Female sex hormones and periodontal health-awareness among gynecologists - A questionnaire survey

Oral Health Care Among Women in Perimenopause or Menopause: An Integrative Review

INTRODUCTION

Women in menopause are at a higher risk of developing oral health problems, affecting their overall quality of life. Several studies have identified the role of health care providers in addressing women's oral health needs across various phases of their lives, yet a review in the area of perimenopause and menopause has not been undertaken. Therefore, the aim of this review was to explore current evidence regarding the oral health knowledge, attitudes, and practices of women in perimenopause or menopause and their health care providers. Additionally, guidelines and recommendations to inform strategies for oral health promotion are included.

METHODS

A systematic search was carried out across 5 databases. Inclusion criteria included articles published in English that examined at least one study outcome: oral health knowledge, attitudes, and practices of either women in perimenopause or menopause or of health care providers or guidelines around oral health care. Qualitative, quantitative, mixed-methods, and experimental studies with survey components were included with no restrictions on publication period, quality, or setting.

RESULTS

A total of 12 articles met the inclusion criteria, with a majority being of poor quality and mostly from low-income and middle-income countries. Overall findings indicated that there was a lack of knowledge and limited practices in maintaining oral hygiene and visiting the dentist among women in perimenopause or menopause. Health care providers exhibited poor attitudes in advising the importance of periodic dental check-ups and informing oral health changes during this period. There were also insufficient guidelines to adopt care for women and guide health care providers in their practice.

DISCUSSION

Women in perimenopause or menopause have limited oral health knowledge and unmet oral health needs. Appropriate guidelines and supportive strategies are required to assist health care providers in providing comprehensive care and encouragement to women in perimenopause or menopause to improve their oral health.

Oral health knowledge, attitude, and practice of pregnant women in Deccan, South India: a cross-sectional prenatal survey

Pregnancy is a unique condition for women, associated with physiological and emotional changes in the body. Various research showed an association between periodontal disease and adverse pregnancy outcomes. Importance to hygiene maintenance should be given during pregnancy and improve the wellbeing of the mother and child. This study assessed oral health knowledge, attitude, and practices among pregnant women in Hyderabad. The study design was cross-sectional and included 445 women who responded and completed the survey. Subjects were selected using a random sampling technique in gynecology clinics. The questionnaire form consisted of four sections: demographic data, knowledge, attitude, and oral hygiene practice. Out of the 482 pregnant females invited to participate in the study, 445 women completed the survey, giving a response rate of 92%. The majority of women showed good knowledge and attitude regarding oral hygiene and its relation to pregnancy. However, the participants showed poor compliance with the recommended protocol. There are certain myths and barriers to dental treatment that need to be considered in the prenatal education of women. If explained by the gynecologist, the importance of oral health and its correlation with systemic health will play a crucial role in improving oral hygiene practice and regular dental visits.

Prevalence of gingivitis and risk factors among pregnant women from Acapulco, Guerrero: a cross-sectional study

Introduction

Gingivitis is a condition that has been associated with an exaggerated inflammatory response of the gums to oral biofilm, attributed to the secretion of hormones during pregnancy.

Objectives

To estimate the prevalence of gingivitis and identify associated risk factors among pregnant women in a private medical clinic from Acapulco, Guerrero.

Material and methods

Cross-sectional study in a convenience sample of 92 pregnant women, during the period from January to March 2020. A self-administered questionnaire collected sociodemographic data, economic income, oral hygiene habits and personal pathological history. The periodontium was evaluated based on the new classification of gingival health and gingivitis induced by oral biofilm on six representative teeth. Multivariate analysis identified factors associated with gingivitis using the odds ratio and its 95% confidence interval as an estimate of the strength of association with CIETmap statistical software.

Results

The prevalence of gingivitis was 60% (55/92). Two factors remained in the final model of the multivariate analysis. The main associated strength was found in the variable of not using oral hygiene aids (ORa= 6.76; CI 95%= 2.01-22.78). The other variable was not attending dental visits (ORa= 3.74; CI 95%= 1.44-9.73).

Conclusion

Gingivitis affected about six out of ten pregnant women. Knowing the risk factors, it will be important to reinforce health education strategies and the importance of clinical monitoring during pregnancy.

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

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.

Awareness and knowledge regarding maternal periodontal status and associated pregnancy outcomes among the gynecologists of Hubli-Dharwad

Introduction

Periodontitis is an inflammatory disease of gingiva and its supporting structures and is known to cause systemic infection which has adverse effect on pregnancy outcomes, such as preterm birth, preeclampsia, or miscarriage, which have been linked to maternal periodontitis.

Aim

Thus, this study aimed to evaluate the knowledge and awareness regarding the association of periodontitis and adverse pregnancy outcomes among the gynecologists practicing in Hubli-Dharwad city.

Materials and Methods

The study involved a survey for 50 practicing gynecologists in Hubli-Dharwad city, a pretested close-ended questionnaire was distributed comprising 10 questions on oral health for expectant mothers, and thus, their knowledge and awareness levels were assessed.

Results

The results showed that majority of gynecologists agreed importance of maintaining good general health during pregnancy and supported that providing dental treatment during pregnancy improved the pregnancy outcomes.

Conclusion

However, practical implementation and referring patients to dentists were less. The gynecologists were aware of the facts but failed to execute at the clinical level. Thus, this bilateral interdisciplinary protocol can thus reduce the incidence of maternal and neonatal complications.

Regulatory effect of 17β-estradiol on the expression of β-defensin-2 and proinflammatory cytokines in human oral epithelial cells

BACKGROUND

Although estrogen deficiency has been proposed as a risk factor for oral mucosal inflammatory diseases in post-menopausal women, the mechanisms involved remain unclear. This study aimed to investigate the effect of 17β-estradiol (E2) on the inflammatory response stimulated by interleukin-1 beta (IL-1β) in human oral mucosal epithelial cells (hOMECs) and its possible mechanism.

METHODS

Primary hOMECs were obtained from female infants and cultured in keratinocyte growth medium. The hOMECs at second passage were collected and stimulated by 10^-7  mol/L ICI182,780 or 10^-7  mol/L G1 for 1 hour, E2 (10^-7  mol/L, 10^-8  mol/L, 10^-9  mol/L) for 36 hour, 100 ng/mL IL-1β for 12 hours, respectively. Human beta-2 defensin (hBD-2), tumor necrosis factor-alpha (TNF)-α, IL-6, IL-8, estrogen receptor-alpha (ERα), estrogen receptor-beta (ERβ), and G protein-coupled receptor 30 (GPR30) mRNA levels and protein levels were measured by real-time quantitative polymerase chain reaction (RT-qPCR), enzyme-linked immunosorbent assay (ELISA), and Western Blot (WB), respectively.

RESULTS

Expression of hBD-2 and inflammatory cytokines increased after IL-1β stimulation, which was down-regulated by E2 pre-treatment. With ICI182,780, the suppression of E2 on hBD-2 mRNA was attenuated. With G1, the mRNA expression and protein expression of hBD-2 were reduced.

CONCLUSION

Pre-treatment of hOMECs with E2 at physiological concentrations inhibited the IL-1β-induced expression of hBD-2 and inflammatory cytokines. The protective effects of E2 suggest its potential use treating oral inflammatory diseases in clinical practice.

Evaluation of Gynecologists' Awareness About Oral Health Condition During Pregnancy in Chennai City

BACKGROUND/OBJECTIVES

A cross-sectional study was conducted to evaluate the knowledge and practiced behaviors of gynecologists regarding oral health during pregnancy and association of periodontal disease with adverse pregnancy outcomes.

MATERIALS AND METHODS

This study was conducted among 200 gynecologists. A self-structured, close-ended questionnaire containing 22 questions was prepared. The principal investigator approached the gynecologists personally and distributed the questionnaire after obtaining their informed consent.

RESULTS

Of the 200 gynecologists approached, 200 filled the questionnaire, yielding a response rate of 100%. The majority (87%) acknowledged a connection between oral health and pregnancy and 63% agreed that periodontal disease can affect the outcome of pregnancy. However, only 60% gynecologists advise major/minor surgery during pregnancy, and many of them (74%) said that second trimester is the safe period for dental treatment. Almost three-quarters of the participants (79%) regarded dental radiograph and more than half (74%) considered administration of local anesthesia to be unsafe during pregnancy.

CONCLUSION

This study demonstrated that gynecologists have a relatively certain level of knowledge regarding oral health status during pregnancy and the relationship of periodontal disease to pregnancy outcomes. However, there clearly exist misconceptions regarding the provision of dental treatment during pregnancy. To provide better oral health care, more knowledge needs to be made available to the pregnant women and medical community, mainly to the gynecologists who are primary health-care providers for pregnant women, and misconception regarding the types of dental treatments during pregnancy should be clarified.

Awareness, Attitude and Knowledge Regarding Oral Health among Pregnant Women: A Comparative Study

Background:

Pregnancy in a woman's life is associated with many physiological changes in the body due to alterations in the hormone levels. These altered hormonal levels are associated with many systemic diseases. The incidence of oral diseases in general and periodontal diseases in particular are higher in pregnant women, with gingivitis and periodontitis being the most common. Furthermore, it has been evidenced in literature that periodontal diseases are associated with adverse pregnancy outcomes such as preterm low birth weight and preeclampsia.

Aims and Objectives:

The aim of this study was to evaluate the oral health knowledge among pregnant women visiting and not visiting a dental professional.

Materials and Methods:

The study was a survey-based one with a sample size of 260. The study population was divided into two groups based on their visits to a dentist. A questionnaire comprising 20 questions has been used to assess their awareness and attitude towards oral health.

Results:

The awareness regarding oral health and association with adverse pregnancy outcomes among the study population was very low, irrespective of their dental visit. Furthermore, majority of the study population in neither of the groups were aware that dental treatment was safe during pregnancy.

Conclusion:

The results of the study clearly reflected that the awareness levels among the pregnant women regarding this association were low. Hence, more collective efforts are required from dental and medical professionals to improve the oral and periodontal health outcomes during pregnancy.

Periodontal Health Status and Pregnancy Outcomes: A Survey in Medical Doctors

INTRODUCTION

Periodontal disease and caries are the most common causes of tooth loss worldwide. Studies have demonstrated strong association between periodontitis and adverse pregnancy outcomes. Medical doctors, who are the primary healthcare providers, seldom advise women to seek dental care during pregnancy. This study was undertaken to explore the knowledge, attitudes and behaviours of medical doctors towards oral health and to identify the barriers of prenatal periodontal healthcare in their practices and its possible implications on pregnancy outcomes.

METHODS

Total 377 doctors filled the questionnaire. The data collected through personal contacts, social networking, emails, online forms and networking at conferences were analysed using Statistical Package for the Social Sciences 20 software program and presented in tables, charts and diagrams.

RESULTS

Out of 263 (69.8%) male and 114 (30.2%) female doctors enrolled in the study, only 52 (13.8%) had received education or training on oral care during pregnancy. Among them 299 (79.3%) agreed that there is possible link between health of teeth-gums and pregnancy. Approximately 105 (27.9%) encountered patients with oral/periodontal problem every week but only 108 (28.6%) "always" advised their patient for regular dental check-ups. Similarly, 358 (95%) agreed that there is need for universal guidelines however, 133 (35.3%) thought there was insufficient time to advise patients on oral health during check-ups.

CONCLUSIONS

There is need for training on 'oral healthcare during pregnancy' for medical doctors. Developing universal guidelines for oral healthcare in pregnant women for all health professionals would be another important step. An adequate referral system to oral healthcare providers and biannual check-ups is recommended for both general patient as well as pregnant women for preventing adverse situations related to oral and specifically periodontal diseases.

What do antenatal care providers understand and do about oral health care during pregnancy: a cross-sectional survey in New South Wales, Australia

BACKGROUND

There is mounting evidence to support the lack of awareness among pregnant women about health consequences and long term risks associated with poor oral hygiene during pregnancy. A recognised and important point of influence is their interaction with health professionals, particularly when receiving Antenatal Care. However, there is limited evidence about the perceptions of ANC providers in Australia toward the provision of perinatal oral healthcare. This study was undertaken to explore the knowledge, attitudes and practices of Antenatal Care (ANC) providers in New South Wales (NSW), Australia providing perinatal oral healthcare and to identify barriers to and predictors of their practices in this area.

METHODS

A cross sectional survey was undertaken of ANC providers (general practitioners, obstetricians/gynaecologists and midwives) practising in NSW, Australia. Participants were recruited through their professional organisations via email, postal mail, and networking at conferences. The survey addressed the domains of knowledge, attitude, barriers and practices towards oral healthcare, along with demographics. Data was entered into SPSS software and analysed using descriptive and inferential statistics.

RESULTS

A total of 393 surveys (17.6% response rate) were completed comprising 124 general practitioners, 74 obstetricians/gynaecologists and 195 midwives. The results showed limited knowledge among ANC providers regarding the impact of poor maternal oral health on pregnancy/infant outcomes. Most (99%) participants agreed that maternal oral health was important yet few were discussing the importance of oral health or advising women to visit a dentist (16.4-21.5%). Further, less than a third felt they had the skills to provide oral health advice during pregnancy. ANC providers who were more knowledgeable about maternal oral health, had training and information in this area and greater experience, were more likely to engage in practices addressing the oral health of pregnant women.

CONCLUSION

The findings suggest that ANC providers in NSW are not focussing on oral health with pregnant women. ANC providers seem willing to discuss oral health if they have appropriate education/training and information in this area. Further research at a national level is required to confirm whether these findings are similar in all Australian states.

Awareness of periodontal disease and its management among medical faculty in Guntur district: A questionnaire-based study

Aim:

The aim of this study was to assess the awareness of periodontal disease, its influence on general health, and attitude toward periodontal disease management among medical faculty in Guntur district.

Materials and Methods:

In this cross-sectional study, 150 medical faculty members from different specialties in Guntur district were included in the study. A self-administered questionnaire was prepared based on knowledge, attitude, and practice surveys to assess the awareness of periodontal disease and its management.

Results:

Majority of the study participants (82%) had a previous dental visit. Only 31.3% believed that plaque is the major cause for periodontal disease. 56.7% responded that the relation between periodontal disease and systemic diseases is bidirectional. Only 39.3% were aware that periodontal disease is a risk factor for preterm low-birth weight infants. 52.6% of the medical faculty thought that scaling causes loss of enamel. 54.7% were aware that light amplification by stimulated emission of radiation is used in the periodontal treatment. Medical professionals who visited specialist in their previous dental visit obtained mean periodontal score (5.35 ± 1.686) greater than those who had visited general dentist and the difference is statistically significant (0.024).

Conclusion:

This study clearly demonstrates that medical practitioners had fair knowledge about various aspects of periodontal disease. This was particularly evident among those who have had a previous visit to a dentist. It was also found that young professionals with limited experience in the profession had better knowledge.

Oral health knowledge and awareness among pregnant women in India: A systematic review

Pregnancy is a unique period during a woman's life and is characterized by complex physiological changes, which may adversely affect oral health. The present systematic review was conducted to assess knowledge and awareness regarding oral health among pregnant women in India. Relevant cross-sectional observational studies were included in the systematic review to assess the level of knowledge and awareness regarding oral health among pregnant women in India. Seven studies out of 255 were finally included in the present review after conducting both electronic and manual search of scientific databases. Potential biases were reported and appropriate data were extracted by the concerned investigators. Almost 67% of the subjects had good knowledge and awareness regarding oral health in one of the study findings. Knowledge regarding effect of decayed teeth on the appearance of the people was significantly related to the parity status of the subjects (P = 0.024) in other study reports. Very few subjects (17.1% and 37.5%) felt the need for visiting a dentist during pregnancy in two studies. The results of the present review showed that pregnant women had poor knowledge and awareness regarding oral health. Therefore, there is an urgent need for education and motivation of expectant mothers regarding oral health through various health promotion interventions.

Periodontal health awareness among gynecologists in Riyadh, Saudi Arabia

Objective:

To determine the knowledge of periodontal disease and pregnancy outcomes among the gynecologists practicing in Riyadh, Saudi Arabia.

Materials and Methods:

A cross-sectional survey of 200 randomly chosen gynecologists from Riyadh was carried out by using a structured, self-administered, closed-ended questionnaire. Knowledge of periodontal disease and possible ways of prevention; knowledge of periodontal disease and pregnancy outcomes; and oral self-care attitudes among gynecologists were assessed.

Results:

One-quarter of the gynecologists knew the meaning of dental plaque. Almost 57.5% believed that the frequency of toothbrushing should be increased during pregnancy. Eighty percent of gynecologists were aware of the serious effects of smoking on the pregnant woman and her child. Less than half (44.5%) believed that there is a relationship between gum disease and premature labor. Gynecologists working in the government sector were significantly more aware about the causes of inflamed gum in pregnancy, gum disease and its prevention, and negative effects of smoking on pregnancy. A significantly higher percentage of male and senior gynecologists aged between 50 and 54 years answered that gum disease would lead to the delivery of a preterm or low-birth-weight infant.

Conclusion:

Gynecologists considered in the present study showed an acceptable level of knowledge and awareness toward periodontal health and the association between periodontal disease and adverse pregnancy outcomes.

Menopause and oral health

Different phases of a woman's life: Puberty, menses, pregnancy, and menopause have varied influence on her oral health. During the menopause, women go through biological and endocrine changes, particularly in their sex steroid hormone production, affecting their health. Because the oral mucosa contains estrogen receptors, variations in hormone levels directly affect the oral cavity. A few oral conditions and or diseases are seen more frequently during post menopausal years. Role of hormones affecting the health of oro-dental tissues, as well as treatment by HRT in ameliorating these conditions is not clear. There is paucity of randomized controlled trials in this field and more data is needed, before the recommendations for oral health care in post menopausal women can be made. A gynecologist sitting in menopausal clinic should be aware of oral changes happening during this period, and dental needs of these women and should refer them to the dental specialists accordingly. On the other hand, a dentist should also be sensitized about the menopausal status of the woman, her HRT status and special preventive and treatment needs.