Periodontal Status of Women on Hormonal Contraceptives Visiting Maternal Child Health and Family Planning Clinic and Youth Clinic at Kenyatta National Hospital

Abstract

Introduction Periodontal disease is a form of oral disease commonly including gingivitis and periodontitis. The primary etiologic factor for periodontal disease is microbial plaque, however the disease is multifactorial and modified by various factors including female sex steroid hormones. Hormonal contraceptives based on these hormones may influence the periodontal disease in women. Thus, the periodontal health of women on hormonal contraceptives must be understood to improve knowledge on hormonal contraceptives. Objective The objective of this study was to investigate periodontal status of women on hormonal contraceptives visiting the Maternal Child Health and Family Planning Clinic and Youth Clinic at Kenyatta National Hospital. Materials and Methods This was a descriptive cross-sectional study with an analytical component conducted among 218 women aged 18-45 years who were recruited using systematic random sampling. A questionnaire was administered to collect socio-demographic details and oral hygiene practices. The mode and duration of hormonal contraceptive was obtained from records and full mouth clinical examination carried out to determine the periodontal status. The clinical parameters investigated included plaque score (PS), gingival index (GI) and clinical attachment loss (CAL) calculated to determine periodontitis. The data was analyzed using SPSS. Spearmans correlation test and logistic regression analysis was carried out.

Results The mean age of the women was 33.3 years and the implant mode of hormonal contraceptive was the most dominant (56.9%) followed by the oral pill (20.6%). The gingival status showed a mean gingival index of 1.36 and majority of the women (77.5%) had moderate gingivitis. The mean clinical attachment loss was 3.23mm and majority(65.1%) of the women had mild periodontitis. Logistic regression showed a statistically significant relationship between injectable and implant modes of hormonal contraceptives and periodontitis. It was noted the women on injectable (OR=4.16, p=0.005) and implants (OR=2.73, p=0.020) had higher odds of periodontitis than women on oral pills. There was a positive correlation between mode of hormonal contraceptive and periodontitis (ρ=0.208, p=0.002) where implants and injectables correlated to increased severity of periodontitis. The duration of hormonal contraceptive use and periodontitis also showed a positive correlation (ρ=0.240, p˂0.001) where the women who had used hormonal contraceptives for a longer period were more likely to exhibit periodontitis. Conclusion The women on hormonal contraceptives had mild to moderate forms of periodontitis and gingivitis respectively. The use of the injectable and implant mode of hormonal contraceptives particularly for longer durations had adverse effects on the periodontal health of the women.