Abstract
Objectives
To assess the periodontal status and oral health-related quality of life (OHRQoL) among postmenopausal women attending a tertiary government hospital.
Methods
A cross-sectional study was conducted among 266 postmenopausal women visiting a tertiary government hospital. Demographic data, such as age, education level, marital status, hormonal fluctuations, parity, frequency of tooth brushing, and history of recent dental visits were collected. Participants’ OHRQoL was assessed using the oral health impact profile-14 (OHIP-14) questionnaire, and their periodontal status was evaluated using the World Health Organization oral health assessment form for adults.
Results
The total mean OHIP-14 score among participants was 26.9 ± 8.48, with the majority (57.1%) reporting poor OHRQoL. Further, they had a significantly higher mean number of teeth with pockets and loss of attachment (P = 0.001). Moreover, the number of teeth with bleeding showed significant negative correlations with the overall OHIP-14 score (r = −0.11, P = 0.05), functional limitation (r = −0.14, P = 0.01), psychological discomfort (r = −0.21, P = 0.004), and psychological disability (r = −0.13, P = 0.02). Overall, OHIP-14 and all its categories demonstrated statistically significant, but, weak positive correlations with the number of teeth with pockets and loss of attachment (P = 0.001).
Conclusion
The mean numbers of teeth with bleeding, as well as teeth with pockets and loss of attachment are significantly associated with OHRQoL in postmenopausal women.
Keywords: Menopause, Oral health, Oral health impact profile, Periodontitis, Quality of life
INTRODUCTION
Menopause is an unavoidable, physiological condition occurring during fifth decade of life. Women spend one-third of their lives in this particular state after their reproductive years have ended [1]. The World Health Organization (WHO) has defined menopause as the permanent cessation of menstruation due to loss of ovarian follicular activity [2].
Menopause is associated with several systemic and oral changes. Estrogen plays a pivotal role in maintaining the integrity of periodontal tissues by modulating immune and inflammatory responses. In addition to its effects on bone metabolism, estrogen influences the expression of pro-inflammatory cytokines, such as interleukin-1 (IL-1), IL-6, and tumor necrosis factor-α, which are key mediators in periodontal inflammation and tissue breakdown. Estrogen deficiency in postmenopausal women has been associated with an enhanced proinflammatory state, increased alveolar bone resorption, and greater susceptibility to periodontal destruction. These biological mechanisms suggest that hormonal changes of menopause may contribute to periodontal deterioration and its impact on oral health-related quality of life [3].
Alves et al. [4] reported that postmenopausal women had fewer teeth than the premenopausal women and number of teeth lost for periodontal reasons, gingival recession and attachment loss was also slightly higher in the study group.
As menopausal symptoms can be very distressing and noticeably affect a woman’s personal and social life, appropriate diagnosis, treatment and early prevention of various oral signs and symptoms may predominantly influences their oral health-related quality of life (OHRQoL). Hence, the present study aimed to assess periodontal status and OHRQoL among postmenopausal women.
MATERIALS AND METHODS
A cross-sectional study was carried out to assess periodontal status and OHRQoL among postmenopausal women visiting tertiary government hospital.
Prior to the commencement of the study, ethical approval was obtained from Institutional Ethics Committee of Osmania Medical College and Hospital, Hyderabad (IEC-BHR/OMC/M.NO (03)/P-32). Before the start of the study, permission to conduct the study was obtained respective institution. The study was conducted in accordance with Declaration of Helsinki and fulfils strengthening the reporting of observational studies in epidemiology (STROBE) guidelines [5].
All eligible subjects were given oral and written information about the purpose of the study. Upon agreement and explanation of the study, written informed consent was obtained from all the participants before the start of the study.
Source of the data
Sample size was calculated using Cochran’s formula.
Based on the prevalence of periodontal disease from the previous study [6] with an expected proportion of 53.2% (p) and a precision of 6% (d) at a confidence interval of 95%, the minimum sample size of 266 was obtained.
Sample selection
Subjects were selected based on the following inclusion and exclusion criteria.
Inclusion criteria
- Females with natural menopause for at least 12 consecutive months.
- Female below the age of 65 years.
- Subjects willing to participate and who give written informed consent.
Exclusion criteria
- Subject with artificially induced menopause by radiation, surgery and chemotherapy will be excluded.
- Subjects who are not willing for oral examination was excluded.
Screening was done till the sample size of 266 was achieved based on inclusion criteria, therefore, no missing data was accounted.
Survey instrument
The following information was recorded from postmenopausal women.
- Demographic details included age, education status, marital status, hormonal therapy, number of children (parity), frequency of tooth brushing, and history of last dental visit.
- Participants were interviewed regarding OHRQoL for postmenopausal women using 14 items- oral health impact profile-14 (OHIP-14) given by Slade [7]. It consists of seven domains (two items within each of the seven domains) and intends to assess the impairment caused by oral conditions in the last 1 year. The domains of OHIP-14 were functional limitation (item-1, trouble pronouncing words; item-2, worsened taste), physical pain (item-3, ache in the mouth; item-4, discomfort eating food), psychological discomfort (item-5&6, feeling self-conscious or feeling tense), physical disability (item-7&8, interrupted meals or poor diet), psychological disability (item-9, difficulty in relaxing; item-10, embarrassment), social disability (item-11, irritability; item-12, difficulty in doing usual job) and handicap (item-13, less satisfying; item-14, inability to function). The index provides a comprehensive measure of self-reported dysfunction, discomfort, and disability arising from oral conditions. The responses were rated on a 5-point Likert scale: 0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often, and 4 = very often/every day. The scores ranged from 0 to 56 and are calculated by summing the ordinal values for the 14 items. Higher OHIP-14 scores indicate worse and lower scores indicate better OHRQoL.
Periodontal examination protocol
Periodontal status (gingival bleeding, probing depth, and loss of attachment [LOA]) was assessed according to the WHO oral health assessment form for adults (2013) [8]. Two indicators of periodontal status are used for this assessment: gingival bleeding and periodontal pockets. A specially designed, lightweight CPI metallic probe with a 0.5-mm ball tip is used, with a black band between 3.5 and 5.5 mm, and rings at 8.5 and 11.5 mm from the ball tip. All teeth present in the mouth are examined for absence or presence of gingival bleeding and absence or presence of periodontal pockets; pocket depth is measured with the WHO CPI periodontal probe. LOA is recorded by dividing the mouth in sextants, defined by tooth numbers: 18–14, 13–23, 24–28, 38–34, 33–43, and 44–48.
Gingival bleeding scores: 0 = absence of condition, 1 = presence of condition, 9 = tooth excluded, and X = tooth not present.
Pocket depth: 0 = absence of condition, 1 = pocket 4–5 mm, 2 = pocket 6 mm or more, 9 = tooth excluded, and X = tooth not present.
LOA: 0 = 0–3 mm, 1 = 4–5 mm (CEJ within black band), 2 = 6–8 mm (CEJ between upper limit of black band and 8.5 mm ring), 3 = 9–11 mm (CEJ between 8.5 and 11.5 mm ring), 4 = 12 mm or more (CEJ beyond 11.5 mm ring), X = excluded sextant, and 9 = not recorded.
The clinical examination was carried out by a single trained dentist. To assess intra-examiner reliability, 10% of the participants were re-examined after 1 week. Cohen’s kappa values were 0.82 for bleeding, 0.85 for pocket depth, and 0.87 for LOA, indicating good to excellent agreement data was recorded by a single trained and calibrated dentist.
This study followed the strengthening the reporting of observational studies in epidemiology (STROBE) guidelines. A completed STROBE checklist is provided in Supplementary Table 1 (available online), indicating the page numbers where each item is addressed.
Statistical analysis
The completed questionnaires were collected, and data were entered and analyzed using IBM SPSS Statistics 26.0 (IBM Co.). Descriptive statistics were presented as means and standard deviations for numerical variables, and as frequencies and percentages for categorical variables. Inferential statistics included Chi-square tests for group comparisons.
For our primary analysis strategy, OHIP-14 as a continuous variable was considered and multiple linear regression model was performed. For the descriptive group comparisons, categorized OHIP-14 was considered. Multicollinearity among independent variables was evaluated using the variance inflation factor (VIF). Model fit was assessed using the adjusted R2. Residual diagnostics were examined to assess linearity, normality, and homoscedasticity.
Multiple linear regression was performed with OHIP-14 as the dependent variable and periodontal parameters as independent variables. OHRQoL was categorized as poor (≥ mean) and good (< mean) based on mean scores. The level of significance was set at P ≤ 0.05.
Periodontal parameters, including the number of teeth with gingival bleeding, periodontal pockets, and LOA, were analysed as absolute tooth counts in accordance with the WHO oral health assessment form [8] and were not normalized by the total number of remaining teeth.
RESULTS
This study included 266 postmenopausal women, wherein most of them were aged between 50–59 years (132, 49.6%), were illiterates (114, 42.9%) and married (159, 59.8%). Majority of them reported no history of undergoing any hormonal therapy (259, 97.4%) and more than half of the study participants had one/two children (168, 63.2%). More than three-quarter of the study participants reported brushing their teeth once a day (230, 86.5%) and visited a dentist more than 6 months back (228, 85.7%) (Table 1).
Table 1. Demographic characteristics of the study participants.
| Demographic characteristic | ||
|---|---|---|
| Age (y) | ||
| 40–49 | 52 (19.6) | |
| 50–59 | 132 (49.6) | |
| 60–65 | 82 (30.8) | |
| Education | ||
| Illiterate | 114 (42.9) | |
| Primary | 90 (33.8) | |
| High school | 46 (17.3) | |
| Graduate | 16 (6.0) | |
| Marital status | ||
| Married | 159 (59.8) | |
| Divorced/widowed | 107 (40.2) | |
| Hormonal therapy | ||
| Yes | 7 (2.6) | |
| No | 259 (97.4) | |
| No. of children (parity) | ||
| One/two children | 168 (63.2) | |
| Three/more children | 98 (36.8) | |
| Frequency of tooth brushing | ||
| Once | 230 (86.5) | |
| ≥ 2 times | 36 (13.5) | |
| Last dental visit (mo) | ||
| ≤ 6 | 38 (14.3) | |
| > 6 | 228 (85.7) | |
| Total | 266 (100.0) | |
Data are presented as number (%).
The total mean OHIP-14 score in this study participant was 26.9 ± 8.48. Among seven domains, physical pain and functional limitation had higher mean score of 4.7 ± 1.1 and 4.6 ± 1.1, respectively. On the other hand, least mean score of 2.9 ± 1.74 was recorded for handicap domain (Table 2).
Table 2. Item wise frequency distribution and each domain mean score of OHIP-14.
| OHIP-14 | OHIP-14 item | Frequency distribution | Mean ± standard deviation | ||||
|---|---|---|---|---|---|---|---|
| Never (0) | Hardly ever (1) | Occasionally (2) | Fairly often (3) | Very often (4) | |||
| Functional limitation | OHIP-1 | 10 (3.8) | 14 (5.3) | 165 (62.0) | 66 (24.8) | 11 (4.1) | 4.6 ± 1.1 |
| OHIP-2 | 5 (1.9) | 26 (9.8) | 81 (30.4) | 154 (57.9) | 0 (0.0) | ||
| Physical pain | OHIP-3 | 4 (1.5) | 8 (3.0) | 71 (26.7) | 168 (63.2) | 15 (5.6) | 4.7 ± 1.1 |
| OHIP-4 | 8 (3.0) | 36 (13.5) | 149 (56.0) | 67 (25.2) | 6 (2.3) | ||
| Psychological discomfort | OHIP-5 | 18 (6.8) | 59 (22.2) | 100 (37.6) | 88 (33.0) | 1 (0.4) | 3.8 ± 1.6 |
| OHIP-6 | 29 (10.9) | 44 (16.5) | 127 (47.8) | 62 (23.3) | 4 (1.5) | ||
| Physical disability | OHIP-7 | 19 (7.1) | 56 (21.0) | 137 (51.6) | 54 (20.3) | 0 (0.0) | 3.7 ± 1.46 |
| OHIP-8 | 23 (8.6) | 54 (20.3) | 119 (44.8) | 68 (25.6) | 2 (0.7) | ||
| Psychological disability | OHIP-9 | 26 (9.8) | 62 (23.3) | 134 (50.4) | 44 (16.5) | 0 (0.0) | 3.5 ± 1.52 |
| OHIP-10 | 28 (10.5) | 62 (23.3) | 118 (44.4) | 54 (20.3) | 4 (1.5) | ||
| Social disability | OHIP-11 | 27 (10.1) | 63 (23.7) | 114 (42.9) | 59 (22.2) | 3 (1.1) | 3.4 ± 1.62 |
| OHIP-12 | 32 (12.0) | 77 (28.9) | 110 (41.4) | 43 (16.2) | 4 (1.5) | ||
| Handicap | OHIP-13 | 49 (18.4) | 69 (25.9) | 110 (41.4) | 36 (13.5) | 2 (0.8) | 2.9 ± 1.74 |
| OHIP-14 | 61 (22.9) | 74 (27.8) | 92 (34.6) | 39 (14.7) | 0 (0.0) | ||
| Overall | 26.9 ± 8.48 | ||||||
Data are presented as number (%) or mean ± standard deviation.
OHIP: oral health impact profile.
Participants were categorized into poor OHRQoL (≥ mean) and good (< mean) OHRQoL based on mean OHIP-14 score. Most of the participants in the study had poor OHRQoL (152, 57.1%).
Based on the age group, most of the participants in the age groups 40–49 years had good OHRQoL (61.5%) whereas higher percentage of poor OHRQoL was observed among 50–59 years (65.2%) which was statistically significant (P = 0.004). Of the seven participants who reported hormone replacement therapy (HRT) use, 71.4% had “good” OHRQoL compared to 42.1% among those not on HRT; however, this difference was not statistically significant (P = 0.120). None of the other demographic characteristics showed any significance based on level of OHIP-14 scores (Table 3).
Table 3. Categorization of the study participants based on levels of OHIP-14 score and association with demographic characteristics.
| Demographic characteristic | Level of OHIP | P value | |||
|---|---|---|---|---|---|
| Good OHRQoL (< mean) | Poor OHRQoL (≥ mean) | Total | |||
| Age (y) | |||||
| 40–49 | 32 (61.5) | 20 (38.5) | 52 | 0.004* | |
| 50–59 | 46 (34.8) | 86 (65.2) | 132 | ||
| 60–65 | 36 (43.9) | 46 (56.1) | 82 | ||
| Education | |||||
| Illiterate | 55(48.3) | 59 (51.7) | 114 | 0.230 | |
| Primary | 31 (34.4) | 59 (65.6) | 90 | ||
| High school | 20 (43.5) | 26 (56.5) | 46 | ||
| Graduate | 8 (50.0) | 8 (50.0) | 16 | ||
| Marital status | |||||
| Married | 68 (42.8) | 91 (57.2) | 159 | 0.970 | |
| Divorced/widowed | 46 (42.9) | 61 (57.1) | 107 | ||
| Hormonal therapy | |||||
| Yes | 5 (71.4) | 2 (28.6) | 7 | 0.120 | |
| No | 109 (42.1) | 150 (57.9) | 259 | ||
| No. of children | |||||
| One/two children | 68 (40.5) | 100 (59.5) | 168 | 0.300 | |
| Three/more children | 46 (46.9) | 52 (53.1) | 98 | ||
| Frequency of brushing | |||||
| Once | 100 (43.5) | 130 (56.5) | 230 | 0.600 | |
| ≥ 2 times | 14 (38.9) | 22 (61.1) | 36 | ||
| Last dental visit (mo) | |||||
| ≤ 6 | 19 (50.0) | 19 (50.0) | 38 | 0.330 | |
| > 6 | 95 (41.7) | 133 (58.3) | 228 | ||
| Total | 114 (42.9) | 152 (57.1) | 266 | ||
Data are presented as number only or number (%).
OHIP: oral health impact profile, OHRQoL: oral health-related quality of life.
*P ≤ 0.05 is considered statistically significant.
Mean number of teeth with pocket and LOA were significantly higher among study participants with poor OHRQoL (14.5 ± 2.94, 4.9 ± 1.02, respectively; P = 0.001). Whereas mean number of teeth with bleeding were significantly higher among participants with good OHRQoL (16.9 ± 4.63; P = 0.034) (Table 4).
Table 4. Mean number of teeth affected by bleeding, pocket and loss of attachment according to status of OHIP-14.
| Parameter | Good OHRQoL | Poor OHRQoL | P value |
|---|---|---|---|
| Bleeding | 16.9 ± 4.63 | 15.4 ± 6.44 | 0.034* |
| 12.4 ± 3.11 | 14.5 ± 2.94 | 0.001* | |
| Loss of attachment | 4.3 ± 1.33 | 4.9 ± 1.02 | 0.001* |
Data are presented as mean ± standard deviation.
OHIP: oral health impact profile, OHRQoL: oral health-related quality of life.
*P ≤ 0.05 is considered statistically significant.
Overall OHIP-14 (r = −0.11, P = 0.05), functional limitation (r = −0.14, P = 0.01), psychological discomfort (r = −0.21, P = 0.004) and psychological disability (r = −0.13, P = 0.02) showed statistically significant negative correlation with number of teeth with bleeding. Overall OHIP-14 score and all its domains showed statistically significant but weak positive correlations with the number of teeth with periodontal pockets and LOA (P < 0.001) (Table 5).
Table 5. Correlation of overall OHIP-14 and its domains with number of teeth with bleeding, pocket, and loss of attachment.
| OHIP-14 domain | Number of teeth with bleeding | Number of teeth with pocket | Number of teeth with loss of attachment | |||
|---|---|---|---|---|---|---|
| r value | P value | r value | P value | r value | P value | |
| Functional limitation | –0.14 | 0.010* | 0.21 | 0.004* | 0.19 | 0.001* |
| Physical pain | –0.11 | 0.059 | 0.30 | 0.001* | 0.31 | 0.001* |
| Psychological discomfort | –0.21 | 0.004* | 0.35 | 0.001* | 0.28 | 0.001* |
| Physical disability | –0.08 | 0.190 | 0.32 | 0.001* | 0.31 | 0.001* |
| Psychological disability | –0.13 | 0.020* | 0.36 | 0.001* | 0.32 | 0.001* |
| Social disability | –0.00 | 0.980 | 0.33 | 0.001* | 0.35 | 0.001* |
| Handicap | –0.01 | 0.840 | 0.42 | 0.001* | 0.37 | 0.001* |
| OHIP-14 | –0.11 | 0.050* | 0.40 | 0.001* | 0.38 | 0.001* |
OHIP: oral health impact profile.
*P ≤ 0.05 is considered statistically significant.
Multiple linear regression analysis showed that number of teeth with bleeding, pocket and LOA are significantly associated with OHRQoL of study participants (P = 0.0001) (Table 6). The regression model showed acceptable fit with no evidence of multicollinearity (VIF < 5), and residual diagnostics indicated no major violations of model assumptions.
Table 6. Multiple linear regression analysis of overall OHIP-14 and oral health status among study participants.
| Independent variable | β coefficient | SE of estimate | P value |
|---|---|---|---|
| Intercept | 13.47 | 2.27 | 0.0001* |
| Number of teeth with bleeding | –0.27 | 0.08 | 0.0013* |
| Number of teeth with pocket | 0.94 | 0.17 | 0.0001* |
| Loss of attachment | 2.04 | 0.65 | 0.0019* |
OHIP: oral health impact profile, SE: standard error.
P ≤ 0.05 is considered statistically significant.
DISCUSSION
Menopause is the permanent termination of menstruation resulting from the loss of ovarian activity. Menopause usually begins at approximately 45–55 years of age, unless accelerated by hysterectomy or ovariectomy. Many physiological changes occur in postmenopausal women, and majority of these changes are as a result of decreased estrogen production. According to some researchers, decreasing estrogen levels have been shown to increase the incidence of periodontitis and reduce alveolar bone density, which in turn may lead to tooth loss [9]. Hence the present study aimed to assess periodontal status and OHRQoL among postmenopausal women.
OHRQoL is a complex and multidimensional construct composed of a set of concepts. It refers to an individual’s perception of their own physical and mental health, and their ability to react to factors in the physical and social environment. Specifically, it includes how oral health affects a person’s functioning such as chewing, biting and speaking, experiences of pain/discomfort, and psychologic and social well-being [10]. In this study, we used shorter version of OHIP-14 as it has good statistical properties and validity, with the obvious benefit that the data could be collected with less fieldwork effort and respondent burden [7].
Most of the participants in the study had poor OHRQoL (152, 57.1%). Also, overall OHIP-14 and all the domains of OHIP-14 showed significant positive correlation with number of teeth with pocket and LOA. Though the primary cause of periodontitis is formation of dental plaque, the estrogen deficiency in menopausal women is one of the factors due to which the antiinflammatory action of this hormone on the periodontium is decreased and the periodontium gets compromised [11]. It may manifest as bleeding gingiva, tooth mobility and eventual tooth loss this could have lead to functional and social difficulties while biting, chewing and speaking eventually worsening OHRQoL and systemic health.
In our current study, physical pain (4.7 ± 1.1) had higher mean item score compared to other domains, similar finding was reported by Sivadas and Nayar [12]. It could be because, most of the participants reported pain and loss of function as around 50% of teeth had periodontal pockets (14.5 ± 2.94) and LOA (4.9 ± 1.02). Additionally, in this study functional limitation domain had higher mean score (4.6 ± 1.1). This can be attributed to tooth loss increases which may be due to periodontal condition, thereby making difficulty in pronouncing word, chewing, mastication and worsening taste perception. Hence, this highlights the influence of periodontal condition on daily life and its significance for overall QoL.
In the present study, most of the participants in the age groups 40–49 years had significant good OHRQoL (61.5%) where as poor OHRQoL was observed among 50–59 years (65.2%) (P = 0.004). This could be attributed to the fact that prevalence and severity of periodontitis increases with increasing age. Likewise, Huang and Dong [13] reported that among 35–54-year-old, 30.2% had moderate or severe periodontitis, whereas this increased to 61.3% and 86.9% for 55–64-year and over 65-year-old respectively. Periodontal disease is of concern in older adults as it may be a primary cause of tooth loss thereby worsening masticatory ability which can further affect, nutrition and speech and impact the patient’s overall quality of life.
In this current study, 71.4% participant who underwent HRT had good OHRQoL when compared to those who did not undergo HRT. This finding is consistent with other studies [14,15,16]. Furthermore, López-Marcos et al. [17] reported improvement of probing depth of periodontal pockets and reduction of tooth mobility in women on hormone therapy for 1 year. There are several possible mechanisms by which estrogen promotes tooth retention in postmenopausal women. Estrogen supplement has protective effects on periodontal tissue by decreasing bone resorption and increasing oral bone density (decreased oral bone porosity) with increasing skeletal bone mineral density or decreasing inflammation of periodontal tissue surrounding the teeth [18]. Thus, by improving these periodontal parameters, HRT might improve OHRQoL. However, study by Pizzo et al. [19] concluded that clinical periodontal parameters did not significantly differ with HRT and it could be irrelevant for protection against periodontitis in postmenopausal women. Similarly, Pilgram et al. [20] when examining a group of women receiving estrogen therapy for 3 years did not find any changes in periodontal parameters.
Mean number of teeth with bleeding was significantly higher among participants with good OHRQoL (16.9 ± 4.63, P = 0.034). Although bleeding gums is a reversible condition and may have minimal immediate effect on perceived oral health-related quality of life, this counterintuitive finding may also reflect the influence of confounding factors such as the total number of remaining teeth, oral hygiene behaviours, or individual perceptions of oral health. Mean number of teeth with pocket and LOA were significantly higher among study participants with poor OHRQoL (14.5 ± 2.94, 4.9 ± 1.02, respectively, P = 0.001). Likewise, study conducted by DeBaz et al. [21] showed that postmenopausal women with chronic periodontitis had significantly poor quality of life. This could be because periodontal attachment loss can lead to exposure of root surface and making it more difficult to treat, also can be associated with root sensitivity, increased root caries, food impaction, poor aesthetics, gingival irritation, difficult hygiene, loss of supporting bone, and even tooth loss and thereby affecting OHRQoL.
Oral health status and OHRQoL are influenced by several systemic and contextual factors, including tobacco use, systemic conditions such as diabetes mellitus, and socioeconomic status. Recent studies have demonstrated that diabetes and smoking are associated with increased severity and progression of periodontal disease, while lower socioeconomic status is linked to poorer oral health behaviours, reduced access to dental care, and worse OHRQoL outcomes [22,23]. In the present study, information on tobacco, systemic conditions such as diabetes, and socioeconomic indicators were not assessed, adding to the limitation of this study. Therefore, the observed associations between periodontal parameters (CPITN and LOA) and OHIP-14 scores should be interpreted with caution, as these unmeasured factors may influence the findings.
The strength of this study lies in its methodology, calculation of sample size based on prevalence of periodontitis and use of validated OHIP-14 questionnaire.
Though this cross sectional study represents any association between periodontal status and OHRQoL among postmenopausal women, it is difficult to establish causality. In addition, the relatively small sample size, involvement of a single trained investigator, the single centre, hospital-based nature of the study, and the absence of data regarding age at menopause should be considered as limitations. Thus, more extensive, long-term research including large sample size is needed to evaluate postmenopausal women’s oral health-related quality of life in relation to periodontitis.
This study demonstrates a significant association between periodontal status and OHRQoL in postmenopausal women, with bleeding, periodontal pockets, and LOA showing statistically significant relationships. As this is a cross-sectional study, the findings indicate associations rather than causal relationships.
The findings highlight the crucial role of gynaecologists and primary care providers in early identification of oral health problems in postmenopausal women, as they represent the first point of healthcare contact. Integrating basic oral health screening and referral mechanisms into routine medical and gynaecological practice may enable timely periodontal care. Moreover, the results support the need for inter-professional collaboration between dental and medical disciplines to promote comprehensive care and enhance overall quality of life of postmenopausal women.
ACKNOWLEDGMENTS
The authors are very grateful to all participants of the tertiary government hospital. This project would not have been possible without the enthusiasm and support of the faculty of government hospital.
Footnotes
FUNDING: No funding to declare.
CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported.
SUPPLEMENTARY MATERIAL
STROBE Checklist
References
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