The Effect of Menstrual Cycle on Periodontal Health

Antibacterial Effect of Silver Nanoparticles against Oral Biofilms in Subjects with Motor and Intellectual Disabilities

BACKGROUND

Motor and intellectual disabilities (MIDs) represent a great challenge for maintaining general health due to physical and cognitive limitations, particularly in the maintenance and preservation of oral health. Silver nanoparticles (AgNPs) have emerged as a promising therapeutic tool for bacterial control, including oral biofilms; however, knowledge of the bactericidal effectiveness of oral biofilms from patients with MIDs is insufficient. This study aims to determine the antimicrobial effect of AgNPs on different oral biofilms taken from patients with and without MIDs.

METHODS

Two sizes of AgNPs were prepared and characterized by dynamic light scattering (DLS) and transmission electron microscopy (TEM). Through consecutive sampling, biofilm samples were collected from 17 subjects with MIDs and 20 subjects without disorders. The antimicrobial effect was determined by obtaining the minimum inhibitory concentration (MIC) of AgNPs, and the identification and distribution of oral bacterial species were determined by polymerase chain reaction (PCR). Finally, correlations between sociodemographic characteristics and the antimicrobial levels of AgNPs were also explored. The values of the MIC results were analyzed with IBM-SPSS software (version25) using non-parametric tests for independent groups and correlations, with statistical significance being considered as p < 0.05.

RESULTS

Both sizes of AgNPs exhibited tight particle size distributions (smaller: 10.2 ± 0.7 nm; larger: 29.3 ± 2.3 nm) with zeta potential values (-35.0 ± 3.3 and -52.6 ± 8.5 mV, respectively) confirming the stability that resulted in little to no agglomeration of nanoparticles. Although both sizes of AgNPs had good antimicrobial activity in all oral biofilms, the smallest particles had the best antimicrobial effects on the oral biofilm samples from patients with and without MIDs, even better than chlorhexidine (CHX) (p < 0.05). Likewise, the patients with disabilities showed higher levels of antimicrobial sensitivity to AgNPs compared with CHX (p < 0.05). Although the microorganisms included in the biofilms of females had a statistically higher growth level, the AgNP antimicrobial effect was statistically similar in both genders (p > 0.05). The most frequent bacteria for all oral biofilms were S. mutans (100%), P. intermedia (91.6%), T. forsythia (75.0%), T. denticola (75.0%), P. gingivalis (66.6%), F. nucleatum (66.6%), S. sobrinus (50.0%), and A. actinomycetemcomitans (8.3%).

CONCLUSIONS

AgNPs exhibited considerable antimicrobial potential to be used as a complementary and alternative tool in maintaining and preserving oral health in patients with MIDs.

Premenstrual Syndrome: Awareness and Oral Manifestations in Patients Attending Dental Hospital in Pune

Fluctuations in androgenic hormonal levels are noticeable through women's menstrual cycle. Changes in estrogen and progesterone have been shown to affect periodontium. Many women report an increase in gingival inflammation and discomfort associated with their menstrual cycle, most commonly before the menstrual period. Approximately 80% of women experience complaints of premenstrual syndrome (PMS) 7 to 10 days before menstruation. Therefore, the present study was carried out to check prevalence of PMS and its oral and periodontal manifestations in patients attending dental hospital. For the study, 100 systemically healthy women of reproductive age attending dental hospital were selected. Thorough recording of oral discomfort and associated symptoms during late luteal phase was done. Clinical parameters such as plaque index and gingival index were recorded. Thirty-seven females reported complaints suggestive of PMS. Oral changes during PMS were experienced by 59 females. Halitosis and oral ulcers were more frequent. Findings of the present study showed the possibility of influence of sex hormones on oral manifestations during premenstrual period.

Bactericidal Activity of Silver Nanoparticles on Oral Biofilms Related to Patients with and without Periodontal Disease

BACKGROUND AND OBJECTIVES

Periodontal disease (PD) is a multifactorial oral disease regularly caused by bacterial biofilms. Silver nanoparticles (AgNP) have offered good antimicrobial activity; moreover, there is no available scientific information related to their antimicrobial effects in biofilms from patients with PD. This study reports the bactericidal activity of AgNP against oral biofilms related to PD.

MATERIALS AND METHODS

AgNP of two average particle sizes were prepared and characterized. Sixty biofilms were collected from patients with (30 subjects) and without PD (30 subjects). Minimal inhibitory concentrations of AgNP were calculated and the distribution of bacterial species was defined by polymerase chain reaction.

RESULTS

Well-dispersed sizes of AgNP were obtained (5.4 ± 1.3 and 17.5 ± 3.4 nm) with an adequate electrical stability (-38.2 ± 5.8 and -32.6 ± 5.4 mV, respectively). AgNP showed antimicrobial activities for all oral samples; however, the smaller AgNP had significantly the most increased bactericidal effects (71.7 ± 39.1 µg/mL). The most resistant bacteria were found in biofilms from PD subjects (p < 0.05). P. gingivalis, T. denticola, and T. forsythia were present in all PD biofilms (100%).

CONCLUSIONS

The AgNP showed efficient bactericidal properties as an alternative therapy for the control or progression of PD.

Oral microbiome changes associated with the menstrual cycle in healthy young adult females

The relationship between the menstrual cycle and the oral microbiome has not been clarified. The purpose of this study was to assess potential changes in the oral microbiome of healthy young adults using 16S rRNA-based sequencing. Eleven females (aged 23–36 years) with stable menstrual cycles and without any oral problems were recruited. Saliva samples were collected before brushing every morning during the menstrual period. Based on basal body temperatures, menstrual cycles were divided into four phases, namely the menstrual, follicular, early luteal, and late luteal phases. Our results showed that the follicular phase had a significantly higher abundance ratio of the Streptococcus genus than the early and late luteal phases, whereas the abundance ratios of the Prevotella 7 and Prevotella 6 genera were significantly lower in the follicular phase than those in the early and late luteal phases and that in the early luteal phase, respectively. Alpha diversity by the Simpson index was significantly lower in the follicular phase than that in the early luteal phase, and beta diversity showed significant differences among the four phases. Using the relative abundance data and copy numbers of the 16S rRNA genes in the samples, the bacterial amounts in the four phases were compared, and we observed that the follicular phase had significantly lower amounts of the Prevotella 7 and Prevotella 6 genera than the menstrual and early luteal phase, respectively. These results indicate reciprocal changes with the Streptococcus genus and Prevotella genera, particularly in the follicular phase. In the present study, we showed that the oral microbiome profiles are affected by the menstrual cycles of healthy young adult females.

Comparing Gingival Inflammation And Salivary Acidity To Hormonal Variation During Menstruation

Introduction

Hormonal changes are associated with healthy female in different stages of her life, such as menarche, pregnancy, and menopause. The main female hormones (i.e., Estrogen and progesterone) act as modulators and effectors during different phases of menstrual cycle. Additionally, these hormones were shown to affect the body inflammatory status. Few studies addressed gingivitis and female hormones. Although gingivitis main cause is dental biofilm, female hormones might modulate this inflammation. If no treatment provided, gingivitis might proceed to periodontitis and alveolar bone destruction may appear.

The study aim

was to assess the changes in gingival inflammation, and salivary pH in relation to changes in hormonal levels during different menstrual phases in young females.

Method

25 healthy young females with regular menstrual cycles were included. The volunteers were invited to visit the clinic during their 2nd day of menstrual cycle (menses phase (MP)). During the visit, plaque index (PLI) and gingival index (GI) were scored. Additionally, salivary pH was calculated. Follow-up readings were taken on the 20th day of menstruation (pre-menstrual phase (PMP)). The difference in PLI, GI and salivary pH was analysed using t-test and chi-square test.

Results

The study showed that PLI and GI increased statistically significantly with increasing levels of female hormones during PMP and decreased during MP (P-value = 0.012 for PLI and 0.0003 for GI). Salivary pH decreases slightly during PMP and saliva becomes more alkaline during MP (P-value = 0.015).

Conclusion

The study showed increased gingival inflammation and plaque accumulation during the premenstrual period. It is recommended to raise awareness of gingival inflammation among adult females to prevent progressive changes of periodontitis. However, due to the limited sample size of this study, a comprehensive population-based study is needed to support the findings.

Influence of female sex hormones in different stages of women on periodontium

The primary etiologic factor for periodontal diseases is “Dental plaque.” Although pathogenic bacteria in dental plaque are required for the incidence of periodontal disease, a susceptible host is also very important. The susceptibility of the host can be modified by many systemic factors with hormones level being one. The periodontium shows an exaggerated inflammatory response to plaque modified by female sex hormones during puberty, pregnancy, in women taking oral contraceptives, and at the postmenopausal stage. This review provides an in detail analysis of how periodontium is influenced by the fluctuation in sex steroid hormones of females during different phases of their lifetime and to discuss how much the same hormone at different ages and stages shows an exaggerated gingival response to plaque.

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.

Evaluation of the Association between Menstrual Cycle Irregularity and Dental Pain or Chewing Discomfort in Women before Menopause

This study was performed to assess the relationship between menstrual irregularity and dental pain or chewing discomfort in women before menopause, using nationally representative data. This study analyzed 4595 participants who were ≥19 years or older, and did not have missing values for outcome variables from the Korean National Health and Nutrition Examination Survey. Tooth pain was considered present if the participant felt throbbing discomfort, pain, or sensitivity when eating hot or cold food or drinking hot or cold beverages. Self-reported oral chewing discomfort was obtained. Adjusted odds ratios and their 95% confidence intervals for tooth pain in the individuals with menstrual cycle irregularity were 1.30 (1.05, 1.62) after adjustment for age, body mass index, drinking, smoking, income, exercise, stress, metabolic syndrome, and the frequency of tooth brushing. Adjusted odds ratios and their 95% confidence intervals for chewing discomfort in the individuals with menstrual cycle irregularity were 1.33 (1.03, 1.72) after adjustment. The association between menstrual irregularity and dental pain or chewing discomfort in women before menopause was proven—after adjusting for confounding factors—by multiple logistic regression analyses. Menstrual cycle irregularity may be considered a potential risk indicator for dental pain or chewing discomfort in Korean women before menopause.

Effect of Asymptomatic Visible Third Molars on Periodontal Health of Adjacent Second Molars: A Cross-Sectional Study

PURPOSE

Evidence that asymptomatic third molars (M3s) negatively affect their adjacent second molars (A-M2s) is limited. The present study evaluated the association between visible M3s (V-M3s) of various clinical status with the periodontal pathologic features of their A-M2s.

PATIENTS AND METHODS

Subjects with at least 1 quadrant having intact first and second molars, either with V-M3s and symptom free or without adjacent V-M3s, were enrolled in the present cross-sectional investigation. Periodontal parameters, including plaque index (PLI), bleeding on probing (BOP), probing pocket depth (PPD), and at least 1 site with a PPD of 5 mm or more (PPD5+), obtained from M2s were analyzed according to the presence or absence of V-M3s or the status of the M3s. The χ² test or t test was used to compare the mean PLI, PPD, BOP percentage, and PPD5+ percentage. The association of PPD5+ with V-M3 status was assessed using a multivariable logistic regression model (quadrant-based analysis), and variances were adjusted for clustered observations within subjects.

RESULTS

In total, 572 subjects were enrolled in the study, and 423 had at least 1 V-M3. At the in-quadrant level, the presence of a V-M3 significantly increased M2 pathologic parameters, including PLI, PPD, BOP, and PPD5+. When analyzed using a multivariate logistic regression model, impacted M3s and normally erupted M3s significantly elevated the risk of PPD5+ on their A-M2s (odds ratio 3.20 and 1.67, respectively). Other factors associated with an increased odds of PPD5+ were mandibular region and older age. Finally, the patient-matched comparison showed that the percentage of BOP and PPD5+ on M2s increased when V-M3s were present.

CONCLUSIONS

Irrespective of their status, the presence of V-M3s is a risk factor for the development of periodontal pathologic features in their A-M2s. Although the prophylactic removal of asymptomatic V-M3s remains controversial, medical decisions should be made as early as possible, because, ideally, extraction should be performed before symptom onset.

Comparison of prevalence of periodontal disease in women with polycystic ovary syndrome and healthy controls

BACKGROUND

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age, affecting 4-18% of them. Previous studies also showed that periodontal diseases are associated with different components of the metabolic syndrome. The aim of this study is to determine the association between PCOS and periodontal diseases.

MATERIALS AND METHODS

A total of 196 women (98 with PCOS and 98 healthy controls) were enrolled. PCOS diagnosis was confirmed by history, clinical signs, physical examination, laboratory parameters, and ultrasound studies. Both cases and controls were examined by the same periodontist. Periodontal parameters including bleeding on probing (BOP), probing depth, clinical attachment loss (CAL), plaque index, and tooth loss were investigated in all participants. Pregnant women, smokers, individuals with a history of malignancy or osteoporosis, and those taking prophylactic antibiotics for dental procedures or receiving periodontal treatment during the 6-month period before examination were excluded. Data were analyzed using t-test, Chi-square test, and linear regression. Statistical significance was set at P < 0.05.

RESULTS

CAL and sites with BOP were significantly higher in women with PCOS (P < 0.05). However, no significant difference was observed in the tooth loss rate between PCOS and non-PCOS participants (P = 0.384).

CONCLUSION

The prevalence of periodontal disease seems to be higher in women with PCOS. This may be related to the role of chronic systemic inflammation in the pathophysiology of both PCOS and periodontal diseases.

Effects of Scaling and Root Planing on Gingival Status during Menstrual Cycle- A Cross-Sectional Analytical Study

INTRODUCTION

Variations in sex steroid hormones, noticeable through the menstrual cycle of women, may impact periodontal health. A relationship between female sex hormone levels and periodontal changes during puberty, pregnancy, and menopause has been reported. Little research on gingival status at different periods of menstrual cycle, but very less work has been done to observe the effect of scaling on gingival status during different periods of menstrual cycle.

MATERIALS AND METHODS

Thirty female subjects, aged 18-25 years were selected for a three month study. In Stage 1, clinical parameters {Plaque Index (PI), Gingival Index (GI), Modified Sulcular Bleeding Index (mSBI) and Probing depth (PD)} were recorded at three different time intervals {OV (Ovulation), PM (Premenstruation), M (Menstruation)} of their menstrual cycle, without scaling and polishing. In Stage 2, all clinical parameters were recorded at their subsequent menstrual cycle after scaling and polishing.

RESULTS

In interstage analysis, OV 1 > OV 2, PM 1 > PM 2 and M 1> M 2. In intrastage analysis, for PI, mean difference between all values was not statistically significant. For mSBI, PM 1 > OV 1 > M 1, also PM 2 > OV 2 > M 2. For GI, PM 1 > OV 1 > M 1, also PM 2 > OV 2 > M 2. For PD, mean difference was not statistically significant.

CONCLUSION

Ovarian hormones influence gingival status of females, with an increase observed primarily during PM and OV phases of menstrual cycle. Scaling leads to a subsequent decrease in gingival inflammation.

Prevalence of chronic periodontitis in an obese population: a preliminary study

Background

Chronic periodontitis (CP) is a global public health issue. Studies have suggested CP could be linked to obesity due to their similar pathophysiological pathway. The aim of this study is to determine the prevalence of CP and to assess the predictors for CP among the obese Malaysian population.

Methods

This is a cross-sectional study on obese participants. Obesity is defined as an individual who has Body Mass Index (BMI) ≥27.5 kg/m². A convenience sampling method was used. A total of 165 paricipants were recruited. This study involved answering questionnaires, obtaining biometric and clinical measurements of Visible plaque index (VPI), Gingival bleeding index (GBI), Probing pocket depth (PPD) and Clinical attachment loss (CAL). Data analysis was carried out using SPSS statistical software (SPSS Inc., version 20, US).

Results

A total of 165 participants; 67 (40.6 %) males and 98 (59.4 %) females participated in the study. Mean age of the participants was 43.9 (±8.9). The prevalence of CP among the obese population was found to be 73.9 %. Out of this, 43 and 55 % were categorised as moderate and severe CP respectively. Around 64 % of participants had sites with CAL ≥4 mm and participants with sites with PPD ≥4 mm were reported to be 25 %. Around 83 % of the participants had sites with GBI ≥30 and 92 % of participants had sites with VPI ≥20 %. GBI and VPI were found to have significantly higher odds for CP.

Conclusion

Prevalence of CP was high among obese Malaysians. GBI and VPI were potential predictors for CP in this obese population.

Pain Perception and Anxiety Levels during Menstrual Cycle Associated with Periodontal Therapy

Objectives. To compare the pain perception and anxiety levels of female patients undergoing scaling and root planing during menstrual (perimenstrual) period with those observed during postmenstrual period. Materials and Methods. This was a single blind study, with a split-mouth design. Forty-four women with chronic periodontitis with regular menstrual cycles were subjected to complete Corah's Dental Anxiety Scale (DAS) during their first debridement visit. Patients were randomly selected to undergo their first debridement visit during either their menstrual or postmenstrual period. Scaling was performed under local anesthesia in bilateral quadrants of patients during the periods. Visual Analogue Scale (VAS) was used to score pain levels for each quadrant after performing scaling and root planing. Results. Increase in pain perception among females during their menstrual or perimenstrual period was significantly greater than their postmenstrual period (P < 0.05). It is observed that women whose first appointment was given in perimenstrual period had more pain (VAS) (P = 0.0000) when compared to those women whose first appointment was given in postmenstrual period. Conclusion. Females in their menstrual period demonstrated higher pain responses and high anxiety levels to supra- and subgingival debridement. This increase in the pain levels of women during their menstrual period was statistically significant. If the appointments are given in postmenstrual period, women feel less pain.

Association between viral hepatitis B infection and halitosis

OBJECTIVE

Oral malodor can be increased in breath of liver patients. However, no study has been performed for the association between volatile sulfur compounds (VSCs) and viral hepatitis. The aim of the present study was to determine the relationship between viral hepatitis and VSCs.

METHODS

This study analyzed 182 subjects and measured hydrogen sulfide (H2S), methyl mercaptan (CH3SH) and dimethyl sulfide [(CH3)2S] using the OralChroma(®). Hepatitis type B was evaluated. Periodontal health was assessed using the Community Periodontal Index (CPI) and bleeding on probing (BOP). Tongue coating score (TCS) was evaluated. Multiple logistic regression analyses were conducted to evaluate the relationship.

RESULTS

Viral hepatitis had an elevated odds of dimethyl sulfide defined halitosis (OR = 9.22, 95% CI = 2.08-40.95) after controlling for age, gender, alcohol consumption, current smoking, periodontitis, BOP, TCS and tongue brushing habit. The magnitude of the association between viral hepatitis and VSCs defined halitosis attenuated with adjustment of mediators (alcohol consumption, periodontitis, BOP, TCS and tongue brushing habit for hydrogen sulfide defined halitosis; periodontitis, TCS and tongue brushing habit for methyl mercaptan defined halitosis; tongue brushing habit for dimethyl sulfide defined halitosis).

CONCLUSIONS

Findings of this study suggest that viral hepatitis may be associated with methyl mercaptan defined halitosis.

Effect of the menstrual cycle on inflammatory cytokines in the periodontium

BACKGROUND AND OBJECTIVE

The effects of different levels of steroid hormones, as experienced during puberty, pregnancy and menopause, on the periodontium have been demonstrated, but changes in sex hormone levels during the menstrual cycle, and the influence of these changes on the periodontium, remain unresolved. The aim of this study was to investigate the effect of the menstrual cycle on the levels of interleukin-1beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) in gingival crevicular fluid and on periodontal clinical parameters, including the gingival bleeding index (GBI) and the modified gingival index (MGI), in periodontally healthy women.

MATERIAL AND METHODS

Twenty-seven periodontally healthy women with a regular menstrual cycle were included in the study. Clinical parameters, including the GBI, the MGI and the simplified oral health index, were recorded during menstruation, ovulation and premenstruation phases (e.g. on days 1-2, 12-14 and 22-24, respectively) of the menstrual cycle. Gingival crevicular fluid and unstimulated saliva were collected, at each study phase, for assessment of IL-1β, TNF-α, estrogen and progesterone.

RESULTS

Both the GBI and the MGI increased significantly during the menstrual cycle, and were significantly higher during ovulation than during menstruation or premenstruation (p < 0.001). No significant change in the simplified oral health index was observed during the menstrual cycle ( p = 0.18). The levels of IL-1β and TNF-α increased during the different phases of the menstrual cycle, but only the change in the TNF-α concentration was significant ( p < 0.05).

CONCLUSION

This study indicated that changes occurring during the menstrual cycle influence the periodontium and induce inflammatory conditions.

Bi-directional relationship between pregnancy and periodontal disease

During pregnancy profound perturbations in innate and adaptive immunity impact the clinical course of a number of infectious diseases, including those affecting periodontal tissues. Conversely, it has been suggested that periodontal infections may increase the risk of adverse pregnancy outcomes. In this review, a summary of the literature associated with the bidirectional relationship between pregnancy and periodontal disease as well as the possible mechanisms behind this interaction were examined.

The influence of cigarette smoking on gingival bleeding and serum concentrations of haptoglobin and alpha 1-antitrypsin

The objectives of this study were to evaluate the influence of cigarette smoking on gingival bleeding and serum concentrations of cotinine, haptoglobin, and alpha 1-antitrypsin in Malaysian smokers. A total of 197 male smokers and nonsmokers were recruited for this study. Plaque index, bleeding on probing (BOP), and levels of serum cotinine, haptoglobin, and alpha 1-antitrypsin were evaluated. The data were analyzed using SPSS version 20.0, with the significance level set at α ≤ 0.05. Linear regression analyses were performed. The mean cigarette consumption per day was 13.39 ± 5.75 cigarettes; the mean duration was 16.03 ± 8.78 years. Relatively low BOP values (26.05 ± 1.48) and moderate plaque indexes (51.35 ± 11.27) were found. The levels of serum cotinine (106.9 ± 30.71 ng/dL), haptoglobin (76.04 ± 52.48 mg/dL), and alpha 1-antitrypsin (141.90 ± 18.40 mg/dL) were significantly higher in smokers compared to non-smokers. Multiple logistic regression models for all variables and smokers demonstrated observed differences between BOP, the number of cigarettes per day, and duration of smoking, while serum cotinine, haptoglobin and alpha-1 antitrypsin levels showed no significant differences. Duration of smoking (years) and the cotinine level in serum showed a significant correlation with plaque index. The present analysis demonstrated that the duration of smoking in years, but not the number of cigarettes smoked per day, was associated with reduced gingival bleeding in smokers.

A study to evaluate mobility of teeth during menstrual cycle using Periotest

BACKGROUND AND OBJECTIVE

Over a century, an increased prevalence of gingival disease associated with increasing plasma sex steroid hormone levels has been reported. These situations present unique challenges to the oral health care professional. It is believed that hormonal fluctuations such as those associated with pregnancy, menstruation, and use of hormonal contraceptives lead to an increase in tooth mobility. However, this effect of female sex hormones on periodontal ligament and tooth supporting alveolar bone has rarely been investigated. So this study was undertaken to understand the effect on tooth mobility because of hormonal changes during the menstrual cycle.

MATERIALS AND METHODS

The mobility of index teeth 16, 13, 21, 23, 24, 36, 33, 41, 43, and 44 was measured with Periotest in 50 females at menstruation, ovulation, and premenstruation time points. Simplified oral hygiene index, plaque index, gingival index, and probing depth were also evaluated during the different phases of menstrual cycle for each subject participating in the study.

STATISTICAL ANALYSIS

The results of the study were subjected to statistical analysis. Data analysis was done by applying Z test for comparing difference between two sample means.

RESULT

The stages of menstrual cycle had no significant influence on the Periotest value. Despite no significant change in plaque levels, GI was significantly higher during ovulation and premenstruation time points.

CONCLUSION

No change in tooth mobility was seen during the phases of the menstrual cycle. However, an exaggerated gingival response was seen during ovulation and premenstruation time when the entire menstrual cycle was observed.

Sex/Gender differences in tooth loss and edentulism: historical perspectives, biological factors, and sociologic reasons

This review highlights what is known regarding differences in tooth loss by sex/gender, and describes: gender-related tooth ablation (the deliberate removal of anterior teeth during life) found in skulls from history and prehistory; potential mediators of the relationship between sex/gender and tooth loss; the current epidemiology of gender differences in tooth loss (limited to North America); and risk factors for tooth loss in the general population and in women.

Influence of combined oral contraceptives on the periodontal condition

Most studies investigating the impact of oral contraceptives have been performed some years ago, when the level of sexual hormones was greater than the actual formulations.

OBJECTIVE

The aim of this study was to evaluate the effects of current combined oral contraceptives (COC) on periodontal tissues, correlating the clinical parameters examined with the total duration of continuous oral contraceptive intake.

MATERIAL AND METHODS

Twenty-five women (19-35 years old) taking combined oral contraceptives for at least 1 year were included in the test group. The control group was composed by 25 patients at the same age range reporting no use of hormone-based contraceptive methods. Clinical parameters investigated included pocket probing depth (PD), clinical attachment level (CAL), sulcular bleeding index (SBI) and plaque index (Pl.I). Data were statistically evaluated by unpaired t test, Pearson's correlation test and Spearman's correlation test.

RESULTS

The test group showed increased PD (2.228±0.011 x 2.154±0.012; p<0.0001) and SBI (0.229±0.006 x 0.148±0.005, p<0.0001) than controls. No significant differences between groups were found in CAL (0.435±0.01 x 0.412±0.01; p=0.11). The control group showed greater Pl.I than the test group (0.206±0.007 x 0.303±0.008; p<0.0001). No correlation between the duration of oral contraceptive intake, age and periodontal parameters was observed.

CONCLUSIONS

These findings suggest that the use of currently available combined oral contraceptives can influence the periodontal conditions of the patients, independently of the level of plaque accumulation or total duration of medication intake, resulting in increased gingival inflammation.

Acute gingival bleeding as a complication of falciparum malaria: a case report

INTRODUCTION

Acute gingival bleeding can occasionally be the only sign of systemic bleeding problems. The diagnosis and management of such conditions may challenge the skills of the dentist.

CASE REPORT

The present report describes a case of severe, prolonged gingival bleeding in a 54-year-old woman as a consequence of Plasmodium falciparum malaria infection. Specific highlights are focused on the management of the patient with emphasis on early diagnosis of the disease so as to improve the prognosis. This case report also stresses that medical intervention to correct the underlying aberration of hemostasis is necessary for local dental measures to successfully stop bleeding.

CONCLUSIONS

Acute gingival bleeding as a complication of systemic disease can be challenging to manage unless the underlying systemic cause is diagnosed. Therefore, the dentist must be aware of various systemic conditions that can lead to gingival bleeding. The present case report describes a patient with acute gingival bleeding secondary to Plasmodium falciparum infection.

Periodontal status in smokers and nonsmokers: a clinical, microbiological, and histopathological study

A case-control study was done to assess the influence of smoking on clinical, microbiological, and histopathological parameters. Methods. Two hundred dentate male patients (100 smokers and 100 nonsmokers) ranging between 25 and 50 years were enrolled in the study. Periodontal parameters were recorded. Plaque samples were collected for microbial analysis for BANA test. Gingival biopsies were obtained from selected site for assessing histopathological changes. Results. Both groups showed almost similar plaque levels (P=0.258), but smokers had reduced gingival (0.62 ± 0.31) and bleeding indices (28.53 ± 17.52) and an increased calculus index (1.62 ± 0.36). Smokers had an increased probing depth of 4-7 mm (P=0.009) and overall increased CAL. No difference in microbiota was found between the two groups. Histopathologically smokers showed a decreased blood vessel density (8.84 ± 0.96) and inflammatory cells (52.00 ± 9.79). Conclusions. It is quite possible that many of the pathogenic mechanisms involved in tissue degradation in periodontitis in smokers could be quite different from those in nonsmokers.

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

Sex hormones play an important role in periodontal health and disease. For example, puberty, menses, pregnancy, menopause, and oral contraceptive use influence a woman's periodontal health. Periodontal infection has also been associated with adverse pregnancy outcomes. Subsequently, it is important that gynecologists are educated about hormonal effects on women's oral health. The current study assessed gynecologist's awareness regarding the effect of female sex hormones on periodontal health, preterm delivery, and maternal periodontal disease.

METHODS

Gynecologists from the Bagalkot district of the Karnataka state, India, completed a questionnaire regarding female hormonal and periodontal health. Respondents were divided into two groups: Group A (doctors that practiced at a medical college or hospital) and Group B (doctors that practiced at private hospitals). Out of 73 gynecologists, 62 (85%) completed the survey, with 19 (30.6%) participants in Group A and 43 (69.4%) participants in Group B. Survey responses were collected in the presence of the investigator, and data between the groups were statistically compared.

RESULTS

Our findings showed that most gynecologists were aware and concerned about female patient's oral health during various hormonal phases. However, gynecologists practicing at medical colleges and hospitals (Group A) had significantly greater health awareness than doctors practicing at private hospitals (Group B).

CONCLUSION

Women have special periodontal health care considerations, and there is a need for better oral health education among caregivers. Our results suggest that increasing dental health awareness among gynecologists would significantly improve women's health and pregnancy outcomes.

Oral microcirculation in post-menopause: a possible correlation with periodontitis

OBJECTIVES

The reduction in the level of oestrogen, typical in menopause, has some effect on the health of the oral cavity. In fact, post-menopausal women present more severe periodontal disease than pre-menopausal women. Numerous factors can be held to be responsible for this increase, among which are the effects of oestrogens on the oral epithelium, on the salivary glands, on bone tissue and on the endothelium. Our double blind study aims to evaluate the possible variations in oral microcirculation in post-menopausal women.

METHODS

Twenty-seven women in post-menopause (age: Mean ± SD: 57.3 ± 8.73) and 27 women in pre-menopause (age: Mean ± SD: 27.77 ± 3.56) were examined. Oral microcirculation was investigated using oral videocapillaroscopy.

RESULTS

The study showed significant differences between cases and controls for the following parameters: decrease in diameter of loops (mean ± SD: 0.038 ± 0.008; 0.045 ± 0.005), increase in tortuosity (mean ± SD: 3.83 ± 1.13; 1.83 ± 1.06) in labial mucosa and decrease in density in periodontal mucosa (Mean ± SD: 28.86 ± 10.92; 89.62 ± 17.83).

CONCLUSION

The decrease in periodontal density may compromise the epithelium tropism, making it prone to inflammation. The tortuosity may indicate a greater permanence of inflammatory factors, increased in post-menopausal women.

The influence of sex hormones on proinflammatory cytokines in gingiva of periodontally healthy premenopausal women

BACKGROUND AND OBJECTIVE

The aim of this work was to investigate any correlation between the fluctuation of levels of specific proinflammatory cytokines in gingival crevicular fluid and the fluctuation of sex hormones in peripheral blood at ovulation and progesterone peak.

MATERIAL AND METHODS

Eighteen premenopausal women with normal and consistent menstrual cycles and healthy periodontium were included in this study. The exclusion criteria were as follows: (i) pregnancy; (ii) use of oral contraceptives; (iii) metabolic or systemic disease that might affect the periodontium; (iv) use of antimicrobial or nonsteroidal anti-inflammatory drugs during the past 6 mo; and (v) smoking. The measurements were performed at two specific time points for each participant [(i) on the day of ovulation; and (ii) on the day of the progesterone peak) and included the following: (i) plaque index; (ii) bleeding on probing; and (iii) the gingival crevicular fluid levels of interleukin (IL)-1β, IL-6, IL-8 and tumor necrosis factor-α (TNF-α).

RESULTS

During the menstrual cycle, plaque index values remained unchanged (0.71 ± 0.07 at ovulation; 0.73 ± 0.08 at progesterone peak; p > 0.05), as did bleeding on probing (0.35 ± 0.07 at ovulation; 0.41 ± 0.07 at progesterone peak; p > 0.05). At ovulation, mean gingival crevicular fluid levels were as follows: IL-1β, 13.3 pg/sample; IL-6, 5.9 pg/sample; IL-8, 18.7 pg/sample; and TNF-α, 25.9 pg/sample. The corresponding values at progesterone peak were as follows: 14.1, 10.1, 19.5 and 26.3 pg/sample. Only IL-6 gingival crevicular fluid levels were significantly different between ovulation and progesterone peak (p < 0.05). This could reflect sensitivity to subclinical amounts of plaque and biofilm constituents.

CONCLUSION

The subclinical increase of IL-6 at progesterone peak is not accompanied by clinical changes in the periodontium.

Gingival inflammation and interleukin-1 beta and tumor necrosis factor-alpha levels in gingival crevicular fluid during the menstrual cycle

BACKGROUND

Hormonal changes during puberty, pregnancy, and menopause may impact periodontal tissues by altering the host response. There are only a few studies that examined gingival changes during the menstrual cycle. This longitudinal and prospective study aims to investigate clinical and laboratory markers of gingival inflammation in women at different phases during their menstrual cycles.

METHODS

Twenty-seven females were included in this study. Subjects were given oral hygiene instructions before the study, and their plaque index scores were recorded once a week for 2 months. The duration and regularity of the menstrual cycle were also checked at the same time. The gingival index and bleeding on probing (BOP) were recorded. Probing depths were measured to assess the periodontal condition of the subjects. Gingival crevicular fluid (GCF) was collected to analyze the levels of interleukin (IL)-1beta and tumor necrosis factor-alpha on the first menstruation day (MD), estimated ovulation day (OD), and estimated predominant progesterone secretion day (PgD). These exact menstrual cycle days were determined according to serum progesterone and estradiol levels.

RESULTS

BOP and IL-1beta levels in GCF showed significant increases from the MD to PgD under optimal plaque control. Among the 12 subjects that had premenstrual symptoms, six subjects reported oral complaints during the premenstrual period, whereas apthous lesions were more frequent during the menstruation period.

CONCLUSION

These results demonstrate that the fluctuation of sex steroid hormones impact gingival inflammation during menstruation.

Effects of ovariectomy and aging on tooth attachment in female mice assessed by morphometric analysis

OBJECTIVE

Non-human primates, dogs, rats, hamsters and ferrets, have frequently been used as laboratory animals in periodontal biology and pathology. In the past, mice have been used less for this purpose, but nowadays attract a lot of interest because gene knockout and transgenic technologies utilize mice primarily. In this study, we investigate the effects of ovariectomy and aging on tooth attachment in female mice.

MATERIAL AND METHODS

Eight-week-old mice (n=15) were divided into three experimental groups (control, n=5; sham-operated, n=5; ovariectomy, n=5) and ovaries removed bilaterally. Attachment level, assessed by measuring alveolar bone height and apical termination of the junctional epithelium, was determined 6 weeks post-ovariectomy by digital morphometric analysis in sagittal sections of the mandible. The plasma level of the inflammation marker serum amyloid A (SAA) was determined by ELISA. In another series of experiments, tooth attachment was determined in female mice (n=7) at 8-26 weeks of age.

RESULTS

Withdrawal of female sex hormone production by ovariectomy had no effect on alveolar bone height and apical termination of the junctional epithelium. The SAA level in plasma was unaffected by removal of the ovaries, suggesting that systemic inflammation is not induced by ovariectomy. Bone height was similar in mice sacrificed at 8-26 weeks of age and apical termination of the junctional epithelium was at the cemento-enamel junction at all ages.

CONCLUSIONS

Removal of ovarian production of female sex hormones by ovariectomy has no influence on tooth attachment, and further tooth attachment is preserved with age in female mice.

The influence of sex steroid hormones on gingiva of women

Steroid sex hormones have a significant effect on different organ systems. As far as gingiva are concerned, they can influence the cellular proliferation, differentiation and growth of keratinocytes and fibroblasts. Estrogen is mainly responsible for alterations in blood vessels and progesterone stimulates the production of inflammatory mediators. In addition, some micro-organisms found in the human mouth synthesize enzymes needed for steroid synthesis and catabolism. In women, during puberty, ovulation and pregnancy, there is an increase in the production of sex steroid hormones which results in increased gingival inflammation, characterized by gingival enlargement, increased gingival bleeding and crevicular fluid flow and microbial changes.

A combination of alleles 2 of interleukin (IL)-1A(-889) and IL-1B(+3954) is associated with lower gingival bleeding tendency in plaque-induced gingivitis in young adults of Arabic heritage

The aim of this study was to investigate the possible association of a distinct combination of polymorphisms in the interleukin (IL)-1 gene cluster on gingival bleeding tendency in young adult Arabs with plaque-induced gingivitis. Fifty otherwise healthy, nonsmoking volunteers, 19-28 years of age, participated. Clinical examinations included periodontal probing depth, bleeding on probing, and plaque index. Probing was done with a pressure-controlled probe at about 1.27 MPa. Examinations were repeated after 2 and 4 weeks. Polymorphisms in the IL-1 gene cluster were assessed using a reverse hybridization assay. A subject carrying alleles 2 at IL-1A ( -889 ) and IL-1B ( +3954 ) was designated genotype-positive. Twenty-six subjects were genotype-positive (52%). A repeated measures two-level (occasion, subject) model of the proportion of sites bleeding on probing, which was adjusted for gender, average plaque index, probing depth, and calculus, revealed a significantly lower proportion of bleeding sites in genotype-positive subjects (estimate -0.050, standard error 0.025, p < 0.05). Biserial correlations of bleeding proportions were high (0.71-0.78), confirming the steady-state plaque environment. It was concluded that inflammatory responses to dental plaque were considerably dampened in genotype-positive, nonsmoking young adults of Arabic heritage.

Effect of triclosan/copolymer-containing toothpaste on the association between plaque and gingival bleeding: a randomized controlled clinical trial

AIM

To study longitudinal associations between plaque and gingival bleeding and multilevel variance/covariance structures after introducing triclosan-containing toothpaste.

MATERIAL AND METHODS

A 10-week, randomized, two-arm, double-masked, controlled clinical trial was conducted in 34 healthy, non-smoking females with plaque-induced gingivitis. Clinical periodontal examinations were repeated every other week. At week 4, test toothpaste containing 0.24% sodium monofluorophosphate, 0.3% triclosan, and 2% polyvinyl-methyl ether maleic acid; or control toothpaste containing 0.76% sodium monofluorophosphate and 0.1% sodium fluoride, were randomly distributed.

RESULTS

Multivariate multilevel models indicated that, after introducing experimental toothpastes, subject random error was reduced from 0.6 to below 0.2. The odds ratio (OR) of bleeding on probing (BOP) was about 30% less in the test than in the control group (p<0.01). At the end of the experiment, ORs for BOP and plaque index scores 1-3 (reference 0) were 2.1-2.4 in the control group, but 1.1-1.9 in the test group (p<0.05). No effects on plaque levels and calculus were observed.

CONCLUSIONS

Multivariate multilevel modelling allows the study of fixed and random effects of experimental toothpastes on gingival inflammation in small sample. Triclosan appears to attenuate the causal association between supragingival plaque and gingival bleeding in gingivitis.

Analysis of Interleukin-Activated Human Gingival Fibroblasts: Modulation of Chemokine Responses by Female Hormones

BACKGROUND

The female sex hormones are known to affect the response of numerous tissues to an immune challenge. Because such hormones normally fluctuate during puberty, pregnancy, and the menstrual cycle, more information about the hormonal modulation of such responses in the oral cavity is needed. Gingival fibroblasts (GF), major components of the oral tissues, are potentially sources for inflammatory mediators.

METHODS

Macroarrays specific for cytokines and related proteins were used to examine the regulation of gene expression in GF under serum-free, resting conditions, after immune challenge with interleukin-1beta (IL-1beta), and in the presence of IL-1beta plus a progestin, +/-17beta-estradiol. Additional studies used enzymelinked immunosorbent assays (ELISAs) to test for secreted chemokines after the same treatments.

RESULTS

Of the 392 genes on the macroarray, 66 were up- or downregulated at least 2-fold relative to the unstimulated control in an average of six different sub-lines. Chemokines represented the largest group (18%) of these regulated genes. Numerous genes whose expression was upregulated by IL-1beta were modulated downward by IL-1beta plus progestin, +/-17beta-estradiol. Measurements of the secretion of IL-8, a CXC chemokine, and MCP-1, a CC chemokine, confirmed the inhibitory effect of a progestin on these genes.

CONCLUSIONS

Gingival fibroblasts are active participants in the immune response in the oral cavity, and may potentially produce many chemokine signals after exposure to IL-1beta. GF can attract neutrophils, monocytes, eosinophils, and fibroblasts to the area of injury, and aid in the wound repair process. The concentration of female sex hormones, especially progestin, may significantly affect these signaling systems.

Periodic exacerbation of gingival inflammation during the menstrual cycle

Sex hormones are believed to be a risk factor for periodontitis because of their ability to proliferate specific periodontal microorganisms and affect host immunologic response. In this case report, gingival redness and swelling occurred during the menstrual cycle, although the patient maintained good oral hygiene during periodontal treatment. Medical history revealed that exacerbation of gingival inflammation corresponded to the menstrual cycle and occurred during the ovulation period, when estrogen levels are high. Mean bleeding index of the ovulation period (18.9%) showed higher levels than that during the menstrual phase (5.3%). This case indicates that frequent and effective maintenance should be provided while considering the influence of the menstrual cycle, as sex hormones may be involved in exacerbating gingival inflammation.