The Effects Of Oral Contraceptives On Gingival And Periodontal Health

Introduction

Oral contraceptives are hormone-containing pills that are 99% effective if used correctly in preventing pregnancy. It contains artificial female hormones (oestrogen and/or progesterone) and works by preventing ovulation or the release of an egg every month by the ovaries, it also thickens the neck of the womb making it harder for the sperm to reach the egg to fertilise it, and thins the lining of the womb so it is less possible for a fertilised egg to attach itself and grow into a foetus.¹

Although they have their side effects like headaches, nausea, mood changes, breast tenderness, bloating and increased blood pressure, and some serious risks like blood clots and strokes.² Oral contraceptives have some other health benefits, which is why non-contraceptive usage of hormonal oral contraceptives is not uncommon, they have been used to treat acne, endometriosis, and ovarian cysts, and regulate the menstrual cycle. Some studies have linked the pills to decreased risk of ovarian, benign breast cancer, colorectal, and colon cancer, improved bone mineral density, and improved menstrual migraine and rheumatoid arthritis.³

The unique hormonal changes that people assigned female at birth face during their life due to different hormonal phases (puberty, monthly menstruation, pregnancy, menopause) make them more sensitive and susceptible to oral health problems. Hormones don’t only affect the blood supply to the gum and oral tissues but also alter the body’s response to toxins in the plague and the inflammatory response. Those changes result in gingival and periodontal diseases.⁴

The effects of oral contraceptives on gingival tissues

The oestrogen and progesterone in oral contraceptives can change the physiological response of gingiva to plague and toxins and can have some other effects that are concluded as follows⁵ 

• High levels of progesterone can increase the blood flow to the gum, resulting in a more sensitive reaction to irritation
• Oestrogen and progesterone together cause vasodilation and increase the permeability of the capillaries, increasing in return the inflammatory response of the gingival tissues by increasing the migration of fluids and white blood cells out of blood vessels
• The change in oestrogen and progesterone levels decreases the gingival immune response to plaque bacteria and negatively affects the collagen production in the gingiva, altering its ability to heal and repair
• Some studies have linked the use of oral contraceptives with an increased risk of gingival hypergrowth and also higher prevalence of streptococcus mutans, an important pathogen that has a central role in the etiology of dental caries

The effects of oral contraceptives on periodontal health

The periodontium, or periodontal tissue, is a complex structure, composed of tissues that surround and support the teeth. When any of the tissues supporting the teeth are inflamed it is called periodontitis and can lead to loosening of teeth and eventually tooth loss if left untreated. Studies have proved the link between the use of oral contraceptives and an increased prevalence of severe periodontitis, also altered microflora and the presence of certain candida species have been studied.⁶

Some other effects of oral contraceptives in the oral cavity

There is available data that suggests that oral contraceptives significantly increase the risk of dry socket after extraction.⁷ After tooth extraction, a blood clot is supposed to form at the extraction site to initiate the wound healing process, studies suggest that the use of oral contraceptives prevents clot formation leading to a painful infection after extraction or what dentists call “dry socket”.

The use of synthetic oestrogen (contraceptive pills) can result in a decrease in natural oestrogen levels affecting the TMJ (the temporomandibular joint is the joint connecting your jaw to the upper part of the head). Recent research indicates that a low level of natural oestrogen combined with compression from an existing temporomandibular joint disorder results in increased inflammation and can lead to osteoarthritis in the joint.⁴

Tips to avoid gingival and periodontal problems

• Brush your teeth well at least twice a day, and remember it is more important to brush your teeth at night before you sleep
• Floss and rinse with a mouthwash at least once per day
• Maintain a well-balanced diet
• Visit your dentist regularly at least twice per year for check-ups and dental scaling (cleaning)
• Avoid sugary snacks
• If your medications are causing any noticeable oral changes consult with your physician and your dentist to explore your options and think of other alternatives

FAQ's

Can birth control pills cause swollen gum?

Yes, the use of oral contraceptives can cause swollen and bleeding gums.

Should I tell my dentist I am on birth control?

Oral contraceptives can widely affect your oral health, it is also important for your dentist to be aware of your contraceptive use because some medications prescribed by dental professionals can lower the effect of contraceptive pills. So always inform your dentist about any medications you take and their dosage.

Does birth control affect dental treatment?

If you are having a tooth extraction, you are more likely to develop a dry socket after the extraction. Telling your dental surgeon is crucial to take extra measures to avoid that.

Summary

The effects of oral contraceptives on gingival and periodontal health have been a subject of interest and debate for dental research. Oral contraceptives are widely used to prevent pregnancies and to treat other hormonal conditions in people assigned females at birth, while very beneficial for these conditions, the systematic hormonal changes can induce a wide range of effects on different systems and the oral cavity is no exclusion, their effects can include increased inflammation, and higher prevalence of gingivitis and periodontitis, gingival hypergrowth, and dental caries.

It’s important to mention that not enough data is present on the effects of the new contraceptive pills that have low levels of estrogen and progesterone, most of the available data is old and associated with old forms of oral contraceptives.

When taking oral contraceptives, or any new medications, pay close attention to your oral health and report to your dentist any new changes. Follow all the protective measures to ensure a healthy oral cavity, brush and floss regularly, eat healthy, and remember two visits to your dentist a year to keep the tooth fairy away.