Preventive dentistry: current concepts in women’s oral health

Oral manifestations in women using hormonal contraceptive methods: a systematic review

OBJECTIVES

To investigate the oral manifestations in women of reproductive age using hormonal contraceptive methods.

MATERIALS AND METHODS

This review is based on the PRISMA statement. A literature search incorporated observational studies from the last 21 years. An investigative question was formulated using the PICO model, studies were selected, and a quality analysis was performed using the modified STROBE guidelines. A bibliometric analysis was performed, and the data were examined.

RESULTS

Thirteen articles were included, with the majority evaluating periodontal status. Others analyzed factors such as the presence of alveolar osteitis, oral candidiasis, and salivary microbiome dysbiosis. Ten articles were deemed to have a low risk of bias.

CONCLUSIONS

Hormonal contraceptives may increase the risk of alveolar osteitis following tooth extraction and increase the presence of the Candida species in the oral cavity. They also affect the periodontium, such as the frequent development of gingivitis, but do not lead to changes in the salivary microbiome.

CLINICAL RELEVANCE

The increasing number of women using hormonal contraceptives and the knowledge that these contraceptives can produce oral cavity alterations underscore the need to evaluate the oral manifestations found in these women.

Making sense of medieval mouths: Investigating sex differences of dental pathological lesions in a late medieval Italian community

OBJECTIVES

Bioarchaeological investigations of sex-based differences in the prevalence of dental pathological lesions, particularly caries, have drawn considerable attention, and out of this work, two dominant models have emerged. Traditionally, the first model interprets sex-related patterns in caries as a product of gendered differences in diet. A more recent model interprets a generally higher propensity for caries prevalence in females in light of reproductive ecology. To test the hypothesis that females have higher risk of caries in accordance with reproductive ecology, we examined and analyzed caries prevalence and other potentially synergistic oral pathological lesions in a late medieval (A.D. 1300-1500) Italian archaeological sample.

MATERIALS AND METHODS

We examined sex- and age-related prevalence in caries and other oral pathological lesions in a late medieval Italian skeletal assemblage excavated from Villamagna consisting of 38 females and 37 males (n = 1,534 teeth). We examined age- and sex-related patterns in six dental traits: antemortem tooth loss, caries, calculus, periapical inflammation, tooth wear, and periodontitis.

RESULTS

Significant age-related increases in antemortem tooth loss, caries, calculus, and tooth wear were observed in both males and females. However, there was a lack of expected sex differences in oral pathological lesions, with instead older males exhibiting significantly more antemortem tooth loss and corrected caries than females.

DISCUSSION

Results are discussed in relation to the ethnohistoric context of medieval rural dietary practices as well as biomedical salivary literature, which suggest that dietary changes throughout the life course may have facilitated trade-offs that buffered females from higher rates of dental pathological lesions.

Introduction of agriculture and its effects on women's oral health

This study explores the dynamic relationship between the introduction of agriculture and its effects on women's oral health by testing the hypothesis that female reproductive physiology contributes to an oral environment more susceptible to chronic oral disease and that, in a population undergoing the foraging to farming transition, females will exhibit a higher prevalence of oral pathology than males. This is tested by comparing the presence, location, and severity of caries lesions and antemortem tooth loss across groups of reproductive aged and postreproductive females (n = 71) against corresponding groups of males (n = 71) in an Early Agricultural period (1600 B.C.-A.D. 200) skeletal sample from northwest Mexico. Caries rates did not differ by sex across age groups in the sample; however, females were found to exhibit significantly more antemortem tooth loss than males (P > 0.01). Differences were initially minimal but increased by age cohort until postreproductive females experienced a considerable amount of tooth loss, during a life stage when the accumulation of bodily insults likely contributed to dental exfoliation. Higher caries rates in females are often cited as the result of gender differences and dietary disparities in agricultural communities. In an early farming community, with diets being relatively equal, women were found to experience similar caries expression but greater tooth loss. We believe this differential pattern of oral pathology provides new evidence in support of the interpretation that women's oral health is impacted by effects relating to reproductive biology.