Sex hormone replacement therapy in periodontology-A systematic review

Hormone Replacement Therapy Relieves Periodontitis by Inhibiting Alveolar Bone Loss and Inflammation

OBJECTIVE

Hormone replacement therapy (HRT) is a commonly used strategy for treating menopausal symptoms, while its relation with periodontitis remains unclear. This study aimed to explore the potential effects of HRT on periodontitis, mainly in aspects of bone loss and inflammation.

METHODS

The alveolar bone height (ABH), alveolar bone thickness (ABT), and bone mineral density (BMD) were measured in menopausal women with periodontitis who had received HRT or had not received HRT by cone beam computed tomography. Based on a rat model of periodontitis, the alveolar bone loss was evaluated by micro-computed tomography and bone-related biochemical markers. The expression/levels of inflammatory markers were measured to reflect periodontal inflammation.

RESULTS

Although the differences were not all significant in each premolars/molars, the mesial/distal ABH and buccal/lingual ABT were lower, and the mesial/distal BMD was higher in patients in the HRT group than those in the control group. In a rat model of periodontitis, the alveolar bone loss was relieved by HRT. Additionally, HRT significantly weakened the elevation of inflammatory markers, including TNF-α, IL-1β, and IL-6 in periodontitis rats.

CONCLUSIONS

HRT contributes to the remission of periodontitis by inhibiting alveolar bone loss and inflammation.

The association of reproductive health factors with periodontitis in 45-80 years old US women from NHANES 2009-2014

OBJECTIVES

We investigated the association of female reproductive factors with periodontitis.

MATERIALS AND METHODS

This cross-sectional study analyzed data from the US National Health and Nutrition Examination Survey 2009-2014 on 2321 women aged 45-80 years who had full-mouth periodontal examination and reproductive questionnaire. The 2018 World Workshop Classification of Periodontal and Peri-implant Diseases was used to classify periodontitis stages.

RESULTS

After adjustment, > 3 pregnancies or live births were associated with increased stage III/IV periodontitis but age at first birth (AFB) > 23 years and female hormone use were associated with decreased stage III/IV periodontitis, while there were no associations of oral contraceptive use or menopause status with stage III/IV periodontitis. Stage III/IV periodontitis was more common in women with > 3 pregnancies or live births and AFB ≤ 23 years or never using female hormones but less common in women with ≥ 3 pregnancies or > 3 live births and AFB > 23 years or using female hormones. >3 pregnancies or live births were related with increased stage III/IV periodontitis and increased AFB was related with lowered stage III/IV periodontitis in overweight and smoking subgroups but using female hormone was related with reduced stage III/IV periodontitis in nonsmoking, non-overweight and black subgroups.

CONCLUSIONS

>3 pregnancies/live births were related with severe periodontitis but AFB > 23 years and female hormone use were related with ameliorating periodontitis.

CLINICAL RELEVANCE

Women with > 3 pregnancies/live births should receive intensive periodontal interventions. Female hormone therapy or AFB > 23 years may be beneficial for periodontal health of > 3 pregnancies/live births women.

Medications Affecting Outcomes and Prognosis of Dental Treatment: Part 1

This article gives valuable insight into the effect of selected groups of medications on dental treatment outcome and prognosis. The review emphasizes the importance of thorough medical history, which may have an impact on the prognosis of dental treatment. We discuss drugs acting on the central nervous system, gastrointestinal tract, respiratory tract, endocrine system, and bone metabolism among others. Other pertinent drugs are discussed elsewhere in this special issue.

Hormone replacement therapy and periodontitis progression in postmenopausal women: A prospective cohort study

OBJECTIVE

This study aimed to investigate the responses of periodontal environment to hormone replacement therapy (HRT) in postmenopausal women with or without periodontitis.

BACKGROUND

HRT is a common and effective strategy for controlling menopausal symptoms, while the changes of periodontal environment under it, particularly in postmenopausal women with periodontitis, remain unclear.

METHODS

As a prospective cohort study, a total of 97 postmenopausal women receiving HRT were screened, including 47 with and 50 without periodontitis. Correspondingly, 97 women did not receiving HRT were screened as controls during the same period. The full-mouth sulcus bleeding index (SBI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were measured using periodontal probes. The levels of interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) in the gingival crevicular fluid were measured using enzyme-linked immunosorbent assay. In addition, cone beam computed tomography was performed to measure the alveolar bone height (ABH) and bone mineral density (BMD).

RESULTS

In postmenopausal women without periodontitis, no significantly changes on periodontal parameters were observed after HRT. In women with stage II periodontitis, SBI, BOP, IL-6, and TNF-α were significant decreased after one year and two years of HRT. Compared to the controls, women with stage II periodontitis who underwent HRT had significantly lower CAL and ABH and higher BMD in the second year. The incidence of at least one site with CAL increase ≥1 mm between baseline and 2 years was significantly lower in the HRT group than in the control group in women with stage II periodontitis. In addition, HRT was significantly associated with a decrease in SBI, BOP, IL-6, and TNF-α in the first year and with a decrease in CAL, SBI, BOP, IL-6, and ABH and an increase in BMD in the second year.

CONCLUSIONS

In postmenopausal women with stage II periodontitis, HRT is associated with the alleviation of inflammation within two years and the remission of alveolar bone loss in the second year. HRT appears to decrease the incidence of CAL increase ≥1 mm within 2 years in women with periodontitis by inhibiting inflammation and alveolar bone loss.

Association of endogenous sex hormone levels with tooth loss due to periodontitis in men and post-menopausal women: The multi-ethnic study of atherosclerosis

AIM

To investigate the association between endogenous sex hormone levels and history of tooth loss related to periodontitis in healthy middle-aged to older men and post-menopausal women.

METHODS

This cross-sectional study included 5649 participants aged 45-84 (mean age, 63 ± 10 years) from the Multi-Ethnic Study of Atherosclerosis cohort who had sex hormone levels measured and answered a questionnaire regarding perceived periodontal status at exam 1. Multivariable logistic regression was used to examine the association of sex hormones (exposure) with history of tooth loss (outcome), stratified by sex.

RESULTS

Among post-menopausal women, higher free testosterone (per 1SD) was associated with a greater prevalence of tooth loss [OR 1.49 (95% CI, 1.08-2.05)], whereas higher sex hormone binding globulin (SHBG) was associated with a lower prevalence of tooth loss [OR 0.74 (0.58-0.94)], after adjustment for cardiometabolic risk factors and reproductive factors. In men, higher free testosterone and lower SHBG were associated with a lower prevalent probability of tooth loss in unadjusted analysis, but these associations lost significance after covariate adjustment.

CONCLUSION

A higher androgenic sex hormone profile in post-menopausal women (i.e., increased free testosterone, lower SHBG) was associated with an increased prevalence of tooth loss, after adjusting cardiometabolic risk factors. No such association was found in men. These findings suggest that sex hormones may influence or serve as a marker for periodontal health.

Influence of gender on periodontal outcomes: A retrospective analysis of eight randomized clinical trials

AIMS

To explore the influence of gender on periodontal treatment outcomes in a dataset of eight RCTs conducted in Brazil, United States, and Germany.

METHODS

Clinical parameters were compared between men and women with stages III/IV grades B/C generalized periodontitis at baseline and 1-year post-therapy, including scaling and root planing with or without antibiotics.

RESULTS

Data from 1042 patients were analyzed. Men presented a tendency towards higher probing depth (p = .07, effect size = 0.11) and clinical attachment level (CAL) than women at baseline (p = .01, effect size = 0.16). Males also presented statistically significantly lower CAL gain at sites with CAL of 4-6 mm at 1-year post-therapy (p = .001, effect size = 0.20). Among patients with Grade B periodontitis who took antibiotics, a higher frequency of women achieved the endpoint for treatment (i.e., ≤4 sites PD ≥5 mm) at 1 year than men (p < .05, effect size = 0.12).

CONCLUSION

Men enrolled in RCTs showed a slightly inferior clinical response to periodontal therapy in a limited number of sub-analyses when compared to women. These small differences did not appear to be clinically relevant. Although gender did not dictate the clinical response to periodontal treatment in this population, our findings suggest that future research should continue to explore this topic.

Higher Prevalence of the Periodontal Pathogen Selenomonas noxia among Pediatric and Adult Patients May Be Associated with Overweight and Obesity

New evidence has suggested that oral and gut microflora may have significant impacts on the predisposition, development, and stability of obesity in adults over time-although less is known about this phenomenon in children. Compared with healthy-weight controls, overweight and obese adult patients are now known to harbor specific pathogens, such as Selenomonas noxia (S. noxia), that are capable of digesting normally non-digestible cellulose and fibers that significantly increase caloric extraction from normal dietary intake. To evaluate this phenomenon, clinical saliva samples (N = 122) from subjects with a normal BMI (18-25) and a BMI over 25 (overweight, obese) from an existing biorepository were screened using qPCR. The prevalence of S. noxia in samples from normal-BMI participants were lower (21.4%) than in overweight-BMI (25-29; 46.1%) and obese-BMI (30 and above; 36.8%) samples-a strong, positive correlation that was not significantly affected by age or race and ethnicity. These data strongly suggest that S. noxia may be intricately associated with overweight and obesity among patients, and more research will be needed to determine the positive and negative feedback mechanisms that may be responsible for these observations as well as the interventions needed to remove or reduce the potential effects of this oral pathogen.

The Effectiveness and Practicality of a Novel Barrier Membrane for the Open Window in Maxillary Sinus Augmentation with a Lateral Approach, with Risk Indicators for Bone Graft Displacement and Bone Height Decrease: A Prospective Study in Humans

Maxillary sinus augmentation with a lateral approach (MSA) is a well-established treatment. In this prospective study, we evaluated risk factors for postoperative bone graft displacement and reported the clinical application of long-term resorbable L-lactic acid/-caprolactone (PLA/PCL) as a barrier membrane to cover the open window in the lateral wall in MSA. Twenty-four patients underwent MSA according to the relevant criteria; CT data obtained before and 1 week (1 w) and 5-6 months (5 m) post-MSA, bone height changes, bone height reduction rates at 1 w and 5 m post-MSA, bone graft displacement measurements, and risk factors were examined. All patients showed bone height increments (p < 0.005). However, no difference was observed between 1 w and 5 m post-MSA. Bone graft displacement was observed in eight patients; the reduction rate from 1 w to 5 m post-MSA was 8.38% ± 4.88%. Sex, septa, maxillary sinus floor-palatal bone distance, and maxillary sinus floor-maxillary ostium distance were associated with bone graft displacement (p < 0.05). The height from the maxillary sinus floor to the palatal bone and the sinus angle influenced the augmentation degree (p < 0.05). The PLA/PCL membrane is compared favorably with other membranes and may be useful as a barrier membrane for the MSA open window.

Use of Systemic Steroids, Hormone Replacement Therapy, or Oral Contraceptives Is Associated with Decreased Implant Survival in Women

BACKGROUND

Systemic steroids, such as prednisone, hormonal replacement therapies, or oral contraceptives, are commonly prescribed to women who might also be receiving dental implant therapy. However, the effect of these medications on dental implant survival is unknown.

METHODS

The medical and dental records of individuals with dental implants (N = 1480 implants) who visited a postgraduate periodontics clinic between 2000 and 2017 were initially considered. Those younger than 21 years old, pregnant, or male were excluded according to the study's exclusion criteria. The presence of systemic diseases and conditions was assessed. Implant failure rates among female patients using systemic steroids, hormone replacement therapy, or oral contraceptives were compared with failure rates among patients not taking those medications.

RESULTS

The implant failure rate for the 65 implants in patients taking steroid medications was 7.69%; the failure rate for the 712 implants in patients not taking steroids was 1.54% (p < 0.001). After adjusting for smoking and the presence of diabetes, that relationship persisted, with an 8.47% implant failure rate for the 59 implants in patients taking steroids (vs. 1.54% failure for the 585 implants in patients not taking steroids; p < 0.001). Regression analyses demonstrated that the odds of implant failure versus success were 5.31 times greater in patients taking systemic steroids, hormone replacement therapy, or oral contraceptives (p < 0.05). No statistically significant differences in patient plaque control were found between the experimental and control groups.

CONCLUSIONS

Among women, the use of systemic steroids is associated with a five-fold increase in the rate of dental implant failure, regardless of the presence of smoking or diabetes.

High serum iron markers are associated with periodontitis in post-menopausal women: A population-based study (NHANES III)

AIM

To investigate the association between increased serum markers of iron (ferritin and transferrin saturation) and the severity and extent of periodontitis in post-menopausal (PM) women.

MATERIALS AND METHODS

Data from 982 PM women participating in NHANES III were analysed. Exposures were high ferritin (≥300 μg/ml) and transferrin saturation (≥45%). The primary outcome was moderate/severe periodontitis defined according to Centers for Disease Control and Prevention and the American Academy of Periodontology. The extent of periodontitis was also assessed as outcome: proportion of sites affected by clinical attachment loss ≥4 mm and probing depth ≥4 mm. Crude and adjusted prevalence ratio (PR) and mean ratio (MR) were estimated using Poisson regression.

RESULTS

The prevalence of moderate/severe periodontitis was 27.56%. High ferritin was associated with moderate/severe periodontitis in the crude (PR 1.55, p = .018) and in the final adjusted model (PR 1.53, p = .008). High ferritin and transferrin saturation levels were associated with a higher proportion of sites with clinical attachment loss ≥4 mm (p < .05).

CONCLUSIONS

The increasing serum iron markers seem to contribute to periodontitis severity and extent in PM women.

Sex Steroid Hormones as a Balancing Factor in Oral Host Microbiome Interactions

Sex steroid hormones (SSH) are cholesterol-derived molecules. They are secreted into saliva and enter the oral cavity, triggering physiological responses from oral tissues, with possible clinical implications, such as gingival inflammation and bleeding. SSH and hormonal changes affect not only oral host cells but also oral microorganisms.

Historically, most research has focused on the effect of hormonal changes on specific bacteria and yeasts. Recently a broader effect of SSH on oral microorganisms was suggested. In order to assess the role of SSH in host-microbe interactions in the oral cavity, this review focuses on how and up to what extent SSH can influence the composition and behavior of the oral microbiome. The available literature was reviewed and a comprehensive hypothesis about the role of SSH in host-microbiome interactions is presented. The limited research available indicates that SSH may influence the balance between the host and its microbes in the oral cavity.

Repercussions of osteoporosis on the maxillofacial complex: a critical overview

INTRODUCTION

We present here a literature review focusing on the repercussions of osteoporosis on the oral and maxillofacial complex. Osteoporosis is a silent metabolic disorder characterized by reduced bone mineral density (BMD), which can lead to bone fractures, particularly affecting elderly women. The prevalence of this disease has increased significantly worldwide, and since it accelerates bone resorption also in the jaw bones, some attention has been paid to possible oral and maxillofacial manifestations.

MATERIALS AND METHODS

The databases PubMed and Google Scholar were searched for reports of oral and maxillofacial changes related to osteoporosis.

RESULTS

Several parameters evaluating bone changes in panoramic radiography have been proposed to estimate osteoporosis-related BMD loss, but they tend to warn about the possibility of osteoporosis, rather than being diagnostic criteria. Meanwhile, it seems that osteoporosis-related BMD loss could delay alveolar bone healing and potentiate bone loss in periodontal disease.

CONCLUSION

Even though orofacial bones are not compromised by osteoporosis as much as the axial/appendicular skeleton, a regular dental follow-up of osteoporotic patients is advised, especially in the case of periodontal disease and maxillofacial surgery. Further controlled longitudinal studies considering the site-specificity of osteogenesis would be helpful regarding this issue.

Hormone-related events and periodontitis in women

AIM

While the short-term effects of hormonal events on gingival inflammation have been well described, long-term effects on the periodontium have received less attention. The aim of this cross-sectional population-based study was to evaluate the association between hormone-related events and periodontitis in a representative sample of the postmenopausal women of South Korea.

MATERIALS AND METHODS

A total of 10,273 postmenopausal women representative of 6.1 million of Koreans were examined. Periodontitis and severe periodontitis were defined according to the Community Periodontal Index (CPI ≧ 3 and CPI = 4, respectively). Univariate and multivariate regression analyses using 3 different models were applied controlling for age, smoking, marital status, educational level, income, BMI, hypertension, stress and frequency of toothbrushing.

RESULTS

Severe periodontitis was directly associated with a longer reproductive life (p-trend = .027) and with a longer duration of breastfeeding (48-72 vs. 1-17 months: OR = 1.49; 95% CI: 1.01-2.21). Conversely, early menopausal age (<46 vs. 49-50 years: OR = 0.74; 95% CI: 0.56-0.97), history of artificial menopause (OR = 0.72; 95% CI: 0.53-0.97), having had more than 6 pregnancies (vs. 4: OR = 0.73; 95% CI: 0.55-0.97), having had more than three abortions (vs. 0: OR = 0.51; 95% CI: 0.28-0.93) and having had the first birth age >26 years (vs. <21 years: OR = 0.71; 95% CI: 0.52-0.97) were inversely associated with severe periodontitis.

CONCLUSIONS

In this large nationally representative population, severe periodontitis was related to menopausal age, reproductive life length, number of pregnancies/abortions, first birth age and breastfeeding duration, while it was not to oral contraceptive and hormone replacement therapy usages.

Estrogen signaling impacts temporomandibular joint and periodontal disease pathology

Women experience a higher incidence of oral diseases including periodontal diseases and temporomandibular joint disease (TMD) implicating the role of estrogen signaling in disease pathology. Fluctuating levels of estrogen during childbearing age potentiates facial pain, high estrogen levels during pregnancy promote gingivitis, and low levels of estrogen during menopause predisposes the TMJ to degeneration and increases alveolar bone loss. In this review, an overview of estrogen signaling pathways in vitro and in vivo that regulate pregnancy-related gingivitis, TMJ homeostasis, and alveolar bone remodeling is provided. Deciphering the specific estrogen signaling pathways for individual oral diseases is crucial for potential new drug therapies to promote and maintain healthy tissue.