceptives for over 5 years, 63 had been taking oral contraceptives for less than 5 years, and 39 formed the control group. It was found that there was a statistically significant increase in gingival inflammation related to the duration of drug therapy. There were no significant differences in level of attachment between the groups of subjects.There have been several studies concerning the effect of oral contraceptives on the gingiva and periodontal tissues. These drugs act by altering the level of estrogen and progesterone. El-Ashiry et al.1 found that there was an increase in clinically assessed inflammation for subjects taking oral contraceptives. Lindhe and Björn2 showed that gingival fluid flow increased during the first 6 months of such medication, and that this was not associated with an increase in dental plaque. The study by Knight and Wade3 found no significant differences between Plaque Index, Gingival Index or loss of attachment between subjects taking oral contraceptives and control subjects. However, there was a trend for subjects who had taken the hormonal drugs for more than 1.5 years to show a higher Gingival Index and more loss of periodontal attachment than those who had taken drugs for less than 1.5 years or those who were not taking hormones. A recent study by Kalkwarf4 has shown that there was no significant difference in the severity of inflammation between subjects taking various combinations and concentrations of hormones although there was significantly more severe gingival inflammation in the group taking oral contraceptives than in the control group.In light of these findings, it was decided that there was a need for longer studies into the gingival status of subjects taking oral contraceptives, and that more work was required to evaluate the effect of these drugs on the periodontal attachment. Thus, the aim of this study was to investigate the inter-relationship between the responses of the periodontal tissues to plaque in subjects who had been taking oral contraceptives for various periods of time compared with control subjects.The participants in the present study were females between the ages of 18 and 40 years who were attending the Margaret Pyke Centre, London. The subjects were divided into three groups: those who had used oral contraceptives regularly but for less than 5 years; those who had used contraceptives regularly for more than 5 years, and a control group who used an alternative form of contraception. For inclusion in the control group it was stipulated that the subjects must have either never used hormonal contraceptives, or alternatively have terminated a course of therapy of less than 1 year's duration more than 12 months previously.Additional requirements for inclusion in the study were as follows: the subjects were neither pregnant at the time of examination, nor had they been pregnant in the preceding year. The medication being taken by the subjects in the experimental group were ...

A influência de contraceptivos orais combinados na condição periodontal

“…Entretanto a maioria dos estudos encontrados na literatura referentes à influência de contraceptivos orais sobre os parâmetros clínicos tendem, em sua maior parte, avaliar somente os dentes anteriores (Lindhe e Bjorn, 1967;Nakagawa, Fuji et al, 1994) ou somente uma face de um molar e uma face de um pré-molar (Kalkwarf, 1978;Kornman e Loesche, 1980), e em grande parte desses estudos, somente seis dentes (Knight e Wade, 1974;Jensen, Liljemark et al, 1981;Pankhurst, Waite et al, 1981) especificados por Ramfjord (Ramfjord, 1967). Por este motivo, esse estudo se propôs a avaliar a condição periodontal geral de mulheres fazendo uso de contraceptivos orais comparativamente a mulheres que não fazem uso desse medicamento, de forma que a avaliação dos parâmetros clínicos foi realizada em todos os dentes presentes na cavidade bucal, com exceção dos terceiros molares.…”

“…No presente estudo, foram investigadas as medidas de profundidade de sondagem, nível de inserção clínica, índice de placa e índice de sangramento do sulco em pacientes usuárias e não usuárias de medicamentos anticoncepcionais, estando de acordo com outros estudos publicados na literatura (El-Ashiry, El-Kafrawy et al, 1970;Knight e Wade, 1974;Kalkwarf, 1978;Kornman e Loesche, 1980;Pankhurst, Waite et al, 1981;Kornman e Loesche, 1982;Klinger, Eick et al, 1998;Preshaw, Knutsen et al, 2001;Yalcin, Basegmez et al, 2002;Machtei, Mahler et al, 2004;Mullally, Coulter et al, 2007).…”

“…Diversos estudos publicados na literatura sugeriram que o aumento da inflamação gengival influenciada pelo aumento dos níveis dos hormônios sexuais, como aquele observado durante as fases de puberdade e gestação, não estão associadas com aumento no índice de placa (Kalkwarf, 1978;Pankhurst, Waite et al, 1981;Sooriyamoorthy e Gower, 1989;Amar e Chung, 1994;Machtei, Mahler et al, 2004) (Kalkwarf, 1978;Kornman e Loesche, 1982;Amar e Chung, 1994;RaberDurlacher, Van Steenbergen et al, 1994;Gornstein, Lapp et al, 1999;Reinhardt, Payne et al, 1999;Machtei, Mahler et al, 2004). Porém, essa associação não foi observada em outros estudos (Knight e Wade, 1974;Jensen, Liljemark et al, 1981;Preshaw, Knutsen et al, 2001).…”

“…Considerando que os hormônios sexuais exercem sua influência através da ligação aos receptores intracelulares específicos e que a formação e atividade do complexo hormônio sexual-receptor apresentam uma função importante nas interações celulares, na inflamação e destruição do tecido conjuntivo, diversos estudos (Kristen, 1976;Kalkwarf, 1978;Brooks, 1980;Pankhurst, Waite et al, 1981;Parkar, Newman et al, 1996) sugeriram uma importante função aos hormônios sexuais nas doenças periodontais inflamatórias crônicas, pois a inflamação gengival e hiperplasia são freqüentes durante a gravidez, a puberdade, a menstruação e em mulheres que fazem uso de anticoncepcionais orais. Portanto, estudos (Wenk, Hernandez et al, 1981;Vittek, Gordon et al, 1982;Vittek, Hernandez et al, 1982;Vittek, Munnangi et al, 1982;Parkar, Newman et al, 1996) já foram desenvolvidos com o intuito de demonstrar a presença destes receptores nos tecidos periodontais e assim confirmar ou não a influência destes hormônios nos tecidos em questão.…”

“…Os estudos existentes relativos ao desenvolvimento de gengivite associada ao uso de contraceptivos hormonais em mulheres saudáveis sem história prévia de hiperplasia gengival (Lynn, 1967;Kaufman, 1969;Sperber, 1969;Kristen, 1976;Brooks, 1980;Mariotti, 1999) sugeriram que a massa hiperplásica regrediu após a interrupção do uso da medicação ou da redução da dosagem do medicamento. Outros estudos sugeriram que mulheres que utilizam anticoncepcionais à base de hormônios regularmente demonstram maior inflamação gengival do que mulheres que não tomam esse medicamento (Lindhe e Bjorn, 1967;El-Ashiry, El-Kafrawy et al, 1970;Pankhurst, Waite et al, 1981;Mariotti, 1999).…”