Abstract
Introduction:
Periodontitis is inflammation of periodontium. Periodontal disease is associated with various risk factors among which female hormonal alterations such as menopause have been found to be connected with periodontal breakdown and osteoporosis in women. The aim of this study was to determine the periodontal status in pre- and postmenopausal females.
Materials and Methods:
In this study, 60 female patients were analyzed aged between 40 and 60 years. Group 1 (test) comprised 30 premenopausal women with/without chronic periodontitis and Group II (control) comprised 30 postmenopausal women with/without chronic periodontitis. After recording clinical parameters, the scores were provided using Orthopantomograph for each patient. Paired t-test was applied for intragroup comparison and independent sample t-test was applied for intergroup comparison. The value of P < 0.05 was considered statistically significant.
Results:
The mean plaque index, gingival index, calculus index, pocket probing depth, and clinical attachment loss scores in the premenopausal group were less as compared to postmenopausal group. Both the groups showed statistically significant differences with T=15.28 and P = 0.01.
Conclusion:
Postmenopausal women are more susceptible to periodontitis. Hence, precaution and initial management of oral diseases should be the utmost priority in women's health. The effect of sex hormones can be reduced with regular dental examination, maintaining good oral hygiene, and hormonal replacement therapies.
KEYWORDS: Estrogen, hormonal replacement therapy, periodontitis, postmenopausal, premenopausal
INTRODUCTION
Periodontitis results in inflammation of gingiva extending into adjacent bone and ligaments and may eventually lead to loss of tooth.[1] Periodontitis has multifactorial etiology, with primary etiological agents being pathogenic bacteria such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans.[2] Periodontal disease is associated with various risk factors among which female hormonal alterations such as menopause has been found to be connected with periodontal breakdown and osteoporosis in females; hence, the influence of menopause on periodontal health has gained more attention about the stability of alveolar bone structure.[3]
Aim and objective
The objective of this study was to determine periodontal status in pre- and postmenopausal females.
MATERIALS AND METHODS
The study was conducted in the Outpatient Department of Periodontology at Mansarovar Dental College. The study comprised 60 females. Every enrolled patient was explained the design of the study and their consent was obtained before starting the procedure. Local ethical committee approval was also obtained. Considering the menstrual history, two groups were formulated each comprising 30 participants: Group I – 30 premenopausal women with/without chronic periodontitis were included in this group and Group II – consisted of 30 postmenopausal women with/without chronic periodontitis. Patients having chronic moderate periodontitis within the age of 40–60 years, with pocket depth ≥4 mm or loss of attachment ≥3 mm with a minimum of 15 natural teeth left behind, and no history of systemic problem/disease over the last 6 months were included in this study. While patients under any medication or under long-term steroid therapy, smokers, and women with pregnancy or planning for the same were eliminated from this study. Clinical parameters such as gingival bleeding index (Ainamo and Bay, 1975), plaque index (PI) (Silness and Loe 1964), and pocket probing depth (PD) were also assessed with a UNC 15 periodontal probe at four sites of each tooth.
Statistical analysis
IBM SPSS version 21 software (Armonk, NY, USA: IBM Corp) was used to perform the statistical analysis of the resultant data. Percentage decrement and paired t-test were applied for intragroup comparison and independent sample t-test was applied for intergroup comparison. The value of P < 0.05 was considered statistically significant.
RESULTS
The study revealed that the mean age of patients in Group I was 42.45 ± 1.99 years, and in the Group II, it was 54.33 ± 3.45 years. A statistically significant difference was observed between the two groups with T=15.28 and p=0.01, as shown in Table 1.
Table 1.
Comparison of age among the groups
| Group | n | Mean±SD | t | P |
|---|---|---|---|---|
| Group I | 1.00 | 42.45±1.99 | 23.05 | 0.01* |
| Group II | 2.00 | 54.33±3.45 |
*Significant. SD: Standard deviation
The mean PI was significantly less in females in premenopausal women (0.96 ± 0.36) as compared to the postmenopausal women (1.94 ± 0.46). A statistically significant difference was seen in the gingival index between premenopausal women (0.98 ± 0.48) and postmenopausal women (1.78 ± 0.44). A statistically significant difference was also seen in the calculus index between premenopausal women (0.29 ± 0.32) and postmenopausal women group (0.78 ± 0.34), as shown in Table 2. The mean PD in the premenopausal women was 1.56 ± 0.44 mm, while in the postmenopausal women group was 4.36 ± 1.34 mm. A statistically significant difference was observed between the two with t = 15.28 and P = 0.01. Mean clinical attachment loss in the premenopausal women was 1.57 ± 0.45 mm, while in the postmenopausal women group was 5.08 ± 1.45 mm. There was a statistically significant difference between the two with t = 15.28 and P = 0.01, as shown in Table 2.
Table 2.
Comparison of plaque index, gingival index, calculus index, probing depth, and clinical attachment loss among the groups
| Index | Group | n | Mean±SD | t | P |
|---|---|---|---|---|---|
| PI | Group I | 60 | 0.96±0.36 | 12.79 | 0.01* |
| Group II | 60 | 1.94±0.46 | |||
| GI | Group I | 60 | 0.98±0.48 | 9.38 | 0.01* |
| Group II | 60 | 1.78±0.44 | |||
| Calculus index | Group I | 60 | 0.29±0.32 | 8.15 | 0.01* |
| Group II | 60 | 0.78±0.34 | |||
| Probing depth | Group I | 60 | 1.56±0.44 | 15.28 | 0.01* |
| Group II | 60 | 4.36±1.34 | |||
| CAL | Group I | 60 | 1.57±0.45 | 17.81 | 0.01* |
| Group II | 60 | 5.08±1.45 |
*Significant. PI: Plaque index, GI: Gingival index, CAL: Clinical attachment loss, SD: Standard deviation
DISCUSSION
Menopause is defined as the period in a women's life between the age of 45 to 90 when menstruation ceases permanently because of the lack of function of ovarian follicles.[4] Menopause activates comprehensive changes in women's body along with the oral cavity.[5] Deficiency of estrogen is one of the major reasons for osteoporosis in females during menopause and this reduced bone mineral density contributes to the progression of periodontal disease with resultant alveolar bone loss.[6] Due to estrogen deficiency at menopause, the anti-inflammatory action of this hormone on the periodontium is ceased and the periodontium gets compromised.[7]
In this study also, the results showed a remarkable difference in the clinical parameters between the two groups. There was a statistically significant difference between the two groups with T=15.28 and P = 0.01 for mean PI, gingival index, and calculus index scores. Considering the results, we can conclude that the influence of menopause effect on periodontal health in postmenopausal women was significant and they were found to be more susceptible to periodontal infection. Although bacteria are mandatory in the equation, it is the host's immune response that is majorly responsible for most of the periodontal destruction. Hence, it is confirmed that environmental circumstances can alter a patient's health in developing periodontal disease. Several studies have confirmed that estrogen deficiency results in upregulating immune cells and osteoclasts which are liable to produce more bone-resorbing cytokines such as interleukin (IL)-1 and IL-6and tumor necrosis factor (TNF) (1 and 2). IL-1 and TNF and are well known for bone resorption and inhibition of bone formation.[8] When analyzing the correlation among periodontitis and osteoporosis, it is documented that osteoporosis is certainly not a direct etiological factor for periodontitis yet may alter the intensity of disease in the foregoing periodontitis by causing reduced crestal alveolar bone per unit volume which promotes quicker bone loss when exposed to infection, such as periodontal infection.[9,10] Kribbs suggested that postmenopausal women with osteoporosis show a decrease in mandibular bone density, thinned cortex at the gonion, and more tooth exfoliation as compared to healthy postmenopausal women.[11] Considering the treatment for postmenopausal patients, prevention of periodontal destruction by modifying the response of host to infection could be a new supportive method. Hormone replacement therapy and host-modulation therapy along with awareness of oral health care can curtail this problem to a great extent.[12] Buencamino et al. recommended that women with menopause can be handled by following basic instructions suggested by the American Dental Association (ADA): Regular dental examinations; regular professional cleaning to remove bacterial plaque biofilm under the gum-line where a toothbrush will not reach. Daily oral hygiene practices to remove biofilm at and above the gum-line including brushing twice daily with an ADA-accepted toothpaste. Replacing the toothbrush every 3–4 months (or sooner if the bristles begin to look frayed). Cleaning interproximally (between teeth) with floss or interdental cleaner. Maintaining a balanced diet. No smoking.[13,14]
CONCLUSION
The study confirms that endogenous sex steroid hormones can alter their responses to local factors such as the presence of microbial plaque and also regulate the responses of periodontal tissues as well. Hence, prophylactic precautions and early intervention of oral diseases can show promising results in maintaining good oral health for all women.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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