Study finds link between contraceptive and periodontitis

An injectable contraceptive administered every three months may be putting women who opt for this method at increased risk for periodontal disease, according to a new study in the Journal of Peridontology.

Depot medroxyprogesterone acetate (DMPA) is a progestin-only, injectable contraceptive that is most often seen under the brand name Depo-Provera, marketed by Pfizer.

It has been suggested that progestins may have an inflammatory component and/or stimulate the synthesis of prostaglandins, which is why the extended use of DMPA may be associated with a higher risk of periodontal diseases, according to the study authors (JOP, February 6,2012).

"There are many hormonal contraceptive options out there for women to prevent or delay pregnancy, yet we have little information on how they may affect women's oral health," lead author Susan Taichman, RDH, MPH, PhD, assistant professor at the University of Michigan School of Dentistry, said in an interview with DrBicuspid.com.

Information regarding the pill and gingival inflammation is mixed, she added, with some studies showing an association and others not.

"There remains some controversy over the impact of new, low-dose oral contraceptives and periodontal diseases," she said. "We previously reported in an analysis of National Health and Nutrition Examination Survey (NHANES) data that low-dose oral contraceptives had no significant association with decreased periodontal health."

Two recentclinical studies illustrated a relationship between progestin-only contraceptive use and gingival inflammation and clinical attachment (CA) loss, Taichman added (Journal of Contemporary Dental Practice, May 1, 2010, Vol. 11:3, pp. 33-40; JOP, July 2010, Vol. 81:7, pp. 1010-1018).

Economic status plays a role

In the current JOP study, Taichman and her co-authors found that although women of all socioeconomic backgrounds and ages use DMPA, roughly twice as many blacks and one-third Hispanics and Latinas use it as compared with whites. In addition, the majority of DMPA users are women of low socioeconomic status who are already at risk for increased levels of gingival disease, they noted.

"Given that DMPA use is common among high-risk women, it is important to learn more about potential deleterious effects on periodontal tissues," the researchers wrote.

The study authors collected the data from the 1999-2004 NHANES, a set of cross-sectional studies designed to obtain information on the health and nutritional status of the non-institutionalized population of the U.S.

They looked at 4,460 U.S. women between 15 and 44 who were asked about their use of DMPA. In the final sample, 4% were current DMPA users while 12 % indicated a past history of DMPA use.

In addition, they included data on the women's periodontal health, which was assessed using randomly assigned half-mouths (one upper and one lower quadrant) for each individual using a periodontal probe.

The authors also took into account sociodemographic and behavioral factors, which have been shown to be associated with DMPA use, they noted.

They found significant differences in pocket depths, gingival bleeding, and CA loss between DMPA users and non users. The prevalence of gingivitis was 53.9% for women who reported having used DMPA, compared to 46.1% for never having used DMPA.

DMPA use was associated with an increased risk of gingivitis and periodontitis after adjusting for age, race, education, poverty income ratio, dental care utilization, and smoking status, the researchers noted.

More research needed

The study findings suggest that DMPA use may be associated with periodontal disease, they concluded.

"Although many women of child-bearing age use DMPA, a large portion of DMPA users are young, non-white women of low socioeconomic status with a history of smoking, and thus may be at an already increased risk for periodontal diseases," explained Taichman.

"Women and adolescents who use this method of birth control may be at a higher risk for gingivitis and periodontitis," she said. "Dentists should encourage women who use DMPA contraceptives to maintain good oral health habits and seek regular dental examinations."

Future clinical studies that also look at oral health behaviors and duration of DMPA use are required to further understand the relationship between DMPA use and the incidence periodontal health, she and her co-authors concluded.