Mea A. Weinberg, D.M.D., M.S.D., R.Ph.

US Pharmacist. 2002;27(9) 

In This Article

Hormones and Periodontal Diseases

As females go through certain stages in their reproductive life cycle, alterations arise in the level of sex (steroid) hormones circulating in their bloodstream. Specifically, variations in levels of progesterone and estrogen in women may adversely affect the periodontal tissues in the mouth. Extensive research suggests a relationship between periodontal diseases, which are subclassified as gingivitis and periodontitis, and puberty, menstruation, pregnancy, oral contraceptive use, and menopause.

Gingivitis is defined as inflammation of the gingiva (gums) surrounding the teeth, with no radiographic evidence of bone loss. It is caused primarily by bacterial plaque, a sticky substance composed of bacteria and other deposits that then accumulates on the teeth. While a "plaque-free" mouth is an ideal that cannot be achieved, plaque build-up must be minimized to maintain healthy gums. If plaque is allowed to accumulate beyond threshold levels, the gingiva reacts by becoming inflamed. This process is similar to the events incurred when a splinter lodges in the skin. Vascularity increases, causing the blood vessels in the underlying connective tissue to become engorged and increase in number. This results in redness, bleeding and enlargement (overgrowth) of the gingiva. Associated with this inflammation is an increase in the flow of tissue fluid and a change in the immune response. This type of gingivitis is called "dental plaque-induced gingivitis" and is caused by the accumulation of dental plaque on the teeth due to inadequate oral home care.

Gingival diseases can also be modified by systemic factors, such as sex hormones. In these cases, the elevated levels of hormones cause an exaggerated response to the dental plaque on the teeth and gums, resulting in gingival inflammation. Unique to gingival diseases associated with sex hormones is that the gingival inflammation is elicited by relatively small amounts of dental plaque.[4]

Estrogen and progesterone affect the entire body, including the oral tissues. The gingival tissues respond to increased levels of estrogen and progesterone by undergoing vasodilation and increased capillary permeability. Consequently, there is an increased migration of fluid and white blood cells out of blood vessels.

Also associated with increased progesterone levels are alterations in the existing microbial populations. The levels of Gram-negative anaerobic bacteria, such as Prevotella intermedia, increase as a result of the high concentration of hormones available as a nutrient for growth.[5,6]

Gingival diseases can also be drug induced. Phenytoin, calcium channel blockers (especially nifedipine) and cyclosporine are widely reported in the literature to cause gingival enlargement. Of particular importance due to the large number of fertile women is the fact that oral contraceptive use is also reported to cause gingival disease.[7] Oral contraceptives act to mimic pregnancy; thus, all of the dramatic hormonal changes seen in pregnancy also occur in women taking oral contraceptives. Why does hormonal-induced gingivitis occur in some individuals and not others? The answer to this question is not completely understood. Most likely, individual variability in the immune response to the various irritants and stimulants is responsible.

Periodontitis involves the loss of supporting bone around the tooth. While changes in hormonal levels do not directly cause this loss of bone, it may occur as a result of a generalized osteoporosis in the body.

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